WellSpan Ephrata Community Hospital
169 Martin Ave, Ephrata, PA · Wellspan · · NPI 1083615587
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $236.00 | $295.00 | $93.10 – $253.23 | 7 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $230.40 | $288.00 | $76.38 – $207.74 | 7 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $58.40 | $73.00 | $10.41 – $28.32 | 7 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $58.40 | $73.00 | $57.89 – $157.45 | 7 |
| Ghs musc test done w/n test comp CPT 95886 | $368.80 | $461.00 | $36.74 – $225.39 | 7 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $368.80 | $461.00 | $34.86 – $141.81 | 7 |
| Ghs myocardial strain img spckl track CPT 93356 | $888.00 | $1,110.00 | $8.30 – $8.30 | 1 |
| Ghs nailbed repair/nail removal CPT 11760 | $1,268.00 | $1,585.00 | $28.75 – $1,034.60 | 20 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $3,346.40 | $4,183.00 | $54.38 – $1,504.72 | 20 |
| Ghs nerve blk intercostal, single level CPT 64420 | $1,108.00 | $1,385.00 | $54.38 – $1,170.47 | 20 |
| Ghs nerve block axillary nerve CPT 64417 | $1,220.80 | $1,526.00 | $26.25 – $1,504.72 | 20 |
| Ghs nerve block celiac plexus CPT 64530 | $1,292.80 | $1,616.00 | $67.50 – $1,504.72 | 20 |
| Ghs nerve block interscaline CPT 64510 | $1,192.80 | $1,491.00 | $68.13 – $1,504.72 | 20 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $1,138.40 | $1,423.00 | $67.50 – $1,504.72 | 20 |
| Ghs nerve block sciatic nerve CPT 64445 | $3,346.40 | $4,183.00 | $29.38 – $1,170.47 | 20 |
| Ghs nerve block suprascapular CPT 64418 | $1,444.00 | $1,805.00 | $43.75 – $1,170.47 | 20 |
| Ghs ng placement w fluoro guidance CPT 43752 | $576.00 | $720.00 | $299.28 – $674.43 | 15 |
| Ghs o2 saturation CPT 82810 | $40.80 | $51.00 | $9.87 – $44.36 | 23 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $1,594.40 | $1,993.00 | $62.00 – $168.64 | 7 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $1,756.80 | $2,196.00 | $53.01 – $144.19 | 7 |
| Ghs peritonsillar abscess i andd CPT 42700 | $1,325.60 | $1,657.00 | $77.50 – $392.49 | 20 |
| Ghs plngl fx pm cl CPT 26725 | $452.00 | $565.00 | $96.25 – $405.44 | 20 |
| Ghs ppd (tb intradermal) CPT 86580 | $104.80 | $131.00 | $5.50 – $85.11 | 23 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $40.00 | $50.00 | $9.76 – $43.86 | 23 |
| Ghs protoporphyrins fract CPT 84202 | $60.00 | $75.00 | $14.49 – $67.46 | 23 |
| Ghs pr without cont pulse ox CPT 94625 | $284.00 | $355.00 | $29.70 – $100.40 | 16 |
| Ghs removal intranasal foreign body CPT 30300 | $462.40 | $578.00 | $28.13 – $217.86 | 20 |
| Ghs semen analysis fert CPT 89320 | $51.20 | $64.00 | $9.23 – $55.89 | 18 |
| Ghs sensitivity (per antimicro) CPT 87184 | $30.40 | $38.00 | $7.55 – $33.96 | 23 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $1,411.20 | $1,764.00 | $115.00 – $675.27 | 20 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $1,204.00 | $1,505.00 | $59.38 – $335.83 | 20 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $1,262.40 | $1,578.00 | $60.63 – $335.83 | 20 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $1,262.40 | $1,578.00 | $76.88 – $335.83 | 20 |
| Ghs sleep study unattended CPT 95800 | $847.20 | $1,059.00 | $115.03 – $423.67 | 20 |
| Ghs sphenopalatine ganglion block CPT 64505 | $1,124.00 | $1,405.00 | $68.13 – $498.91 | 20 |
| Ghs st - re-eval for alt comm CPT 92597 | $737.60 | $922.00 | $51.71 – $120.65 | 15 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,033.60 | $1,292.00 | $117.50 – $1,034.60 | 20 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $989.60 | $1,237.00 | $91.25 – $405.44 | 20 |
| Ghs urine, porphyrins quant CPT 84120 | $61.60 | $77.00 | $7.50 – $66.78 | 23 |
| Gi inhouse confirmation CPT 87045 | $39.20 | $49.00 | $6.90 – $42.86 | 23 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $1,449.40 | $1,811.75 | $148.99 – $526.54 | 24 |
| Glucose 1 hr post dose CPT 82950 | $20.00 | $25.00 | $4.80 – $22.20 | 23 |
| Glucose blood quantitative CPT 82947 | $16.80 | $21.00 | $3.97 – $17.84 | 23 |
