CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Prisma Health Hillcrest Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $13,775
  • Cash Discount Price: $24,773
  • vs. Medicare Baseline: 0.98x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Prisma Health Hillcrest Hospital is $13,775. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24,773. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.98x the Medicare baseline. Located in 741 South East Main Street, Simpsonville, SC.
Cash / Self-Pay
$24,773

Average discount available for prompt cash payment at this facility.

Insurance Median
$13,775

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: $24,773 (175%)
Insurance Median: $13,775 (98%)
Cash: $24,773 (175% of Medicare)
Ins. Median: $13,775 (98% 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.

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 - $13,676 42%
First Choice Benefits Mgmt [3074] $9,060 64%
Medicare (plans) $9,060 - $14,535 64%
Golden Rule Insurance Company [2991] $10,303 73%
Oxford Health Plans [2992] $10,303 73%
Zzumr-Salt Lake City Ut [3169] $10,303 73%
Humana $12,987 - $13,241 92%
Blue Cross Blue Shield $13,214 - $28,206 94%
Champva [3049] $13,214 94%
Cigna $13,214 - $39,676 94%
Deseret Mutual Ins Co [3066] $13,214 94%
Generic Skilled Nursing [3196] $13,214 94%
Hospice Contracted [1500] $13,214 94%
Hospice Non Contracted [3190] $13,214 94%
Veterans Administration [3194] $13,214 94%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904] $13,396 95%
Triwest Healthcare Alliance Vcp [902] $13,396 95%
Va Community Care Network-Vaccn [903] $13,396 95%
Aetna $13,874 98%
Healthy Conn Prime-Wellcare Prime By Atc [5310] $13,874 98%
Healthy Conn Prime-First Choice Vip Care [5300] $14,007 99%
Healthy Conn Prime-Molina Healthcare [5330] $14,535 103%
Sc Dept Of Corrections [2998] $17,364 123%
Scdc-Sc Dept Of Corrections [7232] $17,364 123%
Workers Comp [600] $18,499 131%
Bluechoice [810] $19,119 - $28,819 135%
Bob Jones Univ-Pai [821] $27,656 196%
Planned Administrators [820] $28,206 200%
Preferred Administrators Contracted [2839] $34,495 244%
Ambetter / Centene $35,232 250%
Promise Health Plan Contracted [2401] $37,879 268%
Evernorth Behavioral Contracted [2982] $39,676 281%
Mvp Health Care [3037] $39,676 281%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 741 South East Main Street, Simpsonville, SC 29681
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals