Diffusing capacity at Lee County Community Hospital
127 HEALTHCARE DRIVE, PENNINGTON GAP, VA · Balladhealth · · NPI 1205488996
$98.21
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$427.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$56.06 with UNITED HEALTHCARE vs $427.00 with MEDCOST — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| UNITED HEALTHCARE | TENNCARE UNITED HEALTHCARE | $56.06 | ↓ -43% |
| AMBETTER | AMBETTER | $93.94 | ↓ -4% |
| MANAGED MEDICAIRE | MANAGED MEDICAIRE | $93.94 | ↓ -4% |
| MOUNTAIN EMPIRE PACE | MOUNTAIN EMPIRE PACE | $93.94 | ↓ -4% |
| SENTARA HEALTH | SENTARA MEDICARE | $93.94 | ↓ -4% |
| UNITED MINE WORKERS OF AMERICA | UNITED MINE WORKERS OF AMERICA | $93.94 | ↓ -4% |
| UNITED MINE WORKERS OF AMERICA | UNITED MINE WORKERS OF AMERICA MEDICARE | $93.94 | ↓ -4% |
| AMERIGROUP | AMERIGROUP MEDICARE WELLPOINT | $93.94 | ↓ -4% |
| UNITED HEALTHCARE | UNITED HEALTHCARE MEDICARE | $93.94 | ↓ -4% |
| ALLCARE MEDICARE | ALLCARE MEDICARE | $93.94 | ↓ -4% |
| AETNA | AETNA BETTER HEALTH OF VIRGINIA MEDICARE | $93.94 | ↓ -4% |
| AETNA | AETNA HEALTHCARE MEDICARE | $93.94 | ↓ -4% |
| HUMANA | HUMANA MEDICARE | $95.44 | ↓ -3% |
| BLUE CROSS | ANTHEM MEDICARE VIRGINIA | $96.76 | ↓ -1% |
| MOLINA HEALTHCARE | MOLINA HEALTHCARE MEDICARE | $97.70 | ↓ -1% |
| NHC ADVANTAGE | NHC ADVANTAGE | $98.64 | ↑ +0% |
| DEVOTED HEALTH PLAN | DEVOTED HEALTH PLAN MEDICARE | $98.64 | ↑ +0% |
| CIGNA HEALTHCARE | CIGNA MEDICARE | $98.64 | ↑ +0% |
| BLUE CROSS | BLUE CROSS MEDICARE | $99.58 | ↑ +1% |
| OPTIMA HEALTH | OPTIMA HEALTH MEDICAID | $105.50 | ↑ +7% |
| BLUE CROSS | ANTHEM HLTHKEEP MEDICIAD | $105.50 | ↑ +7% |
| UNITED HEALTHCARE | UNITED HEALTHCARE MEDICAID VIRGINIA | $108.66 | ↑ +11% |
| MOLINA HEALTHCARE | MOLINA HEALTHCARE MEDICAID | $109.72 | ↑ +12% |
| AETNA | AETNA BETTER HEALTH OF VIRGINIA | $109.72 | ↑ +12% |
| SENTARA HEALTH | SENTARA HEALTH | $110.21 | ↑ +12% |
| CIGNA HEALTHCARE | CIGNA INDIVIDUAL FAMILY PLAN | $198.13 | ↑ +102% |
| SEVEN CORNERS, INC. | SEVEN CORNERS, INC. | $225.46 | ↑ +130% |
| BLUE CROSS | BLUE CROSS BALLAD HEALTH EMPLOYEE | $298.90 | ↑ +204% |
| BLUE CROSS | TENNCARE BLUE SELECT | $427.00 | ↑ +335% |
| UNITED HEALTHCARE | UHC HERITAGE RIVER VALLEY | $427.00 | ↑ +335% |
| UNITED HEALTHCARE | UHC HERITAGE SELECT | $427.00 | ↑ +335% |
| AETNA | AETNA | $427.00 | ↑ +335% |
| AMERIGROUP | AMERIGROUP | $427.00 | ↑ +335% |
| BLUE CROSS | TENNCARE BLUE CARE | $427.00 | ↑ +335% |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $427.00 | ↑ +335% |
| CIGNA HEALTHCARE | CIGNA PPO | $427.00 | ↑ +335% |
| CIGNA HEALTHCARE | CIGNA OPEN ACCESS PLUS | $427.00 | ↑ +335% |
| FIRST HEALTH COVENTRY | FIRST HEALTH COVENTRY | $427.00 | ↑ +335% |
| MEDCOST | MEDCOST VHN | $427.00 | ↑ +335% |
Visitor-reported prices
Comments
Diffusing capacity at other Virginia hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Inova Alexandria Hospital | Alexandria | $350.00 | $83.53 – $509.53 |
| Inova Fairfax Hospital | Falls Church | $350.00 | $83.53 – $509.53 |
| Inova Fair Oaks Hospital | VA 22033-1709 | $350.00 | $83.53 – $509.53 |
| Inova Loudoun Hospital | Leesburg | $350.00 | $83.53 – $509.53 |
| Inova Mount Vernon Hospital | Alexandria | $350.00 | $83.53 – $509.53 |
| Johnston Memorial Hospital | ABINGDON | $100.35 | $40.95 – $125.63 |
| Russell County Hospital | LEBANON | $100.35 | $56.06 – $125.63 |
| Sentara Martha Jefferson Hospital | Charlottesville | $244.50 | not published |