▸ Hospital · TN · CCN 440110

FORT LOUDOUN MEDICAL CENTER

550 FORT LOUDOUN MEDICAL CENTER DR, LENOIR CITY, TN, 37772-1965

30 bedsAcute Care Hospitals2

Compliance grade

100/100

Rates published

30,715

last crawl 2026-05-23

Procedures tracked

201

of 209 target codes

Payers

with negotiated rates

Procedures tracked

...

Payers

...

▸ Compare with other hospitals All TN hospitals JSON

Source MRF: https://mrfs.hyvehealthcare.com/CovenantHealth/621373691_fort-loudoun-medical-center_standardcharges.json · JSON

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
behavioral
Psychoses	MS-DRG	885	24	—	—	$45	$9,834.19	$21,719
Psychiatric diagnostic evaluation	CPT	90791	24	$275	$88	$52.5	$154.05	$247.5
Psychiatric eval with medical services	CPT	90792	24	$330	$105.6	$63	$154.05	$270
Psychotherapy 30 minutes	CPT	90832	24	$205	$65.6	$28.77	$109.6	$154.05
Psychotherapy 45 minutes	CPT	90834	24	$205	$65.6	$38.85	$142.8	$183.6
Psychotherapy 60 minutes	CPT	90837	24	$220	$70.4	$44.1	$147	$198
Crisis psychotherapy 60 minutes	CPT	90839	24	$220	$70.4	$42	$146.71	$198
emergency
ED visit level 1	CPT	99281	24	$325	$104	$77.39	$116	$916
ED visit level 2	CPT	99282	24	$586	$187.52	$142.55	$151.83	$1,393
ED visit level 3	CPT	99283	24	$750	$240	$215	$265.47	$2,047
ED visit level 4	CPT	99284	24	$1,000	$320	$386.06	$408.26	$2,894
ED visit level 5	CPT	99285	24	$1,144	$366.08	$514.8	$587.82	$3,207
Critical care, first hour	CPT	99291	24	$1,320	$422.4	$367.5	$807.87	$3,947
imaging
CT head without contrast	CPT	70450	24	$1,245	$398.4	$52.56	$101.96	$1,120.5
CT head with contrast	CPT	70460	24	$1,245	$398.4	$121.19	$170.68	$1,120.5
CT head with and without contrast	CPT	70470	24	$1,927	$616.64	$123.57	$170.68	$1,734.3
CT neck with contrast	CPT	70491	24	$1,125	$360	$123.57	$170.68	$1,012.5
MRI brain without contrast	CPT	70551	24	$1,772	$567.04	$105.33	$231.76	$1,594.8
MRI brain with contrast	CPT	70552	24	$2,023	$647.36	$198.87	$342.41	$1,820.7
MRI brain with and without contrast	CPT	70553	24	$2,526	$808.32	$198.87	$342.41	$2,273.4
Chest X-ray single view	CPT	71045	24	$162	$51.84	$17.69	$84.42	$163.61
Chest X-ray 2 views	CPT	71046	24	$248	$79.36	$23.38	$84.42	$223.2
Chest X-ray 3 views	CPT	71047	24	$265	$84.8	$28.97	$84.42	$238.5
CT chest without contrast	CPT	71250	24	$1,590	$508.8	$52.56	$101.96	$1,431
CT chest with contrast	CPT	71260	24	$1,868	$597.76	$123.57	$170.68	$1,681.2
CT chest with and without contrast	CPT	71270	24	$2,383	$762.56	$123.57	$170.68	$2,144.7
MRI chest without contrast	CPT	71550	24	$1,769	$566.08	$105.33	$231.76	$1,592.1
MRI chest with contrast	CPT	71551	24	$1,777	$568.64	$306.29	$757.49	$1,599.3
MRI chest with and without contrast	CPT	71552	24	$2,526	$808.32	$198.87	$344.75	$2,273.4
Lumbosacral spine X-ray	CPT	72100	24	$251	$80.32	$28.65	$101.96	$229.76
CT cervical spine without contrast	CPT	72125	24	$1,814	$580.48	$52.56	$101.96	$1,632.6
CT thoracic spine without contrast	CPT	72128	24	$1,814	$580.48	$52.56	$101.96	$1,632.6
CT lumbar spine without contrast	CPT	72131	24	$1,814	$580.48	$52.56	$101.96	$1,632.6
MRI cervical spine without contrast	CPT	72141	24	$2,350	$752	$105.33	$231.76	$2,115
MRI thoracic spine without contrast	CPT	72146	24	$2,350	$752	$105.33	$231.76	$2,115
