LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge 17-HYDROXYPREGNENOLONE (HORMONE) LEVEL 84143 $327.00 21-HYDROXYLASE ANTIBODY 83519 $445.00 3D REPORT WITH WORKSTATION 76377 $3,505.00 3D REPORT WITHOUT WORKSTATION 76376 $3,014.00 7-DIHYDROCHOLESTEROL 82542 $324.00 AB TITER FLOUR NON INFECT EA 86256 $111.00 ACE - ANGIO CONVERTING ENZYME 82164 $288.00 ACETAMINOPHEN-TYLENOL) 80307 $346.00 ACETYLCHOLINE BINDING AB 83519 $445.00 ACETYLCHOLINE BLOCK AB 83516 $160.00 ACETYLCHOLINE MODULATING AB 83516 $160.00 ACH RECEP (MUSCLE) BINDING AB 83519 $445.00 ACHR GANGLION NEURO AB 83519 $445.00 ACID HGB ELECTROPHORESIS 83020 $172.00 ACNE SURGERY 10040 $264.00 ACTH LEVEL 82024 $370.00 ACTIVITY THERAPY G0176 $1,082.00 ACUTE DIGESTIVE TRACT BLOOD LOSS IMAGING 78278 $2,102.00 ACUTE HEPATITIS PANEL 80074 $255.00 ADAPTER EXTERNAL FIXATION ILIZAROV ADD A CLAMP $1,248.80 ADAPTER FEMORAL GMK 3 MM OFFSET KNEE REVISION CONN C1776 $4,550.00 ADAPTER FEMORAL PFC SIGMA +2/-2 OFFSET KNEE BOLT S C1776 $1,680.00 ADAPTER HEAD LEGACY +4 MM HIP FEMUR UNIPOLAR C1776 $325.00 ADDING WALKER TO PREVIOUSLY APPLIED CAST 29440 $350.00 ADENOVIRUS AB 86603 $70.00 ADENOVIRUS ANTIGEN DETECTION 87449 $702.00 ADENOVIRUS ANTIGEN IMMUNOFLUORESCENT 87260 $182.00 ADH (ANTIDIURETIC HORMONE) LEVEL 84588 $537.00 ADH (ANTIDIURETIC HORMONE) LEVEL 84586 $561.00 ADMINISTRATION FLU VIRUS VACCINATION 90471 $106.00 ADMINISTRATION HEPATITIS B VACCINATION 90471 $106.00 ADMINISTRATION OF 1 NASAL OR ORAL VACCINE 90473 $50.00 ADMINISTRATION OF 1 VACCINE 90471 $106.00 ADMINISTRATION OF DRUG FOR HELICOBACTER PYLORI 83014 $61.00 ADMINISTRATION OF MEDICATION TO INDUCE VOMITING 99175 $187.00 ADMINISTRATION OF NASAL OR ORAL VACCINE 90474 $26.00 ADMINISTRATION OF VACCINE 90472 $106.00 ADMINISTRATION OF VACCINE OR TOXOID COMPONENT THRO 90461 $106.00 ADMINISTRATION PNEUMOCOCCAL VACCINATION 90471 $106.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ADRENAL GLAND STIMULATION PANEL 80412 $2,557.00 ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL 82024 $370.00 AFB ISOLATION 87116 $321.00 AG DETECT LEGIONELLA EIA QL MULTI 87449 $702.00 AGNA-1 86255 $287.00 AIR AND BONE CONDUCTION ASSESSMENT OF HEARING LOSS 92557 $464.00 AIR TONE CONDUCTION HEARING ASSESSMENT SCREENING 92551 $83.00 ALBUMIN SERUM PLASMA WHOLE BLD 82040 $138.00 ALBUMIN, FLUID 82042 $125.00 ALCOHOL-ETHYL, URINE 80320 $424.00 ALCOHOLS LEVELS 80322 $244.00 ALCOHOLS LEVELS 80307 $424.00 ALDOLASE (ENZYME) LEVEL 82085 $203.00 ALDOSTERONE HORMONE LEVEL 82088 $533.00 ALDOSTERONE SUPPRESSION EVALUATION PANEL 80408 $974.00 ALKALOIDS LEVELS 80323 $424.00 ALLERGENS, EA (RAST) 86003 $96.00 ALLERGENS,EA(RAST) 86003 $13.00 ALLERGY TESTING W/DRUGS/BIOLOGICALS SKIN IMMEDIATE 95018 $120.00 ALLERGY TESTING W/VENOMS SKIN IMMEDIATE REACTION W 95017 $120.00 ALPHA FETOPROTEIN, TUMOR MARKER 82105 $422.00 ALPHA-1-ANTITRYPSIN (PROTEIN) BLOOD TEST 82103 $246.00 ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM 82105 $422.00 ALUMINUM LEVEL 82108 $273.00 AMBULANCE AIR SERVICES A0431 $16,001.00 AMBULANCE BASIC LIFE SUPPORT DEFIBRILLATION A0384 $2,574.00 AMBULANCE BASIC LIFE SUPPORT SUPPLIES A0382 $278.00 AMBULANCE OXYGEN A0422 $188.00 AMBULANCE ROTARY WING A0436 $128.00 AMBULATORY BLOOD PRESSURE MONITOR SCAN ANALYSIS & 93788 $365.00 AMBULATORY BLOOD PRESSURE MONITORING AND RECORDING 93790 $191.00 AMBULATORY BLOOD PRESSURE MONITORING AND RECORDING 93786 $322.00 AMBULATORY CONTINUOUS GLUCOSE (SUGAR) MONITORING F 95250 $558.00 AMIKACIN - PEAK 80150 $328.00 AMIKACIN - RANDOM 80150 $328.00 AMIKACIN - TROUGH 80150 $328.00 AMIKACIN (ANTIBIOTIC) LEVEL 80150 $328.00 AMINO ACID ANALYSIS 82127 $108.00 AMINO ACID LEVEL, MULTIPLE AMINO ACIDS 82136 $131.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge AMMONIA LEVEL 82140 $251.00 AMPHETAMINES LEVELS 80325 $104.00 AMPHETAMINES LEVELS 80324 $368.00 AMYLASE (ENZYME) LEVEL 82150 $226.00 AMYLASE ISOENZYMES 82150 $226.00 AMYLASE, BODY FLUID 82150 $226.00 AMYLASE, SERUM 82150 $226.00 ANA PROFILE 86038 $241.00 ANA SERUM SCREEN 86038 $241.00 ANABOLIC STEROIDS LEVELS 80328 $244.00 ANABOLIC STEROIDS LEVELS 80327 $371.00 ANALGESICS LEVELS 80330 $244.00 ANALGESICS LEVELS 80331 $244.00 ANALGESICS LEVELS 80329 $346.00 ANALYSIS & PROGRAMMING INNER EAR (COCHLEAR) IMPLAN 92601 $499.00 ANALYSIS & REPORT OF EXTERNAL EKG RECORDING MORE T 0297T $837.00 ANALYSIS & REPROGRAMMING INNER EAR (COCHLEAR) IMPL 92603 $383.00 ANALYSIS & REPROGRAMMING INNER EAR (COCHLEAR) IMPL 92602 $502.00 ANALYSIS & REPROGRAMMING INNER EAR (COCHLEAR) IMPL 92604 $529.00 ANALYSIS ANTIBODY FRANCISELLA TULARENSIS (BACTERIA 86668 $93.00 ANALYSIS ANTIBODY LA CROSSE (CALIFORNIA) VIRUS (EN 86651 $83.00 ANALYSIS FOR ANTIBODY (IGM) TO CHLAMYDIA (BACTERIA 86632 $58.00 ANALYSIS FOR ANTIBODY (IGM) TO CYTOMEGALOVIRUS (CM 86645 $148.00 ANALYSIS FOR ANTIBODY (IGM) TO TOXOPLASMA (PARASIT 86778 $56.00 ANALYSIS FOR ANTIBODY (IGM) TO WEST NILE VIRUS 86788 $83.00 ANALYSIS FOR ANTIBODY TO ADENOVIRUS (RESPIRATORY V 86603 $70.00 ANALYSIS FOR ANTIBODY TO BORRELIA (RELAPSING FEVER 86619 $103.00 ANALYSIS FOR ANTIBODY TO BRUCELLA (BACTERIA) 86622 $119.00 ANALYSIS FOR ANTIBODY TO CANDIDA (YEAST) 86628 $372.00 ANALYSIS FOR ANTIBODY TO CYTOMEGALOVIRUS (CMV) IGG 86644 $62.00 ANALYSIS FOR ANTIBODY TO EASTERN EQUINE VIRUS (VIR 86652 $83.00 ANALYSIS FOR ANTIBODY TO ENTEROVIRUS (GASTROINTEST 86658 $125.00 ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONON 86663 $52.00 ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONON 86664 $62.00 ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONON 86665 $252.00 ANALYSIS FOR ANTIBODY TO FUNGUS 86671 $164.00 ANALYSIS FOR ANTIBODY TO HELICOBACTER PYLORI (GAST 86677 $180.00 ANALYSIS FOR ANTIBODY TO HELMINTH (INTESTINAL WORM 86682 $193.00 ANALYSIS FOR ANTIBODY TO HEPATITIS D VIRUS 86692 $544.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS 86694 $109.00 ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYP 86695 $51.00 ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYP 86696 $82.00 ANALYSIS FOR ANTIBODY TO HIV-1 AND HIV-2 VIRUS 86703 $231.00 ANALYSIS FOR ANTIBODY TO HUMAN T-CELL LYMPHOTROPIC 86687 $43.00 ANALYSIS FOR ANTIBODY TO HUMAN T-CELL LYMPHOTROPIC 86688 $52.00 ANALYSIS FOR ANTIBODY TO JOHN CUNNINGHAM VIRUS 86711 $112.00 ANALYSIS FOR ANTIBODY TO LEISHMANIA (PARASITE) 86717 $95.00 ANALYSIS FOR ANTIBODY TO LEPTOSPIRA 86720 $84.00 ANALYSIS FOR ANTIBODY TO LYMPHOCYTIC CHORIOMENINGI 86727 $97.00 ANALYSIS FOR ANTIBODY TO MUCORMYCOSIS (FUNGUS) 86732 $102.00 ANALYSIS FOR ANTIBODY TO MUMPS VIRUS 86735 $90.00 ANALYSIS FOR ANTIBODY TO MYCOPLASMA (BACTERIA) 86738 $227.00 ANALYSIS FOR ANTIBODY TO PARVOVIRUS 86747 $86.00 ANALYSIS FOR ANTIBODY TO PROTOZOA (PARASITE) 86753 $245.00 ANALYSIS FOR ANTIBODY TO RESPIRATORY SYNCYTIAL VIR 86756 $70.00 ANALYSIS FOR ANTIBODY TO RICKETTSIA (BACTERIA) 86757 $324.00 ANALYSIS FOR ANTIBODY TO SHIGELLA (INTESTINAL BACT 86771 $102.00 ANALYSIS FOR ANTIBODY TO ST. LOUIS VIRUS (VIRAL EN 86653 $83.00 ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (C 86787 $243.00 ANALYSIS FOR ANTIBODY TO VIRUS 86790 $511.00 ANALYSIS FOR ANTIBODY TO WEST NILE VIRUS 86789 $83.00 ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM 86780 $205.00 ANALYSIS FOR DETECTION OF TUMOR MARKER 86316 $83.00 ANALYSIS OF GENETIC MATERIAL 88365 $445.00 ANALYSIS OF STONE 82355 $90.00 ANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE 83518 $36.00 ANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE 83516 $160.00 ANALYSIS TEST FOR HEPATITIS C VIRUS 87902 $763.00 ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT A 82397 $36.00 ANCHOR SUTURE BIO-CORKSCREW FIBERWIRE POLY L LACTI C1713 $3,264.00 ANCHOR SUTURE HEALIX ADVANCE PERMACORD PEEK OD4.5 C1713 $2,632.00 ANCHOR SUTURE QUICKANCHOR PLUS ETHIBOND 2-0 V-5 MI C1713 $1,956.50 ANCHOR SUTURE Y-KNOT RC HI-FI 2 3 LOAD SELF PUNCH C1713 $4,673.50 ANDROSTANEDIOL GLUCURONIDE (HORMONE) LEVEL 82154 $198.00 ANDROSTENEDIONE (HORMONE) LEVEL 82157 $348.00 ANDROSTERONE (HORMONE) LEVEL 82160 $194.00 ANESTHESIA GENERAL 1ST 15 MINUTES $3,822.00 ANESTHESIA GENERAL EACH ADDITIONAL 15 MINUTES $806.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ANESTHESIA MAC 1ST 15 MINUTES $2,548.00 ANESTHESIA MAC EACH ADDITIONAL 15 MINUTES $537.00 ANESTHESIA REGIONAL 1ST 15 MINUTES $1,274.00 ANESTHESIA REGIONAL EACH ADDITIONAL 15 MINUTES $269.00 ANGIO COVETING ENZYME,CSF 82164 $288.00 ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL 82164 $288.00 ANGIOTENSIN LL (PROTEIN) LEVEL 82163 $159.00 ANTERIOR PITUITARY GLAND EVALUATION PANEL 80418 $4,497.00 ANTIBODY EVALUATION 88346 $191.00 ANTIBODY EVALUATION 88350 $314.00 ANTIBODY IDENTIFICATION TEST FOR PLATELET ANTIBODI 86022 $650.00 ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL 86021 $601.00 ANTIDEPRESSANTS LEVELS 80333 $244.00 ANTIDEPRESSANTS LEVELS 80334 $244.00 ANTIDEPRESSANTS LEVELS 80337 $244.00 ANTIDEPRESSANTS LEVELS 80335 $288.00 ANTIEPILEPTICS LEVELS 80340 $244.00 ANTIEPILEPTICS LEVELS 80341 $244.00 ANTI-GLOMER SB MB FLUORESCENT AB 86256 $111.00 ANTI-MITOCHONDRIA FLUORESCENT AB 83516 $160.00 ANTIPSYCHOTICS LEVELS 80344 $244.00 ANTI-SMOOTH MUSCU FLUORESCENT AB 86255 $287.00 ANTITHROMBIN III ANTIGEN (CLOTTING INHIBITOR) ACTI 85300 $383.00 AORTIC DYSFUNCTION/DILATION DUP/DEL ANALYSIS 81411 $4,040.00 APOLIPROTEIN B 82172 $72.00 APPLICATION ALLERGENIC EXTRACT MUCOUS MEMBRANE NOS 95065 $120.00 APPLICATION OF ALLERGENIC EXTRACT SKIN PATCH WITH 95044 $1,223.00 APPLICATION OF BODY CAST SHOULDER TO HIPS 29035 $535.00 APPLICATION OF BODY CAST SHOULDER TO HIPS INCLUDIN 29044 $535.00 APPLICATION OF BODY CAST SHOULDER TO HIPS INCLUDIN 29046 $535.00 APPLICATION OF BODY CAST SHOULDER TO HIPS INCLUDIN 29040 $1,038.00 APPLICATION OF CAST SHOULDER TO HAND (LONG ARM) 29065 $338.00 APPLICATION OF CAST TO FINGER 29086 $344.00 APPLICATION OF CAST TO HAND AND LOWER FOREARM 29085 $279.00 APPLICATION OF CAST, ELBOW TO FINGER (SHORT ARM) 29075 $312.00 APPLICATION OF CHEMICAL AGENT TO EXCESSIVE WOUND T 17250 $159.00 APPLICATION OF CHEMICAL AGENTS ACTIVATED BY ULTRAV 96912 $180.00 APPLICATION OF CYLINDER CAST (THIGH TO ANKLE) 29365 $553.00 APPLICATION OF ELECTRICAL STIMULATION TO 1 OR MORE 97032 $117.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge APPLICATION OF HIP SPICA CAST ON ONE LEG 29305 $1,328.00 APPLICATION OF HIP SPICA CAST, ONE AND ONE-HALF HI 29325 $1,554.00 APPLICATION OF HOT OR COLD PACKS TO 1 OR MORE AREA 97010 $154.00 APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS 97018 $59.00 APPLICATION OF JACKET TYPE BODY CAST 29010 $1,038.00 APPLICATION OF KNEE CAP TENDON BEARING CAST 29435 $653.00 APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND) 29105 $701.00 APPLICATION OF LONG LEG CAST (THIGH TO TOES) 29345 $475.00 APPLICATION OF LONG LEG CAST (THIGH TO TOES), WALK 29355 $698.00 APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR 29505 $770.00 APPLICATION OF LONG OR SHORT LEG CLUBFOOT CAST 29450 $959.00 APPLICATION OF MOVEABLE, HINGED FINGER SPLINT 29131 $408.00 APPLICATION OF MOVEABLE, HINGED SHORT ARM SPLINT ( 29126 $714.00 APPLICATION OF MULTIPLANE EXTERNAL BONE FIXATION S 20697 $7,934.00 APPLICATION OF NON-MOVEABLE HINGED FINGER SPLINT 29130 $85.00 APPLICATION OF NON-MOVEABLE, SHORT ARM SPLINT (FOR 29125 $484.00 APPLICATION OF RIGID TOTAL CONTACT LEG CAST 29445 $259.00 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) 29405 $314.00 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) 29515 $701.00 APPLICATION OF TOPICAL FLUORIDE 99188 $81.00 APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 97035 $117.00 APPLICATION OF WHIRLPOOL THERAPY TO 1 OR MORE AREA 97022 $255.00 APPLICATION SHORT LEG CAST (BELOW KNEE TO TOES) WA 29425 $959.00 APPLIER INTERNAL CLIP ATRICLIP PRO2 GILLINOV-COSGR $22,750.00 AQUAPORIN-4 RECEPTOR ANTIBODY 83516 $160.00 ARCH EXTERNAL FIXATION ILIZAROV CARBON FIBER EPOXY $7,910.96 ARSENIC LEVEL 82175 $56.00 ARTERIAL PUNCTURE WITHDRAWL OF BLOOD FOR DIAGNOSIS 36600 $198.00 ARUP - ADENOVIRUS BY PCR QUALITATIVE 87798 $96.00 ARUP - ADENOVIRUS BY PCR QUANTITATIVE 87799 $678.00 ARUP - AMPHET CONFIRM QUANT MECONIUM 80324 $368.00 ARUP - AMPHET CONFIRM QUANT URINE 80324 $368.00 ARUP - COCAIN CONF MEC 80353 $319.00 ARUP COCAINE QUANT BLOOD 80353 $319.00 ARUP PHENYTOIN, TOTAL 80185 $216.00 ARUP 14-3-3 PROTEIN TAU/THETA CSF 86317 $67.00 ARUP A2 MACROGLOBULIN 83883 $282.00 ARUP ACANTHAMOEBA AND NAEGLERIA CULTURE 87081 $311.00 ARUP ACETONE QUANTITATIVE SERUM 80320 $424.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ARUP ACETYLCHOLINESTERASE 82013 $86.00 ARUP ACYLCARNITINES QUANTITATIVE 82017 $445.00 ARUP ADENOVIRUS ANTIGEN EIA 87301 $130.00 ARUP ALBUMIN OTHER SOURCE QUANTITATIVE EACH 82042 $125.00 ARUP ALCOHOL URINE 80320 $424.00 ARUP ALDOSTERONE 82088 $533.00 ARUP ALLERGEN IGE QUANT OR SEMI 86003 $96.00 ARUP ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT 86008 $13.00 ARUP ALPHA FETOPROTEIN AMNIOTIC 82106 $136.00 ARUP ALPHA FETROPROTEIN, MATERNA 82105 $422.00 ARUP AMINO ACIDS 6 OR MORE QUANTITATIVE 82139 $803.00 ARUP AMITRIPTYLINE AND NORTRIPTYLINE 80335 $288.00 ARUP ANCA TITER 86256 $111.00 ARUP ANTI MULLARIAN HORMONE 83520 $348.00 ARUP AQUAPORIN 4 RECEPTOR AB IGG, CSF W/ REFLEX 86255 $287.00 ARUP ARSENIC URINE 82175 $56.00 ARUP ASPER GALACT AG 87305 $366.00 ARUP ASSAY C-D TRANSFER MEASURE 82373 $695.00 ARUP B2 GLYCOPROTEIN AB IGA 86146 $367.00 ARUP B2 GLYCOPROTEIN AB IGG 86146 $367.00 ARUP B2 GLYCOPROTEIN AB IGM 86146 $367.00 ARUP BARBITURATES CONF URINE 80345 $352.00 ARUP BARBITURATES CONFIRMATION 80345 $352.00 ARUP BCR/ABL1 TA MAJOR BREAKPOINT QL/QN 81206 $1,427.00 ARUP BCR/ABL1 TA MINOR BREAKPOINT QL/QN 81207 $1,427.00 ARUP BENZODIAZEPINES QUANT 1-12 80346 $471.00 ARUP BENZODIAZEPINES QUANT 1-12, MECONIUM 80346 $471.00 ARUP BETA-2 TRANSFERRIN 86335 $277.00 ARUP BETHESDA 85335 $627.00 ARUP BILE ACIDS 82239 $699.00 ARUP BILE ACIDS FRACTIONATED AND TOTAL 83789 $129.00 ARUP BIOTINIDASE 82261 $401.00 ARUP BK VIRUS URINE 87799 $678.00 ARUP BLASTOMYCES ANTIBODY 86612 $273.00 ARUP BUPRENORPHINE MECONIUM 80348 $409.00 ARUP BUPRENORPHINE, SERUM/PLASMA 80348 $409.00 ARUP C DIFFICILE BY PCR 87493 $164.00 ARUP C1 ESTERASE INHIBITOR 86160 $174.00 ARUP C1-ESTERASE INHIB FUNCTION 86161 $489.