CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Dlp Swain County Hospital LLC

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $2,235
Cash Discount Price: $10,163
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Dlp Swain County Hospital LLC is $2,235. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,163. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.16x the Medicare baseline. Located in 45 Plateau Street, Bryson City, NC.

Cash / Self-Pay

$10,163

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,235

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: $10,163 (72%)

Insurance Median: $2,235 (16%)

Cash: $10,163 (72% of Medicare)

Ins. Median: $2,235 (16% 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
Advantra	$2,235	16%
Aetna	$2,235	16%
American Progressive	$2,235	16%
Americas First Choice	$2,235	16%
Blue Cross Blue Shield	$2,235 - $21,408	16%
Care Improvement	$2,235	16%
Care Plus	$2,235	16%
Citrus	$2,235	16%
Evercare	$2,235	16%
Health Markets	$2,235	16%
Healthnet	$2,235	16%
Medical Mutual	$2,235	16%
Medicare (plans)	$2,235	16%
Physicians	$2,235	16%
Pyramid	$2,235	16%
Sterling	$2,235	16%
Unicare	$2,235	16%
UnitedHealthcare	$2,235 - $30,434	16%
Wellcare	$2,235	16%
Wellpath	$2,235	16%
Windsor Health	$2,235	16%
Zickgraf	$2,235	16%
Ambetter / Centene	$5,374	38%
Cigna	$19,036	135%

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 $10,163.
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 Dlp Swain County Hospital LLC 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.