Established Patient Office Visit (level 4) at WellSpan Ephrata Community Hospital
169 Martin Ave, Ephrata, PA · Wellspan · · NPI 1083615587
$1,034.40
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.
$1,293.00
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.
$40.13 with Blue_Cross_BlueJourney_Medicare vs $570.74 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 |
|---|---|---|---|
| Blue_Cross_BlueJourney_Medicare | All_Plans | $40.13 | ↓ -96% |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $50.00 | ↓ -95% |
| UPMC_Medicaid | All_Plans | $50.00 | ↓ -95% |
| PA_Health_&_Wellness_Medicaid | All_Plans | $50.00 | ↓ -95% |
| Geisinger_Medicaid | All_Plans | $50.00 | ↓ -95% |
| Health_Partners_Medicaid | All_Other_Plans | $50.00 | ↓ -95% |
| Health_Partners_Medicaid | Kidz_Partners | $68.40 | ↓ -93% |
| Amerihealth_Caritas_Medicaid | All_Plans | $77.28 | ↓ -93% |
| Highmark_Medicare | All_Plans | $125.70 | ↓ -88% |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $130.68 | ↓ -87% |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $130.68 | ↓ -87% |
| Devoted_Medicare | All_Plans | $130.68 | ↓ -87% |
| Geisinger_Gold_Medicare | All_Plans | $130.68 | ↓ -87% |
| United_Medicare | ISNP_DSNP_Plans | $130.68 | ↓ -87% |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $131.24 | ↓ -87% |
| Amerihealth_Medicare | All_Plans | $131.31 | ↓ -87% |
| Jefferson_Health_Medicare_Advantage | All_Plans | $134.42 | ↓ -87% |
| PA_Health_&_Wellness_Medicare | All_Plans | $134.42 | ↓ -87% |
| Aetna_Better_Health_Kids | All_Plans | $136.00 | ↓ -87% |
| Cigna | All_Plans | $145.51 | ↓ -86% |
| WellSpan_Capital_Blue_Cross | All_Plans | $145.92 | ↓ -86% |
| Tower Health | All_Plans | $148.20 | ↓ -86% |
| UPMC | UPMC_For_Kids | $148.20 | ↓ -86% |
| Geisinger | All_Plans | $148.20 | ↓ -86% |
| Independence_Blue_Cross | All_Plans | $148.20 | ↓ -86% |
| UPMC | Employees_And_Dependents | $148.20 | ↓ -86% |
| PHC | All_Plans | $159.60 | ↓ -85% |
| Highmark | Higmark_Healthy_Kids | $193.22 | ↓ -81% |
| United_Healthcare | All_Plans | $215.00 | ↓ -79% |
| United_Medicaid | Community_Plan_For_Kids | $217.81 | ↓ -79% |
| Highmark | My_Direct_Blue | $456.59 | ↓ -56% |
| Highmark | My_Priority_Blue_Flex | $456.59 | ↓ -56% |
| Highmark | Choice_Blue_PPO | $473.71 | ↓ -54% |
| Highmark | Blue_Cross_High_Performance_Network | $473.71 | ↓ -54% |
| Highmark | Performance_Blue | $473.71 | ↓ -54% |
| Highmark | All_Other_Plans | $570.74 | ↓ -45% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 4) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $274.20 | $20.00 – $365.60 |
| UPMC Bedford | Everett | $142.20 | $36.08 – $213.30 |
| UPMC Cole | Coudersport | $273.00 | $51.57 – $190.40 |
| UPMC Community Osteopathic | Harrisburg | $271.80 | $31.00 – $337.75 |
| UPMC East | Monroeville | $216.00 | $36.08 – $288.00 |
| UPMC Hamot | Erie | $178.20 | $59.86 – $247.66 |
| UPMC Northwest | Seneca | $201.60 | $59.86 – $122.03 |
| UPMC Hanover | Hanover | $93.00 | $69.11 – $127.70 |