CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $20,159
Cash Discount Price: $22,399
vs. Medicare Baseline: 1.43x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Anthony Regional Hospital & Nursing Home is $20,159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,399. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.43x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.

Cash / Self-Pay

$22,399

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,159

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: $22,399 (159%)

Insurance Median: $20,159 (143%)

Cash: $22,399 (159% of Medicare)

Ins. Median: $20,159 (143% 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
Aetna	$17,919 - $20,159	127%
UnitedHealthcare	$18,054	128%
Humana	$19,039	135%
Ia Total Care Mcaid	$20,312	144%
Wellpoint Mcaid - All Other Plans	$20,312	144%
Molina Mcaid - All Plans	$20,718	147%
Midlands Choice - All Plans	$21,055	149%

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 $22,399.
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 St Anthony Regional Hospital & Nursing Home 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.