CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Carolina East Medical Center

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $48,398
Cash Discount Price: $42,967
vs. Medicare Baseline: 3.78x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Carolina East Medical Center is $48,398. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42,967. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 3.78x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$42,967

Average discount available for prompt cash payment at this facility.

Insurance Median

$48,398

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: $42,967 (335%)

Insurance Median: $48,398 (378%)

Cash: $42,967 (335% of Medicare)

Ins. Median: $48,398 (378% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 378% of the Medicare baseline (a markup of 278%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$15,402	120%
Inclusive Health (Nchirp)-All Plans	$15,402	120%
Pamlico Co Jail-All Plans	$19,049	149%
Tricare	$22,200	173%
Blue Cross Blue Shield	$30,592	239%
Cigna	$36,184	283%
Medcost Ppo Employees And Retirees	$40,733	318%
Medcost Ppo Ultra (Employees)	$40,733	318%
Craven Co. Jail Systems - All Plans	$48,398	378%
UnitedHealthcare	$50,916	398%
Medcost Ppo City Employees	$52,191	408%
Medcost Ppo County Employee	$54,282	424%
Benefit Mgmt, Svcs-All Plans	$60,870	475%
Medcost Benefit Svc-All Other Plans	$63,326	494%
Aetna	$63,448	495%
Acs Consult Svc Inc-All Plans	$64,723	505%
Medcost Ppo Standard	$64,723	505%

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 $42,967.
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 Carolina East 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.