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 |
|---|---|---|---|---|
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $154.00 | $154.00 | $63.12 – $63.12 | 1 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $76.00 | $76.00 | $36.06 – $36.06 | 1 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $154.00 | $154.00 | $119.25 – $119.25 | 1 |
| Tc-99m sestamibi p study dose HCPCS A9500 | not published | not published | $1,351.74 – $1,351.74 | 1 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $11,143.00 | $11,143.00 | $1,979.79 – $1,979.79 | 1 |
| Tc-99m sulfur colloid HCPCS A9541 | $254.00 | $254.00 | $2,254.20 – $2,254.20 | 1 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | not published | not published | $350.70 – $350.70 | 1 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $1,488.00 | $1,488.00 | $40.88 – $68.12 | 19 |
| T cells absolute cd 4 count CPT 86361 | $1,488.00 | $1,488.00 | $23.31 – $38.83 | 19 |
| T cells total count CPT 86359 | $523.00 | $523.00 | $32.84 – $54.71 | 19 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | not published | not published | $182.55 – $666.63 | 4 |
| Teflon or equal cable lining HCPCS L6665 | not published | not published | $54.61 – $68.75 | 18 |
| Telavancin injection HCPCS J3095 | not published | not published | $6.03 – $22.11 | 4 |
| Telehealth original site facility fee HCPCS Q3014 | $68.00 | $68.00 | $26.36 – $30.08 | 3 |
| Telethx isodose plan cplx CPT 77307 | not published | not published | $659.35 – $659.35 | 1 |
| Telethx isodose plan simple CPT 77306 | not published | not published | $339.63 – $339.63 | 1 |
| Temozolomide HCPCS J8700 | not published | not published | $0.32 – $1.62 | 4 |
| Temozolomide 100 mg intravenous solution HCPCS J9328 | not published | not published | $8.85 – $31.20 | 4 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | not published | not published | $25.77 – $60.96 | 4 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | not published | not published | $138.09 – $560.91 | 4 |
| Tension based scoliosis orth HCPCS L1005 | not published | not published | $3,263.32 – $4,107.94 | 18 |
| Tens suppl 2 lead per month HCPCS A4595 | not published | not published | $11.25 – $14.17 | 18 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $357.00 | $357.00 | $1.20 – $7.41 | 4 |
| Teriparatide injection HCPCS J3110 | not published | not published | $235.20 – $235.20 | 1 |
| Term dev auto grasp feature HCPCS L6881 | not published | not published | $4,176.42 – $5,257.37 | 18 |
| Term device, multi art digit HCPCS L6715 | not published | not published | $3,225.21 – $4,059.98 | 18 |
| Term dev mech hand vol close HCPCS L6709 | not published | not published | $1,408.75 – $1,773.36 | 18 |
| Term dev mech hand vol open HCPCS L6708 | not published | not published | $870.44 – $1,095.73 | 18 |
| Term dev mech hook vol close HCPCS L6707 | not published | not published | $1,530.28 – $1,926.35 | 18 |
| Term dev mech hook vol open HCPCS L6706 | not published | not published | $363.09 – $457.06 | 18 |
| Term dev modifier wrist unit HCPCS L6805 | not published | not published | $374.58 – $471.53 | 18 |
| Term dev, passive hand mitt HCPCS L6703 | not published | not published | $368.02 – $463.28 | 18 |
| Term dev precision pinch dev HCPCS L6810 | not published | not published | $204.18 – $257.02 | 18 |
| Term dev, sport/rec/work att HCPCS L6704 | not published | not published | $609.42 – $767.15 | 18 |
| Tert gene targeted seq alys CPT 81345 | $215.00 | $215.00 | $185.20 – $268.54 | 16 |
| Test for chlorohydrocarbons CPT 82441 | not published | not published | $5.23 – $8.71 | 19 |
| Test for porphobilinogen CPT 84106 | $307.00 | $307.00 | $5.07 – $8.44 | 19 |
| Test for urine cystines CPT 82615 | not published | not published | $8.31 – $13.85 | 19 |
| Testicular imaging w/vasc flow CPT 78761 | not published | not published | $149.39 – $848.52 | 2 |
| Testosterone response panel CPT 80414 | not published | not published | $44.94 – $74.88 | 19 |
| Testosterone undecanoate 1mg HCPCS J3145 | not published | not published | $1.72 – $6.21 | 4 |
| Test pathogen(s) for platelets reference HCPCS P9100 | not published | not published | $33.84 – $189.98 | 2 |
| Test sock elbw disart/above HCPCS L6682 | not published | not published | $270.58 – $340.61 | 18 |
| Test socket above knee HCPCS L5624 | not published | not published | $421.55 – $530.66 | 18 |
| Test socket below knee HCPCS L5620 | not published | not published | $289.31 – $364.19 | 18 |
| Test socket hemipelvectomy HCPCS L5628 | not published | not published | $561.22 – $706.48 | 18 |
| Test socket hip disarticulat HCPCS L5626 | not published | not published | $592.55 – $745.92 | 18 |
| Test socket knee disarticula HCPCS L5622 | not published | not published | $441.82 – $556.18 | 18 |
| Test socket shldr disart/tho HCPCS L6684 | not published | not published | $362.73 – $456.61 | 18 |
