Does WellSpan Ephrata Community Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at WellSpan Ephrata Community Hospital. In a medical emergency, call 911.

Where is WellSpan Ephrata Community Hospital?

169 Martin Avenue, Ephrata, PA 17522, in Lancaster County, Pennsylvania.

What is the phone number of WellSpan Ephrata Community Hospital?

(717) 733-0311, as listed by Medicare (CMS).

What is the Medicare star rating of WellSpan Ephrata Community Hospital?

5 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

WellSpan Ephrata Community Hospital

Quick answers

Does WellSpan Ephrata Community Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at WellSpan Ephrata Community Hospital. In a medical emergency, call 911.
Where is WellSpan Ephrata Community Hospital?: 169 Martin Avenue, Ephrata, PA 17522, in Lancaster County, Pennsylvania.
What is the phone number of WellSpan Ephrata Community Hospital?: (717) 733-0311, as listed by Medicare (CMS).
What is the Medicare star rating of WellSpan Ephrata Community Hospital?: 5 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[6][7]

Conditions treated^[6][7]

Prematurity
Low birth weight
Newborn respiratory problems
Newborn infections
Birth complications in newborns

Treatments^[6][7]

Vaginal birth after cesarean (VBAC)

Programs and centers^[4][6][7]

Maternity Center
Ephrata Cancer Center
Neonatal intensive care unit (Level III-A NICU)
Perinatal education classes
Lactation support
Healthy Beginnings Plus free prenatal care

Emergency care (hospital website)^[4][10]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Main entrance open daily 7 a.m.-9 p.m.; use ER entrance when closed. Photo ID and visitor badge required^[4][5]
Interpreters and languages	Interpreter services available^[4]

Recognition^[4][8][9]

ANCC Pathway to Excellence designation
U.S. News & World Report High Performing, maternity care 2026
Healthgrades Critical Care Excellence Award 2027
Healthgrades Cardiology Excellence Award 2027
Healthgrades Pulmonary Care Excellence Award 2027
Healthgrades Gastrointestinal Medical Excellence Award 2027
Healthgrades Emergency Hospitalization Excellence Award 2027
Healthgrades Stroke Care Excellence Award 2027

Doctors and clinicians (746)

746 doctors and other clinicians list WellSpan Ephrata Community Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Doctors with a page on this site (746)

Abdul H. Cheema, MDHospitalist
Abdullateef O. Abdulkareem, MDHematology/Oncology
Abigail L. Eby, NPNurse Practitioner
Abroo T. Nawaz, MDInternal Medicine
Adam Batog, DOEmergency Medicine
Adam C. Truax, PAPhysician Assistant
Adam E. Hyatt, MDOrthopedic Surgery
Adam M. Shipe, DOCardiovascular Disease (Cardiology)
Adam R. Becker, CNACertified Registered Nurse Anesthetist (CRNA)
Adam T. Griska, MDHand Surgery
Addison Atkins, PAPhysician Assistant
Adrienne S. Topic, MDCardiovascular Disease (Cardiology)
Ahsan Khan, DODiagnostic Radiology
Ajay R. Marwaha, MDCardiovascular Disease (Cardiology)
Akil Hassam, MDGastroenterology
Alan J. Malmer, NPNurse Practitioner
Alan S. Tuckman, MDOrthopedic Surgery
Alex T. Krahulik, PAPhysician Assistant
Alexa M. Maddy, PAPhysician Assistant
Alexandra P. Lucas, PAPhysician Assistant
Alexandria Klumpp, CNACertified Registered Nurse Anesthetist (CRNA)
Alexandria O. Starks, MDOrthopedic Surgery
Alison Lima, MDFamily Practice
Alison Pasierb, NPNurse Practitioner

And 722 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

UPMC Lititz7.6 mi · Lititz, PA · Acute Care Hospital
Lancaster General Hospital12 mi · Lancaster, PA · Acute Care Hospital
Penn State Health Lancaster Medical Center13 mi · Lancaster, PA · Acute Care Hospital
Lebanon VA Medical Center15 mi · Lebanon, PA · Federal/VA Acute Care Hospital
Reading Hospital16 mi · West Reading, PA · Acute Care Hospital

Other hospitals nearby

Lancaster Behavioral Health Hospital12 mi · Lancaster, PA · Psychiatric Hospital
Wernersville State Hospital12 mi · Wernersville, PA · Psychiatric Hospital
Lancaster Rehabilitation Hospital12 mi · Lancaster, PA · Inpatient Rehabilitation Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Ephrata Manor1.6 mi · Ephrata, PA · 4 of 5 stars
Maple Farm2.5 mi · Akron, PA · 5 of 5 stars
The Gardens at Stevens3.2 mi · Stevens, PA · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Compassus Hospice and Palliative Care - Philadelphia10 mi · Lancaster, PA · 3 of 5 stars
Amedisys Hospice of Lancaster12 mi · Lancaster, PA · 4 of 5 stars
Caring Hospice Services13 mi · Lancaster, PA · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Aveanna Healthcare10 mi · Lancaster, PA
Bayada Home Health Care, Inc.10 mi · Lancaster, PA · 3 of 5 stars
Bayada Home Health Care, Inc.10 mi · Lancaster, PA

All home health agencies in the state →

Dialysis facilities

DaVita PDI - Ephrata3.1 mi · Stevens, PA · 4 of 5 stars
DaVita Leola Dialysis6.1 mi · Leola, PA · 3 of 5 stars
DaVita Manheim Pike Dialysis10 mi · Lancaster, PA · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Mid-Atlantic Gastrointestinal Center II1.1 mi · Ephrata, PA
WellSpan Endoscopy Center at Barrett Boulevard1.1 mi · Ephrata, PA
Advanced Surgery Center of Lancaster10 mi · Lancaster, PA

All outpatient surgery centers in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

The Living Room0.8 mi · Ephrata, PA · Community health center
Union Community Care1.1 mi · Ephrata, PA · Community health center
Denver Declaration House- Dental Care4.0 mi · Denver, PA · Community health center

Clinics and urgent care

American Current Care P.A.1.1 mi · Ephrata, PA · Urgent care center
Lancaster General Medical Group1.1 mi · Ephrata, PA · Urgent care center
WellSpan Medical Group1.1 mi · Ephrata, PA · Urgent care center

Pharmacies

Ephrata Pharmacy LLC1.1 mi · Ephrata, PA · Community/retail pharmacy
The Giant Company, LLC1.1 mi · Ephrata, PA · Community/retail pharmacy
Wal-Mart Stores East LP1.1 mi · Ephrata, PA · Community/retail pharmacy

Assisted living nearby

Licensed homes from the official state licence list, by straight-line distance.

Ephrata Manor1.1 mi · Ephrata, PA
Fairmount Homes - Farm Crest1.1 mi · Ephrata, PA
Fairmount Homes - Wheat Ridge1.1 mi · Ephrata, PA
Keystone Villa at Ephrata1.1 mi · Ephrata, PA

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What WellSpan Ephrata Community Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	3 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	2 of 5 stars
Quiet at night	2 of 5 stars
Rated the hospital 9 or 10 out of 10	67%National average: 72%
Would definitely recommend the hospital	63%National average: 71%
Nurses “always” communicated well	77%National average: 80%
Doctors “always” communicated well	74%National average: 80%
Staff “always” explained medicines before giving them	52%National average: 62%
Were given information about recovery at home	90%National average: 86%
Room and bathroom “always” clean	60%National average: 74%
Area around the room “always” quiet at night	42%National average: 60%
Completed surveys	416Response rate: 31%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	0No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.51No different from the national benchmark
Surgical site infections after colon surgery	1.958No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.616No different from the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	12.7%
Deaths within 30 days: heart failure patients	9.8%
Deaths within 30 days: pneumonia patients	15.7%
Deaths within 30 days: COPD patients	8.2%
Deaths within 30 days: stroke patients	9.9%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.89No different from the national rate
Complications after hip or knee replacement	Too few cases to report

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	13.7%
Readmitted within 30 days: heart failure	19.2%
Readmitted within 30 days: pneumonia	17%
Readmitted within 30 days: COPD	19.2%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Too few cases to report

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	184 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	70%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Pennsylvania Best hospitals in Pennsylvania