MRI lumbar spine without contrast	CPT	72148	24	$2,350	$752	$105.33	$231.76	$2,115
MRI lumbar spine with and without contrast	CPT	72149	24	$2,350	$752	$198.87	$342.41	$2,115
MRI cervical spine with and without contrast	CPT	72156	24	$2,890	$924.8	$198.87	$342.41	$2,601
MRI lumbar spine with contrast	CPT	72158	24	$2,890	$924.8	$198.87	$342.41	$2,601
CT pelvis without contrast	CPT	72192	24	$1,320	$422.4	$52.56	$101.96	$1,188
CT pelvis with contrast	CPT	72193	24	$1,320	$422.4	$123.57	$170.68	$1,188
Shoulder X-ray	CPT	73030	24	$437	$139.84	$23.38	$82.81	$163.61
Humerus X-ray	CPT	73060	24	$437	$139.84	$24.59	$82.81	$163.61
Hand X-ray 3 views	CPT	73130	24	$438	$140.16	$27.84	$82.81	$163.61
MRI upper extremity joint without contrast	CPT	73221	24	$1,769	$566.08	$45	$231.76	$987
MRI upper extremity joint with and without contrast	CPT	73223	24	$2,715	$868.8	$45	$342.41	$987
Knee X-ray 1-2 views	CPT	73560	24	$308	$98.56	$27.03	$82.81	$163.61
Ankle X-ray 3 views	CPT	73610	24	$437	$139.84	$27.84	$82.81	$163.61
MRI lower extremity joint without contrast	CPT	73721	24	$1,551	$496.32	$45	$231.76	$987
MRI lower extremity joint with and without contrast	CPT	73723	24	$2,715	$868.8	$45	$342.41	$987
CT abdomen without contrast	CPT	74150	24	$1,320	$422.4	$52.56	$101.96	$1,188
CT abdomen with contrast	CPT	74160	24	$1,320	$422.4	$123.57	$170.68	$1,188
CT abdomen with and without contrast	CPT	74170	24	$1,979	$633.28	$123.57	$170.68	$1,781.1
CT abdomen and pelvis without contrast	CPT	74176	24	$2,640	$844.8	$105.33	$231.76	$2,376
CT abdomen and pelvis with contrast	CPT	74177	24	$2,640	$844.8	$123.57	$342.41	$2,376
CT abdomen and pelvis with and without contrast	CPT	74178	24	$3,958	$1,266.56	$198.87	$342.41	$3,562.2
MRI abdomen without contrast	CPT	74181	24	$1,777	$568.64	$105.33	$231.76	$1,599.3
MRI abdomen with and without contrast	CPT	74183	24	$2,526	$808.32	$198.87	$342.41	$2,273.4
Abdominal ultrasound complete	CPT	76700	24	$894	$286.08	$52.56	$101.96	$804.6
Abdominal ultrasound limited	CPT	76705	24	$487	$155.84	$52.56	$101.96	$438.3
Retroperitoneal ultrasound complete	CPT	76770	24	$290	$92.8	$52.56	$101.96	$331
Obstetric ultrasound first trimester	CPT	76801	24	$662	$211.84	$52.56	$101.96	$595.8
Obstetric ultrasound after first trimester	CPT	76805	24	$662	$211.84	$52.56	$101.96	$595.8
Obstetric ultrasound with fetal anatomy	CPT	76811	24	$301	$96.32	$45	$227.34	$477.73
Transvaginal ultrasound	CPT	76830	24	$279	$89.28	$52.56	$101.96	$331
Pelvic ultrasound complete	CPT	76856	24	$364	$116.48	$52.56	$101.96	$331
Scrotal ultrasound	CPT	76870	24	$345	$110.4	$52.56	$101.96	$331
Diagnostic mammography unilateral	CPT	77065	17	$271	$86.72	$44.35	$89	$261
Diagnostic mammography bilateral	CPT	77066	17	$348	$111.36	$56.73	$247.11	$313.2
Screening mammography bilateral	CPT	77067	17	$234	$74.88	$46.86	$185.6	$261
EKG complete	CPT	93000	17	—	—	$18.31	$65	$234
EKG tracing only	CPT	93005	24	$157	$50.24	$8.81	$56.95	$234
EKG interpretation only	CPT	93010	17	$38	$12.16	$3.68	$15.46	$34.2
Transthoracic echocardiogram complete	CPT	93306	24	$1,249	$399.68	$140.09	$525.69	$1,124.1
Transthoracic echocardiogram	CPT	93307	24	$785	$251.2	$100.29	$231.76	$706.5
Stress echocardiogram	CPT	93350	24	$89.54	$28.65	$45	$480.86	$619
inpatient
