Braxton County Memorial Hospital
100 Hoylman Dr, Gassaway, WV · Wvumedicine · · NPI 1356304547
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 |
|---|---|---|---|---|
| Ultrasound dx ophth b-scan CPT 76512 | $51.50 | $103.00 | not published | 0 |
| Ultrasound encephalogram CPT 76506 | $353.00 | $706.00 | not published | 0 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $372.00 | $744.00 | not published | 0 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $92.50 | $185.00 | not published | 0 |
| Ultrasound guidance for vascular access CPT 76937 | $14.00 | $28.00 | not published | 0 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $185.00 | $370.00 | not published | 0 |
| Ultrasound guide intraoperative CPT 76998 | $425.50 | $851.00 | not published | 0 |
| Ultrasound joint complete left CPT 76881 | $59.00 | $118.00 | not published | 0 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $205.00 | $410.00 | not published | 0 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $193.00 | $386.00 | not published | 0 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $368.50 | $737.00 | not published | 0 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $232.50 | $465.00 | not published | 0 |
| Ultrasound prostate/transrectal CPT 76872 | $124.00 | $248.00 | not published | 0 |
| Ultrasound retroperitoneal limited CPT 76775 | $227.50 | $455.00 | not published | 0 |
| Ultrasound scrotum and contents CPT 76870 | $337.50 | $675.00 | not published | 0 |
| Ultrasound transvaginal non obstetric CPT 76830 | $311.50 | $623.00 | not published | 0 |
| Unlisted hematology&coagj px CPT 85999 | $8.00 | $16.00 | not published | 0 |
| Unlisted laparoscopic liver biopy 47379 CPT 47379 | $1,395.00 | $2,790.00 | not published | 0 |
| Unlisted laparoscopic procedure 49659 CPT 49659 | $1,188.00 | $2,376.00 | not published | 0 |
| Unlisted laparoscopic reduction intestine 44238 CPT 44238 | $1,668.00 | $3,336.00 | not published | 0 |
| Unlisted laparoscopy procedure biliary tract 47579 CPT 47579 | $1,228.00 | $2,456.00 | not published | 0 |
| Unlisted laps px appendix CPT 44979 | $825.00 | $1,650.00 | not published | 0 |
| Unlisted laps px lymphtc sys CPT 38589 | $21.50 | $43.00 | not published | 0 |
| Unlisted laps px uterus CPT 58578 | $1,081.00 | $2,162.00 | not published | 0 |
| Unlisted maaa CPT 81599 | $587.00 | $1,174.00 | not published | 0 |
| Unlisted muscskel px head CPT 21499 | $109.50 | $219.00 | not published | 0 |
| Unlisted procedure colon CPT 45399 | $1,091.00 | $2,182.00 | not published | 0 |
| Unlisted procedure esophagus CPT 43499 | $1,200.00 | $2,400.00 | not published | 0 |
| Unlisted procedure larynx CPT 31599 | $137.00 | $274.00 | not published | 0 |
| Unlisted procedure rectum CPT 45999 | $348.50 | $697.00 | not published | 0 |
| Unlisted procedure spine CPT 22899 | $106.50 | $213.00 | not published | 0 |
| Unlisted px abdomen muscskel CPT 22999 | $133.50 | $267.00 | not published | 0 |
| Unlisted px arthroscopy CPT 29999 | $596.50 | $1,193.00 | not published | 0 |
| Unlisted px biliary tract CPT 47999 | $886.50 | $1,773.00 | not published | 0 |
| Unlisted px conjunctiva CPT 68399 | $387.00 | $774.00 | not published | 0 |
| Unlisted px diaphragm CPT 39599 | $118.50 | $237.00 | not published | 0 |
| Unlisted px external ear CPT 69399 | $21.00 | $42.00 | not published | 0 |
| Unlisted px foot/toes CPT 28899 | $244.00 | $488.00 | not published | 0 |
| Unlisted px forearm/wrist CPT 25999 | $872.00 | $1,744.00 | not published | 0 |
| Unlisted px hands/fingers CPT 26989 | $231.50 | $463.00 | not published | 0 |
| Unlisted px lacrimal system CPT 68899 | $273.50 | $547.00 | not published | 0 |
| Unlisted px leg/ankle CPT 27899 | $284.50 | $569.00 | not published | 0 |
| Unlisted px male genital sys CPT 55899 | $306.50 | $613.00 | not published | 0 |
| Unlisted px mediastinum CPT 39499 | $118.50 | $237.00 | not published | 0 |
| Unlisted px neck/thorax CPT 21899 | $460.00 | $920.00 | not published | 0 |
| Unlisted px pelvis/hip joint CPT 27299 | $576.50 | $1,153.00 | not published | 0 |
| Unlisted px small intestine CPT 44799 | $541.00 | $1,082.00 | not published | 0 |
| Unlisted spec derm svc/px CPT 96999 | $113.00 | $226.00 | not published | 0 |
