CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Mercyone Oelwein Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $4,771
Cash Discount Price: $13,469
vs. Medicare Baseline: 0.34x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Mercyone Oelwein Medical Center is $4,771. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,469. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.34x the Medicare baseline. Located in 201 Eighth Avenue Se, Oelwein, IA.

Cash / Self-Pay

$13,469

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,771

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: $13,469 (95%)

Insurance Median: $4,771 (34%)

Cash: $13,469 (95% of Medicare)

Ins. Median: $4,771 (34% 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)	$2,462 - $3,726	17%
Blue Cross Blue Shield	$3,550	25%
UnitedHealthcare	$3,802	27%
Aetna	$4,125	29%
Amish Hospital Aid	$4,771	34%
Centivo	$5,380	38%
Ambetter / Centene	$6,026	43%
Claimdoc	$7,210	51%
Nova	$7,210	51%
Iowa Total Care	$15,131	107%
Medicaid / KanCare	$15,353 - $15,427	109%

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 $13,469.
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 Oelwein 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.