Lehigh Valley Hospital - Schuylkill S. Jackson Street — price list

← Hospital overviewVerified from Lehigh Valley Hospital - Schuylkill S. Jackson Street’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

137 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
"insulin regular human u-500""concentrate"" 500 unit/ml (pump refill) " Outpatient	0002850101 NDC	$715	$357	$2.43 – $356	—
1 cc sterile syringe&needle Outpatient	A4206 HCPCS	—	—	$0.20 – $0.34	—
1 pc ost pou w built-in conv Outpatient	A5057 HCPCS	—	—	$5.78 – $83.24	—
1 pc ost pouch w filter Outpatient	A5056 HCPCS	—	—	$2.81 – $40.53	—
100 insulin syringes Outpatient	S8490 HCPCS	—	—	$13.30 – $22.42	—
12-24hr sealed lead acid Outpatient	K0733NU HCPCS	—	—	$2.13 – $226	—
1pc ost pch drain hgh output Outpatient	A4435 HCPCS	—	—	$3.51 – $49.96	—
1st hosp ip/obs high 75 Outpatient	99223 HCPCS	—	—	$153 – $933	—
1st hosp ip/obs moderate 55 Outpatient	99222 HCPCS	—	—	$115 – $698	—
1st hosp ip/obs sf/low 40 Outpatient	99221 HCPCS	—	—	$73.01 – $444	—
1st nf care high mdm 50 Outpatient	99306 HCPCS	—	—	$82.51 – $972	—
1st nf care moderate mdm 35 Outpatient	99305 HCPCS	—	—	$66.26 – $712	—
1st nf care sf/low mdm 25 Outpatient	99304 HCPCS	—	—	$51.63 – $423	—
1st opn implt bat modulj sys Outpatient	64654 HCPCS	—	—	$45,057 – $274,173	—
1st psyc collab care mgmt Outpatient	99492 HCPCS	—	—	$81.15 – $632	—
1st/sbsq psyc collab care Outpatient	99494 HCPCS	—	—	$35.41 – $215	—
2 cc sterile syringe&needle Outpatient	A4207 HCPCS	—	—	$0.20 – $0.34	—
2 pc drainable ost pouch Outpatient	A4413 HCPCS	—	—	$3.08 – $47.77	—
20+ cc syringe only Outpatient	A4213 HCPCS	—	—	$0.20 – $0.62	—
ncov diagnostic p Outpatient	U0001 HCPCS	—	—	$32.00 – $219	—
22nf nonsealed leadacid Outpatient	E2360NU HCPCS	—	—	$5.84 – $904	—
22nf sealed leadacid battery Outpatient	E2361NU HCPCS	—	—	$7.81 – $1,043	—
2d cephal radio image Outpatient	D0702 HCPCS	—	—	$89.02 – $542	—
2d oral/facial photo image Outpatient	D0703 HCPCS	—	—	$89.02 – $542	—
2d tee w or without fol withcon,in Outpatient	C8925 HCPCS	—	—	$526 – $4,880	—
2d tte w or without fol withcon,co Outpatient	C8923 HCPCS	—	—	$526 – $4,880	—
2d tte w or without fol withcon,fu Outpatient	C8924 HCPCS	—	—	$271 – $2,172	—
2vhpv vaccine 3 dose IM Outpatient	90650 HCPCS	—	—	$11.80 – $557	—
3 cc sterile syringe&needle Outpatient	A4208 HCPCS	—	—	$0.20 – $0.34	—
3-d radiotherapy plan Outpatient	77295 HCPCS	—	—	$626 – $8,616	—