| Test socket symes HCPCS L5618 | not published | not published | $329.27 – $414.50 | 18 |
| Test sock wrist disart/bel e HCPCS L6680 | not published | not published | $241.43 – $303.91 | 18 |
| Test urine for lactose CPT 83633 | not published | not published | $9.79 – $16.31 | 19 |
| Test urine for porphyrins CPT 84119 | $596.00 | $596.00 | $11.63 – $19.37 | 19 |
| Test urine urobilinogen CPT 84578 | not published | not published | $3.89 – $6.48 | 19 |
| Tetanus ig im CPT 90389 | not published | not published | $2,360.37 – $2,360.37 | 1 |
| Tetanus immune globulin inj HCPCS J1670 | $3,203.00 | $3,203.00 | $489.40 – $1,765.62 | 4 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | not published | not published | $15.10 – $53.46 | 4 |
| Tgfbi gene common variants CPT 81333 | not published | not published | $137.00 – $198.65 | 16 |
| Tgsap hl neo 5-50 rna alys CPT 81451 | not published | not published | $759.53 – $1,101.32 | 16 |
| Tgsap so/hl 51/< rna alys CPT 81456 | not published | not published | $2,919.60 – $4,233.42 | 16 |
| Tgsap so neo 5-50 rna alys CPT 81449 | $1,605.00 | $1,605.00 | $597.91 – $866.97 | 16 |
| Thaw cryoprsvrd reprod tiss CPT 89354 | not published | not published | $149.16 – $837.38 | 2 |
| Thawing cryopresrved embryo CPT 89352 | not published | not published | $149.16 – $837.38 | 2 |
| Thawing cryopresrved oocyte CPT 89356 | not published | not published | $149.16 – $837.38 | 2 |
| Thawing cryopresrved sperm CPT 89353 | not published | not published | $49.76 – $279.35 | 2 |
| Theophylline therapeutic drug level CPT 80198 | $601.00 | $601.00 | $12.31 – $20.50 | 19 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | not published | not published | $29.96 – $34.19 | 18 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | not published | not published | $26.13 – $29.82 | 18 |
| Ther nma rdctj intus/obstrcj CPT 74283 | not published | not published | $401.74 – $471.32 | 2 |
| Ther radiology tx plng cplx CPT 77263 | not published | not published | $117.32 – $770.68 | 4 |
| Ther radiology tx plng intrm CPT 77262 | not published | not published | $75.57 – $492.25 | 4 |
| Ther radiology tx plng smpl CPT 77261 | not published | not published | $48.98 – $320.85 | 4 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $393.00 | $393.00 | $1.50 – $5.43 | 4 |
| Thigh/wght bear high roll cu HCPCS L2550 | not published | not published | $280.53 – $353.14 | 18 |
| Thigh/wght bear lacer molded HCPCS L2540 | not published | not published | $412.96 – $519.84 | 18 |
| Thigh/wght bear lacer non-mo HCPCS L2530 | not published | not published | $229.49 – $288.89 | 18 |
| Thi/glut/ischia wgt bearing HCPCS L2500 | not published | not published | $317.44 – $399.60 | 18 |
| Thiotepa 15 mg solution for injection HCPCS J9341 | not published | not published | $115.65 – $115.65 | 1 |
| Thiotepa injection HCPCS J9340 | not published | not published | $208.29 – $237.70 | 3 |
| Thorac cont lat support upri HCPCS L2680 | not published | not published | $163.52 – $205.85 | 18 |
| Thorac cont paraspinal uprig HCPCS L2670 | not published | not published | $176.54 – $222.23 | 18 |
| Thoracic control thoracic ba HCPCS L2660 | not published | not published | $182.04 – $229.16 | 18 |
| Thoracic intern lock elbow HCPCS L6350 | not published | not published | $4,076.00 – $5,130.96 | 18 |
| Thoracic pad HCPCS L1060 | not published | not published | $117.57 – $148.00 | 18 |
| Thor rib belt custom fabrica HCPCS L0220 | not published | not published | $137.74 – $173.39 | 18 |
| Throat x-ray & fluoroscopy CPT 70370 | not published | not published | $70.18 – $182.03 | 2 |
| Thrombin time CPT 85670 | $255.00 | $255.00 | $5.02 – $8.37 | 19 |
| Thrombin time titer CPT 85675 | not published | not published | $5.96 – $9.93 | 19 |
| Thrombomodulin CPT 85337 | not published | not published | $15.03 – $25.04 | 19 |
| Thromboplastin inhibition CPT 85705 | $378.00 | $378.00 | $8.38 – $13.96 | 19 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | not published | not published | $5.63 – $9.38 | 19 |
| Thromboxane urine CPT 84431 | not published | not published | $30.56 – $50.91 | 19 |
| Th/wght bear nar m-l brim cu HCPCS L2526 | not published | not published | $723.37 – $910.59 | 18 |
| Th/wght bear nar m-l brim mo HCPCS L2525 | not published | not published | $1,267.59 – $1,595.67 | 18 |
| Th/wght bear quad-lat brim c HCPCS L2520 | not published | not published | $469.83 – $591.43 | 18 |
| Th/wght bear quad-lat brim m HCPCS L2510 | not published | not published | $712.23 – $896.57 | 18 |
| Thyroglobulin antibody CPT 86800 | $351.00 | $351.00 | $13.85 – $23.07 | 19 |
| Thyroid imaging CPT 78013 | $4,237.00 | $4,237.00 | $76.16 – $848.52 | 2 |
| Thyroid met imaging CPT 78015 | not published | not published | $141.71 – $848.52 | 2 |
| Thyroid met imaging/studies CPT 78016 | not published | not published | $146.61 – $848.52 | 2 |
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.