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ARUP CAFFEINE THERAPUTIC DRUG ANALYSIS 80155 $194.00 ARUP CARBAMAZEPINE FREE THERAPUTIC DRUG ANALYSIS 80157 $49.00 ARUP CARBOXYHEMOGLOBIN QUANTITATIVE 82375 $142.00 ARUP CELL FUNCTION ASSAY W/STIMULATION 86352 $352.00 ARUP CHLAMYDIA ANTIBODY 86631 $54.00 ARUP CHLORIDE REGULAR STOOL 82438 $184.00 ARUP CHROMOSOME COUNT 15-20/2 88262 $928.00 ARUP CHROMOSOME COUNT 20-25 88264 $1,437.00 ARUP CHROMOSOME COUNT AMNIO IN SITU 88237 $683.00 ARUP CHROMOSOME COUNT AMNIO IN SITU 88269 $3,543.00 ARUP CLONAZEPAM LEVEL 80346 $471.00 ARUP COCAINE URINE 80353 $319.00 ARUP COCCIDIOIDES ANTIBODY 86635 $221.00 ARUP COMPLEMENT 4 86160 $174.00 ARUP COMPLEMENT C1Q BINDING 86332 $83.00 ARUP COMPLEMENT C6 86160 $174.00 ARUP COMPOUND S SPECIFIC 82634 $501.00 ARUP CONCENTRATION INFECTION AGENTS ANY TYPE 87015 $237.00 ARUP CORTISOL FREE, 24 HR URINE 82530 $72.00 ARUP CORTISOL FREE, SERUM 82530 $72.00 ARUP CRYPTOCOCCUS ANTIGEN 87327 $206.00 ARUP CULTURE FUNGUS DEFINITIVE ID MOLD 87107 $225.00 ARUP CULTURE VIRUS DEFINITIVE ID 87253 $450.00 ARUP CULTURE VIRUS SHELL VIAL 87254 $450.00 ARUP CYCLIC CITRULLINATED PEPTIDE TEST 86200 $122.00 ARUP CYSTINE URINE 24 HOUR 82131 $223.00 ARUP CYTO MOLECULAR INTERP & REPORT MM FISH 88291 $231.00 ARUP CYTO/MOLECULAR INTERP AND REPORT MDS PANEL 88291 $231.00 ARUP CYTOGENETICS AND MOLECULAR CYTOGENETICS INTER 88291 $231.00 ARUP CYTOGENOMIC CONSTITUTIONAL (GENOME-WIDE) MICR 81229 $3,440.00 ARUP DEOXYRIBONUCLEASE ANTIBODY 86215 $53.00 ARUP DESOXYCORTICOSTERONE-11 82633 $359.00 ARUP DHEA (DEHYDROEPIANDROSTERONE) 82626 $345.00 ARUP DIHYDROTESTOSTERONE 82642 $90.00 ARUP DIPHTHERIA ANTIBODY, IGG 86317 $67.00 ARUP ENCEPHALITIS AB WEST NILE IGM, CSF 86788 $83.00 ARUP ENDOMYSIAL ANTIBODY, IGA 86256 $111.00 ARUP EPSTEIN BARR VIRUS QUANT PCR 87799 $678.00 ARUP ESTRADIOL ULTRASENSITIVE 82670 $481.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ARUP ETHOSUXIMIDE 80168 $217.00 ARUP EVB AB EARLY (D) AG,IGG 86663 $52.00 ARUP EXTRACTABLE NUC ANTIGENS, RIBONUCLEIC PROTEIN 86235 $94.00 ARUP EXTRACTABLE NUC ANTIGENS, SMITH-IGG 86235 $94.00 ARUP FACTOR 9 ACTIVITY 85250 $239.00 ARUP FACTOR II PROTHROMBIN 85210 $459.00 ARUP FACTOR V ASSAY 85220 $316.00 ARUP FACTOR VII STABLE FACTOR 85230 $440.00 ARUP FACTOR VIII VON WILLEBRAND FACTOR MULTIMETRIC 85247 $732.00 ARUP FACTOR X STUART PROWER 85260 $279.00 ARUP FACTOR XIII FIBRIN STABILIZING 85290 $417.00 ARUP FAT QUANTITATIVE FECES 82710 $262.00 ARUP FATTY ACIDS VERY LONG CHAIN 82726 $615.00 ARUP FELBAMATE 80339 $244.00 ARUP FIBROBLAST GROWTH FACTOR 23 83520 $348.00 ARUP FLECAINIDE 80299 $395.00 ARUP FLUCONAZOLE 80299 $395.00 ARUP FLUCONAZOLE SUSCEPTIBILITY 87181 $172.00 ARUP FLUNITRAZEPAM URINE 80307 $706.00 ARUP FLUORESCENT ANTIBODY SCREEN 86255 $287.00 ARUP FLUOXETINE 80332 $244.00 ARUP FMR1 (FRAGILE X MENTAL RETARDATION 1) GENE DE 81243 $404.00 ARUP FSH, SERUM 83001 $365.00 ARUP GABAPENTIN 80171 $65.00 ARUP GENOTYPE CYTOMEGALOVIRUS 87910 $467.00 ARUP GHB CONFIRMATION, URINE 80375 $244.00 ARUP GHB SCREEN, URINE 80307 $706.00 ARUP HAEMOPHILIUS INFLUENZA B AB IGG 86317 $67.00 ARUP HEP C GENOTYP SEQ #55593 87902 $763.00 ARUP HEPATITIS C AB 86803 $249.00 ARUP HERPES 6 QUANTIFICATION NUCLEIC ACID PROBE 87533 $715.00 ARUP HGB ELP 83020 $172.00 ARUP HISTAMINE 83088 $112.00 ARUP HISTOPLASMA AG 87385 $388.00 ARUP HIT PF4 IGG 86022 $650.00 ARUP HIV 2 ANTIBODY 86702 $82.00 ARUP HIV-1 QUANTIFICATION NUCLEIC ACID PROBE 87536 $514.00 ARUP HIV1-2 W/RFLX HIV 1 WESTERN BLOT 86703 $231.00 ARUP HLA-B5701 81381 $782.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ARUP HSV 1&2 BY NUCLEIC ACID AMPLIFICATION 87529 $716.00 ARUP IA-2 AUTOANTIBODY 86341 $292.00 ARUP IFE FLUID 86355 $235.00 ARUP IGA IGG IGM GAMMAGLOBULIN 82784 $141.00 ARUP IGF BINDING PROTEIN 3 82397 $36.00 ARUP IL28B UNLISTED MOLECULARE PATH 81479 $400.00 ARUP IMMUNOASSAY NON INF AGENT QUALITATIVE/SEMIQUA 83516 $160.00 ARUP IMMUNOGLOBULIN D 82784 $141.00 ARUP IMMUNOGLOBULIN E 82785 $273.00 ARUP IMMUNOGLOBULIN G 82784 $141.00 ARUP IMMUNOGLOBULIN G CSF 82784 $141.00 ARUP IN SITU HYBRIDIZATION PER SPECIMEN MAN EA ADD 88377 $1,018.00 ARUP INDIA INK 87210 $136.00 ARUP INHIBIN B 83520 $348.00 ARUP INSULIN FASTING 83525 $152.00 ARUP IRON 83540 $196.00 ARUP IRON BINDING CAPACITY 83550 $97.00 ARUP JAK2 EXON 12 MUT ANALYS PCR 81403 $609.00 ARUP JAK2 GENE V671F MUT QUAL 81270 $1,587.00 ARUP LACTOFERRIN FECES QUALITATIVE 83630 $109.00 ARUP LD BLOOD 83615 $237.00 ARUP LD ISOENZYME 83625 $311.00 ARUP LDH 83615 $237.00 ARUP LEAD URINE 83655 $133.00 ARUP LEGIONELLA ABS 86713 $318.00 ARUP LIVER KIDNEY MICROSOME AB 86376 $228.00 ARUP LYME DISEASE AB 86618 $201.00 ARUP LYME DISEASE AB CONFIRM, IGG 86617 $578.00 ARUP LYME DISEASE AB CONFIRM, IGG CSF 86617 $578.00 ARUP LYME DISEASE AB CONFIRM, IGM CSF 86617 $578.00 ARUP LYME DISEASE AB, CSF 86618 $201.00 ARUP LYME DISEASE ANTIBODY CONFIRM, IGM 86617 $578.00 ARUP MANGANESE 83785 $82.00 ARUP MDA/MDEA/MDMA DEFIN ASSAY MECONIUM 80359 $244.00 ARUP MERCURY URINE 83825 $34.00 ARUP METABOLITE 80184 $215.00 ARUP METANEPHRINES, URINE 83835 $310.00 ARUP METHADONE CONF URINE 80358 $393.00 ARUP METHOADONE CONF MECONIUM 80358 $393.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ARUP MIC PER PLATE 87186 $160.00 ARUP MOLECULAR CYTO DNA PROBE FISH 88271 $241.00 ARUP MOLECULAR CYTO DNA PROBE FISH PML-RARA 88271 $241.00 ARUP MOLECULAR CYTO HER-2/NEU 88271 $241.00 ARUP MOLECULAR CYTO INSITU 100-300 MDS PANEL 88275 $671.00 ARUP MOLECULAR CYTO INSITU 100-300 MM FISH 88275 $671.00 ARUP MOLECULAR CYTO MDS PANEL 88271 $241.00 ARUP MOLECULAR CYTO MM FISH 88271 $241.00 ARUP MOLECULAR CYTOGENETICS IN SITU HYBRIDIZATION 88273 $282.00 ARUP MOLECULAR CYTOGENETICS IN SITU HYBRIDIZATION 88275 $671.00 ARUP MUSK ANTIBODY 83519 $445.00 ARUP MYCOBACTERIA TB NUCLEIC ACID PROBE AMPLIFIED 87556 $775.00 ARUP MYCOPHENOLIC ACID THERAPUTIC DRUG ANALYSIS 80180 $166.00 ARUP MYELOPEROXIDASE AB 83520 $348.00 ARUP NEURONAL NUCLEAR ANTIBODIES 83516 $160.00 ARUP NORTRIPTYLINE 80335 $288.00 ARUP NUCLEOTIDASE 5 83915 $277.00 ARUP OPIATES CONFIRM MECONIUM 80361 $359.00 ARUP OPIATES CONFIRM/QUANT URINE 80361 $359.00 ARUP ORGANIC ACIDS PLASMA 83918 $394.00 ARUP ORGANIC ACIDS QUANT URINE 83918 $394.00 ARUP OXYCODONE CONFIRM MECONIUM 80365 $244.00 ARUP OXYCODONE CONFIRM URINE 80365 $244.00 ARUP P JIROVECI QNT PCR 87798 $96.00 ARUP PANCREATIC POLYPEPTIDE 83519 $445.00 ARUP PARTIAL THROMBOPLASTIN 85730 $195.00 ARUP PARVO QNT PCR 87799 $678.00 ARUP PARVOVIRUS B19 IGG 86747 $86.00 ARUP PARVOVIRUS B19 IGM 86747 $86.00 ARUP PHENCYCLIDINE CONF URINE 83992 $321.00 ARUP PINWORM EXAM 87172 $192.00 ARUP PROTEIN TOTAL XCPT REFRACTOMETRY URINE 84156 $227.00 ARUP PROTEIN WESTERN BLOT BAND ID 84182 $415.00 ARUP PROTHROMBIN TIME 85610 $165.00 ARUP PYRUVATE 84210 $297.00 ARUP RAST ALLERGEN QUALITATIVE MULTI SCR 86005 $163.00 ARUP RNP IGG 86235 $94.00 ARUP ROTAVIRUS ANTIGEN INFECTIOUS AGENT IMMUNOASSA 87425 $130.00 ARUP RUFINAMIDE 80339 $244.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ARUP SEROTONIN 84260 $441.00 ARUP SEROTONIN RELEASE HEPARIN DEPENDENT PLT AB 86022 $193.00 ARUP SEX HORMONE BINDING GLOBULIN 84270 $225.00 ARUP SMEAR SPECIAL STAIN INCLUSION BODIES 87207 $221.00 ARUP SMITH IGG 86235 $94.00 ARUP SS-A IGG 86235 $94.00 ARUP SS-B IGG 86235 $94.00 ARUP SSDNA AB 84156 $227.00 ARUP STRONGYLOIDES ANTIBODY 86682 $193.00 ARUP SUSCEPTIBILITY AGAR PER PLATE 87181 $172.00 ARUP T GONDII AB IGG 86777 $355.00 ARUP T GONDII AB IGM 86778 $56.00 ARUP T VAGINALIS BY PCR 87661 $357.00 ARUP T3 UPTAKE 84479 $144.00 ARUP T4 TOTAL 84436 $154.00 ARUP TCA CONFIRMATION 80337 $244.00 ARUP TESTOSTERONE TOTAL 84403 $435.00 ARUP TETANUS ANTIBODY IGG 86317 $67.00 ARUP THC METABOLITE SERUM QUANT 80349 $219.00 ARUP THROMBIN CLOTTING TIME 85670 $165.00 ARUP THROMBIN MIXING STUDY 85670 $165.00 ARUP THYROGLOBULIN ANTIBODY 86800 $227.00 ARUP THYROID PEROXIDASE TPO AB 86376 $228.00 ARUP THYROID STIM HORMONE RECE AB 83520 $348.00 ARUP TIS TRANSGLUTAMINASE AB IGA 83516 $160.00 ARUP TISSUE CULTURE AMNIOTIC 88235 $876.00 ARUP TISSUE CULTURE AMNIOTIC 88264 $1,437.00 ARUP TISSUE CULTURE LYMPHOCYTE 88230 $480.00 ARUP TISSUE CULTURE NEOPLASTIC DISORDERS 88237 $683.00 ARUP TISSUE CULTURE SKIN 88230 $605.00 ARUP TISSUE CULTURE SOLID TUMOR 88239 $691.00 ARUP TSH 84443 $152.00 ARUP TYROSINE 84510 $103.00 ARUP UREA NITROGEN URINE 84540 $22.00 ARUP URINE DRUG SCREEN 80307 $706.00 ARUP VANILLYMANDELIC ACID VMA URINE 84585 $298.00 ARUP VARICELLA ZOSTER AG IMMUNOFLUORESCENT 87290 $271.00 ARUP VARICELLA ZOSTER VIRUS, PCR 87798 $96.00 ARUP VIMPAT (LACOSAMIDE) 80339 $244.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ARUP VIRAL CULTURE NON-RESP 87252 $450.00 ARUP VIRUS ISOLATION, HERPES 87252 $450.00 ARUP VOLATILES GC QUANT 84600 $118.00 ARUP WEST NILE AB CSF 86789 $83.00 ARUP WNV AB IGM 86788 $83.00 ARUP ZIKA VIRUS NUCLEIC ACID PROBE AMPLIFIED 87798 $96.00 ARUP ZINC URINE 84630 $171.00 ARUP-ADENSN DEAMNSE PLRL FL 84311 $527.00 ARUP-A-FETOPRTN TUMOR MRKR CSF 86316 $83.00 ARUP-ANAPLASMA ABS IGG IGM 86666 $127.00 ARUP-BK VIRUS 87799 $678.00 ARUP-BORDETALLA PERT/PARAPERT B/F 87798 $96.00 ARUP-CARNITINE,URINE 83789 $129.00 ARUP-CLOBAZAM QUANT SERUM/PLASMA 80339 $244.00 ARUP-COMPL COMPONENT 1Q LEVEL 86160 $174.00 ARUP-CREATININE,URINE 24HR 82570 $74.00 ARUP-DRG PAN 9 SER/PLA 80307 $706.00 ARUP-EBV CAP IGM 86665 $252.00 ARUP-EBV NUCLEAR AG,IGG 86664 $62.00 ARUP-ESTRADIOL BY TMS 82670 $481.00 ARUP-FREE LIGHT CHAIN, URINE 83883 $282.00 ARUP-GLUCAN (FUNGITELL) 87449 $702.00 ARUP-HEMOGLOBIN F 83021 $171.00 ARUP-HTLV WB INTERP 86689 $409.00 ARUP-IGF 1 W CALCULATED Z SCORE 84305 $267.00 ARUP-IL2 RECEPT (CD25) 83520 $348.00 ARUP-INF AGT ASPERGILLUS 87305 $366.00 ARUP-INTERLEUKIN-6 83520 $348.00 ARUP-MATERNAL SCREEN INTEG 2 81511 $586.00 ARUP-MUMPS AB,IGG 86735 $90.00 ARUP-MUMPS RNA QUAL BY PCR 87798 $96.00 ARUP-PHENCYCLIDINE CONF MEC 83992 $321.00 ARUP-PHOSPHOLIPIDS,SERUM/PLAS 84311 $527.00 ARUP-RMSF AB IGM 86757 $324.00 ARUP-SCHISTOSOMA AB 86682 $193.00 ARUP-SMOOTH MUSCLE IGG TITER 86256 $111.00 ARUP-T CRUZI AB IGG 86753 $245.00 ARUP-TESTOSTERONE,MS/MS 84403 $435.00 ARUP-THIOPURINE DRUG METABOLITES 80299 $395.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ARUP-TITAN ANTIBODY 83516 $160.00 ARUP-URIC ACID,URINE 84560 $231.00 ASCORBIC ACID (VITAMIN C) LEVEL, BLOOD 82180 $282.00 ASPIRATION AND/OR INJECT OF MAJOR JOINT OR JOINT C 20611 $739.00 ASPIRATION AND/OR INJECTION KIDNEY CYST, ACCESSED 50390 $2,013.00 ASPIRATION AND/OR INJECTION OF CYSTS 20612 $675.00 ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOIN 20610 $389.00 ASPIRATION AND/OR INJECTION OF MEDIUM JOINT OR JOI 20605 $677.00 ASPIRATION AND/OR INJECTION OF SMALL JOINT OR JOIN 20600 $758.00 ASPIRATION INJECTION INTERMEDIATE JOINT OR JOINT C 20606 $1,040.00 ASPIRATION OF ABSCESS, BLOOD ACCUMULATION, BLISTER 10160 $747.00 ASPIRATION OF BLADDER WITH INSERTION OF BLADDER TU 51102 $5,296.00 ASPIRATION OF FLUID FROM SAC THAT COVERS THE HEART 33010 $2,211.00 ASPIRATION OR INJECTION OF CEREBROSPINAL FLUID SHU 61070 $1,487.00 ASSAY OF BLOOD CHLORIDE 82435 $115.00 ASSAY OF PYRUVATE KINASE 84220 $129.00 ASSAY OF SERUM POTASSIUM 84132 $118.00 ASSAY OF SERUM SODIUM 84295 $94.00 ASSESSMENT ANTIBODIES CLASS I & II HUMAN LEUKOCYTE 86829 $230.00 ASSESSMENT ANTIBODIES CLASS I & II HUMAN LEUKOCYTE 86828 $275.00 ASSESSMENT ANTIBODY HUMAN LEUKOCYTE ANTIGENS W/ANT 86831 $537.00 ASSESSMENT ANTIBODY HUMAN LEUKOCYTE ANTIGENS W/ANT 86830 $627.00 ASSESSMENT ANTIBODY HUMAN LEUKOCYTE ANTIGENS W/HIG 86833 $895.00 ASSESSMENT ANTIBODY HUMAN LEUKOCYTE ANTIGENS W/HIG 86832 $985.00 ASSESSMENT FOR PRESCRIPTIVE EYE WEAR USING A RANGE 92015 $368.00 ASSESSMENT HEARING LOSS W/PLACE PROBE IN EAR ASSES 92568 $101.00 ASSESSMENT OF EARDRUM AND MUSCLE FUNCTION 92550 $397.00 ASSESSMENT OF HEARING AID FUNCTION FOR BOTH EARS 92595 $284.00 ASSESSMENT OF HEARING AID FUNCTION FOR ONE EAR 92594 $191.00 ASSESSMENT OF HEARING LOSS AND SPEECH RECOGNITION 92556 $89.00 ASSESSMENT OF SIMULTANEOUS BUT DIFFERENT HEARING T 92565 $128.00 ASSESSMENT OF SPEECH HEARING LOSS 92555 $240.00 ASSESSMENT OF TWO SIMULTANEOUS WORDS AT DIFFERENT 92577 $1,252.00 ASSISTIVE TECHNOLOGY ASSESS TO ENHANCE FUNCTION PE 97755 $264.00 ATHENA GEN TST INH COND 81443 $6,734.00 ATTEMPT TO RESTART HEART AND LUNGS 92950 $545.00 AUGMENT FEMORAL VANGUARD 360 SMALL KNEE CRUCIATE W C1776 $4,550.00 AUTOMATED URINALYSIS TEST 81003 $52.00 AUTOPSY FOR FORENSIC INVESTIGATIVE EXAMINATION 88040 $8,116.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge AUTOPSY, CORONER CALL 88045 $250.00 AUTOPSY, GROSS AND MICROSCOPIC WITH SPINAL CORD 88099 $6,082.20 BACTERIAL COLONY COUNT, URINE 87086 $176.00 BACTERIAL CULTURE 87070 $171.00 BACTERIAL CULTURE AND COLONY COUNT FOR ANAEROBIC B 87073 $61.00 BALLOON CATHETER ENLARGEMENT OF OPENING BETWEEN TW 92992 $3,111.00 BALLOON CATHETER OPENING OF MAJOR LUNG ARTERY 92998 $5,214.00 BALLOON CATHETER OPENING OF MAJOR LUNG ARTERY 92997 $26,590.00 BALLOON DILATION OF ARTERY ACCESSED THROUGH THE SK 37247 $7,070.00 BALLOON DILATION OF ARTERY ACCESSED THROUGH THE SK 37246 $14,139.00 BALLOON DILATION OF ESOPHAGUS STOMACH/UPPER SMALL 43233 $4,803.00 BALLOON DILATION OF ESOPHAGUS USING AN ENDOSCOPE 43249 $2,598.00 BALLOON ENDOSCOPIC L8 CM L75 CM OD35 MM ODSEC16 FR C1726 $1,500.00 BALLOON RETRIEVAL EXTRACTOR PRO RX L200 CM OD6-7 F $1,430.52 BALLOON SIZING BARRX 360 OD47.5 MM ESOPHAGEAL SOFT $2,684.50 BAR EXTERNAL FIXATION JET-X CARBON FIBER L L160 MM $1,450.16 BAR EXTERNAL FIXATION JET-X CARBON FIBER L500 MM S $1,596.56 BAR SPINAL L200 MM OD6 MM SACRAL THREADED KIT NONS C1713 $4,370.00 BAR SPINAL STAINLESS STEEL L260 MM OD6 MM SACRAL S C1713 $4,370.00 BAR SPINAL VEPTR II DISTRACTION LOCK REMOVAL NONST C1713 $1,960.00 BARBITURATES LEVELS 80345 $352.00 BARTONELLA AB IGG 86611 $48.00 BARTONELLA AB IGM 86611 $48.00 BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE C1776 $20,260.50 BASEPLATE TIBIAL ATTUNE 5 KNEE CEMENTED ROTATE PLA C1776 $5,850.00 BASEPLATE TIBIAL ATTUNE 8 KNEE CEMENT FIX BEARING C1776 $5,850.00 BASEPLATE TIBIAL ATTUNE 8 KNEE CEMENTED FIX BEARIN C1776 $5,850.00 BASEPLATE TIBIAL OSS SHORT L63 MM KNEE NONMODULAR C1776 $27,236.00 BASEPLATE TIBIAL PERSONA NATURAL TIBIA 5 D E KNEE C1776 $5,850.00 BASEPLATE TIBIAL PERSONA NATURAL TIBIA 5 D F KNEE C1776 $5,850.00 BASKET STONE RETRIEVAL BAGLEY HELICAL L90 CM OD10 $1,182.32 BASKET STONE RETRIEVAL SEGURA HEMISPHERE PERMAFORM $1,364.48 BEARING TIBIAL OXFORD ARCOM SMALL H3 MM KNEE RIGHT C1776 $3,900.00 BEARING TIBIAL VANGUARD ARCOM 0 D L79/83 MM X H10 C1776 $3,900.00 BEHAVIOR TREATMENT WITH PROTOCOL MODIFICATION FIRS 0373T $569.00 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND R 92524 $888.00 BENZODIAZEPINES LEVELS 80346 $471.00 BETA-2 MICROGLOBULIN 82232 $208.00 B-HEXOSAMINIDASE (ENZYME) LEVEL 83080 $131.