▸ Hospital · VA · CCN 491991

LYNN HOUSE OF POTOMAC VALLEY INC.

4400 W BRADDOCK ROAD, ALEXANDRIA, VA, 22304-1010

11 beds1

Compliance grade

86/100

Procedures tracked

142

of 209 target codes

Payers

with negotiated rates

Rates published

512

last crawl 2026-05-24

▸ Compare with other hospitals All VA hospitals JSON Full cost report on HCRIS.io →

Source MRF: https://wvumedicine.org/wp-content/uploads/2026/04/550420956_Potomac-Valley-Hospital-of-WV-Inc._standardcharges.csv · CSV

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
behavioral
Psychiatric diagnostic evaluation	CPT	90791	0	$404	$202	—	—	—
Psychiatric eval with medical services	CPT	90792	0	$377	$188.5	—	—	—
Psychotherapy 30 minutes	CPT	90832	0	$201	$100.5	—	—	—
Psychotherapy 45 minutes	CPT	90834	0	$301	$150.5	—	—	—
Psychotherapy 60 minutes	CPT	90837	0	$401	$200.5	—	—	—
Crisis psychotherapy 60 minutes	CPT	90839	0	$341	$170.5	—	—	—
emergency
ED visit level 1	CPT	99281	0	$340	$170	—	—	—
ED visit level 2	CPT	99282	0	$378	$189	—	—	—
ED visit level 3	CPT	99283	0	$533	$266.5	—	—	—
ED visit level 4	CPT	99284	0	$813	$406.5	—	—	—
ED visit level 5	CPT	99285	0	$1,223	$611.5	—	—	—
Critical care, first hour	CPT	99291	0	$1,679	$839.5	—	—	—
imaging
CT head without contrast	CPT	70450	0	$960	$480	—	—	—
CT head with contrast	CPT	70460	0	$1,192	$596	—	—	—
CT head with and without contrast	CPT	70470	0	$1,450	$725	—	—	—
CT neck with contrast	CPT	70491	0	$1,138	$569	—	—	—
MRI brain without contrast	CPT	70551	0	$1,987	$993.5	—	—	—
MRI brain with contrast	CPT	70552	0	$2,132	$1,066	—	—	—
MRI brain with and without contrast	CPT	70553	0	$3,020	$1,510	—	—	—
Chest X-ray single view	CPT	71045	0	$247	$123.5	—	—	—
Chest X-ray 2 views	CPT	71046	0	$332	$166	—	—	—
Chest X-ray 3 views	CPT	71047	0	$415	$207.5	—	—	—
CT chest without contrast	CPT	71250	0	$1,181	$590.5	—	—	—
CT chest with contrast	CPT	71260	0	$1,457	$728.5	—	—	—
CT chest with and without contrast	CPT	71270	0	$1,782	$891	—	—	—
MRI chest without contrast	CPT	71550	0	$3,273	$1,636.5	—	—	—
MRI chest with and without contrast	CPT	71552	0	$5,311	$2,655.5	—	—	—
Lumbosacral spine X-ray	CPT	72100	0	$318	$159	—	—	—
CT cervical spine without contrast	CPT	72125	0	$1,239	$619.5	—	—	—
CT thoracic spine without contrast	CPT	72128	0	$1,260	$630	—	—	—
CT lumbar spine without contrast	CPT	72131	0	$1,260	$630	—	—	—
MRI cervical spine without contrast	CPT	72141	0	$1,987	$993.5	—	—	—
MRI thoracic spine without contrast	CPT	72146	0	$2,287	$1,143.5	—	—	—
MRI lumbar spine without contrast	CPT	72148	0	$2,266	$1,133	—	—	—
MRI lumbar spine with and without contrast	CPT	72149	0	$2,456	$1,228	—	—	—
MRI cervical spine with and without contrast	CPT	72156	0	$3,048	$1,524	—	—	—
MRI lumbar spine with contrast	CPT	72158	0	$3,510	$1,755	—	—	—
CT pelvis without contrast	CPT	72192	0	$1,233	$616.5	—	—	—
CT pelvis with contrast	CPT	72193	0	$1,394	$697	—	—	—
Shoulder X-ray	CPT	73030	0	$266	$133	—	—	—
Humerus X-ray	CPT	73060	0	$262	$131	—	—	—
Hand X-ray 3 views	CPT	73130	0	$254	$127	—	—	—
MRI upper extremity joint without contrast	CPT	73221	0	$2,264	$1,132	—	—	—
