Off/op cnsltj new/est mod 40 at WellSpan Ephrata Community Hospital
169 Martin Ave, Ephrata, PA · Wellspan · · NPI 1083615587
$328.00
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.
$410.00
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.
$72.16 with Blue_Cross_BlueJourney_Medicare vs $386.63 with United_Healthcare — 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 | $72.16 | ↓ -78% |
| Health_Partners_Medicaid | Kidz_Partners | $123.00 | ↓ -63% |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $132.43 | ↓ -60% |
| Cigna | All_Plans | $261.66 | ↓ -20% |
| WellSpan_Capital_Blue_Cross | All_Plans | $262.40 | ↓ -20% |
| Tower Health | All_Plans | $266.50 | ↓ -19% |
| UPMC | UPMC_For_Kids | $266.50 | ↓ -19% |
| Geisinger | All_Plans | $266.50 | ↓ -19% |
| Independence_Blue_Cross | All_Plans | $266.50 | ↓ -19% |
| UPMC | Employees_And_Dependents | $266.50 | ↓ -19% |
| PHC | All_Plans | $287.00 | ↓ -13% |
| Aetna_Better_Health_Kids | All_Plans | $360.20 | ↑ +10% |
| United_Healthcare | All_Plans | $386.63 | ↑ +18% |
Visitor-reported prices
Comments
Off/op cnsltj new/est mod 40 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Cole | Coudersport | $537.00 | $135.27 – $390.40 |
| UPMC Community Osteopathic | Harrisburg | $693.60 | $138.78 – $982.60 |
| UPMC Somerset | Somerset | $693.60 | $22.91 – $294.71 |
| UPMC Wellsboro | Wellsboro | $268.20 | $135.60 – $294.71 |
| UPMC Western Psychiatric | Pittsburgh | $487.20 | $133.92 – $133.92 |