Home › Hospitals › Potomac Valley Hospital Posts prices for 34 of the 66 common shoppable procedures we track. Price file retrieved 2026-08-28.
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Procedure Cash price Gross charge × Medicare
Epidural injection, lumbar/sacral (with imaging) (62322) $859
$1,718
1.0×
CT head/brain without contrast (70450) $480
$960
4.8×
MRI brain without contrast (70551) $993.50
$1,987
4.3×
MRI brain with contrast (70552) $1,066
$2,132
3.2×
MRI brain without and with contrast (70553) $1,510
$3,020
4.5×
X-ray lower spine, 4+ views (72110) $218
$436
2.2×
MRI lumbar spine without contrast (72148) $1,133
$2,266
5.0×
CT pelvis with contrast (72193) $697
$1,394
4.1×
MRI lower-extremity joint without contrast (73721) $1,121.50
$2,243
4.9×
CT abdomen and pelvis with contrast (74177) $1,410.50
$2,821
4.2×
Ultrasound, abdomen complete (76700) $457.50
$915
4.6×
Ultrasound, transvaginal (76830) $103
$206
1.0×
Mammography, one breast (diagnostic) (77065) $164
$328
1.9×
Mammography, both breasts (diagnostic) (77066) $204.50
$409
1.8×
Mammography, screening (bilateral) (77067) $187.50
$375
2.1×
Basic metabolic panel (80048) $39
$78
4.6×
Comprehensive metabolic panel (80053) $49
$98
4.6×
Lipid panel (80061) $62.50
$125
4.7×
Renal function panel (80069) $40
$80
4.6×
Hepatic function panel (80076) $38
$76
4.7×
Urinalysis, non-automated, with microscopy (81000) $5
$10
1.2×
Urinalysis, non-automated, without microscopy (81002) $8.50
$17
2.4×
PSA, total (84153) $51.50
$103
2.8×
Thyroid stimulating hormone (TSH) (84443) $47.75
$95.50
2.8×
CBC with automated differential (85025) $34
$68
4.4×
CBC, automated (85027) $28.50
$57
4.4×
Prothrombin time (PT) (85610) $24.50
$49
5.7×
Partial thromboplastin time (PTT) (85730) $34
$68
5.7×
Family psychotherapy, without patient (50 min) (90846) $195
$390
1.1×
Family psychotherapy, with patient (50 min) (90847) $191
$382
1.1×
Electrocardiogram (ECG), complete (93000) $209
$418
3.7×
Physical therapy, therapeutic exercise (per 15 min) (97110) $53
$106
1.8×
Preventive visit, new patient (age 18–39) (99385) $60.50
$121
—
Preventive visit, new patient (age 40–64) (99386) $71
$142
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As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
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