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 |
|---|---|---|---|---|
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $142.60 | $178.25 | $11.10 – $42.00 | 10 |
| Dpyd gene common variants CPT 81232 | $360.80 | $451.00 | $87.41 – $793.64 | 19 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $496.80 | $621.00 | $33.13 – $1,189.18 | 20 |
| Drainage external ear complex 69005 CPT 69005 | $2,546.40 | $3,183.00 | $171.85 – $467.43 | 7 |
| Drainage external ear simple 69000 CPT 69000 | $700.80 | $876.00 | $53.75 – $1,189.18 | 20 |
| Drainage of kidney lesion CPT 50390 | $1,200.00 | $1,500.00 | $114.44 – $1,189.18 | 20 |
| Drain blood from under nail 11740 CPT 11740 | $284.00 | $355.00 | $30.00 – $217.86 | 20 |
| Drain cath image guided visceral pq CPT 49405 | $1,820.00 | $2,275.00 | $216.71 – $589.46 | 7 |
| Drain finger abscess;simple 26010 CPT 26010 | $525.60 | $657.00 | $33.13 – $335.83 | 20 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $685.60 | $857.00 | $25.00 – $335.83 | 20 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Drng of scrotum abscess 55100 CPT 55100 | $4,390.40 | $5,488.00 | $43.75 – $119.00 | 7 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $113.60 | $142.00 | $5.56 – $34.58 | 10 |
| Drug assay posaconazole CPT 80187 | $104.00 | $130.00 | $21.69 – $123.08 | 23 |
| Drug assay rufinamide CPT 80210 | $83.20 | $104.00 | $19.13 – $123.08 | 19 |
| Drug assay vedolizumab CPT 80280 | $144.80 | $181.00 | $28.93 – $175.11 | 18 |
| Drug assay voriconazole CPT 80285 | $104.00 | $130.00 | $21.69 – $123.08 | 23 |
| Drug test def 1-7 classes HCPCS G0480 | $524.00 | $655.00 | $63.95 – $519.51 | 23 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $258.40 | $323.00 | $62.76 – $282.12 | 23 |
| Drvvt confirm - quest CPT 85597 | $136.00 | $170.00 | $18.16 – $84.46 | 23 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | $3,328.80 | $4,161.00 | $1,464.58 – $1,464.58 | 1 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $480.00 | $600.00 | $100.64 – $314.47 | 20 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $1,835.20 | $2,294.00 | $149.17 – $481.30 | 20 |
| Dxa bone density axl vrt fx CPT 77085 | $501.60 | $627.00 | $64.92 – $602.31 | 18 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Dx bronchoscope/lavage 31624 CPT 31624 | $1,983.20 | $2,479.00 | $168.94 – $9,629.00 | 9 |
| Dx bronchoscope/wash 31622 CPT 31622 | $6,220.80 | $7,776.00 | $167.33 – $9,629.00 | 9 |
| Ear cartilage graft CPT 21235 | not published | not published | $17,510.00 – $17,510.00 | 1 |
| Ear irrigation 69209 CPT 69209 | $225.60 | $282.00 | $12.00 – $100.40 | 20 |
| Ecg 12 lead tracing only CPT 93005 | $276.80 | $346.00 | $13.08 – $100.40 | 20 |
| Ecg external < 48 hours recording CPT 93225 | $753.60 | $942.00 | $22.81 – $217.86 | 20 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $1,004.80 | $1,256.00 | $49.70 – $135.18 | 20 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $546.40 | $683.00 | $11.38 – $66.34 | 20 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $546.40 | $683.00 | $10.92 – $66.34 | 20 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $3,730.40 | $4,663.00 | $122.67 – $926.71 | 20 |
