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 |
|---|---|---|---|---|
| Urethrocystography void s&i CPT 74455 | $2,398.00 | $2,398.00 | $71.71 – $517.79 | 2 |
| Uric acid blood CPT 84550 | not published | not published | $3.94 – $6.55 | 19 |
| Uric acid urine CPT 84560 | not published | not published | $4.42 – $7.37 | 19 |
| Urinalysis glass test CPT 81020 | not published | not published | $4.09 – $6.82 | 19 |
| Urinalysis microscopic only CPT 81015 | not published | not published | $2.65 – $4.42 | 19 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | $95.00 | $95.00 | $1.89 – $3.15 | 19 |
| Urinalysis (with microscopy) CPT 81001 | not published | not published | $2.76 – $4.60 | 19 |
| Urinalysis (without microscopy) CPT 81003 | not published | not published | $1.95 – $3.26 | 19 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $35.54 – $35.54 | 1 |
| Urinary pouch on barr w/flng HCPCS A5073 | not published | not published | $3.30 – $4.15 | 18 |
| Urinary pouch w/barrier HCPCS A5071 | not published | not published | $7.28 – $9.17 | 18 |
| Urinary suspensory HCPCS A5105 | not published | not published | $41.98 – $52.85 | 18 |
| Urine Culture Test CPT 87086 | $116.00 | $116.00 | $7.02 – $11.70 | 19 |
| Urine ost pouch w faucet/tap HCPCS A4428 | not published | not published | $7.90 – $9.94 | 18 |
| Urine pregnancy test CPT 81025 | not published | not published | $7.49 – $12.48 | 19 |
| Urine screen for bacteria CPT 81007 | not published | not published | $26.09 – $43.47 | 19 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $3.00 – $12.80 | 16 |
| Urography, antegrade CPT 74425 | not published | not published | $108.19 – $828.27 | 2 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $105.59 – $401.74 | 2 |
| Use 1st target lesion CPT 76982 | $1,092.00 | $1,092.00 | $128.32 – $245.18 | 2 |
| User adjustable heel height HCPCS L5990 | not published | not published | $1,853.35 – $2,333.04 | 18 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | not published | not published | $10.89 – $37.47 | 4 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | not published | not published | $1,223.13 – $1,223.13 | 1 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | not published | not published | $137.40 – $484.95 | 4 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | not published | not published | $125.00 – $441.18 | 4 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | not published | not published | $132.52 – $505.11 | 4 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | not published | not published | $74.61 – $284.40 | 4 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | not published | not published | $55.72 – $196.41 | 4 |
| Vaccine dtap < 7 years im CPT 90700 | $254.00 | $254.00 | $27.02 – $111.12 | 4 |
| Vaccine dtap-hep b-ipv im CPT 90723 | not published | not published | $93.36 – $398.10 | 4 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | not published | not published | $57.66 – $236.07 | 4 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $141.19 – $599.79 | 4 |
| Vaccine dtap-ipv/hib im CPT 90698 | $962.00 | $962.00 | $108.18 – $423.81 | 4 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | not published | not published | $27.55 – $112.86 | 4 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $102.00 | $102.00 | $11.97 – $48.96 | 4 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | not published | not published | $61.34 – $220.62 | 4 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | not published | not published | $119.32 – $508.86 | 4 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $165.00 | $165.00 | $35.13 – $129.03 | 4 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | not published | not published | $94.20 – $94.20 | 1 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $63.88 – $225.45 | 4 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $884.00 | $884.00 | $59.82 – $225.45 | 4 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | not published | not published | $150.93 – $532.68 | 4 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $121.00 | $121.00 | $26.92 – $99.60 | 4 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $2,660.00 | $2,660.00 | $277.16 – $1,184.28 | 4 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | not published | not published | $339.69 – $339.69 | 1 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $228.00 | $228.00 | $70.97 – $294.48 | 4 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | not published | not published | $70.97 – $294.48 | 4 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | $71.00 | $71.00 | $18.58 – $66.21 | 4 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | not published | not published | $19.00 – $69.66 | 4 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | not published | not published | $31.32 – $148.50 | 4 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $9.29 – $33.09 | 4 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $830.00 | $830.00 | $213.65 – $904.26 | 4 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | $600.00 | $600.00 | $171.43 – $812.82 | 4 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $295.00 | $295.00 | $637.14 – $637.14 | 1 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $622.00 | $622.00 | $152.59 – $635.70 | 4 |
