CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Sisters of Charity Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $13,595
Cash Discount Price: $48,580
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Sisters of Charity Hospital is $13,595. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48,580. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.06x the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$48,580

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,595

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: $48,580 (379%)

Insurance Median: $13,595 (106%)

Cash: $48,580 (379% of Medicare)

Ins. Median: $13,595 (106% 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
Beacon Health Options [100023]	$11,137	87%
Beacon Health Options Alt [100024]	$11,137	87%
Beacon Essential [350122]	$11,137 - $11,248	87%
Medicaid / KanCare	$11,137 - $14,139	87%
Molina Essential [100167]	$12,083	94%
Amerigroup [350102]	$12,083	94%
Univera Healthcare Essential [100170]	$12,083	94%
Fidelis Essential [100163]	$12,083 - $12,391	94%
Blue Cross Blue Shield	$12,083 - $38,388	94%
UnitedHealthcare	$12,083 - $33,720	94%
Crime Victims [100176]	$12,391	97%
Excellus Rochester McD [350117]	$12,391	97%
Federal Workers Compensation [500100]	$13,595	106%
VA Veterans Affairs [700001]	$13,595 - $21,451	106%
Wellcare Fidelis Dual [450451]	$13,595	106%
Fidelis Dual Advantage [450120]	$13,595	106%
Cigna	$13,595	106%
Aetna	$13,595	106%
Fallon Health [450115]	$13,595	106%
Wellcare [450129]	$13,595	106%
Seneca Nation [450119]	$13,595	106%
Medicare (plans)	$13,595	106%
No Fault [114001]	$17,487	137%
Workers Compensation [500101]	$17,487	137%
Fidelis Exchange [100164]	$17,894	140%
Mvp Healthcare [100168]	$18,292	143%
Tricare	$21,451	167%
Univera Healthcare [100169]	$23,755 - $33,937	185%
UPMC Health Plan [100181]	$31,788	248%
Ghi [100153]	$34,936	273%

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 $48,580.
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 Sisters of Charity 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.