CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Roxborough Memorial Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $17,200
Cash Discount Price: $16,753
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Roxborough Memorial Hospital is $17,200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,753. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.34x the Medicare baseline. Located in 5800 Ridge Ave, Philadelphia, PA.

Cash / Self-Pay

$16,753

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,200

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: $16,753 (131%)

Insurance Median: $17,200 (134%)

Cash: $16,753 (131% of Medicare)

Ins. Median: $17,200 (134% 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
Worker Compensation	$6,016	47%
Blue Cross Blue Shield	$14,112	110%
Health Partners Plan	$14,112 - $20,451	110%
Pa Health & Wellness	$14,112 - $20,104	110%
Ubh	$14,112 - $16,754	110%
UnitedHealthcare	$14,112 - $17,143	110%
Keystone	$14,676	115%
Medicare (plans)	$14,817 - $16,754	116%
Providers Partner Health Plan	$17,256	135%
Spartan	$17,591	137%
Luminary	$17,752	139%
Auto Insurance	$18,429	144%
Humana	$19,481	152%
Employer Direct Healthcare	$21,780	170%
Cigna	$23,309	182%
Tricare	$25,900	202%
Naphcare	$25,968	203%
Highmark	$30,536	238%

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 $16,753.
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 Roxborough Memorial 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.