▸ Hospital · WV · CCN 511316

GRANT MEMORIAL HOSPITAL

117 HOSPITAL DRIVE, PETERSBURG, WV, 26847

25 bedsCritical Access Hospitals9

Compliance grade

78/100

Rates published

1,242

last crawl 2026-05-24

Procedures tracked

140

of 209 target codes

Payers

with negotiated rates

Procedures tracked

...

Payers

...

▸ Compare with other hospitals All WV hospitals JSON

Source MRF: https://wvumedicine.org/wp-content/uploads/2026/04/881740605_Grant-Memorial-Hospital-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	$313	$250.4	—	—	—
Psychiatric eval with medical services	CPT	90792	0	$366	$292.8	—	—	—
Psychotherapy 30 minutes	CPT	90832	0	$158	$126.4	—	—	—
Psychotherapy 45 minutes	CPT	90834	0	$209	$167.2	—	—	—
Psychotherapy 60 minutes	CPT	90837	0	$308	$246.4	—	—	—
Crisis psychotherapy 60 minutes	CPT	90839	0	$295	$236	—	—	—
emergency
ED visit level 1	CPT	99281	0	$228	$182.4	—	—	—
ED visit level 2	CPT	99282	0	$424	$339.2	—	—	—
ED visit level 3	CPT	99283	0	$742	$593.6	—	—	—
ED visit level 4	CPT	99284	0	$1,157	$925.6	—	—	—
ED visit level 5	CPT	99285	0	$2,112	$1,689.6	—	—	—
Critical care, first hour	CPT	99291	0	$2,324	$1,859.2	—	—	—
imaging
CT head without contrast	CPT	70450	0	$3,108	$2,486.4	—	—	—
CT head with contrast	CPT	70460	0	$973	$778.4	—	—	—
CT head with and without contrast	CPT	70470	0	$1,022	$817.6	—	—	—
CT neck with contrast	CPT	70491	0	$1,022	$817.6	—	—	—
MRI brain without contrast	CPT	70551	0	$1,212	$969.6	—	—	—
MRI brain with contrast	CPT	70552	0	$2,435	$1,948	—	—	—
MRI brain with and without contrast	CPT	70553	0	$1,986	$1,588.8	—	—	—
Chest X-ray single view	CPT	71045	0	$480	$384	—	—	—
Chest X-ray 2 views	CPT	71046	0	$252	$201.6	—	—	—
CT chest without contrast	CPT	71250	0	$1,760	$1,408	—	—	—
CT chest with contrast	CPT	71260	0	$2,091	$1,672.8	—	—	—
CT chest with and without contrast	CPT	71270	0	$958	$766.4	—	—	—
MRI chest without contrast	CPT	71550	0	$1,154	$923.2	—	—	—
MRI chest with and without contrast	CPT	71552	0	$1,891	$1,512.8	—	—	—
Lumbosacral spine X-ray	CPT	72100	0	$217	$173.6	—	—	—
CT cervical spine without contrast	CPT	72125	0	$1,879	$1,503.2	—	—	—
CT thoracic spine without contrast	CPT	72128	0	$590	$472	—	—	—
CT lumbar spine without contrast	CPT	72131	0	$1,530	$1,224	—	—	—
MRI cervical spine without contrast	CPT	72141	0	$1,212	$969.6	—	—	—
MRI thoracic spine without contrast	CPT	72146	0	$1,212	$969.6	—	—	—
MRI lumbar spine without contrast	CPT	72148	0	$1,212	$969.6	—	—	—
MRI lumbar spine with and without contrast	CPT	72149	0	$2,936	$2,348.8	—	—	—
MRI cervical spine with and without contrast	CPT	72156	0	$1,986	$1,588.8	—	—	—
MRI lumbar spine with contrast	CPT	72158	0	$1,986	$1,588.8	—	—	—
CT pelvis without contrast	CPT	72192	0	$590	$472	—	—	—
CT pelvis with contrast	CPT	72193	0	$958	$766.4	—	—	—
Shoulder X-ray	CPT	73030	0	$252	$201.6	—	—	—
Humerus X-ray	CPT	73060	0	$252	$201.6	—	—	—
Hand X-ray 3 views	CPT	73130	0	$252	$201.6	—	—	—
MRI upper extremity joint without contrast	CPT	73221	0	$1,212	$969.6	—	—	—
MRI upper extremity joint with and without contrast	CPT	73223	0	$1,986	$1,588.8	—	—	—
