CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Mercy Health Lakeshore Campus

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $2,556
Cash Discount Price: $10,827
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Mercy Health Lakeshore Campus is $2,556. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,827. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.18x the Medicare baseline. Located in 72 South State Street, Shelby, MI.

Cash / Self-Pay

$10,827

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,556

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: $10,827 (77%)

Insurance Median: $2,556 (18%)

Cash: $10,827 (77% of Medicare)

Ins. Median: $2,556 (18% 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
Access Health	$1,826	13%
Vitalcore	$2,000	14%
Wellpath	$2,000	14%
Blue Care Network Advantage	$2,556	18%
Blue Cross Blue Shield	$2,556	18%
Medicare (plans)	$2,556	18%
Aetna	$2,608	18%
Align Senior Care	$2,608	18%
Correctional Recovery	$2,608	18%
UnitedHealthcare	$2,664	19%
Longevity Ipa Of Michigan Llc Health Plan Isnp	$2,939	21%
Oscar	$3,076	22%
Molina Marketplace	$3,548	25%
U Of M Health Plan	$27,247	193%

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 $10,827.
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 Lakeshore Campus 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.