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 62 common services exactly as WellSpan Ephrata Community Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: New Outpatient Visit Level 3 or Over 30 Minutes	$371	$296.80	$50 – $570.74
New patient office visit (about 30–44 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $77.04 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $65.30 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $241.15 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $111.30
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: Lc New Patient Visit Level 3	$153	$122.40	$26.93 – $570.74
New patient office visit (about 30–44 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $77.04 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $26.93 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $99.45 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $45.90
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) In the file: New Outpatient Visit Level 3 or Over 30 Minutes	$371	$296.80	$236.77 – $296.80
New patient office visit (about 30–44 minutes): rates for 6 insurance plans Cigna — All_Plans: $236.77 Independence_Blue_Cross — All_Plans: $241.15 PHC — All_Plans: $263.41 Tower Health — All_Plans: $254.14 UPMC — Employees_And_Dependents: $296.80 UPMC — UPMC_For_Kids: $296.80
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: New Outpatient Visit Level 4 or Over 45 Minutes	$483	$386.40	$50 – $570.74
New patient office visit (about 45–59 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $128.33 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $85.01 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $313.95 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $144.90
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) In the file: New Outpatient Visit Level 4 or Over 45 Minutes	$483	$386.40	$308.25 – $386.40
New patient office visit (about 45–59 minutes): rates for 6 insurance plans Cigna — All_Plans: $308.25 Independence_Blue_Cross — All_Plans: $313.95 PHC — All_Plans: $342.93 Tower Health — All_Plans: $330.86 UPMC — Employees_And_Dependents: $386.40 UPMC — UPMC_For_Kids: $386.40
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: New Outpatient Visit Level 5 or Over 60 Minutes	$866	$692.80	$50 – $816.64
New patient office visit (about 60–74 minutes): 10 of 34 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $152.42 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $562.90 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $259.80 Highmark — All_Other_Plans: $570.74
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) In the file: New Outpatient Visit Level 5 or Over 60 Minutes	$866	$692.80	$552.68 – $692.80
New patient office visit (about 60–74 minutes): rates for 6 insurance plans Cigna — All_Plans: $552.68 Independence_Blue_Cross — All_Plans: $562.90 PHC — All_Plans: $614.86 Tower Health — All_Plans: $593.21 UPMC — Employees_And_Dependents: $692.80 UPMC — UPMC_For_Kids: $692.80
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Est Outpatient Visit Level 3 or Over 20 Minutes	$667	$533.60	$50 – $628.98
Established patient office visit (about 20–29 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $56.80 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $117.39 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $433.55 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $200.10
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Maternity Triage 3-5 Hrs	$1,085	$868	$50 – $1,023.16
Established patient office visit (about 20–29 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $56.80 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $190.96 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $705.25 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $325.50
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Lc Est Patient Visit Level 3	$445	$356	$50 – $570.74
Established patient office visit (about 20–29 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $56.80 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $78.32 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $289.25 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $133.50
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Est Outpatient Visit Level 4 or Over 30 Minutes	$585	$468	$50 – $570.74
Established patient office visit (about 30–39 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $77.28 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $102.96 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $380.25 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $175.50
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Maternity Triage 5-7 Hrs	$1,293	$1,034.40	$50 – $1,219.30
Established patient office visit (about 30–39 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $77.28 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $227.57 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $840.45 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $387.90
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Lc Est Patient Visit Level 4	$228	$182.40	$40.13 – $570.74
Established patient office visit (about 30–39 minutes): 10 of 35 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $136 Amerihealth_Caritas_Medicaid — All_Plans: $77.28 Amerihealth_Medicare — All_Plans: $131.31 Blue_Cross_BlueJourney_Medicare — All_Plans: $40.13 Devoted_Medicare — All_Plans: $130.68 Geisinger — All_Plans: $148.20 Geisinger_Gold_Medicare — All_Plans: $130.68 Geisinger_Medicaid — All_Plans: $50 Health_Partners_Medicaid — All_Other_Plans: $50 Health_Partners_Medicaid — Kidz_Partners: $68.40
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: Office Consultation, Typically 40 Minutes	$410	$328	$72.16 – $386.63
Office consultation with a specialist (moderate to high): 10 of 12 insurance plan rates Aetna_Better_Health_Kids — All_Plans: $360.20 Blue_Cross_BlueJourney_Medicare — All_Plans: $72.16 Geisinger — All_Plans: $266.50 Health_Partners_Medicaid — Kidz_Partners: $123 Highmark_Wholecare_Gateway_Medicaid — All_Plans: $132.43 Independence_Blue_Cross — All_Plans: $266.50 PHC — All_Plans: $287 Tower Health — All_Plans: $266.50 United_Healthcare — All_Plans: $386.63 UPMC — Employees_And_Dependents: $266.50
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient (hospital stay) In the file: Office Consultation, Typically 40 Minutes	$410	$328	$261.66 – $328
Office consultation with a specialist (moderate to high): rates for 6 insurance plans Cigna — All_Plans: $261.66 Independence_Blue_Cross — All_Plans: $266.50 PHC — All_Plans: $291.10 Tower Health — All_Plans: $280.85 UPMC — Employees_And_Dependents: $328 UPMC — UPMC_For_Kids: $328
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: Emergency Department Visit for Problem of Moderate Severity	$2,048	$1,638.40	$98.75 – $2,281
Emergency room visit (moderate): 10 of 43 insurance plan rates Aetna — All_Plans: $2,074 Aetna_Advantra_Medicare — All_Plans: $275.44 Aetna_Better_Health_Kids — All_Plans: $268.60 Aetna_Medicare — All_Plans: $275.44 Amerihealth_Caritas_Medicaid — All_Plans: $200 Amerihealth_Medicare — All_Plans: $282.13 Blue_Cross — All_Other_Plans: $1,318.50 Blue_Cross — Capital_Blue_Performance_PPO: $1,318.50 Blue_Cross — Capital_Cares_4_kids: $922.95 Blue_Cross_BlueJourney_Medicare — All_Plans: $360.45
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) In the file: Emergency Department Visit for Problem of Moderate Severity	$2,048	$1,638.40	$1,307.03 – $1,638.40
Emergency room visit (moderate): rates for 6 insurance plans Cigna — All_Plans: $1,307.03 Independence_Blue_Cross — All_Plans: $1,331.20 PHC — All_Plans: $1,454.08 Tower Health — All_Plans: $1,402.88 UPMC — Employees_And_Dependents: $1,638.40 UPMC — UPMC_For_Kids: $1,638.40
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: Emergency Department Visit for Problem of High Severity	$2,977	$2,381.60	$153.75 – $2,281
Emergency room visit (moderately high): 10 of 43 insurance plan rates Aetna — All_Plans: $2,074 Aetna_Advantra_Medicare — All_Plans: $423.60 Aetna_Better_Health_Kids — All_Plans: $418.20 Aetna_Medicare — All_Plans: $423.60 Amerihealth_Caritas_Medicaid — All_Plans: $200 Amerihealth_Medicare — All_Plans: $433.88 Blue_Cross — All_Other_Plans: $1,916.59 Blue_Cross — Capital_Blue_Performance_PPO: $1,916.59 Blue_Cross — Capital_Cares_4_kids: $1,341.61 Blue_Cross_BlueJourney_Medicare — All_Plans: $523.95
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) In the file: Emergency Department Visit for Problem of High Severity	$2,977	$2,381.60	$1,899.92 – $2,381.60
Emergency room visit (moderately high): rates for 6 insurance plans Cigna — All_Plans: $1,899.92 Independence_Blue_Cross — All_Plans: $1,935.05 PHC — All_Plans: $2,113.67 Tower Health — All_Plans: $2,039.25 UPMC — Employees_And_Dependents: $2,381.60 UPMC — UPMC_For_Kids: $2,381.60
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Emergency Department Visit for Life Threatening or Functioning Severity	$3,842	$3,073.60	$200 – $2,689.40
Emergency room visit (high): 10 of 43 insurance plan rates Aetna — All_Plans: $2,074 Aetna_Advantra_Medicare — All_Plans: $609.89 Aetna_Better_Health_Kids — All_Plans: $656.20 Aetna_Medicare — All_Plans: $609.89 Amerihealth_Caritas_Medicaid — All_Plans: $200 Amerihealth_Medicare — All_Plans: $624.70 Blue_Cross — All_Other_Plans: $2,473.48 Blue_Cross — Capital_Blue_Performance_PPO: $2,473.48 Blue_Cross — Capital_Cares_4_kids: $1,731.44 Blue_Cross_BlueJourney_Medicare — All_Plans: $676.19
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) In the file: Emergency Department Visit for Life Threatening or Functioning Severity	$3,842	$3,073.60	$2,451.96 – $3,073.60
Emergency room visit (high): rates for 6 insurance plans Cigna — All_Plans: $2,451.96 Independence_Blue_Cross — All_Plans: $2,497.30 PHC — All_Plans: $2,727.82 Tower Health — All_Plans: $2,631.77 UPMC — Employees_And_Dependents: $3,073.60 UPMC — UPMC_For_Kids: $3,073.60

