CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Clark Regional Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $14,036
Cash Discount Price: $37,521
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Clark Regional Medical Center is $14,036. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37,521. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.99x the Medicare baseline. Located in 175 Hospital Drive, Winchester, KY.

Cash / Self-Pay

$37,521

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,036

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: $37,521 (266%)

Insurance Median: $14,036 (99%)

Cash: $37,521 (266% of Medicare)

Ins. Median: $14,036 (99% 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
Bluegrass Family Health	$1,794 - $14,316	13%
Multiplan	$1,850	13%
Humana	$1,972 - $14,036	14%
UnitedHealthcare	$3,196	23%
Advantra	$14,036	99%
Cigna	$14,036	99%
Essence	$14,036	99%
Evercare	$14,036	99%
Healthspring	$14,036	99%
Medical Mutual Of Ohio	$14,036	99%
Medicare (plans)	$14,036	99%
Mvp Healthcare	$14,036	99%
Passport	$14,036	99%
Pyramid	$14,036	99%
Secure Horizons	$14,036	99%
Unicare	$14,036	99%
Wellcare	$14,036	99%
Aetna	$14,457	102%
Blue Cross Blue Shield	$14,457 - $21,673	102%
Tricare	$14,700	104%

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 $37,521.
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 Clark Regional 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.