CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Prisma Health Tuomey Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $14,723
Cash Discount Price: $73,865
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Prisma Health Tuomey Hospital is $14,723. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73,865. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.15x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.

Cash / Self-Pay

$73,865

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,723

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: $73,865 (577%)

Insurance Median: $14,723 (115%)

Cash: $73,865 (577% of Medicare)

Ins. Median: $14,723 (115% 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
Medicaid / KanCare	$5,073	40%
UnitedHealthcare	$5,073 - $31,995	40%
Blue Cross Blue Shield	$14,022 - $49,475	109%
Cigna	$14,022 - $36,009	109%
Humana	$14,022	109%
Medicare (plans)	$14,022 - $14,723	109%
Ambetter / Centene	$14,510	113%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$14,510	113%
Triwest Healthcare Alliance Vcp [902]	$14,510	113%
Va Community Care Network-Vaccn [903]	$14,510	113%
Aetna	$14,723	115%
Healthy Conn Prime-First Choice Vip Care [5300]	$14,723	115%
Healthy Conn Prime-Molina Healthcare [5330]	$14,723	115%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$14,723	115%
Workers Comp [600]	$19,631	153%
Preferred Administrators Contracted [2839]	$31,307	244%
Golden Rule Insurance Company [2991]	$31,995	250%
Oxford Health Plans [2992]	$31,995	250%
Zzumr-Salt Lake City Ut [3169]	$31,995	250%
Promise Health Plan Contracted [2401]	$34,378	268%
Scdc-Sc Dept Of Corrections [7232]	$35,960	281%
Bluechoice [810]	$48,235	377%
Planned Administrators [820]	$49,475	386%

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 $73,865.
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 Prisma Health Tuomey 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.