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: Blood Test, Basic Group of Blood Chemicals (Calcium, Total)	$46	$20	$8.10 – $38.80
Basic metabolic panel (blood test): 10 of 43 insurance plan rates Aetna — All_Plans: $34.94 Aetna_Advantra_Medicare — All_Plans: $8.71 Aetna_Better_Health_Kids — All_Plans: $31.82 Aetna_Medicare — All_Plans: $8.71 Amerihealth_Caritas_Medicaid — All_Plans: $9.36 Amerihealth_Medicare — All_Plans: $8.93 Blue_Cross — All_Other_Plans: $29.61 Blue_Cross — Capital_Blue_Performance_PPO: $29.61 Blue_Cross — Capital_Cares_4_kids: $20.73 Blue_Cross_BlueJourney_Medicare — All_Plans: $8.10
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) In the file: Blood Test, Basic Group of Blood Chemicals (Calcium, Total)	$46	$20	$29.36 – $36.80
Basic metabolic panel (blood test): rates for 6 insurance plans Cigna — All_Plans: $29.36 Independence_Blue_Cross — All_Plans: $29.90 PHC — All_Plans: $32.66 Tower Health — All_Plans: $31.51 UPMC — Employees_And_Dependents: $36.80 UPMC — UPMC_For_Kids: $36.80
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: Blood Test, Comprehensive Group of Blood Chemicals	$57	$25	$10.03 – $48.42
Comprehensive metabolic panel (blood test): 10 of 43 insurance plan rates Aetna — All_Plans: $43.61 Aetna_Advantra_Medicare — All_Plans: $10.88 Aetna_Better_Health_Kids — All_Plans: $39.75 Aetna_Medicare — All_Plans: $10.88 Amerihealth_Caritas_Medicaid — All_Plans: $11.69 Amerihealth_Medicare — All_Plans: $11.14 Blue_Cross — All_Other_Plans: $36.70 Blue_Cross — Capital_Blue_Performance_PPO: $36.70 Blue_Cross — Capital_Cares_4_kids: $25.69 Blue_Cross_BlueJourney_Medicare — All_Plans: $10.03
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: Blood Test, Comprehensive Group of Blood Chemicals	$57	$25	$36.38 – $45.60
Comprehensive metabolic panel (blood test): rates for 6 insurance plans Cigna — All_Plans: $36.38 Independence_Blue_Cross — All_Plans: $37.05 PHC — All_Plans: $40.47 Tower Health — All_Plans: $39.05 UPMC — Employees_And_Dependents: $45.60 UPMC — UPMC_For_Kids: $45.60
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: Obstetric Blood Test Panel	$249	$190	$12 – $219.24
Obstetric blood test panel: 10 of 43 insurance plan rates Aetna — All_Plans: $197.46 Aetna_Advantra_Medicare — All_Plans: $49.24 Aetna_Better_Health_Kids — All_Plans: $40.80 Aetna_Medicare — All_Plans: $49.24 Amerihealth_Caritas_Medicaid — All_Plans: $12 Amerihealth_Medicare — All_Plans: $50.44 Blue_Cross — All_Other_Plans: $160.31 Blue_Cross — Capital_Blue_Performance_PPO: $160.31 Blue_Cross — Capital_Cares_4_kids: $112.21 Blue_Cross_BlueJourney_Medicare — All_Plans: $43.82
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) In the file: Obstetric Blood Test Panel	$249	$190	$158.91 – $199.20
Obstetric blood test panel: rates for 6 insurance plans Cigna — All_Plans: $158.91 Independence_Blue_Cross — All_Plans: $161.85 PHC — All_Plans: $176.79 Tower Health — All_Plans: $170.57 UPMC — Employees_And_Dependents: $199.20 UPMC — UPMC_For_Kids: $199.20
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: Blood Test, Lipids (Cholesterol and Triglycerides)	$70	$40	$12.32 – $61.40
Cholesterol panel (lipid panel): 10 of 43 insurance plan rates Aetna — All_Plans: $55.30 Aetna_Advantra_Medicare — All_Plans: $13.79 Aetna_Better_Health_Kids — All_Plans: $47.60 Aetna_Medicare — All_Plans: $13.79 Amerihealth_Caritas_Medicaid — All_Plans: $14 Amerihealth_Medicare — All_Plans: $14.13 Blue_Cross — All_Other_Plans: $45.07 Blue_Cross — Capital_Blue_Performance_PPO: $45.07 Blue_Cross — Capital_Cares_4_kids: $31.55 Blue_Cross_BlueJourney_Medicare — All_Plans: $12.32
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) In the file: Blood Test, Lipids (Cholesterol and Triglycerides)	$70	$40	$44.67 – $56
Cholesterol panel (lipid panel): rates for 6 insurance plans Cigna — All_Plans: $44.67 Independence_Blue_Cross — All_Plans: $45.50 PHC — All_Plans: $49.70 Tower Health — All_Plans: $47.95 UPMC — Employees_And_Dependents: $56 UPMC — UPMC_For_Kids: $56
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: Kidney Function Blood Test Panel	$45	$36	$7.92 – $39.80
Kidney function panel: 10 of 43 insurance plan rates Aetna — All_Plans: $35.85 Aetna_Advantra_Medicare — All_Plans: $8.94 Aetna_Better_Health_Kids — All_Plans: $32.64 Aetna_Medicare — All_Plans: $8.94 Amerihealth_Caritas_Medicaid — All_Plans: $9.60 Amerihealth_Medicare — All_Plans: $9.16 Blue_Cross — All_Other_Plans: $28.97 Blue_Cross — Capital_Blue_Performance_PPO: $28.97 Blue_Cross — Capital_Cares_4_kids: $20.28 Blue_Cross_BlueJourney_Medicare — All_Plans: $7.92
Kidney function panel CPT 80069 · Inpatient (hospital stay) In the file: Kidney Function Blood Test Panel	$45	$36	$28.72 – $36
Kidney function panel: rates for 6 insurance plans Cigna — All_Plans: $28.72 Independence_Blue_Cross — All_Plans: $29.25 PHC — All_Plans: $31.95 Tower Health — All_Plans: $30.83 UPMC — Employees_And_Dependents: $36 UPMC — UPMC_For_Kids: $36
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: Liver Function Blood Test Panel	$43	$25	$7.57 – $37.47
Liver function panel: 10 of 43 insurance plan rates Aetna — All_Plans: $33.74 Aetna_Advantra_Medicare — All_Plans: $8.42 Aetna_Better_Health_Kids — All_Plans: $30.70 Aetna_Medicare — All_Plans: $8.42 Amerihealth_Caritas_Medicaid — All_Plans: $9.03 Amerihealth_Medicare — All_Plans: $8.62 Blue_Cross — All_Other_Plans: $27.68 Blue_Cross — Capital_Blue_Performance_PPO: $27.68 Blue_Cross — Capital_Cares_4_kids: $19.38 Blue_Cross_BlueJourney_Medicare — All_Plans: $7.57
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: Liver Function Blood Test Panel	$43	$25	$27.44 – $34.40
Liver function panel: rates for 6 insurance plans Cigna — All_Plans: $27.44 Independence_Blue_Cross — All_Plans: $27.95 PHC — All_Plans: $30.53 Tower Health — All_Plans: $29.46 UPMC — Employees_And_Dependents: $34.40 UPMC — UPMC_For_Kids: $34.40
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: Manual Urinalysis Test With Examination Using Microscope, Automated	$21	$10	$3 – $17.53
Urine test (automated, with microscope): 10 of 43 insurance plan rates Aetna — All_Plans: $13.09 Aetna_Advantra_Medicare — All_Plans: $3.27 Aetna_Better_Health_Kids — All_Plans: $10.20 Aetna_Medicare — All_Plans: $3.27 Amerihealth_Caritas_Medicaid — All_Plans: $3 Amerihealth_Medicare — All_Plans: $3.34 Blue_Cross — All_Other_Plans: $13.52 Blue_Cross — Capital_Blue_Performance_PPO: $13.52 Blue_Cross — Capital_Cares_4_kids: $9.46 Blue_Cross_BlueJourney_Medicare — All_Plans: $3.70
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) In the file: Manual Urinalysis Test With Examination Using Microscope, Automated	$21	$10	$13.40 – $16.80
Urine test (automated, with microscope): rates for 6 insurance plans Cigna — All_Plans: $13.40 Independence_Blue_Cross — All_Plans: $13.65 PHC — All_Plans: $14.91 Tower Health — All_Plans: $14.39 UPMC — Employees_And_Dependents: $16.80 UPMC — UPMC_For_Kids: $16.80
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Automated Urinalysis Test	$11	$10	$1.94 – $10.54
Urine test (automated, without microscope): 10 of 43 insurance plan rates Aetna — All_Plans: $9.29 Aetna_Advantra_Medicare — All_Plans: $2.32 Aetna_Better_Health_Kids — All_Plans: $10.54 Aetna_Medicare — All_Plans: $2.32 Amerihealth_Caritas_Medicaid — All_Plans: $3.10 Amerihealth_Medicare — All_Plans: $2.37 Blue_Cross — All_Other_Plans: $7.08 Blue_Cross — Capital_Blue_Performance_PPO: $7.08 Blue_Cross — Capital_Cares_4_kids: $4.96 Blue_Cross_BlueJourney_Medicare — All_Plans: $1.94
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) In the file: Automated Urinalysis Test	$11	$10	$7.02 – $8.80
Urine test (automated, without microscope): rates for 6 insurance plans Cigna — All_Plans: $7.02 Independence_Blue_Cross — All_Plans: $7.15 PHC — All_Plans: $7.81 Tower Health — All_Plans: $7.54 UPMC — Employees_And_Dependents: $8.80 UPMC — UPMC_For_Kids: $8.80
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: Psa (Prostate Specific Antigen) Measurement, Total	$96	$45	$16.90 – $84.33
PSA (prostate specific antigen) blood test: 10 of 43 insurance plan rates Aetna — All_Plans: $75.95 Aetna_Advantra_Medicare — All_Plans: $18.94 Aetna_Better_Health_Kids — All_Plans: $82.82 Aetna_Medicare — All_Plans: $18.94 Amerihealth_Caritas_Medicaid — All_Plans: $24.36 Amerihealth_Medicare — All_Plans: $19.40 Blue_Cross — All_Other_Plans: $61.80 Blue_Cross — Capital_Blue_Performance_PPO: $61.80 Blue_Cross — Capital_Cares_4_kids: $43.26 Blue_Cross_BlueJourney_Medicare — All_Plans: $16.90
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) In the file: Psa (Prostate Specific Antigen) Measurement, Total	$96	$45	$61.27 – $76.80
PSA (prostate specific antigen) blood test: rates for 6 insurance plans Cigna — All_Plans: $61.27 Independence_Blue_Cross — All_Plans: $62.40 PHC — All_Plans: $68.16 Tower Health — All_Plans: $65.76 UPMC — Employees_And_Dependents: $76.80 UPMC — UPMC_For_Kids: $76.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Blood Test, Thyroid Stimulating Hormone (Tsh)	$119	$40	$16.97 – $99.32
Thyroid stimulating hormone (TSH) test: 10 of 43 insurance plan rates Aetna — All_Plans: $69.38 Aetna_Advantra_Medicare — All_Plans: $17.30 Aetna_Better_Health_Kids — All_Plans: $78.91 Aetna_Medicare — All_Plans: $17.30 Amerihealth_Caritas_Medicaid — All_Plans: $23.21 Amerihealth_Medicare — All_Plans: $17.72 Blue_Cross — All_Other_Plans: $76.61 Blue_Cross — Capital_Blue_Performance_PPO: $76.61 Blue_Cross — Capital_Cares_4_kids: $53.63 Blue_Cross_BlueJourney_Medicare — All_Plans: $20.94
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) In the file: Blood Test, Thyroid Stimulating Hormone (Tsh)	$119	$40	$75.95 – $95.20
Thyroid stimulating hormone (TSH) test: rates for 6 insurance plans Cigna — All_Plans: $75.95 Independence_Blue_Cross — All_Plans: $77.35 PHC — All_Plans: $84.49 Tower Health — All_Plans: $81.52 UPMC — Employees_And_Dependents: $95.20 UPMC — UPMC_For_Kids: $95.20
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Complete Blood Cell Count, With Diff	$118	$15	$6 – $98.48
Complete blood count (CBC) with differential: 10 of 43 insurance plan rates Aetna — All_Plans: $32.09 Aetna_Advantra_Medicare — All_Plans: $8 Aetna_Better_Health_Kids — All_Plans: $20.40 Aetna_Medicare — All_Plans: $8 Amerihealth_Caritas_Medicaid — All_Plans: $6 Amerihealth_Medicare — All_Plans: $8.20 Blue_Cross — All_Other_Plans: $75.97 Blue_Cross — Capital_Blue_Performance_PPO: $75.97 Blue_Cross — Capital_Cares_4_kids: $53.18 Blue_Cross_BlueJourney_Medicare — All_Plans: $20.77
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) In the file: Complete Blood Cell Count, With Diff	$118	$15	$75.31 – $94.40
Complete blood count (CBC) with differential: rates for 6 insurance plans Cigna — All_Plans: $75.31 Independence_Blue_Cross — All_Plans: $76.70 PHC — All_Plans: $83.78 Tower Health — All_Plans: $80.83 UPMC — Employees_And_Dependents: $94.40 UPMC — UPMC_For_Kids: $94.40
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: Complete Blood Cell Count, W/O Diff	$92	$15	$6.53 – $76.78
Complete blood count (CBC), automated: 10 of 43 insurance plan rates Aetna — All_Plans: $26.72 Aetna_Advantra_Medicare — All_Plans: $6.66 Aetna_Better_Health_Kids — All_Plans: $25.57 Aetna_Medicare — All_Plans: $6.66 Amerihealth_Caritas_Medicaid — All_Plans: $7.52 Amerihealth_Medicare — All_Plans: $6.83 Blue_Cross — All_Other_Plans: $59.23 Blue_Cross — Capital_Blue_Performance_PPO: $59.23 Blue_Cross — Capital_Cares_4_kids: $41.46 Blue_Cross_BlueJourney_Medicare — All_Plans: $16.19
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) In the file: Complete Blood Cell Count, W/O Diff	$92	$15	$58.71 – $73.60
Complete blood count (CBC), automated: rates for 6 insurance plans Cigna — All_Plans: $58.71 Independence_Blue_Cross — All_Plans: $59.80 PHC — All_Plans: $65.32 Tower Health — All_Plans: $63.02 UPMC — Employees_And_Dependents: $73.60 UPMC — UPMC_For_Kids: $73.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Blood Test, Clotting Time	$46	$15	$4 – $38.39
Blood clotting time test (prothrombin time, PT): 10 of 43 insurance plan rates Aetna — All_Plans: $17.72 Aetna_Advantra_Medicare — All_Plans: $4.42 Aetna_Better_Health_Kids — All_Plans: $13.60 Aetna_Medicare — All_Plans: $4.42 Amerihealth_Caritas_Medicaid — All_Plans: $4 Amerihealth_Medicare — All_Plans: $4.53 Blue_Cross — All_Other_Plans: $29.61 Blue_Cross — Capital_Blue_Performance_PPO: $29.61 Blue_Cross — Capital_Cares_4_kids: $20.73 Blue_Cross_BlueJourney_Medicare — All_Plans: $8.10
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) In the file: Blood Test, Clotting Time	$46	$15	$29.36 – $36.80
Blood clotting time test (prothrombin time, PT): rates for 6 insurance plans Cigna — All_Plans: $29.36 Independence_Blue_Cross — All_Plans: $29.90 PHC — All_Plans: $32.66 Tower Health — All_Plans: $31.51 UPMC — Employees_And_Dependents: $36.80 UPMC — UPMC_For_Kids: $36.80
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: Coagulation Assessment Blood Test, Plasma or Whole Blood	$80	$30	$6.07 – $66.77
Blood clotting test (partial thromboplastin time, PTT): 10 of 43 insurance plan rates Aetna — All_Plans: $24.82 Aetna_Advantra_Medicare — All_Plans: $6.19 Aetna_Better_Health_Kids — All_Plans: $25.50 Aetna_Medicare — All_Plans: $6.19 Amerihealth_Caritas_Medicaid — All_Plans: $7.50 Amerihealth_Medicare — All_Plans: $6.34 Blue_Cross — All_Other_Plans: $51.50 Blue_Cross — Capital_Blue_Performance_PPO: $51.50 Blue_Cross — Capital_Cares_4_kids: $36.05 Blue_Cross_BlueJourney_Medicare — All_Plans: $14.08
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) In the file: Coagulation Assessment Blood Test, Plasma or Whole Blood	$80	$30	$51.06 – $64
Blood clotting test (partial thromboplastin time, PTT): rates for 6 insurance plans Cigna — All_Plans: $51.06 Independence_Blue_Cross — All_Plans: $52 PHC — All_Plans: $56.80 Tower Health — All_Plans: $54.80 UPMC — Employees_And_Dependents: $64 UPMC — UPMC_For_Kids: $64

