What Hospitals Charge in Virginia: A Price Transparency Data Analysis

MRI Prices Across Virginia

MRI scans are among the most commonly shopped medical procedures, and Virginia's data shows some of the widest price spreads we've seen in any state. Here's what Virginia hospitals charge for cash-pay MRIs:

MRI Shoulder (CPT 73221)

The single widest spread in our Virginia dataset — a 21.8x difference:

A patient at LewisGale Hospital Pulaski would pay 21.8x more for the same shoulder MRI than a patient at Carilion Roanoke Memorial — even though the two hospitals are only about 60 miles apart in southwestern Virginia.

MRI Cervical Spine (CPT 72141)

The cheapest cervical spine MRI in our Virginia data ($1,228 at Carilion Franklin Memorial) costs less than a twentieth of the most expensive ($26,650 at LewisGale Medical Center) — a 21.7x spread.

All MRI Types — Lowest vs. Highest Cash Price

The pattern is stark: Carilion Health's four hospitals in southwestern Virginia (Roanoke, Christiansburg, Rocky Mount, and Tazewell) consistently charge $1,200–$3,700 for any MRI. The HCA-affiliated LewisGale hospitals in the same region charge $9,000–$49,000 for the same scans — despite competing for many of the same patients.

Note: Reston Hospital Center reported a $19 MRI Brain price that appears to be a component fee rather than a total price. That anomaly is excluded from headline comparisons.

Beyond MRIs: Price Variation Across Common Procedures

The price gaps extend well beyond imaging. For routine lab work and CT scans, the spreads are even more extreme:

Some of the extreme high-end prices — particularly for lab work like lipid panels and CBCs — likely reflect hospitals reporting their full chargemaster rates as "cash" prices. A $30,623 lipid panel is not a price anyone actually pays, but it is what the hospital disclosed in their federally required file. This raises questions about how meaningfully some hospitals are complying with the transparency rule.

Cash vs. Negotiated: An Unusual Reversal

At Carilion New River Valley Medical Center, we found something we haven't seen in other states: for surgical procedures, insurance-negotiated rates are consistently higher than the cash price — the opposite of the usual pattern.

Surgery: Negotiated Rates Exceed Cash Prices

For these surgical procedures, insured patients are paying roughly 19% more than the hospital's posted cash price. A patient paying cash for a C-section would save over $4,300 compared to their insurer's negotiated rate.

Imaging: Negotiated Rates Are Lower (As Expected)

For imaging procedures at the same hospital, the relationship flips back to normal: insurers negotiate rates 28–33% below the cash price. This split — where surgery favors cash patients but imaging favors insured patients — suggests fundamentally different pricing strategies by procedure category at this hospital.

What This Means for Patients

1. System affiliation matters more than geography — In southwestern Virginia, the Carilion system charges a fraction of what the LewisGale system charges for identical procedures in neighboring cities. Knowing which system a hospital belongs to is more predictive of price than knowing which city it's in.
2. Cash isn't always more expensive — At Carilion New River Valley, surgical cash prices are 19% lower than insurer-negotiated rates. Patients facing major surgery should ask for the cash price even if they have insurance — it may be substantially cheaper.
3. MRI spreads are extreme — A shoulder MRI ranges from $2,248 to $49,050 across Virginia hospitals. For a single scan, that's a potential savings of over $46,000 by choosing a different facility.
4. Watch for chargemaster reporting — Some Virginia hospitals appear to report inflated chargemaster rates as their "cash" prices, making direct comparisons difficult. A $30,623 lipid panel is a chargemaster artifact, not a real price for patients.

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