Surgical pathology level 5 gross & microscopic examination at WellSpan Ephrata Community Hospital
169 Martin Ave, Ephrata, PA · Wellspan · · NPI 1083615587
$1,124.00
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.
$1,405.00
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.
$14.38 with UPMC_Medicaid vs $1,593.16 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 |
|---|---|---|---|
| UPMC_Medicaid | All_Plans | $14.38 | ↓ -99% |
| Amerihealth_Caritas_Medicaid | All_Plans | $45.50 | ↓ -96% |
| Health_Partners_Medicaid | All_Other_Plans | $56.88 | ↓ -95% |
| Geisinger_Medicaid | All_Plans | $56.88 | ↓ -95% |
| PA_Health_&_Wellness_Medicaid | All_Plans | $56.88 | ↓ -95% |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $56.88 | ↓ -95% |
| Aetna_Better_Health_Kids | All_Plans | $154.70 | ↓ -86% |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $247.28 | ↓ -78% |
| United_Medicaid | Community_Plan_For_Kids | $347.42 | ↓ -69% |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $347.42 | ↓ -69% |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $347.42 | ↓ -69% |
| Highmark_Medicare | All_Plans | $350.89 | ↓ -69% |
| Aetna_Advantra_Medicare | All_Plans | $357.84 | ↓ -68% |
| Aetna_Medicare | All_Plans | $357.84 | ↓ -68% |
| Devoted_Medicare | All_Plans | $364.79 | ↓ -68% |
| United_Medicare | ISNP_DSNP_Plans | $364.79 | ↓ -68% |
| Geisinger_Gold_Medicare | All_Plans | $364.79 | ↓ -68% |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $366.35 | ↓ -67% |
| Amerihealth_Medicare | All_Plans | $366.53 | ↓ -67% |
| PA_Health_&_Wellness_Medicare | All_Plans | $375.21 | ↓ -67% |
| Jefferson_Health_Medicare_Advantage | All_Plans | $375.21 | ↓ -67% |
| Highmark | Higmark_Healthy_Kids | $539.37 | ↓ -52% |
| Health_Partners_Medicaid | Kidz_Partners | $573.24 | ↓ -49% |
| Blue_Cross | Capital_Cares_4_kids | $633.18 | ↓ -44% |
| Cigna | All_Plans | $896.67 | ↓ -20% |
| WellSpan_Capital_Blue_Cross | All_Plans | $899.20 | ↓ -20% |
| Blue_Cross | All_Other_Plans | $904.54 | ↓ -20% |
| Blue_Cross | Capital_Blue_Performance_PPO | $904.54 | ↓ -20% |
| Tower Health | All_Plans | $913.25 | ↓ -19% |
| UPMC | Employees_And_Dependents | $913.25 | ↓ -19% |
| UPMC | UPMC_For_Kids | $913.25 | ↓ -19% |
| Geisinger | All_Plans | $913.25 | ↓ -19% |
| Independence_Blue_Cross | All_Plans | $913.25 | ↓ -19% |
| PHC | All_Plans | $983.50 | ↓ -13% |
| United_Healthcare | All_Plans | $1,027.44 | ↓ -9% |
| Aetna | All_Plans | $1,142.81 | ↑ +2% |
| First_Health_Network | All_Plans | $1,256.26 | ↑ +12% |
| Highmark | My_Direct_Blue | $1,274.55 | ↑ +13% |
| Highmark | My_Priority_Blue_Flex | $1,274.55 | ↑ +13% |
| Highmark | Choice_Blue_PPO | $1,322.32 | ↑ +18% |
| Highmark | Blue_Cross_High_Performance_Network | $1,322.32 | ↑ +18% |
| Highmark | Performance_Blue | $1,322.32 | ↑ +18% |
| Highmark | All_Other_Plans | $1,593.16 | ↑ +42% |
Visitor-reported prices
Comments
Surgical pathology level 5 gross & microscopic examination at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $234.60 | $11.50 – $312.80 |
| UPMC Bedford | Everett | $189.60 | $36.42 – $284.40 |
| UPMC Carlisle | Carlisle | $664.80 | $15.06 – $941.80 |
| UPMC Cole | Coudersport | $572.40 | $47.77 – $763.20 |
| UPMC Community Osteopathic | Harrisburg | $664.80 | $15.06 – $378.62 |
| UPMC East | Monroeville | $379.20 | $35.92 – $505.60 |
| UPMC Hamot | Erie | $360.60 | $45.50 – $427.47 |
| UPMC Northwest | Seneca | $360.60 | $36.26 – $360.10 |