Knee X-ray 1-2 views	CPT	73560	0	$252	$201.6	—	—	—
Ankle X-ray 3 views	CPT	73610	0	$252	$201.6	—	—	—
MRI lower extremity joint without contrast	CPT	73721	0	$1,212	$969.6	—	—	—
MRI lower extremity joint with and without contrast	CPT	73723	0	$1,986	$1,588.8	—	—	—
CT abdomen without contrast	CPT	74150	0	$590	$472	—	—	—
CT abdomen with contrast	CPT	74160	0	$958	$766.4	—	—	—
CT abdomen with and without contrast	CPT	74170	0	$958	$766.4	—	—	—
CT abdomen and pelvis without contrast	CPT	74176	0	$1,225	$980	—	—	—
CT abdomen and pelvis with contrast	CPT	74177	0	$2,540	$2,032	—	—	—
CT abdomen and pelvis with and without contrast	CPT	74178	0	$2,006	$1,604.8	—	—	—
MRI abdomen without contrast	CPT	74181	0	$1,212	$969.6	—	—	—
MRI abdomen with and without contrast	CPT	74183	0	$1,986	$1,588.8	—	—	—
Abdominal ultrasound complete	CPT	76700	0	$325	$260	—	—	—
Abdominal ultrasound limited	CPT	76705	0	$322	$257.6	—	—	—
Retroperitoneal ultrasound complete	CPT	76770	0	$325	$260	—	—	—
Obstetric ultrasound after first trimester	CPT	76805	0	$498	$398.4	—	—	—
Obstetric ultrasound with fetal anatomy	CPT	76811	0	$202	$161.6	—	—	—
Transvaginal ultrasound	CPT	76830	0	$325	$260	—	—	—
Pelvic ultrasound complete	CPT	76856	0	$325	$260	—	—	—
Scrotal ultrasound	CPT	76870	0	$325	$260	—	—	—
Diagnostic mammography unilateral	CPT	77065	0	$235	$188	—	—	—
Diagnostic mammography bilateral	CPT	77066	0	$300	$240	—	—	—
Screening mammography bilateral	CPT	77067	0	$498	$398.4	—	—	—
EKG tracing only	CPT	93005	0	$456	$364.8	—	—	—
EKG interpretation only	CPT	93010	0	$19	$15.2	—	—	—
Transthoracic echocardiogram complete	CPT	93306	0	$1,265	$1,012	—	—	—
Transthoracic echocardiogram	CPT	93307	0	$96	$76.8	—	—	—
Stress echocardiogram	CPT	93350	0	$151	$120.8	—	—	—
inpatient
Initial hospital care, low complexity	CPT	99221	0	$173	$138.4	—	—	—
Initial hospital care, moderate complexity	CPT	99222	0	$285	$228	—	—	—
Initial hospital care, high complexity	CPT	99223	0	$377	$301.6	—	—	—
Hospital discharge, <30 min	CPT	99238	0	$175	$140	—	—	—
Hospital discharge, >30 min	CPT	99239	0	$247	$197.6	—	—	—
lab
Basic metabolic panel (BMP)	CPT	80048	0	$78	$62.4	—	—	—
General health panel	CPT	80050	0	$354	$283.2	—	—	—
Electrolyte panel	CPT	80051	0	$23	$18.4	—	—	—
Comprehensive metabolic panel	CPT	80053	0	$98	$78.4	—	—	—
Lipid panel	CPT	80061	0	$125	$100	—	—	—
Renal function panel	CPT	80069	0	$29	$23.2	—	—	—
Hepatic function panel	CPT	80076	0	$30	$24	—	—	—
Urinalysis non-automated	CPT	81002	0	$5	$4	—	—	—
Urinalysis automated	CPT	81003	0	$13	$10.4	—	—	—
Glucose quantitative	CPT	82947	0	$24	$19.2	—	—	—
Hemoglobin A1c	CPT	83036	0	$25	$20	—	—	—
Thyroid stimulating hormone (TSH)	CPT	84443	0	$35	$28	—	—	—
Complete blood count with automated differential	CPT	85025	0	$82	$65.6	—	—	—
Complete blood count without differential	CPT	85027	0	$20	$16	—	—	—
Urine culture bacterial	CPT	87086	0	$25	$20	—	—	—
Urine culture identification	CPT	87088	0	$152	$121.6	—	—	—
Tissue exam by pathologist level IV	CPT	88305	0	$900	$720	—	—	—
maternity
Fetal non-stress test	CPT	59025	0	$481	$384.8	—	—	—
