CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: St Mary's General Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $25,846
Cash Discount Price: $21,930
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at St Mary's General Hospital is $25,846. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,930. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 2.02x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$21,930

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,846

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: $21,930 (171%)

Insurance Median: $25,846 (202%)

Cash: $21,930 (171% of Medicare)

Ins. Median: $25,846 (202% 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 202% of the Medicare baseline (a markup of 102%). 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	$17,545	137%
Aetna	$17,916 - $39,695	140%
Amerihealth	$17,916	140%
Clover Health	$17,916	140%
Horizon	$17,916	140%
Ubh	$17,916	140%
UnitedHealthcare	$17,916 - $31,545	140%
Wellcare	$17,916 - $29,607	140%
Wellpoint Amerigroup	$17,916	140%
Medicare (plans)	$21,931	171%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$23,027	180%
Cigna	$25,793	201%
Employer Direct Healthcare	$28,510	223%
Tricare	$32,133	251%
Fairprice Healthcare Holdings	$35,089	274%
Coventry	$37,282	291%

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 $21,930.
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 Mary's General 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.