CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Duke University Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $19,253
Cash Discount Price: $21,662
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Duke University Hospital is $19,253. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,662. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.50x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$21,662

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,253

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: $21,662 (169%)

Insurance Median: $19,253 (150%)

Cash: $21,662 (169% of Medicare)

Ins. Median: $19,253 (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.

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
Sentara	$7,256	57%
Humana	$9,900 - $16,538	77%
Troy Health	$11,647	91%
Voans	$11,647	91%
Cigna	$11,880 - $51,010	93%
Liberty	$11,880	93%
Aetna	$15,025 - $39,472	117%
Blue Cross Blue Shield	$15,570 - $24,093	122%
UnitedHealthcare	$15,570 - $32,594	122%
Alliance Health	$19,253	150%
Amerihealth	$19,253	150%
Carolina Complete Health	$19,253	150%
Partners	$19,253	150%
Trillium	$19,253	150%
Medcost	$34,178	267%

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 $21,662.
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 Duke University Hospital 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.