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge BILE ACIDS LEVEL 82240 $206.00 BILIRUBIN LEVEL 82247 $181.00 BILIRUBIN LEVEL 82248 $201.00 BILIRUBIN, FLD 82247 $181.00 BINAURAL BODY AID V5120 $2,149.00 BIOFEEDBACK TRAINING 90901 $215.00 BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL 90911 $669.00 BIOPSY OF BONE USING NEEDLE OR TROCAR 20220 $2,183.00 BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH MR 19085 $2,270.00 BIOPSY OF FINGER OR TOE NAIL 11755 $1,243.00 BIOPSY OF LARGE BOWEL USING AN ENDOSCOPE 45331 $1,795.00 BIOPSY OF LARGE BOWEL USING AN ENDOSCOPE 45380 $4,632.00 BIOPSY OF LUNG AIRWAYS USING AN ENDOSCOPE 31625 $2,609.00 BIOPSY OF RECTUM 45100 $3,121.00 BIOPSY OF RECTUM AND LARGE BOWEL USING AN ENDOSCOP 45305 $2,576.00 BIOPSY OF SOFT TISSUE OF NECK OR CHEST 21550 $3,326.00 BIOPSY OF THE WALL DIVIDING THE LEFT AND RIGHT HEA 93505 $3,274.00 BIOPSY THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL 43239 $3,924.00 BIOTIN B7 84591 $96.00 BIT DRILL 140 MM L400 MM OD2.5 MM JACOBS CHUCK CAL $3,601.76 BIT DRILL 95 MM L248 MM OD2.8 MM QUICK COUPLING CA $1,104.00 BIT DRILL BADGER L9 IN OD9.5 MM ACL TAPERED HEAD T $884.00 BIT DRILL BUD OD10 MM NONSTERILE $1,690.00 BIT DRILL DVR OD2.2 MM CROSSLOCK TRAY $476.58 BIT DRILL EASYCLIP OD3 MM ANKLE FOOT AO REAMER DIS $962.00 BIT DRILL HELIX-R L10 MM OD2.5 MM POWER NONSTERILE $325.00 BIT DRILL L110 MM OD2.5 MM QUICK COUPLING NONSTERI $411.13 BIT DRILL L140 MM OD2.9 MM STERILE $701.81 BIT DRILL L145 MM OD5 MM 3 FLUTED QUICK COUPLING S $1,226.36 BIT DRILL L180 MM OD3.2 MM JACOBS CHUCK NONSTERILE $634.80 BIT DRILL L3.8 MM OD3 MM NEURO LESS AGGRESSIVE STE $813.93 BIT DRILL L55 MM OD1.3 MM MINI QUICK COUPLING SELF $422.31 BIT DRILL L65 MM OD1.1 MM J LATCH THREAD HOLE $487.05 BIT DRILL L75 MM OD1.5 MM J LATCH COUPLING NONSTER $519.76 BIT DRILL MATRIXMANDIBLE L125 MM OD1.5 MM MINI QUI $889.20 BIT DRILL OD2 MM $640.00 BIT DRILL SMALL L180 MM OD4.2 MM AO COUPLING STERI $1,039.48 BLADDER IRRIGATION AND/OR INSTILLATION 51700 $300.00 BLADE FIXATION LCP DHHS STAINLESS STEEL L75 MM HIP C1713 $2,378.16 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge BLADE INTRAMEDULLARY FIXATION TITANIUM L75 MM FEMU C1713 $4,860.96 BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB C1713 $3,660.15 BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM HE C1713 $3,660.13 BLADE OSTEOTOME EXPLANT 54 MM HEMISPHERE HIP TRUNC $3,575.00 BLOCK AUGMENTATION GMK THK5 MM 2 TIBIA SCREWED C1776 $4,550.00 BLOCK AUGMENTATION NEXGEN PRECOAT E H10 MM DISTAL C1776 $4,550.00 BLOCK AUGMENTATION NEXGEN TRABECULAR METAL F H5 MM C1776 $13,487.50 BLOOD ADMINISTRATION ? REVENUE CODE 391 DEDUCT 2 H G0378 $185.00 BLOOD BANK PHYSICIAN SERVICES INVESTIGATION TRANSF 86078 $574.00 BLOOD CENTER HLA MATCH PLATELET 86022 $2,606.40 BLOOD CREATININE LEVEL 82565 $228.00 BLOOD CULTURE 87040 $284.00 BLOOD CULTURE - PEDIATRIC 87040 $284.00 BLOOD DRAW VENIPUNCTURE 36415 $29.00 BLOOD GASES MEASUREMENT 82803 $512.00 BLOOD GLUCOSE (SUGAR) LEVEL 82947 $65.00 BLOOD GLUCOSE (SUGAR) MEASUREMENT USING REAGENT ST 82948 $37.00 BLOOD GLUCOSE (SUGAR) TOLERANCE TEST 82952 $78.00 BLOOD GLUCOSE (SUGAR) TOLERANCE TEST 82951 $342.00 BLOOD GROUP TYPING (ABO) 86900 $68.00 BLOOD PRODUCT BLOOD P9011 $81.00 BLOOD PRODUCT BLOOD P9011 $82.00 BLOOD PRODUCT BLOOD P9011 $89.00 BLOOD PRODUCT BLOOD P9011 $90.00 BLOOD PRODUCT BLOOD P9011 $132.00 BLOOD PRODUCT BLOOD P9011 $136.00 BLOOD PRODUCT BLOOD P9011 $282.00 BLOOD PRODUCT BLOOD P9021 $377.00 BLOOD PRODUCT BLOOD P9016 $385.00 BLOOD PRODUCT BLOOD P9010 $467.00 BLOOD PRODUCT BLOOD P9011 $560.00 BLOOD PRODUCT BLOOD P9040 $563.00 BLOOD PRODUCT BLOOD P9022 $579.00 BLOOD PRODUCT BLOOD P9011 $600.00 BLOOD PRODUCT BLOOD P9050 $2,377.00 BLOOD PRODUCT CRYOPRECIPITATE P9012 $343.00 BLOOD PRODUCT PLASMA P9017 $348.00 BLOOD PRODUCT PLATELETES P9019 $387.00 BLOOD PRODUCT PLATELETS P9032 $558.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge BLOOD PRODUCT PLATELETS P9036 $1,200.00 BLOOD PRODUCT PLATELETS P9035 $2,389.00 BLOOD PRODUCT PLATELETS P9037 $2,557.00 BLOOD SMEAR FOR IRON 85536 $47.00 BLOOD TEST PANEL FOR ELECTROLYTES 80051 $374.00 BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS 80048 $306.00 BLOOD TEST, CLOTTING TIME 85610 $165.00 BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS 80053 $378.00 BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) 80061 $277.00 BLOOD TEST, THYROID STIMULATING HORMONE (TSH) 84443 $152.00 BLOOD TYPING FOR PATERNITY TESTING 86910 $129.00 BLOOD TYPING FOR PATERNITY TESTING EACH ADDITIONAL 86911 $344.00 BLOOD TYPING FOR RED BLOOD CELL ANTIGENS 86905 $52.00 BLOOD TYPING FOR RH (D) ANTIGEN 86901 $45.00 BLOOD TYPING FOR RH (D) ANTIGEN 86906 $143.00 BLOOD UNIT COMPATIBILITY TEST 86920 $185.00 BLOOD UNIT COMPATIBILITY TEST 86921 $236.00 BLOOD UNIT COMPATIBILITY TEST 86922 $240.00 BODY CONE RESTORATION TITANIUM +10 MM OD25 MM HIP C1776 $19,710.60 BODY FEMORAL EXPRT LATERAL OFFSET H75 MM HIP REVIS C1776 $16,900.00 BODY FLUID CELL COUNT 89050 $118.00 BODY FLUID CELL COUNT WITH CELL IDENTIFICATION 89051 $216.00 BOLT EXTERNAL FIXATION OD6 MM LOCK BALL JOINT $482.56 BOLT LOCKING STAINLESS STEEL 3.5 MM L52 MM OD4.9 M C1713 $1,135.44 BOLT LOCKING TITANIUM 3.5 MM L50 MM OD4.9 MM ODSEC C1713 $1,217.52 BOLT LOCKING TITANIUM 3.5 MM L56 MM OD3.9 MM ODSEC C1713 $1,554.96 BOLT LOCKING TITANIUM 3.5 MM L64 MM OD4.9 MM ODSEC C1713 $1,554.96 BOLT LOCKING TITANIUM FULL THREAD L70 MM OD3.9 MM C1713 $1,217.52 BOLT LOCKING TITANIUM L30 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52 BOLT ORTHOPEDIC STAINLESS STEEL L90 MM OD4.9 MM LO C1713 $1,135.44 BOLT ORTHOPEDIC TITANIUM L110 MM OD6.5 MM MIDFOOT C1713 $4,121.60 BOLT ORTHOPEDIC TITANIUM L70 MM OD3.9 MM LOCK STER C1713 $1,554.96 BOLT SPINAL DECADE LARGE L45 MM OD5.5 MM PLATE NON C1713 $1,625.00 BOLT SPINAL EXPEDIUM STAINLESS STEEL L25 MM OD4 MM C1713 $2,800.00 BOLT SPINAL EXPEDIUM TITANIUM L27.5 MM OD4 MM 4.5 C1713 $2,800.00 BOLT SPINAL EXPEDIUM TITANIUM L40 MM OD4 MM 4.5 MM C1713 $2,800.00 BONE AND/OR JOINT IMAGING 78300 $2,025.00 BONE AND/OR JOINT IMAGING, 3 PHASE STUDY 78315 $1,744.00 BONE AND/OR JOINT IMAGING, WHOLE BODY 78306 $2,504.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge BONE DENSITY MEASUREMENT USING DEDICATED X-RAY MAC 77080 $530.00 BONE DENSITY MEASUREMENT USING DEDICATED X-RAY MAC 77081 $587.00 BONE MARROW ASPIRATION 38220 $3,490.00 BONE MARROW BIOPSY AND ASPIRATION 38222 $3,491.00 BORDETELLA PERTUS ANTIBODY IGG 86615 $207.00 BOWL BONE CEMENT VORTEX VACUUM MIX $150.00 BRA POST SURGICAL FABRIC 46-48 DETACHABLE HOOK LOO L8000 $188.70 BRACE ORTHOPEDIC ROLYAN D-RING ALUMINUM COTTON SMA L3908 $54.93 BRACE WALKING PACESETTER II FOAM MEDIUM LARGE L8-1 L4386 $222.89 BREATH ALCOHOL LEVEL 82075 $77.00 BRIEF EMOTIONAL OR BEHAVIORAL ASSESSMENT 96127 $144.00 BRONCHOSCOPY W/FLUORO GUIDANCE WITH BRONCHIAL THER 31660 $13,728.00 BTE HEARING AID BINAURAL V5140 $3,788.00 BTE HEARING AID MONAURAL V5060 $1,896.00 BURN TREATMENT 16000 $214.00 BURR SHAVER SIGNATURE SERIES OVAL STRAIGHT L19 CM $845.00 BURR SHAVER XPS RAD 40 D L130 MM OD3 MM FRONTAL SI $1,552.53 BURR SURGICAL CARBIDE LONG OD4 MM ROUND HEAD FLUTE $669.92 BURR SURGICAL DIAMOND COARSE ROUND OD3 MM $910.59 BURR SURGICAL DIAMOND ROUND OD3 MM $910.59 BURR SURGICAL E9000 CARBIDE ROUND 10 FLUTE L38 MM $331.50 BURR SURGICAL E9000 DIAMOND ROUND L48 MM OD4 MM CO $370.50 BURR SURGICAL ELITE OD5 MM PEAR $1,074.40 BURR SURGICAL MICROMAX DIAMOND BALL L8 CM OD2 MM Q $458.19 BURR SURGICAL MICROMAX DIAMOND BALL L8 CM OD4 MM Q $458.19 BURR SURGICAL MICROMAX L14 CM OD6 MM BALL DIAMOND $551.20 BURR SURGICAL MICROMAX SHORT STRAIGHT DIAMOND BALL $546.48 BURR SURGICAL OD2.5 MM NEURO CURVED STERILE MIS $1,434.96 BURR SURGICAL TPS ELITE FLUTE OD4 MM STERILE $950.00 BURR SURGICAL XMAX MICROMAX EMAX 2 PLUS MEDIUM EXT $604.18 BUTTON FIXATION PARCUS TITANIUM L12 MM X W3.9 MM L C1713 $2,152.00 BUTTON SUTURE OD3.5 MM C1713 $617.50 C. DIFF TOXIN AG 87324 $236.00 C1 ESTERASE INHIBITOR 86160 $174.00 CA-125 86304 $273.00 CA-19-9 86301 $71.00 CAFFEINE LEVEL 80155 $194.00 CAGE SPINAL BRECKENRIDGE PEEK L30 MM X W10 MM X H9 C1821 $13,650.00 CAGE SPINAL CLYDESDALE PTC PEEK TITANIUM 6 D L45 M C1821 $22,750.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CAGE SPINAL COROENT PEEK XL L35 MM X W16 MM X H8 M C1821 $26,000.00 CAGE SPINAL FOUNDATION PEEK 7 D LORDOTIC LARGE H7 C1821 $4,225.00 CAGE SPINAL FOUNDATION PEEK L30 MM X H13 MM NONSTE C1821 $14,950.00 CAGE SPINAL FOUNDATION PEEK OBLIQUE L26 MM X W10 M C1821 $7,475.00 CAGE SPINAL IMPIX 6 D L28 MM X W10 MM X H9 MM 3D P C1821 $14,950.00 CAGE SPINAL SANTORINI PEEK 7 D L12 MM X W14 MM X H C1821 $19,500.00 CAGE SPINAL VERTA 7 D L14.5 MM X W12 MM X H17 MM N C1821 $19,851.00 CAGE SPINAL VERTA 7 D L14.5 MM X W12 MM X H27 MM N C1821 $19,851.00 CALCITONIN (HORMONE) LEVEL 82308 $481.00 CALCIUM LEVEL 82331 $41.00 CALCIUM LEVEL 82310 $179.00 CALCIUM URINE 82340 $179.00 CANNABINOIDS LEVELS 80350 $244.00 CANNABINOIDS LEVELS 80351 $244.00 CANNABINOIDS LEVELS 80352 $244.00 CANNULA ENDOSCOPIC VERSASEAL PLUS OD5-11 MM FIXATI $611.00 CANNULA ENDOSCOPIC VERSASTEP PLUS SANTOPRENE FABRI $325.00 CANNULA IV MONOJECT ALUMINUM STAINLESS STEEL POLYP $408.85 CAP END OFFSET L12 MM OD5 MM LOW PROFILE C1713 $983.04 CAP END PHOENIX L15 MM OD15 MM OFFSET C1713 $983.04 CAP END PHOENIX L15 MM OD5 MM OFFSET C1713 $983.04 CAP END TITANIUM 0 MM HUMERUS T25 STARDRIVE RECESS C1713 $1,600.56 CAP END TITANIUM 0 MM T25 HUMERUS STARDRIVE GOLD E C1713 $1,021.44 CAP PROTECTIVE HOFFMANN XPRESS STAINLESS STEEL L50 C1713 $240.50 CAR SEAT OR BED AIRWAY TESTING OF NEONATE 94781 $258.00 CAR SEAT OR BED AIRWAY TESTING OF NEONATE, MINIMUM 94780 $258.00 CARBAMAZEPINE LEVEL 80156 $305.00 CARBOHYDRATE ANALYSIS 84379 $70.00 CARBOHYDRATES ANALYSIS 84377 $282.00 CARBON DIOXIDE (BICARBONATE) LEVEL 82374 $120.00 CARBOXYHEMOGLOBIN (PROTEIN) ANALYSIS 82376 $47.00 CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL 82378 $305.00 CARDIAC OUTPUT MEASUREMENTS 93561 $660.00 CARDIAC OUTPUT MEASUREMENTS 93562 $4,300.00 CARDIOLIPIN ANTIBODY IGA 86147 $55.00 CARDIOLIPIN ANTIBODY IGG 86147 $55.00 CARDIOLIPIN ANTIBODY, IGA 86147 $55.00 CARINITINE-CARINITINE 82379 $369.00 CARINITINE-URINE 82379 $369.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CARNITINE LEVEL 82379 $369.00 CATECHOLAMINES-PLASMA 82384 $309.00 CATECHOLAMINES-URINE 82384 $309.00 CATHEPSIN-D (ENZYME) LEVEL 82387 $60.00 CATHETER ANGIOGRAPHIC CHOICE-PAK PRO-FLO OD6 FR SO $411.13 CATHETER ANGIOGRAPHIC CORDIS SUPER TORQUE POLYURET $406.25 CATHETER ANGIOGRAPHIC CORDIS TEMPO AQUA NYLON HYDR $468.00 CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON JII C $406.25 CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON PIGTA $406.25 CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON UNIV $406.25 CATHETER ANGIOGRAPHIC PRO-FLO .038 IN JL/JR/STRAIG $411.13 CATHETER ANGIOGRAPHIC PRO-FLO ANGIOKIT STAINLESS S $411.13 CATHETER ANGIOGRAPHIC PRO-FLO CHOICE-PAK OD6 FR LA $411.13 CATHETER ANGIOGRAPHIC PRO-FLO CHOICE-PAK STAINLESS $411.13 CATHETER ANGIOGRAPHIC PRO-FLO XT ANGIOKIT STAINLES $411.13 CATHETER ANGIOGRAPHIC PRO-FLO XT CHOICE-PAK STAINL $411.13 CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON T $617.50 CATHETER ATHERECTOMY CROSSER L154 CM OD5 FR ODSEC1 C1714 $7,975.00 CATHETER ATHERECTOMY DIAMONDBACK 360 1.25 MM L135 C1724 $18,975.00 CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL L1 C1725 $3,875.00 CATHETER BALLOON DILATATION ANGIOSCULPT XL NITINOL C1725 $3,750.00 CATHETER BALLOON DILATATION APEX OPTILEAP L142 CM C1725 $696.00 CATHETER BALLOON DILATATION ATLAS LARGE DIAMETER L C1725 $1,560.65 CATHETER BALLOON DILATATION AVIATOR PLUS DURALYN L C1725 $1,365.00 CATHETER BALLOON DILATATION CORDIS AVIATOR PLUS DU C1725 $1,170.00 CATHETER BALLOON DILATATION CORDIS OPTA PRO DURALY C1725 $390.00 CATHETER BALLOON DILATATION CORDIS POWERFLEX EXTRE C1725 $300.00 CATHETER BALLOON DILATATION CORDIS POWERFLEX EXTRE C1725 $390.00 CATHETER BALLOON DILATATION CORDIS POWERFLEX P3 DU C1725 $390.00 CATHETER BALLOON DILATATION CORDIS POWERFLEX P3 DU C1725 $1,989.00 CATHETER BALLOON DILATATION CORDIS POWERFLEX PRO D C1725 $425.00 CATHETER BALLOON DILATATION CORDIS POWERFLEX PRO D C1725 $552.50 CATHETER BALLOON DILATATION CORDIS POWERFLEX PRO D C1725 $2,307.50 CATHETER BALLOON DILATATION CORDIS SAVVY DURALYN S C1725 $1,040.00 CATHETER BALLOON DILATATION CORDIS SAVVY LONG QUAD C1725 $1,137.50 CATHETER BALLOON DILATATION CORDIS SAVVY LONG QUAD C1725 $3,315.00 CATHETER BALLOON DILATATION CORDIS SLALOM DURALYN C1725 $1,365.00 CATHETER BALLOON DILATATION CORDIS SLEEK QUADFLEX C1725 $1,000.00 CATHETER BALLOON DILATATION COYOTE ES NYBAX BIOSLI C1725 $1,053.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CATHETER BALLOON DILATATION COYOTE ES NYBAX BIOSLI C1725 $3,667.52 CATHETER BALLOON DILATATION COYOTE MONORAIL NYBAX C1725 $1,164.15 CATHETER BALLOON DILATATION EMERGE MONORAIL WORKHO C1725 $942.50 CATHETER BALLOON DILATATION EMERGE WORKHORSE OPTIL C1725 $942.50 CATHETER BALLOON DILATATION EUPHORA ULTRA-SLIM DUR C1725 $585.00 CATHETER BALLOON DILATATION FUSION TITAN .035 IN L C1726 $975.00 CATHETER BALLOON DILATATION MUSTANG NYBAX L135 CM C1725 $848.25 CATHETER BALLOON DILATATION NC EMERGE MONORAIL XTR C1725 $942.50 CATHETER BALLOON DILATATION NC EUPHORA DURA-TRAC N C1725 $450.00 CATHETER BALLOON DILATATION NC QUANTUM APEX MONORA C1725 $696.00 CATHETER BALLOON DILATATION NC SPRINTER FULCRUM PL C1725 $400.00 CATHETER BALLOON DILATATION NC TREK TUNGSTEN L12 M C1725 $400.00 CATHETER BALLOON DILATATION NC TREK TUNGSTEN L15 M C1725 $400.00 CATHETER BALLOON DILATATION NC TREK TUNGSTEN L15 M C1725 $425.00 CATHETER BALLOON DILATATION OPTA PRO DURALYN MDX L C1725 $1,989.00 CATHETER BALLOON DILATATION POWERFLEX PRO DURALYN C1725 $2,307.50 CATHETER BALLOON DILATATION SAVVY QUADFLEX SILX LO C1725 $3,315.00 CATHETER BALLOON DILATATION SLALOM DURALYN .018 IN C1725 $3,315.00 CATHETER BALLOON DILATATION SPRINTER FULCRUM DURA- C1725 $400.00 CATHETER BALLOON DILATATION SPRINTER FULCRUM DURA- C1725 $640.00 CATHETER BALLOON DILATATION SPRINTER LEGEND MICRO- C1725 $400.00 CATHETER BALLOON DILATATION SPRINTER LEGEND MICRO- C1725 $640.00 CATHETER BALLOON DILATATION STERLING PEBAX BIOSLID C1725 $825.00 CATHETER BALLOON DILATATION STERLING PEBAX BIOSLID C1725 $877.50 CATHETER BALLOON DILATATION TREK SLIM SEAL CROSSFL C1725 $400.00 CATHETER BALLOON DILATATION TREK SLIM SEAL CROSSFL C1725 $680.00 CATHETER BALLOON DILATATION ULTRAVERSE 018 CHECKER C1725 $713.00 CATHETER BALLOON DILATATION UROMAX ULTRA QUADRA-FO C1726 $1,443.00 CATHETER BALLOON DILATATION VASCUTRAK HYDROPHILIC C1725 $2,850.00 CATHETER BALLOON DILATATION VIATRAC 14 PLUS XCELON C1725 $1,192.00 CATHETER BASED CLOSURE OF CONGENITAL HEART DEFECT 93580 $20,575.00 CATHETER BASED CLOSURE OF CONGENITAL HEART DEFECT 93581 $62,922.00 CATHETER BASED ENLARGEMENT OF OPENING BETWEEN TWO 92993 $3,729.00 CATHETER BASED REPAIR OF HEART VALVE (PULMONARY) T 92990 $6,441.00 CATHETER BASED REPAIR OF LEFT LOWER HEART (AORTIC) 92986 $5,827.00 CATHETER DELIVERY SYSTEM NEURON STAINLESS STEEL .0 C1757 $3,737.50 CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EY C1729 $46.24 CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EY C1729 $101.73 CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EY C1729 $104.91 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CATHETER DRAINAGE CODMAN BACTISEAL BARIUM SILICONE C1729 $2,496.00 CATHETER ELECTROPHYSIOLOGY BLAZER II 2.5 MM SPACE C1733 $8,320.00 CATHETER ELECTROPHYSIOLOGY LIVEWIRE 2 MM SPACE XL C1730 $1,965.00 CATHETER ELECTROPHYSIOLOGY SAFIRE COMFORTGRIP 2-5- C1733 $3,185.00 CATHETER ELECTROPHYSIOLOGY SUPREME 5 MM SPACE COUR C1730 $178.20 CATHETER ELECTROPHYSIOLOGY SUPREME 5 MM SPACE COUR C1730 $231.66 CATHETER EMBOLECTOMY FOGARTY L80 CM OD5 FR ODSEC8 C1757 $1,202.50 CATHETER EMBOLECTOMY FOGARTY STAINLESS STEEL SILIC C1757 $432.51 CATHETER GUIDING C1887 $352.00 CATHETER GUIDING CELLO L95 CM L3 MM L103 CM L7 MM C1887 $6,012.50 CATHETER GUIDING CORDIS VISTA BRITE TIP IG STAINLE C1887 $455.00 CATHETER GUIDING CORDIS VISTA BRITE TIP IG STAINLE C1887 $864.50 CATHETER GUIDING CORDIS VISTA BRITE TIP STAINLESS C1887 $227.50 CATHETER GUIDING CORDIS VISTA BRITE TIP STAINLESS C1887 $352.00 CATHETER GUIDING CORDIS VISTA BRITE TIP STAINLESS C1887 $1,132.00 CATHETER GUIDING HEARTRAIL III PTFE IL3.5 CURVE L1 C1887 $350.00 CATHETER GUIDING LAUNCHER NYLON AL.75 CURVE L100 C C1887 $200.00 CATHETER GUIDING LAUNCHER NYLON AL4 CURVE L100 CM C1887 $200.00 CATHETER GUIDING LAUNCHER NYLON AMPLATZ RIGHT 2 CU C1887 $200.00 CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP LEFT C1887 $200.00 CATHETER GUIDING LAUNCHER NYLON HSI CURVE L100 CM C1887 $200.00 CATHETER GUIDING LAUNCHER NYLON SCR3.5 CURVE L100 C1887 $200.00 CATHETER GUIDING LAUNCHER NYLON SHEPHERDS CROOK RI C1887 $200.00 CATHETER GUIDING LAUNCHER NYLON SL4 CURVE L100 CM C1887 $320.00 CATHETER GUIDING LAUNCHER RIGHT BACKUP 4 CURVE L10 C1887 $200.00 CATHETER GUIDING MACH1 PTFE ART3.5 CURVE L100 CM O C1887 $227.50 CATHETER GUIDING MACH1 PTFE FR4 CURVE L100 CM OD6 C1887 $227.50 CATHETER GUIDING Z2 JL4 CURVE L100 CM OD6 FR CORON C1887 $320.00 CATHETER HEMODIALYSIS EQUISTREAM XK AIRGUARD POLYU C1750 $2,280.00 CATHETER INFUSION CRAGG-MCNAMARA CRAGG MICROVALVE C1751 $235.71 CATHETER PERITONEAL BARIUM STANDARD L90 CM CARDIAC C1750 $874.77 CATHETER SUPPORT QUICK-CROSS 50 MM SPACE L135 CM O C1887 $800.00 CATHETER SUPRAPUBIC MALECOT SILICONE L25 CM OD16 F C2627 $251.60 CATHETER SUPRAPUBIC SIMPLASTIC PVC OD16 FR 5 ML 3 C2627 $273.39 CATHETER THROMBECTOMY EXPORT AP L140 CM OD6 FR ID. C1757 $1,925.00 CATHETER TIP CULTURE 87070 $171.00 CATHETER ULTRASOUND L90 CM OD8 FR STERILE DISPOSAB C1753 $4,000.00 CATHETER URETERAL .038 IN L70 CM OD5 FR OPEN END S C1758 $46.75 CATHETER URETERAL BARD POLYURETHANE LARGE L70 CM O C1758 $21.31 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CEA CARCINOEMBRYONIC ANTIGEN 82378 $305.00 CEFOTAXIME 1 GRAM SOLR 1 EACH VIAL J0698 $24.05 CELIAC DIS REFLEX PANEL 82784 $141.00 CELIAC DIS SCREEN 83516 $160.00 CELL EXAMINATION OF BODY FLUID 88104 $62.00 CELL EXAMINATION OF BODY FLUID 88106 $81.00 CELL EXAMINATION OF SPECIMEN 88108 $278.00 CEMENT BONE NORIAN CRS 3 ML ROTATORY MIX STERILE R C1713 $7,648.00 CENTRALIZER STEM CEMENTRALIZER OD12 MM CEMENT STER C1776 $260.00 CENTRALIZER STEM VERSYS PMMA OD12 MM HIP DISTAL CE C1776 $260.00 CERULOPLASMIN 82390 $172.00 CERULOPLASMIN (PROTEIN) LEVEL 82390 $172.00 CHANGE OF BREATHING TUBE OF WINDPIPE IN NECK 31502 $615.00 CHECK OF HEARING AID OF BOTH EARS 92593 $236.00 CHECK OF HEARING AID OF ONE EAR 92592 $156.00 CHEMICAL ANALYSIS FOR GENETIC DISORDER 82016 $108.00 CHEMICAL ANALYSIS USING CHROMATOGRAPHY TECHNIQUE 82542 $324.00 CHEMOTHERAPY ADMINISTRATION INTO SPINAL CANAL REQU 96450 $3,031.00 CHERRY SYRUP SYRP 473 ML BOTTLE $50.12 CHEST ULTRASOUND EXAMINATION OF HEART W/CONTRAST 93307 $664.00 CHIMERISM ANALYSIS POST TRANSPLANTATION 81268 $30.00 CHIMERISM ANALYSIS POST TRANSPLANTATION 81267 $1,563.00 CHLAMYDIA AMPLIFIED DETECTION 87491 $81.00 CHLORIDE - CSF 82438 $184.00 CHLORIDE BODY FLUID 82438 $184.00 CHLORIDE URINE 82436 $30.00 CHLORIDE, URINE, RANDOM 82436 $30.00 CHLORIDE-QUANT, URINE, 24HRS 82436 $118.00 CHNOLA HEMODIALYSIS OUTPATIENT 90999 $2,799.00 CHNOLA HOME CCPD PER DAY 90999 $2,280.00 CHOLESTEROL LEVEL 82465 $246.00 CHONDROITIN B SULFATE (PROTEIN) LEVEL 82485 $160.00 CHROMATOGRAPHY 82542 $324.00 CHROMATOGRAPHY(HGB,EVAL) 83021 $171.00 CHROMOSOME ANALYSIS FOR GENETIC DEFECTS 88272 $208.00 CHROMOSOME ANALYSIS FOR GENETIC DEFECTS 88283 $264.00 CHROMOSOME ANALYSIS FOR GENETIC DEFECTS 88273 $282.00 CHROMOSOME ANALYSIS FOR GENETIC DEFECTS 88289 $318.00 CHROMOSOME ANALYSIS FOR GENETIC DEFECTS 88245 $496.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CHROMOSOME ANALYSIS FOR GENETIC DEFECTS 88262 $928.00 CI-EARMOLD V5264 $189.00 CINCINNATI CHILDRENS IL-18 83520 $1,575.00 CINCINNATI CHILDRENS SOLUBLE CD163 83520 $2,183.00 CITRATE LEVEL 82507 $67.00 CITRATE, 24HR 82507 $67.00 CLAMP EXTERNAL FIXATION CONSTRUX ALUMINUM 5- CM ST $3,469.20 CLAMP EXTERNAL FIXATION HEX-FIX 1 SWIVEL $7,038.00 CLAMP EXTERNAL FIXATION ILIZAROV 5 HOLE PIN $2,714.08 CLAMP EXTERNAL FIXATION LARGE OD6 MM EXTRA SMALL R $5,635.20 CLAMP EXTERNAL FIXATION MONOTUBE TRIAX OD20 MM T A $2,720.00 CLAMP EXTERNAL FIXATION STANDARD OD4 MM BONE SCREW $1,286.40 CLINICAL PATHOLOGY CONSULTATION 80500 $108.00 CLIP ANEURYSM T2 SUGITA TITANIUM MINI BENT L5 MM W $2,470.00 CLIP ANEURYSM T2 SUGITA TITANIUM MINI SLIM STRAIGH $2,470.00 CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD BENT L10 $2,470.00 CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD SLIGHT C $2,470.00 CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD STRAIGHT $2,470.00 CLIP ANEURYSM YASARGIL PHYNOX 3.3 MM OPEN MINI L3 $1,991.41 CLIP ANEURYSM YASARGIL PHYNOX TITANIUM 5.5 MM OPEN $1,991.41 CLIP ANEURYSM YASARGIL TITANIUM STANDARD 13.3 MM O $1,991.41 CLIP ANEURYSM YASARGIL TITANIUM STANDARD 5 MM OPEN $1,991.41 CLIP INTERNAL DEBAKEY 350 G L25 MM VESSEL STRAIGHT $4,098.34 CLIP INTERNAL LAPRO-CLIP TITANIUM LARGE L12 MM LIG $374.34 CLO TEST 87081 $311.00 CLOSED TREATEMENT FRACTURE AT ROOF OF MOUTH OR CHE 21421 $6,136.00 CLOSED TREATMENT BROKEN & DISLOCATED FOREARM BONES 24620 $3,569.00 CLOSED TREATMENT BROKEN UPPER ARM BONE AT SHOULDER 23625 $3,086.00 CLOSED TREATMENT BROKEN/GROWTH PLATE SEPARATE FORE 25605 $3,569.00 CLOSED TREATMENT OF ANKLE DISLOCATION 27840 $681.00 CLOSED TREATMENT OF BROKE FOREARM BONE AT ELBOW 24670 $494.00 CLOSED TREATMENT OF BROKEN ANKLE 27786 $532.00 CLOSED TREATMENT OF BROKEN ANKLE 27760 $586.00 CLOSED TREATMENT OF BROKEN ANKLE 27808 $772.00 CLOSED TREATMENT OF BROKEN ANKLE 27780 $790.00 CLOSED TREATMENT OF BROKEN ANKLE 27816 $1,064.00 CLOSED TREATMENT OF BROKEN ANKLE JOINT BONE 28430 $586.00 CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27788 $748.00 CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27818 $3,569.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27781 $3,569.00 CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27810 $3,569.00 CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27762 $4,909.00 CLOSED TREATMENT OF BROKEN CHEST BONE 21820 $617.00 CLOSED TREATMENT OF BROKEN EYE SOCKET BONE 21400 $4,238.00 CLOSED TREATMENT OF BROKEN FINGER OR THUMB WITH MA 26755 $586.00 CLOSED TREATMENT OF BROKEN FINGER OR THUMB WITH MA 26725 $586.00 CLOSED TREATMENT OF BROKEN FOOT BONE 28470 $532.00 CLOSED TREATMENT OF BROKEN FOREARM AT WRIST BONE 25650 $586.00 CLOSED TREATMENT OF BROKEN FOREARM BONE 25500 $586.00 CLOSED TREATMENT OF BROKEN FOREARM BONE 25530 $586.00 CLOSED TREATMENT OF BROKEN FOREARM BONE AT ELBOW 24650 $586.00 CLOSED TREATMENT OF BROKEN FOREARM BONE WITH MANIP 25535 $586.00 CLOSED TREATMENT OF BROKEN FOREARM BONE WITH MANIP 25505 $3,569.00 CLOSED TREATMENT OF BROKEN FOREARM BONES 25560 $494.00 CLOSED TREATMENT OF BROKEN FOREARM BONES 25600 $586.00 CLOSED TREATMENT OF BROKEN FOREARM BONES WITH MANI 25565 $3,569.00 CLOSED TREATMENT OF BROKEN GREAT TOE 28490 $586.00 CLOSED TREATMENT OF BROKEN GREAT TOE WITH MANIPULA 28495 $586.00 CLOSED TREATMENT OF BROKEN HAND OR FINGER 26740 $617.00 CLOSED TREATMENT OF BROKEN HEEL BONE 28400 $494.00 CLOSED TREATMENT OF BROKEN JAW BONE 21450 $1,434.00 CLOSED TREATMENT OF BROKEN JAW BONE WITH MANIPULAT 21451 $3,044.00 CLOSED TREATMENT OF BROKEN NASAL BONE 21310 $1,059.00 CLOSED TREATMENT OF BROKEN NASAL BONE 21315 $1,221.00 CLOSED TREATMENT OF BROKEN NASAL BONE WITH STABILI 21320 $6,048.00 CLOSED TREATMENT OF BROKEN SHIN BONE 27750 $586.00 CLOSED TREATMENT OF BROKEN SHIN BONE WITH MANIPULA 27752 $1,041.00 CLOSED TREATMENT OF BROKEN SHIN BONES 27538 $591.00 CLOSED TREATMENT OF BROKEN TAILBONE 27200 $617.00 CLOSED TREATMENT OF BROKEN THIGH BONE 27508 $263.00 CLOSED TREATMENT OF BROKEN THIGH BONE 27501 $591.00 CLOSED TREATMENT OF BROKEN THIGH BONE WITH MANIPUL 27510 $3,569.00 CLOSED TREATMENT OF BROKEN TOE 28510 $586.00 CLOSED TREATMENT OF BROKEN TOE WITH MANIPULATION 28515 $586.00 CLOSED TREATMENT OF BROKEN UPPER ARM BONE AT SHOUL 24576 $431.00 CLOSED TREATMENT OF BROKEN UPPER ARM BONE AT SHOUL 24560 $455.00 CLOSED TREATMENT OF BROKEN UPPER ARM BONE AT SHOUL 24565 $3,612.00 CLOSED TREATMENT OF BROKEN UPPER ARM BONE WITH MAN 23605 $3,568.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CLOSED TREATMENT OF BROKEN UPPER ARM BONE WITH MAN 24505 $3,569.00 CLOSED TREATMENT OF BROKEN WRIST BONE 25622 $586.00 CLOSED TREATMENT OF BROKEN WRIST BONE 25630 $586.00 CLOSED TREATMENT OF COLLAR BONE AND SHOULDER JOINT 23540 $494.00 CLOSED TREATMENT OF DISLOCATED FINGER JOINT WITH M 26770 $586.00 CLOSED TREATMENT OF DISLOCATED HAND BONE WITH MANI 26670 $639.00 CLOSED TREATMENT OF DISLOCATED HAND JOINT WITH MAN 26700 $494.00 CLOSED TREATMENT OF DISLOCATED HIP PROSTHESIS UNDE 27266 $4,797.00 CLOSED TREATMENT OF DISLOCATION OF KNEE CAP 27560 $916.00 CLOSED TREATMENT OF DISLOCATION OF TOE JOINT 28660 $591.00 CLOSED TREATMENT OF FRACTURE AND/OR DISLOCATION OF 27197 $852.00 CLOSED TREATMENT OF FRACTURE BELOW NECK OF UPPER T 27238 $3,713.00 CLOSED TREATMENT OF FRACTURE HAND BONE 26600 $576.00 CLOSED TREATMENT OF FRACTURE OF BONE OF HAND WITH 26605 $1,059.00 CLOSED TREATMENT OF FRACTURE OF LOWER WEIGHT BEARI 27824 $586.00 CLOSED TREATMENT OF FRACTURE OF LOWER WEIGHT BEARI 27825 $3,569.00 CLOSED TREATMENT OF FRACTURE OF SHIN BONE 27530 $790.00 CLOSED TREATMENT OF FRACTURE OF UPPER ARM BONE AT 23620 $494.00 CLOSED TREATMENT OF GROWTH PLATE OR BROKEN UPPER A 24530 $586.00 CLOSED TREATMENT OF GROWTH PLATE OR BROKEN UPPER A 24535 $3,569.00 CLOSED TREATMENT OF GROWTH PLATE SEPARATION AT END 27516 $278.00 CLOSED TREATMENT OF HIP DISLOCATION UNDER ANESTHES 27252 $4,797.00 CLOSED TREATMENT OF HIP SOCKET FRACTURES 27220 $290.00 CLOSED TREATMENT OF JAW TEMPOROMANDIBULAR JOINT (T 21480 $438.00 CLOSED TREATMENT OF KNEE CAP FRACTURE 27520 $586.00 CLOSED TREATMENT OF KNEE DISLOCATION 27550 $623.00 CLOSED TREATMENT OF NASAL CARTILAGE DIVIDING NASAL 21337 $4,238.00 CLOSED TREATMENT OF SHOULDER BLADE FRACTURE 23570 $1,436.00 CLOSED TREATMENT OF SHOULDER DISLOCATION AND BROKE 23675 $3,713.00 CLOSED TREATMENT OF SHOULDER DISLOCATION WITH MANI 23650 $582.00 CLOSED TREATMENT OF SHOULDER DISLOCATION WITH MANI 23655 $3,291.00 CLOSED TREATMENT OF THIGH BONE FRACTURE 27500 $591.00 CLOSED TREATMENT OF THUMB DISLOCATION WITH MANIPUL 26641 $617.00 CLOSED TREATMENT OF UPPER ARM FRACTURE 23600 $586.00 CLOSED TREATMENT OF UPPER ARM FRACTURE 24500 $586.00 CLOSED TREATMENT OF UPPER THIGH BONE FRACTURE 27230 $494.00 CLOSURE CONGENITAL HEART DEFECT FROM PULMONARY ART 93582 $15,113.00 CLOTTING FACTOR IX (PTC OR CHRISTMAS) MEASUREMENT 85250 $239.00 CLOTTING FACTOR VII (PROCONVERTIN, STABLE FACTOR) 85230 $440.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CLOTTING FACTOR VIII (AHG) MEASUREMENT 85240 $397.00 CLOTTING FACTOR VIII (VW FACTOR) ANTIGEN 85246 $388.00 CLOTTING FACTOR VIII (VW FACTOR) MEASUREMENT 85245 $431.00 CLOTTING FACTOR X ASSESSMENT TEST 85612 $68.00 CLOTTING FACTOR X ASSESSMENT TEST 85613 $144.00 CLOTTING FACTOR XI (PTA) MEASUREMENT 85270 $306.00 CLOTTING FACTOR XII (HAGEMAN) MEASUREMENT 85280 $280.00 CLOZAPINE LEVEL 80159 $333.00 CMV AB,IGM 86645 $148.00 COAGULATION ASSESSMENT BLOOD TEST 85732 $217.00 COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) SO J7189 $8,004.45 COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) SO J7189 $14,943.70 COAGULATION FUNCTION MEASUREMENT 85380 $72.00 COAGULATION FUNCTION MEASUREMENT 85379 $335.00 COAGULATION TIME MEASUREMENT 85348 $27.00 COAGULATION TIME MEASUREMENT 85345 $31.00 COCAINE DEFINITIVE ASSAY, URINE 80353 $319.00 COENZYME Q10 100 MG CAP 45 EACH BOTTLE $3.41 COIL EMBOLIZATION AZUR CX PLATINUM HYDROGEL HYDROP $6,000.00 COIL EMBOLIZATION AZUR PLATINUM HYDROGEL L10 CM L1 $3,750.00 COIL EMBOLIZATION COMPLEX PLATINUM FIBER .018 IN H $396.50 COIL EMBOLIZATION CONCERTO L40 CM OD18 MM DETACHAB $5,167.50 COIL EMBOLIZATION COSMOS V-TRAK L8 CM OD4 MM 10 CO $6,422.00 COIL EMBOLIZATION GDC 10 L15 CM OD6 MM NEUROVASCUL $3,900.00 COIL EMBOLIZATION HYDROFILL HYDROCOIL V-TRAK HYDRO $7,013.50 COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK HYDR $9,750.00 COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK L19 $11,661.00 COIL EMBOLIZATION MREYE PLATINUM L2 CM OD3 MM ARTE $521.24 COIL EMBOLIZATION NESTER PLATINUM SYNTHETIC FIBER $378.00 COIL EMBOLIZATION NESTER PLATINUM SYNTHETIC FIBER $406.65 COIL EMBOLIZATION SMART COIL HELIX L3 CM OD1 MM EX $6,955.00 COIL EMBOLIZATION SMART COIL L6 CM OD2 MM SOFT $10,465.00 COIL EMBOLIZATION TARGET 360 D L6 CM OD4 MM DETACH $9,100.00 COIL EMBOLIZATION TARGET 360 D L6 CM OD4 MM DETACH $9,425.00 COIL EMBOLIZATION TARGET 360 D STANDARD L20 CM OD5 $9,100.00 COIL EMBOLIZATION TARGET 360 D STANDARD L30 CM OD7 $9,100.00 COIL EMBOLIZATION THE PENUMBRA COIL 400 .02 IN STA $14,092.00 COLLECTION & ANALYSIS EXHALED AIR FOR EVALUATION O 94690 $353.00 COLLECTION BLOOD SPECIMEN FROM COMPLETELY IMPLANTA 36591 $172.