CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Penn Presbyterian Medical Center

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $17,584
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Penn Presbyterian Medical Center is $17,584. 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 1.37x the Medicare baseline. Located in 51 North 39Th Street, Philadelphia, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,584

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: $17,584 (137%)

Ins. Median: $17,584 (137% 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
UnitedHealthcare	$3,121 - $41,842	24%
Penn Life (Living Independently For Elders)	$4,748	37%
Us Family Health Plan	$6,155	48%
Pgm - Embassy Of Qatar	$11,430	89%
Workers Compensation	$11,955	93%
Pgm - Embassy Of The United Emirates/Ipc	$12,309	96%
Blue Cross Blue Shield	$14,979 - $19,984	117%
Medicare (plans)	$14,979 - $18,507	117%
Upmc	$14,979	117%
Cigna	$15,428 - $37,164	120%
Geisinger Health Plan	$15,428 - $17,584	120%
Health Partners	$15,428	120%
Humana	$15,428	120%
Ibc	$15,720	123%
Keystone First	$15,727	123%
Pa Health And Wellness	$15,727 - $30,536	123%
Aetna	$15,877 - $32,372	124%
Clover Health Plan	$15,877	124%
Gateway Health Plan	$16,332	128%
Ibc Commercial Hpn	$17,584	137%
Keystone Hmo Proactive	$17,584	137%
Philadelphia Va Medical Center	$18,507	145%
Elap	$26,280	205%
Claims Watcher	$29,611 - $33,312	231%
Oscar Health Plan	$31,462	246%
Centivo	$33,312	260%
Elap Services	$34,423	269%
Olympus	$37,446	292%
Highmark	$38,324	299%
Penn Global Medicine	$49,043	383%

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 Penn Presbyterian 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.