CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Highlands Cashiers Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $1,672
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.12x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Highlands Cashiers Hospital is $1,672. 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 0.12x the Medicare baseline. Located in 190 Hospital Drive, Highlands, NC.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,672

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: $1,672 (12%)

Ins. Median: $1,672 (12% 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
Aetna	$1,592	11%
Apex Health	$1,592	11%
Alignment Health	$1,624	12%
Devoted Health	$1,624	12%
Cigna	$1,640	12%
Humana	$1,640 - $1,656	12%
Wellcare	$1,640 - $23,127	12%
Nhc Advantage	$1,656	12%
Healthteam Advantage	$1,672	12%
Provider Partners Health Plan	$1,672	12%
Troy Healthcare	$1,672	12%
Longevity Health Plan	$1,703	12%
Amerihealth Caritas	$1,815	13%
Blue Cross Blue Shield	$2,010 - $22,453	14%
United	$2,010	14%
Vaya Health	$23,127	164%
Amerihealth	$23,351	165%
Partners Health Management	$23,576	167%

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 Highlands Cashiers Hospital 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.