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 |
|---|---|---|---|---|
| Detect agent nos dna dir CPT 87797 | $389.00 | $389.00 | $26.13 – $43.54 | 19 |
| Detect agnt mult dna direc CPT 87800 | not published | not published | $38.00 – $63.32 | 19 |
| Device intraute mirena HCPCS J7298 | not published | not published | $4,580.79 – $4,580.79 | 1 |
| Dev interrog remote 1/2/mlt CPT 93295 | not published | not published | $24.70 – $28.19 | 3 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | not published | not published | $42.73 – $182.03 | 2 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $94.08 – $295.98 | 4 |
| Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr HCPCS J1095 | not published | not published | $8.13 – $8.13 | 1 |
| Dexamethasone 4 mg tablet HCPCS J8540 | not published | not published | $0.03 – $0.06 | 4 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | not published | not published | $0.08 – $0.33 | 4 |
| Dexamethasone intra implant HCPCS J7312 | not published | not published | $174.45 – $613.62 | 4 |
| Dexamethasone panel CPT 80420 | not published | not published | $140.87 – $234.73 | 19 |
| Dexmedetomidine film, 1 mcg HCPCS J1105 | not published | not published | $2.64 – $2.64 | 1 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | not published | not published | $68.82 – $174.03 | 4 |
| Dextran 40 infusion HCPCS J7100 | $801.00 | $801.00 | $1,142.97 – $1,142.97 | 1 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $468.00 | $468.00 | $1.06 – $3.93 | 4 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $520.00 | $520.00 | $18.15 – $18.15 | 1 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | not published | not published | $1.55 – $5.25 | 4 |
| Dextrose 5 % IV bolus HCPCS J7070 | $506.00 | $506.00 | $3.09 – $8.82 | 4 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $309.00 | $309.00 | $19.35 – $32.23 | 19 |
| Diabetes (HbA1c) Test CPT 83036 | $265.00 | $265.00 | $8.45 – $14.08 | 19 |
| Diabetic custom molded shoe HCPCS A5501 | not published | not published | $231.03 – $290.83 | 18 |
| Diabetic shoe with wedge HCPCS A5504 | not published | not published | $38.92 – $49.00 | 18 |
| Diabetic shoe w/off set heel HCPCS A5506 | not published | not published | $38.92 – $49.00 | 18 |
| Diabetic shoe w/roller/rockr HCPCS A5503 | not published | not published | $38.92 – $49.00 | 18 |
| Diab manage trn ind/group HCPCS G0109 | not published | not published | $12.78 – $17.55 | 18 |
| Diab shoe for density insert HCPCS A5500 | not published | not published | $77.04 – $96.97 | 18 |
| Diab shoe w/metatarsal bar HCPCS A5505 | not published | not published | $38.92 – $49.00 | 18 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | not published | not published | $103.22 – $263.00 | 4 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | not published | not published | $83.74 – $205.70 | 4 |
| Diagnostic Mammogram (both breasts) CPT 77066 | not published | not published | $90.51 – $120.41 | 18 |
| Diagnostic Mammogram (one breast) CPT 77065 | not published | not published | $71.03 – $93.69 | 18 |
| Diagnostic radio unlisted proc CPT 76499 | not published | not published | $182.03 – $182.03 | 1 |
| Diathermy eg microwave CPT 97024 | not published | not published | $5.92 – $8.22 | 18 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $1,187.00 | $1,187.00 | $0.07 – $0.21 | 4 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $293.00 | $293.00 | $4.92 – $20.07 | 4 |
| Dicyclomine injection HCPCS J0500 | $947.00 | $947.00 | $10.93 – $33.99 | 4 |
| Difelikefalin, esrd on dialy HCPCS J0879 | not published | not published | $0.84 – $0.84 | 1 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $357.00 | $357.00 | $4.15 – $28.71 | 4 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $12,338.00 | $12,338.00 | $4,223.29 – $15,500.97 | 4 |
| Digoxin total therapeutic drug level CPT 80162 | not published | not published | $11.56 – $19.26 | 19 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $1,327.00 | $1,327.00 | $72.89 – $171.24 | 4 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | not published | not published | $0.09 – $0.09 | 1 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $2.76 – $8.10 | 4 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | not published | not published | $607.51 – $2,247.69 | 4 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | not published | not published | $4.26 – $4.26 | 1 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $212.00 | $212.00 | $0.56 – $2.13 | 4 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | not published | not published | $55.11 – $55.11 | 1 |
| Dipyridamole injection HCPCS J1245 | not published | not published | $3.26 – $25.23 | 4 |
| Disaccharidases CPT 82657 | $592.00 | $592.00 | $19.29 – $32.15 | 19 |
| Discography cerv/thor spine CPT 72285 | not published | not published | $262.53 – $3,947.38 | 2 |
