CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Pennsylvania Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 322
  • Insurance Median: $16,938
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.32x Medicare
The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Pennsylvania Hospital is $16,938. 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 1.32x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$16,938

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: $16,938 (132%)
Ins. Median: $16,938 (132% 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.

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 $3,308 - $41,842 26%
Penn Life (Living Independently For Elders) $4,748 37%
Us Family Health Plan $6,155 48%
Workers Compensation $10,952 86%
Pgm - Embassy Of Qatar $11,430 89%
Pgm - Embassy Of The United Emirates/Ipc $12,309 96%
Blue Cross Blue Shield $14,842 - $21,425 116%
Medicare (plans) $14,842 - $16,938 116%
Upmc $14,842 116%
Cigna $15,287 - $37,164 119%
Geisinger Health Plan $15,287 - $53,145 119%
Health Partners $15,287 119%
Humana $15,287 119%
Ibc $15,375 120%
Keystone First $15,584 122%
Pa Health And Wellness $15,584 - $27,948 122%
Aetna $15,732 - $30,560 123%
Clover Health Plan $15,732 123%
Gateway Health Plan $16,183 126%
Philadelphia Va Medical Center $16,938 132%
Ibc Commercial Hpn $17,584 137%
Keystone Hmo Proactive $17,584 137%
Elap $24,052 188%
Claims Watcher $27,101 - $30,489 212%
Oscar Health Plan $28,795 225%
Centivo $30,489 238%
Elap Services $31,505 246%
Highmark $33,607 262%
Olympus $37,104 290%
Penn Global Medicine $44,886 350%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 800 Spruce Street, Philadelphia, PA 19107
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals