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 |
|---|---|---|---|---|
| Osmolality urine CPT 83935 | $184.00 | $184.00 | $5.93 – $9.89 | 19 |
| Ostomy clamp, replacement HCPCS A4363 | not published | not published | $2.44 – $3.07 | 18 |
| Ostomy irrigation set HCPCS A4400 | not published | not published | $50.32 – $63.34 | 18 |
| Ost pch drain 2 piece system HCPCS A4426 | not published | not published | $3.31 – $4.16 | 18 |
| Ost pch drain for barrier fl HCPCS A4425 | not published | not published | $4.33 – $5.46 | 18 |
| Ost pch drain w bar & filter HCPCS A4424 | not published | not published | $5.76 – $7.25 | 18 |
| Ost pch for bar w flange/flt HCPCS A4419 | not published | not published | $2.09 – $2.63 | 18 |
| Ost skn barr extnd >4 sq HCPCS A4410 | not published | not published | $10.95 – $13.78 | 18 |
| Ost urine pch w b/bltin conv HCPCS A4430 | not published | not published | $10.32 – $12.99 | 18 |
| Ot evaluation high complexity patient/family CPT 97167 | not published | not published | $84.65 – $96.60 | 18 |
| Ot evaluation low complexity patient/family CPT 97165 | not published | not published | $84.65 – $96.60 | 18 |
| Ot evaluation moderate complexity patient/family CPT 97166 | not published | not published | $84.65 – $96.60 | 18 |
| Other immunoelectrophoresis CPT 86325 | not published | not published | $20.13 – $33.54 | 19 |
| Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes CPT 97763 | not published | not published | $42.11 – $48.05 | 18 |
| Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes CPT 97760 | not published | not published | $38.60 – $44.05 | 18 |
| Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 | not published | not published | $22.87 – $26.52 | 18 |
| Ot re-evaluation patient/family CPT 97168 | not published | not published | $58.45 – $66.70 | 18 |
| Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 | not published | not published | $29.10 – $33.52 | 18 |
| Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 | not published | not published | $17.48 – $22.59 | 18 |
| Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 | not published | not published | $18.31 – $21.39 | 18 |
| Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 | not published | not published | $24.24 – $27.79 | 18 |
| Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 | not published | not published | $26.96 – $31.27 | 18 |
| Ot training self care/home management direct contact each 15 minutes CPT 97535 | not published | not published | $26.95 – $30.97 | 18 |
| Outrigger HCPCS L1080 | not published | not published | $64.57 – $81.28 | 18 |
| Outrigger bil with vert extens HCPCS L1085 | not published | not published | $174.70 – $219.92 | 18 |
| Ovine, 1000 usp units HCPCS J3472 | not published | not published | $329.67 – $329.67 | 1 |
| Ovulation tests CPT 84830 | not published | not published | $11.05 – $18.41 | 19 |
| Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr HCPCS J2700 | $76.00 | $76.00 | $0.54 – $1.71 | 4 |
| Oxaliplatin 5 mg/ml desensitization HCPCS J9263 | not published | not published | $0.04 – $0.15 | 4 |
| Oxymorphone hcl injection HCPCS J2410 | not published | not published | $7.02 – $7.02 | 1 |
| Oxytocin 10 unit/ml injection solution HCPCS J2590 | $246.00 | $246.00 | $8.07 – $8.07 | 1 |
| P-32 chromic phos ther per mci HCPCS A9564 | not published | not published | $468.96 – $468.96 | 1 |
| P-32 sod phosphate ther per mci HCPCS A9563 | not published | not published | $834.72 – $834.72 | 1 |
| Pabpn1 gene detc abnor allel CPT 81312 | not published | not published | $137.00 – $198.65 | 16 |
| Packing strips, non-impreg HCPCS A6407 | not published | not published | $2.26 – $2.85 | 18 |
| Paclitaxel 6 mg/ml concentrate,intravenous HCPCS J9267 | not published | not published | $0.11 – $0.30 | 4 |
| Paclitaxel protein-bound 100 mg intravenous suspension HCPCS J9264 | not published | not published | $11.10 – $24.54 | 4 |
| Palb2 gene full gene seq CPT 81307 | not published | not published | $676.50 – $980.92 | 16 |
| Palb2 gene known famil vrnt CPT 81308 | not published | not published | $301.35 – $436.96 | 16 |
| Palifermin injection HCPCS J2425 | not published | not published | $28.89 – $109.89 | 4 |
| Palingen or palingen xplus HCPCS Q4173 | not published | not published | $306.43 – $381.42 | 4 |
| Palingen or promatrx HCPCS Q4174 | not published | not published | $4,324.50 – $4,324.50 | 1 |
| Paliperidone 117 mg/0.75 ml inj HCPCS J2426 | not published | not published | $12.53 – $45.33 | 4 |
| Palivizumab 50 mg/0.5 ml inj CPT 90378 | $3,152.00 | $3,152.00 | $1,310.25 – $1,310.25 | 1 |
| Palonosetron hcl HCPCS J2469 | not published | not published | $0.42 – $1.05 | 4 |
| Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution HCPCS J2430 | $3,319.00 | $3,319.00 | $11.80 – $33.87 | 4 |
| Panitumumab 20 mg/ml intravenous solution (wrapper) HCPCS J9303 | not published | not published | $140.18 – $521.01 | 4 |
| Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr HCPCS J2470 | $740.00 | $740.00 | $26.07 – $26.07 | 1 |
| Papaverin hcl injection HCPCS J2440 | not published | not published | $137.82 – $137.82 | 1 |