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT Scan Head or Brain Without Contrast	$1,610	$296	$96.88 – $1,127
CT scan of the head or brain, without contrast: 10 of 43 insurance plan rates Aetna — All_Plans: $957 Aetna_Advantra_Medicare — All_Plans: $105.78 Aetna_Better_Health_Kids — All_Plans: $396.95 Aetna_Medicare — All_Plans: $105.78 Amerihealth_Caritas_Medicaid — All_Plans: $165.79 Amerihealth_Medicare — All_Plans: $108.35 Blue_Cross — All_Other_Plans: $1,036.52 Blue_Cross — Capital_Blue_Performance_PPO: $230 Blue_Cross — Capital_Cares_4_kids: $725.56 Blue_Cross_BlueJourney_Medicare — All_Plans: $283.36
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) In the file: CT Scan Head or Brain Without Contrast	$1,610	$296	$1,027.50 – $1,288
CT scan of the head or brain, without contrast: rates for 6 insurance plans Cigna — All_Plans: $1,027.50 Independence_Blue_Cross — All_Plans: $1,046.50 PHC — All_Plans: $1,143.10 Tower Health — All_Plans: $1,102.85 UPMC — Employees_And_Dependents: $1,288 UPMC — UPMC_For_Kids: $1,288
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI Scan of Brain Before and After Contrast	$2,544	$701.50	$336.25 – $2,106.92
MRI of the brain, before and after contrast: 10 of 43 insurance plan rates Aetna — All_Plans: $1,477 Aetna_Advantra_Medicare — All_Plans: $355.27 Aetna_Better_Health_Kids — All_Plans: $1,152.60 Aetna_Medicare — All_Plans: $355.27 Amerihealth_Caritas_Medicaid — All_Plans: $481.38 Amerihealth_Medicare — All_Plans: $363.89 Blue_Cross — All_Other_Plans: $1,637.83 Blue_Cross — Capital_Blue_Performance_PPO: $718 Blue_Cross — Capital_Cares_4_kids: $1,146.48 Blue_Cross_BlueJourney_Medicare — All_Plans: $447.74
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) In the file: MRI Scan of Brain Before and After Contrast	$2,544	$701.50	$1,623.58 – $2,035.20
MRI of the brain, before and after contrast: rates for 6 insurance plans Cigna — All_Plans: $1,623.58 Independence_Blue_Cross — All_Plans: $1,653.60 PHC — All_Plans: $1,806.24 Tower Health — All_Plans: $1,742.64 UPMC — Employees_And_Dependents: $2,035.20 UPMC — UPMC_For_Kids: $2,035.20
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-Ray of Chest, 2 Views	$403	$322.40	$18.57 – $497.84
Chest X-ray, 2 views: 10 of 43 insurance plan rates Aetna — All_Plans: $311.92 Aetna_Advantra_Medicare — All_Plans: $87.59 Aetna_Better_Health_Kids — All_Plans: $80.38 Aetna_Medicare — All_Plans: $87.59 Amerihealth_Caritas_Medicaid — All_Plans: $33.57 Amerihealth_Medicare — All_Plans: $89.72 Blue_Cross — All_Other_Plans: $259.45 Blue_Cross — Capital_Blue_Performance_PPO: $259.45 Blue_Cross — Capital_Cares_4_kids: $181.62 Blue_Cross_BlueJourney_Medicare — All_Plans: $70.93
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) In the file: X-Ray of Chest, 2 Views	$403	$322.40	$257.19 – $322.40
Chest X-ray, 2 views: rates for 6 insurance plans Cigna — All_Plans: $257.19 Independence_Blue_Cross — All_Plans: $261.95 PHC — All_Plans: $286.13 Tower Health — All_Plans: $276.06 UPMC — Employees_And_Dependents: $322.40 UPMC — UPMC_For_Kids: $322.40
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-Ray of Lower and Sacral Spine, Minimum of 4 Views	$829	$663.20	$28.13 – $705.48
X-ray of the lower spine, at least 4 views: 10 of 43 insurance plan rates Aetna — All_Plans: $641.65 Aetna_Advantra_Medicare — All_Plans: $105.78 Aetna_Better_Health_Kids — All_Plans: $124.51 Aetna_Medicare — All_Plans: $105.78 Amerihealth_Caritas_Medicaid — All_Plans: $52 Amerihealth_Medicare — All_Plans: $108.35 Blue_Cross — All_Other_Plans: $533.71 Blue_Cross — Capital_Blue_Performance_PPO: $533.71 Blue_Cross — Capital_Cares_4_kids: $373.60 Blue_Cross_BlueJourney_Medicare — All_Plans: $145.90
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) In the file: X-Ray of Lower and Sacral Spine, Minimum of 4 Views	$829	$663.20	$529.07 – $663.20
X-ray of the lower spine, at least 4 views: rates for 6 insurance plans Cigna — All_Plans: $529.07 Independence_Blue_Cross — All_Plans: $538.85 PHC — All_Plans: $588.59 Tower Health — All_Plans: $567.87 UPMC — Employees_And_Dependents: $663.20 UPMC — UPMC_For_Kids: $663.20
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI Scan of Lower Spinal Canal Without Contrast	$2,225	$454	$234 – $1,624
MRI of the lower back (lumbar spine), without contrast: 10 of 43 insurance plan rates Aetna — All_Plans: $1,477 Aetna_Advantra_Medicare — All_Plans: $240.45 Aetna_Better_Health_Kids — All_Plans: $870.91 Aetna_Medicare — All_Plans: $240.45 Amerihealth_Caritas_Medicaid — All_Plans: $363.73 Amerihealth_Medicare — All_Plans: $246.29 Blue_Cross — All_Other_Plans: $1,432.46 Blue_Cross — Capital_Blue_Performance_PPO: $468 Blue_Cross — Capital_Cares_4_kids: $1,002.72 Blue_Cross_BlueJourney_Medicare — All_Plans: $391.60
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) In the file: MRI Scan of Lower Spinal Canal Without Contrast	$2,225	$454	$1,420 – $1,780
MRI of the lower back (lumbar spine), without contrast: rates for 6 insurance plans Cigna — All_Plans: $1,420 Independence_Blue_Cross — All_Plans: $1,446.25 PHC — All_Plans: $1,579.75 Tower Health — All_Plans: $1,524.13 UPMC — Employees_And_Dependents: $1,780 UPMC — UPMC_For_Kids: $1,780
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT Scan of Pelvis With Contrast	$2,362	$475.50	$108.13 – $1,653.40
CT scan of the pelvis, with contrast: 10 of 43 insurance plan rates Aetna — All_Plans: $957 Aetna_Advantra_Medicare — All_Plans: $177.09 Aetna_Better_Health_Kids — All_Plans: $476.31 Aetna_Medicare — All_Plans: $177.09 Amerihealth_Caritas_Medicaid — All_Plans: $198.93 Amerihealth_Medicare — All_Plans: $181.39 Blue_Cross — All_Other_Plans: $1,520.66 Blue_Cross — Capital_Blue_Performance_PPO: $407 Blue_Cross — Capital_Cares_4_kids: $1,064.46 Blue_Cross_BlueJourney_Medicare — All_Plans: $415.71
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) In the file: CT Scan of Pelvis With Contrast	$2,362	$475.50	$1,507.43 – $1,889.60
CT scan of the pelvis, with contrast: rates for 6 insurance plans Cigna — All_Plans: $1,507.43 Independence_Blue_Cross — All_Plans: $1,535.30 PHC — All_Plans: $1,677.02 Tower Health — All_Plans: $1,617.97 UPMC — Employees_And_Dependents: $1,889.60 UPMC — UPMC_For_Kids: $1,889.60
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI Scan of Leg Joint Without Contrast	$2,225	$462	$235.78 – $1,624
MRI of a leg joint (such as the knee), without contrast: 10 of 43 insurance plan rates Aetna — All_Plans: $1,477 Aetna_Advantra_Medicare — All_Plans: $240.45 Aetna_Better_Health_Kids — All_Plans: $1,126.73 Aetna_Medicare — All_Plans: $240.45 Amerihealth_Caritas_Medicaid — All_Plans: $470.57 Amerihealth_Medicare — All_Plans: $246.29 Blue_Cross — All_Other_Plans: $1,432.46 Blue_Cross — Capital_Blue_Performance_PPO: $468 Blue_Cross — Capital_Cares_4_kids: $1,002.72 Blue_Cross_BlueJourney_Medicare — All_Plans: $391.60
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) In the file: MRI Scan of Leg Joint Without Contrast	$2,225	$462	$1,420 – $1,780
MRI of a leg joint (such as the knee), without contrast: rates for 6 insurance plans Cigna — All_Plans: $1,420 Independence_Blue_Cross — All_Plans: $1,446.25 PHC — All_Plans: $1,579.75 Tower Health — All_Plans: $1,524.13 UPMC — Employees_And_Dependents: $1,780 UPMC — UPMC_For_Kids: $1,780