| Disconnect insert locking wr HCPCS L6616 | not published | not published | $90.00 – $113.29 | 18 |
| Disconnect locking wrist uni HCPCS L6615 | not published | not published | $213.64 – $268.93 | 18 |
| Dis site tele svcs rhc/fqhc HCPCS G2025 | not published | not published | $67.22 – $76.71 | 3 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $279.00 – $404.55 | 16 |
| Dmpk gene charac alleles CPT 81239 | not published | not published | $274.83 – $398.50 | 16 |
| Dmpk gene detc abnor allele CPT 81234 | not published | not published | $137.00 – $198.65 | 16 |
| Dna antibody native/double stranded CPT 86225 | $221.00 | $221.00 | $11.96 – $19.92 | 19 |
| Dna gardnerella CPT 87510 | $389.00 | $389.00 | $17.45 – $29.07 | 19 |
| Dna probe chlamydia CPT 87490 | $273.00 | $273.00 | $19.80 – $32.99 | 19 |
| Dna probe gc CPT 87590 | $273.00 | $273.00 | $23.39 – $38.98 | 19 |
| Dna trichomonas CPT 87660 | $389.00 | $389.00 | $17.45 – $29.07 | 19 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | not published | not published | $6.93 – $24.06 | 4 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | not published | not published | $0.52 – $1.95 | 4 |
| Docetaxel (docivyx), 1 mg HCPCS J9172 | not published | not published | $43.88 – $149.28 | 4 |
| Dolasetron mesylate HCPCS J1260 | not published | not published | $11.01 – $11.01 | 1 |
| Dolasetron mesylate oral HCPCS Q0180 | not published | not published | $171.36 – $171.36 | 1 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | not published | not published | $0.60 – $2.40 | 4 |
| Dornase alfa non-comp unit HCPCS J7639 | $1,143.00 | $1,143.00 | $45.55 – $165.48 | 4 |
| Dornhoffer fixed part w/window HCPCS L8614 | not published | not published | $20,291.80 – $25,543.79 | 18 |
| Dorsi & plantar flex ass/res HCPCS L2220 | not published | not published | $79.98 – $100.69 | 18 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | not published | not published | $204.12 – $742.32 | 4 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | not published | not published | $2.68 – $8.34 | 4 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | not published | not published | $127.85 – $312.03 | 4 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $1,140.00 | $1,140.00 | $0.10 – $0.30 | 4 |
| Dpyd gene common variants CPT 81232 | $386.00 | $386.00 | $174.81 – $253.47 | 16 |
| Drainable plastic pch w fcpl HCPCS A4375 | not published | not published | $20.80 – $26.18 | 18 |
| Drain chst dry seal exp thorastat HCPCS A7041 | not published | not published | $89.87 – $113.13 | 18 |
| Drain ostomy pouch w/flange HCPCS A5063 | not published | not published | $3.28 – $4.13 | 18 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | not published | not published | $42.91 – $381.42 | 4 |
| Driver pneumatic vad, rep HCPCS Q0480 | not published | not published | $92,006.55 – $115,820.01 | 18 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $1.26 – $4.05 | 4 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $236.00 | $236.00 | $7.28 – $21.54 | 4 |
| Drop lock knee HCPCS L2182 | not published | not published | $97.08 – $122.20 | 18 |
| Drop lock retainer each HCPCS L2785 | not published | not published | $31.08 – $39.13 | 18 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $10.65 – $381.42 | 4 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | not published | not published | $10.21 – $381.42 | 4 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | not published | not published | $7.73 – $381.42 | 4 |
| Drsg surg adh 11x11 3/4 occl drap wnd 28x30 HCPCS A6259 | not published | not published | $13.25 – $16.68 | 18 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | not published | not published | $381.42 – $381.42 | 1 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | not published | not published | $381.42 – $381.42 | 1 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | not published | not published | $42.32 – $381.42 | 4 |
| Drsg wound/burn 18x10cm suprathel resorb cost per sq cm HCPCS A2012 | not published | not published | $381.42 – $381.42 | 1 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | not published | not published | $381.42 – $381.42 | 1 |
| Drug assay caffeine CPT 80155 | $203.00 | $203.00 | $33.57 – $55.93 | 19 |
| Drug assay posaconazole CPT 80187 | not published | not published | $23.60 – $39.31 | 19 |
| Drug assay rufinamide CPT 80210 | $73.00 | $73.00 | $23.60 – $39.31 | 19 |
| Drug assay vedolizumab CPT 80280 | $242.00 | $242.00 | $33.57 – $55.93 | 19 |
| Drug assay voriconazole CPT 80285 | not published | not published | $23.60 – $39.31 | 19 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $16.22 – $27.03 | 19 |
| Drug of abuse screen urine CPT 80305 | not published | not published | $10.96 – $18.27 | 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.