CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Prisma Health Baptist

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $17,127
Cash Discount Price: $31,858
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Prisma Health Baptist is $17,127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31,858. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.21x the Medicare baseline. Located in 1330 Taylor at Marion St, Columbia, SC.

Cash / Self-Pay

$31,858

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,127

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: $31,858 (226%)

Insurance Median: $17,127 (121%)

Cash: $31,858 (226% of Medicare)

Ins. Median: $17,127 (121% 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	$16,312 - $89,064	116%
Cigna	$16,312 - $46,859	116%
Humana	$16,312	116%
Medicare (plans)	$16,312 - $17,127	116%
Ambetter / Centene	$16,351	116%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$16,351	116%
Triwest Healthcare Alliance Vcp [902]	$16,351	116%
Va Community Care Network-Vaccn [903]	$16,351	116%
Aetna	$17,127	121%
Healthy Conn Prime-First Choice Vip Care [5300]	$17,127	121%
Healthy Conn Prime-Molina Healthcare [5330]	$17,127	121%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$17,127	121%
Scdc-Sc Dept Of Corrections [7232]	$18,725	133%
Workers Comp [600]	$22,836	162%
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%
Planned Administrators [820]	$89,064	631%
Bluechoice [810]	$89,272	632%

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 $31,858.
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 Baptist 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.