CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Prisma Health Richland Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $18,450
Cash Discount Price: $40,994
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Prisma Health Richland Hospital is $18,450. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40,994. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.31x the Medicare baseline. Located in 5 Medical Park, Columbia, SC.

Cash / Self-Pay

$40,994

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,450

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: $40,994 (290%)

Insurance Median: $18,450 (131%)

Cash: $40,994 (290% of Medicare)

Ins. Median: $18,450 (131% 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
Medicaid / KanCare	$5,976	42%
UnitedHealthcare	$5,976 - $61,795	42%
Blue Cross Blue Shield	$16,575 - $89,292	117%
Cigna	$16,575 - $46,859	117%
Humana	$16,575	117%
Medicare (plans)	$16,575 - $18,450	117%
Aetna	$17,404	123%
Healthy Conn Prime-First Choice Vip Care [5300]	$17,404	123%
Healthy Conn Prime-Molina Healthcare [5330]	$17,404	123%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$17,404	123%
Ambetter / Centene	$18,450	131%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$18,450	131%
Triwest Healthcare Alliance Vcp [902]	$18,450	131%
Va Community Care Network-Vaccn [903]	$18,450	131%
Sc Dept Of Corrections [2998]	$22,054	156%
Scdc-Sc Dept Of Corrections [7232]	$22,054	156%
Workers Comp [600]	$23,206	164%
Bob Jones Univ-Pai [821]	$27,656	196%
Preferred Administrators Contracted [2839]	$34,495	244%
Promise Health Plan Contracted [2401]	$37,879	268%
Evernorth Behavioral Contracted [2982]	$46,859	332%
Golden Rule Insurance Company [2991]	$61,795	438%
Oxford Health Plans [2992]	$61,795	438%
Zzumr-Salt Lake City Ut [3169]	$61,795	438%
Bluechoice [810]	$81,139 - $89,292	575%
Planned Administrators [820]	$89,023	631%

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 $40,994.
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 Prisma Health Richland 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.