CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Carilion Medical Center

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $88,705
Cash Discount Price: $50,075
vs. Medicare Baseline: 6.93x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Carilion Medical Center is $88,705. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50,075. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 6.93x the Medicare baseline. Located in 1906 Belleview Avenue, Se, Roanoke, VA.

Cash / Self-Pay

$50,075

Average discount available for prompt cash payment at this facility.

Insurance Median

$88,705

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: $50,075 (391%)

Insurance Median: $88,705 (693%)

Cash: $50,075 (391% of Medicare)

Ins. Median: $88,705 (693% 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 693% of the Medicare baseline (a markup of 593%). 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
Aetna	$14,152 - $95,000	111%
Humana	$14,754 - $17,371	115%
Blue Cross Blue Shield	$15,356 - $55,869	120%
UnitedHealthcare	$15,507 - $116,948	121%
Sentara Health Plan	$15,808 - $88,705	123%
Vhn - Ultra	$88,705	693%
Cigna	$96,431 - $103,012	753%
Gateway - Tier 3	$97,289	760%
Connecticare	$100,151	782%
Vhn - Plus	$110,166	860%
Gateway - Tier 2	$114,458	894%
Vhn	$114,458	894%
Vhn - Link	$128,765	1005%
Gateway - Tier 1	$135,919	1061%
Vhn - Secondary Payors	$135,919	1061%

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 $50,075.
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 Carilion 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.