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 |
|---|---|---|---|---|
| Sinus CT scan (without contrast) CPT 70486 | $295.00 | $1,610.00 | $96.88 – $602.31 | 23 |
| Sinus/juglr venogram s&i CPT 75860 | $6,960.00 | $8,700.00 | $18.75 – $17,462.81 | 8 |
| Sinusotomy sinus remove polyps 31032 CPT 31032 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Sleep study unattended CPT 95806 | $375.20 | $469.00 | $66.84 – $264.44 | 17 |
| Sleeve fing rolyan med HCPCS L3933 | $309.60 | $387.00 | $67.93 – $399.56 | 16 |
| Sling arm deluxe w/pad xs HCPCS A4565 | $26.40 | $33.00 | $9.08 – $24.68 | 2 |
| Small bowel endoscopy CPT 44376 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $22.40 | $28.00 | $3.00 – $24.47 | 23 |
| Smear gram stain CPT 87205 | $16.80 | $21.00 | $4.31 – $19.39 | 23 |
| Smear nasal eosinophil CPT 89190 | $24.00 | $30.00 | $5.85 – $26.29 | 23 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $29.60 | $37.00 | $4.50 – $27.19 | 23 |
| Sodium 24 hour urine CPT 84300 | $20.80 | $26.00 | $5.11 – $22.97 | 23 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $37.20 | $46.50 | $1.95 – $8.65 | 10 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $78.80 | $98.50 | $297.50 – $297.50 | 1 |
| Sodium serum/plasma/whole blood CPT 84295 | $25.60 | $32.00 | $4.86 – $22.10 | 23 |
| Sp bone algrft morsel add-on CPT 20930 | not published | not published | $5,627.00 – $5,627.00 | 1 |
| Special physics consult CPT 77370 | $1,786.40 | $2,233.00 | $120.63 – $328.10 | 20 |
| Special radiation dosimetry CPT 77331 | $1,407.20 | $1,759.00 | $21.83 – $224.40 | 20 |
| Special radiation treatment CPT 77470 | $4,496.80 | $5,621.00 | $26.88 – $977.71 | 20 |
| Special teletx port plan CPT 77321 | $2,329.60 | $2,912.00 | $39.38 – $618.71 | 20 |
| Spinal bone autograftlocal 20936 CPT 20936 | not published | not published | $5,627.00 – $5,627.00 | 1 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,209.60 | $1,512.00 | $91.73 – $1,170.47 | 20 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $841.60 | $1,052.00 | $14.25 – $526.31 | 20 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $637.60 | $797.00 | $312.50 – $850.00 | 16 |
| Split blood or products CPT 86985 | $653.60 | $817.00 | $128.52 – $488.22 | 16 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $412.80 | $516.00 | $50.00 – $181.09 | 19 |
| Staph a dna amp probe CPT 87640 | $145.60 | $182.00 | $35.44 – $159.31 | 23 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $401.60 | $502.00 | $50.00 – $205.97 | 20 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $22,448.00 | $28,060.00 | $531.88 – $1,446.70 | 3 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $7,729.60 | $9,662.00 | $225.63 – $613.70 | 4 |
| Sterile water/saline, 10 ml HCPCS A4216 | $38.20 | $47.75 | $0.45 – $1.22 | 2 |
| St evaluate speech sound production CPT 92522 | $412.80 | $516.00 | $50.00 – $184.24 | 19 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $412.80 | $516.00 | $50.00 – $378.46 | 19 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $750.40 | $938.00 | $52.90 – $149.84 | 20 |
| St evaluation swallow function CPT 92610 | $446.40 | $558.00 | $50.00 – $140.75 | 20 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $352.80 | $441.00 | $25.00 – $266.68 | 20 |
| Stress test pulmonary CPT 94618 | $455.20 | $569.00 | $10.83 – $217.86 | 20 |
| St treatment speech individual CPT 92507 | $412.80 | $516.00 | $1.77 – $73.78 | 20 |
| St treatment swallow dysfunction/oral CPT 92526 | $296.80 | $371.00 | $50.00 – $162.32 | 20 |
| Suction lipectomy head&neck CPT 15876 | not published | not published | $3,571.12 – $10,638.00 | 14 |
| Suction lipectomy trunk CPT 15877 | not published | not published | $3,571.12 – $10,638.00 | 14 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $78.40 | $98.00 | $7.36 – $33.60 | 10 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $52.20 | $65.25 | $132.09 – $524.03 | 2 |
| Surgical pathology level 1 gross examination only CPT 88300 | $104.00 | $130.00 | $1.88 – $85.11 | 23 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $104.00 | $130.00 | $6.25 – $141.92 | 23 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $208.80 | $261.00 | $8.13 – $184.46 | 23 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $218.40 | $273.00 | $11.25 – $311.94 | 23 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $1,124.00 | $1,405.00 | $14.38 – $1,256.26 | 23 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,920.00 | $2,400.00 | $21.88 – $2,457.87 | 23 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $20.00 | $25.00 | $4.80 – $21.57 | 23 |
