CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Lehigh Valley Hospital - Macungie

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $20,826
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.63x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Lehigh Valley Hospital - Macungie is $20,826. 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 1.63x 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

$20,826

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: $20,826 (163%)

Ins. Median: $20,826 (163% 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
Blue Cross Blue Shield	$12,230 - $31,214	95%
Highmark Blue Shield	$12,352 - $46,224	96%
Humana	$12,352	96%
Amerihealth	$12,596	98%
Cigna	$12,596 - $31,661	98%
Geisinger	$12,596 - $30,657	98%
Pa Health & Wellness (Allwell)	$12,596	98%
Aetna	$12,841 - $34,335	100%
Gateway	$12,841	100%
Jefferson Health Partners	$12,841 - $23,236	100%
Upmc	$12,963 - $37,469	101%
Emblem	$13,208 - $29,812	103%
Populytics	$17,465	136%
Ambetter / Centene	$28,190	220%
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 - Macungie 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.