CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Paradise Valley Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $18,033
Cash Discount Price: $18,032
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Paradise Valley Hospital is $18,033. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,032. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.41x the Medicare baseline. Located in 2400 East 4Th St, National City, CA.

Cash / Self-Pay

$18,032

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,033

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: $18,032 (141%)

Insurance Median: $18,033 (141%)

Cash: $18,032 (141% of Medicare)

Ins. Median: $18,033 (141% 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.

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 Of Ca, Va	$18,033	141%
Ca Foundation For Medical Care	$18,033	141%
Central Health	$18,033	141%
Choice Physicians Network	$18,033	141%
Clever Care Of Golden State, Inc	$18,033	141%
Community Health Group	$18,033	141%
Health Excel Ins	$18,033	141%
Health Net Of Ca	$18,033 - $32,676	141%
Heritage Provider Netwrok	$18,033 - $23,443	141%
Managed Health Network	$18,033	141%
Medicare (plans)	$18,033	141%
Molina	$18,033	141%
Renal Payer Solutions	$18,033	141%
Tricare	$18,033 - $29,442	141%
UnitedHealthcare	$18,033	141%
Usa Senior Care Network	$18,033	141%
Verda Health Plan	$18,033	141%
Brand New Day	$18,213	142%
Imperial Health Plan Of Ca	$19,115	149%
Health Net Federal Service (Cdcr)	$22,541	176%
Employer Direct Healthcare	$23,443	183%
Integrated Medical Solutions	$23,443	183%
Ca Dept Of Correction & Rehab	$25,246	197%
Naphcare	$27,951 - $36,066	218%
National Healthcare Solutions, Inc (Nhsi)	$28,853	225%
Scripps Health	$30,656	239%
Aetna	$32,253	252%
Worker Comp	$33,251	260%

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 $18,032.
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 Paradise Valley Hospital 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.