Respiratory infections & inflammations w MCC	MS-DRG	177	24	—	—	$45	$12,192	$24,907
COPD w MCC	MS-DRG	190	24	—	—	$45	$8,397.94	$17,303
COPD w CC	MS-DRG	191	24	—	—	$45	$6,201.99	$13,237
COPD w/o CC/MCC	MS-DRG	192	24	—	—	$45	$4,644.9	$9,972.06
Simple pneumonia & pleurisy w CC	MS-DRG	194	24	—	—	$45	$5,886.99	$12,635
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	24	—	—	$45	$4,418.28	$9,594.56
AMI discharged alive w MCC	MS-DRG	280	24	—	—	$45	$12,379	$25,291
AMI discharged alive w CC	MS-DRG	281	24	—	—	$45	$7,023.1	$14,203
AMI discharged alive w/o CC/MCC	MS-DRG	282	24	—	—	$45	$5,549.52	$13,339
Heart failure & shock w MCC	MS-DRG	291	24	—	—	$45	$9,754.62	$20,104
Heart failure & shock w CC	MS-DRG	292	24	—	—	$45	$6,347.06	$13,269
Heart failure & shock w/o CC/MCC	MS-DRG	293	24	—	—	$45	$4,138.29	$8,454.37
Cardiac arrhythmia w MCC	MS-DRG	308	24	—	—	$45	$9,094.89	$18,581
Cardiac arrhythmia w CC	MS-DRG	309	24	—	—	$45	$5,575.79	$11,391
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	24	—	—	$45	$4,219.74	$8,620.78
GI hemorrhage w CC	MS-DRG	378	24	—	—	$45	$6,972.8	$15,191
GI hemorrhage w/o CC/MCC	MS-DRG	379	24	—	—	$45	$4,801.99	$9,810.27
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	24	—	—	$45	$5,542.11	$12,023
Fractures of femur w/o MCC	MS-DRG	533	24	—	—	$45	$11,671	$23,902
Kidney/UTI w MCC	MS-DRG	689	24	—	—	$45	$8,299.16	$18,032
Kidney/UTI w/o MCC	MS-DRG	690	24	—	—	$45	$5,696.63	$12,366
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	24	—	—	$45	$13,960	$30,232
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	24	—	—	$45	$7,295.46	$15,886
Initial hospital care, low complexity	CPT	99221	18	$225	$72	$83.25	$160.15	$4,949
Initial hospital care, moderate complexity	CPT	99222	18	$252	$80.64	$112.5	$214.2	$4,949
Initial hospital care, high complexity	CPT	99223	18	$370	$118.4	$123.75	$296	$4,949
Hospital discharge, <30 min	CPT	99238	18	$132	$42.24	$59.4	$2,000	$4,949
Hospital discharge, >30 min	CPT	99239	18	$196	$62.72	$59.4	$156.8	$4,949
lab
Basic metabolic panel (BMP)	CPT	80048	23	$131	$41.92	$1.01	$8.88	$117.9
General health panel	CPT	80050	16	—	—	$21.92	$80	$90
Electrolyte panel	CPT	80051	23	$65	$20.8	$3.15	$7.36	$58.5
Comprehensive metabolic panel	CPT	80053	23	$234	$74.88	$1	$11.09	$210.6
Lipid panel	CPT	80061	23	$135	$43.2	$1.07	$14.06	$121.5
Renal function panel	CPT	80069	23	$70	$22.4	$3.91	$9.11	$63
Hepatic function panel	CPT	80076	23	$120	$38.4	$1.03	$8.58	$108
Urinalysis non-automated	CPT	81002	23	$26	$8.32	$1.57	$5.01	$23.4
Urinalysis automated	CPT	81003	23	$23	$7.36	$1	$2.36	$20.7
Glucose quantitative	CPT	82947	23	$38	$12.16	$1.77	$4.13	$34.2
Hemoglobin A1c	CPT	83036	23	$98	$31.36	$1.21	$10.2	$88.2
Thyroid stimulating hormone (TSH)	CPT	84443	23	$169	$54.08	$1	$17.64	$152.1
Complete blood count with automated differential	CPT	85025	23	$90	$28.8	$1	$8.16	$81
Complete blood count without differential	CPT	85027	23	$65	$20.8	$2.91	$6.79	$58.5
Urine culture bacterial	CPT	87086	23	$81	$25.92	$3.63	$8.47	$72.9
Urine culture identification	CPT	87088	23	$82	$26.24	$3.64	$8.49	$73.8
Tissue exam by pathologist level IV	CPT	88305	24	$424	$135.68	$18.51	$51.23	$381.6
maternity
Fetal non-stress test	CPT	59025	24	$302	$96.64	$84	$192.87	$2,244
