LEWISGALE MEDICAL CENTER
1423 W RURITAN RD, ROANOKE, VA · HCA Virginia · · NPI 1619914785
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 | $414.00 | $414.00 | $25.48 – $42.46 | 19 |
| 17-hydroxypregnenolone CPT 84143 | $933.00 | $933.00 | $19.85 – $33.07 | 19 |
| 17-ketosteroids CPT 83586 | $182.00 | $182.00 | $11.13 – $18.56 | 19 |
| 1pc ost pch drain hgh output HCPCS A4435 | not published | not published | $6.98 – $8.78 | 18 |
| 1 pc ost pouch w filter HCPCS A5056 | not published | not published | $5.66 – $7.13 | 18 |
| 1 pc ost pou w built-in conv HCPCS A5057 | not published | not published | $11.63 – $14.64 | 18 |
| 2019-ncov diagnostic p HCPCS U0001 | not published | not published | $31.25 – $52.08 | 19 |
| 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 | $1,034.33 – $1,034.33 | 1 |
| 3d recon without postprocess indpndt CPT 76376 | not published | not published | $42.73 – $42.73 | 1 |
| 4-bar link above knee w/swng HCPCS L5614 | not published | not published | $1,723.85 – $2,170.02 | 18 |
| 5' nucleotidase - sendout CPT 83915 | $159.00 | $159.00 | $9.71 – $16.17 | 19 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $213.00 | $213.00 | $19.19 – $107.73 | 2 |
| 99381 initial comp preventive med less than 1 year new CPT 99381 | not published | not published | $50.11 – $57.18 | 3 |
| 99382 initial comp preventive med 1 to 4 years new CPT 99382 | not published | not published | $53.72 – $61.30 | 3 |
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | not published | not published | $56.98 – $65.03 | 3 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | not published | not published | $45.74 – $52.20 | 3 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | not published | not published | $50.11 – $57.18 | 3 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | not published | not published | $50.11 – $57.18 | 3 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | not published | not published | $56.98 – $65.03 | 3 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | not published | not published | $67.29 – $76.79 | 3 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | not published | not published | $36.87 – $134.31 | 4 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $758.00 | $758.00 | $10.46 – $17.41 | 19 |
| Abciximab injection HCPCS J0130 | not published | not published | $1,730.49 – $1,730.49 | 1 |
| Abd aorta w/runoff s&i CPT 75630 | not published | not published | $307.32 – $6,438.74 | 2 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $10,668.00 | $10,668.00 | $292.90 – $401.74 | 2 |
| Abdominal CT scan (with contrast) CPT 74160 | $8,511.00 | $8,511.00 | $266.79 – $401.74 | 2 |
| Abdominal CT scan (without contrast) CPT 74150 | $4,889.00 | $4,889.00 | $245.18 – $249.86 | 2 |
| Abdominal MRI (with and without contrast) CPT 74183 | $11,042.00 | $11,042.00 | $463.09 – $828.27 | 2 |
| Abdominal MRI (with contrast) CPT 74182 | $9,738.00 | $9,738.00 | $361.42 – $828.27 | 2 |
| Abdominal MRI (without contrast) CPT 74181 | $8,869.00 | $8,869.00 | $303.68 – $517.79 | 2 |
| Abdominal pad HCPCS L1270 | not published | not published | $87.75 – $110.46 | 18 |
| Abdominal Ultrasound (complete) CPT 76700 | $4,011.00 | $4,011.00 | $170.96 – $245.18 | 2 |
| Abdominal Ultrasound (limited) CPT 76705 | not published | not published | $125.13 – $245.18 | 2 |
| Abduct control hip semi-flex HCPCS L1630 | not published | not published | $165.51 – $208.35 | 18 |
| Abduction bar jointed adjust HCPCS L2300 | not published | not published | $278.81 – $350.97 | 18 |
| Abduction bar-straight HCPCS L2310 | not published | not published | $139.61 – $175.75 | 18 |
| Abduction rotation bar shoe HCPCS L3140 | not published | not published | $90.78 – $114.28 | 18 |
| Abduct rotation bar without shoe HCPCS L3150 | not published | not published | $82.99 – $104.46 | 18 |
| Abl1 gene CPT 81170 | not published | not published | $300.00 – $435.00 | 16 |
| Abobotulinumtoxina HCPCS J0586 | not published | not published | $7.68 – $26.40 | 4 |
| Above elbow prosth tiss shap HCPCS L6500 | not published | not published | $3,210.91 – $4,041.97 | 18 |
| Above knee cushion socket HCPCS L5648 | not published | not published | $685.11 – $862.43 | 18 |
| Above knee flex cover system HCPCS L5964 | not published | not published | $1,095.62 – $1,379.19 | 18 |
| Above knee hydracadence HCPCS L5610 | not published | not published | $2,154.46 – $2,712.09 | 18 |
| Above knee leather socket HCPCS L5642 | not published | not published | $647.57 – $815.18 | 18 |
| Above knee manual lock HCPCS L5925 | not published | not published | $349.66 – $440.16 | 18 |
| Above knee wood socket HCPCS L5644 | not published | not published | $614.63 – $773.71 | 18 |
| Absorpt drg >16<=48 in w/bdr HCPCS A6255 | not published | not published | $3.69 – $4.64 | 18 |
