CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $33,418
Cash Discount Price: $22,279
vs. Medicare Baseline: 2.37x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Iowa Specialty Hospital - Clarion is $33,418. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,279. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 2.37x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$22,279

Average discount available for prompt cash payment at this facility.

Insurance Median

$33,418

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,116.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,116.91 (100%)

Cash / Self-Pay: $22,279 (158%)

Insurance Median: $33,418 (237%)

Cash: $22,279 (158% of Medicare)

Ins. Median: $33,418 (237% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,116.91 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 237% of the Medicare baseline (a markup of 137%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Wellmark Hmo	$12,628	89%
Wellmark Ppo - All Other Plans	$12,628	89%
Auxiant Clarion Schools-All Plans	$24,135	171%
Health Partners Prestage	$27,848	197%
Health Partners Ish-All Other Plans	$29,705	210%
Aetna	$31,561	224%
UnitedHealthcare	$35,274	250%
Cigna	$36,017	255%
Midlands Choice-All Plans	$36,017	255%
Tricare	$38,835	275%
Triwest Va - All Plans	$38,835	275%
Healthscope Stellar-All Plans	$60,142	426%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $22,279.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 871.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Iowa Specialty Hospital - Clarion is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 871.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.