| Parathormone (pth) intact CPT 83970 | not published | not published | $35.92 – $59.86 | 19 |
| Parathyrd planar w/spect&ct CPT 78072 | $4,947.00 | $4,947.00 | $323.36 – $1,101.15 | 2 |
| Parathyroid planar imaging CPT 78070 | $3,580.00 | $3,580.00 | $166.24 – $848.52 | 2 |
| Parathyroid planar img w/tomo spect CPT 78071 | not published | not published | $246.98 – $848.52 | 2 |
| Parenteral 50% dextrose solu HCPCS B4164 | not published | not published | $20.96 – $23.92 | 3 |
| Paricalcitol HCPCS J2501 | not published | not published | $0.69 – $2.91 | 4 |
| Particle matristem matrix 1000mg micron-q4118-cost per mg HCPCS Q4118 | not published | not published | $2.17 – $23.79 | 4 |
| Passy muir valve metal trach HCPCS L8501 | not published | not published | $125.70 – $158.23 | 18 |
| Paste skin barrier .5oz adapt HCPCS A4406 | not published | not published | $6.94 – $8.73 | 18 |
| Path clin consltj high 41-60 CPT 80505 | not published | not published | $152.32 – $855.12 | 2 |
| Path clin consltj mod 21-40 CPT 80504 | not published | not published | $152.32 – $855.12 | 2 |
| Path clin consltj prolng svc CPT 80506 | not published | not published | $43.26 – $242.86 | 2 |
| Path clin consltj sf 5-20 CPT 80503 | not published | not published | $50.75 – $284.91 | 2 |
| Patten bottom HCPCS L2370 | not published | not published | $327.47 – $412.23 | 18 |
| Pca3/klk3 antigen CPT 81313 | not published | not published | $221.95 – $369.82 | 19 |
| Pcv21 vaccine im CPT 90684 | not published | not published | $278.71 – $1,032.75 | 4 |
| Pdgfra gene CPT 81314 | $950.00 | $950.00 | $329.51 – $477.79 | 16 |
| Pd hl 3.5in 4d med rbr mld 6432 HCPCS L3350 | not published | not published | $23.36 – $29.40 | 18 |
| Pediatric electric hand HCPCS L7008 | not published | not published | $6,376.22 – $8,026.54 | 18 |
| Pediatric electric hook HCPCS L7045 | not published | not published | $1,681.97 – $2,117.31 | 18 |
| Ped term dev, hand, vol clos HCPCS L6714 | not published | not published | $1,351.80 – $1,701.67 | 18 |
| Ped term dev, hand, vol open HCPCS L6713 | not published | not published | $1,596.03 – $2,009.12 | 18 |
| Ped term dev, hook, vol clos HCPCS L6712 | not published | not published | $1,264.54 – $1,591.83 | 18 |
| Ped term dev, hook, vol open HCPCS L6711 | not published | not published | $686.80 – $864.56 | 18 |
| Pegaspargase injection HCPCS J9266 | not published | not published | $23,009.92 – $85,272.18 | 4 |
| Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 | not published | not published | $16.98 – $368.52 | 4 |
| Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe HCPCS Q5122 | not published | not published | $114.11 – $399.15 | 4 |
| Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 | not published | not published | $139.06 – $485.97 | 4 |
| Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5127 | not published | not published | $213.56 – $441.72 | 4 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | not published | not published | $95.97 – $296.61 | 4 |
| Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5130 | not published | not published | $139.53 – $381.69 | 4 |
| Pegloticase 8 mg/ml intravenous solution HCPCS J2507 | not published | not published | $3,030.52 – $11,306.43 | 4 |
| Pegunigalsidase alfa-iwxj HCPCS J2508 | not published | not published | $192.89 – $677.85 | 4 |
| Pelv band/spread bar thigh c HCPCS L1640 | not published | not published | $503.82 – $634.22 | 18 |
| Pelvic band & belt thigh fla HCPCS L2192 | not published | not published | $399.97 – $503.49 | 18 |
| Pelvic control band & belt b HCPCS L2640 | not published | not published | $328.24 – $413.20 | 18 |
| Pelvic control band & belt u HCPCS L2630 | not published | not published | $241.87 – $304.47 | 18 |
| Pelvic control hip heavy dut HCPCS L2620 | not published | not published | $295.65 – $372.17 | 18 |
| Pelvic control pelvic sling HCPCS L2580 | not published | not published | $453.32 – $570.65 | 18 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $10,668.00 | $10,668.00 | $256.01 – $401.74 | 2 |
| Pelvic CT scan (with contrast) CPT 72193 | $8,511.00 | $8,511.00 | $243.70 – $401.74 | 2 |
| Pelvic CT scan (without contrast) CPT 72192 | $7,214.00 | $7,214.00 | $227.08 – $245.18 | 2 |
| Pelvic & hip control thigh c HCPCS L1680 | not published | not published | $1,190.09 – $1,498.12 | 18 |
| Pelvic MRI (with and without contrast) CPT 72197 | $10,663.00 | $10,663.00 | $463.09 – $828.27 | 2 |
| Pelvic MRI (with contrast) CPT 72196 | $9,345.00 | $9,345.00 | $363.03 – $828.27 | 2 |
| Pelvic MRI (without contrast) CPT 72195 | $8,473.00 | $8,473.00 | $305.30 – $517.79 | 2 |
| Pelvic Ultrasound (complete) CPT 76856 | $2,999.00 | $2,999.00 | $147.95 – $245.18 | 2 |
| Pelvic Ultrasound (limited) CPT 76857 | not published | not published | $108.28 – $245.18 | 2 |
| Pelv & thor control gluteal HCPCS L2650 | not published | not published | $139.76 – $175.93 | 18 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | not published | not published | $50.45 – $179.19 | 4 |
| Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 | not published | not published | $3.20 – $10.77 | 4 |
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.