CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Samaritan Hospital of Troy, New York

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $19,312
Cash Discount Price: $38,166
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Samaritan Hospital of Troy, New York is $19,312. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38,166. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.51x the Medicare baseline. Located in 2215 Burdett Avenue, Troy, NY.

Cash / Self-Pay

$38,166

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,312

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: $38,166 (298%)

Insurance Median: $19,312 (151%)

Cash: $38,166 (298% of Medicare)

Ins. Median: $19,312 (151% 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
Wellpath	$3,000	23%
Blue Cross Blue Shield	$16,920 - $17,265	132%
Medicare (plans)	$17,258 - $19,288	135%
Eddy Seniorcare Pace	$17,265	135%
Secure Horizons Ma Pffs	$17,596	137%
UnitedHealthcare	$17,596 - $63,205	137%
Aetna	$18,273 - $37,882	143%
Medicaid / KanCare	$18,301	143%
Hudson Headwaters Pace	$18,646	146%
Nascentia Health Plus	$19,337	151%
Fidelis Care	$31,077	243%
1199 National Benefit Fund	$37,882	296%
Allied Benefit Systems	$37,882	296%
Asr Health Benefits	$37,882	296%
Christian Brother Services	$37,882	296%
Geha	$37,882	296%
Lucent Health	$37,882	296%
Luminare Health	$37,882	296%
Medical Mutual	$37,882	296%
Meritain	$37,882	296%
Trustmark Small Business Benefits	$37,882	296%
Capital District Physicians Health Plan	$48,750	381%
Emblem Health	$48,997	383%
Nova	$48,997	383%
Harvard Pilgrim Healthcare	$63,205	494%

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 $38,166.
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 Samaritan Hospital of Troy, New York 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.