ARH Our Lady of the Way Hospital
11203 Main Street, Martin, KY · Arh · · NPI 1306339460
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Abdominal CT scan (with and without contrast) CPT 74170 | $2,256.60 | $3,761.00 | $542.00 – $542.00 | 2 |
| Abdominal CT scan (with contrast) CPT 74160 | $1,892.40 | $3,154.00 | $542.00 – $542.00 | 2 |
| Abdominal CT scan (without contrast) CPT 74150 | $1,533.00 | $2,555.00 | $542.00 – $542.00 | 2 |
| Abdominal MRI (with and without contrast) CPT 74183 | $2,667.00 | $4,445.00 | $760.00 – $760.00 | 2 |
| Abdominal MRI (without contrast) CPT 74181 | $2,166.60 | $3,611.00 | $760.00 – $760.00 | 2 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $49.20 | $82.00 | $0.06 – $0.06 | 2 |
| Acetaminophen level CPT 80143 | $34.20 | $57.00 | $18.64 – $18.64 | 5 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $138.60 | $231.00 | $20.31 – $20.31 | 2 |
| Acetylcholine receptor modulating antibody CPT 86043 | $255.00 | $425.00 | $12.05 – $12.05 | 5 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $37.80 | $63.00 | $0.04 – $0.04 | 2 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $1.20 | $2.00 | $1.06 – $1.06 | 2 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $257.40 | $429.00 | $62.59 – $62.59 | 2 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $88.80 | $148.00 | $5.78 – $5.78 | 5 |
| Albumin serum plasma or whole blood CPT 82040 | $64.20 | $107.00 | $4.95 – $4.95 | 5 |
| Alkaline phosphatase CPT 84075 | $57.60 | $96.00 | $5.18 – $5.18 | 5 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $1,313.47 | $2,189.12 | $177.28 – $177.28 | 2 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $284.00 | $473.34 | $109.19 – $109.19 | 2 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $380.73 | $634.55 | $285.23 – $285.23 | 2 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $32,310.00 | $53,850.00 | $111.03 – $111.03 | 2 |
| Alt/sgpt CPT 84460 | $89.40 | $149.00 | $5.30 – $5.30 | 5 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $154.80 | $258.00 | $3.08 – $3.08 | 2 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $7.80 | $13.00 | $0.60 – $0.60 | 2 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $23.40 | $39.00 | $0.58 – $0.58 | 2 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $55.20 | $92.00 | $1.76 – $1.76 | 2 |
| Amylase CPT 82150 | $73.20 | $122.00 | $6.48 – $6.48 | 5 |
| Angiotensin ii 0.5 mg/ml soln 1 ml vial HCPCS J3490 | $23.40 | $39.00 | $0.01 – $0.01 | 2 |
| Appl modality 1/> areas paraffin bath 97018 CPT 97018 | $115.20 | $192.00 | $10.28 – $10.28 | 2 |
| Assay of interleukin-6 (il-6) CPT 83529 | $86.40 | $144.00 | $17.27 – $17.27 | 5 |
| Ast/sgot CPT 84450 | $89.40 | $149.00 | $5.18 – $5.18 | 5 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | $30.60 | $51.00 | $0.08 – $0.08 | 2 |
| Azithromycin 500 mg intravenous solution HCPCS J0456 | $25.20 | $42.00 | $3.09 – $3.09 | 2 |
| Aztreonam 1 gram solution for injection HCPCS J0457 | $145.80 | $243.00 | $3.14 – $3.14 | 2 |
| Bilirubin total CPT 82247 | $89.40 | $149.00 | $5.02 – $5.02 | 5 |
| Blood Clotting (PT/INR) Test CPT 85610 | $55.20 | $92.00 | $4.29 – $4.29 | 5 |
| Blood Count (CBC) Test CPT 85025 | $82.20 | $137.00 | $7.77 – $7.77 | 5 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $37.80 | $63.00 | $15.92 – $15.92 | 5 |
| Blood occult peroxidase activity qualitative gastric CPT 82271 | $22.80 | $38.00 | $5.32 – $5.32 | 5 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $24.60 | $41.00 | $17.03 – $17.03 | 5 |
| Brain MRA (blood vessel MRI, without contrast) CPT 70544 | $2,646.60 | $4,411.00 | $760.00 – $760.00 | 2 |
| Brain MRI (with and without contrast) CPT 70553 | $4,602.60 | $7,671.00 | $760.00 – $760.00 | 2 |
| Brain MRI (without contrast) CPT 70551 | $3,205.20 | $5,342.00 | $760.00 – $760.00 | 2 |
| Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr HCPCS J1939 | $13.80 | $23.00 | $0.71 – $0.71 | 2 |
| Bupivacaine 0.1 % epidural pca - 1 hour dose limit HCPCS J0665 | $11.40 | $19.00 | $0.01 – $0.01 | 2 |
| Calcium gluconate 100 mg/ml (10 %) intravenous solution HCPCS J0612 | $41.40 | $69.00 | $0.05 – $0.05 | 2 |
| Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution HCPCS J0613 | $153.00 | $255.00 | $0.09 – $0.09 | 2 |
| Calcium ionized CPT 82330 | $218.40 | $364.00 | $13.68 – $13.68 | 5 |
| Calcium total CPT 82310 | $20.40 | $34.00 | $5.16 – $5.16 | 5 |
| Carbamazepine free -sendout CPT 80161 | $87.00 | $145.00 | $18.64 – $18.64 | 5 |
| Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr HCPCS J0690 | $24.00 | $40.00 | $0.99 – $0.99 | 2 |
| Cefepime 1 gram solution for injection HCPCS J0692 | $34.20 | $57.00 | $1.45 – $1.45 | 2 |
