Delayed breast prosthesis 19342 at WellSpan Ephrata Community Hospital
169 Martin Ave, Ephrata, PA · Wellspan · · NPI 1083615587
not published by hospital
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.
not published by hospital
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.
$970.00 with Highmark_Wholecare_Gateway_Medicaid vs $42,380.08 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 |
|---|---|---|---|
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $970.00 | — |
| Geisinger_Medicaid | All_Plans | $970.00 | — |
| UPMC_Medicaid | All_Plans | $970.00 | — |
| PA_Health_&_Wellness_Medicaid | All_Plans | $970.00 | — |
| Health_Partners_Medicaid | All_Other_Plans | $970.00 | — |
| Amerihealth_Caritas_Medicaid | All_Plans | $1,101.92 | — |
| Aetna_Better_Health_Kids | All_Plans | $6,420.00 | — |
| Health_Partners_Medicaid | Kidz_Partners | $9,241.79 | — |
| Highmark_Medicare | All_Plans | $9,334.21 | — |
| Aetna_Advantra_Medicare | All_Plans | $9,519.04 | — |
| Aetna_Medicare | All_Plans | $9,519.04 | — |
| Geisinger_Gold_Medicare | All_Plans | $9,703.88 | — |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $9,703.88 | — |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $9,703.88 | — |
| United_Medicare | ISNP_DSNP_Plans | $9,703.88 | — |
| Devoted_Medicare | All_Plans | $9,703.88 | — |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $9,745.47 | — |
| Amerihealth_Medicare | All_Plans | $9,750.09 | — |
| Jefferson_Health_Medicare_Advantage | All_Plans | $9,981.13 | — |
| PA_Health_&_Wellness_Medicare | All_Plans | $9,981.13 | — |
| Aetna | All_Plans | $10,638.00 | — |
| Highmark | Higmark_Healthy_Kids | $14,324.77 | — |
| United_Medicaid | Community_Plan_For_Kids | $16,173.13 | — |
| Highmark | My_Priority_Blue_Flex | $33,904.43 | — |
| Highmark | My_Direct_Blue | $33,904.43 | — |
| Highmark | Choice_Blue_PPO | $35,175.18 | — |
| Highmark | Blue_Cross_High_Performance_Network | $35,175.18 | — |
| Highmark | Performance_Blue | $35,175.18 | — |
| Highmark | All_Other_Plans | $42,380.08 | — |
| PHC | All_Plans | not published by hospital | — |
| Cigna | All_Plans | not published by hospital | — |
| Geisinger | All_Plans | not published by hospital | — |
| United_Healthcare | All_Plans | not published by hospital | — |
| UPMC | UPMC_For_Kids | not published by hospital | — |
| UPMC | Employees_And_Dependents | not published by hospital | — |
| WellSpan_Capital_Blue_Cross | All_Plans | not published by hospital | — |
| Independence_Blue_Cross | All_Plans | not published by hospital | — |
| Blue_Cross_BlueJourney_Medicare | All_Plans | not published by hospital | — |
| Tower Health | All_Plans | not published by hospital | — |
| Blue_Cross | Capital_Cares_4_kids | not published by hospital | — |
| Blue_Cross | Capital_Blue_Performance_PPO | not published by hospital | — |
| Blue_Cross | All_Other_Plans | not published by hospital | — |
Visitor-reported prices
Comments
Delayed breast prosthesis 19342 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | not published | $836.96 – $9,852.78 |
| UPMC Community Osteopathic | Harrisburg | not published | $1,016.56 – $15,488.55 |
| UPMC East | Monroeville | not published | $844.93 – $10,035.23 |
| UPMC Hamot | Erie | not published | $836.96 – $13,268.67 |
| UPMC Lititz | Lititz | not published | $1,016.56 – $14,705.10 |
| UPMC Magee | Pittsburgh | not published | $844.93 – $10,035.23 |
| UPMC Memorial | York | not published | $682.16 – $14,681.22 |
| UPMC Presbyterian | Pittsburgh | not published | $844.93 – $10,035.23 |