CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Prisma Health Tuomey Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $15,969
Cash Discount Price: $33,559
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Prisma Health Tuomey Hospital is $15,969. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33,559. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.13x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.

Cash / Self-Pay

$33,559

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,969

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: $33,559 (238%)

Insurance Median: $15,969 (113%)

Cash: $33,559 (238% of Medicare)

Ins. Median: $15,969 (113% 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 - $15,854	42%
Golden Rule Insurance Company [2991]	$7,344	52%
Oxford Health Plans [2992]	$7,344	52%
Zzumr-Salt Lake City Ut [3169]	$7,344	52%
Blue Cross Blue Shield	$15,318 - $131,971	109%
Cigna	$15,318 - $39,676	109%
Humana	$15,318	109%
Medicare (plans)	$15,318 - $16,084	109%
Ambetter / Centene	$15,855	112%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$15,855	112%
Triwest Healthcare Alliance Vcp [902]	$15,855	112%
Va Community Care Network-Vaccn [903]	$15,855	112%
Aetna	$16,084	114%
Healthy Conn Prime-First Choice Vip Care [5300]	$16,084	114%
Healthy Conn Prime-Molina Healthcare [5330]	$16,084	114%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$16,084	114%
Bluechoice [810]	$17,351 - $128,662	123%
Scdc-Sc Dept Of Corrections [7232]	$17,531	124%
Workers Comp [600]	$21,445	152%
Bob Jones Univ-Pai [821]	$27,656	196%
Preferred Administrators Contracted [2839]	$34,495	244%
Promise Health Plan Contracted [2401]	$37,879	268%
Planned Administrators [820]	$131,971	935%

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 $33,559.
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 Tuomey 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.