CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Wellspan Ephrata Community Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $374
Cash Discount Price: $468
vs. Medicare Baseline: 2.76x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Wellspan Ephrata Community Hospital is $374. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $468. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.76x the Medicare baseline. Located in 169 Martin Avenue, Ephrata, PA.

Cash / Self-Pay

$468

Average discount available for prompt cash payment at this facility.

Insurance Median

$374

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $468 (345%)

Insurance Median: $374 (276%)

Cash: $468 (345% of Medicare)

Ins. Median: $374 (276% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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 276% of the Medicare baseline (a markup of 176%). 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
Medicare (plans)	$40 - $228	29%
Medicaid / KanCare	$50 - $388	37%
Aetna	$136	100%
Cigna	$146 - $825	108%
Wellspan_Capital_Blue_Cross	$146 - $828	108%
Geisinger	$148 - $840	109%
Independence_Blue_Cross	$148 - $840	109%
Tower Health	$148 - $886	109%
Upmc	$148 - $1,034	109%
Phc	$160 - $918	118%
Highmark	$193 - $571	142%
United_Healthcare	$215 - $1,219	159%

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 $468.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.