CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Piedmont Athens Regional Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $27,294
Cash Discount Price: $17,900
vs. Medicare Baseline: 1.93x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Piedmont Athens Regional Medical Center is $27,294. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,900. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.93x the Medicare baseline. Located in 1199 Prince Avenue, Athens, GA.

Cash / Self-Pay

$17,900

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,294

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: $17,900 (127%)

Insurance Median: $27,294 (193%)

Cash: $17,900 (127% of Medicare)

Ins. Median: $27,294 (193% 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
Ambetter / Centene	$13,593	96%
Medicare (plans)	$16,377 - $17,013	116%
UnitedHealthcare	$16,616 - $41,713	118%
Clear Spring Health Care [30192]	$16,854	119%
Georgia Health Advantage [30143]	$17,013	121%
Blue Cross Blue Shield	$27,294 - $54,124	193%
Aetna	$29,419	208%
Cigna	$29,516 - $45,806	209%
Alliant Solocare [11101]	$34,750	246%
Caresource Marketplace [11106]	$36,692	260%
Alliant Health Plans Of Georgia [10952]	$38,561	273%

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 $17,900.
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 Piedmont Athens 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.