CMS Price Transparency Data

Blood antibody screen

Facility: Wellspan Ephrata Community Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $111
Cash Discount Price: $209
vs. Medicare Baseline: 2.08x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Wellspan Ephrata Community Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 2.08x the Medicare baseline. Located in 169 Martin Avenue, Ephrata, PA.

Cash / Self-Pay

$209

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$53.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $53.24 (100%)

Cash / Self-Pay: $209 (393%)

Insurance Median: $111 (208%)

Cash: $209 (393% of Medicare)

Ins. Median: $111 (208% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $53.24 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 208% of the Medicare baseline (a markup of 108%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medicaid / KanCare	$8 - $85	15%
Aetna	$29 - $53	54%
United_Healthcare	$29	54%
First_Health_Network	$44	83%
Medicare (plans)	$46 - $56	86%
Highmark	$80 - $237	150%
Phc	$104 - $185	195%
Blue_Cross	$118 - $168	222%
Cigna	$167 - $218	314%
Wellspan_Capital_Blue_Cross	$167	314%
Geisinger	$170	319%
Independence_Blue_Cross	$170	319%
Tower Health	$170 - $179	319%
Upmc	$170 - $209	319%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $209.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86850.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Wellspan Ephrata Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86850.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.