CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Merit Health Madison

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $20,396
Cash Discount Price: $20,257
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Merit Health Madison is $20,396. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,257. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.44x the Medicare baseline. Located in 161 River Oaks Drive, Canton, MS.

Cash / Self-Pay

$20,257

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,396

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: $20,257 (143%)

Insurance Median: $20,396 (144%)

Cash: $20,257 (143% of Medicare)

Ins. Median: $20,396 (144% 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)	$16,728	118%
Wellcare	$17,230	122%
Humana	$17,397	123%
Devoted_Health	$17,564	124%
Advhealth	$19,425	138%
Blue Cross Blue Shield	$19,721	140%
Cigna	$20,396	144%
Firstchoice	$20,396	144%
Mpcn	$20,979	149%
Ambetter / Centene	$26,806	190%
United	$26,884	190%
Molina_Exchange	$28,166	200%
United_Exchange	$32,615	231%

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 $20,257.
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 Merit Health Madison 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.