| Echocardiography doppler color flow mapping CPT 93325 | $556.00 | $695.00 | $20.15 – $63.17 | 7 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $1,780.80 | $2,226.00 | $26.88 – $408.54 | 20 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $568.00 | $710.00 | $25.69 – $96.22 | 7 |
| Echo exam of fetal heart CPT 76825 | $888.00 | $1,110.00 | $23.75 – $3,022.37 | 21 |
| Echo exam of fetal heart CPT 76826 | $970.40 | $1,213.00 | $32.25 – $1,342.45 | 21 |
| Echo exam of fetal heart CPT 76827 | $853.60 | $1,067.00 | $45.69 – $602.31 | 21 |
| Echo exam of fetal heart CPT 76828 | $501.60 | $627.00 | $25.67 – $602.31 | 21 |
| Echo exam uterus 76831- CPT 76831 | $446.40 | $558.00 | $181.29 – $1,342.45 | 16 |
| Echo guide for amniocentesis CPT 76946 | $559.20 | $699.00 | $23.25 – $126.11 | 7 |
| Echo stress CPT 93350 | $1,440.00 | $1,800.00 | $58.13 – $926.71 | 20 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $4,019.20 | $5,024.00 | $166.16 – $926.71 | 20 |
| Echo transthoracic CPT 93303 | $2,035.20 | $2,544.00 | $118.75 – $926.71 | 20 |
| Echo transthoracic CPT 93304 | $1,244.00 | $1,555.00 | $26.88 – $926.71 | 20 |
| Echo tte 2d comp wo ctrst wo clr/dplr CPT 93307 | $2,407.20 | $3,009.00 | $118.75 – $1,335.32 | 20 |
| Eeg 41-60 minutes 95812-26 CPT 95812 | $826.40 | $1,033.00 | $48.66 – $526.31 | 20 |
| Eeg monitor/record/awake/drowsy 95816 CPT 95816 | $1,268.00 | $1,585.00 | $16.88 – $526.31 | 20 |
| Eeg over 1 hour 95813 - 26 CPT 95813 | $1,654.40 | $2,068.00 | $55.57 – $526.31 | 20 |
| Eeg recording awake and asleep CPT 95819 | $1,268.00 | $1,585.00 | $16.88 – $526.31 | 20 |
| Eeg without vid 2-12 hr unmntr CPT 95705 | $2,904.00 | $3,630.00 | $100.00 – $526.31 | 20 |
| Eeg wo vid ea 12-26hr unmntr CPT 95708 | $2,904.00 | $3,630.00 | $150.00 – $896.79 | 20 |
| Egd dilate stricture CPT 43245 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Egd lesion ablation CPT 43270 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Egd remove lesion snare CPT 43251 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Egd varices ligation CPT 43244 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Ehrlicha chaffeensis amp prb CPT 87484 | $162.40 | $203.00 | $28.07 – $159.31 | 23 |
| Elec analys infus pump w/reprog 62368 CPT 62368 | $418.40 | $523.00 | $41.27 – $506.89 | 20 |
| Elect analysis of infusion pump 62367 CPT 62367 | $400.00 | $500.00 | $224.93 – $506.89 | 15 |
| Electrical stimulation/unattended 97014 CPT 97014 | $184.80 | $231.00 | $11.70 – $56.95 | 19 |
| Electrolyte panel CPT 80051 | $29.60 | $37.00 | $7.00 – $31.83 | 23 |
| Electron microscopy diagnostic CPT 88348 | $628.00 | $785.00 | $21.88 – $2,457.87 | 23 |
| Electrophysiology evaluation CPT 93620 | $9,696.80 | $12,121.00 | $945.00 – $7,588.10 | 3 |
| Electrophysiology evaluation CPT 93622 | $8,600.00 | $10,750.00 | $874.80 – $2,379.46 | 2 |
| Embo or occlude vascular arterial s&i CPT 37242 | $29,632.80 | $37,041.00 | $511.17 – $1,390.40 | 7 |
