How many shoppable procedure prices are published for Wellspan Ephrata Community Hospital?

Wellspan Ephrata Community Hospital in Ephrata, PA currently has 101 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Wellspan Ephrata Community Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Wellspan Ephrata Community Hospital's median negotiated commercial rate is 3.0× the regionally adjusted fair BaseRate benchmark.

What is Wellspan Ephrata Community Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns Wellspan Ephrata Community Hospital an overall hospital quality rating of 5 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Other 115 Beds · rural Updated: 1/1/2026

Wellspan Ephrata Community Hospital

169 Martin Avenue, Ephrata, PA 17522 · 101 Priced Procedures · 65% Patient Recommendation

CMS Overall Rating 5 / 5 Stars

High Markup · Shop Alternatives

3.01×vs. Fair Market Price

Typical commercial prices here are +201% above the fair benchmark (3.01×) even after accounting for local nurse/doctor wages and patient complexity.

77/100 · Corroborated

77/100Self-Pay Cash Beats Insurance 35% of the Time

File Completeness100

Price Logic52

Peer Alignment79

Clean Billing63

Real Cash Discount100

High-Markup · Check Safety

3-Star CMS clinical quality rating paired with 3.01× fair market pricing.

Behavioral Pricing FingerprintHigh-HHI Market Leverage

Consolidated System Premium Pricer

Operating in a concentrated regional market (CBSA HHI 4,081), Wellspan Ephrata Community Hospital commands a 3.01× BaseRate commercial premium across insurers. Self-pay cash quotes, in-state peer hospitals, and freestanding outpatient facilities offer critical leverage against consolidated system pricing.

#131 of 134 in PA · 97th State Percentile#3,338 of 3,385 in U.S. · 98th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 2.48× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 35% of shoppable procedures (99/100 Cash Honesty)
5-Star CMS clinical rating with 65% patient recommendation (65/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (47.2% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 2.6× markup over Medicare rates
Commercial insurance median sits at 2.98× Fair BaseRate (3.5× Medicare), so insured patients should always compare the self-pay cash price before paying.
Specialty infusion drugs (J-codes) average 1.4× Medicare — verify per-unit billing on itemized statements
Consolidated metro market (HHI 4,081) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

3.5× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER0.66× Divergence

2.3× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+12% Upper Tail

Q25 2.48× · Q50 2.98× · Q75 3.35×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

