Inova Fair Oaks Hospital
3600 Joseph Siewick Drive Fairfax, VA 22033-1709, VA · Inova · · NPI 1760513980
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $2.61 | $5.21 | $0.06 – $0.79 | 5 |
| Levetiracetam therapeutic drug level CPT 80177 | $139.00 | $278.00 | $13.25 – $174.89 | 9 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $40.44 | $80.88 | $3.05 – $20.24 | 5 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | $2,988.50 | $5,977.00 | $3,216.41 – $10,187.63 | 9 |
| Liberta rc ipg HCPCS C1820 | $55,660.00 | $111,320.00 | $16,320.02 – $38,574.59 | 2 |
| Lidocaine therapeutic drug level CPT 80176 | $236.50 | $473.00 | $14.43 – $297.56 | 9 |
| Ligate/strip long leg vein CPT 37722 | $7,509.00 | $15,018.00 | $3,147.50 – $6,895.00 | 9 |
| Ligate/strip short leg vein CPT 37718 | $7,509.00 | $15,018.00 | $3,147.50 – $5,515.00 | 9 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | $1,620.24 – $3,529.00 | 9 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $2,149.00 – $5,515.00 | 9 |
| Ligation of inf vena cava CPT 37619 | $5,275.50 | $10,551.00 | $3,508.00 – $6,895.00 | 9 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | $18,613.00 | $37,226.00 | $3,147.50 – $4,413.00 | 9 |
| Lig/band angioaccess av fistula CPT 37607 | $907.00 | $1,814.00 | $1,414.92 – $5,515.00 | 9 |
| Liletta, 52 mg HCPCS J7297 | $1,056.99 | $2,113.97 | $691.98 – $761.18 | 6 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $17.81 | $35.61 | $4.99 – $21.31 | 5 |
| Lipase CPT 83690 | $109.00 | $218.00 | $6.47 – $137.14 | 9 |
| Lipoprotein blood high res frac & quant CPT 83701 | $203.50 | $407.00 | $33.33 – $256.04 | 9 |
| Lipoprotein blood quant CPT 83704 | $240.00 | $480.00 | $33.33 – $301.97 | 9 |
| Lipoprotein direct measurement hdl CPT 83718 | $70.50 | $141.00 | $6.47 – $88.70 | 9 |
| Lipoprotein direct measurement ldl CPT 83721 | $77.00 | $154.00 | $6.47 – $96.88 | 9 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | $113.00 | $226.00 | $33.33 – $158.82 | 9 |
| Listeria monocytogenes CPT 86723 | $176.50 | $353.00 | $13.19 – $222.07 | 9 |
| Lithium therapeutic drug level CPT 80178 | $121.00 | $242.00 | $6.61 – $152.24 | 9 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $3,899.50 | $7,799.00 | $1,509.00 – $12,791.91 | 9 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | $1,778.50 | $3,557.00 | $1,625.55 – $8,521.32 | 9 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | $381.00 | $762.00 | $176.19 – $479.37 | 9 |
| Liver Function Test CPT 80076 | $228.00 | $456.00 | $8.17 – $286.87 | 9 |
| Liver imaging CPT 78201 | $1,254.00 | $2,508.00 | $421.24 – $1,652.77 | 9 |
| Liver imag w/vasclr flow CPT 78202 | $1,320.50 | $2,641.00 | $506.49 – $1,740.42 | 9 |
| Liver/spleen imag static only CPT 78215 | $1,320.50 | $2,641.00 | $401.83 – $1,740.42 | 9 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $1,320.50 | $2,641.00 | $401.83 – $1,740.42 | 9 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | $8,407.00 | $16,814.00 | $3,244.61 – $5,515.00 | 9 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $15.38 | $30.75 | $1.06 – $23.99 | 5 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | $289.31 | $578.61 | $216.90 – $337.38 | 8 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $15.55 | $31.09 | $1.92 – $7.31 | 5 |
| Low back disk surgery CPT 63030 | not published | not published | $3,469.00 – $9,927.00 | 9 |
| Low-Dose Lung Cancer Screening CT Scan CPT 71271 | $418.50 | $837.00 | $106.34 – $1,432.00 | 9 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $919.50 | $1,839.00 | $178.02 – $1,508.95 | 9 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $885.50 | $1,771.00 | $357.13 – $1,432.00 | 9 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $651.50 | $1,303.00 | $106.34 – $1,432.00 | 9 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $1,479.00 | $2,958.00 | $357.13 – $4,034.21 | 9 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $887.50 | $1,775.00 | $357.13 – $2,267.12 | 9 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $835.00 | $1,670.00 | $241.72 – $2,149.00 | 9 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $575.50 | $1,151.00 | $80.04 – $758.51 | 9 |
| Lower Back (Lumbar Spine) X-ray (4 or more views) CPT 72110 | $575.50 | $1,151.00 | $80.04 – $758.51 | 9 |
| Lower Back (Lumbar Spine) X-ray (with bending views) CPT 72114 | $575.50 | $1,151.00 | $80.04 – $758.51 | 9 |
| Lower jaw bone graft CPT 21215 | not published | not published | $4,817.00 – $9,927.00 | 9 |
| Lower Leg (Shin) X-ray (both sides) CPT 73590 | $328.00 | $656.00 | $80.04 – $432.30 | 9 |
