Supplies, drugs & other prices at LewisGale Medical Center

Salem, VA · every code in this section with a posted price and a Medicare benchmark.

37 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Admin hepatitis b vaccine (G0010) $84 $84 1.8×
Admin influenza virus vac (G0008) $92 $92 2.0×
Admin pneumococcal vaccine (G0009) $96 $96 2.1×
Chemo extend iv infus w/pump (G0498) $1,148 $1,148 3.6×
Covid-19 lab test non-cdc (U0002) $76 $76 1.5×
Direct refer hospital observ (G0379) $1,018 $1,018 1.8×
Drug test def 1-7 classes (G0480) $431 $431 3.8×
Drug test def 22+ classes (G0483) $2,834 $2,834 11.5×
Drug test def 8-14 classes (G0481) $678 $678 4.3×
Elec stim other than wound (G0283) $614 $614 48.4×
Lev 1 hosp type b ed visit (G0380) $254 $254 3.5×
Lev 2 hosp type b ed visit (G0381) $433 $433 4.8×
Lev 3 hosp type b ed visit (G0382) $516 $516 3.1×
Lev 4 hosp type b ed visit (G0383) $903 $903 3.5×
Lev 5 hosp type b ed visit (G0384) $1,448 $1,448 3.6×
Mra w/cont, abd (C8900) $9,955 $9,955 29.2×
Mra w/o cont, abd (C8901) $9,955 $9,955 42.8×
Mra w/o cont, chest (C8910) $6,701 $6,701 28.8×
Mra w/o fol w/cont, abd (C8902) $9,955 $9,955 29.2×
Mra w/o fol w/cont, chest (C8911) $8,715 $8,715 25.6×
Mra w/o fol w/cont, lwr ext (C8914) $10,648 $10,648 31.3×
Mra w/o fol w/cont, pelvis (C8920) $10,663 $10,663 31.3×
Mra, w/dye, upper extremity (C8934) $10,648 $10,648 31.3×
Mra, w/o dye, upper extr (C8935) $10,648 $10,648 45.7×
Mra, w/o&w/dye, upper extr (C8936) $10,648 $10,648 31.3×
Mri w/o fol w/cont, breast, (C8908) $11,749 $11,749 34.5×
Mri w/o fol w/cont, brst, un (C8905) $9,957 $9,957 29.3×
Neuro csf prion prtn qual (0035U) $1,562 $1,562 2.9×
Pathogen test for platelets (P9100) $136 $136 2.4×
Prostate biopsy, any mthd (G0416) $1,058 $1,058 3.0×
Psa screening (G0103) $315 $315 16.3×
Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) $2,080 $2,080 2.9×
Tomosynthesis, mammo (G0279) $102 $102 8.0×
Trauma respons w/hosp criti (G0390) $21,812 $21,812 16.8×
Tte w or w/o fol w/cont, com (C8921) $3,407 $3,407 4.5×
Tte w or wo fol wcon,doppler (C8929) $2,370 $2,370 3.1×
Unsched dialysis esrd pt hos (G0257) $2,463 $2,463 3.7×