| Absorpt drg >16 <=48 without bdr HCPCS A6252 | not published | not published | $3.94 – $4.96 | 18 |
| Absorpt drg <=16 sq in w/bdr HCPCS A6254 | not published | not published | $1.44 – $1.82 | 18 |
| Absorpt drg <=16 sq in without b HCPCS A6251 | not published | not published | $2.41 – $3.04 | 18 |
| Absorpt drg > 48 sq in without b HCPCS A6253 | not published | not published | $7.68 – $9.66 | 18 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | not published | not published | $0.04 – $0.18 | 4 |
| Acetaminophen level CPT 80143 | not published | not published | $16.22 – $27.03 | 19 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $1,708.00 | $1,708.00 | $16.20 – $76.77 | 4 |
| Acetone qualitative CPT 82009 | $365.00 | $365.00 | $3.94 – $6.55 | 19 |
| Acetylcholine receptor modulating antibody CPT 86043 | $34.00 | $34.00 | $10.49 – $17.47 | 19 |
| Acetylcholinesterase assay CPT 82013 | not published | not published | $10.69 – $17.82 | 19 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $4,483.00 | $4,483.00 | $0.38 – $1.11 | 4 |
| Acetylcysteine non-comp unit HCPCS J7608 | not published | not published | $7.17 – $25.38 | 4 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | not published | not published | $114.30 – $192.60 | 18 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | not published | not published | $90.02 – $151.96 | 18 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | not published | not published | $13.86 – $15.84 | 18 |
| Acth stimulation panel CPT 80402 | not published | not published | $75.68 – $126.09 | 19 |
| Acth stimulation panel CPT 80406 | not published | not published | $68.10 – $113.48 | 19 |
| Acute hepatitis panel CPT 80074 | $767.00 | $767.00 | $41.45 – $69.06 | 19 |
| Acute venous thrombus image CPT 78456 | not published | not published | $209.82 – $2,938.37 | 2 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | not published | not published | $0.03 – $0.36 | 4 |
| #acylcarnitineprfl CPT 82017 | $567.00 | $567.00 | $14.68 – $24.46 | 19 |
| Acylcarnitines qual CPT 82016 | not published | not published | $14.35 – $23.91 | 19 |
| Additional switch, ext power HCPCS L6611 | not published | not published | $420.62 – $529.49 | 18 |
| Add le poly knee custom kafo HCPCS L2387 | not published | not published | $188.50 – $237.28 | 18 |
| Add ue prost a/e acrylic HCPCS L7404 | not published | not published | $567.82 – $714.78 | 18 |
| Add ue prost a/e ultlite mat HCPCS L7401 | not published | not published | $350.53 – $441.26 | 18 |
| Add ue prost b/e acrylic HCPCS L7403 | not published | not published | $376.19 – $473.56 | 18 |
| Add ue prost be/wd, ultlite HCPCS L7400 | not published | not published | $313.10 – $394.13 | 18 |
| Add ue prost s/d acrylic HCPCS L7405 | not published | not published | $742.60 – $934.81 | 18 |
| Add ue prost s/d ultlite mat HCPCS L7402 | not published | not published | $378.53 – $476.50 | 18 |
| Add up-ex prosthes lock mech HCPCS L6698 | not published | not published | $517.62 – $651.59 | 18 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | not published | not published | $0.33 – $1.59 | 4 |
| Adenovirus ag ia CPT 87301 | $42.00 | $42.00 | $10.43 – $17.37 | 19 |
| Adenovirus antibody,serum - quest CPT 86603 | $182.00 | $182.00 | $11.20 – $18.66 | 19 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $18.94 – $31.55 | 19 |
| Adhesive, liquid or equal HCPCS A4364 | not published | not published | $3.56 – $4.48 | 18 |
| Adh-sendout CPT 84588 | $468.00 | $468.00 | $29.54 – $49.21 | 19 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | not published | not published | $1.59 – $1.59 | 1 |
| Admin ecg contrast agent CPT 93352 | not published | not published | $24.11 – $27.52 | 3 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | not published | not published | $15.91 – $18.16 | 3 |
| Administration vaccine influenza virus HCPCS G0008 | not published | not published | $21.00 – $21.00 | 1 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | not published | not published | $13.58 – $15.50 | 3 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | not published | not published | $34.94 – $126.57 | 4 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $155.55 – $2,938.37 | 2 |
| Adrenalin epinephrine inject HCPCS J0171 | not published | not published | $0.62 – $0.71 | 3 |
| Advance care planning each additional 30 min 99498 CPT 99498 | not published | not published | $80.96 – $86.63 | 15 |
| Afamelanotide implant, 1 mg HCPCS J7352 | not published | not published | $8,830.26 – $8,830.26 | 1 |
| Afamitresgene autoleucel HCPCS Q2057 | not published | not published | $2,311,860.00 – $2,311,860.00 | 1 |
| _afb id by dna probe rflx ast CPT 87149 | $461.00 | $461.00 | $17.45 – $29.07 | 19 |
| #afb mycobacteria suscep. #1 CPT 87190 | $647.00 | $647.00 | $6.36 – $10.60 | 19 |
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.