126094 — Revsc Low Extr Ivl/stnt
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). REVSC LOW EXTR IVL/STNT (CDM 126094) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/126094?code_type=CDM
MLA (9th ed.)
“REVSC LOW EXTR IVL/STNT (CDM 126094) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/126094?code_type=CDM. Accessed .
Chicago (notes-bibliography)
“REVSC LOW EXTR IVL/STNT (CDM 126094) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/126094?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $24,507–$52,856 (25th–75th percentile) across 5 hospitals · 32 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 126094 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.
Hospital rates (per row)
Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.
| Hospital | Payer | Plan | Negotiated rate | Gross | Cash | Observed | Source |
|---|---|---|---|---|---|---|---|
| LEWISGALE MEDICAL CENTER Outpatient | Aetna | MGMCR | $7,819.95 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Aetna | MGMCR | $8,726.97 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Aetna | MGMCR | $8,809.38 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Cigna | NPR | $9,071.14 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Lifeworks | MCR | $9,905.27 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Lifeworks | MCR | $11,054.16 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Lifeworks | MCR | $11,158.55 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Universal Healthcare Group | MCR | $11,469.26 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Cigna | IFP | $11,519.59 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Universal Healthcare Group | MCR | $12,799.55 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Cigna | IFP | $15,621.97 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | United | OptionsPPO | $16,290.34 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | United | OptionsPPO | $16,444.18 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Virginia Health Network | ULTRA | $18,246.55 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | United | OptionsPPO | $19,028.54 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Cigna | HMO | $19,606.58 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Cigna | PPO | $19,606.58 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Cigna | HMO | $19,791.74 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Cigna | PPO | $19,791.74 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Virginia Health Network | ULTRA | $20,555.22 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Cigna | HMO | $20,905.33 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Cigna | PPO | $22,938.52 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Cigna | IFP | $23,363.63 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Cigna | IFP | $23,363.63 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | United | GlobalBenefitPlan | $23,459.85 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Aetna | MGMCR | $24,507.30 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Aetna | MGMCR | $24,507.30 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | CareFirst | HMO | $25,599.10 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | CareFirst | RPN | $25,599.10 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Naphcare | Federal | $26,066.50 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | United | GlobalBenefitPlan | $26,180.90 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | United | GlobalBenefitPlan | $26,428.14 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Lifeworks | MCR | $31,042.58 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Lifeworks | MCR | $31,042.58 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Greenvbrier Sporting Club | COMM | $31,279.80 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | United | OptionsPPO | $33,983.46 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | United | OptionsPPO | $33,983.46 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Cigna | PPO | $34,310.22 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Cigna | PPO | $34,310.22 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Cigna | HMO | $34,310.22 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Cigna | HMO | $34,310.22 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Kaiser | COMM | $34,650.23 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Greenvbrier Sporting Club | COMM | $34,907.86 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Greenvbrier Sporting Club | COMM | $35,237.52 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Universal Healthcare Group | MCR | $35,944.04 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Universal Healthcare Group | MCR | $35,944.04 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Graham-White Manufacturing | COMM | $36,493.10 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Richfield Nursing Center | COMM | $36,493.10 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Virginia Health Network | COMM | $37,014.43 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Virginia Health Network | WC | $37,014.43 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | CorVel | WorkersComp | $37,535.76 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Virginia Health Network | WC | $38,173.98 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Virginia Health Network | COMM | $38,173.98 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Community Care Network | COMM | $39,099.75 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Richfield Retirement Community | COMM | $39,099.75 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Virginia Health Network | ULTRA | $41,307.64 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Virginia Health Network | COMM | $41,307.64 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | Virginia Health Network | WC | $41,307.64 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Multiplan | MPI | $41,697.73 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Multiplan | PHCS | $41,697.73 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | One Health Plan | POS | $41,706.40 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | One Health Plan | PPO | $41,706.40 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | CSX Hotels | Product | $41,706.40 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | OccuNet Workers Comp | WorkersComp | $41,706.40 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | CorVel | WorkersComp | $41,889.43 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | CorVel | WorkersComp | $42,285.02 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Patients Choice | COMM | $45,877.04 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | OccuNet Workers Comp | WorkersComp | $46,543.82 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | C&O Employees Hospital Assn | COMM | $46,919.70 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | PHCS | COMM | $46,919.70 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Multiplan | PHCS | $46,919.70 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | 4Most | COMM | $46,919.70 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Alleghany Highland Community | COMM | $46,919.70 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | American Postal Workers Union | COMM | $46,919.70 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | Star Transportation | COMM | $46,919.70 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | OccuNet Workers Comp | WorkersComp | $46,983.36 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| LEWISGALE MEDICAL CENTER Outpatient | United Behavioral Health | VACCN | $52,133.00 | $52,133.00 | $52,133.00 | 2026-03-07 | MRF ↗ |
| RESTON HOSPITAL CENTER Outpatient | 4Most Health Network | COMM | $52,361.79 | $58,179.77 | $58,179.77 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Three Rivers Provider Network | COMM | $52,856.28 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | 4Most Health Nework | COMM | $52,856.28 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | Three Rivers Provider Network | WorkersComp | $52,856.28 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Virginia Health Network | ULTRA | $57,183.70 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Virginia Health Network | ULTRA | $57,183.70 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER Outpatient | United Behavioral Health | VACCN | $58,729.20 | $58,729.20 | $58,729.20 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | United | GlobalBenefitPlan | $73,521.90 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | United | GlobalBenefitPlan | $73,521.90 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Greenvbrier Sporting Club | COMM | $98,029.20 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Value Options | COMM | $98,029.20 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Greenvbrier Sporting Club | COMM | $98,029.20 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Virginia Health Network | COMM | $106,198.30 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Virginia Health Network | WC | $106,198.30 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Virginia Health Network | COMM | $106,198.30 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Naphcare | GVT | $106,198.30 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Virginia Health Network | WC | $106,198.30 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | CorVel | WorkersComp | $117,635.04 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | CorVel | WorkersComp | $117,635.04 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | OccuNet Workers Comp | WorkersComp | $130,705.60 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | OccuNet Workers Comp | WorkersComp | $130,705.60 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Evernorth | COMM | $130,705.60 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Multiplan | PHCS | $147,043.80 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | 4Most Health Nework | COMM | $147,043.80 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | 4Most Health Nework | COMM | $147,043.80 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Multiplan | PHCS | $147,043.80 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | United Behavioral Health | VACCN | $163,382.00 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | United Behavioral Health | VACCN | $163,382.00 | $163,382.00 | $163,382.00 | 2026-03-01 | MRF ↗ |