Routine obstetric care including vaginal delivery	CPT	59400	0	$5,230	$4,184	—	—	—
Vaginal delivery only	CPT	59409	0	$1,753	$1,402.4	—	—	—
Vaginal delivery with postpartum	CPT	59410	0	$2,359	$1,887.2	—	—	—
Routine obstetric care with C-section	CPT	59510	0	$5,893	$4,714.4	—	—	—
C-section delivery only	CPT	59514	0	$2,014	$1,611.2	—	—	—
C-section with postpartum	CPT	59515	0	$2,978	$2,382.4	—	—	—
office
Office visit, new patient, 15-29 min	CPT	99202	0	$118	$94.4	—	—	—
Office visit, new patient, 30-44 minutes	CPT	99203	0	$180	$144	—	—	—
Office visit, new patient, 45-59 min	CPT	99204	0	$584	$467.2	—	—	—
Office visit, new patient, 60-74 min	CPT	99205	0	$396	$316.8	—	—	—
Office visit, established patient, 5 min	CPT	99211	0	$118	$94.4	—	—	—
Office visit, established patient, 10-19 min	CPT	99212	0	$118	$94.4	—	—	—
Office visit, established patient, 20-29 minutes	CPT	99213	0	$210	$168	—	—	—
Office visit, established patient, 30-39 minutes	CPT	99214	0	$422	$337.6	—	—	—
Office visit, established patient, 40-54 min	CPT	99215	0	$628	$502.4	—	—	—
preventive
Upper GI endoscopy diagnostic	CPT	43235	0	$1,008	$806.4	—	—	—
Upper GI endoscopy with biopsy	CPT	43239	0	$1,512	$1,209.6	—	—	—
Sigmoidoscopy diagnostic	CPT	45330	0	$812	$649.6	—	—	—
Sigmoidoscopy with biopsy	CPT	45331	0	$756	$604.8	—	—	—
Colonoscopy diagnostic	CPT	45378	0	$2,808	$2,246.4	—	—	—
Colonoscopy with biopsy	CPT	45380	0	$3,696	$2,956.8	—	—	—
Colonoscopy with polyp removal	CPT	45385	0	$3,108	$2,486.4	—	—	—
surgery
Total shoulder arthroplasty	CPT	23472	0	$13,936	$11,149	—	—	—
Hip hemiarthroplasty	CPT	27125	0	$2,370	$1,896	—	—	—
Total hip replacement	CPT	27130	0	$17,848	$14,278	—	—	—
Total knee replacement	CPT	27447	0	$15,617	$12,494	—	—	—
Knee revision arthroplasty single component	CPT	27486	0	$2,930	$2,344	—	—	—
Knee revision arthroplasty all components	CPT	27487	0	$13,095	$10,476	—	—	—
Shoulder arthroscopy with decompression	CPT	29826	0	$348	$278.4	—	—	—
Shoulder arthroscopy with rotator cuff repair	CPT	29827	0	$9,409	$7,527.2	—	—	—
Knee arthroscopy with meniscectomy	CPT	29881	0	$5,463.34	$4,370.67	—	—	—
ACL reconstruction	CPT	29888	0	$7,307.34	$5,845.87	—	—	—
CABG single arterial graft	CPT	33533	0	$4,176	$3,340.8	—	—	—
Open appendectomy	CPT	44950	0	$1,421	$1,136.8	—	—	—
Laparoscopic appendectomy	CPT	44970	0	$8,344	$6,675.2	—	—	—
Laparoscopic cholecystectomy	CPT	47562	0	$8,642	$6,913.6	—	—	—
Lap cholecystectomy with cholangiography	CPT	47563	0	$13,708	$10,966	—	—	—
Lap inguinal hernia repair	CPT	49650	0	$976	$780.8	—	—	—
Total abdominal hysterectomy	CPT	58150	0	$7,488	$5,990.4	—	—	—
Vaginal hysterectomy	CPT	58260	0	$12,272	$9,817.6	—	—	—
Lap-assisted vaginal hysterectomy	CPT	58550	0	$1,825	$1,460	—	—	—
Lap-assisted vaginal hysterectomy >250g	CPT	58552	0	$2,041	$1,632.8	—	—	—
Lap salpingo-oophorectomy	CPT	58661	0	$8,344	$6,675.2	—	—	—
Complex cataract surgery	CPT	66982	0	$1,390	$1,112	—	—	—
Cataract surgery with lens implant	CPT	66984	0	$1,016	$812.8	—	—	—
Intravitreal injection	CPT	67028	0	$169	$135.2	—	—	—

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

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