CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Davis County Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $18,733
Cash Discount Price: $25,992
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Davis County Hospital is $18,733. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,992. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.33x the Medicare baseline. Located in 509 North Madison Street, Bloomfield, IA.

Cash / Self-Pay

$25,992

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,733

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: $25,992 (184%)

Insurance Median: $18,733 (133%)

Cash: $25,992 (184% of Medicare)

Ins. Median: $18,733 (133% 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
Blue Cross Blue Shield	$15,595	110%
Aetna	$18,000	128%
Midlands Choice - All Plans	$18,194	129%
Choicecare Mcr Adv	$18,366	130%
Home State Hlth Mcr	$18,366	130%
Mt Carmel Hp-All Plans	$18,366	130%
Tricare	$18,366	130%
Amerigroup Mcr Adv-All Other Plans	$18,733	133%
Home State Hlth Exch - All Other Plans	$18,733	133%
American Hp Mcr Adv-All Plans	$19,284	137%
Preferred Hlth Choices - All Plans	$19,494	138%
Choicecare Comm - All Other Plans	$24,692	175%
Home State Hlth Mcaid	$25,992	184%
Iowa Total Care Mcaid-All Plans	$67,710	480%
Molina Mcaid-All Plans	$68,706	487%
Amerigroup Mcaid	$69,038	489%

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 $25,992.
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 Davis County Hospital 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.