Routine obstetric care including vaginal delivery	CPT	59400	18	—	—	$40	$85	$3,295
Vaginal delivery only	CPT	59409	24	$2,609	$834.88	$1,174.05	$2,990.39	$4,055
Vaginal delivery with postpartum	CPT	59410	18	—	—	$45	$86.5	$3,295
Routine obstetric care with C-section	CPT	59510	18	—	—	$40	$85	$3,295
C-section delivery only	CPT	59514	18	—	—	$40	$85	$3,295
C-section with postpartum	CPT	59515	18	—	—	$45	$86.5	$3,295
office
Office visit, new patient, 15-29 min	CPT	99202	17	$225	$72	$34.65	$132	$237
Office visit, new patient, 30-44 minutes	CPT	99203	17	$250	$80	$40.74	$150	$237
Office visit, new patient, 45-59 min	CPT	99204	17	$282	$90.24	$57.75	$169.85	$253.8
Office visit, new patient, 60-74 min	CPT	99205	17	$345	$110.4	$63	$190	$310.5
Office visit, established patient, 5 min	CPT	99211	17	$182	$58.24	$16.38	$70.2	$237
Office visit, established patient, 10-19 min	CPT	99212	17	$200	$64	$19.32	$86.18	$237
Office visit, established patient, 20-29 minutes	CPT	99213	17	$225	$72	$22.68	$102.3	$237
Office visit, established patient, 30-39 minutes	CPT	99214	17	$250	$80	$25.62	$125	$237
Office visit, established patient, 40-54 min	CPT	99215	17	$276	$88.32	$32.34	$140.76	$248.4
preventive
Upper GI endoscopy diagnostic	CPT	43235	24	—	—	$45	$898.91	$2,610
Upper GI endoscopy with biopsy	CPT	43239	24	—	—	$45	$898.91	$2,610
Sigmoidoscopy diagnostic	CPT	45330	24	—	—	$45	$874.13	$2,244
Sigmoidoscopy with biopsy	CPT	45331	24	—	—	$45	$874.13	$2,244
Colonoscopy diagnostic	CPT	45378	24	—	—	$45	$874.13	$2,610
Colonoscopy with biopsy	CPT	45380	24	—	—	$45	$1,130.47	$2,805
Colonoscopy with polyp removal	CPT	45385	24	—	—	$45	$1,130.47	$2,805
surgery
Total shoulder arthroplasty	CPT	23472	24	—	—	$45	$14,052	$17,632
PCI w drug-eluting stent w MCC	MS-DRG	246	1	—	—	$16,591	$16,591	$16,591
PCI w drug-eluting stent w/o MCC	MS-DRG	247	1	—	—	$10,639	$10,639	$10,639
Hip hemiarthroplasty	CPT	27125	18	—	—	$45	$2,281	$11,500
Total hip replacement	CPT	27130	24	—	—	$45	$11,907	$20,333
Total knee replacement	CPT	27447	24	—	—	$45	$11,907	$20,970
Knee revision arthroplasty single component	CPT	27486	18	—	—	$45	$2,281	$24,147
Knee revision arthroplasty all components	CPT	27487	18	—	—	$45	$2,281	$24,147
Shoulder arthroscopy with decompression	CPT	29826	18	—	—	$45	$147	$2,669
Shoulder arthroscopy with rotator cuff repair	CPT	29827	24	—	—	$45	$6,523.08	$8,352
Knee arthroscopy with meniscectomy	CPT	29881	24	—	—	$45	$3,051.6	$5,482
ACL reconstruction	CPT	29888	24	—	—	$45	$6,523.08	$8,352
Major small/large bowel procedures w MCC	MS-DRG	329	24	—	—	$45	$33,917	$70,752
Major small/large bowel procedures w CC	MS-DRG	330	24	—	—	$45	$17,827	$36,420
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	24	—	—	$45	$12,396	$25,439
CABG single arterial graft	CPT	33533	18	—	—	$45	$1,575	$3,295
CABG 2 arterial grafts	CPT	33534	18	—	—	$45	$1,575	$3,295
CABG 3 arterial grafts	CPT	33535	18	—	—	$45	$1,575	$3,295
CABG 4+ arterial grafts	CPT	33536	18	—	—	$45	$1,575	$3,295
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	24	—	—	$45	$12,508	$25,553
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	24	—	—	$45	$9,826.76	$20,302
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	24	—	—	$45	$23,882	$54,383
Open appendectomy	CPT	44950	24	—	—	$45	$5,697.64	$6,848
