CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Grossmont Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $79,620
Cash Discount Price: $112,140
vs. Medicare Baseline: 6.22x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Grossmont Hospital is $79,620. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112,140. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 6.22x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$112,140

Average discount available for prompt cash payment at this facility.

Insurance Median

$79,620

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: $112,140 (876%)

Insurance Median: $79,620 (622%)

Cash: $112,140 (876% of Medicare)

Ins. Median: $79,620 (622% 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 622% of the Medicare baseline (a markup of 522%). 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
Aetna	$44,408	347%
Cigna	$44,408	347%
Kaiser	$44,408	347%
Managed Health Network	$59,808	467%
Blue Cross Blue Shield	$71,635 - $103,169	559%
Health Net	$71,635 - $104,664	559%
UnitedHealthcare	$71,770 - $74,760	560%
Molina	$84,479	660%
Community Health Group	$95,394	745%
Blue Shield	$146,530	1144%

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 $112,140.
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 Grossmont 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.