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT Scan of Abdomen and Pelvis With Contrast	$3,608	$437.50	$240.91 – $2,525.60
CT scan of the abdomen and pelvis, with contrast: 10 of 43 insurance plan rates Aetna — All_Plans: $957 Aetna_Advantra_Medicare — All_Plans: $355.27 Aetna_Better_Health_Kids — All_Plans: $894.74 Aetna_Medicare — All_Plans: $355.27 Amerihealth_Caritas_Medicaid — All_Plans: $373.69 Amerihealth_Medicare — All_Plans: $363.89 Blue_Cross — All_Other_Plans: $2,322.83 Blue_Cross — Capital_Blue_Performance_PPO: $407 Blue_Cross — Capital_Cares_4_kids: $1,625.98 Blue_Cross_BlueJourney_Medicare — All_Plans: $635.01
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) In the file: CT Scan of Abdomen and Pelvis With Contrast	$3,608	$437.50	$2,302.63 – $2,886.40
CT scan of the abdomen and pelvis, with contrast: rates for 6 insurance plans Cigna — All_Plans: $2,302.63 Independence_Blue_Cross — All_Plans: $2,345.20 PHC — All_Plans: $2,561.68 Tower Health — All_Plans: $2,471.48 UPMC — Employees_And_Dependents: $2,886.40 UPMC — UPMC_For_Kids: $2,886.40
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: Complete Ultrasound Scan of Abdomen	$1,707	$1,365.60	$71.88 – $1,452.66
Ultrasound of the abdomen, complete: 10 of 43 insurance plan rates Aetna — All_Plans: $1,321.22 Aetna_Advantra_Medicare — All_Plans: $105.78 Aetna_Better_Health_Kids — All_Plans: $323.92 Aetna_Medicare — All_Plans: $105.78 Amerihealth_Caritas_Medicaid — All_Plans: $135.28 Amerihealth_Medicare — All_Plans: $108.35 Blue_Cross — All_Other_Plans: $1,098.97 Blue_Cross — Capital_Blue_Performance_PPO: $1,098.97 Blue_Cross — Capital_Cares_4_kids: $769.28 Blue_Cross_BlueJourney_Medicare — All_Plans: $300.43
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) In the file: Complete Ultrasound Scan of Abdomen	$1,707	$1,365.60	$1,089.41 – $1,365.60
Ultrasound of the abdomen, complete: rates for 6 insurance plans Cigna — All_Plans: $1,089.41 Independence_Blue_Cross — All_Plans: $1,109.55 PHC — All_Plans: $1,211.97 Tower Health — All_Plans: $1,169.30 UPMC — Employees_And_Dependents: $1,365.60 UPMC — UPMC_For_Kids: $1,365.60
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: Ultrasound Scan of Pregnant Uterus (14 Weeks or More), Single or 1st Fetus	$1,274	$1,019.20	$58.13 – $1,084.17
Pregnancy ultrasound (after the first trimester): 10 of 43 insurance plan rates Aetna — All_Plans: $986.08 Aetna_Advantra_Medicare — All_Plans: $105.78 Aetna_Better_Health_Kids — All_Plans: $263.50 Aetna_Medicare — All_Plans: $105.78 Amerihealth_Caritas_Medicaid — All_Plans: $110.05 Amerihealth_Medicare — All_Plans: $108.35 Blue_Cross — All_Other_Plans: $820.20 Blue_Cross — Capital_Blue_Performance_PPO: $820.20 Blue_Cross — Capital_Cares_4_kids: $574.14 Blue_Cross_BlueJourney_Medicare — All_Plans: $224.22
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) In the file: Ultrasound Scan of Pregnant Uterus (14 Weeks or More), Single or 1st Fetus	$1,274	$1,019.20	$813.07 – $1,019.20
Pregnancy ultrasound (after the first trimester): rates for 6 insurance plans Cigna — All_Plans: $813.07 Independence_Blue_Cross — All_Plans: $828.10 PHC — All_Plans: $904.54 Tower Health — All_Plans: $872.69 UPMC — Employees_And_Dependents: $1,019.20 UPMC — UPMC_For_Kids: $1,019.20
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: Ultrasound of Uterus, Ovaries, Tubes, Cervix and Pelvic Area Through Vagina	$886	$708.80	$58.13 – $753.99
Transvaginal ultrasound: 10 of 42 insurance plan rates Aetna — All_Plans: $685.76 Aetna_Advantra_Medicare — All_Plans: $105.78 Aetna_Better_Health_Kids — All_Plans: $260.10 Aetna_Medicare — All_Plans: $105.78 Amerihealth_Medicare — All_Plans: $108.35 Blue_Cross — All_Other_Plans: $570.41 Blue_Cross — Capital_Blue_Performance_PPO: $570.41 Blue_Cross — Capital_Cares_4_kids: $399.28 Blue_Cross_BlueJourney_Medicare — All_Plans: $155.94 Cigna — All_Plans: $478.44
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) In the file: Ultrasound of Uterus, Ovaries, Tubes, Cervix and Pelvic Area Through Vagina	$886	$708.80	$565.45 – $708.80
Transvaginal ultrasound: rates for 6 insurance plans Cigna — All_Plans: $565.45 Independence_Blue_Cross — All_Plans: $575.90 PHC — All_Plans: $629.06 Tower Health — All_Plans: $606.91 UPMC — Employees_And_Dependents: $708.80 UPMC — UPMC_For_Kids: $708.80
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: Diagnostic Mammography of 1 Breast	$499	$222	$79.65 – $493.29
Diagnostic mammogram, one breast: 10 of 43 insurance plan rates Aetna — All_Plans: $386.23 Aetna_Advantra_Medicare — All_Plans: $81.23 Aetna_Better_Health_Kids — All_Plans: $348.19 Aetna_Medicare — All_Plans: $81.23 Amerihealth_Caritas_Medicaid — All_Plans: $145.42 Amerihealth_Medicare — All_Plans: $83.20 Blue_Cross — All_Other_Plans: $321.26 Blue_Cross — Capital_Blue_Performance_PPO: $194 Blue_Cross — Capital_Cares_4_kids: $224.88 Blue_Cross_BlueJourney_Medicare — All_Plans: $87.82
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) In the file: Diagnostic Mammography of 1 Breast	$499	$222	$318.46 – $399.20
Diagnostic mammogram, one breast: rates for 6 insurance plans Cigna — All_Plans: $318.46 Independence_Blue_Cross — All_Plans: $324.35 PHC — All_Plans: $354.29 Tower Health — All_Plans: $341.82 UPMC — Employees_And_Dependents: $399.20 UPMC — UPMC_For_Kids: $399.20
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: Diagnostic Mammography of Both Breasts	$564	$208	$99.26 – $632.62
Diagnostic mammogram, both breasts: 10 of 43 insurance plan rates Aetna — All_Plans: $436.54 Aetna_Advantra_Medicare — All_Plans: $103.46 Aetna_Better_Health_Kids — All_Plans: $441.49 Aetna_Medicare — All_Plans: $103.46 Amerihealth_Caritas_Medicaid — All_Plans: $184.39 Amerihealth_Medicare — All_Plans: $105.97 Blue_Cross — All_Other_Plans: $363.10 Blue_Cross — Capital_Blue_Performance_PPO: $194 Blue_Cross — Capital_Cares_4_kids: $254.17 Blue_Cross_BlueJourney_Medicare — All_Plans: $99.26
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) In the file: Diagnostic Mammography of Both Breasts	$564	$208	$359.94 – $451.20
Diagnostic mammogram, both breasts: rates for 6 insurance plans Cigna — All_Plans: $359.94 Independence_Blue_Cross — All_Plans: $366.60 PHC — All_Plans: $400.44 Tower Health — All_Plans: $386.34 UPMC — Employees_And_Dependents: $451.20 UPMC — UPMC_For_Kids: $451.20
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: Screening Mammography	$427	$225	$75.15 – $521.53
Screening mammogram, both breasts: 10 of 43 insurance plan rates Aetna — All_Plans: $330.50 Aetna_Advantra_Medicare — All_Plans: $85.55 Aetna_Better_Health_Kids — All_Plans: $355.98 Aetna_Medicare — All_Plans: $85.55 Amerihealth_Caritas_Medicaid — All_Plans: $148.67 Amerihealth_Medicare — All_Plans: $87.63 Blue_Cross — All_Other_Plans: $274.90 Blue_Cross — Capital_Blue_Performance_PPO: $194 Blue_Cross — Capital_Cares_4_kids: $192.43 Blue_Cross_BlueJourney_Medicare — All_Plans: $75.15
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) In the file: Screening Mammography	$427	$225	$272.51 – $341.60
Screening mammogram, both breasts: rates for 6 insurance plans Cigna — All_Plans: $272.51 Independence_Blue_Cross — All_Plans: $277.55 PHC — All_Plans: $303.17 Tower Health — All_Plans: $292.50 UPMC — Employees_And_Dependents: $341.60 UPMC — UPMC_For_Kids: $341.60

