CMS Price Transparency Data

Ultrasound, pelvis

Facility: Penn State Health Hampden Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $116
Cash Discount Price: $167
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Penn State Health Hampden Medical Center is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.09x the Medicare baseline. Located in 2200 Good Hope Road, Enola, PA.

Cash / Self-Pay

$167

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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%)

Cash / Self-Pay: $167 (156%)

Insurance Median: $116 (109%)

Cash: $167 (156% of Medicare)

Ins. Median: $116 (109% 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]	$87 - $102	81%
[Highmark Wholecare]	$87 - $102	81%
[Geisinger]	$92 - $355	86%
[Health Partners Plans]	$95 - $104	89%
[Pa Health & Wellness]	$96 - $105	90%
[Highmark]	$101 - $437	95%
UnitedHealthcare	$102 - $286	95%
[Cbc]	$102 - $266	95%
Aetna	$103 - $301	96%
Humana	$103	96%
[Healthspring]	$103	96%
[Upmc]	$104 - $393	97%
[Point Comfort Underwriters]	$128	120%
[Highmark Choice Blue]	$349	327%
Cigna	$350	328%
[Highmark Aca]	$367	344%
[Preferred Healthcare Systems]	$399	374%
[First Health]	$426	399%
[Multiplan]	$426	399%

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 $167.
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 Penn State Health Hampden Medical Center 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.