CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Lehigh Valley Hospital - Pocono

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $31,046
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Lehigh Valley Hospital - Pocono is $31,046. 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 $23,503.93, this hospital’s rate is 1.32x 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

$31,046

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$23,503.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $23,503.93 (100%)

Insurance Median: $31,046 (132%)

Ins. Median: $31,046 (132% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $23,503.93 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	$25,083 - $83,787	107%
Amerihealth	$25,329	108%
Cigna	$25,329 - $93,287	108%
Pa Health & Wellness (Allwell)	$25,329	108%
UnitedHealthcare	$25,575 - $66,565	109%
Aetna	$25,821 - $56,137	110%
Gateway	$25,821	110%
Geisinger	$25,821 - $58,712	110%
Jefferson Health Partners	$25,821 - $44,006	110%
Devoted Health	$26,067	111%
Humana	$26,067	111%
Upmc	$26,067 - $55,381	111%
Emblem	$26,559 - $50,851	113%
Ambetter / Centene	$56,685	241%

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: 451.

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 451.
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.