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 |
|---|---|---|---|---|
| Knee arthroscopy/surgery CPT 29880 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Knee arthroscopy/surgery CPT 29882 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Knee arthroscopy/surgery CPT 29884 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Knee arthroscopy/surgery CPT 29888 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Knee MRI (with and without contrast) CPT 73723 | $712.50 | $2,544.00 | $348.37 – $2,106.92 | 23 |
| Knee MRI (with contrast) CPT 73722 | $645.00 | $2,250.00 | $384.69 – $4,386.56 | 23 |
| Knee MRI (without contrast) CPT 73721 | $462.00 | $2,225.00 | $235.78 – $1,342.45 | 23 |
| Knee X-ray CPT 73564 | $483.20 | $604.00 | $28.02 – $602.31 | 22 |
| Kyleena, 19.5 mg HCPCS J7296 | $4,771.20 | $5,964.00 | $1,103.08 – $4,664.19 | 3 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $36.40 | $45.50 | $0.34 – $24.96 | 10 |
| Lacosamide 200 mg/20 ml intravenous solution HCPCS C9254 | $436.80 | $546.00 | $140.00 – $140.00 | 1 |
| Lactate dehydrogenase (ldh) CPT 83615 | $25.00 | $31.00 | $6.10 – $27.42 | 23 |
| Lactated ringers intravenous solution HCPCS J7120 | $28.80 | $36.00 | $2.41 – $8.06 | 9 |
| Lactic acid CPT 83605 | $75.20 | $94.00 | $8.00 – $52.53 | 23 |
| Lactoferrin fecal qualitative CPT 83630 | $82.40 | $103.00 | $12.31 – $89.44 | 23 |
| Lam facetec & foramot crv CPT 63045 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Lam facetec & foramot lumbar CPT 63047 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Lam facetec & foramot thrc CPT 63046 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Laparo cholecystectomy/graph CPT 47563 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Laparo proc abdm/per/oment 49329 CPT 49329 | not published | not published | $5,627.00 – $5,627.00 | 1 |
| Laparoscopy aspiration CPT 49322 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Laparoscopye procstom 43659 CPT 43659 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Laparoscopy excise lesions CPT 58662 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Laparoscopy lymphadenectomy CPT 38571 | not published | not published | $10,055.16 – $35,016.00 | 2 |
| Laparoscopy lymph node biop CPT 38570 | not published | not published | $10,055.16 – $15,634.00 | 2 |
| Laparoscopy remove adnexa CPT 58661 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Laparoscopy surg colpopexy CPT 57425 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Lap ing hernia repair init CPT 49650 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Lap ing hernia repair recur CPT 49651 | not published | not published | $17,510.00 – $17,510.00 | 1 |
| Lap paraesophag hern repair CPT 43281 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Laryngoscop w/vc inj + scope CPT 31571 | not published | not published | $3,560.86 – $8,754.00 | 2 |
| Laryngoscopy w/biopsy CPT 31535 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Laryngoscopy w/bx & op scope CPT 31536 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Larynscop w/tumr exc + scope CPT 31541 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Lead capillary CPT 83655 | $50.40 | $63.00 | $10.00 – $54.98 | 23 |
| Left compres band <3"/yd HCPCS A6448 | $5.60 | $7.00 | $1.16 – $3.16 | 2 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $994.40 | $1,243.00 | $142.75 – $498.64 | 20 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $18.40 | $23.00 | $2.00 – $8.75 | 10 |
| Levetiracetam therapeutic drug level CPT 80177 | $55.20 | $69.00 | $13.38 – $60.16 | 23 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $130.00 | $162.50 | $2.03 – $8.49 | 10 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $584.20 | $730.25 | $68.72 – $254.10 | 10 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $86.40 | $108.00 | $0.04 – $0.19 | 2 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $100.20 | $125.25 | $6.00 – $70.00 | 23 |
| Lidocaine therapeutic drug level CPT 80176 | $60.80 | $76.00 | $13.00 – $66.69 | 23 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Lig/band angioaccess av fistula CPT 37607 | not published | not published | $3,039.86 – $10,638.00 | 2 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $107.40 | $134.25 | $10.71 – $36.44 | 10 |
| Lipase CPT 83690 | $28.00 | $35.00 | $5.00 – $31.28 | 23 |
| Lipoprotein blood quant CPT 83704 | $142.40 | $178.00 | $25.64 – $155.22 | 18 |
