CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Mercy Health St Ritas Medical Center

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $13,387
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Mercy Health St Ritas Medical Center is $13,387. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.05x the Medicare baseline. Located in 730 West Market Street, Lima, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,387

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%)

Insurance Median: $13,387 (105%)

Ins. Median: $13,387 (105% 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
Aetna	$13,255	103%
Blue Cross Blue Shield	$13,255 - $48,704	103%
Buckeye Mycare Benefits [4237]	$13,255	103%
Humana	$13,255	103%
Medigold [4435]	$13,255	103%
UnitedHealthcare	$13,255 - $33,761	103%
Devoted Health Plan [4501]	$13,387	105%
Medicare (plans)	$13,387	105%
Caresource Mycare Ohio [4236]	$13,520	106%
Molina Mycare Ohio [4235]	$13,917	109%
Paramount Elite [3723]	$14,559	114%
Buckeye [4178]	$22,566	176%
Caresource [4179]	$25,478	199%
Cigna	$39,213	306%
Medical Mutual [3067]	$41,563	325%

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 $X.
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 Mercy Health St Ritas 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.