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIP 36592 $115.00 COLLECTION OF DONOR STEM CELLS FOR TRANSPLANTATION 38205 $5,515.00 COLLECTION OF STEM CELLS FOR TRANSPLANTATION 38206 $6,271.00 COLORECTAL CANCER SCREENING NOT HIGH RISK 45378 $3,175.00 COMMUNITY OR WORK REINTEGRATION TRAINING, EACH 15 97537 $106.00 COMMUNITY REINTEGRATION $72.00 COMPARATIVE ANALYSIS SHORT TANDEM REPEAT (STR) MAR 81265 $1,574.00 COMPLEMENT C3 86160 $174.00 COMPLEMENT C-4 86160 $174.00 COMPLEMENT C-5 86160 $174.00 COMPLETE BLOOD CELL COUNT AUTOMATED TEST 85027 $192.00 COMPLETE BLOOD CELL COUNT AUTOMATED TEST 85025 $272.00 COMPLEX CONTROL OF NOSE BLEED 30903 $473.00 COMPONENT FEMORAL ATTUNE 6 NARROW KNEE RIGHT CEMEN C1776 $9,750.00 COMPONENT FEMORAL COLUMBUS F3 KNEE RIGHT CEMENTED C1776 $26,000.00 COMPONENT FEMORAL GENDER SOLUTIONS NEXGEN PRECOAT C1776 $19,500.00 COMPONENT FEMORAL GMK 2 KNEE RIGHT SPHERE CEMENTED C1776 $9,750.00 COMPONENT FEMORAL GMK 3+ KNEE LEFT SPHERE CEMENTED C1776 $9,750.00 COMPONENT FEMORAL GMK 6+ KNEE LEFT SPHERE CEMENTED C1776 $9,750.00 COMPONENT FEMORAL PERSONA COCR 3 NARROW KNEE LEFT C1776 $9,750.00 COMPONENT FEMORAL PERSONA COCR 5 STANDARD KNEE LEF C1776 $9,750.00 COMPONENT FEMORAL PFC SIGMA NONPOROUS 2 L60 MM X W C1776 $7,800.00 COMPONENT FEMORAL PFC SIGMA NONPOROUS 2.5 L63 MM X C1776 $7,800.00 COMPONENT FEMORAL SIGMA COCR 2.5 KNEE RIGHT CEMENT C1776 $7,800.00 COMPONENT HUMERAL DISCOVERY L150 MM OD4 MM ELBOW R C1776 $23,764.00 COMPONENT PATELLAR GENESIS II OXINIUM L29 MM KNEE C1776 $1,625.00 COMPONENT PATELLAR TRIATHLON X3 H10 MM OD36 MM KNE C1776 $1,950.00 COMPONENT TIBIAL TRAY GMK 4 RIGHT PRIMARY CEMENTED C1776 $5,850.00 COMPONENT TIBIAL TRIATHLON 2 KNEE STERILE LATEX FR C1776 $7,150.00 COMPUTERIZED MAPPING OF CORNEAL CURVATURE 92025 $235.00 CONCENTRATION OF SPECIMEN FOR INFECTIOUS AGENTS 87015 $237.00 CONFIRMATION TEST FOR ANTIBODY TO HUMAN T-CELL LYM 86689 $409.00 CONJUGATED ESTROGENS 0.625 MG/GRAM CREA 30 G TUBE/ $971.45 CONNECTOR EXTERNAL FIXATION UNIVERSAL ROD $6,364.80 CONNECTOR ROD CD HORIZON LEGACY STAINLESS STEEL L2 C1713 $2,400.00 CONNECTOR ROD CD HORIZON LEGACY STAINLESS STEEL L3 C1713 $2,400.00 CONNECTOR ROD CD HORIZON LEGACY TITANIUM OFFSET L1 C1713 $1,625.00 CONNECTOR ROD CD HORIZON LEGACY TITANIUM OFFSET L6 C1713 $2,400.00 CONNECTOR ROD CREO L30 MM SPINE THREAD HEAD OFFSET C1713 $5,037.50 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CONNECTOR ROD CREO L58-70 MM OD5.5 MM SPINE CROSS C1713 $4,550.00 CONNECTOR ROD EVEREST LARGE OD6 MM ODSEC5.5 MM SPI C1713 $3,250.00 CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4.5-4.75 C1713 $2,000.00 CONNECTOR ROD EXPEDIUM TITANIUM OD5.5 MM ODSEC6.35 C1713 $2,000.00 CONNECTOR ROD L25 MM SPINE OPEN OFFSET C1713 $1,625.00 CONNECTOR ROD L45 MM SPINE C1713 $3,841.60 CONNECTOR ROD L50 MM SPINE LATERAL OFFSET C1713 $2,000.00 CONNECTOR ROD LATERAL OFFSET L30 MM CLOSED NONSTER C1713 $1,625.00 CONNECTOR ROD RAIL LATERAL OFFSET L25 MM SPINE CLO C1713 $2,000.00 CONNECTOR ROD REVERE ADDITION L15 MM SPINE HEAD OF C1713 $4,056.00 CONNECTOR ROD SFX TITANIUM A2 OD5.5 MM SPINE MEDIA C1713 $4,000.00 CONNECTOR ROD SFX TITANIUM F12 OD6.35 MM SPINE MED C1713 $4,000.00 CONNECTOR ROD SFX TITANIUM F6 OD5.5 MM SPINE LATER C1713 $4,000.00 CONNECTOR ROD STAINLESS STEEL L150 MM OD5.5 MM LAT C1713 $8,371.20 CONNECTOR ROD STAINLESS STEEL L60 MM OD5.5 MM SPIN C1713 $2,000.00 CONNECTOR ROD TIGER L16 MM SPINE LATERAL TOP LOAD C1713 $1,625.00 CONNECTOR ROD TITANIUM L32 MM OD6.35 MM LATERAL SP C1713 $2,000.00 CONNECTOR ROD XIA L70 MM OD4.5 MM SPINE OFFSET C1713 $2,000.00 CONNECTOR ROD XIA TITANIUM L30 MM OD4.5 MM SPINE O C1713 $2,000.00 CONNECTOR SPINAL EXPEDIUM TITANIUM OD4.5 MM END TO $2,000.00 CONTINUOUS MONITORING OF NERVOUS SYSTEM DURING OPE 95941 $108.00 CONTINUOUS MONITORING OF NERVOUS SYSTEM DURING OPE 95940 $154.00 CONTRAST INJECTION FOR X-RAY IMAGING PROCEDURE TO 36598 $1,033.00 CONTRAST INJECTS X-RAY IMAGING THRU EXIST TUBE STO 49465 $471.00 CONTROL OF BLEEDING IN LARGE BOWEL USING AN ENDOSC 45382 $3,425.00 CONTROL OF BLEEDING OF ESOPHAGUS STOMACH AND/OR UP 43255 $4,012.00 CONTROL OF NOSE BLEED AND INSERTION OF PACKING 30905 $846.00 CONVERSION OF STOMACH TUBE TO SMALL BOWEL TUBE 49446 $2,716.00 CONVERSION TO TWO CHAMBER PACEMAKER SYSTEM 33214 $36,345.00 CONVERT STOMACH TUBE TO SMALL BOWEL TUBE (ACCESSED 44373 $9,648.00 COPPER LEVEL 82525 $227.00 COPPER-COPPER 82525 $227.00 COPPER-URINE 82525 $227.00 COPROPORPHYIN, QUAN & FRACT 84120 $339.00 CORONARY ARTERY FFR W/O HEART CATH 93799 $375.00 CORTICOSTERONE (HORMONE) LEVEL 82528 $306.00 CORTISOL (HORMONE) MEASUREMENT 82530 $72.00 CORTISOL (HORMONE) MEASUREMENT 82533 $385.00 CORTISOL PM 82533 $385.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CORTISOL, TOTAL, SERUM 82533 $385.00 COUNSELING VISIT FOR LUNG CANCER SCREENING G0296 $312.00 COVER BURR HOLE CPS TITANIUM PEDIATRIC L24 MM OD24 C1713 $1,900.80 COVER BURR HOLE THK20 MM STANDARD LOW PROFILE TAB C1713 $2,085.44 COVER BURR HOLE TITANIUM OD15 MM CRANIOFACIAL 6 HO C1713 $2,040.00 COXSACKIE A VIRUS 86658 $125.00 COXSACKIE B ABS 86658 $125.00 C-PEPTIDE (PROTEIN) LEVEL 84681 $276.00 CREATINE KINASE (CARDIAC ENZYME) LEVEL 82554 $92.00 CREATINE KINASE (CARDIAC ENZYME) LEVEL 82550 $190.00 CREATINE KINASE (CARDIAC ENZYME) LEVEL 82552 $255.00 CREATINE MEASUREMENT 82540 $36.00 CREATININE CLEARANCE MEASUREMENT TO TEST FOR KIDNE 82575 $189.00 CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MU 82570 $74.00 CREATININE, BODY FLD 82570 $74.00 CREATININE, URINE 24 HR 82570 $74.00 CRITICAL CARE EACH ADDL 30 MINUTES 99292 $1,078.00 CRITICAL CARE FIRST 30-74 MINUTE 99291 $2,155.00 CRYOGLOBULIN (PROTEIN) MEASUREMENT 82595 $29.00 CRYPTOCOCCUS ANTIG, CSF 87327 $206.00 CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID 89060 $103.00 CSF CULT 87070 $171.00 CT ? REVENUE CODE 35X G0378 $185.00 CT SCAN ABDOMEN 74150 $315.00 CT SCAN ABDOMEN BEFORE AND AFTER CONTRAST 74170 $696.00 CT SCAN ABDOMEN WITH CONTRAST 74160 $696.00 CT SCAN CHEST 71250 $2,405.00 CT SCAN CHEST BEFORE AND AFTER CONTRAST 71270 $696.00 CT SCAN CHEST WITH CONTRAST 71260 $2,336.00 CT SCAN GUIDANCE FOR AND MONITORING OF TISSUE DEST 77013 $681.00 CT SCAN GUIDANCE FOR STEREOTACTIC LOCALIZATION 77011 $2,871.00 CT SCAN HEAD OR BRAIN 70450 $2,257.00 CT SCAN HEAD OR BRAIN BEFORE AND AFTER CONTRAST 70470 $2,482.00 CT SCAN HEAD OR BRAIN WITH CONTRAST 70460 $2,372.00 CT SCAN LEG 73700 $1,150.00 CT SCAN LEG WITH CONTRAST INJECTION 73701 $1,128.00 CT SCAN LIMITED OR FOLLOW-UP STUDY 76380 $171.00 CT SCAN OF ABDOMEN AND PELVIS 74176 $4,448.00 CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CON 74178 $7,608.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST 74177 $5,526.00 CT SCAN OF ABDOMINAL AND PELVIC BLOOD VESSELS WITH 74174 $5,508.00 CT SCAN OF ABDOMINAL AORTA AND BOTH LEG ARTERIES W 75635 $696.00 CT SCAN OF ABDOMINAL BLOOD VESSELS WITH CONTRAST 74175 $2,442.00 CT SCAN OF ARM 73200 $2,009.00 CT SCAN OF ARM BEFORE AND AFTER CONTRAST 73202 $696.00 CT SCAN OF ARM BLOOD VESSELS WITH CONTRAST 73206 $696.00 CT SCAN OF ARM WITH CONTRAST 73201 $2,208.00 CT SCAN OF BLOOD VESSEL OF HEAD WITH CONTRAST 70496 $2,491.00 CT SCAN OF BLOOD VESSELS IN CHEST WITH CONTRAST 71275 $2,462.00 CT SCAN OF CONGENITAL HEART STRUCTURE DEFECT WITH 75573 $2,499.00 CT SCAN OF CRANIAL CAVITY 70480 $1,994.00 CT SCAN OF CRANIAL CAVITY BEFORE AND AFTER CONTRAS 70482 $2,336.00 CT SCAN OF CRANIAL CAVITY WITH CONTRAST 70481 $2,313.00 CT SCAN OF FACE 70486 $1,747.00 CT SCAN OF FACE BEFORE AND AFTER CONTRAST 70488 $2,096.00 CT SCAN OF FACE WITH CONTRAST 70487 $1,940.00 CT SCAN OF HEART BLOOD VESSELS AND GRAFTS WITH CON 75574 $696.00 CT SCAN OF HEART STRUCTURE WITH CONTRAST 75572 $1,747.00 CT SCAN OF HEART WITH EVALUATION OF BLOOD VESSEL C 75571 $171.00 CT SCAN OF LEG BEFORE AND AFTER CONTRAST INJECTION 73702 $1,404.00 CT SCAN OF LOWER LEG BLOOD VESSELS WITH CONTRAST 73706 $1,200.00 CT SCAN OF LOWER SPINE 72131 $1,351.00 CT SCAN OF LOWER SPINE BEFORE AND AFTER CONTRAST 72133 $2,141.00 CT SCAN OF LOWER SPINE WITH CONTRAST 72132 $1,755.00 CT SCAN OF MIDDLE SPINE 72128 $1,872.00 CT SCAN OF MIDDLE SPINE BEFORE AND AFTER CONTRAST 72130 $696.00 CT SCAN OF MIDDLE SPINE WITH CONTRAST 72129 $2,096.00 CT SCAN OF NECK 70490 $315.00 CT SCAN OF NECK BEFORE AND AFTER CONTRAST 70492 $696.00 CT SCAN OF NECK BLOOD VESSELS WITH CONTRAST 70498 $2,481.00 CT SCAN OF NECK WITH CONTRAST 70491 $1,788.00 CT SCAN OF PELVIC BLOOD VESSELS WITH CONTRAST 72191 $1,861.00 CT SCAN OF PELVIS BEFORE AND AFTER CONTRAST 72194 $696.00 CT SCAN OF UPPER SPINE 72125 $1,864.00 CT SCAN OF UPPER SPINE BEFORE AND AFTER CONTRAST 72127 $696.00 CT SCAN OF UPPER SPINE WITH CONTRAST 72126 $2,266.00 CT SCAN PELVIS 72192 $315.00 CT SCAN PELVIS WITH CONTRAST 72193 $1,739.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CULT BACT, EYE 87070 $171.00 CULT BACT, GENITAL 87070 $171.00 CULT BACT, THROAT 87070 $171.00 CULT BACT, TISSUE, AEROBIC 87070 $171.00 CULT BACT, WOUND, AEROBIC 87070 $171.00 CULT TYP ID NUCLEIC AC SEQ METH 87153 $548.00 CULT, GC SCREEN 87081 $311.00 CULT, STREP GRP B SCREEN 87081 $311.00 CULTURE AEROBIC ADD DEF EACH 87077 $90.00 CULTURE AEROBIC IDENTIFY 87077 $90.00 CULTURE ANAEROBIC ADD DEF EACH 87076 $87.00 CULTURE FOR ACID-FAST BACILLI 87116 $321.00 CULTURE FOR CHLAMYDIA 87110 $317.00 CULTURE FUNGUS DEFINITIVE ID MOLD 87107 $225.00 CULTURE STOOL AEROBIC ADDL PATHOGENS AND ID EACH 87046 $83.00 CULTURE STREP B 87081 $311.00 CULTURE TYPING ID NUCLEIC ACID 87149 $263.00 CULTURE, URINE EACH ISOLATE 87088 $286.00 CYANOCOBALAMIN (VITAMIN B-12) LEVEL 82608 $209.00 CYANOCOBALAMIN (VITAMIN B-12) LEVEL 82607 $243.00 CYCLOSPORINE LEVEL 80158 $395.00 CYCLOSPORINE MODIFIED 100 MG CAP 1 EACH BLIST PACK J7502 $15.27 CYLCOSPORINE 80158 $395.00 CYSTINE AND HOMOCYSTINE (AMINO ACIDS) ANALYSIS 82615 $63.00 CYTOLOGY FL BRUSH 88104 $62.00 CYTOMEGALOVIRUS AB,IGG 86644 $62.00 CYTOTOXIC PRA ANTIBODY SCREENING STANDARD METHOD S 86807 $456.00 DAILY MANAGEMENT EXTERNAL VEIN TO VEIN BLOOD CIRCU 33948 $10,510.00 DAILY MANAGEMENT OF EXTERNAL VEIN TO ARTERY BLOOD 33949 $10,510.00 DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS AC 36593 $747.00 DEEP BIOPSY OF BONE USING NEEDLE OR TROCAR 20225 $5,237.00 DEFIBRILLATOR CARDIAC COMPIA MRI CRT-D SURESCAN PH C1882 $94,575.00 DEFIBRILLATOR CARDIAC EVERA MRI S PHYSIOCURVE SMAR C1721 $67,925.00 DEFIBRILLATOR CARDIAC EVERA S DR 2 CHAMBER ICD DF- C1721 $65,000.00 DEFIBRILLATOR CARDIAC IPERIA DR-T PROMRI HOME MONI C1721 $105,920.43 DEFIBRILLATOR CARDIAC QUADRA ASSURA MP THK14 MM 40 C1882 $136,000.00 DEFIBRILLATOR CARDIAC VIVA CRT D QUAD S IS-4 DF4 U C1882 $94,575.00 DEMONSTRATION EVALUATION OF PATIENT USE OF AEROSOL 94664 $110.00 DEMONSTRATION/EVALUATION MANUAL MANEUVERS CHEST WA 94667 $263.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge DENGUE FEVER ANTIBODY IGG 86790 $511.00 DEOXYCORTISOL, 11 (HORMONE) LEVEL 82634 $501.00 DESTRUCTION OF 1 OR MORE GROWTHS IN LIVER, ACCESSE 47382 $12,344.00 DESTRUCTION OF 1 OR MORE GROWTHS IN ONE KIDNEY, AC 50592 $14,559.00 DESTRUCTION OF 1 OR MORE LIVER GROWTHS, ACCESSED T 47383 $20,172.00 DESTRUCTION OF 2-14 SKIN GROWTHS 17003 $104.00 DESTRUCTION OF SKIN GROWTH (LESS THAN 10 SQ CENTIM 17106 $774.00 DESTRUCTION OF UP TO 14 SKIN GROWTHS 17110 $131.00 DESTRUCTION TISSUE RT/LT UPPER HEART CHAMBER VIA C 93657 $13,393.00 DETECT INF AGT NUC ACID NOS 87798 $96.00 DETECTION OF INFECTIOUS AGENT ANTIBODY 86318 $100.00 DETECTION OF MIDDLE EAR FLUID WITH ASSESSMENT EARD 92570 $392.00 DETECTION TEST FOR ADENOVIRUS 87809 $93.00 DETECTION TEST FOR ASPERGILLUS (FUNGUS) 87305 $366.00 DETECTION TEST FOR BACTERIA TOXIN (SHIGA-LIKE TOXI 87427 $31.00 DETECTION TEST FOR BARTONELLA HENSELAE AND BARTONE 87472 $333.00 DETECTION TEST FOR BORRELIA BURGDORFERI, (BACTERIA 87475 $156.00 DETECTION TEST FOR CANDIDA SPECIES (YEAST) 87482 $324.00 DETECTION TEST FOR CHLAMYDIA 87491 $81.00 DETECTION TEST FOR CHLAMYDIA 87320 $93.00 DETECTION TEST FOR CHLAMYDIA 87810 $93.00 DETECTION TEST FOR CHLAMYDIA 87270 $146.00 DETECTION TEST FOR CHLAMYDIA 87492 $272.00 DETECTION TEST FOR CHLAMYDIA PNEUMONIAE 87486 $70.00 DETECTION TEST FOR CHLAMYDIA PNEUMONIAE 87485 $156.00 DETECTION TEST FOR CHLAMYDIA PNEUMONIAE 87487 $333.00 DETECTION TEST FOR CLOSTRIDIUM DIFFICILE 87493 $164.00 DETECTION TEST FOR CLOSTRIDIUM DIFFICILE TOXIN A ( 87803 $93.00 DETECTION TEST FOR CRYPTOSPORIDIUM (PARASITE) 87272 $93.00 DETECTION TEST FOR CRYPTOSPORIDIUM (PARASITE) 87328 $123.00 DETECTION TEST FOR CYTOMEGALOVIRUS 87332 $93.00 DETECTION TEST FOR CYTOMEGALOVIRUS (CMV) 87495 $156.00 DETECTION TEST FOR CYTOMEGALOVIRUS (CMV) 87496 $228.00 DETECTION TEST FOR CYTOMEGALOVIRUS (CMV) 87271 $450.00 DETECTION TEST FOR CYTOMEGALOVIRUS, QUANTIFICATION 87497 $828.00 DETECTION TEST FOR DIGESTIVE TRACT PATHOGEN 87507 $1,030.00 DETECTION TEST FOR E. COLI, (ESCHERICHIA COLI 0157 87335 $93.00 DETECTION TEST FOR ENTAMOEBA HISTOLYTICA DISPAR GR 87336 $93.00 DETECTION TEST FOR ENTEROVIRUS (INTESTINAL VIRUS) 87498 $749.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA 87511 $272.00 DETECTION TEST FOR GIARDIA (INTESTINAL PARASITE) 87329 $140.00 DETECTION TEST FOR HELICOBACTER PYLORI (GI TRACT B 87339 $93.00 DETECTION TEST FOR HEPATITIS B SURFACE ANTIGEN 87341 $74.00 DETECTION TEST FOR HEPATITIS B SURFACE ANTIGEN 87340 $157.00 DETECTION TEST FOR HEPATITIS BE SURFACE ANTIGEN 87350 $85.00 DETECTION TEST FOR HEPATITIS C VIRUS 87520 $156.00 DETECTION TEST FOR HEPATITIS C VIRUS 87521 $461.00 DETECTION TEST FOR HEPATITIS G VIRUS 87525 $156.00 DETECTION TEST FOR HEPATITIS G VIRUS 87527 $324.00 DETECTION TEST FOR HERPES SIMPLEX VIRUS 87530 $131.00 DETECTION TEST FOR HERPES SIMPLEX VIRUS 87528 $156.00 DETECTION TEST FOR HERPES SIMPLEX VIRUS 87529 $716.00 DETECTION TEST FOR HISTOPLASMA CAPSULATUM (PARASIT 87385 $388.00 DETECTION TEST FOR HIV-1 AND HIV-2 87389 $86.00 DETECTION TEST FOR HIV-1 VIRUS 87534 $156.00 DETECTION TEST FOR HIV-1 VIRUS 87535 $855.00 DETECTION TEST FOR HIV-2 87391 $136.00 DETECTION TEST FOR HIV-2 VIRUS 87537 $156.00 DETECTION TEST FOR HIV-2 VIRUS 87538 $272.00 DETECTION TEST FOR HIV-2 VIRUS 87539 $333.00 DETECTION TEST FOR HUMAN PAPILLOMAVIRUS (HPV) 87624 $209.00 DETECTION TEST FOR HUMAN PAPILLOMAVIRUS (HPV) 87623 $209.00 DETECTION TEST FOR INFLUENZA A VIRUS 87276 $450.00 DETECTION TEST FOR INFLUENZA B VIRUS 87275 $450.00 DETECTION TEST FOR INFLUENZA VIRUS 87804 $128.00 DETECTION TEST FOR INFLUENZA VIRUS 87501 $399.00 DETECTION TEST FOR LEGIONELLA PNEUMOPHILA (WATER B 87540 $156.00 DETECTION TEST FOR LEGIONELLA PNEUMOPHILA (WATER B 87542 $324.00 DETECTION TEST FOR MULTIPLE ORGANISMS 87801 $216.00 DETECTION TEST FOR MULTIPLE TYPES INFLUENZA VIRUS 87502 $123.00 DETECTION TEST FOR MULTIPLE TYPES OF RESPIRATORY V 87633 $1,222.00 DETECTION TEST FOR MYCOBACTERIA AVIUM-INTRACELLULA 87560 $156.00 DETECTION TEST FOR MYCOBACTERIA AVIUM-INTRACELLULA 87562 $333.00 DETECTION TEST FOR MYCOBACTERIA SPECIES (BACTERIA) 87550 $156.00 DETECTION TEST FOR MYCOBACTERIA SPECIES (BACTERIA) 87551 $272.00 DETECTION TEST FOR MYCOBACTERIA SPECIES (BACTERIA) 87552 $333.00 DETECTION TEST FOR MYCOBACTERIA TUBERCULOSIS (TB B 87555 $156.00 DETECTION TEST FOR MYCOBACTERIA TUBERCULOSIS (TB B 87557 $333.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge DETECTION TEST FOR MYCOPLASMA PNEUMONIAE (BACTERIA 87581 $70.00 DETECTION TEST FOR MYCOPLASMA PNEUMONIAE (BACTERIA 87580 $156.00 DETECTION TEST FOR NEISSERIA GONORRHOEAE (GONORRHO 87591 $81.00 DETECTION TEST FOR NEISSERIA GONORRHOEAE (GONORRHO 87850 $93.00 DETECTION TEST FOR NEISSERIA GONORRHOEAE (GONORRHO 87592 $333.00 DETECTION TEST FOR PARAINFLUENZA VIRUS 87279 $450.00 DETECTION TEST FOR RESPIRATORY SYNCYTIAL VIRUS (RS 87807 $230.00 DETECTION TEST FOR RESPIRATORY SYNCYTIAL VIRUS (RS 87280 $450.00 DETECTION TEST FOR ROTAVIRUS 87425 $130.00 DETECTION TEST FOR STREP (STREPTOCOCCUS, GROUP A) 87650 $156.00 DETECTION TEST FOR STREP (STREPTOCOCCUS, GROUP A) 87651 $272.00 DETECTION TEST FOR STREP (STREPTOCOCCUS, GROUP A) 87652 $324.00 DETECTION TEST FOR TREPONEMA PALLIDUM (SYPHILIS OR 87285 $93.00 DETECTION TEST FOR TRICHOMONAS VAGINAL (GENITAL PA 87808 $104.00 DETECTION TEST FOR VANCOMYCIN RESISTANCE STREP (VR 87500 $272.00 DETECTION TEST FOR VARICELLA (CHICKEN POX) ZOSTER 87290 $450.00 DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPH 94726 $1,197.00 DEVELOPMENTAL SCREENING 96110 $527.00 DEVICE ABLATION CARDIOBLATE LOW PROFILE NONSTERILE $21,560.00 DEVICE CLOSURE ATRICLIP NITINOL TITANIUM POLYESTER $6,175.00 DEVICE COMPRESSION FEMOSTOP PNEUMATIC DOME INTEGRA $220.50 DEVICE IRRIGATION XPRESS ULTRA 1.5 MM BALL SUPER S C1726 $10,010.00 DEVICE REMOVAL MYOSURE REACH HYSTEROSCOPIC POLYPS $6,467.50 DEVICE SUTURING ENDO STITCH SURGIDAC POLYESTER SHO $1,988.81 DEVICE UTERINE RUMI II KOH-EFFICIENT OD4 CM CERVIX $600.60 DEXAMETHASONE (STEROID) SUPPRESSION EVALUATION PAN 80420 $559.00 DIABETES TRAINING G0109 $118.00 DIABETES TRAINING G0108 $351.00 DIAGNOSTIC CT SCAN OF LARGE BOWEL 74261 $315.00 DIAGNOSTIC EXAM OF ESOPHAGUS STOMACH/UPPER SMALL B 43235 $2,425.00 DIAGNOSTIC EXAM OF LARGE BOWEL 44388 $1,897.00 DIAGNOSTIC EXAM OF THE BLADDER AND BLADDER CANAL ( 52000 $2,701.00 DIAGNOSTIC EXAM SMALL BOWEL USING ENDOSCOPE 44380 $4,289.00 DIAGNOSTIC EXAMINATION OF ANUS AND RECTUM UNDER AN 45990 $9,746.00 DIAGNOSTIC EXAMINATION OF EAR AND NOSE 92504 $110.00 DIAGNOSTIC EXAMINATION OF LARGE BOWEL USING AN END 45330 $1,385.00 DIAGNOSTIC EXAMINATION OF LUNG AIRWAYS USING AN EN 31622 $1,941.00 DIAGNOSTIC EXAMINATION OF NASAL PASSAGES USING AN 31231 $1,186.00 DIAGNOSTIC EXAMINATION OF RECTUM AND LARGE BOWEL U 45300 $1,884.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge DIAGNOSTIC EXAMINATION OF VOICE BOX USING AN ENDOS 31505 $286.00 DIAGNOSTIC EXAMINATION OF VOICE BOX USING AN ENDOS 31525 $4,994.00 DIAGNOSTIC EXAMINATION OF VOICE BOX USING FLEXIBLE 31575 $777.00 DIAGNOSTIC EYE EXAMINATION UNDER GENERAL ANESTHESI 92018 $4,161.00 DIAGNOSTIC TESTING IN A PULMONARY FUNCTION LAB 94400 $475.00 DIGITAL BTE MONAURAL ECONOMY V5257 $2,654.00 DIGITAL BTE BINAURAL ECONOMY V5261 $5,786.00 DIGITAL BTE BINAURAL LOW V5261 $6,429.00 DIGITAL BTE BINAURAL MEDIUM V5261 $7,808.00 DIGITAL BTE BINAURAL PREMIUM V5261 $11,478.00 DIGITAL BTE MONAURAL LOW V5257 $3,216.00 DIGITAL BTE MONAURAL MEDIUM V5257 $3,905.00 DIGITAL BTE MONAURAL PREMIUM V5257 $5,741.00 DIGITAL ITE BINAURAL LOW V5260 $6,888.00 DIGITAL ITE BINAURAL MEDIUM V5260 $8,265.00 DIGITAL ITE BINAURAL PREMIUM V5260 $11,938.00 DIGITAL ITE BINAURAL ECONOMY V5260 $5,236.00 DIGITAL ITE MONAURAL ECONOMY V5256 $2,620.00 DIGITAL ITE MONAURAL LOW V5256 $3,446.00 DIGITAL ITE MONAURAL MEDIUM V5256 $4,136.00 DIGITAL ITE MONAURAL PREMIUM V5256 $5,972.00 DIGOXIN LEVEL 80163 $100.00 DIGOXIN LEVEL 80162 $235.00 DILATION OF ESOPHAGUS 43450 $2,632.00 DILATION OF NARROWING OF BLADDER CANAL 53605 $7,670.00 DILATOR ENDOSCOPIC HERCULES NITINOL 2.8 MM L8 CM L C1726 $900.00 DILATOR ENDOSCOPIC HERCULES PET FLEX 2.8 MM L5.5 C C1726 $950.00 DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE C1713 $29,250.00 DISC SPINAL BRYAN OD15 MM CERVICAL MOTION $29,250.00 DMPK GENE DETC ABNOR ALLELE 81234 $377.00 DNA ANTIBODY NATIVE 86225 $216.00 DNA TESTING FOR GENETIC DEFECTS 88271 $241.00 DOPPLER ULTRASOUND STUDY OF COLOR-DIRECTED HEART B 93325 $617.00 DOPPLER ULTRASOUND STUDY OF HEART BLOOD FLOW, VALV 93320 $608.00 DOXORUBICIN 2 MG/ML SOLN 75 ML VIAL J9000 $273.50 DRAINAGE OF ABSCESS CYST OR BLOOD ACCUMULATION OF 41800 $384.00 DRAINAGE OF ABSCESS SIMPLE 10060 $747.00 DRAINAGE OF BLOOD OR FLUID ACCUMULATION 10140 $3,708.00 DRAINAGE OF FINGER ABSCESS COMPLICATED 26011 $2,680.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge DRAINAGE OF FINGER ABSCESS SIMPLE 26010 $449.00 DRAINAGE OF FLUID FROM ABDOMINAL CAVITY 49082 $2,051.00 DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAG 49083 $2,136.00 DRAINAGE OF MULTIPLE ABSCESS 10061 $506.00 DRAINAGE OF RECTAL ABSCESS 46050 $2,401.00 DRAINAGE OF RECTAL ABSCESS 46040 $4,737.00 DRAINAGE OF TAILBONE CYST COMPLICATED 10081 $1,315.00 DRAINAGE OF TAILBONE CYST SIMPLE 10080 $1,576.00 DRAINAGE OF TONSIL ABSCESS 42700 $849.00 DRESSING ALGINATE AQUACEL AG EXTRA HYDROFIBER RECT A6197 $23.70 DRESSING CHANGE AND/OR REMOVAL BURN TISSUE (5% TO 16025 $849.00 DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE 16030 $998.00 DRESSING CHANGE AND/OR REMOVE BURN TISSUE (LESS TH 16020 $747.00 DRESSING CHANGE UNDER ANESTHESIA 15852 $702.00 DRESSING FOAM MEPILEX BORDER AG L6 IN X W4 IN POST A6212 $12,152.00 DRESSING PETROLATUM ADAPTIC CELLULOSE ACETATE FABR A6223 $12.97 DRESSING WOUND KALTOSTAT CALCIUM SODIUM ALGINATE L A6199 $24.62 DRESSING WOUND PURAPLY 25 SQ CM L5 CM X W5 CM ANTI Q4196 $18,850.00 DRILL SURGICAL L340 MM OD5 MM AO FIT NONSTERILE $1,042.25 DRILL SURGICAL MINI L2.75 MM OD.066 IN CANNULATED $2,275.00 DRILL SURGICAL OD3.2 MM FLEXIBLE STERILE $1,859.00 DRILL SURGICAL PROFILE MINI COMPRESSION FT SCREW $975.00 DRILL TWIST DELTA OD1.8 MM SHAFT END STERILE 3MM 4 $726.48 DRILL TWIST HEXAGON OD1.2 MM SHAFT LATEX FREE $677.95 DRILL TWIST L130 MM OD2.5 MM ID1.4 MM CANNULATED $487.50 DRUG INFUSION DURING CARDIAC CATHETERIZATION 93463 $7,935.00 DRUG QUANT NOT ELSEWHERE SPEC 80299 $393.00 DRUG SCREEN, ACETOMINOPHEN 80307 $198.00 DRUG SCREEN, SALICYLATES 80307 $198.00 DRUG SCREEN, TRICYCLICS 80307 $198.00 EAR CULTURE 87070 $171.00 EARDRUM TESTING USING EAR PROBE 92567 $257.00 EBV CAP IGG 86665 $252.00 EBV CAP IGM 86665 $252.00 EBV DNA PCR QT 87799 $678.00 EBV NUC AG 86664 $62.00 ECHINOCOCCUS, IGG 86682 $193.00 ED VISIT, LVL 1 99281 $556.00 ED VISIT, LVL 2 99282 $835.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ED VISIT, LVL 3 99283 $1,112.00 ED VISIT, LVL 4 99284 $1,465.00 ED VISIT, LVL 5 99285 $1,959.00 EDUCATION TRAINING SESSION G0177 $6,382.00 ELEC ALYS IMPLT SMPL CN NPGT PRGRMG 95976 $104.00 ELECTRICAL STIMULATION GUIDANCE W/INJECT CHEMICAL 95873 $515.00 ELECTRICAL STIMULATION UNATTENDED TO ONE OR MORE A 97014 $154.00 ELECTRODE ELECTROSURGICAL COLORADO TUNGSTEN NEEDLE $846.00 ELECTRODE ELECTROSURGICAL LOOP OD24 FR CUT OLYMPUS $448.84 ELECTRODE ELECTROSURGICAL OD24/26 FR COAGULATE POI $866.67 ELECTRODE ELECTROSURGICAL USA ELITE SYSTEM USA SER $648.30 ELECTRON MICROSCOPY FOR DIAGNOSIS 88348 $1,232.00 ELECTRONIC ANALYSIS AND REPROGRAMMING OF SPINAL CA 62368 $800.00 ELECTRONIC ANALYSIS IMPLANT BRAIN SPINAL CORD/PERI 95970 $289.00 ELECTRONIC ANALYSIS REPROGRAM & REFILL OF SPINAL C 62369 $800.00 ELECTRONIC ANALYSIS REPROGRAM AND REFILL OF SPINAL 62370 $800.00 ELECTRONIC ASSESSMENT OF BLADDER EMPTYING 51741 $374.00 ELECTROPHORESIS, LABORATORY TESTING TECHNIQUE 82664 $197.00 EMERGENT INSERTION BREATHING TUBE INTO WINDPIPE CA 31500 $701.00 EMERGENT SURGICAL OPENING OF WINDPIPE FOR INSERTIO 31605 $2,162.00 ENZYME ACTIVITY MEASUREMENT 82657 $240.00 EPOETIN ALFA 20,000 UNIT/ML SOLN 1 ML VIAL $566.56 ERY-OSMOT-FRAGIL 85555 $33.00 ERYTHROPOIETIN (PROTEIN) LEVEL 82668 $273.00 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VIS 99211 $50.00 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VIS 99212 $60.00 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VIS 99213 $70.00 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VI 99214 $80.00 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VI 99215 $100.00 ESTRIOL (HORMONE) LEVEL 82677 $201.00 ESTROGEN ANALYSIS 82671 $109.00 ESTROGEN RECEPTOR ANALYSIS 84233 $378.00 ETHOSUXIMIDE LEVEL 80168 $217.00 ETHYLENE GLYCOL (ANTIFREEZE) MEASUREMENT 82693 $81.00 ETIOCHOLANOLONE (TESTOSTERONE BYPRODUCT) LEVEL 82696 $183.00 ETONOGESTREL 68 MG IMPL 1 EACH PF APPLI J7307 $3,302.10 EVALUATION & INSERT CATHETERS REC PACING & ATTEMPT 93654 $43,784.00 EVALUATION & INSERT CATHETERS REC PACING & TREATME 93656 $34,720.00 EVALUATION AND INSERTION OF CATHETERS FOR CREATION 93653 $33,484.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge EVALUATION AND PROGRAMMING ADJUSTMENT OF DEFIBRILL 93287 $238.00 EVALUATION MD ANALYSIS REV&REP&PROGRAM ADJ SNGL/DU 93286 $188.00 EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTI 87185 $37.00 EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTI 87186 $160.00 EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTI 87184 $161.00 EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION R 93289 $84.00 EVALUATION OF DEFIBRILLATOR WITH ANALYSIS, REVIEW, 93261 $173.00 EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETA 88173 $159.00 EVALUATION OF HEARING FUNCTION BRAIN RESPONSES 92621 $247.00 EVALUATION OF HEARING FUNCTION BRAIN RESPONSES 92521 $406.00 EVALUATION OF HEARING REHABILITATION 92627 $215.00 EVALUATION OF HEARING REHABILITATION FIRST HOUR 92626 $400.00 EVALUATION OF HEART FUNCTION USING TILT TABLE 93660 $1,967.00 EVALUATION OF IMPLANTABLE HEART RECORDER SYSTEM 93291 $49.00 EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLA 97167 $683.00 EVALUATION OF OCCUPATIONAL THERAPY TYPICALLY 30 MI 97165 $403.00 EVALUATION OF OCCUPATIONAL THERAPY TYPICALLY 45 MI 97166 $544.00 EVALUATION OF ORTHOTIC OR PROSTHETIC USE, EACH 15 97763 $128.00 EVALUATION OF PHYSICAL THERAPY TYPICALLY 20 MINUTE 97161 $383.00 EVALUATION OF PHYSICAL THERAPY TYPICALLY 30 MINUTE 97162 $510.00 EVALUATION OF PHYSICAL THERAPY TYPICALLY 45 MINUTE 97163 $637.00 EVALUATION OF SPECIMEN ENZYMES 88319 $235.00 EVALUATION OF SPEECH SOUND PRODUCTION 92522 $406.00 EVALUATION OF SWALLOWING FUNCTION 92610 $950.00 EVALUATION OF THICKNESS OF COMMON CAROTID ARTERY ( 0126T $88.00 EVALUATION OF THICKNESS OF COMMON CAROTID ARTERY ( 93895 $258.00 EVALUATION PARAMETERS SNGL/DUAL/MULT LD CARD-DEFIB 93290 $113.00 EVALUATION PARAMETERS SNGL/DUAL/MULT LD PACEMKR W/ 93288 $69.00 EVALUATION PATIENT W/PRESCRIPTION SPEECH-GENERAT & 92607 $1,091.00 EVALUATION SNGL/DUAL CHAMBER PACING CARD-DEFIB & G 93641 $7,587.00 EVALUATION SNGL/DUAL CHAMBER PACING CARD-DEFIB AT 93640 $7,587.00 EVALUATION SNGL/DUAL CHAMBER PACING CARD-DEFIB W/P 93642 $2,766.00 EVALUATION SPEECH SOUND PRODUCTION W/EVAL LANGUAGE 92523 $1,091.00 EVALUATION TEST & PROGRAM ADJUST IMPLANT PATIENT A 93285 $311.00 EVALUATION TEST & PROGRAM ADJUSTMENT PERMANENT MUL 93281 $104.00 EVALUATION TESTING & PROGRAM ADJUST PERMANENT SNGL 93279 $71.00 EVALUATION TESTING & PROGRAMMING ADJUST PERMANENT 93280 $84.00 EVALUATION TESTING AND PROGRAMMING ADJUSTMENT OF D 93282 $104.00 EVALUATION TESTING AND PROGRAMMING ADJUSTMENT OF D 93283 $104.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge EVALUATION TESTING AND PROGRAMMING ADJUSTMENT OF D 93284 $104.00 EXAM OF WINDPIPE & LUNG AIRWAYS THROUGH PERMANENT 31615 $2,110.00 EXAMINATION OF CORNEA AND IRIS USING LENS DEVICE A 92020 $235.00 EXAMINATION OF EYE BY OPHTHALMOSCOPE WITH RETINAL 92225 $235.00 EXAMINATION OF EYE BY OPHTHALMOSCOPE WITH RETINAL 92226 $235.00 EXAMINATION OF THE NOSE AND THROAT USING AN ENDOSC 92511 $286.00 EXCHANGE BLOOD TRANSFUSION 36455 $1,103.00 EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL ST 93017 $1,119.00 EXERCISE TEST FOR SPASM OF LUNG AIRWAYS 94617 $289.00 EXPANDER TISSUE CPX4 CENTERSCOPE SILTEX P6.6 CM ME $6,370.00 EXPLANATION OF PSYCHIATRIC MEDICAL EXAMS PROCEDURE 90887 $265.00 EXPLORATION OF PENETRATING WOUND OF ARM OR LEG 20103 $2,427.00 EXTENDED COLOR VISION EXAMINATION 92283 $235.00 EXTENDED RECOVERY $52.00 EXTENDER GRAFT INQU POLYSACCHARIDHYALURONIC ACID P $9,587.50 EXTENSION NEUROSTIMULATOR STRETCH-COIL L40 CM 1X8 C1778 $3,250.00 EXTENSION STEM NEXGEN FLUTE L75 MM L120 MM OD15 MM C1776 $4,550.00 EXTERNAL EKG RECORDING FOR MORE THAN 48 HOURS UP T 0296T $713.00 EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT 92960 $918.00 EXTRACTOR STONE NGAGE NITINOL L115 CM OD2.2 FR ODS $1,261.00 EXTRACTOR STONE OD.4 MM 4 WIRE BASKET STERILE DISP $2,139.20 EXTRACTOR STONE OD.6 MM 4 WIRE TIPLESS HANDLE STER $2,240.00 EXTRACTOR STONE PERC NCIRCLE NITINOL L38 CM OD10 F $550.85 EYE & MEDICAL EXAM DIAGNOSIS & TREATMENT ESTAB PAT 92014 $272.00 EYE AND MEDICAL EXAM FOR DIAGNOSIS & TREATMENT NEW 92004 $358.00 EYE AND MEDICAL EXAMINATION FOR DIAGNOSIS & TREATM 92012 $272.00 EYE AND MEDICAL EXAMINATION FOR DIAGNOSIS AND TREA 92002 $358.00 EYE CHART TESTING OF VISUAL ACUITY OF BOTH EYES 99173 $21.00 FABRIC CARDIOVASCULAR BARD SAUVAGE POLYESTER PTFE C1768 $570.00 F-ACTIN SM MUSCLE AB IGG 83516 $160.00 FACTOR 8 INHIBITOR 85335 $627.00 FACTOR V ASSAY 85220 $316.00 FAMILY PSYCHOTHERAPY INCLUDING PATIENT, 50 MINUTES 90847 $397.00 FAMILY PSYCHOTHERAPY, 50 MINUTES 90846 $397.00 FATTY ACIDS MEASUREMENT 82725 $284.00 FERRIC GLUCONATE 62.5 MG/5 ML SOLN 5 ML VIAL J2916 $78.10 FERRITIN (BLOOD PROTEIN) LEVEL 82728 $253.00 FETAL LUNG MATURITY ASSESSMENT 83662 $147.00 FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT 85384 $237.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge FILLER BONE VOID DBX 5 CC ALLOGRAFT PUTTY FREEZE D $4,090.45 FINE NEEDLE ASPIRATION 10021 $858.00 FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION 10007 $1,594.00 FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION 10005 $1,594.00 FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL 10006 $144.00 FITTING AND INSERTION OF VAGINAL SUPPORT DEVICE 57160 $438.00 FIXATOR EXTERNAL FIXATION JET-X LONG CENTRAL BODY $13,404.32 FIXATOR EXTERNAL FIXATION LARGE SHORT CENTRAL BODY $19,849.20 FIXATOR EXTERNAL FIXATION RADIAL DISTAL REPACK $3,408.00 FIXATOR EXTERNAL FIXATION SMALL COMPRESSION DISTRA $3,483.36 FLOW CYTOMETRY TECHNIQUE FOR DNA OR CELL ANALYSIS 88182 $123.00 FLUID COLLECTION DRAINAGE BY CATHETER ACCESSED THR 10030 $1,320.00 FLUID COLLECTION DRAINAGE BY CATHETER USING IMAGIN 49407 $2,364.00 FLUID COLLECTION DRAINAGE BY CATHETER USING IMAGIN 49406 $3,765.00 FLUID COLLECTION DRAINAGE BY CATHETER USING IMAGIN 49405 $3,830.00 FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION 92611 $1,057.00 FLUOROSCOPIC GUIDANCE FOR INJECTION INTO SPINE OR 77003 $554.00 FLUOROSCOPIC GUIDANCE FOR INSERTION OF NEEDLE 77002 $776.00 FLUOROSCOPIC GUIDE INSERTION REPLACE OR REMOVAL OF 77001 $822.00 FOLIC ACID LEVEL 82746 $224.00 FOLIC ACID LEVEL 82747 $384.00 FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF CON 93304 $723.00 FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEA 93308 $721.00 FOLLOW-UP OR REPEAT ULTRASOUND OF FETAL HEART 76828 $586.00 FOLLOW-UP OR REPEAT ULTRASOUND OF FETAL HEART BLOO 76826 $394.00 FOLLOW-UP/LIMITED HEART DOPPLER US STUDY HEART BLO 93321 $738.00 FOOTPLATE BONE TITANIUM LEFT ANTERIOR MIDFACIAL EL C1713 $5,342.40 FOOTPLATE BONE TITANIUM MANDIBLE TYPE A MESH NONST C1713 $4,867.20 FOOTPLATE BONE TITANIUM MANDIBLE TYPE B CLOVERLEAF C1713 $4,867.20 FORCEPS BONE HOLDING L190 MM SELF CENTER $4,992.00 FORCEPS GRASPING JAKO CUP RIGHT ANGLE L9.5 IN OD4. $1,270.88 FORCEPS SURGICAL MIXTER RIGHT ANGLE L8 IN CARDIOVA $327.28 FORCEPS SURGICAL RUSSIAN L12 IN TISSUE $770.25 FOSPHENYTOIN 100 MG PE/2 ML SOLN 2 ML VIAL Q2009 $127.28 FRACTURE ASSESS SPINE BONES USING X-RAY MACHINE FO 77086 $307.00 FRAME EXTERNAL FIXATION ACCESSORY BLOCK TAYLOR SPA $1,476.48 FRAME EXTERNAL FIXATION TEMPORARY $33,713.55 FREE LIGHT CHAIN, SERUM 83883 $282.00 FREEZING, PRESERVATION, AND STORAGE OF STEM CELLS 38207 $4,531.