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Physical Therapy, Each 15 Minutes	$246	$196.80	$27.47 – $231.98
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 43 insurance plan rates Aetna — All_Plans: $190.40 Aetna_Advantra_Medicare — All_Plans: $27.75 Aetna_Better_Health_Kids — All_Plans: $28.49 Aetna_Medicare — All_Plans: $27.75 Amerihealth_Caritas_Medicaid — All_Plans: $56.80 Amerihealth_Medicare — All_Plans: $27.75 Blue_Cross — All_Other_Plans: $158.37 Blue_Cross — Capital_Blue_Performance_PPO: $158.37 Blue_Cross — Capital_Cares_4_kids: $110.86 Blue_Cross_BlueJourney_Medicare — All_Plans: $43.30
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Occupational Therapy, Each 15 Minutes	$276	$220.80	$27.47 – $260.27
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 43 insurance plan rates Aetna — All_Plans: $213.62 Aetna_Advantra_Medicare — All_Plans: $27.75 Aetna_Better_Health_Kids — All_Plans: $28.49 Aetna_Medicare — All_Plans: $27.75 Amerihealth_Caritas_Medicaid — All_Plans: $56.80 Amerihealth_Medicare — All_Plans: $27.75 Blue_Cross — All_Other_Plans: $177.69 Blue_Cross — Capital_Blue_Performance_PPO: $177.69 Blue_Cross — Capital_Cares_4_kids: $124.38 Blue_Cross_BlueJourney_Medicare — All_Plans: $48.58
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) In the file: Physical Therapy, Each 15 Minutes	$246	$196.80	$157 – $196.80
Physical therapy: therapeutic exercise (each 15 minutes): rates for 6 insurance plans Cigna — All_Plans: $157 Independence_Blue_Cross — All_Plans: $159.90 PHC — All_Plans: $174.66 Tower Health — All_Plans: $168.51 UPMC — Employees_And_Dependents: $196.80 UPMC — UPMC_For_Kids: $196.80
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: Evaluation for Physical Therapy, Typically 20 Minutes	$580	$464	$56.80 – $546.94
Physical therapy evaluation (low complexity): 10 of 43 insurance plan rates Aetna — All_Plans: $448.92 Aetna_Advantra_Medicare — All_Plans: $94.49 Aetna_Better_Health_Kids — All_Plans: $216.27 Aetna_Medicare — All_Plans: $94.49 Amerihealth_Caritas_Medicaid — All_Plans: $56.80 Amerihealth_Medicare — All_Plans: $94.49 Blue_Cross — All_Other_Plans: $373.40 Blue_Cross — Capital_Blue_Performance_PPO: $373.40 Blue_Cross — Capital_Cares_4_kids: $261.38 Blue_Cross_BlueJourney_Medicare — All_Plans: $102.08
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) In the file: Evaluation for Physical Therapy, Typically 20 Minutes	$580	$464	$370.16 – $464
Physical therapy evaluation (low complexity): rates for 6 insurance plans Cigna — All_Plans: $370.16 Independence_Blue_Cross — All_Plans: $377 PHC — All_Plans: $411.80 Tower Health — All_Plans: $397.30 UPMC — Employees_And_Dependents: $464 UPMC — UPMC_For_Kids: $464
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: Evaluation for Physical Therapy, Typically 30 Minutes	$632	$505.60	$56.80 – $595.98
Physical therapy evaluation (moderate complexity): 10 of 43 insurance plan rates Aetna — All_Plans: $489.17 Aetna_Advantra_Medicare — All_Plans: $94.49 Aetna_Better_Health_Kids — All_Plans: $216.27 Aetna_Medicare — All_Plans: $94.49 Amerihealth_Caritas_Medicaid — All_Plans: $56.80 Amerihealth_Medicare — All_Plans: $94.49 Blue_Cross — All_Other_Plans: $406.88 Blue_Cross — Capital_Blue_Performance_PPO: $406.88 Blue_Cross — Capital_Cares_4_kids: $284.82 Blue_Cross_BlueJourney_Medicare — All_Plans: $111.23
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) In the file: Evaluation for Physical Therapy, Typically 30 Minutes	$632	$505.60	$403.34 – $505.60
Physical therapy evaluation (moderate complexity): rates for 6 insurance plans Cigna — All_Plans: $403.34 Independence_Blue_Cross — All_Plans: $410.80 PHC — All_Plans: $448.72 Tower Health — All_Plans: $432.92 UPMC — Employees_And_Dependents: $505.60 UPMC — UPMC_For_Kids: $505.60
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: Evaluation for Physical Therapy, Typically 45 Minutes	$668	$534.40	$56.80 – $629.92
Physical therapy evaluation (high complexity): 10 of 43 insurance plan rates Aetna — All_Plans: $517.03 Aetna_Advantra_Medicare — All_Plans: $94.49 Aetna_Better_Health_Kids — All_Plans: $216.27 Aetna_Medicare — All_Plans: $94.49 Amerihealth_Caritas_Medicaid — All_Plans: $56.80 Amerihealth_Medicare — All_Plans: $94.49 Blue_Cross — All_Other_Plans: $430.06 Blue_Cross — Capital_Blue_Performance_PPO: $430.06 Blue_Cross — Capital_Cares_4_kids: $301.04 Blue_Cross_BlueJourney_Medicare — All_Plans: $117.57
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) In the file: Evaluation for Physical Therapy, Typically 45 Minutes	$668	$534.40	$426.32 – $534.40
Physical therapy evaluation (high complexity): rates for 6 insurance plans Cigna — All_Plans: $426.32 Independence_Blue_Cross — All_Plans: $434.20 PHC — All_Plans: $474.28 Tower Health — All_Plans: $457.58 UPMC — Employees_And_Dependents: $534.40 UPMC — UPMC_For_Kids: $534.40

