CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: McLaren Macomb

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $17,482
Cash Discount Price: $41,589
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at McLaren Macomb is $17,482. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41,589. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.37x the Medicare baseline. Located in 1000 Harrington St, Mount Clemens, MI.

Cash / Self-Pay

$41,589

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,482

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: $41,589 (325%)

Insurance Median: $17,482 (137%)

Cash: $41,589 (325% of Medicare)

Ins. Median: $17,482 (137% 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
Humana	$12,200	95%
Medicare (plans)	$13,518 - $25,661	106%
Mi Amish Medical Board	$18,444	144%
Tricare	$19,751	154%
Aetna	$38,582	301%
Blue Cross Blue Shield	$48,444	378%
Priority Health	$48,451	378%

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 $41,589.
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 McLaren Macomb 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.