MRI upper extremity joint with and without contrast	CPT	73223	0	$3,455	$1,727.5	—	—	—
Knee X-ray 1-2 views	CPT	73560	0	$247	$123.5	—	—	—
Ankle X-ray 3 views	CPT	73610	0	$254	$127	—	—	—
MRI lower extremity joint without contrast	CPT	73721	0	$2,243	$1,121.5	—	—	—
MRI lower extremity joint with and without contrast	CPT	73723	0	$3,455	$1,727.5	—	—	—
CT abdomen without contrast	CPT	74150	0	$1,230	$615	—	—	—
CT abdomen with contrast	CPT	74160	0	$1,440	$720	—	—	—
CT abdomen with and without contrast	CPT	74170	0	$1,736	$868	—	—	—
CT abdomen and pelvis without contrast	CPT	74176	0	$2,465	$1,232.5	—	—	—
CT abdomen and pelvis with contrast	CPT	74177	0	$2,821	$1,410.5	—	—	—
CT abdomen and pelvis with and without contrast	CPT	74178	0	$3,413	$1,706.5	—	—	—
MRI abdomen without contrast	CPT	74181	0	$2,264	$1,132	—	—	—
MRI abdomen with and without contrast	CPT	74183	0	$3,481	$1,740.5	—	—	—
Abdominal ultrasound complete	CPT	76700	0	$915	$457.5	—	—	—
Abdominal ultrasound limited	CPT	76705	0	$884	$442	—	—	—
Retroperitoneal ultrasound complete	CPT	76770	0	$981	$490.5	—	—	—
Obstetric ultrasound after first trimester	CPT	76805	0	$105	$52.5	—	—	—
Obstetric ultrasound with fetal anatomy	CPT	76811	0	$202	$101	—	—	—
Transvaginal ultrasound	CPT	76830	0	$206	$103	—	—	—
Pelvic ultrasound complete	CPT	76856	0	$826	$413	—	—	—
Scrotal ultrasound	CPT	76870	0	$788	$394	—	—	—
Diagnostic mammography unilateral	CPT	77065	0	$328	$164	—	—	—
Diagnostic mammography bilateral	CPT	77066	0	$409	$204.5	—	—	—
Screening mammography bilateral	CPT	77067	0	$375	$187.5	—	—	—
EKG complete	CPT	93000	0	$418	$209	—	—	—
EKG tracing only	CPT	93005	0	$266	$133	—	—	—
EKG interpretation only	CPT	93010	0	$78	$39	—	—	—
Transthoracic echocardiogram complete	CPT	93306	0	$1,444	$722	—	—	—
Transthoracic echocardiogram	CPT	93307	0	$96	$48	—	—	—
Stress echocardiogram	CPT	93350	0	$151	$75.5	—	—	—
inpatient
Initial hospital care, low complexity	CPT	99221	0	$280	$140	—	—	—
Initial hospital care, moderate complexity	CPT	99222	0	$390	$195	—	—	—
Initial hospital care, high complexity	CPT	99223	0	$573	$286.5	—	—	—
Hospital discharge, <30 min	CPT	99238	0	$204	$102	—	—	—
Hospital discharge, >30 min	CPT	99239	0	$305	$152.5	—	—	—
lab
Basic metabolic panel (BMP)	CPT	80048	0	$78	$39	—	—	—
General health panel	CPT	80050	0	$456	$228	—	—	—
Electrolyte panel	CPT	80051	0	$65	$32.5	—	—	—
Comprehensive metabolic panel	CPT	80053	0	$98	$49	—	—	—
Lipid panel	CPT	80061	0	$125	$62.5	—	—	—
Renal function panel	CPT	80069	0	$80	$40	—	—	—
Hepatic function panel	CPT	80076	0	$76	$38	—	—	—
Urinalysis non-automated	CPT	81002	0	$19	$9.5	—	—	—
Urinalysis automated	CPT	81003	0	$26	$13	—	—	—
Glucose quantitative	CPT	82947	0	$38	$19	—	—	—
Hemoglobin A1c	CPT	83036	0	$150	$75	—	—	—
Thyroid stimulating hormone (TSH)	CPT	84443	0	$148	$74	—	—	—
Complete blood count with automated differential	CPT	85025	0	$68	$34	—	—	—
Complete blood count without differential	CPT	85027	0	$57	$28.5	—	—	—
Urine culture bacterial	CPT	87086	0	$92	$46	—	—	—
Urine culture identification	CPT	87088	0	$126	$63	—	—	—
