CMS Price Transparency Data
Heart stent placement (inpatient stay)
Facility: Overlook Medical Center
Billing Code: 322 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 322
- Insurance Median: $35,377
- Cash Discount Price: $21,296
- vs. Medicare Baseline: 2.76x Medicare
The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Overlook Medical Center is $35,377. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,296. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 2.76x the Medicare baseline. Located in 99 Beauvoir Avenue, Summit, NJ.
Cash / Self-Pay
$21,296
Average discount available for prompt cash payment at this facility.
Insurance Median
$35,377
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: $21,296 (166%)
Insurance Median: $35,377 (276%)
Cash: $21,296 (166% of Medicare)
Ins. Median: $35,377 (276% 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 276% of the Medicare baseline (a markup of 176%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Occunet [5490] | $7,532 | 59% |
| The Fairly Group [5528] | $7,532 | 59% |
| Praxis Workers Comp [5515] | $8,500 | 66% |
| Inservco Workers Compensation [5158] | $8,682 | 68% |
| Medlogix/Consumer Health Network (Chn) [5415] | $8,682 | 68% |
| Gallagher Bassett Workers Comp [5117] | $9,028 | 70% |
| Liberty Mutual Worker's Comp [5174] | $9,028 | 70% |
| Pma Workers Comp [5224] | $9,028 | 70% |
| Sedgwick [5235] | $9,028 | 70% |
| Sentry Worker's Comp [5489] | $9,028 | 70% |
| Travelers Workers Compensation [5250] | $9,028 | 70% |
| Karen Ann Quinlan [5285] | $13,630 | 106% |
| Aetna | $13,902 - $45,355 | 109% |
| Cigna | $15,447 - $46,652 | 121% |
| Medicare (plans) | $15,447 - $17,889 | 121% |
| Amerihealth Administrators Supplemental [5512] | $15,756 | 123% |
| Amerihealth Medigap [5049] | $15,756 | 123% |
| Wellcare Behavioral Health [5335] | $16,528 | 129% |
| Wellcare Health Plans Ip Splits [5475] | $16,528 | 129% |
| Wellcare Health Plans [5269] | $16,528 | 129% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $16,992 | 133% |
| Highmark Wholecare Health Plan [5413] | $16,992 | 133% |
| UPMC [5455] | $16,992 | 133% |
| VA Community Care Network [5403] | $17,037 | 133% |
| Kindred Giralda Hospital [5341] | $18,741 | 146% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $19,593 | 153% |
| Medicaid / KanCare | $19,593 | 153% |
| Omc Pediatric Muscle Lengthening [5360] | $19,593 | 153% |
| Specialty Imaging [5433] | $19,593 | 153% |
| Sedgwick Wtc Health Program Wc [5514] | $21,296 | 166% |
| Champva [5354] | $22,414 | 175% |
| Tricare | $22,414 | 175% |
| Us Family Health Plan [5258] | $22,414 | 175% |
| Wtc Health Program [5273] | $22,716 | 177% |
| Claim Watcher/Homestead [5488] | $29,349 | 229% |
| Fairos [5491] | $32,541 | 254% |
| Ambetter / Centene | $35,097 | 274% |
| Claimdoc [5434] | $37,652 | 294% |
| Ghi Emblem Health [5122] | $41,237 | 322% |
| Humana | $41,237 | 322% |
| Ila Local 1478-2 Welfare Fund [5448] | $41,237 | 322% |
| Oscar [5213] | $41,237 | 322% |
| Qualcare [5026] | $41,237 | 322% |
| Evolution Healthcare [5438] | $42,411 - $45,355 | 331% |
| Healthez [5445] | $42,411 - $45,355 | 331% |
| Mvp Health Care [5197] | $42,411 | 331% |
| Nalc [5198] | $42,411 | 331% |
| Tufts Health Plan [5344] | $42,411 | 331% |
| Webtpa [5447] | $42,411 - $45,355 | 331% |
| Centivo [5405] | $42,846 - $46,652 | 335% |
| 1199 Seiu Benefit and Pension [5037] | $45,355 | 354% |
| Allied Benefit Systems [5046] | $45,355 - $46,652 | 354% |
| Banner Health Network [5510] | $45,355 | 354% |
| Boon-Chapman [5441] | $45,355 | 354% |
| Christian Brothers Services [5439] | $45,355 | 354% |
| Continental Assurance [5091] | $45,355 | 354% |
| Healthsmart Benefit Solutions [5446] | $45,355 | 354% |
| Luminare Health Benefits [5483] | $45,355 | 354% |
| Marpai Health [5449] | $45,355 | 354% |
| Meritain Health [5185] | $45,355 | 354% |
| Nippon Benefit Life [5201] | $45,355 | 354% |
| Starmark [5240] | $45,355 | 354% |
| Iaa - Insurance Administrators of America [5482] | $46,652 | 364% |
| Prime Healthcare [5435] | $47,111 | 368% |
| Oxford Behavioral Health [5291] | $47,213 | 369% |
| Oxford [5024] | $47,213 | 369% |
| UnitedHealthcare | $47,213 - $48,675 | 369% |
| Apwu Healthcare [5053] | $48,675 | 380% |
| Geha [5119] | $48,675 | 380% |
| Golden Rule Insurance [5124] | $48,675 | 380% |
| Harvard Pilgrim Healthcare [5133] | $48,675 | 380% |
| Ntca [5208] | $48,675 | 380% |
| Surest [5437] | $48,675 | 380% |