CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: UPMC Northwest

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $14,102
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at UPMC Northwest is $14,102. 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 1.10x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,102

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: $14,102 (110%)

Ins. Median: $14,102 (110% 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
Intergroup	$3,704	29%
Upmc Work Partners	$9,224	72%
Upmc Health Plan	$12,758 - $15,409	100%
Blue Cross Blue Shield	$13,059 - $31,761	102%
Aetna	$13,451 - $13,712	105%
UnitedHealthcare	$13,712 - $14,365	107%
Highmark Wholecare (Prev Gateway)	$14,102	110%
Amerihealth Caritas	$14,104	110%
Pa Health & Wellness	$14,104	110%

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 UPMC Northwest 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.