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 |
|---|---|---|---|---|
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $96.60 | $161.00 | $0.14 – $0.14 | 2 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $9.00 | $15.00 | $6.33 – $6.33 | 2 |
| Drug test def 1-7 classes HCPCS G0480 | $203.40 | $339.00 | $114.43 – $114.43 | 5 |
| Drug test def 8-14 classes HCPCS G0481 | $156.60 | $261.00 | $156.59 – $156.59 | 5 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $574.20 | $957.00 | $59.68 – $59.68 | 5 |
| Electrical stimulation/unattended 97014 CPT 97014 | $197.40 | $329.00 | $20.14 – $20.14 | 2 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $249.00 | $415.00 | $0.68 – $0.68 | 2 |
| Epinephrine 0.1 mg/ml injection syringe HCPCS J0168 | $54.90 | $91.50 | $2.56 – $2.56 | 2 |
| Epinephrine 1 mg/ml im kit - pediatric HCPCS J0165 | $897.90 | $1,496.50 | $0.84 – $0.84 | 2 |
| Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution HCPCS J0166 | $45.00 | $75.00 | $2.69 – $2.69 | 2 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $429.60 | $716.00 | $10.64 – $10.64 | 2 |
| ER Visit (level 5, high severity) CPT 99285 | $222.60 | $371.00 | $116.04 – $168.41 | 4 |
| Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr HCPCS J1308 | $4.20 | $7.00 | $0.01 – $0.01 | 2 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $10.20 | $17.00 | $1.14 – $1.14 | 2 |
| Filgrastim-sndz 300 mcg/0.5 ml injection syringe HCPCS Q5101 | $919.20 | $1,532.00 | $0.44 – $0.44 | 2 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $21.00 | $35.00 | $2.66 – $2.66 | 2 |
| Folic acid 5 mg/ml injection solution HCPCS J1808 | $139.80 | $233.00 | $0.06 – $0.06 | 2 |
| Fructosamine glycated protein CPT 82985 | $155.40 | $259.00 | $16.76 – $16.76 | 5 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $11.40 | $19.00 | $0.03 – $0.03 | 2 |
| Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution HCPCS A9575 | $336.00 | $560.00 | $0.14 – $0.14 | 2 |
| Gamma glutamyltransferase CPT 82977 | $111.00 | $185.00 | $7.20 – $7.20 | 5 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $141.00 | $235.00 | $38.72 – $38.72 | 2 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $1,080.00 | $1,800.00 | $230.89 – $230.89 | 2 |
| Glucose blood quantitative CPT 82947 | $67.80 | $113.00 | $3.93 – $3.93 | 5 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $286.80 | $478.00 | $18.58 – $18.58 | 5 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $286.80 | $478.00 | $18.52 – $18.52 | 5 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $5,087.40 | $8,479.00 | $35.74 – $35.74 | 2 |
| Graft axiofill 1000mg HCPCS J3590 | $133.20 | $222.00 | $0.01 – $0.01 | 2 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $70.67 | $117.78 | $36.69 – $36.69 | 2 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $94.08 | $156.80 | $77.13 – $77.13 | 2 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $22,192.80 | $36,988.00 | $116.20 – $116.20 | 2 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $10,595.70 | $17,659.50 | $160.59 – $160.59 | 2 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $526.26 | $877.10 | $57.61 – $57.61 | 2 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $517.44 | $862.40 | $105.16 – $105.16 | 2 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $4.80 | $8.00 | $0.99 – $0.99 | 2 |
| Hcg qualitative CPT 84703 | $120.00 | $200.00 | $7.52 – $7.52 | 5 |
| Head CT scan (with and without contrast) CPT 70470 | $2,240.40 | $3,734.00 | $542.00 – $542.00 | 2 |
| Head CT scan (with contrast) CPT 70460 | $1,577.40 | $2,629.00 | $542.00 – $542.00 | 2 |
| Head CT scan (without contrast) CPT 70450 | $1,440.60 | $2,401.00 | $542.00 – $542.00 | 2 |
| Hematocrit CPT 85014 | $61.20 | $102.00 | $2.37 – $2.37 | 5 |
| Hemoglobin CPT 85018 | $60.60 | $101.00 | $2.37 – $2.37 | 5 |
| Heparin bolus from bag HCPCS J1644 | $32.40 | $54.00 | $0.26 – $0.26 | 2 |
| Hepatitis c antibody CPT 86803 | $47.40 | $79.00 | $14.27 – $14.27 | 5 |
| Heterophile antibodies screening CPT 86308 | $89.40 | $149.00 | $5.18 – $5.18 | 5 |
| Hocm 350-399mg/ml iodine,1ml HCPCS Q9963 | $296.40 | $494.00 | $0.25 – $0.25 | 2 |
| Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution HCPCS J7165 | $4,688.40 | $7,814.00 | $3.71 – $3.71 | 2 |
| Hydralazine 20 mg/ml injection solution HCPCS J0360 | $42.60 | $71.00 | $6.11 – $6.11 | 2 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | $47.40 | $79.00 | $25.00 – $25.00 | 2 |
| Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) HCPCS J1171 | $17.40 | $29.00 | $0.10 – $0.10 | 2 |
| Hysteroscopy remove myoma CPT 58561 | $1,355.40 | $2,259.00 | $305.51 – $426.04 | 4 |
