Dickenson Community Hospital
312 HOSPITAL DR., CLINTWOOD, VA · Balladhealth · · NPI 1285685727
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 |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | $27.37 | $119.00 | $19.88 – $64.24 | 6 |
| 17-hydroxypregnenolone CPT 84143 | $37.49 | $163.00 | $19.88 – $50.52 | 6 |
| 17-ketosteroids CPT 83586 | $22.08 | $96.00 | $12.80 – $28.15 | 6 |
| 2d tte w or without fol w/con,co HCPCS C8923 | $180.32 | $784.00 | $501.02 – $887.49 | 5 |
| 5' nucleotidase - sendout CPT 83915 | $19.09 | $83.00 | $11.15 – $24.54 | 6 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $20.47 | $89.00 | $12.01 – $26.71 | 6 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $605.36 | $2,632.00 | $300.68 – $606.37 | 6 |
| Abdominal CT scan (with contrast) CPT 74160 | $576.61 | $2,507.00 | $270.44 – $606.37 | 6 |
| Abdominal CT scan (without contrast) CPT 74150 | $549.24 | $2,388.00 | $172.70 – $427.00 | 6 |
| Abdominal MRI (with and without contrast) CPT 74183 | $656.19 | $2,853.00 | $480.63 – $786.00 | 6 |
| Abdominal MRI (without contrast) CPT 74181 | $593.63 | $2,581.00 | $304.57 – $786.00 | 6 |
| Abdominal Ultrasound (complete) CPT 76700 | $99.82 | $434.00 | $86.68 – $312.26 | 6 |
| Abdominal Ultrasound (limited) CPT 76705 | $94.76 | $412.00 | $82.20 – $206.11 | 6 |
| Abl1 gene CPT 81170 | $280.14 | $1,218.00 | $240.04 – $661.15 | 6 |
| Ablat 1/+thyr ndul addl prq rf CPT 60661 | $359.26 | $1,562.00 | $320.00 – $320.00 | 1 |
| Ablate bone tumor(s) cryo perq 20983 CPT 20983 | $13,674.19 | $59,453.00 | $3,317.10 – $3,449.79 | 5 |
| Ablation cryo abd perit om CPT 49999 | $3,081.08 | $13,396.00 | $1,338.53 – $1,392.07 | 5 |
| Ablation of upper extremity nerves rf CPT 64999 | $2,427.88 | $10,556.00 | $190.09 – $758.02 | 5 |
| Abltj 1/+thyr ndul 1lobe prq CPT 60660 | $718.75 | $3,125.00 | $320.00 – $3,125.00 | 2 |
| Acetaminophen level CPT 80143 | $23.69 | $103.00 | $16.78 – $41.14 | 6 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $142.25 | $618.47 | $31.98 – $34.92 | 2 |
| Acetone qualitative CPT 82009 | $8.05 | $35.00 | $4.52 – $10.10 | 6 |
| Acetylcholine receptor modulating antibody CPT 86043 | $20.70 | $90.00 | $10.85 – $26.71 | 6 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $822.76 | $3,577.20 | $0.67 – $2.52 | 3 |
| Acetylcysteine non-comp unit HCPCS J7608 | $21.85 | $94.99 | $8.46 – $12.52 | 2 |
| Acute hepatitis panel CPT 80074 | $79.12 | $344.00 | $13.59 – $104.66 | 6 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $42.18 | $183.41 | $0.02 – $0.07 | 2 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $41.06 | $178.52 | $0.99 – $0.99 | 1 |
| Adh-sendout CPT 84588 | $30.13 | $131.00 | $33.94 – $75.07 | 6 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $418.88 | $1,821.23 | $0.12 – $74.79 | 2 |
| Administration immunization 1 vaccine CPT 90471 | $25.07 | $109.00 | $26.22 – $75.37 | 5 |
| Administration immunization each additional vaccine CPT 90472 | $14.49 | $63.00 | $22.33 – $75.37 | 5 |
