CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Thomas Jefferson University Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $19,652
Cash Discount Price: $21,179
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Thomas Jefferson University Hospital is $19,652. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,179. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.53x the Medicare baseline. Located in 111 South 11Th Street, Philadelphia, PA.

Cash / Self-Pay

$21,179

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,652

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: $21,179 (165%)

Insurance Median: $19,652 (153%)

Cash: $21,179 (165% of Medicare)

Ins. Median: $19,652 (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
Medicare (plans)	$14,260 - $21,221	111%
Aetna	$17,430 - $52,659	136%
Jefferson Health Plan Aca Qhp Exchange	$17,704	138%
Inspira Life	$18,453	144%
Point Of Comfort Refugee Resettlement	$18,453	144%
St Agnes	$18,453	144%
Tricare	$18,453	144%
UnitedHealthcare	$18,453 - $19,929	144%
Humana	$18,822	147%
Innovage	$18,822	147%
Cigna	$19,191 - $50,697	150%
Keystone First Vip Choice	$19,191	150%
Ambetter / Centene	$19,362	151%
Devoted Health Participation	$19,375	151%
Provider Partners Health Plan	$19,744	154%
Allwell Pa Health_Wellness Ma	$20,298	158%
Highmark Wholecare Gateway	$20,298	158%
Perennial	$21,405	167%
Ibc Employee Benefit	$23,066	180%
Ibc Main Line Health	$23,066	180%
Naphcare	$23,234 - $29,524	181%
Blue Cross Blue Shield	$30,073 - $43,592	235%
Highmark	$32,368 - $40,105	253%
Upmc Commercial	$50,697	396%
Geisinger Health Plan	$56,711	443%

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 $21,179.
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 Thomas Jefferson University Hospital 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.