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 |
|---|---|---|---|---|
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $145.60 | $182.00 | $35.44 – $159.31 | 23 |
| Cv line/pic reposition CPT 36597 | $2,060.80 | $2,576.00 | $72.67 – $197.68 | 7 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $19.00 | $23.75 | $0.69 – $3.36 | 10 |
| Cyclic citrullinated peptide antibody CPT 86200 | $54.40 | $68.00 | $13.08 – $58.79 | 23 |
| Cyclosporine 2 hour CPT 80158 | $75.20 | $94.00 | $17.09 – $81.95 | 23 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | $7.40 | $9.25 | $0.80 – $2.68 | 10 |
| Cyclosporine oral 100 mg HCPCS J7502 | $11.60 | $14.50 | $2.04 – $7.07 | 10 |
| Cystatin c CPT 82610 | $77.60 | $97.00 | $15.20 – $84.08 | 23 |
| Cystine urine quantitative CPT 82131 | $96.00 | $120.00 | $23.19 – $104.33 | 23 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $531.20 | $664.00 | $26.88 – $2,106.92 | 21 |
| Cystometrogram w/up 51727 CPT 51727 | $1,421.60 | $1,777.00 | $175.15 – $771.32 | 7 |
| Cystoscopy and treatment CPT 52235 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Cystoscopy and treatment CPT 52260 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Cystoscopy (Bladder Scope) CPT 52000 | not published | not published | $5,627.00 – $5,627.00 | 1 |
| Cystoscopy chemodenervation CPT 52287 | $1,615.20 | $2,019.00 | $163.42 – $444.52 | 7 |
| Cystoscopy & revise urethra CPT 52275 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Cysto/uretero stricture tx CPT 52344 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Cystouretero w/biopsy CPT 52354 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Cysto/uretero w/lithotripsy CPT 52356 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Cystourethroscop/calib/dilat stric 52281 CPT 52281 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Cystourethroscopy w/biopsy(s) 52204 CPT 52204 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Cytogenetics 25-99 CPT 88274 | $185.60 | $232.00 | $21.19 – $192.41 | 20 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $60.00 | $75.00 | $14.53 – $67.42 | 23 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $69.60 | $87.00 | $17.02 – $79.15 | 23 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $208.80 | $261.00 | $51.58 – $313.07 | 23 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $112.00 | $140.00 | $26.75 – $120.81 | 23 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $84.00 | $105.00 | $16.00 – $91.98 | 23 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $141.60 | $177.00 | $5.00 – $287.25 | 23 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $141.60 | $177.00 | $8.13 – $301.32 | 23 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $29.60 | $37.00 | $5.85 – $129.16 | 4 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $193.60 | $242.00 | $85.68 – $488.22 | 19 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $208.80 | $261.00 | $26.72 – $704.52 | 19 |
| Cytopath smear other source CPT 88160 | $104.00 | $130.00 | $3.13 – $326.56 | 23 |
| Cytp urine 3-5 probes cmptr CPT 88121 | $272.00 | $340.00 | $165.50 – $1,807.28 | 23 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $109.60 | $137.00 | $14.00 – $52.50 | 10 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $2,416.20 | $3,020.25 | $3.45 – $994.00 | 24 |
| D&c after delivery 59160 CPT 59160 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Dch pulmonary stress test CPT 94621 | $2,496.00 | $3,120.00 | $79.45 – $526.31 | 20 |
| Deamidated gliadin antibody iga CPT 86258 | $49.60 | $62.00 | $6.03 – $54.71 | 19 |
| Debridement (>20 cm) charge pt CPT 97598 | $472.00 | $590.00 | $14.45 – $39.30 | 7 |
| Debridement bone <= 20 sq cm CPT 11044 | not published | not published | $1,564.83 – $8,754.00 | 2 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $1,103.20 | $1,379.00 | $41.25 – $675.27 | 20 |
| Debride skin bone at fx site CPT 11012 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $370.40 | $463.00 | $18.06 – $49.13 | 2 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $996.00 | $1,245.00 | $41.25 – $1,034.60 | 20 |
| Decalcification CPT 88311 | $91.20 | $114.00 | $16.72 – $89.94 | 10 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $1,002.40 | $1,253.00 | $31.33 – $560.61 | 20 |
| Decompression of tibia nerve CPT 28035 | not published | not published | $12,504.00 – $12,504.00 | 1 |
| Decompress spinal cord lmbr CPT 63056 | not published | not published | $15,634.00 – $15,634.00 | 1 |
