CMS Price Transparency Data

Ultrasound, pelvis

Facility: Lehigh Valley Hospital - Hazleton

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $111
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Lehigh Valley Hospital - Hazleton is $111. 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 $106.81, this hospital’s rate is 1.04x the Medicare baseline. Located in 700 East Broad Street, Hazleton, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Insurance Median: $111 (104%)

Ins. Median: $111 (104% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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
Amerihealth Caritas	$53 - $88	50%
UnitedHealthcare	$53 - $377	50%
Geisinger	$55 - $237	51%
Highmark Wholecare/Gateway	$59 - $97	55%
Jefferson Health Partners	$63 - $210	59%
Pa Health & Wellness	$63 - $103	59%
Aetna	$67 - $582	63%
Upmc	$77 - $512	72%
Highmark Blue Shield	$107 - $370	100%
Amerihealth	$108	101%
Cigna	$108	101%
Devoted Health	$111	104%
Humana	$111	104%
Emblem	$113 - $468	106%
Gateway	$114	107%
Pa Health & Wellness (Allwell)	$116	109%
Ambetter / Centene	$319	299%
Valley Preferred	$612	573%

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 CPT Code matches exactly: 76856.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lehigh Valley Hospital - Hazleton is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 76856.
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.