Exc ben+marg excep skin tag feenlm <0.5cm 11440 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.
$679.53 with Health_Partners_Medicaid vs $8,754.00 with Aetna — 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 | Kidz_Partners | $679.53 | — |
| Highmark_Medicare | All_Plans | $686.33 | — |
| Aetna_Medicare | All_Plans | $699.92 | — |
| Aetna_Advantra_Medicare | All_Plans | $699.92 | — |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $713.51 | — |
| United_Medicare | ISNP_DSNP_Plans | $713.51 | — |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $713.51 | — |
| Devoted_Medicare | All_Plans | $713.51 | — |
| Geisinger_Gold_Medicare | All_Plans | $713.51 | — |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $716.56 | — |
| Amerihealth_Medicare | All_Plans | $716.90 | — |
| Jefferson_Health_Medicare_Advantage | All_Plans | $733.89 | — |
| PA_Health_&_Wellness_Medicare | All_Plans | $733.89 | — |
| PA_Health_&_Wellness_Medicaid | All_Plans | $970.00 | — |
| UPMC_Medicaid | All_Plans | $970.00 | — |
| Health_Partners_Medicaid | All_Other_Plans | $970.00 | — |
| Geisinger_Medicaid | All_Plans | $970.00 | — |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $970.00 | — |
| Highmark | Higmark_Healthy_Kids | $1,053.27 | — |
| Amerihealth_Caritas_Medicaid | All_Plans | $1,101.92 | — |
| United_Medicaid | Community_Plan_For_Kids | $1,189.18 | — |
| Highmark | My_Priority_Blue_Flex | $2,492.92 | — |
| Highmark | My_Direct_Blue | $2,492.92 | — |
| Highmark | Performance_Blue | $2,586.36 | — |
| Highmark | Blue_Cross_High_Performance_Network | $2,586.36 | — |
| Highmark | Choice_Blue_PPO | $2,586.36 | — |
| Highmark | All_Other_Plans | $3,116.12 | — |
| Aetna_Better_Health_Kids | All_Plans | $6,420.00 | — |
| Aetna | All_Plans | $8,754.00 | — |
| Blue_Cross | Capital_Blue_Performance_PPO | not published by hospital | — |
| Blue_Cross | All_Other_Plans | not published by hospital | — |
| 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 | — |
Visitor-reported prices
Comments
Exc ben+marg excep skin tag feenlm <0.5cm 11440 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $286.80 | $54.50 – $545.04 |
| UPMC Carlisle | Carlisle | $2,184.60 | $69.22 – $3,094.85 |
| UPMC Cole | Coudersport | $123.00 | $25.78 – $2,325.85 |
| UPMC Community Osteopathic | Harrisburg | $2,184.60 | $69.22 – $3,094.85 |
| UPMC Hanover | Hanover | $2,184.60 | $69.22 – $1,075.42 |
| UPMC Horizon-Greenville | Greenville | $2,304.60 | $59.95 – $1,060.34 |
| UPMC Kane | Kane | $1,045.20 | $59.95 – $597.98 |
| UPMC Lititz | Lititz | $2,184.60 | $69.22 – $1,081.23 |