| Ceftriaxone 1 gram solution for injection HCPCS J0696 | $3.90 | $6.50 | $0.56 – $0.56 | 2 |
| Chest CT scan (with and without contrast) CPT 71270 | $2,899.80 | $4,833.00 | $542.00 – $542.00 | 2 |
| Chest CT scan (with contrast) CPT 71260 | $2,422.80 | $4,038.00 | $542.00 – $542.00 | 2 |
| Chest CT scan (without contrast) CPT 71250 | $1,773.00 | $2,955.00 | $542.00 – $542.00 | 2 |
| Cholesterol CPT 82465 | $130.80 | $218.00 | $4.35 – $4.35 | 5 |
| Cholesterol (Lipid) Test CPT 80061 | $114.00 | $190.00 | $13.39 – $13.39 | 5 |
| Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 | $58.80 | $98.00 | $1.98 – $1.98 | 2 |
| Covid-19 lab test non-cdc HCPCS U0002 | $93.00 | $155.00 | $51.31 – $51.31 | 5 |
| Creatine kinase CPT 82550 | $93.60 | $156.00 | $6.51 – $6.51 | 5 |
| Creatinine CPT 82565 | $20.40 | $34.00 | $5.12 – $5.12 | 5 |
| Creatinine 24 hour urine CPT 82570 | $89.40 | $149.00 | $5.18 – $5.18 | 5 |
| Crotalidae poly immune fab HCPCS J0840 | $10,873.20 | $18,122.00 | $2,194.74 – $2,194.74 | 2 |
| Cta abdomen without & /or w/contrast CPT 74175 | $2,098.20 | $3,497.00 | $542.00 – $542.00 | 2 |
| Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast CPT 75635 | $2,219.40 | $3,699.00 | $542.00 – $542.00 | 2 |
| Cta lower extremity without & w/contrast (both sides) CPT 73706 | $4,195.20 | $6,992.00 | $542.00 – $542.00 | 2 |
| Cta neck without &/or w/contrast CPT 70498 | $2,098.20 | $3,497.00 | $542.00 – $542.00 | 2 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $4,195.20 | $6,992.00 | $542.00 – $542.00 | 2 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $2,693.40 | $4,489.00 | $542.00 – $542.00 | 2 |
| CT Angiogram of the Head CPT 70496 | $2,098.20 | $3,497.00 | $542.00 – $542.00 | 2 |
| CT angio pelvis CPT 72191 | $2,098.20 | $3,497.00 | $542.00 – $542.00 | 2 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $2,098.20 | $3,497.00 | $542.00 – $542.00 | 2 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $4,135.80 | $6,893.00 | $542.00 – $542.00 | 2 |
| CT lower extremity without contrast (both sides) CPT 73700 | $3,175.20 | $5,292.00 | $542.00 – $542.00 | 2 |
| CT neck soft tissue w/contrast CPT 70491 | $2,067.60 | $3,446.00 | $542.00 – $542.00 | 2 |
| CT neck soft tissue without contrast CPT 70490 | $1,636.20 | $2,727.00 | $542.00 – $542.00 | 2 |
| CT neck soft tissue without & w/contrast CPT 70492 | $2,346.60 | $3,911.00 | $542.00 – $542.00 | 2 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $2,067.60 | $3,446.00 | $542.00 – $542.00 | 2 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $1,636.20 | $2,727.00 | $542.00 – $542.00 | 2 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $5,270.40 | $8,784.00 | $542.00 – $542.00 | 2 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $4,247.40 | $7,079.00 | $542.00 – $542.00 | 2 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $3,231.00 | $5,385.00 | $542.00 – $542.00 | 2 |
| CT thoracic spine without contrast CPT 72128 | $2,247.00 | $3,745.00 | $542.00 – $542.00 | 2 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $1,773.00 | $2,955.00 | $542.00 – $542.00 | 2 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,636.20 | $2,727.00 | $542.00 – $542.00 | 2 |
| Culture aerobic additional method definitive id each CPT 87077 | $110.40 | $184.00 | $8.08 – $8.08 | 5 |
| Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 | $25.80 | $43.00 | $218.06 – $218.06 | 5 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $24.00 | $40.00 | $1.11 – $1.11 | 2 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $116.40 | $194.00 | $0.04 – $0.04 | 2 |
| Deamidated gliadin antibody iga CPT 86258 | $11.40 | $19.00 | $12.05 – $12.05 | 5 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $4.20 | $7.00 | $0.03 – $0.03 | 2 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $5.40 | $9.00 | $0.14 – $0.14 | 2 |
| Diabetes (HbA1c) Test CPT 83036 | $80.40 | $134.00 | $9.71 – $9.71 | 5 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $567.60 | $946.00 | $120.00 – $120.00 | 2 |
| Diagnostic Mammogram (one breast) CPT 77065 | $567.60 | $946.00 | $120.00 – $120.00 | 2 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $91.80 | $153.00 | $7.28 – $7.28 | 2 |
| Dicyclomine injection HCPCS J0500 | $268.20 | $447.00 | $13.76 – $13.76 | 2 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $19.20 | $32.00 | $4.71 – $4.71 | 2 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $22.20 | $37.00 | $0.04 – $0.04 | 2 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $4.80 | $8.00 | $1.06 – $1.06 | 2 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $19.20 | $32.00 | $9.41 – $9.41 | 2 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.