| Embo or occlude vascular hemorrhage s&i CPT 37244 | $33,797.60 | $42,247.00 | $710.98 – $1,933.85 | 7 |
| Embo or occlude vascular tumor/organ/infarct s&i CPT 37243 | $6,191.20 | $7,739.00 | $609.50 – $1,657.84 | 7 |
| Emb without cervical dilation 58100 CPT 58100 | $529.60 | $662.00 | $63.75 – $340.01 | 20 |
| Endo abl/incom vein/ext/rad fre/#1 36475 CPT 36475 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Endoluminl ivus oct c 1st CPT 92978 | $3,145.60 | $3,932.00 | $300.06 – $816.17 | 2 |
| Endoscopic injection/implant CPT 51715 | $4,883.20 | $6,104.00 | $232.11 – $10,638.00 | 9 |
| Endoscopy maxillary sinus CPT 31267 | not published | not published | $10,638.00 – $10,638.00 | 1 |
| Endo, single, pulmonary HCPCS C1601 | $543.20 | $679.00 | $194.19 – $712.41 | 14 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $962.80 | $1,203.50 | $1.76 – $5.89 | 10 |
| Enzyme histochemistry CPT 88319 | $324.80 | $406.00 | $9.26 – $2,457.87 | 23 |
| Ep & ablate supravent arrhyt CPT 93653 | $47,574.40 | $59,468.00 | $818.88 – $24,532.30 | 3 |
| Epidural/lumbar/sacral/ea add level64484 CPT 64484 | $2,314.40 | $2,893.00 | $74.50 – $202.64 | 7 |
| Epinephrine 1 mg/ml im kit - adult HCPCS J0169 | $1,052.40 | $1,315.50 | $10.58 – $42.24 | 9 |
| Epinephrine 1 mg/ml im kit - pediatric HCPCS J0165 | $235.40 | $294.25 | $4.80 – $18.56 | 9 |
| Episiotomy/vag rpr oth/thn attending phys 59300 CPT 59300 | $4,389.60 | $5,487.00 | $166.18 – $4,669.44 | 3 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | $2,260.80 | $2,826.00 | $9.26 – $52.51 | 24 |
| Epstein barr early antigen antibody CPT 86663 | $55.20 | $69.00 | $13.25 – $61.64 | 23 |
| Epstein barr nuclear antigen antibody CPT 86664 | $63.20 | $79.00 | $15.44 – $71.88 | 23 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $76.00 | $95.00 | $18.32 – $85.24 | 23 |
| Eptifibatide 0.75 mg/ml intravenous solution HCPCS J1327 | $810.00 | $1,012.50 | $3.53 – $291.97 | 3 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $100.60 | $125.75 | $18.72 – $65.94 | 10 |
| ER Visit (level 1, minor) CPT 99281 | $511.20 | $639.00 | $26.25 – $148.82 | 17 |
| ER Visit (level 2) CPT 99282 | $923.20 | $1,154.00 | $43.75 – $267.65 | 17 |
| ER Visit (level 3) CPT 99283 | $1,638.40 | $2,048.00 | $98.75 – $467.99 | 17 |
| ER Visit (level 4) CPT 99284 | $2,381.60 | $2,977.00 | $153.75 – $719.71 | 17 |
| ER Visit (level 5, high severity) CPT 99285 | $3,073.60 | $3,842.00 | $241.25 – $1,036.23 | 17 |
| Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1364 | $553.60 | $692.00 | $64.62 – $240.16 | 10 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | $642.00 | $802.50 | $2.18 – $9.80 | 10 |
| Esoph egd dilation <30 mm CPT 43249 | not published | not published | $8,754.00 – $8,754.00 | 1 |
| Established Patient Office Visit (level 1) CPT 99211 | $460.00 | $575.00 | $50.00 – $217.81 | 20 |
| Established Patient Office Visit (level 2) CPT 99212 | $675.20 | $844.00 | $50.00 – $217.81 | 18 |
| Established Patient Office Visit (level 3) CPT 99213 | $868.00 | $1,085.00 | $50.00 – $217.81 | 18 |
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.