| Low frequency non-thermal Ultrasound CPT 97610 | $546.00 | $1,092.00 | $152.00 – $686.98 | 9 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $3,469.00 – $11,913.00 | 9 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $3,469.00 – $9,927.00 | 9 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $3,469.00 – $14,298.00 | 9 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $3,469.00 – $14,298.00 | 9 |
| Lso flex no ri stays pre ots HCPCS L0628 | $77.50 | $155.00 | $51.15 – $120.90 | 3 |
| Lso full corset HCPCS L0976 | $186.50 | $373.00 | $123.09 – $290.94 | 3 |
| L/s ratio fetal lung CPT 83661 | $199.00 | $398.00 | $14.35 – $250.38 | 9 |
| Lumbar diskogram s&i CPT 72295 | $1,186.00 | $2,372.00 | $801.76 – $1,563.15 | 9 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $3,275.00 – $19,125.65 | 9 |
| Lung Function Test Before and After an Inhaler CPT 94060 | $330.00 | $660.00 | $152.37 – $415.21 | 9 |
| Lung function test (mbc/mvv) CPT 94200 | $206.50 | $413.00 | $59.40 – $259.82 | 9 |
| Lung Function Test (Spirometry) CPT 94010 | $298.50 | $597.00 | $83.53 – $375.57 | 9 |
| Lung perfusion imaging CPT 78580 | $854.50 | $1,709.00 | $401.83 – $1,126.23 | 9 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $285.42 | $570.83 | $207.13 – $320.86 | 8 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $56.41 | $112.82 | $41.98 – $65.32 | 8 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $267.02 | $534.03 | $316.99 – $348.68 | 7 |
| Lutetium lu 177 vipivotide HCPCS A9607 | $216.72 | $433.43 | $255.84 – $281.42 | 7 |
| Lvad shower bag heartmate HCPCS Q0501 | $289.00 | $578.00 | $178.86 – $239.02 | 3 |
| Lymphatics/lymph node imaging CPT 78195 | $1,056.00 | $2,112.00 | $538.27 – $1,391.81 | 9 |
| Lymphocyte culture mixed CPT 86821 | $298.50 | $597.00 | $36.56 – $375.57 | 9 |
| Lymphocyte transformation mitogen CPT 86353 | $434.50 | $869.00 | $48.37 – $546.69 | 9 |
| Lymphocytotoxicity assay CPT 86805 | $213.00 | $426.00 | $189.51 – $268.00 | 9 |
| Lymph vessel x-ray arm/leg CPT 75801 | $525.50 | $1,051.00 | $468.54 – $932.90 | 9 |
| Lymph vessel x-ray arms/legs CPT 75803 | $1,186.50 | $2,373.00 | $989.94 – $1,689.76 | 9 |
| Lymph vessel x-ray trunk CPT 75805 | $1,176.00 | $2,352.00 | $1,031.71 – $1,787.25 | 9 |
| Lymph vessel x-ray trunk CPT 75807 | $1,988.50 | $3,977.00 | $1,090.89 – $2,755.02 | 9 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $1,509.00 – $3,529.00 | 9 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $2,048.51 – $4,413.00 | 9 |
| Macro exam dissect molec study ea CPT 88387 | $75.00 | $150.00 | $7.96 – $94.37 | 9 |
| Macroscopic exam arthropod CPT 87168 | $38.50 | $77.00 | $4.27 – $48.44 | 9 |
| Macroscopic exam parasite CPT 87169 | $38.50 | $77.00 | $4.31 – $48.44 | 9 |
| Magnesium CPT 83735 | $78.00 | $156.00 | $6.47 – $98.14 | 9 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $20.64 | $41.28 | $0.67 – $3.91 | 5 |
| Malaria antibody CPT 86750 | $176.50 | $353.00 | $13.19 – $222.07 | 9 |
| Male sling procedure CPT 53440 | not published | not published | $2,149.00 – $9,409.65 | 9 |
| Mammosite ced HCPCS C1728 | $6,918.00 | $13,836.00 | $4,565.88 – $10,792.08 | 2 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $1,458.67 – $3,529.00 | 9 |
| Manipulation of hip joint CPT 27275 | not published | not published | $1,458.67 – $2,485.00 | 9 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | $2,133.50 | $4,267.00 | $497.00 – $2,684.37 | 9 |
| Mapping io sentinel lymph node CPT 38900 | $1,256.00 | $2,512.00 | $497.88 – $1,509.00 | 9 |
| Map tachycard site(s) CPT 93609 | $4,516.00 | $9,032.00 | $1,480.64 – $25,465.37 | 9 |
| Marker biop eviva buckle ss HCPCS A4648 | $1,219.50 | $2,439.00 | $24.90 – $58.84 | 2 |
| Marker lymphatic sentimag magtrace 10 vial HCPCS A9697 | $1,552.50 | $3,105.00 | $1,254.00 – $1,379.40 | 7 |
| Mastectomy partial CPT 19301 | $11,639.00 | $23,278.00 | $3,508.00 – $5,515.00 | 9 |
| Mast mod rad CPT 19307 | not published | not published | $3,469.00 – $9,927.00 | 9 |
| Mastoidectomy CPT 69501 | not published | not published | $4,817.00 – $8,272.00 | 9 |
| Mastoids complete CPT 70130 | $222.00 | $444.00 | $80.04 – $292.60 | 9 |
| Mastopexy CPT 19316 | not published | not published | $3,689.00 – $8,272.00 | 9 |
| Mast simple complete CPT 19303 | not published | not published | $3,689.00 – $9,927.00 | 9 |
| Matrion 1 sq cm HCPCS Q4201 | $733.91 | $1,467.82 | $106.23 – $1,144.90 | 4 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $160.09 | $320.17 | $27.88 – $80.97 | 4 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.