Laparoscopic appendectomy	CPT	44970	24	—	—	$45	$5,407.38	$8,352
Spinal fusion (non-cervical) w MCC	MS-DRG	459	2	—	—	$44,628	$44,628	$45,326
Spinal fusion (non-cervical) w/o MCC	MS-DRG	460	2	—	—	$24,119	$24,613	$24,613
Major joint replacement w MCC	MS-DRG	469	24	—	—	$45	$24,652	$50,364
Major joint replacement w/o MCC	MS-DRG	470	24	—	—	$45	$14,220	$29,052
Laparoscopic cholecystectomy	CPT	47562	24	—	—	$45	$5,407.38	$8,352
Lap cholecystectomy with cholangiography	CPT	47563	24	—	—	$45	$5,407.38	$8,352
Hip & femur procedures except major joint w MCC	MS-DRG	480	24	—	—	$45	$22,181	$45,315
Hip & femur procedures except major joint w CC	MS-DRG	481	24	—	—	$45	$15,649	$31,970
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	24	—	—	$45	$11,965	$24,443
Open umbilical hernia repair	CPT	49560	1	—	—	$2,826.21	$2,826.21	$2,826.21
Umbilical hernia repair age 5+	CPT	49585	1	—	—	$2,826.21	$2,826.21	$2,826.21
Lap inguinal hernia repair	CPT	49650	24	—	—	$45	$5,407.38	$8,352
Lap incisional hernia repair	CPT	49652	1	—	—	$4,393.57	$4,393.57	$4,393.57
Total abdominal hysterectomy	CPT	58150	18	—	—	$45	$1,851	$6,848
Vaginal hysterectomy	CPT	58260	24	—	—	$45	$4,499.79	$5,482
Lap-assisted vaginal hysterectomy	CPT	58550	24	—	—	$45	$5,407.38	$8,352
Lap-assisted vaginal hysterectomy >250g	CPT	58552	24	—	—	$45	$8,561	$9,982.02
Lap salpingo-oophorectomy	CPT	58661	24	—	—	$45	$5,407.38	$8,352
OR procedure for obesity w MCC	MS-DRG	619	24	—	—	$45	$20,867	$42,010
OR procedure for obesity w CC	MS-DRG	620	24	—	—	$45	$12,223	$24,607
OR procedure for obesity w/o CC/MCC	MS-DRG	621	24	—	—	$45	$11,188	$22,865
Complex cataract surgery	CPT	66982	24	—	—	$45	$2,186.71	$5,120
Cataract surgery with lens implant	CPT	66984	24	—	—	$45	$2,186.71	$5,120
Intravitreal injection	CPT	67028	24	—	—	$45	$318.01	$2,244
Vitrectomy mechanical	CPT	67042	24	—	—	$45	$3,783.55	$6,324
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	24	—	—	$45	$8,362.95	$18,470
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	24	—	—	$45	$13,593	$30,107
PCI single major coronary artery	CPT	92920	24	$5,696	$1,822.72	$45	$5,466.48	$11,074
PCI with drug-eluting stent	CPT	92928	24	$8,652	$2,768.64	$45	$9,972.17	$11,074
PCI bypass graft	CPT	92937	24	$8,652	$2,768.64	$1,941	$10,511	$11,074
Left heart catheterization	CPT	93452	24	$3,986	$1,275.52	$1,793.7	$3,083.82	$9,300
Coronary angiography with cath	CPT	93455	24	$5,634	$1,802.88	$1,941	$3,083.82	$9,300
Coronary angiography with bypass cath	CPT	93458	24	$5,266	$1,685.12	$2,186	$3,083.82	$9,300

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 24)

Payer	Codes covered	Median rate
Aetna	194	$396
ehn	194	$45
galaxy health network	194	$90
initial group	194	$88
medsave usa	194	$80
national provider network	194	$80
novanet	194	$75
UnitedHealthcare	194	$477.73
usa managed care organization	194	$70
beech street	194	$85
Blue Cross Blue Shield	194	$522
ccn managed care	194	$85
Cigna	194	$454
community services network	194	$65
correctional medical services	194	$60
direct care america	194	$80
wellpoint	186	$525.69
Ambetter	178	$987
farm bureau	162	$335.21
WellCare	160	$342.41
TRICARE	160	$326.1
Humana	160	$335.88
optum	160	$326.1
devoted health	160	$342.41

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