Biopsy abdominal mass at WellSpan Ephrata Community Hospital
169 Martin Ave, Ephrata, PA · Wellspan · · NPI 1083615587
$2,391.20
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$2,989.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$101.21 with Health_Partners_Medicaid vs $7,175.84 with Highmark — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| Health_Partners_Medicaid | All_Other_Plans | $101.21 | ↓ -96% |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $101.21 | ↓ -96% |
| PA_Health_&_Wellness_Medicaid | All_Plans | $101.21 | ↓ -96% |
| Geisinger_Medicaid | All_Plans | $101.21 | ↓ -96% |
| UPMC_Medicaid | All_Plans | $101.22 | ↓ -96% |
| Amerihealth_Caritas_Medicaid | All_Plans | $114.98 | ↓ -95% |
| Aetna_Better_Health_Kids | All_Plans | $275.30 | ↓ -88% |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $526.06 | ↓ -78% |
| Blue_Cross | Capital_Cares_4_kids | $1,347.02 | ↓ -44% |
| Highmark_Medicare | All_Plans | $1,580.48 | ↓ -34% |
| Aetna_Advantra_Medicare | All_Plans | $1,611.77 | ↓ -33% |
| Aetna_Medicare | All_Plans | $1,611.77 | ↓ -33% |
| Devoted_Medicare | All_Plans | $1,643.07 | ↓ -31% |
| United_Medicare | ISNP_DSNP_Plans | $1,643.07 | ↓ -31% |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $1,643.07 | ↓ -31% |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $1,643.07 | ↓ -31% |
| Geisinger_Gold_Medicare | All_Plans | $1,643.07 | ↓ -31% |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $1,650.11 | ↓ -31% |
| Amerihealth_Medicare | All_Plans | $1,650.90 | ↓ -31% |
| Jefferson_Health_Medicare_Advantage | All_Plans | $1,690.02 | ↓ -29% |
| PA_Health_&_Wellness_Medicare | All_Plans | $1,690.02 | ↓ -29% |
| Cigna | All_Plans | $1,819.70 | ↓ -24% |
| WellSpan_Capital_Blue_Cross | All_Plans | $1,912.96 | ↓ -20% |
| Blue_Cross | Capital_Blue_Performance_PPO | $1,924.32 | ↓ -20% |
| Blue_Cross | All_Other_Plans | $1,924.32 | ↓ -20% |
| Tower Health | All_Plans | $1,942.85 | ↓ -19% |
| UPMC | Employees_And_Dependents | $1,942.85 | ↓ -19% |
| UPMC | UPMC_For_Kids | $1,942.85 | ↓ -19% |
| Geisinger | All_Plans | $1,942.85 | ↓ -19% |
| Independence_Blue_Cross | All_Plans | $1,942.85 | ↓ -19% |
| PHC | All_Plans | $2,092.30 | ↓ -13% |
| Highmark | Higmark_Healthy_Kids | $2,429.40 | ↑ +2% |
| Health_Partners_Medicaid | Kidz_Partners | $2,581.97 | ↑ +8% |
| United_Medicaid | Community_Plan_For_Kids | $2,738.45 | ↑ +15% |
| United_Healthcare | All_Plans | $2,818.63 | ↑ +18% |
| Aetna | All_Plans | $5,627.00 | ↑ +135% |
| Highmark | My_Direct_Blue | $5,740.74 | ↑ +140% |
| Highmark | My_Priority_Blue_Flex | $5,740.74 | ↑ +140% |
| Highmark | Choice_Blue_PPO | $5,955.90 | ↑ +149% |
| Highmark | Performance_Blue | $5,955.90 | ↑ +149% |
| Highmark | Blue_Cross_High_Performance_Network | $5,955.90 | ↑ +149% |
| First_Health_Network | All_Plans | $6,190.00 | ↑ +159% |
| Highmark | All_Other_Plans | $7,175.84 | ↑ +200% |
Visitor-reported prices
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Biopsy abdominal mass at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $1,224.60 | $80.97 – $1,632.80 |
| UPMC Carlisle | Carlisle | $2,461.20 | $102.83 – $3,486.70 |
| UPMC Community Osteopathic | Harrisburg | $2,461.20 | $102.83 – $3,486.70 |
| UPMC East | Monroeville | $1,689.60 | $89.07 – $2,252.80 |
| UPMC Hamot | Erie | $2,312.40 | $89.07 – $2,246.66 |
| UPMC Northwest | Seneca | $2,419.20 | $89.07 – $1,621.93 |
| UPMC Hanover | Hanover | $2,461.20 | $102.83 – $2,476.51 |
| UPMC Horizon-Greenville | Greenville | $2,304.60 | $89.07 – $1,668.28 |