CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Lehigh Valley Hospital - Macungie

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $7,814
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Lehigh Valley Hospital - Macungie is $7,814. 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 $5,675.87, this hospital’s rate is 1.38x the Medicare baseline. Located in 3369 State Route 100, Macungie, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,814

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Insurance Median: $7,814 (138%)

Ins. Median: $7,814 (138% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 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
Blue Cross Blue Shield	$5,275 - $12,998	93%
Highmark Blue Shield	$5,327 - $13,101	94%
Humana	$5,327	94%
Amerihealth	$5,433	96%
Cigna	$5,433 - $13,655	96%
Geisinger	$5,433 - $13,222	96%
Pa Health & Wellness (Allwell)	$5,433	96%
Aetna	$5,538 - $14,809	98%
Gateway	$5,538	98%
Jefferson Health Partners	$5,538 - $10,021	98%
Upmc	$5,591 - $16,160	99%
Emblem	$5,696 - $12,858	100%
Populytics	$6,774	119%
Ambetter / Centene	$12,158	214%
Valley Preferred	$14,754	260%

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: 392.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lehigh Valley Hospital - Macungie is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 392.
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.