| Glucose body fluid CPT 82945 | $16.80 | $21.00 | $3.97 – $17.84 | 23 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $53.60 | $67.00 | $12.50 – $58.43 | 23 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $16.80 | $21.00 | $3.27 – $17.80 | 23 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $124.00 | $155.00 | $1.80 – $7.14 | 23 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $77.60 | $97.00 | $17.50 – $84.35 | 23 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $77.60 | $97.00 | $17.00 – $84.08 | 23 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $1,033.30 | $1,291.63 | $108.89 – $108.89 | 1 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $4,721.60 | $5,902.00 | $101.03 – $369.11 | 7 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $3,208.87 | $4,011.09 | $138.74 – $477.30 | 7 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $69.60 | $87.00 | $50.69 – $181.27 | 7 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $892.17 – $8,754.00 | 14 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $37.60 | $47.00 | $10.79 – $25.17 | 15 |
| Gu dilat ureter/urethra s&i CPT 74485 | $5,041.60 | $6,302.00 | $97.22 – $11,158.80 | 8 |
| Guided cath fluid drainage 10030 CPT 10030 | $8,240.80 | $10,301.00 | $156.60 – $1,189.18 | 20 |
| Guid loc target vol rad tx CPT 77387 | $1,804.80 | $2,256.00 | $79.76 – $270.44 | 7 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $136.20 | $170.25 | $8.80 – $32.27 | 10 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $26.60 | $33.25 | $0.80 – $2.73 | 10 |
| Hand X-ray CPT 73130 | $369.60 | $462.00 | $14.38 – $497.84 | 22 |
| Haptoglobin quantitative CPT 83010 | $45.00 | $66.00 | $12.00 – $57.11 | 23 |
| Hbb full gene sequence CPT 81364 | $670.40 | $838.00 | $162.29 – $1,473.59 | 19 |
| Hbot, full body chamber, 30m HCPCS G0277 | $742.40 | $928.00 | $54.86 – $233.07 | 20 |
| Hcg qualitative CPT 84703 | $32.00 | $40.00 | $7.60 – $34.88 | 23 |
| Hcg quantitative CPT 84702 | $55.00 | $78.00 | $15.20 – $68.33 | 24 |
| Head CT scan (with and without contrast) CPT 70470 | $569.00 | $2,645.00 | $125.00 – $1,006.60 | 23 |
| Head CT scan (with contrast) CPT 70460 | $478.00 | $2,362.00 | $100.00 – $1,006.60 | 23 |
| Head CT scan (without contrast) CPT 70450 | $296.00 | $1,610.00 | $96.88 – $602.31 | 23 |
| Hematocrit CPT 85014 | $18.40 | $23.00 | $2.39 – $10.98 | 23 |
| Hemodialysis one evaluation CPT 90935 | $1,440.00 | $1,800.00 | $524.79 – $1,182.63 | 15 |
| Hemoglobin CPT 85018 | $14.40 | $18.00 | $2.39 – $10.98 | 23 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $34.40 | $43.00 | $3.00 – $37.23 | 23 |
| Hemoglobin plasma CPT 83051 | $30.40 | $38.00 | $3.50 – $33.19 | 23 |
| Hemophilus influenza antibdy CPT 86684 | $65.60 | $82.00 | $16.00 – $72.93 | 23 |
| Heparin assay CPT 85520 | $54.40 | $68.00 | $6.53 – $59.43 | 23 |
| Heparin bolus from bag HCPCS J1644 | $135.80 | $169.75 | $0.21 – $0.77 | 10 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $34.60 | $43.25 | $0.02 – $0.11 | 10 |
| Hepatitis a antibody igm CPT 86709 | $46.40 | $58.00 | $11.37 – $51.68 | 23 |
| Hepatitis b core antibody igm CPT 86705 | $48.80 | $61.00 | $11.89 – $55.25 | 23 |
| Hepatitis b core antibody total CPT 86704 | $49.60 | $62.00 | $12.17 – $54.71 | 23 |
| Hepatitis b surface antibody CPT 86706 | $44.80 | $56.00 | $10.85 – $48.76 | 23 |
| Hepatitis c antibody CPT 86803 | $55.00 | $74.00 | $14.41 – $64.79 | 24 |
| Hepatobiliary system imaging CPT 78226 | $1,713.60 | $2,142.00 | $268.09 – $2,259.58 | 21 |
| Hernia Repair (Inguinal) CPT 49505 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Herpes simplex type 1 antibody igg CPT 86695 | $55.20 | $69.00 | $13.32 – $61.95 | 23 |
| Herpes simplex type 2 antibody igg CPT 86696 | $80.80 | $101.00 | $19.54 – $87.85 | 23 |
| Heterophile antibodies screening CPT 86308 | $21.60 | $27.00 | $5.23 – $24.31 | 23 |
| Hip X-ray CPT 73502 | $629.60 | $787.00 | $27.95 – $497.84 | 22 |
| Histamine CPT 83088 | $123.20 | $154.00 | $13.00 – $134.07 | 23 |
| Histochemical stains add-on CPT 88314 | $167.20 | $209.00 | $10.74 – $392.12 | 10 |
| Hla ii typing 1 loc hr CPT 81382 | $514.40 | $643.00 | $124.92 – $561.51 | 20 |
| Hla i typing high res 1 allele grp ea CPT 81381 | $575.20 | $719.00 | $103.22 – $771.35 | 20 |
| Hocm 350-399mg/ml iodine,1ml HCPCS Q9963 | $5.60 | $7.00 | $0.22 – $0.77 | 7 |
| Homocysteine CPT 83090 | $75.20 | $94.00 | $18.10 – $81.36 | 23 |
| Homogenization tissue CPT 87176 | $24.00 | $30.00 | $5.94 – $26.70 | 23 |
| Hpa-15 genotyping CPT 81112 | $310.40 | $388.00 | $61.11 – $554.88 | 19 |
| Hpa-1 genotyping CPT 81105 | $310.40 | $388.00 | $120.71 – $554.88 | 23 |
| Hpa-2 genotyping CPT 81106 | $310.40 | $388.00 | $61.11 – $554.88 | 19 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.