| Administration vaccine hepatitis b HCPCS G0010 | $13.34 | $58.00 | $19.18 – $75.37 | 5 |
| Administration vaccine influenza virus HCPCS G0008 | $14.95 | $65.00 | $19.18 – $75.37 | 5 |
| Administration vaccine pneumococcal HCPCS G0009 | $13.34 | $58.00 | $19.18 – $75.37 | 5 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $198.26 | $862.00 | $115.36 – $280.67 | 6 |
| Albumin body fluid quantitative each specimen CPT 82042 | $8.97 | $39.00 | $6.60 – $17.32 | 6 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $83.09 | $361.26 | $53.08 – $257.58 | 6 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $9.66 | $42.00 | $4.42 – $12.99 | 6 |
| Albumin serum plasma or whole blood CPT 82040 | $8.51 | $37.00 | $4.95 – $10.83 | 6 |
| Albuterol ipratrop non-comp HCPCS J7620 | $1.67 | $7.25 | $0.20 – $2.83 | 2 |
| Albuterol non-comp con HCPCS J7611 | $1.67 | $7.25 | $0.26 – $2.83 | 2 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $21.85 | $95.00 | $15.54 – $38.25 | 6 |
| Alkaline phosphatase CPT 84075 | $8.97 | $39.00 | $5.18 – $11.55 | 6 |
| Allergen alpha lactalbumin ige CPT 86008 | $28.06 | $122.00 | $16.90 – $39.70 | 6 |
| Allergen egg white ige CPT 86003 | $8.97 | $39.00 | $5.22 – $17.58 | 6 |
| Allergy injections; 2 or more 95117 CPT 95117 | $12.88 | $56.00 | $15.70 – $44.58 | 6 |
| Allergy injection; single 95115 CPT 95115 | $5.75 | $25.00 | $10.47 – $44.58 | 6 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $39,409.85 | $171,347.17 | $40.73 – $108.07 | 2 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $342.47 | $1,489.00 | $1.00 – $1.00 | 1 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $285.52 | $1,241.41 | $217.89 – $217.89 | 1 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $457.47 | $1,989.00 | $1.00 – $1.00 | 1 |
| Alloskin HCPCS Q4115 | $2,826.62 | $12,289.64 | $8.65 – $22.63 | 3 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $110.63 | $481.00 | $42.09 – $142.19 | 6 |
| Alpha-fetoprotein tumor marker CPT 82105 | $28.98 | $126.00 | $16.77 – $36.81 | 6 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $7,469.88 | $32,477.73 | $30.45 – $201.74 | 6 |
| Alt/sgpt CPT 84460 | $9.20 | $40.00 | $5.30 – $11.55 | 6 |
| Amantadine (symmetrel)-sendout CPT 80375 | $6.90 | $30.00 | $30.00 – $108.34 | 5 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $91.91 | $399.62 | $1.11 – $1.30 | 2 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $51.56 | $224.17 | $1.23 – $18.20 | 2 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $130.11 | $565.71 | $0.76 – $21.08 | 2 |
| Amitriptyline (elavil) -sendout CPT 80335 | $13.11 | $57.00 | $20.77 – $21.60 | 5 |
| Ammonia CPT 82140 | $25.07 | $109.00 | $14.57 – $31.76 | 6 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $199.64 | $868.00 | $868.00 – $1,117.95 | 6 |
| Amniocentesis therapeutic CPT 59001 | $140.53 | $611.00 | $611.00 – $1,117.95 | 6 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | $1,489.71 | $6,477.00 | $412.65 – $4,117.05 | 5 |