| Upgrade pm system CPT 33214 | $4,365.00 | $8,730.00 | not published | 0 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $1,928.00 | $3,856.00 | not published | 0 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $1,092.50 | $2,185.00 | not published | 0 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $868.50 | $1,737.00 | not published | 0 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $132.50 | $265.00 | not published | 0 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $150.00 | $300.00 | not published | 0 |
| Uppr gi scope w/submuc inj CPT 43236 | $140.50 | $281.00 | not published | 0 |
| Urachal cyst/sinus excision 51500 CPT 51500 | $660.50 | $1,321.00 | not published | 0 |
| Urea nitrogen CPT 84520 | $27.50 | $55.00 | not published | 0 |
| Urea nitrogen 24 hour urine CPT 84540 | $27.50 | $55.00 | not published | 0 |
| Urethrlys transvag with scope CPT 53500 | $774.50 | $1,549.00 | not published | 0 |
| Uric acid blood CPT 84550 | $24.00 | $48.00 | not published | 0 |
| Uric acid urine CPT 84560 | $24.00 | $48.00 | not published | 0 |
| Urinalysis microscopic only CPT 81015 | $15.50 | $31.00 | not published | 0 |
| Urinalysis (with microscopy) CPT 81001 | $23.00 | $46.00 | not published | 0 |
| Urinalysis (without microscopy) CPT 81003 | $20.50 | $41.00 | not published | 0 |
| Urine Culture Test CPT 87086 | $31.50 | $63.00 | not published | 0 |
| Urine flow measurement 51736 CPT 51736 | $16.00 | $32.00 | not published | 0 |
| Urine pregnancy test CPT 81025 | $20.50 | $41.00 | not published | 0 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $186.00 | $372.00 | $240.77 – $240.77 | 1 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $169.50 | $339.00 | $240.77 – $240.77 | 1 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $150.50 | $301.00 | $216.32 – $216.32 | 1 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $67.50 | $135.00 | $135.00 – $135.00 | 1 |
| Vaccine dtap < 7 years im CPT 90700 | $41.00 | $82.00 | $56.96 – $56.96 | 1 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $94.50 | $189.00 | $187.79 – $187.79 | 1 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $86.00 | $172.00 | $138.00 – $138.00 | 1 |
| Vaccine dtap-ipv/hib im CPT 90698 | $159.00 | $318.00 | $217.26 – $217.26 | 1 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $41.50 | $83.00 | $58.58 – $58.58 | 1 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $18.50 | $37.00 | $25.21 – $25.21 | 1 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $102.00 | $204.00 | $115.93 – $115.93 | 1 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | $143.00 | $286.00 | $213.39 – $213.39 | 1 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $49.00 | $98.00 | $68.72 – $68.72 | 1 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | $69.50 | $139.00 | $124.00 – $124.00 | 1 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $69.50 | $139.00 | $116.13 – $116.13 | 1 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $190.00 | $380.00 | $264.46 – $264.46 | 1 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $33.00 | $66.00 | $50.77 – $50.77 | 1 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $435.50 | $871.00 | $569.07 – $569.07 | 1 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $119.00 | $238.00 | $121.11 – $121.11 | 1 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $109.50 | $219.00 | not published | 0 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $29.00 | $58.00 | $21.07 – $21.07 | 1 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $48.50 | $97.00 | not published | 0 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | $14.50 | $29.00 | $21.62 – $21.62 | 1 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $229.00 | $458.00 | $411.10 – $411.10 | 1 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | $254.50 | $509.00 | $376.46 – $376.46 | 1 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $220.50 | $441.00 | $330.38 – $330.38 | 1 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $156.50 | $313.00 | $299.95 – $299.95 | 1 |
| Vaccine mmr live subcutaneous CPT 90707 | $129.00 | $258.00 | $182.39 – $182.39 | 1 |
| Vaccine mmrv live subcutaneous CPT 90710 | $404.00 | $808.00 | $218.94 – $218.94 | 1 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $158.00 | $316.00 | $220.23 – $220.23 | 1 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | $272.50 | $545.00 | $418.37 – $418.37 | 1 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $363.50 | $727.00 | $476.29 – $476.29 | 1 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | $61.50 | $123.00 | $84.18 – $84.18 | 1 |
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.