CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Mercy St Vincent Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $28,636
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Mercy St Vincent Medical Center is $28,636. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 2.03x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,636

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%)

Insurance Median: $28,636 (203%)

Ins. Median: $28,636 (203% 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 203% of the Medicare baseline (a markup of 103%). 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
Aetna	$14,519 - $37,599	103%
Blue Cross Blue Shield	$14,519 - $29,740	103%
Buckeye Mycare Benefits [4237]	$14,519	103%
Humana	$14,519	103%
Paramount Elite [3723]	$14,519	103%
UnitedHealthcare	$14,519 - $55,639	103%
Devoted Health Plan [4501]	$14,664 - $16,835	104%
Caresource Mycare Ohio [4236]	$14,809	105%
Medicare (plans)	$14,809	105%
Molina Mycare Ohio [4235]	$15,245	108%
Medigold [4435]	$16,668	118%
Caresource [4179]	$24,169	171%
Buckeye [4178]	$25,835	183%
Molina Marketplace Aca [4181]	$26,461	187%
Meritain Health [3068]	$27,502 - $37,599	195%
Medical Mutual [3067]	$27,582 - $41,484	195%
Cigna	$28,636 - $37,277	203%

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 $X.
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 St Vincent 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.