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: Removal of growth and tissue of breast, duct, or nipple	Not listed in the file	Not listed in the file	$970 – $16,959.39
Removal of breast growth (open surgery): 10 of 42 insurance plan rates Aetna — All_Plans: $10,638 Aetna_Advantra_Medicare — All_Plans: $3,809.27 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $3,809.27 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $3,901.73 Devoted_Medicare — All_Plans: $3,883.24 Geisinger_Gold_Medicare — All_Plans: $3,883.24 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: Replacement of thigh bone and hip joint with prosthesis	Not listed in the file	Not listed in the file	$970 – $56,985.44
Total hip replacement: 10 of 42 insurance plan rates Aetna — All_Plans: $15,634 Aetna_Advantra_Medicare — All_Plans: $12,799.57 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $12,799.57 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $13,110.24 Blue_Cross — Capital_Blue_Performance_PPO: $20,845 Devoted_Medicare — All_Plans: $13,048.11 Geisinger_Gold_Medicare — All_Plans: $13,048.11 Geisinger_Medicaid — All_Plans: $970
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: Replacement of knee joint, both sides of knee	Not listed in the file	Not listed in the file	$970 – $56,985.44
Total knee replacement: 10 of 42 insurance plan rates Aetna — All_Plans: $15,634 Aetna_Advantra_Medicare — All_Plans: $12,799.57 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $12,799.57 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $13,110.24 Blue_Cross — Capital_Blue_Performance_PPO: $20,845 Devoted_Medicare — All_Plans: $13,048.11 Geisinger_Gold_Medicare — All_Plans: $13,048.11 Geisinger_Medicaid — All_Plans: $970
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) rele	Not listed in the file	Not listed in the file	$970 – $31,638.62
Shoulder arthroscopy: shaving of shoulder bone: 10 of 39 insurance plan rates Aetna — All_Plans: $10,638 Aetna_Better_Health_Kids — All_Plans: $6,420 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Devoted_Medicare — All_Plans: $7,244.38 Geisinger_Gold_Medicare — All_Plans: $7,244.38 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970 Health_Partners_Medicaid — Kidz_Partners: $6,899.41 Highmark — All_Other_Plans: $31,638.62 Highmark — Blue_Cross_High_Performance_Network: $26,259.84
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: Removal of knee cartilage using an endoscope	Not listed in the file	Not listed in the file	$970 – $14,369.93
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 42 insurance plan rates Aetna — All_Plans: $12,504 Aetna_Advantra_Medicare — All_Plans: $3,227.65 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $3,227.65 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $3,305.99 Devoted_Medicare — All_Plans: $3,290.32 Geisinger_Gold_Medicare — All_Plans: $3,290.32 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: Removal of tonsils and adenoid glands (younger than 12 years)	Not listed in the file	Not listed in the file	$970 – $26,199.66
Removal of tonsils and adenoids (under age 12): 10 of 42 insurance plan rates Aetna — All_Plans: $10,638 Aetna_Advantra_Medicare — All_Plans: $5,884.74 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $5,884.74 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $6,027.57 Devoted_Medicare — All_Plans: $5,999.01 Geisinger_Gold_Medicare — All_Plans: $5,999.01 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope	Not listed in the file	Not listed in the file	$905.50 – $6,420
Upper GI endoscopy (diagnostic): 10 of 42 insurance plan rates Aetna — All_Plans: $5,627 Aetna_Advantra_Medicare — All_Plans: $932.67 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $932.67 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $955.30 Devoted_Medicare — All_Plans: $950.78 Geisinger_Gold_Medicare — All_Plans: $950.78 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	Not listed in the file	Not listed in the file	$905.50 – $9,629
Upper GI endoscopy with biopsy: 10 of 42 insurance plan rates Aetna — All_Plans: $8,754 Aetna_Advantra_Medicare — All_Plans: $932.67 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $932.67 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $955.30 Devoted_Medicare — All_Plans: $950.78 Geisinger_Gold_Medicare — All_Plans: $950.78 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Diagnostic exam of large bowel using a flexible endoscope	Not listed in the file	Not listed in the file	$440.26 – $9,629
Colonoscopy (diagnostic): 10 of 42 insurance plan rates Aetna — All_Plans: $8,754 Aetna_Advantra_Medicare — All_Plans: $453.47 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $453.47 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $464.47 Devoted_Medicare — All_Plans: $462.27 Geisinger_Gold_Medicare — All_Plans: $462.27 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Biopsy of large bowel using a flexible endoscope	Not listed in the file	Not listed in the file	$970 – $9,629
Colonoscopy with biopsy: 10 of 42 insurance plan rates Aetna — All_Plans: $8,754 Aetna_Advantra_Medicare — All_Plans: $1,172.92 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $1,172.92 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $1,201.39 Devoted_Medicare — All_Plans: $1,195.70 Geisinger_Gold_Medicare — All_Plans: $1,195.70 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Removal of polyps or growths of large bowel using an endoscope with mechanical snare	Not listed in the file	Not listed in the file	$569.38 – $9,629
Colonoscopy with removal of polyps (snare): 10 of 42 insurance plan rates Aetna — All_Plans: $8,754 Aetna_Advantra_Medicare — All_Plans: $586.46 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $586.46 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $600.70 Devoted_Medicare — All_Plans: $597.85 Geisinger_Gold_Medicare — All_Plans: $597.85 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: Removal of gallbladder using an endoscope	Not listed in the file	Not listed in the file	$970 – $25,839.59
Gallbladder removal by laparoscope: 10 of 42 insurance plan rates Aetna — All_Plans: $14,381 Aetna_Advantra_Medicare — All_Plans: $5,803.86 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $5,803.86 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $5,944.74 Devoted_Medicare — All_Plans: $5,916.56 Geisinger_Gold_Medicare — All_Plans: $5,916.56 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: Repair of groin hernia (5 years or older)	Not listed in the file	Not listed in the file	$970 – $15,629.76
Groin (inguinal) hernia repair, age 5 or older: 10 of 42 insurance plan rates Aetna — All_Plans: $12,504 Aetna_Advantra_Medicare — All_Plans: $3,510.62 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $3,510.62 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $3,595.83 Devoted_Medicare — All_Plans: $3,578.79 Geisinger_Gold_Medicare — All_Plans: $3,578.79 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: Biopsy of Prostate Gland	Not listed in the file	Not listed in the file	$970 – $9,629
Prostate biopsy: 10 of 42 insurance plan rates Aetna — All_Plans: $8,754 Aetna_Advantra_Medicare — All_Plans: $2,037.80 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $2,037.80 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $2,087.26 Devoted_Medicare — All_Plans: $2,077.37 Geisinger_Gold_Medicare — All_Plans: $2,077.37 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: Biopsy of Lining of Uterus and/or Removal of Polyp Using an Endoscope	Not listed in the file	Not listed in the file	$970 – $14,081.72
Hysteroscopy with biopsy of the uterus lining: 10 of 42 insurance plan rates Aetna — All_Plans: $10,638 Aetna_Advantra_Medicare — All_Plans: $3,162.91 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $3,162.91 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $3,239.68 Devoted_Medicare — All_Plans: $3,224.33 Geisinger_Gold_Medicare — All_Plans: $3,224.33 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: Injection of Substance Into Lower Spine Canal Using Imaging Guidance	$2,900	$2,320	$101.65 – $6,190
Spinal injection, lower back (epidural), with imaging guidance: 10 of 43 insurance plan rates Aetna — All_Plans: $5,627 Aetna_Advantra_Medicare — All_Plans: $688.91 Aetna_Better_Health_Kids — All_Plans: $276.49 Aetna_Medicare — All_Plans: $688.91 Amerihealth_Caritas_Medicaid — All_Plans: $115.47 Amerihealth_Medicare — All_Plans: $705.63 Blue_Cross — All_Other_Plans: $1,867.02 Blue_Cross — Capital_Blue_Performance_PPO: $1,867.02 Blue_Cross — Capital_Cares_4_kids: $1,306.91 Blue_Cross_BlueJourney_Medicare — All_Plans: $510.40
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) In the file: Injection of Substance Into Lower Spine Canal Using Imaging Guidance	$2,900	$2,320	$1,850.78 – $2,320
Spinal injection, lower back (epidural), with imaging guidance: rates for 6 insurance plans Cigna — All_Plans: $1,850.78 Independence_Blue_Cross — All_Plans: $1,885 PHC — All_Plans: $2,059 Tower Health — All_Plans: $1,986.50 UPMC — Employees_And_Dependents: $2,320 UPMC — UPMC_For_Kids: $2,320
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: Inject Anesthetic/Steroid Sacral Spine Nerve W Image Guide, Single Level	$3,984	$3,187.20	$118.80 – $3,942.97
Nerve root injection, lower back, with imaging guidance: 10 of 43 insurance plan rates Aetna — All_Plans: $3,083.62 Aetna_Advantra_Medicare — All_Plans: $885.64 Aetna_Better_Health_Kids — All_Plans: $323.14 Aetna_Medicare — All_Plans: $885.64 Amerihealth_Caritas_Medicaid — All_Plans: $134.96 Amerihealth_Medicare — All_Plans: $907.13 Blue_Cross — All_Other_Plans: $2,564.90 Blue_Cross — Capital_Blue_Performance_PPO: $2,564.90 Blue_Cross — Capital_Cares_4_kids: $1,795.43 Blue_Cross_BlueJourney_Medicare — All_Plans: $701.18
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) In the file: Inject Anesthetic/Steroid Sacral Spine Nerve W Image Guide, Single Level	$3,984	$3,187.20	$2,542.59 – $3,187.20
Nerve root injection, lower back, with imaging guidance: rates for 6 insurance plans Cigna — All_Plans: $2,542.59 Independence_Blue_Cross — All_Plans: $2,589.60 PHC — All_Plans: $2,828.64 Tower Health — All_Plans: $2,729.04 UPMC — Employees_And_Dependents: $3,187.20 UPMC — UPMC_For_Kids: $3,187.20
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: Release and/or relocation of hand nerve	Not listed in the file	Not listed in the file	$970 – $9,629
Carpal tunnel release: 10 of 42 insurance plan rates Aetna — All_Plans: $8,754 Aetna_Advantra_Medicare — All_Plans: $1,942.57 Aetna_Better_Health_Kids — All_Plans: $6,420 Aetna_Medicare — All_Plans: $1,942.57 Amerihealth_Caritas_Medicaid — All_Plans: $1,101.92 Amerihealth_Medicare — All_Plans: $1,989.72 Devoted_Medicare — All_Plans: $1,980.29 Geisinger_Gold_Medicare — All_Plans: $1,980.29 Geisinger_Medicaid — All_Plans: $970 Health_Partners_Medicaid — All_Other_Plans: $970