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge FRUCTOSAMINE-FRUCTOSAMINE 82985 $77.00 FTA/ABS 86780 $205.00 FULL FIELD ELECTRORETINOGRAPHY W/I&R 92273 $694.00 FUNCTIONAL MRI SCAN OF BRAIN 70554 $639.00 FUNCTIONAL MRI SCAN OF BRAIN W/ADMINISTRATION OF N 70555 $639.00 FUNGAL BLOOD CULTURE (MOLD OR YEAST) 87103 $302.00 FUNGAL CULTURE (MOLD OR YEAST) 87102 $322.00 FUNGAL CULTURE (MOLD OR YEAST) OF SKIN, HAIR, OR N 87101 $244.00 FUNGAL CULTURE, YEAST 87106 $87.00 FUNGI SUSCEPTIBILITY, MOLD 87186 $160.00 G6PD (ENZYME) LEVEL 82955 $160.00 GABAPENTIN 300 MG CAP 100 EACH BLIST PACK $3.00 GAD AB (GLTAMIC ACID DECRBXYLASE) 83519 $445.00 GALACTOKINASE (ENZYME) LEVEL 82759 $653.00 GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE (ENZYME) 82775 $527.00 GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE SCREENING 82776 $65.00 GALECTIN-3 LEVEL 82777 $100.00 GAMMAGLOBULIN IGM CSF 82784 $141.00 GAMMAGLOBULIN, IGG SUBCLASSES 82787 $232.00 GAMMAGLOBULIN, IGM, QUANT 82784 $141.00 GASTRIC ACID ANALYSIS 82930 $36.00 GASTRIN (GI TRACT HORMONE) LEVEL 82941 $294.00 GBM AB IGG 86255 $287.00 GC AMPLIFIED DETECTION 87591 $81.00 GENE ANALYSIS (ADENOMATOUS POLYPOSIS COLI) DUPLICA 81203 $853.00 GENE ANALYSIS (ADENOMATOUS POLYPOSIS COLI), FULL G 81201 $853.00 GENE ANALYSIS (ADENOMATOUS POLYPOSIS COLI), KNOWN 81202 $853.00 GENE ANALYSIS (COAGULATION FACTOR V) LEIDEN VARIAN 81241 $449.00 GENE ANALYSIS (CYSTIC FIBROSIS TRANSMEMBRANE CONDU 81222 $168.00 GENE ANALYSIS (CYSTIC FIBROSIS TRANSMEMBRANE CONDU 81220 $376.00 GENE ANALYSIS (FRAGILE X MENTAL RETARDATION) ABNOR 81243 $404.00 GENE ANALYSIS (FRAGILE X MENTAL RETARDATION) CHARA 81244 $124.00 GENE ANALYSIS (METHYL CPG BINDING PROTEIN 2) FULL 81302 $108.00 GENE ANALYSIS (PHOSPHATASE & TENSIN HOMOLOG) DUPLI 81323 $825.00 GENE ANALYSIS (PHOSPHATASE AND TENSIN HOMOLOG), FU 81321 $30.00 GENE ANALYSIS (PROTHROMBIN, COAGULATION FACTOR II) 81240 $1,402.00 GENE ANALYSIS (UDP GLUCURONOSYLTRANSFERASE 1 FAM P 81350 $67.00 GENE ANALYSIS DUPLICATION OR DELETION ANALYSIS 81324 $30.00 GENE ANALYSIS GENOMIC SEQUENCE ANALYSIS 81442 $5,184.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge GENEDX AORTIC DYSFUNCTION/DILATION GENOMIC SEQ ANA 81410 $4,040.00 GENEDX CARDIOMYOPATHY PANEL 81439 $13,190.40 GENEDX STICKLER SYNDROME PANEL 81479 $9,720.00 GENETIC TESTING 88274 $341.00 GENOME-WIDE MICROARRAY ANALYSIS FOR COPY NUMBER VA 81228 $5,554.00 GENTAMICIN (ANTIBIOTIC) LEVEL 80170 $328.00 GENTAMYCIN-PEAK 80170 $328.00 GENTAMYCIN-RANDOM 80170 $328.00 GENTAMYCIN-TROUGH 80170 $328.00 GGT (GLUTAMYLTRANSFERASE GAMMA) 82977 $195.00 GIARDIA ANTIGEN, EIA, STOOL 87329 $140.00 GIRDLE COMPRESSION POWERNET FABRIC COTTON MEDIUM O $479.60 GLIADIN AB, IGA 83516 $160.00 GLIADIN AB, IGG 83516 $160.00 GLUCAGON (HORMONE) TOLERANCE PANEL TO EVALUATE FOR 80422 $357.00 GLUCAGON (HORMONE) TOLERANCE PANEL TO EVALUATE FOR 80424 $392.00 GLUCAGON (PANCREATIC HORMONE) LEVEL 82943 $350.00 GLUCAGON (PANCREATIC HORMONE) TOLERANCE TEST 82946 $91.00 GLUCOSE - 1 HR OB CHALLENGE 82947 $65.00 GLUCOSE - 2HR PP 82947 $65.00 GLUCOSE TOLERANCE TEST (GTT) G0410 $290.00 GLUCOSE, CSF 82945 $116.00 GLUCOSE, FLUID 82945 $116.00 GLUCOSE, URINE 82945 $116.00 GLUCOSE-SERUM 82947 $65.00 GLUTAMATE DEHYDROGENASE (ENZYME) MEASUREMENT 82965 $60.00 GLUTAMIC ACID DECARBOXY AB 83516 $160.00 GLUTATHIONE (PROTEIN) LEVEL 82978 $111.00 GLYCATED PROTEIN LEVEL 82985 $77.00 GLYCERIN 99.5 % SOLN 473 ML BOTTLE $64.13 GLYCOPYRROLATE 0.2 MG/ML SOLN 1 ML VIAL $33.51 GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS 84703 $239.00 GONADOTROPIN CHORIONIC QUANTITATIVE HCG 84702 $151.00 GONADOTROPIN RELEASING HORMONE (REPRODUCTIVE HORMO 80426 $1,151.00 GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) MEA 84704 $117.00 GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE H 83001 $365.00 GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) L 83002 $314.00 GRAFT BONE CARTIFORM DISC OD20 MM ALLOGRAFT C1713 $55,250.00 GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRA C1713 $11,732.50 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge GRAFT BONE VERTIGRAFT CORTICAL TIBIA L100 MM X W15 C1713 $4,595.50 GRAFT BONE VERTIGRAFT ILIAC CREST H20 MM FREEZE DR C1713 $5,455.45 GRAFT BONE VIVIGEN FORMABLE CELLULAR BONE MATRIX S C1713 $3,840.00 GRAFT CARDIOVASCULAR GELWEAVE POLYESTER GELATIN WO C1768 $3,765.19 GRAFT CARDIOVASCULAR HEMASHIELD GOLD MICROVEL L360 C1768 $2,807.68 GRAFT CARDIOVASCULAR HEMASHIELD GOLD POLYESTER L30 C1768 $2,661.36 GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FE $64,967.50 GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L $25,870.00 GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE $64,967.50 GRAFT ENDOVASCULAR ZENITH SPIRAL-Z POLYESTER STAIN C1874 $19,051.50 GRAFT NERVE AVANCE L70 MM OD1-2 MM ALLOGRAFT STERI C1762 $41,275.00 GRAFT PORCINE XENMATRIX AQUAPURE ACELLULAR COLLAGE C1781 $76,687.00 GRAFT SKIN FLEXHD PLIABLE LARGE ALLOGRAFT KIT Q4128 $26,712.56 GRAFT SOFT TISSUE AMNIOFIX PURION AMNIOTIC MEMBRAN V2790 $4,855.50 GRAFT SOFT TISSUE NUSHIELD L4 CM X W4 CM ALLOGRAFT Q4160 $12,090.00 GRAFT SOFT TISSUE XCM BIOLOGIC PORCINE DERMIS THIC Q4142 $20,693.66 GRAFT STENT AFX L80 MM L40 MM OD25 MM ODSEC20 MM S $67,437.50 GRAFT STENT AFX STRATA 2 BRANCH L110 MM L30 MM OD2 $67,437.50 GRAFT STENT ENDURANT POLYESTER NITINOL L174 MM L12 $22,140.00 GRAFT SYNTHETIC TISSUE MEDPOR POLYETHYLENE POROUS $6,726.72 GRAFT SYNTHETIC TISSUE MIIG CALCIUM SULFATE 15 CC C1713 $13,320.00 GRAFT VASCULAR GELSOFT VASCUTEK GELATIN POLYESTER C1768 $2,293.20 GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE THIN WAL C1768 $14,296.00 GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE THIN WAL C1768 $17,855.50 GRAFT VASCULAR GORE-TEX PEDIATRIC THIN WALL L10 CM C1768 $2,888.00 GRAFT VASCULAR GORE-TEX STANDARD WALL L80 CM ID10 C1768 $7,384.00 GRAFT VASCULAR GORE-TEX STANDARD WALL L80 CM ID8 M C1768 $5,488.00 GRAFT VASCULAR GORE-TEX STANDARD WALL STRAIGHT LAR C1768 $6,576.00 GRAFT VASCULAR GORE-TEX THIN WALL L15 CM L5 CM ID4 C1768 $5,416.00 GRAFT VASCULAR GORE-TEX THIN WALL L80 CM ID6 MM LI C1768 $6,368.00 GRAFT VASCULAR GORE-TEX THIN WALL L80 CM ID8 MM LI C1768 $5,112.00 GRAFT VASCULAR VENAFLO II PTFE STRAIGHT L30 CM ID6 C1768 $2,901.54 GROUP TREATMENT SPEECH LANGUAGE COMMUNICATION/HEAR 92508 $172.00 GROWTH HORMONE STIMULATION PANEL 80428 $518.00 GROWTH HORMONE SUPPRESSION PANEL 80430 $609.00 GUIDANCE FOR LOCALIZATION TARGET DELIVERY OF RADIA 77387 $419.00 GUIDE DRILL 2 MM CENTERING $3,607.50 GUIDE DRILL SPEEDGUIDE T10 L70 MM STERILE 3.5 MM S $1,365.00 GUIDE NERVE NEURAGEN COLLAGEN MATRIX L3 CM ID3 MM C9352 $9,269.98 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge GUIDEWIRE ENDOSCOPIC AMPLATZ STAINLESS STEEL PTFE C1769 $132.48 GUIDEWIRE ENDOSCOPIC HIWIRE NITINOL HYDROPHILIC ST C1769 $1,869.28 GUIDEWIRE ENDOSCOPIC SLIP-COAT STAINLESS STEEL STR C1769 $152.08 GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE BENTSON C1769 $97.25 GUIDEWIRE ORTHOPEDIC ACUTRAK 2 MICRO OD.035 IN PAR $1,264.00 GUIDEWIRE ORTHOPEDIC L290 MM OD3.2 MM NONSTERILE $529.82 GUIDEWIRE ORTHOPEDIC STAINLESS STEEL L330 MM OD2 M $414.00 GUIDEWIRE VASCULAR ASAHI CONFIANZA PRO 12 TRUTORQ C1769 $650.00 GUIDEWIRE VASCULAR ASAHI MIRACLEBROS 12 TRUTORQ HY C1769 $650.00 GUIDEWIRE VASCULAR ASAHI PROWATER TRUTORQ HYBRID S C1769 $345.00 GUIDEWIRE VASCULAR ATTAIN HYBRID PRO/PEL STAINLESS C1769 $800.00 GUIDEWIRE VASCULAR CHOICE PT STAINLESS STEEL POLYM C1769 $435.34 GUIDEWIRE VASCULAR COPE MANDRIL PLATINUM NITINOL A C1769 $183.00 GUIDEWIRE VASCULAR CORDIS STABILIZER PLUS DURAGLID C1769 $472.00 GUIDEWIRE VASCULAR CORDIS STORQ SLX STAINLESS STEE C1769 $279.50 GUIDEWIRE VASCULAR FATHOM STAINLESS STEEL NITINOL C1769 $1,322.05 GUIDEWIRE VASCULAR GLIDEWIRE NITINOL POLYURETHANE C1769 $317.60 GUIDEWIRE VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT C1769 $552.00 GUIDEWIRE VASCULAR HI-TORQUE EXTRA SPORT STAINLESS C1769 $448.50 GUIDEWIRE VASCULAR HI-TORQUE IRON MAN STAINLESS ST C1769 $345.00 GUIDEWIRE VASCULAR HI-TORQUE WHISPER ES DURASTEEL C1769 $345.00 GUIDEWIRE VASCULAR HI-TORQUE WHISPER LS DURASTEEL C1769 $345.00 GUIDEWIRE VASCULAR NITREX NITINOL SILICONE 15 D L8 C1769 $391.67 GUIDEWIRE VASCULAR PEGASUS 30 D L185 CM L2 MM OD.0 C1769 $3,250.00 GUIDEWIRE VASCULAR PTFE STRAIGHT L175 CM OD.038 IN C1769 $39.00 GUIDEWIRE VASCULAR TEFCOR STAINLESS STEEL HEPARIN C1769 $75.35 GUIDEWIRE VASCULAR THUNDER PRO/PEL STAINLESS STEEL C1769 $300.00 GUIDEWIRE VASCULAR TRANSEND PLATINUM .014 IN L300 C1769 $3,607.50 HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFE 99001 $288.00 HAPTOGLOBIN (SERUM PROTEIN) LEVEL 83010 $242.00 HAPTOGLOBIN (SERUM PROTEIN) MEASUREMENT 83012 $133.00 HAYWARD AMINO AICDS 6 OR MORE QUANTIT 82139 $803.00 HC ARUP BORRLIEA BURGDORFERI (LYME) NUCLEIC ACID P 87476 $508.00 HC ARUP FATTY ACIDS PROFILE SERUM OR PLASMA 82542 $1,051.00 HC ARUP IFE, TOT PROT 84160 $55.00 HC ARUP LYSOSOMAL ACID LIPASE ACTIVITY DBS 82657 $674.00 HC ASSAY OF AMMONIA 82140 $251.00 HC ASSAY OF FERRITIN 82728 $253.00 HC ASSAY OF LACTIC ACID 83605 $257.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge HC ASSAY OF MAGNESIUM 83735 $141.00 HC ASSAY OF PHOSPHORUS 84100 $174.00 HC ASSAY OF PYRUVATE 84210 $297.00 HC AUTOMATED DIFF WBC COUNT 85004 $47.00 HC BILIRUBIN DIRECT 82248 $201.00 HC CINCINNATI CHILDRENS BCR/ABL QUANTITATIVE 81206 $1,012.00 HC CINCINNATI CHILDRENS IL-2R 83520 $916.00 HC CINNCINNATI CH HLH PANEL 81443 $10,956.00 HC COAGULATION TIME ACTIVATED,TEG6S 85347 $139.00 HC COLORADO CHILD VLCAD DEF ENZ ACTIVITY 82657 $2,733.00 HC COMPREHEN METABOLIC PANEL 80053 $378.00 HC EXCISION OF BRANCHIAL CLEFT CYST 42810 $7,745.00 HC FIBRINOGEN ACTIVITY 85384 $237.00 HC FLOW CYTOMETRY >16 MARKERS INTERP SENDOUT 88189 $387.00 HC FLOW CYTOMETRY 1ST MARKER SENDOUT 88184 $755.00 HC FLOW CYTOMETRY 2-8 MARKER INTERP WASHINGTON 88187 $208.00 HC FLOW CYTOMETRY 9-15 MARKERS INTERP SENDOUT 88188 $303.00 HC GENE DX CLINICAL EXOME SEQUENCE ANALYSIS 81415 $13,750.00 HC GENEDX DM1 SOUTHERN BLOT 81234 $1,155.00 HC GENEDX NUCLEAR MITO 100 GENE GENOMIC SEQUENCE 81440 $16,377.00 HC GENEDX WHOLE MITOCHON GENOME ANALYSIS PANEL 81465 $1,348.00 HC GENEDX WHOLE MITOCHONDRIAL GENOME 81460 $2,352.00 HC GREENWOOD GENETIC MPS PANEL 82657 $2,750.00 HC GREENWOOD GENETICS - X-INACTIVATION 81204 $963.00 HC GREENWOOD GENETICS NEUROLOGICAL DISEASE PANEL 82657 $1,650.00 HC HAYWARD CYTO CHROM ANAL 15-20,2 KARYO 88262 $788.00 HC HAYWARD CYTO PERIPHERIAL BLOOD META 88263 $788.00 HC HAYWARD CYTOGENETICS AFP IN AMNIOTIC FLUID 82106 $108.00 HC HAYWARD CYTOGENETICS BONE MARROW 88237 $526.00 HC HAYWARD CYTOGENETICS CHROM ADD'TL HI RES 88289 $256.00 HC HAYWARD CYTOGENETICS CHROM ANAL 20-25 88264 $872.00 HC HAYWARD CYTOGENETICS CHROMOSOME ANAL45-MOSAIC 88263 $425.00 HC HAYWARD CYTOGENETICS CULTURE LYMPHOCYTE 88230 $352.00 HC HAYWARD CYTOGENETICS FISH INTERPHASE 100-300 88271 $315.00 HC HAYWARD CYTOGENETICS FISH PRENATAL 100-300 88271 $1,573.00 HC HAYWARD CYTOGENETICS FISH PROBES 100-300 88275 $605.00 HC HAYWARD CYTOGENETICS TISSUE CULTURE LYMPHO 88239 $533.00 HC HAYWARD GEN. ORGANIC ACIDS UR (LACTIC ACID) 83605 $121.00 HC HAYWARD GEN. ORGANIC ACIDS UR (MASS SPEC) 83789 $121.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge HC HAYWARD GEN. ORGANIC ACIDS UR (ORGANIC ACID) 83918 $196.00 HC HAYWARD GEN. ORGANIC ACIDS UR (PHENYL) 84035 $47.00 HC HAYWARD GEN. ORGANIC ACIDS URINE GC/MS 82570 $38.00 HC HAYWARD GENETICS AMNIOTIC FLUID 88267 $867.00 HC HAYWARD GENETICS CDG SCREEN 82373 $330.00 HC HAYWARD GENETICS CEBPA MUTATION ANALYSIS 81218 $1,393.00 HC HAYWARD GENETICS CENTER C-KIT MUTATION 81404 $2,405.00 HC HAYWARD GENETICS CENTER QUANT AMINO ACIDS URINE 82139 $533.00 HC HAYWARD GENETICS CONNEXIN 26 (GENE ANAL) 81252 $1,100.00 HC HAYWARD GENETICS CYSTIC FIBROSIS MUTATION 81220 $1,393.00 HC HAYWARD GENETICS CYTO ADD'TL CELLS COUNTED 88285 $8.00 HC HAYWARD GENETICS CYTO ADD'TL KARYOTYPES 88280 $143.00 HC HAYWARD GENETICS CYTO TISSUE CULTURE AMNIOTICS 88235 $473.00 HC HAYWARD GENETICS CYTOGENETICS 10-30 CELLS 88273 $484.00 HC HAYWARD GENETICS CYTOGENETICS 25-99 CELLS 88274 $242.00 HC HAYWARD GENETICS CYTOGENETICS LYMPHOMA 88271 $630.00 HC HAYWARD GENETICS CYTOGENETICS MICRODELETIONS 88271 $867.00 HC HAYWARD GENETICS CYTOGENETICS SKIN BIOPSY 88233 $533.00 HC HAYWARD GENETICS FLY3 MUATAION 81245 $1,008.00 HC HAYWARD GENETICS FRAGILE X 81244 $1,164.00 HC HAYWARD GENETICS GALACTOSE 1 PHOS URIDYL 82775 $304.00 HC HAYWARD GENETICS GALACTOSE 1 PHOSPHATE 84378 $425.00 HC HAYWARD GENETICS GALACTOSEMIA 2 MUTATION 81401 $1,329.00 HC HAYWARD GENETICS JAK2 MUTATION 81270 $1,063.00 HC HAYWARD GENETICS MECP-2 (RETT) 81302 $2,842.00 HC HAYWARD GENETICS METHYLATION STUDY 81331 $825.00 HC HAYWARD GENETICS MICROARRAY CGH 81229 $3,481.00 HC HAYWARD GENETICS MUCO. SPOT UR 84999 $110.00 HC HAYWARD GENETICS MUCO. SPOT UR (CREATININE) 82570 $38.00 HC HAYWARD GENETICS- MUCO. TLC (CHROM ASSAY TLC) 84375 $272.00 HC HAYWARD GENETICS- MUCO. TLC (CREAT) 82570 $38.00 HC HAYWARD GENETICS NPM1 MUTATION 81310 $918.00 HC HAYWARD GENETICS QUANT AMINO ACIDS UR (CREAT) 82570 $38.00 HC HAYWARD GENETICS TOGENETICS INTERPRETATION 88291 $117.00 HC HAYWARD GENETICS Y-CHROMOSOME 81403 $1,340.00 HC HAYWARD GENETICS-BIOTINIDASE 82261 $170.00 HC HAYWARD MONO AND DI SUGARS MULTI QUAL 84377 $267.00 HC HAYWARD MONO AND DI SUGARS URINE 82570 $38.00 HC HAYWARD QUANT AMINO ACIDS (PLASMA&CSF) 82139 $533.