| Infect ag ia optc obs influenza CPT 87804 | $63.60 | $106.00 | $16.55 – $16.55 | 5 |
| Infect ag na influenza r/amp 1st 2 types CPT 87502 | $202.80 | $338.00 | $95.80 – $95.80 | 5 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $208.80 | $348.00 | $14.38 – $14.38 | 5 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $260.40 | $434.00 | $24.08 – $24.08 | 5 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $216.60 | $361.00 | $11.98 – $11.98 | 5 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $146.40 | $244.00 | $142.63 – $142.63 | 5 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | $85.20 | $142.00 | $35.09 – $35.09 | 5 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $262.80 | $438.00 | $142.63 – $142.63 | 5 |
| Infliximab 100 mg intravenous solution HCPCS J1745 | $3,894.60 | $6,491.00 | $36.76 – $36.76 | 2 |
| Inj, acetaminophen (hikma) HCPCS J0137 | $49.20 | $82.00 | $0.06 – $0.06 | 2 |
| Inj, lidocaine w epinephrine HCPCS J2004 | $19.80 | $33.00 | $0.01 – $0.01 | 2 |
| Inj octafluoropropane mic,ml HCPCS Q9956 | $541.80 | $903.00 | $48.59 – $48.59 | 2 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $409.20 | $682.00 | $0.18 – $0.18 | 2 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $321.00 | $535.00 | $0.26 – $0.26 | 2 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $277.80 | $463.00 | $8.17 – $8.17 | 5 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $18.00 | $30.00 | $0.41 – $0.41 | 2 |
| Knee MRI (without contrast) CPT 73721 | $3,205.20 | $5,342.00 | $760.00 – $760.00 | 2 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $33.60 | $56.00 | $0.46 – $0.46 | 2 |
| Lactated ringers intravenous solution HCPCS J7120 | $21.00 | $35.00 | $2.90 – $2.90 | 2 |
| Lactic acid CPT 83605 | $135.00 | $225.00 | $11.57 – $11.57 | 5 |
| Lead capillary CPT 83655 | $50.40 | $84.00 | $12.11 – $12.11 | 5 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $87.00 | $145.00 | $0.05 – $0.05 | 2 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $39.00 | $65.00 | $2.31 – $2.31 | 2 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $135.60 | $226.00 | $4.09 – $4.09 | 2 |
| Lipoprotein direct measurement ldl CPT 83721 | $120.00 | $200.00 | $10.50 – $10.50 | 5 |
| Lithium therapeutic drug level CPT 80178 | $133.20 | $222.00 | $6.61 – $6.61 | 5 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $4.20 | $7.00 | $1.55 – $1.55 | 2 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,088.60 | $3,481.00 | $542.00 – $542.00 | 2 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,754.80 | $6,258.00 | $760.00 – $760.00 | 2 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $3,053.40 | $5,089.00 | $760.00 – $760.00 | 2 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $28.20 | $47.00 | $0.59 – $0.59 | 2 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $96.00 | $160.00 | $42.13 – $42.13 | 5 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $260.40 | $434.00 | $8.89 – $8.89 | 5 |
| Mayo mgrm acetylcholine receptor binding antibody CPT 86041 | $25.80 | $43.00 | $18.40 – $18.40 | 5 |
| Membrane affinity fresh amniotic 2.5x2.5cm -cost per sq cm HCPCS Q4159 | $5,087.40 | $8,479.00 | $277.33 – $277.33 | 2 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | $119.70 | $199.50 | $0.51 – $0.51 | 2 |
| Metabolic Blood Panel (Basic) CPT 80048 | $148.80 | $248.00 | $8.46 – $8.46 | 5 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $172.80 | $288.00 | $10.56 – $10.56 | 5 |
| Metabolic panel ionized ca CPT 80047 | $151.20 | $252.00 | $13.73 – $13.73 | 5 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | $39.00 | $65.00 | $0.14 – $0.14 | 2 |
| Methylprednisolone sodium succinate 1,000 mg intravenous solution HCPCS J2919 | $120.60 | $201.00 | $0.30 – $0.30 | 2 |
| Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr HCPCS J2765 | $11.40 | $19.00 | $1.18 – $1.18 | 2 |
| Metoprolol tartrate 5 mg/5 ml intravenous (wrapper) HCPCS J0616 | $5.40 | $9.00 | $0.16 – $0.16 | 2 |
| Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback HCPCS J1836 | $9.60 | $16.00 | $0.04 – $0.04 | 2 |
| Micafungin 100 mg intravenous solution HCPCS J2248 | $301.20 | $502.00 | $0.36 – $0.36 | 2 |
| Microalbumin urine screen CPT 82044 | $54.00 | $90.00 | $6.23 – $6.23 | 5 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | $27.00 | $45.00 | $0.19 – $0.19 | 2 |
| Midazolam 1 mg/ml in sodium chloride IV infusion (wrapper) HCPCS J2251 | $116.40 | $194.00 | $0.20 – $0.20 | 2 |
| Morphine 4 mg/ml injection (wrapper) HCPCS J2270 | $10.20 | $17.00 | $5.36 – $5.36 | 2 |
| Morphine 4 mg/ml injection (wrapper)|discarded drug not administered HCPCS J2272 | $9.60 | $16.00 | $9.59 – $9.59 | 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.