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: Major joint replacement or reattachment of lower extremity	Not listed in the file	Not listed in the file	$13,094.19 – $50,554.54
Hip or knee replacement (major joint of the leg), without major complications: 10 of 35 insurance plan rates Aetna — All_Plans: $45,957.97 Aetna_Advantra_Medicare — All_Plans: $13,353.48 Aetna_Medicare — All_Plans: $13,353.48 Amerihealth_Medicare — All_Plans: $13,677.59 Blue_Cross — All_Other_Plans: $29,127 Blue_Cross — Capital_Blue_Performance_PPO: $20,845 Blue_Cross — Capital_Cares_4_kids: $20,388.90 Blue_Cross_BlueJourney_Medicare — All_Plans: $13,301.62 Devoted_Medicare — All_Plans: $13,612.77 Geisinger — All_Plans: $46,004.67
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: Cervical spinal fusion	Not listed in the file	Not listed in the file	$16,572.57 – $63,984.03
Neck (cervical) spinal fusion, without complications: 10 of 35 insurance plan rates Aetna — All_Plans: $58,166.41 Aetna_Advantra_Medicare — All_Plans: $16,900.74 Aetna_Medicare — All_Plans: $16,900.74 Amerihealth_Medicare — All_Plans: $17,310.96 Blue_Cross — All_Other_Plans: $29,127 Blue_Cross — Capital_Blue_Performance_PPO: $20,946 Blue_Cross — Capital_Cares_4_kids: $20,388.90 Blue_Cross_BlueJourney_Medicare — All_Plans: $16,835.11 Devoted_Medicare — All_Plans: $17,228.91 Geisinger — All_Plans: $58,225.53
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: Uterine and adnexa procedures for non-malignancy	Not listed in the file	Not listed in the file	$8,422.40 – $32,517.51
Uterus and ovary surgery (not for cancer), without complications: 10 of 35 insurance plan rates Aetna — All_Plans: $29,560.92 Aetna_Advantra_Medicare — All_Plans: $8,589.18 Aetna_Medicare — All_Plans: $8,589.18 Amerihealth_Medicare — All_Plans: $8,797.66 Blue_Cross — All_Other_Plans: $29,127 Blue_Cross — Capital_Blue_Performance_PPO: $20,946 Blue_Cross — Capital_Cares_4_kids: $20,388.90 Blue_Cross_BlueJourney_Medicare — All_Plans: $8,555.82 Devoted_Medicare — All_Plans: $8,755.96 Geisinger — All_Plans: $29,590.98

Source: WellSpan Ephrata Community Hospital’s standard charges file (edge.sitecorecloud.io, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	169 Martin Avenue, Ephrata, PA 17522
County	Lancaster County
State	Pennsylvania
Phone	(717) 733‑0311
Emergency services	Yes
Ownership	Voluntary non-profit - Other
Medicare overall rating	5 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	390225
Name in Medicare records	WELLSPAN EPHRATA COMMUNITY HOSPITAL
Profile level	Medicare data + hospital website
Official website	wellspan.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

WellSpan Ephrata Community Hospital - WellSpan Health — wellspan.org
Visitor Information - WellSpan Health — wellspan.org
WellSpan Ephrata Community Hospital Maternity - WellSpan Health — wellspan.org
WellSpan Ephrata Community Hospital Maternity - WellSpan Health — wellspan.org
Awards and Recognitions - WellSpan Health — wellspan.org
https://www.wellspan.org/articles/2026/10/26/18/48/7-wellspan-hospitals-earn-national-quality-awards — wellspan.org
Visitor Information - WellSpan Health — wellspan.org