STONESPRINGS HOSPITAL CENTER
24440 Stone Springs Boulevard, Dulles, VA · HCA Virginia · · NPI 1972904738
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 | not published | not published | $22.48 – $166.05 | 15 |
| 17-hydroxypregnenolone CPT 84143 | not published | not published | $17.51 – $129.47 | 15 |
| 17-ketosteroids CPT 83586 | not published | not published | $9.82 – $72.63 | 15 |
| 1pc ost pch drain hgh output HCPCS A4435 | not published | not published | $6.16 – $8.78 | 12 |
| 1 pc ost pouch w filter HCPCS A5056 | not published | not published | $5.00 – $7.13 | 12 |
| 1 pc ost pou w built-in conv HCPCS A5057 | not published | not published | $10.26 – $14.64 | 12 |
| 2019-ncov diagnostic p HCPCS U0001 | not published | not published | $27.58 – $145.84 | 15 |
| 24 hr ambulatory b/p monitor CPT 93786 | not published | not published | $127.62 – $127.62 | 1 |
| 2vhpv vaccine 3 dose im CPT 90650 | not published | not published | $135.13 – $135.13 | 1 |
| 3d anat seg imaging preop HCPCS C8001 | not published | not published | $198.11 – $198.11 | 1 |
| 3d bn img algor drvd fr MRI HCPCS G0566 | not published | not published | $352.04 – $352.04 | 1 |
| 3-d radiotherapy plan CPT 77295 | not published | not published | $871.34 – $6,094.54 | 2 |
| 3d recon without postprocess indpndt CPT 76376 | $1,809.69 | $1,809.69 | $36.00 – $367.18 | 2 |
| 4-bar link above knee w/swng HCPCS L5614 | not published | not published | $1,521.05 – $2,170.02 | 12 |
| 5% dextrose and 0.45% saline HCPCS S5010 | not published | not published | $7.33 – $7.33 | 1 |
| 5% dextrose with potassium HCPCS S5012 | not published | not published | $4.41 – $4.41 | 1 |
| 5' nucleotidase - sendout CPT 83915 | not published | not published | $8.56 – $63.25 | 15 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $150.03 | $150.03 | $19.19 – $93.36 | 4 |
| 99381 initial comp preventive med less than 1 year new CPT 99381 | not published | not published | $44.21 – $58.95 | 2 |
| 99382 initial comp preventive med 1 to 4 years new CPT 99382 | not published | not published | $47.40 – $63.20 | 2 |
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | not published | not published | $50.28 – $67.04 | 2 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | not published | not published | $40.36 – $53.81 | 2 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | not published | not published | $44.21 – $58.95 | 2 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | not published | not published | $44.21 – $58.95 | 2 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | not published | not published | $50.28 – $67.04 | 2 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | not published | not published | $59.37 – $79.16 | 2 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | not published | not published | $32.54 – $118.64 | 5 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | not published | not published | $9.23 – $60.62 | 15 |
| Abciximab injection HCPCS J0130 | not published | not published | $1,300.45 – $1,528.60 | 2 |
| Abd aorta w/runoff s&i CPT 75630 | not published | not published | $258.89 – $6,438.74 | 4 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $6,083.80 | $6,083.80 | $246.74 – $1,853.11 | 3 |
| Abdominal CT scan (with contrast) CPT 74160 | $4,721.21 | $4,721.21 | $224.75 – $1,526.75 | 3 |
| Abdominal CT scan (without contrast) CPT 74150 | $3,995.02 | $3,995.02 | $210.48 – $1,292.39 | 3 |
| Abdominal MRI (with and without contrast) CPT 74183 | $11,123.29 | $11,123.29 | $390.12 – $4,986.36 | 3 |
| Abdominal MRI (with contrast) CPT 74182 | $11,123.29 | $11,123.29 | $304.47 – $2,807.85 | 3 |
| Abdominal MRI (without contrast) CPT 74181 | $10,152.15 | $10,152.15 | $255.83 – $2,344.90 | 3 |
| Abdominal pad HCPCS L1270 | not published | not published | $77.42 – $110.46 | 12 |
| Abdominal Ultrasound (complete) CPT 76700 | $3,089.02 | $3,089.02 | $144.02 – $537.64 | 4 |
| Abdominal Ultrasound (limited) CPT 76705 | not published | not published | $105.41 – $387.92 | 4 |
| Abduct control hip semi-flex HCPCS L1630 | not published | not published | $146.04 – $208.35 | 12 |
| Abduction bar jointed adjust HCPCS L2300 | not published | not published | $246.01 – $350.97 | 12 |
| Abduction bar-straight HCPCS L2310 | not published | not published | $123.19 – $175.75 | 12 |
| Abduction rotation bar shoe HCPCS L3140 | not published | not published | $80.10 – $114.28 | 12 |
| Abduct rotation bar without shoe HCPCS L3150 | not published | not published | $73.22 – $104.46 | 12 |
| Abl1 gene CPT 81170 | not published | not published | $300.00 – $1,337.81 | 14 |
| Ablate arrhythmia add on CPT 93655 | not published | not published | $34,575.19 – $34,575.19 | 1 |
| Ablate heart dysrhythm focus CPT 93650 | not published | not published | $2,291.35 – $2,291.35 | 1 |
| Ablation cardiac vagal inputs atrium CPT 93799 | not published | not published | $292.56 – $292.56 | 1 |
| Abobotulinumtoxina HCPCS J0586 | not published | not published | $6.78 – $23.32 | 5 |
