CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Tufts Medical Center

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $22,040
Cash Discount Price: $34,850
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Tufts Medical Center is $22,040. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34,850. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.72x the Medicare baseline. Located in 800 Washington Street, Boston, MA.

Cash / Self-Pay

$34,850

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,040

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: $34,850 (272%)

Insurance Median: $22,040 (172%)

Cash: $34,850 (272% of Medicare)

Ins. Median: $22,040 (172% 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
UnitedHealthcare	$4,284 - $22,040	33%
Health Safety Net [500011]	$7,050	55%
Elementcare [450046]	$12,343	96%
Fallon Senior [450065]	$15,450 - $16,694	121%
Cigna	$16,694 - $35,627	130%
Harvard Pilgrim Stride [450060]	$16,694	130%
Humana	$16,694	130%
Martins Point Generations Replacement [450057]	$16,694	130%
Medicare (plans)	$16,694 - $22,040	130%
Neighborhood Pace [450114]	$16,694	130%
Peak Pace Solutions [450115]	$16,694	130%
Secure Horizons Ma Pffs [450077]	$16,694	130%
Aetna	$17,017 - $28,760	133%
Blue Cross Blue Shield	$17,017 - $54,161	133%
Commonwealth Care Alliance [450067]	$17,017	133%
Medicaid / KanCare	$17,017 - $27,054	133%
Veterans Evaluation Svcs [800004]	$21,622	169%
Champva [800006]	$22,040	172%
Veterans Services [800005]	$22,040	172%
Meritain [100063]	$22,314	174%
Generic Prison [500099]	$27,054	211%
Middlesex County [500015]	$27,054	211%
Suffolk County [500014]	$27,054	211%
Tewksbury Hospital [950008]	$27,054	211%
Tufts Health Public Plan [350009]	$27,054	211%
Wellsense Clarity Connectorcare [100256]	$36,252 - $40,851	283%
Wellpoint [100139]	$36,577	286%
Tufts Health Public Plan Connectorcare [100264]	$39,543 - $46,505	309%
Fallon Health Connectorcare [100260]	$39,893	311%
Fallon Health [100259]	$39,893	311%
Blue Benefits Administrators [100267]	$49,881 - $54,161	389%

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 $34,850.
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 Tufts 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.