3.5× MedicareElevated

Outpatient Surgery & ORBack-Door Captive

2.6× MedicareFair

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

2.8× MedicareFair

Back-Door Captive ER VisitsBack-Door Captive

2.8× MedicareFair

Inpatient Lab & PathologyBack-Door Captive

1.9× MedicareGood

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

1.4× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

35% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

5 CMS · 65/100Fair

Procedure Prices at Wellspan Ephrata Community Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 101 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Total hip replacement CPT Code: `27130`	—	$45,589	$13,413	unverified
Total knee replacement CPT Code: `27447`	—	$45,589	$13,523	unverified
Spinal fusion, single level (inpatient stay) MS-DRG Code: `451`	—	$44,619	$30,775	1.4×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$38,561	$17,936	2.1×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$30,650	$19,087	1.6×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$26,365	$19,432	1.4×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$20,672	$6,109	3.4×
Breast lump removal CPT Code: `19120`	—	$13,568	$3,875	3.5×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$12,534	$8,223	1.5×
Inguinal hernia repair CPT Code: `49505`	—	$12,504	$3,629	3.4×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$11,496	$3,372	3.4×
Bunion correction surgery CPT Code: `28296`	—	$11,496	$3,446	unverified
Colonoscopy with biopsy CPT Code: `45380`	—	$4,334	$1,256	3.5×
Upper endoscopy with biopsy CPT Code: `43239`	—	$3,446	$987	3.5×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$3,438	$2,016	$583	3.5×
Colonoscopy (diagnostic) CPT Code: `45378`	—	$1,676	$981	1.7×
Blood transfusion CPT Code: `36430`	$1,714	$1,549	$498	3.1×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$438	$1,265	$448	2.8×
MRI, brain (with and without contrast) CPT Code: `70553`	$702	$1,265	$511	2.5×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$994	$856	$272	3.1×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$243	$856	$303	2.8×
MRI, lower back (no contrast) CPT Code: `72148`	$454	$864	$338	2.6×
MRI, brain (no contrast) CPT Code: `70551`	$455	$872	$343	2.5×
MRI, knee or other leg joint CPT Code: `73721`	$462	$872	$369	2.4×
CT scan, head (with and without contrast) CPT Code: `70470`	$569	$631	$258	2.4×
CT scan, head (with contrast) CPT Code: `70460`	$478	$631	$242	unverified
Office visit, established patient (30-39 min) CPT Code: `99214`	$468	$465	$123	3.8×
Office visit, established patient (20-29 min) CPT Code: `99213`	$534	$465	$87	unverified
Speech therapy (language evaluation) CPT Code: `92507`	$413	$413	$86	unverified
X-ray, lower back CPT Code: `72110`	$663	$377	$112	3.4×
Ultrasound, abdomen (limited) CPT Code: `76705`	$875	$377	$126	3.0×
Ultrasound, pelvis CPT Code: `76856`	$518	$377	$130	2.9×
Ultrasound, thyroid and neck CPT Code: `76536`	$1,031	$377	$132	2.9×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$208	$375	$148	2.5×
CT scan, head (no contrast) CPT Code: `70450`	$296	$384	$160	2.4×
CT scan, pelvis CPT Code: `72192`	$281	$380	$163	2.3×
CT scan, sinuses CPT Code: `70486`	$295	$384	$166	2.3×
CT scan, chest (no contrast) CPT Code: `71250`	$285	$384	$167	2.3×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$286	$384	$168	2.3×
CT scan, neck (cervical spine) CPT Code: `72125`	$282	$384	$169	2.3×
X-ray, pelvis CPT Code: `72170`	$316	$377	$110	unverified
Ultrasound, abdomen (complete) CPT Code: `76700`	$1,366	$377	$134	unverified
X-ray, chest (single view) CPT Code: `71045`	$293	$312	$92	3.4×
X-ray, shoulder CPT Code: `73030`	$398	$312	$92	3.4×
X-ray, chest (two views) CPT Code: `71046`	$322	$312	$93	3.4×
X-ray, hand CPT Code: `73130`	$370	$312	$93	3.4×
X-ray, hip CPT Code: `73502`	$630	$312	$93	3.4×
X-ray, ankle CPT Code: `73610`	$398	$312	$93	3.4×
Screening mammogram (both breasts) CPT Code: `77067`	$225	$310	$123	2.5×
X-ray, neck (cervical spine) CPT Code: `72040`	$484	$312	$93	unverified
X-ray, foot CPT Code: `73630`	$348	$312	$92	unverified
Breathing treatment (nebulizer) CPT Code: `94640`	$246	$246	$201	unverified
Orthotic fitting and training CPT Code: `97760`	$208	$208	$51	4.1×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$277	$210	$64	3.3×
New patient office visit (30-44 min) CPT Code: `99203`	$210	$210	$110	unverified
Hospital observation (per hour) HCPCS Code: `G0378`	$205	$205	$86	unverified
Physical therapy (gait training) CPT Code: `97116`	$149	$102	$33	3.1×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$211	$122	$40	3.0×
Occupational therapy (self-care training) CPT Code: `97535`	$137	$115	$38	3.0×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$208	$113	$38	3.0×
Speech therapy (group session) CPT Code: `92508`	$326	$83	$27	3.1×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$209	$102	$35	2.9×
Physical therapy (manual therapy) CPT Code: `97140`	$206	$96	$34	2.8×
Typhoid vaccine HCPCS Code: `90675`	$1,222	$1,222	$347	3.5×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$348	$364	$111	unverified
Drug screening test HCPCS Code: `G0480`	$188	$188	$116	unverified
Blood antibody screen CPT Code: `86850`	$209	$135	$46	2.9×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$301	$130	$56	2.3×
Blood test, vitamin D CPT Code: `82306`	$100	$100	$31	3.2×
Hepatitis B vaccine HCPCS Code: `90744`	$212	$104	$37	2.8×
Pneumonia vaccine injection HCPCS Code: `G0009`	$59	$59	$49	1.2×
Flu vaccine (high dose) HCPCS Code: `90656`	$114	$74	$25	unverified
Blood test, sodium CPT Code: `84295`	$26	$26	$5	5.2×
Blood test, clotting time (PTT) CPT Code: `85730`	$30	$30	$6	5.0×
Blood test, calcium CPT Code: `82310`	$22	$22	$5	4.4×
Blood test, magnesium CPT Code: `83735`	$30	$30	$7	4.3×
Culture, blood CPT Code: `87040`	$43	$43	$11	3.9×
Hepatitis C antibody test CPT Code: `86803`	$55	$55	$15	3.7×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$17	$17	$4	4.3×
Culture, bacterial CPT Code: `87070`	$36	$36	$9	4.0×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$45	$45	$20	2.3×
Flu vaccine injection HCPCS Code: `G0008`	$58	$58	$48	1.2×
Blood test, glucose (blood sugar) CPT Code: `82947`	$15	$15	$4	3.8×
Blood test, amylase CPT Code: `82150`	$26	$26	$7	3.7×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$15	$15	$5	3.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$40	$40	$14	2.9×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$10	$10	$3	3.3×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$25	$25	$11	2.3×
Blood test, basic metabolic panel CPT Code: `80048`	$20	$20	$9	2.2×
Blood test, thyroid (TSH) CPT Code: `84443`	$40	$40	$18	2.2×
Colorectal cancer screening HCPCS Code: `G0010`	$23	$23	$49	0.5×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$40	$40	$14	unverified
Blood test, liver function panel CPT Code: `80076`	$25	$25	$9	unverified
Blood test, creatinine (kidney) CPT Code: `82565`	$15	$15	$5	unverified
Blood test, vitamin B12 CPT Code: `82607`	$40	$40	$16	unverified
Blood test, average blood sugar (A1c) CPT Code: `83036`	$25	$25	$10	unverified
Blood test, lipase CPT Code: `83690`	$28	$28	$7	unverified
Blood test, potassium CPT Code: `84132`	$26	$26	$5	unverified
Blood test, PSA (prostate screen) CPT Code: `84153`	$45	$45	$19	unverified
Blood test, hemoglobin CPT Code: `85018`	$14	$14	$3	unverified
Blood test, complete blood count (CBC) CPT Code: `85025`	$15	$15	$8	unverified

