CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Mercy Health Saint Mary's

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $28,806
Cash Discount Price: $25,158
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Mercy Health Saint Mary's is $28,806. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,158. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 2.04x the Medicare baseline. Located in 200 Jefferson Avenue Se, Grand Rapids, MI.

Cash / Self-Pay

$25,158

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,806

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: $25,158 (178%)

Insurance Median: $28,806 (204%)

Cash: $25,158 (178% of Medicare)

Ins. Median: $28,806 (204% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 204% of the Medicare baseline (a markup of 104%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Vitalcore	$2,000	14%
Wellpath	$2,000	14%
Access Health	$10,984	78%
Aetna	$15,378 - $32,009	109%
Blue Care Network Advantage	$15,378	109%
Blue Cross Blue Shield	$15,378 - $37,407	109%
Medicare (plans)	$15,378	109%
Align Senior Care	$15,692	111%
Correctional Recovery	$15,692	111%
UnitedHealthcare	$16,163	114%
Longevity Ipa Of Michigan Llc Health Plan Isnp	$17,685	125%
Oscar	$17,943	127%
Molina Marketplace	$20,400	145%
Caresource	$22,071	156%
Hap	$22,071	156%
U Of M Health Plan	$27,247	193%
Priority Health	$30,365 - $30,416	215%
Geha	$32,009	227%
Medical Mutual	$32,009	227%
Meritain	$32,009	227%
Preferred One	$32,009	227%
Bcn Domestic	$37,407	265%
Blue Benefit Administrators Of Massachusetts	$37,407	265%
Blue Care Network	$37,407	265%
Blue Distinction Transplant	$37,407	265%
Blue Shield - Ca	$37,407	265%
Blue Shield - Id (Regence)	$37,407	265%
Blue Shield - Ny Highmark Northeastern	$37,407	265%
Blue Shield - Ny Highmark Western	$37,407	265%
Blue Shield - Pa (Highmark)	$37,407	265%
Blue Shield - Wa (Regence)	$37,407	265%
Health Choices	$37,407	265%
Kaiser Domestic	$37,407	265%

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 $25,158.
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 Mercy Health Saint Mary's 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.