CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $19,546
Cash Discount Price: $16,238
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Saint Clare's Hospital/ Denville Campus is $19,546. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,238. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.53x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$16,238

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,546

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: $16,238 (127%)

Insurance Median: $19,546 (153%)

Cash: $16,238 (127% of Medicare)

Ins. Median: $19,546 (153% 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	$12,991	101%
Aetna	$15,344 - $29,391	120%
Amerihealth	$15,344	120%
Clover Health	$15,344	120%
Horizon	$15,344	120%
UnitedHealthcare	$15,344 - $25,334	120%
Wellcare	$15,344 - $21,922	120%
Wellpoint Amerigroup	$15,344	120%
Medicare (plans)	$16,238	127%
Ally-Align (Fka Spartan Health Plan)	$17,050	133%
Employer Direct Healthcare	$21,110	165%
Cigna	$22,214	173%
Fairprice Healthcare Holdings - Fphh	$25,981	203%
Coventry	$27,605	216%
Tricare	$28,695	224%

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 $16,238.
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 Saint Clare's Hospital/ Denville Campus 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.