Showing top 25 high-impact procedures of 101 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 47.1%

Audit a Bill or Quote at Wellspan Ephrata Community Hospital (Zero PHI Required)

CMS CCN: 390225

CPT 27130

Select Procedure to Audit:

Fair BaseRate™ $13,413

Medicare Rate $13,117

Self-Pay Cash Request Quote

Insurer Median $45,589

1. Amount on Your Bill or Quote ($) Pre-filled with Wellspan Ephrata Community Hospital’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $51,589 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $51,589

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (47.1% of gross = $51,589).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Wellspan Ephrata Community Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$96,001 Above Fair BaseRate

Negotiate Toward $13,413 Fair BaseRate ($13,117 Medicare)

Your bill ($109,414) is $96,001 above the denoised Fair BaseRate ($13,413) and 8.3× the $13,117 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

EIN: 231370484

Filing Period: 194904

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (47.1% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Safety Composite65/100

Would Recommend65%

Rated 9 or 10 (HCAHPS)67%

Median ER Wait190 min

Left ER Before Seen1%

30-Day Mortality vs U.S.same

Unplanned Readmissionbetter

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionsame

C. diff Hospital-Onset Infectionsame

Source: CMS Hospital Care Compare (457 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Above-Benchmark Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Wellspan Ephrata Community Hospital.

Price Index: 1.54× regional baseline

Quality: 62/100 CMS composite

Median Household Income$83,703U.S. Census ACS

Local Uninsured Share11.0%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 77/100 · Corroborated CMS CCN 390225 EIN 231370484

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 390225) ↗ Verify IRS Form 990 (EIN 231370484) ↗ CMS HCRIS Cost Reports ↗

Published MRF File231370484_ephrata-community-hospital_standardcharges.csv

Publication / Vintage1/1/2026 · 40.14 MB

Validated Rate Rows2,609 (CMS v3.0.0)

File Integrity Digesteff5b3f612a0499b383a…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy