Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
REVASC LITHOTRIP TIBI/PERONE
Low
$28
Average
$19.1k
Median
$13.7k
High
$51.4k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
84 hospitals; the 90th percentile is 3.8× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
92 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $36.7k | $36.7k | — | — | — | $36.7k – $36.7k |
| 2 | Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 3 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $11.2k | $11.2k | — | — | — | $11.2k – $11.2k |
| 4 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $23.5k | $23.5k | — | — | — | $23.5k – $23.5k |
| 5 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $11.2k | $11.2k | — | — | — | $11.2k – $11.2k |
| 6 | CentraState Medical Center Freehold Township, NJ other · both | 2 | $12.6k | $12.6k | — | — | — | $12.6k – $12.6k |
| 7 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $19.9k | $19.9k | — | — | — | $19.9k – $19.9k |
| 8 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $11.4k | $11.4k | — | — | — | $11.4k – $11.4k |
| 9 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $5.6k | $5.6k | $3.4k | 61% | — | $2.2k – $8.9k |
| 10 | Chilton Medical Center Pompton Plains, NJ other · both | 2 | $12.6k | $12.6k | — | — | — | $12.6k – $12.6k |
| 11 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $19.9k | $19.9k | — | — | — | $19.9k – $19.9k |
| 12 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $22.6k | $22.6k | — | — | — | $22.6k – $22.6k |
| 13 | Dallas Regional Medical Center Mesquite, TX fee schedule · outpatient | 1 | $11.5k | $11.5k | — | — | — | $11.5k – $11.5k |
| 14 | Desert Valley Hospital Victorville, CA fee schedule · outpatient | 2 | $14.8k | $14.8k | — | — | — | $14.8k – $14.8k |
| 15 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $20.8k | $20.8k | — | — | — | $20.8k – $20.8k |
| 16 | Eisenhower Medical Center Rancho Mirage, CA other · both | 3 | $14.8k | $14.8k | — | — | — | $14.8k – $14.8k |
| 17 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $10.5k | $10.5k | — | — | — | $10.5k – $10.5k |
| 18 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · both | 1 | $10.5k | $10.5k | — | — | — | $10.5k – $10.5k |
| 19 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $23.5k | $23.5k | — | — | — | $23.5k – $23.5k |
| 20 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $9.8k | $9.8k | — | — | — | $9.8k – $9.8k |
| 21 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $8.2k | $8.2k | — | — | — | $8.2k – $8.2k |
| 22 | Good Samaritan Hospital Suffern, NY facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 23 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $22.5k | $22.5k | — | — | — | $22.5k – $22.5k |
| 24 | Hackettstown Medical Center Hackettstown, NJ other · both | 2 | $12.6k | $12.6k | — | — | — | $12.6k – $12.6k |
| 25 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $19.9k | $19.9k | — | — | — | $19.9k – $19.9k |
← Payers reporting HCPCS C9772 · Snapshot 20261111T120946Z-9134e7f7