| Susceptibility mic per plate CPT 87186 | $36.00 | $45.00 | $8.00 – $39.27 | 23 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $18.40 | $23.00 | $4.44 – $20.71 | 23 |
| T3 (triiodothyronine) free CPT 84481 | $70.40 | $88.00 | $17.11 – $79.59 | 23 |
| T3 (triiodothyronine) total CPT 84480 | $59.20 | $74.00 | $8.00 – $64.38 | 23 |
| T4 (thyroxine) free CPT 84439 | $35.00 | $47.00 | $8.00 – $40.95 | 24 |
| T4 (thyroxine) total CPT 84436 | $28.00 | $35.00 | $6.94 – $32.30 | 23 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $9.20 | $11.50 | $0.16 – $0.67 | 10 |
| Tacrolimus therapeutic drug level CPT 80197 | $50.00 | $72.00 | $13.87 – $62.33 | 23 |
| Target gsa panel hmtlmph neop CPT 81450 | $3,160.00 | $3,950.00 | $607.62 – $3,448.27 | 23 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $12,145.60 | $15,182.00 | $2,335.68 – $13,254.98 | 23 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $727.20 | $909.00 | $0.33 – $388.50 | 24 |
| Tbp gene detc abnor alleles CPT 81344 | $569.60 | $712.00 | $68.50 – $621.98 | 19 |
| Tbs techl calculation only CPT 77091 | $398.40 | $498.00 | $44.03 – $497.84 | 17 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $257.60 | $322.00 | $62.60 – $281.39 | 23 |
| Tc-99m labeled rbc HCPCS A9560 | $941.60 | $1,177.00 | $333.45 – $337.44 | 2 |
| Tc-99m maa HCPCS A9540 | $916.00 | $1,145.00 | $94.21 – $107.10 | 2 |
| Tc-99m mebrofenin HCPCS A9537 | $677.60 | $847.00 | $197.47 – $363.07 | 2 |
| Tc-99m medronate HCPCS A9503 | $203.20 | $254.00 | $46.41 – $189.41 | 2 |
| Tc-99m mertiatide HCPCS A9562 | $2,139.20 | $2,674.00 | $2,458.34 – $2,458.34 | 1 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $17.60 | $22.00 | $7.50 – $32.00 | 16 |
| Tc-99m oxidronate HCPCS A9561 | $115.20 | $144.00 | $157.08 – $161.47 | 2 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $68.80 | $86.00 | $6.06 – $34.14 | 2 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $294.40 | $368.00 | $130.43 – $228.66 | 2 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $788.80 | $986.00 | $347.45 – $1,441.86 | 2 |
| Tc-99m sulfur colloid HCPCS A9541 | $874.40 | $1,093.00 | $954.49 – $2,404.48 | 2 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $747.20 | $934.00 | $304.43 – $362.27 | 2 |
| Tc-99m tilmanocept diag HCPCS A9520 | $3,248.80 | $4,061.00 | $2,361.84 – $2,361.84 | 1 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $195.20 | $244.00 | $47.45 – $218.42 | 23 |
| T cells absolute cd 4 count CPT 86361 | $111.20 | $139.00 | $27.05 – $121.58 | 23 |
| T cells total count CPT 86359 | $157.60 | $197.00 | $38.11 – $171.29 | 23 |
| Telehealth original site facility fee HCPCS Q3014 | $46.40 | $58.00 | $21.20 – $21.20 | 1 |
| Telethx isodose plan cplx CPT 77307 | $2,877.60 | $3,597.00 | $124.95 – $741.03 | 20 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $17,079.40 | $21,349.25 | $203.09 – $28,795.35 | 24 |
| Tenosynovectomy radic 26145 CPT 26145 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $18.40 | $23.00 | $2.85 – $24.72 | 10 |
| Test pathogen(s) for platelets reference HCPCS P9100 | $238.40 | $298.00 | $44.55 – $174.84 | 16 |
| Test stress cardiovascular tracing only CPT 93017 | $2,912.80 | $3,641.00 | $58.13 – $526.31 | 20 |
| Tetanus immune globulin inj HCPCS J1670 | $3,259.80 | $4,074.75 | $593.00 – $2,015.16 | 24 |
| Tgsap so/hl 51/< rna alys CPT 81456 | $12,145.60 | $15,182.00 | $2,335.68 – $13,254.98 | 23 |
| Theophylline therapeutic drug level CPT 80198 | $59.20 | $74.00 | $11.00 – $64.20 | 23 |
| Therapeutic procd strg endur HCPCS G0237 | $189.60 | $237.00 | $18.37 – $41.39 | 15 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $39.20 | $49.00 | $22.76 – $53.10 | 15 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $39.20 | $49.00 | $19.24 – $44.89 | 15 |
| Ther fx nasal inf turbinate CPT 30930 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $40.40 | $50.50 | $3.63 – $12.32 | 10 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $2,615.20 | $3,269.00 | $110.88 – $1,044.96 | 20 |
| Thrombectmy crnry perq mechanical CPT 92973 | $586.40 | $733.00 | $209.20 – $569.02 | 2 |
| Thrombin time CPT 85670 | $40.80 | $51.00 | $5.83 – $27.17 | 23 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $26.40 | $33.00 | $6.53 – $29.37 | 23 |
| Thyroglobulin antibody CPT 86800 | $66.40 | $83.00 | $16.07 – $72.23 | 23 |
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.