CMS Price Transparency Data

Ultrasound, pelvis

Facility: Wellspan Ephrata Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $377
Cash Discount Price: $518
vs. Medicare Baseline: 3.53x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Wellspan Ephrata Community Hospital is $377. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $518. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.53x the Medicare baseline. Located in 169 Martin Avenue, Ephrata, PA.

Cash / Self-Pay

$518

Average discount available for prompt cash payment at this facility.

Insurance Median

$377

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $518 (485%)

Insurance Median: $377 (353%)

Cash: $518 (485% of Medicare)

Ins. Median: $377 (353% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 353% of the Medicare baseline (a markup of 253%). 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	$58 - $180	54%
Medicare (plans)	$104 - $114	97%
Aetna	$106 - $501	99%
Highmark	$159 - $471	149%
Wellspan_Capital_Blue_Cross	$200	187%
Blue_Cross	$292 - $417	273%
Cigna	$349 - $413	327%
Geisinger	$421	394%
Independence_Blue_Cross	$421	394%
Tower Health	$421 - $443	394%
Upmc	$421 - $518	394%
Phc	$453 - $459	424%
First_Health_Network	$551	516%
United_Healthcare	$602	564%

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 $518.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

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 76856.
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.