CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: St Claire Regional Medical Center

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $15,179
Cash Discount Price: $55,878
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at St Claire Regional Medical Center is $15,179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55,878. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.19x the Medicare baseline. Located in 222 Medical Circle, Morehead, KY.

Cash / Self-Pay

$55,878

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,179

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: $55,878 (436%)

Insurance Median: $15,179 (119%)

Cash: $55,878 (436% of Medicare)

Ins. Median: $15,179 (119% 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
Medicaid / KanCare	$7,275 - $11,708	57%
Aetna	$10,665	83%
Wellcare Mcaid	$11,592	91%
Blue Cross Blue Shield	$13,300 - $51,647	104%
Caresource Mcr Adv	$13,300	104%
Humana	$13,300 - $52,153	104%
Healthlink - All Plans	$13,452	105%
Caresource Just4Me - All Other Plans	$17,290	135%
Ky Health Co-Op - All Plans	$17,290	135%
Wellcare Comm - All Other Plans	$63,329	494%

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 $55,878.
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 St Claire Regional Medical Center 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.