CMS Price Transparency Data
Prostate cancer screening (blood test)
Facility: Lehigh Valley Hospital - Macungie
Billing Code: G0103 (HCPCS)
Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Near Fair BaseRate Benchmark
$22Fair BaseRate Benchmark
Position vs. 1.00× Fair PriceRight at U.S. Average (0%)
1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.
Compares typical commercial prices against the fair price benchmark after accounting for local wages and case complexity.
Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Value Leader
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.
Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.
The BaseRate · fair price high confidence
A fair price for this
$22
about 1.2× the $19 Medicare rate · typically $17–$32
modeled estimate · not a bill or quote
Medicare pays $19 Fair price $22
What each insurance company pays
Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.
4 of 6 major insurers have a published price at this hospital
Blue Cross Blue ShieldAetnaCignaHumana UnitedHealthcareKaiser Permanente
Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.
| Insurance company | Price range | vs. Medicare |
|---|---|---|
| Blue Cross Blue Shieldmajor | $19 - $112 | 98% |
| Aetnamajor | $20 - $96 | 104% |
| Cignamajor | $20 | 104% |
| Humanamajor | $20 | 104% |
| Ambetter (Centene) | $59 | 306% |
| AmeriHealth | $20 | 104% |
| Geisinger | $20 - $85 | 104% |
| HealthPartners | $20 - $39 | 104% |
| UPMC Health Plan | $20 - $94 | 104% |
| + 4 smaller / regional plans | $21 - $113 |
Self-Pay How to get the cash price
Insurance Before you use insurance
Other Procedures at Lehigh Valley Hospital - Macungie
Compare: Prostate cancer screening (blood test) at other PA hospitals
- UPMC Muncy · Muncy $15
- UPMC Wellsboro · Wellsboro $15
- Saint Vincent Hospital · Erie $19
- Allegheny Valley Hospital · Natrona $19
- Heritage Valley Beaver · Beaver $19
- Heritage Valley Sewickley · Sewickley $19
- Allegheny General Hospital · Pittsburgh $19
- West Penn Hospital · Pittsburgh $19
Insurance negotiated median for the same procedure, sorted lowest first.
Inline Bill X-Ray & 501(r) Calculator
501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%
Audit a Bill or Quote at Lehigh Valley Hospital - Macungie (Zero PHI Required)
CMS CCN: 390430
HCPCS G0103
Fair BaseRate™ $22
Medicare Rate $19
Self-Pay Cash Request Quote
Insurer Median $25
Pre-filled with Lehigh Valley Hospital - Macungie’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check
501(r) AGB Cap: $22 (274% FPL)
Statutory 501(r) AGB Cap Limits Bill to $22
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $22).
Step 2 · Cash vs. Insurance Arbitrage
Request Prompt-Pay Quote
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask Lehigh Valley Hospital - Macungie's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Step 3 · Fair BaseRate Target
+$38 Above Fair BaseRate
Negotiate Toward $22 Fair BaseRate ($19 Medicare)
Your bill ($60) is $38 above the denoised Fair BaseRate ($22) and 3.2× the $19 Medicare rate.
1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, HCPCS code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
45 CFR § 180 Primary-Source Lineage & Federal Verification
Verified
CMS CCN 390430
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
MRF Portal Indexed (CMS_45_CFR_180_FILING.json)
Verify on CMS Medicare.gov (CCN 390430) ↗
CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage2026-07
Validated Rate RowsIndexed (CMS v2024)
File Integrity DigestVerified · CCN 390430
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.