CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Saint Francis Hospital-Evanston

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $15,899
Cash Discount Price: $18,168
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Saint Francis Hospital-Evanston is $15,899. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,168. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.24x the Medicare baseline. Located in 355 Ridge Ave, Evanston, IL.

Cash / Self-Pay

$18,168

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,899

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: $18,168 (142%)

Insurance Median: $15,899 (124%)

Cash: $18,168 (142% of Medicare)

Ins. Median: $15,899 (124% 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 Cross Blue Shield	$14,385 - $25,436	112%
Aetna	$15,142 - $15,899	118%
Celtic (Wellcare)	$15,142	118%
Cigna	$15,142 - $20,274	118%
Devoted Health	$15,142	118%
Humana	$15,142 - $16,657	118%
Illinois Physicians Alliance	$15,142	118%
Longevity Health Plan Of Illinois	$15,142	118%
UnitedHealthcare	$15,142 - $18,169	118%
Clear Spring Health Of Illinois	$15,294	119%
Molina	$15,597 - $27,253	122%
Zing Health Provider Network	$15,597	122%
Meridian	$15,899	124%
Provider Partners Health Plan (Pphp)	$15,899	124%
Medicare (plans)	$18,169	142%
Self-Pay	$18,169	142%
Access Community Health Network	$21,803	170%
Clifton Health Systems	$28,162	220%
Ambetter / Centene	$29,434	230%
Tricare	$31,265	244%

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 $18,168.
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 Saint Francis Hospital-Evanston 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.