| Above elbow prosth tiss shap HCPCS L6500 | not published | not published | $2,833.15 – $4,041.97 | 12 |
| Above knee cushion socket HCPCS L5648 | not published | not published | $604.51 – $862.43 | 12 |
| Above knee flex cover system HCPCS L5964 | not published | not published | $966.72 – $1,379.19 | 12 |
| Above knee hydracadence HCPCS L5610 | not published | not published | $1,900.99 – $2,712.09 | 12 |
| Above knee leather socket HCPCS L5642 | not published | not published | $571.39 – $815.18 | 12 |
| Above knee manual lock HCPCS L5925 | not published | not published | $308.52 – $440.16 | 12 |
| Above knee wood socket HCPCS L5644 | not published | not published | $542.32 – $773.71 | 12 |
| Absorpt drg >16<=48 in w/bdr HCPCS A6255 | not published | not published | $3.25 – $4.64 | 12 |
| Absorpt drg >16 <=48 without bdr HCPCS A6252 | not published | not published | $3.48 – $4.96 | 12 |
| Absorpt drg <=16 sq in w/bdr HCPCS A6254 | not published | not published | $1.27 – $1.82 | 12 |
| Absorpt drg <=16 sq in without b HCPCS A6251 | not published | not published | $2.13 – $3.04 | 12 |
| Absorpt drg > 48 sq in without b HCPCS A6253 | not published | not published | $6.77 – $9.66 | 12 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | not published | not published | $0.04 – $0.16 | 5 |
| Acetaminophen level CPT 80143 | $416.70 | $416.70 | $14.31 – $75.68 | 15 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $456.75 | $456.75 | $14.29 – $67.81 | 5 |
| Acetone qualitative CPT 82009 | $826.09 | $826.09 | $3.47 – $17.21 | 15 |
| Acetylcholine receptor modulating antibody CPT 86043 | $262.63 | $262.63 | $9.25 – $45.86 | 14 |
| Acetylcholinesterase assay CPT 82013 | not published | not published | $9.44 – $62.77 | 15 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $4,657.52 | $4,657.52 | $0.34 – $0.98 | 5 |
| Acetylcysteine non-comp unit HCPCS J7608 | not published | not published | $6.33 – $22.42 | 5 |
| Acid perfusion of esophagus CPT 91030 | not published | not published | $530.83 – $530.83 | 1 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | not published | not published | $100.85 – $192.60 | 12 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | not published | not published | $79.43 – $151.96 | 12 |
| Aco cont gluc mnt phys/qhp eqp 95250aco CPT 95250 | not published | not published | $554.94 – $554.94 | 1 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | not published | not published | $12.23 – $16.31 | 12 |
| Acoustic immitance testing CPT 92570 | not published | not published | $71.60 – $71.60 | 1 |
| Acoustic refl threshold tst CPT 92568 | not published | not published | $66.74 – $66.74 | 1 |
| Acth stimulation panel CPT 80402 | not published | not published | $66.77 – $493.13 | 15 |
| Acth stimulation panel CPT 80406 | not published | not published | $60.09 – $443.92 | 15 |
| Actigraphy testing CPT 95803 | not published | not published | $152.47 – $152.47 | 1 |
| Actinotherapy uv light CPT 96900 | not published | not published | $150.38 – $150.38 | 1 |
| Acute hepatitis panel CPT 80074 | $745.65 | $745.65 | $36.57 – $270.15 | 15 |
| Acute venous thrombus image CPT 78456 | not published | not published | $176.76 – $2,938.37 | 4 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | not published | not published | $0.03 – $0.32 | 5 |
| #acylcarnitineprfl CPT 82017 | not published | not published | $12.95 – $95.69 | 15 |
| Acylcarnitines qual CPT 82016 | not published | not published | $12.66 – $78.64 | 15 |
| Additional switch, ext power HCPCS L6611 | not published | not published | $371.14 – $529.49 | 12 |
| Add le poly knee custom kafo HCPCS L2387 | not published | not published | $166.32 – $237.28 | 12 |
| Add ue prost a/e acrylic HCPCS L7404 | not published | not published | $501.01 – $714.78 | 12 |
| Add ue prost a/e ultlite mat HCPCS L7401 | not published | not published | $309.29 – $441.26 | 12 |
| Add ue prost b/e acrylic HCPCS L7403 | not published | not published | $331.94 – $473.56 | 12 |
| Add ue prost be/wd, ultlite HCPCS L7400 | not published | not published | $276.26 – $394.13 | 12 |
| Add ue prost s/d acrylic HCPCS L7405 | not published | not published | $655.24 – $934.81 | 12 |
| Add ue prost s/d ultlite mat HCPCS L7402 | not published | not published | $334.00 – $476.50 | 12 |
| Add up-ex prosthes lock mech HCPCS L6698 | not published | not published | $456.72 – $651.59 | 12 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | not published | not published | $0.29 – $1.40 | 5 |
| Adenovirus ag ia CPT 87301 | not published | not published | $9.20 – $62.48 | 15 |
| Adenovirus antibody,serum - quest CPT 86603 | not published | not published | $9.88 – $73.00 | 15 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $16.71 – $82.81 | 15 |
| Adhesive, liquid or equal HCPCS A4364 | not published | not published | $3.14 – $4.48 | 12 |
| Adh-sendout CPT 84588 | not published | not published | $26.06 – $192.57 | 15 |
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.