CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Lehigh Valley Hospital - Pocono

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $22,134
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.73x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Lehigh Valley Hospital - Pocono is $22,134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.73x the Medicare baseline. Located in 206 East Brown Street, East Stroudsburg, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,134

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%)

Insurance Median: $22,134 (173%)

Ins. Median: $22,134 (173% 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
Highmark Blue Shield	$14,921 - $49,333	117%
Amerihealth	$15,067	118%
Cigna	$15,067 - $54,690	118%
Pa Health & Wellness (Allwell)	$15,067	118%
UnitedHealthcare	$15,213 - $39,024	119%
Aetna	$15,359 - $32,911	120%
Gateway	$15,359	120%
Geisinger	$15,359 - $34,924	120%
Jefferson Health Partners	$15,359 - $25,799	120%
Devoted Health	$15,506	121%
Humana	$15,506	121%
Upmc	$15,506 - $32,468	121%
Emblem	$15,798 - $29,812	123%
Ambetter / Centene	$33,719	263%
Valley Preferred	$56,369	440%

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 $X.
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 Lehigh Valley Hospital - Pocono 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.