Tissue exam by pathologist level IV	CPT	88305	0	$159	$79.5	—	—	—
maternity
Fetal non-stress test	CPT	59025	0	$1,177	$588.5	—	—	—
Routine obstetric care including vaginal delivery	CPT	59400	0	$5,230	$2,615	—	—	—
Vaginal delivery only	CPT	59409	0	$1,753	$876.5	—	—	—
Vaginal delivery with postpartum	CPT	59410	0	$2,359	$1,179.5	—	—	—
Routine obstetric care with C-section	CPT	59510	0	$5,893	$2,946.5	—	—	—
C-section delivery only	CPT	59514	0	$2,014	$1,007	—	—	—
C-section with postpartum	CPT	59515	0	$2,978	$1,489	—	—	—
office
Office visit, new patient, 15-29 min	CPT	99202	0	$131	$65.5	—	—	—
Office visit, new patient, 30-44 minutes	CPT	99203	0	$204	$102	—	—	—
Office visit, new patient, 45-59 min	CPT	99204	0	$455	$227.5	—	—	—
Office visit, new patient, 60-74 min	CPT	99205	0	$653	$326.5	—	—	—
Office visit, established patient, 5 min	CPT	99211	0	$73	$36.5	—	—	—
Office visit, established patient, 10-19 min	CPT	99212	0	$290	$145	—	—	—
Office visit, established patient, 20-29 minutes	CPT	99213	0	$290	$145	—	—	—
Office visit, established patient, 30-39 minutes	CPT	99214	0	$290	$145	—	—	—
Office visit, established patient, 40-54 min	CPT	99215	0	$336	$168	—	—	—
preventive
Upper GI endoscopy diagnostic	CPT	43235	0	$933	$466.5	—	—	—
Upper GI endoscopy with biopsy	CPT	43239	0	$1,054	$527	—	—	—
Sigmoidoscopy diagnostic	CPT	45330	0	$122	$61	—	—	—
Sigmoidoscopy with biopsy	CPT	45331	0	$156	$78	—	—	—
Colonoscopy diagnostic	CPT	45378	0	$1,299	$649.5	—	—	—
Colonoscopy with biopsy	CPT	45380	0	$1,419	$709.5	—	—	—
Colonoscopy with polyp removal	CPT	45385	0	$1,524	$762	—	—	—
surgery
Total shoulder arthroplasty	CPT	23472	0	$3,187	$1,593.5	—	—	—
Hip hemiarthroplasty	CPT	27125	0	$2,370	$1,185	—	—	—
Total hip replacement	CPT	27130	0	$2,839	$1,419.5	—	—	—
Total knee replacement	CPT	27447	0	$4,586	$2,293	—	—	—
Knee revision arthroplasty single component	CPT	27486	0	$3,098	$1,549	—	—	—
Knee revision arthroplasty all components	CPT	27487	0	$3,874	$1,937	—	—	—
Shoulder arthroscopy with decompression	CPT	29826	0	$716	$358	—	—	—
Shoulder arthroscopy with rotator cuff repair	CPT	29827	0	$2,352	$1,176	—	—	—
Knee arthroscopy with meniscectomy	CPT	29881	0	$1,845	$922.5	—	—	—
ACL reconstruction	CPT	29888	0	$2,145	$1,072.5	—	—	—
CABG single arterial graft	CPT	33533	0	$4,176	$2,088	—	—	—
Open appendectomy	CPT	44950	0	$1,421	$710.5	—	—	—
Laparoscopic appendectomy	CPT	44970	0	$1,354	$677	—	—	—
Laparoscopic cholecystectomy	CPT	47562	0	$2,080	$1,040	—	—	—
Lap cholecystectomy with cholangiography	CPT	47563	0	$1,618	$809	—	—	—
Lap inguinal hernia repair	CPT	49650	0	$976	$488	—	—	—
Total abdominal hysterectomy	CPT	58150	0	$2,150	$1,075	—	—	—
Vaginal hysterectomy	CPT	58260	0	$1,864	$932	—	—	—
Lap-assisted vaginal hysterectomy	CPT	58550	0	$1,825	$912.5	—	—	—
Lap-assisted vaginal hysterectomy >250g	CPT	58552	0	$2,073	$1,036.5	—	—	—
Lap salpingo-oophorectomy	CPT	58661	0	$1,369	$684.5	—	—	—
Complex cataract surgery	CPT	66982	0	$1,390	$695	—	—	—
Cataract surgery with lens implant	CPT	66984	0	$1,016	$508	—	—	—
Intravitreal injection	CPT	67028	0	$169	$84.5	—	—	—