CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: St Mary Medical Center

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $27,427
Cash Discount Price: $46,870
vs. Medicare Baseline: 2.14x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at St Mary Medical Center is $27,427. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46,870. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 2.14x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$46,870

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,427

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: $46,870 (366%)

Insurance Median: $27,427 (214%)

Cash: $46,870 (366% of Medicare)

Ins. Median: $27,427 (214% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 214% of the Medicare baseline (a markup of 114%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Pace-Trinity Health	$12,659	99%
Cigna	$14,198 - $35,958	111%
Align Senior Care	$14,347	112%
Medicare (plans)	$14,417 - $25,318	113%
Blue Cross Blue Shield	$14,423 - $43,166	113%
Aetna	$14,887 - $39,706	116%
Health America Advantra	$15,050	118%
Jefferson Health Plan Commercial	$24,227	189%
Ambetter / Centene	$25,107	196%
Oscar	$25,318	198%
Prime Healthcare	$25,318	198%
Homestead Health Plans Woods Center	$27,427	214%
Amerihealth	$29,987	234%
Blue Shield - Ca	$29,987	234%
Blue Shield - Id (Regence)	$29,987	234%
Blue Shield - Ny Highmark Western	$29,987	234%
Blue Shield - Wa (Regence)	$29,987	234%
Blue Shield - Pa (Highmark)	$30,426	238%
Group Pension Administrators	$33,605	262%
Reedman Toll	$33,605	262%
Upmc Health Plan	$35,958	281%
Webtpa	$35,958	281%
Meritain	$39,706	310%
Geha	$40,078	313%
UnitedHealthcare	$40,078	313%

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 $46,870.
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 St Mary 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.