| Vaccine mmr live subcutaneous CPT 90707 | $321.00 | $321.00 | $85.77 – $351.42 | 4 |
| Vaccine mmrv live subcutaneous CPT 90710 | not published | not published | $250.62 – $1,039.20 | 4 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $382.00 | $382.00 | $113.45 – $400.41 | 4 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | not published | not published | $219.29 – $773.55 | 4 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | $2,265.00 | $2,265.00 | $221.98 – $807.93 | 4 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | not published | not published | $265.96 – $938.70 | 4 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | not published | not published | $38.42 – $171.66 | 4 |
| Vaccine rabies im CPT 90675 | $5,117.00 | $5,117.00 | $270.02 – $959.25 | 4 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | not published | not published | $265.79 – $1,148.64 | 4 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $859.00 | $859.00 | $468.30 – $2,142.21 | 4 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | not published | not published | $468.30 – $2,142.21 | 4 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | not published | not published | $264.89 – $1,102.86 | 4 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | not published | not published | $132.46 – $560.43 | 4 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | not published | not published | $89.04 – $369.42 | 4 |
| Vaccine tdap >=7 years im CPT 90715 | $242.00 | $242.00 | $33.21 – $119.07 | 4 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $905.00 | $905.00 | $28.87 – $116.91 | 4 |
| Vaccine typhoid vicps im CPT 90691 | not published | not published | $499.17 – $499.17 | 1 |
| Vaccine varicella live subcutaneous CPT 90716 | not published | not published | $164.88 – $691.17 | 4 |
| Vaccine yellow fever live subcutaneous CPT 90717 | not published | not published | $922.80 – $922.80 | 1 |
| Vaccinia vrs vac 0.3 ml perq CPT 90622 | not published | not published | $0.03 – $0.03 | 1 |
| Vacuum drain bottle/tube kit HCPCS A7048 | not published | not published | $50.03 – $62.98 | 18 |
| Vad battery clip set hmii 14-v li-ion HCPCS Q0497 | not published | not published | $478.24 – $602.02 | 18 |
| Vad cable power module dc input HCPCS Q0478 | not published | not published | $187.74 – $236.33 | 18 |
| Vad univ batt charger hm 1440 HCPCS Q0495 | not published | not published | $4,267.14 – $5,371.57 | 18 |
| Vag inser rectal control sys HCPCS A4563 | not published | not published | $1,394.25 – $1,755.12 | 18 |
| Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr HCPCS J3379 | not published | not published | $0.15 – $0.15 | 1 |
| Valproic acid total therapeutic drug level CPT 80164 | $639.00 | $639.00 | $11.78 – $19.63 | 19 |
| Valrubicin injection HCPCS J9357 | not published | not published | $1,227.87 – $3,910.02 | 4 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | not published | not published | $0.09 – $0.09 | 1 |
| Vancomycin 750 mg intravenous solution HCPCS J3374 | not published | not published | $0.30 – $0.30 | 1 |
| Vancomycin hcl injection HCPCS J3370 | not published | not published | $1.66 – $1.89 | 3 |
| Vancomycin peak therapeutic drug level CPT 80202 | not published | not published | $11.78 – $19.63 | 19 |
| Vanomycin dna amp probe CPT 87500 | not published | not published | $30.54 – $50.88 | 19 |
| Vantas implant HCPCS J9225 | not published | not published | $14,128.59 – $14,128.59 | 1 |
| Variable concentration mask HCPCS A4620 | not published | not published | $0.73 – $0.92 | 18 |
| Varicella zoster antibody igg CPT 86787 | not published | not published | $11.21 – $18.68 | 19 |
| Varicella-zoster immue globin im CPT 90396 | not published | not published | $7,090.17 – $7,090.17 | 1 |
| Varus/valgus strap padded/li HCPCS L2270 | not published | not published | $53.92 – $67.88 | 18 |
| Vasopressin 20 unit/ml intravenous solution HCPCS J2598 | not published | not published | $1.21 – $1.59 | 4 |
| Vedolizumab 300 mg intravenous solution HCPCS J3380 | $28,175.00 | $28,175.00 | $17.99 – $64.11 | 4 |
| Vein x-ray adrenal gland CPT 75840 | not published | not published | $239.07 – $6,438.74 | 2 |
| Vein x-ray eye socket CPT 75880 | not published | not published | $147.86 – $1,218.65 | 2 |
| Vein x-ray kidney CPT 75831 | not published | not published | $227.03 – $6,438.74 | 2 |
| Vein x-ray liver CPT 75891 | $4,639.00 | $4,639.00 | $229.46 – $6,438.74 | 2 |
| Vein x-ray liver w/hemodynam CPT 75885 | not published | not published | $287.78 – $6,438.74 | 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.