CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Mercyone Elkader Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $10,475
Cash Discount Price: $6,406
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Mercyone Elkader Medical Center is $10,475. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,406. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.74x the Medicare baseline. Located in 901 Davidson Street Nw, Elkader, IA.

Cash / Self-Pay

$6,406

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,475

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: $6,406 (45%)

Insurance Median: $10,475 (74%)

Cash: $6,406 (45% of Medicare)

Ins. Median: $10,475 (74% 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.

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
Medicare (plans)	$4,967 - $8,182	35%
Blue Cross Blue Shield	$7,796	55%
Aetna	$7,876	56%
UnitedHealthcare	$8,349	59%
Amish Hospital Aid	$10,475	74%
Centivo	$11,814	84%
Ambetter / Centene	$13,232	94%
Claimdoc	$15,831	112%
Nova	$15,831	112%
Iowa Total Care	$17,847	126%
Medicaid / KanCare	$18,109 - $18,197	128%

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 $6,406.
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 Mercyone Elkader Medical Center 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.