CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Adventist Health St Helena

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $41,192
Cash Discount Price: $32,397
vs. Medicare Baseline: 3.22x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Adventist Health St Helena is $41,192. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32,397. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 3.22x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$32,397

Average discount available for prompt cash payment at this facility.

Insurance Median

$41,192

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$12,807.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $12,807.1 (100%)

Cash / Self-Pay: $32,397 (253%)

Insurance Median: $41,192 (322%)

Cash: $32,397 (253% of Medicare)

Ins. Median: $41,192 (322% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $12,807.1 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 322% of the Medicare baseline (a markup of 222%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Shield Bh Mcr Adv	$18,100	141%
Blue Shield Mcr Adv	$18,100	141%
Tricare	$18,100	141%
UnitedHealthcare	$18,100 - $132,416	141%
Va Mcr - All Other Plans	$18,100	141%
Blue Cross Blue Shield	$29,397 - $39,726	230%
Magellan Mcare Ip Only	$30,021	234%
Va Medi-Cal	$32,505	254%
Ah Employee Health Plan - All Plans	$32,580	254%
Interplan-All Plans	$34,083	266%
Western Growers-All Plans	$34,424	269%
Healthnet-All Plans	$34,850	272%
Blue Shield Epn-All Other Plans	$36,680	286%
Blue Shield Non-Epn	$37,354	292%
Phcs-All Plans	$42,657	333%
Aetna	$45,204	353%
Kaiser Mcr Adv	$106,746	833%
Kaiser-All Other Plans	$106,746	833%
Coventry/First Health-All Plans	$129,587	1012%
Beech Street-All Plans	$151,184	1180%
Choicecare-All Plans	$151,184	1180%
Cigna	$151,184	1180%
Health Management Network-All Plans	$183,581	1433%
Galaxy Network-All Plans	$194,380	1518%
Three Rivers-All Plans	$194,380	1518%

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 $32,397.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 322.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health St Helena is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 322.
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.