| Lipoprotein direct measurement hdl CPT 83718 | $34.40 | $43.00 | $7.00 – $37.18 | 23 |
| Lipoprotein direct measurement ldl CPT 83721 | $44.00 | $55.00 | $10.61 – $47.67 | 23 |
| Lithium therapeutic drug level CPT 80178 | $27.20 | $34.00 | $6.68 – $30.01 | 23 |
| Liver Function Test CPT 80076 | $25.00 | $43.00 | $8.25 – $37.09 | 23 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $1.60 | $2.00 | $0.96 – $5.76 | 7 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $25.20 | $31.50 | $1.36 – $5.50 | 10 |
| Low back disk surgery CPT 63030 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $569.00 | $2,645.00 | $170.00 – $1,006.60 | 23 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $472.00 | $2,350.00 | $117.50 – $2,106.92 | 23 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $286.00 | $1,610.00 | $103.73 – $602.31 | 23 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $700.50 | $2,646.00 | $336.25 – $2,106.92 | 23 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $635.50 | $2,350.00 | $336.25 – $2,106.92 | 23 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $454.00 | $2,225.00 | $234.00 – $1,342.45 | 23 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $458.40 | $573.00 | $28.13 – $602.31 | 22 |
| Lower jaw bone graft CPT 21215 | not published | not published | $17,510.00 – $17,510.00 | 1 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $14,381.00 – $14,381.00 | 1 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $15,634.00 – $15,634.00 | 1 |
| Lung Function Test (Spirometry) CPT 94010 | $324.00 | $405.00 | $11.25 – $264.44 | 20 |
| Lung perfusion imaging CPT 78580 | $1,713.60 | $2,142.00 | $59.38 – $2,259.58 | 21 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $496.75 – $8,754.00 | 14 |
| Macro exam dissect molec study ea CPT 88387 | $368.00 | $460.00 | $7.69 – $151.27 | 10 |
| Macroscopic exam arthropod CPT 87168 | $16.80 | $21.00 | $2.14 – $19.39 | 19 |
| Macroscopic exam parasite CPT 87169 | $18.40 | $23.00 | $2.16 – $19.57 | 19 |
| Magnesium CPT 83735 | $30.00 | $47.00 | $6.77 – $31.00 | 24 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $131.80 | $164.75 | $0.48 – $3.43 | 10 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $240.00 | $300.00 | $64.45 – $217.86 | 16 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $328.00 | $410.00 | $96.68 – $217.86 | 15 |
| Mastectomy partial CPT 19301 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $60.00 | $75.00 | $14.60 – $65.65 | 23 |
| Mayo aathr protein s free CPT 85306 | $168.00 | $210.00 | $15.47 – $72.01 | 23 |
| Mayo activated protein c resistance assay CPT 85307 | $80.00 | $100.00 | $15.47 – $69.55 | 23 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $148.00 | $185.00 | $28.93 – $175.11 | 18 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $61.60 | $77.00 | $7.39 – $67.10 | 19 |
| Mayo alpha 1 antitrypsin CPT 82103 | $56.00 | $70.00 | $13.57 – $61.02 | 23 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $62.40 | $78.00 | $11.00 – $68.46 | 23 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $505.60 | $632.00 | $60.82 – $552.20 | 19 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $380.80 | $476.00 | $92.58 – $416.14 | 20 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $4,825.60 | $6,032.00 | $300.20 – $5,266.40 | 20 |
| Mayo androstenedione CPT 82157 | $121.60 | $152.00 | $25.00 – $132.93 | 23 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $60.80 | $76.00 | $14.75 – $68.58 | 23 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $62.40 | $78.00 | $15.20 – $70.72 | 23 |
| Mayo avwpr vw factor activity CPT 85397 | $128.00 | $160.00 | $26.30 – $140.10 | 23 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $162.40 | $203.00 | $28.07 – $159.31 | 23 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $42.40 | $53.00 | $10.28 – $46.22 | 23 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $54.40 | $68.00 | $13.03 – $60.62 | 23 |
| Mayo brcmg brucella antibody igm CPT 86622 | $37.60 | $47.00 | $9.02 – $40.54 | 23 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $69.60 | $87.00 | $8.44 – $76.59 | 19 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $107.20 | $134.00 | $27.05 – $121.58 | 23 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $508.00 | $635.00 | $123.44 – $554.88 | 20 |
| Mayo ceruloplasmin CPT 82390 | $44.80 | $56.00 | $10.00 – $48.76 | 23 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $59.20 | $74.00 | $7.06 – $64.10 | 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.