LEHIGH VALLEY HOSPITAL

"**Family Size****Dept. of Health & Human Services Guideline Poverty Level****200% of Poverty Level****300% of Poverty Level****400% of Poverty Level** 1$15,960$31,920$47,880$63,840 2$21,640$43,280$64,920$86,560 3$27,320$54,640$81,960$109,280 4$33,000$66,000$99,000$132,000 5$38,680$77,360$116,040$154,720 6$44,360$88,720$133,080$177,440 7$50,040$100,080$150,120$200,160 8$55,720$111,440$167,160$222,880 9$61,400$122,800$184,200$245,600 10$67,080$134,160$201,240$268,320"

documented · checked 2026-10-13 · Get Financial Assistance | Lehigh Valley Health Network

"Please detach this form and forward it to: Lehigh Valley Health Network ATTN: Patient Financial Services, Financial Counselor 2100 Mack Blvd PO BOX 4120 Allentown PA 18105-4120"

documented · checked 2026-10-13 · REDUCED COST OF CARE APPLICATION