| Deep muscle biopsy 20205 CPT 20205 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Delayed breast prosthesis 19342 CPT 19342 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Delivery of placenta 59414 CPT 59414 | $3,380.00 | $4,225.00 | $106.78 – $290.43 | 6 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $294.40 | $368.00 | $14.77 – $343.75 | 20 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $679.20 | $849.00 | $29.38 – $217.86 | 20 |
| Design mlc device for imrt CPT 77338 | $4,720.00 | $5,900.00 | $183.04 – $618.71 | 16 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $389.80 | $487.25 | $14.10 – $62.86 | 23 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $3,845.60 | $4,807.00 | $228.77 – $622.27 | 7 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $2,220.00 | $2,775.00 | $69.02 – $187.75 | 7 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | not published | not published | $389.73 – $5,627.00 | 14 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $892.00 | $1,115.00 | $60.02 – $163.27 | 7 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $2,952.00 | $3,690.00 | $224.17 – $609.76 | 7 |
| Device intraute mirena HCPCS J7298 | $5,896.40 | $7,370.50 | $885.80 – $4,664.19 | 9 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $323.20 | $404.00 | $22.10 – $497.84 | 22 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $10.80 | $13.50 | $0.03 – $1.02 | 10 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $18.80 | $23.50 | $0.38 – $1.54 | 10 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $49.00 | $61.25 | $1.41 – $4.73 | 9 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $28.80 | $36.00 | $28.49 – $28.49 | 1 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $31.60 | $39.50 | $1.81 – $6.37 | 9 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $92.00 | $115.00 | $21.00 – $100.92 | 23 |
| Diabetes (HbA1c) Test CPT 83036 | $25.00 | $75.00 | $7.00 – $44.08 | 24 |
| Diab manage trn ind/group HCPCS G0109 | $28.00 | $35.00 | $14.83 – $41.04 | 20 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $93.60 | $117.00 | $14.23 – $163.85 | 21 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $60.80 | $76.00 | $14.23 – $163.85 | 21 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $388.00 | $485.00 | $86.25 – $328.13 | 20 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $208.00 | $564.00 | $101.45 – $632.62 | 23 |
| Diagnostic Mammogram (one breast) CPT 77065 | $222.00 | $499.00 | $79.65 – $493.29 | 23 |
| Diagnostic radio unlisted proc CPT 76499 | $552.80 | $691.00 | $66.04 – $497.84 | 16 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $29,771.20 | $37,214.00 | $182.08 – $495.24 | 7 |
| Dialysis one evaluation CPT 90945 | $960.00 | $1,200.00 | $43.75 – $719.71 | 16 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $1.60 | $2.00 | $0.08 – $0.28 | 7 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $136.60 | $170.75 | $12.80 – $49.14 | 10 |
| Dicyclomine injection HCPCS J0500 | $202.80 | $253.50 | $11.36 – $45.01 | 10 |
| Diffusing capacity CPT 94729 | $901.60 | $1,127.00 | $41.40 – $134.44 | 7 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $34.00 | $42.50 | $4.15 – $30.27 | 10 |
| Digoxin total therapeutic drug level CPT 80162 | $55.20 | $69.00 | $11.00 – $60.29 | 23 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $437.80 | $547.25 | $60.00 – $310.62 | 10 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $1,150.15 – $5,627.00 | 14 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $111.40 | $139.25 | $1.65 – $32.00 | 9 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $23.60 | $29.50 | $0.76 – $2.88 | 10 |
| Disability dlco CPT 94727 | $885.60 | $1,107.00 | $27.42 – $264.44 | 20 |
| Disaccharidases CPT 82657 | $92.00 | $115.00 | $11.09 – $100.65 | 19 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Dna antibody native/double stranded CPT 86225 | $57.60 | $72.00 | $13.88 – $62.38 | 23 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $348.80 | $436.00 | $14.16 – $57.05 | 10 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $114.60 | $143.25 | $6.80 – $27.86 | 10 |
| Doppler echo complete CPT 93320 | $568.00 | $710.00 | $51.74 – $205.80 | 7 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $1,152.80 | $1,441.00 | $87.57 – $311.27 | 20 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $514.40 | $643.00 | $46.39 – $217.86 | 20 |
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.