| Amphetamine confirm urine -sendout CPT 80324 | $11.27 | $49.00 | $20.77 – $21.60 | 5 |
| Amphetamines 5 or more CPT 80326 | $25.30 | $110.00 | $20.77 – $21.60 | 5 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $12.55 | $54.58 | $0.97 – $2.46 | 2 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $54.60 | $237.40 | $2.45 – $5.84 | 2 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | $73.60 | $320.00 | $236.69 – $262.99 | 2 |
| Amputation toe interphalangeal joint CPT 28825 | $819.95 | $3,565.00 | $200.45 – $4,131.17 | 5 |
| Amputation toe metatarsophalangeal joint CPT 28820 | $1,318.36 | $5,732.00 | $291.15 – $4,131.17 | 5 |
| Amylase CPT 82150 | $11.04 | $48.00 | $6.48 – $14.44 | 6 |
| Analgesics non-opioid 6/more CPT 80331 | $33.12 | $144.00 | $20.77 – $21.60 | 5 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $14.49 | $63.00 | $20.77 – $21.60 | 5 |
| Analysis gene f2 20210g>a variant CPT 81240 | $84.64 | $368.00 | $60.42 – $145.08 | 6 |
| Analysis gene f5 leiden variant CPT 81241 | $105.11 | $457.00 | $65.29 – $161.68 | 6 |
| Analyze neurostimulator simple w/reprogramming 95971 CPT 95971 | $58.88 | $256.00 | $45.09 – $260.45 | 6 |
| Anaplsma phgcytophlm amp prb CPT 87468 | $60.49 | $263.00 | $31.58 – $90.76 | 6 |
| Anca screen with reflex to titer -quest CPT 86021 | $24.84 | $108.00 | $15.05 – $33.20 | 6 |
| Angiotensin ii CPT 82163 | $21.62 | $94.00 | $19.88 – $45.47 | 6 |
| Ankle X-ray CPT 73610 | $75.21 | $327.00 | $29.60 – $105.12 | 6 |
| Antibody bacterium, not elsewhere specified CPT 86609 | $22.08 | $96.00 | $12.88 – $28.15 | 6 |
| Antibody elution rbc reference CPT 86860 | $46.69 | $203.00 | $22.38 – $255.74 | 6 |
| Antibody htlv/hiv confirm test CPT 86689 | $33.35 | $145.00 | $16.90 – $42.58 | 6 |
| Antibody htlv-i CPT 86687 | $14.49 | $63.00 | $9.09 – $20.21 | 6 |
| Antibody htlv-ii CPT 86688 | $15.18 | $66.00 | $14.00 – $31.04 | 6 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $30.36 | $132.00 | $16.90 – $40.42 | 6 |
| Antibody id rbc panel CPT 86870 | $92.00 | $400.00 | $22.38 – $255.74 | 6 |
| Antibody screen rbc CPT 86850 | $19.55 | $85.00 | $6.52 – $21.65 | 6 |
| Antibody tetanus CPT 86774 | $25.30 | $110.00 | $14.80 – $32.48 | 6 |
| Antidepressant not specified CPT 80338 | $13.11 | $57.00 | $20.77 – $21.60 | 5 |
| Antidepressants class 6/more CPT 80334 | $29.21 | $127.00 | $20.77 – $21.60 | 5 |
| Antiepileptics nos 7/more CPT 80341 | $10.81 | $47.00 | $20.77 – $21.60 | 5 |
| Anti-inhibitor HCPCS J7198 | $15,596.47 | $67,810.72 | $1.45 – $9,060.46 | 6 |
| Anti mog serum - sendout CPT 86362 | $28.29 | $123.00 | $10.85 – $26.71 | 6 |
| Antineutrophil cytoplasmic antibody screen each antibody CPT 86036 | $27.60 | $120.00 | $10.85 – $26.71 | 6 |
| Antineutrophil cytoplasmic antibody titer each antibody CPT 86037 | $29.21 | $127.00 | $10.85 – $26.71 | 6 |
| Antinuclear antibodies CPT 86038 | $20.70 | $90.00 | $12.09 – $26.71 | 6 |
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.