CMS Price Transparency Data
Heart stent placement (inpatient stay)
Facility: Scripps Mercy Hospital
Billing Code: 322 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 322
- Insurance Median: $19,261
- Cash Discount Price: $29,428
- vs. Medicare Baseline: 1.50x Medicare
The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Scripps Mercy Hospital is $19,261. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29,428. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.50x the Medicare baseline. Located in 4077 5Th Ave, San Diego, CA.
Cash / Self-Pay
$29,428
Average discount available for prompt cash payment at this facility.
Insurance Median
$19,261
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: $29,428 (230%)
Insurance Median: $19,261 (150%)
Cash: $29,428 (230% of Medicare)
Ins. Median: $19,261 (150% 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.
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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 Cross Blue Shield | $14,774 - $48,393 | 115% |
| Aetna | $19,011 - $65,243 | 148% |
| Alignment Health Plan [443] | $19,011 | 148% |
| Astiva Mcr Adv [464] | $19,011 | 148% |
| Bc Mcr Adv [830] | $19,011 | 148% |
| Bs Mcr Adv [829] | $19,011 | 148% |
| Central Health Mcr Adv [441] | $19,011 | 148% |
| Cigna | $19,011 - $33,361 | 148% |
| Clever Care Mcr Adv [465] | $19,011 | 148% |
| D-Snp Mcr Adv [889] | $19,011 | 148% |
| Dsnp/Csnp - Generic [458] | $19,011 | 148% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $19,011 | 148% |
| Family Health Centers Pace Medi-Cal [555] | $19,011 | 148% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $19,011 | 148% |
| Gpmg/Altura - Mcr Adv [888] | $19,011 | 148% |
| Hn Mcr Adv [832] | $19,011 | 148% |
| Humana | $19,011 | 148% |
| Integrated Health Partners - Mcr Adv [895] | $19,011 | 148% |
| Kaiser Northern Ca Region Mcr Adv [386] | $19,011 | 148% |
| La Care Mcr Adv Hmo [612] | $19,011 | 148% |
| Mc Alignment [917] | $19,011 - $20,375 | 148% |
| Mc Blue Shield Promise Health Plan [914] | $19,011 - $20,375 | 148% |
| Mc Blue Shield [902] | $19,011 - $20,375 | 148% |
| Mc Health Net [904] | $19,011 - $20,375 | 148% |
| Mc Scan [905] | $19,011 - $20,375 | 148% |
| Mc United [906] | $19,011 - $20,375 | 148% |
| Medicare (plans) | $19,011 | 148% |
| San Diego Pace Medi-Cal [553] | $19,011 | 148% |
| Scan Mcr Adv [835] | $19,011 | 148% |
| Scan [500] | $19,011 | 148% |
| Scan [818] | $19,011 | 148% |
| Sharp Comm Med Grp Mcr Adv [840] | $19,011 | 148% |
| Sharp Health Plan Mcr Adv [531] | $19,011 | 148% |
| Sharp Health Plan Mcr Adv [897] | $19,011 | 148% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $19,011 | 148% |
| St Paul'S Pace Medi-Cal [551] | $19,011 | 148% |
| Ucsd Mcr Adv [873] | $19,011 | 148% |
| Uh Mcr Adv [831] | $19,011 | 148% |
| Uh Palomar Health Mcr Adv [885] | $19,011 | 148% |
| UnitedHealthcare | $19,011 - $27,956 | 148% |
| Sharp Comm Med Grp [812] | $19,261 - $45,558 | 150% |
| Sharp Rees Stealy Med Grp [811] | $19,261 - $45,558 | 150% |
| Ucsd [807] | $19,261 - $45,558 | 150% |
| Health Net [340] | $20,375 - $40,456 | 159% |
| Mpmg Mcr Adv [836] | $20,375 | 159% |
| Mpmg [800] | $20,375 | 159% |
| Ocn Mcr Adv [890] | $20,375 | 159% |
| Prime Healthcare [614] | $20,375 | 159% |
| Prospect Med Group [893] | $20,375 | 159% |
| Centivo [581] | $24,682 | 193% |
| Bc [814] | $25,227 | 197% |
| Imperial County Phys Med Group [855] | $25,227 | 197% |
| Integrated Health Partners [894] | $25,227 | 197% |
| Perlman Med Group [899] | $25,227 | 197% |
| Uh [819] | $27,956 | 218% |
| Hn [815] | $40,456 | 316% |
| Palomar Health [892] | $45,558 | 356% |
| Veba Med Grp [813] | $45,558 | 356% |