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge HC HEMATOCRIT 85014 $53.00 HC HEMOGLOBIN 85018 $50.00 HC INVITAE CHARCOT-MARIE-TOOTH DISEASE 81479 $4,125.00 HC INVITAE COMPREHENSIVE NEUROMUSCULAR DISORDER 81479 $4,125.00 HC INVITAE CONGENITAL HEART DEFECTS AND HETEROTAXY 81479 $4,125.00 HC INVITAE CYSTINOSIS 81479 $4,125.00 HC INVITAE DYSTO3.3 MOLECULAR PATH PROC LEVEL 9 81408 $1,375.00 HC INVITAE DYSTRO1.3 MOLECULAR PATH PROC LEVEL 7 81406 $1,375.00 HC INVITAE DYSTRO2.3 MOLECULAR PATH PROC LEVEL 8 81407 $1,375.00 HC INVITAE HOLOPROSENCENCEPHALY PANEL 81479 $4,125.00 HC INVITAE X-LINKED HYPOPHOSPHATEMIA (PHEX) 81479 $2,063.00 HC JOHN HOPKINS ANTI-ANGIOTENSIN RECEPTOR 1 AB 83520 $1,703.00 HC KENNEDY KRIEGER PLASALOGEN FATTY ACID RATIO 82542 $454.00 HC MAYO LAB ENC2 PANEL 86255 $3,878.00 HC MAYO LAB GLUCOPSYCHOSINE, BS 82542 $680.00 HC MAYO LAB HYPEROALURIA UR (HYOX) 82542 $1,215.00 HC MAYO LAB LYSO GB3 S 82542 $644.00 HC MAYO LAB MUCOPOLYSACCHARIDES MPSSC-CHROM 82542 $581.00 HC MAYO LAB PTH RELATED PEPTIDE 82397 $932.00 HC MAYO LAB TREC B 81479 $2,256.00 HC MAYO- PYRIDOXAL 5-PHOSPHATE, PLASMA 84207 $748.00 HC METABOLIC PANEL TOTAL CA 80048 $306.00 HC NATIONAL JEWISH C4A LEVEL 86160 $244.00 HC NATIONAL JEWISH HEALTH- MYCOBACT MTMBR 87798 $281.00 HC NATIONAL JEWISH HEALTH- MYCOBACT MTMID 87798 $127.00 HC NATIONAL JEWISH HEALTH- MYCOBACT MTMP6 87186 $1,136.00 HC NATIONAL JEWISH HEALTH, MTB COMPLEX A 87556 $567.00 HC PERKIN ELMER WHOLE EXOME SEQUENCING - PROBAND 81415 $3,456.00 HC PUNCH BIOPSY SKIN SINGLE LESION 11104 $486.00 HC RECONSTRUCTION TOE POLYDACTYLY 28344 $7,215.00 HC REVISION OF URETHRA 53460 $4,785.00 HC ROOM & BOARD INTENSIVE CARE UNIT $8,700.00 HC SCCA LAB BUSULFAN LEVEL 80299 $658.00 HC TANGENTIAL BIOPSY SKIN SINGLE LESION 11102 $486.00 HC THROMBOPLASTIN TIME PARTIAL 85732 $217.00 HC TULANE- FLOW CYTOMETRY 1ST MARKER PNH 88184 $755.00 HC TULANE-FLOW CYTO CELL SURFACE MARKER EA ADD PNH 88185 $156.00 HC UNIV IOWA GENETIC RENAL PANEL 81479 $6,534.00 HC UNIV IOWA MOLECULAR PATHOLOGY PROCEDURE LEVEL 6 81405 $1,716.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge HC USDC GRANULOCYTE CYSTINE ASSAY 83789 $1,238.00 HC VERSITI WISCONSIN BCR/ABL FISH 81206 $1,727.00 HC VERSITI(BCW) HAPLOTYPE STR 81265 $506.00 HCG, TUMOR MARKER, QUANT 84702 $151.00 HDL CHOLESTEROL LEVEL 83718 $104.00 HEAD BIPOLAR SELF-CENTERING OD45 MM ID28 MM HIP FE C1776 $3,250.00 HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA +8.5 MM 12/1 C1776 $5,200.00 HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA TITANIUM +1. C1776 $5,200.00 HEAD FEMORAL ARTICUL/EZE COCR +15.5 MM 12/14 OFFSE C1776 $3,250.00 HEAD FEMORAL BIOLOX DELTA -5 MM OFFSET C TAPER OD3 C1776 $3,900.00 HEAD FEMORAL COCR MEDIUM OD36 MM C1776 $2,925.00 HEAD FEMORAL SELEX M2A-MAGNUM COCR STANDARD OD40 M C1776 $2,925.00 HEAD GLENOID RSP NEUTRAL OD32 MM SHOULDER RETAIN S C1776 $6,500.00 HEAD UNIPOLAR ACUMATCH OD45 MM HIP FEMUR L SERIES C1776 $1,950.00 HEAD UNIPOLAR CATHCART BALL OD42 MM HIP FEMUR MODU C1776 $1,950.00 HEAD UNIPOLAR CATHCART BALL OD47 MM HIP FEMUR MODU C1776 $1,950.00 HEAD UNIPOLAR CATHCART BALL OD49 MM HIP FEMUR MODU C1776 $1,950.00 HEAD UNIPOLAR CATHCART BALL OD58 MM HIP FEMUR MODU C1776 $1,950.00 HEALTH AND BEHAVIOR INTERVENTION, GROUP EACH 15 MI 96153 $97.00 HEARING AID BATTERY EACH V5266 $5.00 HEARING AID DISPENSING FEE V5090 $390.00 HEARING AID EARMOLD EACH V5264 $164.00 HEARING AID EXAMINATION AND SELECTION OF BOTH EARS 92591 $463.00 HEARING AID EXAMINATION AND SELECTION OF ONE EAR 92590 $431.00 HEARING TEST FOR CHILDREN 92579 $504.00 HEARING TEST IN A BOOTH 92583 $159.00 HEARING TESTS FOR CHILDREN 92582 $529.00 HEARING TRAINING AND THERAPY FOR HEARING LOSS AFTE 92633 $159.00 HEARING TRAINING AND THERAPY FOR HEARING LOSS PRIO 92630 $159.00 HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT O 93226 $558.00 HEART RHYTHM SYMPTOM-RELATED TRACING 24-HOUR EKG M 93270 $403.00 HEART RHYTHM TRACING OF 48-HOUR EKG 93225 $400.00 HEAVY METAL LEVEL 83018 $706.00 HELICOBACTER PYLORI ANTIGEN INFECTIOUS AGENT TECH 87338 $209.00 HEMODIALYSIS 90935 $2,414.00 HEMOGLOBIN A1C 83036 $213.00 HEMOGLOBIN A1C LEVEL 83036 $213.00 HEMOGLOBIN A-2 83020 $172.00 HEMOGLOBIN ANALYSIS AND MEASUREMENT 83020 $172.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge HEMOGLOBIN MEASUREMENT 88738 $25.00 HEMOGLOBIN MEASUREMENT 85018 $50.00 HEMOGLOBIN S 85660 $84.00 HEMOGLOBIN S (IN HOUSE) 85660 $84.00 HEMOGLOBIN-OXYGEN AFFINITY MEASUREMENT 82820 $78.00 HEP B SURFACE AB 86317 $67.00 HEPARIN ASSAY 85520 $548.00 HEPARIN THERAPY ASSESSMENT 85530 $101.00 HEPATITIS A (HAAB) ANTIBODY 86708 $239.00 HEPATITIS B CORE ANTIBODY TOTAL 86704 $148.00 HEPATITIS B SURFACE AG 87340 $157.00 HEPATITIS B SURFACE ANTIBODY MEASUREMENT 86706 $190.00 HEPATITIS BE ANTIBODY MEASUREMENT 86707 $85.00 HEPATITIS C ANTIBODY MEASUREMENT 86803 $249.00 HEPATITIS C GENOTYPE 87902 $763.00 HEPATITIS C QUANTATIVE NUCLEIC ACID PROBE 87522 $407.00 HERPESANTIVIRUS 6 ANTIBODY IGG 86790 $511.00 HIPPURIC ACID,URINE 83921 $291.00 HISTOPLASMA AB BY ID 86698 $330.00 HIV 1 ANTIBODY 86701 $296.00 HIV RAPID 1 AND 2 COMBO 86703 $231.00 HLA CLASS I TYPING LOW RESOLUTION 81372 $138.00 HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS 81382 $2,021.00 HLA I & II TYPING LR 81370 $1,229.00 HLA I TYPING HIGH RESOLUTION 1 ALLELE 81381 $782.00 HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1 81378 $1,056.00 HLA I&LI LOW RESOLUTION HLA-A -B&-DRB1 81371 $1,056.00 HLA II TYPING 1 ALLELE HR 81383 $969.00 HOMOCYSTEINE 83090 $119.00 HOMOVANILLIC ACID (ORGANIC ACID) LEVEL 83150 $330.00 HOOK SPINAL CD HORIZON LEGACY TITANIUM MEDIUM THOR C1713 $2,800.00 HOOK SPINAL CD HORIZON TITANIUM MEDIUM LORDOTIC LU C1713 $3,200.00 HOOK SPINAL CD HORIZON TITANIUM OD6.35 MM ANGLE LE C1713 $3,200.00 HOOK SPINAL EXPEDIUM STAINLESS STEEL 3 MM OFFSET L C1713 $2,800.00 HOOK SPINAL EXPEDIUM STAINLESS STEEL L10 MM PEDICL C1713 $2,800.00 HOOK SPINAL EXPEDIUM STAINLESS STEEL RIGHT OFFSET C1713 $2,800.00 HOOK SPINAL EXPEDIUM STAINLESS STEEL W5.5 MM PEDIC C1713 $2,800.00 HOOK SPINAL EXPEDIUM TITANIUM L10 MM PEDICLE NARRO C1713 $2,800.00 HOOK SPINAL EXPEDIUM TITANIUM L4.25 MM EXTEND TAB C1713 $2,800.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM EXTEND TAB W C1713 $2,800.00 HOOK SPINAL LORDOTIC NARROW BLADE C1713 $2,800.00 HOOK SPINAL MESA D8 MM LAMINAR NONSTERILE C1713 $3,200.00 HOOK SPINAL PANGEA TITANIUM SMALL LAMINA TALL BODY C1713 $2,800.00 HOOK SPINAL POLARIS STAINLESS STEEL UNIVERSAL MEDI C1713 $2,800.00 HOOK SPINAL POLARIS TITANIUM LARGE W9 MM EXTEND HE C1713 $2,800.00 HOOK SPINAL POLARIS TITANIUM SMALL LEFT OFFSET W6 C1713 $2,800.00 HOOK SPINAL SOLERA CD HORIZON TITANIUM SMALL LAMIN C1713 $3,200.00 HOOK SPINAL SOLERA CD HORIZON TITANIUM SMALL NARRO C1713 $3,200.00 HOOK SPINAL STAINLESS STEEL LORDOTIC LEFT OFFSET C1713 $3,200.00 HOOK SPINAL STAINLESS STEEL SMALL NARROW BLADE C1713 $3,200.00 HOOK SPINAL TITANIUM SMALL W6.2 MM PEDICLE C1713 $2,800.00 HOOK SPINAL VERTEX MAX TITANIUM ID6 MM LAMINA RIGH C1713 $3,200.00 HOOK SPINAL XIA TITANIUM SUPRA LAMINAR RIGHT OFFSE C1713 $2,800.00 HORMONE PANEL ADRENAL GLAND ASSESSMENT 80406 $608.00 HORMONE PANEL FOR ADRENAL GLAND ASSESSMENT (21 HYD 80402 $675.00 HOSPITAL OBSERVATION SERVICE G0378 $185.00 HSV 1&2 BY NUCLEIC ACID AMPLIFICATION 87529 $716.00 HSV-1/2 AB IGM,SERUM 86694 $109.00 HSV-1/2 AB,IGG,SERUM 86694 $109.00 HSV-1/2 AB,IGM,CSF 86694 $109.00 HUMAN GROWTH HORMONE LEVEL 83003 $194.00 HUMAN T-LYMPHTROPHIC VIRUS 1/11 86790 $511.00 HYDRATION INFUSION INTO A VEIN 96361 $173.00 HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOU 96360 $681.00 HYDROCODONE-ACETAMINOPHEN 7.5-325 MG TAB 100 EACH $3.33 HYDROXYCORTICOSTEROIDS, 17 (ADRENAL GLAND HORMONE) 83491 $339.00 HYDROXYINDOLACETIC ACID (PRODUCT OF METABOLISM) LE 83497 $155.00 HYDROXYPROGESTERONE, 17-D (SYNTHETIC HORMONE) LEVE 83498 $342.00 I&D SHOULDER DEEP ABSCESS/HEMATOMA 23030 $6,541.00 ICTOTEST BILIRUBIN CONF, URINE 81002 $17.00 IDENTIFICATION OF MYCOBACTERIA (TB OR TB LIKE ORGA 87118 $225.00 IDENTIFICATION OF ORGANISM BY PULSE FIELD GEL TYPI 87152 $41.00 IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS 87153 $548.00 IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSI 87140 $450.00 IDENTIFICATION OF RED BLOOD CELL ANTIBODIES 86870 $1,043.00 IF INDIRECT ENDOMYSIAL 88346 $191.00 IGE (IMMUNE SYSTEM PROTEIN) LEVEL 82785 $273.00 IGF 1 INSULIN GROWTH FAC 1 84305 $267.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge IMAGING AND EVALUATION OF DEEP CELLS OF THE EYE 92287 $358.00 IMAGING BRAIN AND SPINAL CORD FLUID FLOW IN BRAIN 78635 $2,086.00 IMAGING FOR ABSCESS OR ABNORMAL DRAINAGE TRACT PRO 76080 $717.00 IMAGING FOR BONE AGE ASSESSMENT 77072 $255.00 IMAGING FOR BONE LENGTH ASSESSMENT 77073 $442.00 IMAGING FOR EVALUATION OF SWALLOWING FUNCTION 74230 $1,098.00 IMAGING FROM NOSE TO RECTUM, SINGLE VIEW, CHILD 76010 $288.00 IMAGING GUIDANCE FOR PROCEDURE, UP TO 1 HOUR 76000 $563.00 IMAGING OF 2 OR MORE JOINTS, SINGLE VIEW 77077 $1,011.00 IMAGING OF ABDOMEN AND CHEST 74022 $741.00 IMAGING OF ANOGENITAL REGION 74775 $943.00 IMAGING OF BLOOD VESSEL 75898 $2,704.00 IMAGING OF BLOOD VESSEL OF GLAND OF KIDNEY 78075 $3,201.00 IMAGING OF BONE MARROW LIMITED AREA 78102 $2,199.00 IMAGING OF BRAIN AND SPINAL CORD FLUID FLOW AT BAS 78630 $3,424.00 IMAGING OF BRAIN AND SPINAL CORD FLUID FLOW SHUNT 78645 $922.00 IMAGING OF BRAIN WITH BLOOD FLOW, LESS THAN 4 STAT 78601 $1,862.00 IMAGING OF COLON USING ENEMA 74283 $555.00 IMAGING OF DIGESTIVE TRACT DONE FROM THE INSIDE OF 91110 $2,503.00 IMAGING OF ESOPHAGUS USING RADIOISOTOPES 78258 $2,496.00 IMAGING OF KIDNEY 78700 $1,501.00 IMAGING OF LIVER AND BILE DUCT SYSTEM 78226 $1,537.00 IMAGING OF LIVER AND BILE DUCT SYSTEM WITH USE OF 78227 $2,049.00 IMAGING OF LIVER AND SPLEEN 78215 $1,813.00 IMAGING OF LIVER AND SPLEEN WITH BLOOD FLOW 78216 $1,401.00 IMAGING OF LYMPHATIC TISSUE AND LYMPH NODE 78195 $1,954.00 IMAGING OF PARATHYROID 78070 $1,774.00 IMAGING OF PARATHYROID WITH NUCLEAR MEDICINE STUDY 78071 $3,164.00 IMAGING OF SALIVARY GLAND 78230 $1,717.00 IMAGING OF URINARY TRACT 74420 $1,023.00 IMAGING OF URINARY TRACT WITH INJECTION OF CONTRAS 74400 $828.00 IMAGING OF VOICE BOX WITH SPEECH EVALUATION 70371 $553.00 IMMUN GLOB G(IGG)-GLY-IGA OV50 10 % SOLN 200 ML VI J1569 $7,362.00 IMMUNG PED PANEL (IGA,IGG,IGM) 82784 $141.00 IMMUNO QN AOMPC IGA 83520 $282.00 IMMUNOASSAY ANALYTE QUANT RIA 83519 $160.00 IMMUNOASSAY NI AGENT AB/AG NOS 83520 $348.00 IMMUNOASSAY NONANTIBODY 83516 $160.00 IMMUNOASSAY QN TRYPTASE 83520 $348.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge IMMUNOFIX ELECTROPHORESIS 86334 $357.00 IMMUNOGLOBULIN A 82784 $141.00 IMMUNOGLOBULIN A SUBCLASSES 82787 $232.00 IMMUNOGLOBULIN G 82784 $141.00 IMMUNOGLOBULIN M 82784 $141.00 IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE 86813 $178.00 IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE 86812 $205.00 IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE 86816 $216.00 IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE 86806 $369.00 IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE 86805 $1,145.00 IMMUNOLOGIC ANALYSIS FOR DETECTION OF ANTIGEN OR A 86331 $142.00 IMMUNOLOGIC ANALYSIS FOR DETECTION OF ORGANISM 87450 $36.00 IMMUNOLOGIC ANALYSIS FOR DETECTION OF ORGANISM 87451 $36.00 IMMUNOLOGIC ANALYSIS FOR DETECTION OF ORGANISM 87449 $702.00 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGE 86300 $62.00 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGE 86294 $90.00 IMMUNOLOGIC ANALYSIS TECHNIQUE 86327 $176.00 IMMUNOLOGIC ANALYSIS TECHNIQUE ON BODY FLUID 86325 $221.00 IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.9 L8600 $5,200.00 IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P5.5 C1789 $5,070.00 IMPLANT BREAST MEMORYGEL P3.4 CM MODERATE CLASSIC L8600 $5,070.00 IMPLANT BREAST NATRELLE INSPIRA 560 CC COHESIVE ST L8600 $6,370.00 IMPLANT NASAL PROPEL MOMETASONE FUROATE CONTOUR 37 C2625 $4,387.50 IMPLANT NASAL SPIROX LATERA POLY 70:30 COPOLYMER L $6,467.50 IMPLANT TOE JOINT TOETAC SMALL STERILE C1776 $7,064.20 IMPLANTATION OF HEART VALVE (PULMONARY) TO LUNGS, 33477 $42,346.00 INCISION AND DRAINAGE OF ABSCESS IN SCROTAL SAC OF 55100 $1,402.00 INCISION AND DRAINAGE OF EXTERNAL EAR ABSCESS OR B 69000 $1,436.00 INCISION AND DRAINAGE OF EYELID ABSCESS 67700 $790.00 INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSC 56420 $395.00 INCISION AND DRAINAGE OF FEMALE GENITALS ABSCESS 56405 $808.00 INCISION AND DRAINAGE OF SPERM RESERVOIR, TESTIS, 54700 $5,260.00 INCISION AND EXPLORATION OF CHEST CAVITY 32100 $3,946.00 INCISION OF ABSCESS, CYST, OR BLOOD ACCUMULATION I 40800 $1,576.00 INCISION OF ENGORGED EXTERNAL HEMORRHOID 46083 $485.00 INCISION OF EXTERNAL URINARY OPENING 53020 $2,704.00 INCISION OF EXTERNAL URINARY OPENING, INFANT 53025 $2,377.00 INCISION OF TISSUE CONNECTING TONGUE AND FLOOR OF 41010 $2,064.00 INCISION OF VEIN FOR INSERTION OF NEEDLE/CATHETER 36420 $112.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge INCISION, ASPIRATION, AND/OR INFLATION OF EARDRUM 69420 $998.00 INDUCTION OF ABNORMAL HEART RHYTHM BY SMALL ELECTR 93618 $2,766.00 INFLUENZA A ANTIBODIES, RAPID 86710 $72.00 INFLUENZA A ASSAY W/OPTIC 87804 $128.00 INFLUENZA B ASSAY W/OPTIC 87804 $128.00 INFRARED ANALYSIS OF STONE 82365 $262.00 INFUSION DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE 96417 $172.00 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR D 96366 $256.00 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR D 96365 $468.00 INFUSION INTO TISSUE FOR THERAPY OR PREVENTION UP 96369 $1,276.00 INFUSION INTO VEIN THERAPY PREVENTION/DIAGNOSIS AD 96367 $591.00 INFUSION INTO VEIN THERAPY PREVENTION/DIAGNOSIS CO 96368 $852.00 INFUSION OF CHEMOTHERAPY INTO A VEIN 96415 $378.00 INFUSION OF CHEMOTHERAPY INTO A VEIN UP TO 1 HOUR 96413 $1,276.00 INFUSION OF CHEMOTHERAPY INTO A VEIN USING PUSH TE 96409 $667.00 INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTAN 96411 $172.00 INFUSION OF DRUG INTO VEIN TO DISSOLVE BLOOD CLOT 37195 $1,553.00 INFUSION OF DRUG INTO VEIN TO DISSOLVE CORONARY BL 92977 $836.00 INGESTION OF TEST ITEMS FOR ALLERGIES 95079 $543.00 INGESTION OF TEST ITEMS FOR ALLERGIES, 120 MINUTES 95076 $965.00 INHALED PNEUMONIA TREATMENT 94642 $377.00 INITIATION & MANAGEMENT CONTINUED PRESSURED RESPIR 94660 $2,361.00 INITIATION OF EXTERNAL VEIN TO ARTERY BLOOD CIRCUL 33947 $14,335.00 INITIATION OF EXTERNAL VEIN TO VEIN BLOOD CIRCULAT 33946 $14,335.00 INJECT CHEMICAL DESTRUCTION OF SALIVARY GLANDS ON 64611 $673.00 INJECT CHEMICAL FOR DESTRUCTION NERVE MUSCLE ON AR 64645 $1,217.00 INJECT CHEMICAL FOR DESTRUCTION NERVE MUSCLE ON AR 64644 $2,446.00 INJECT CHEMICAL FOR DESTRUCTION OF FACIAL & NECK N 64615 $673.00 INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64616 $673.00 INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64643 $1,185.00 INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64646 $1,185.00 INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64647 $1,217.00 INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64642 $2,370.00 INJECT FOR X-RAY IMAGE OF HEART VESSEL GRAFTS DURI 93564 $850.00 INJECT FOR X-RAY IMAGING HEART BLOOD VESSEL DEFECT 93563 $7,540.00 INJECT OF BILE DUCT FOR X-RAY IMAGING PROCEDURE AC 47531 $8,006.00 INJECT OF DIFFERENT DRUG/SUBSTANCE INTO VEIN THERA 96375 $342.00 INJECT OF DRUG/SUBSTANCE INTO VEIN THERAPY/DIAGNOS 96376 $233.00 INJECT PROCEDURE FOR X-RAY IMAGING OF KIDNEY AND U 50430 $1,099.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge INJECT PROCEDURE THROUGH THE BLADDER AND BLADDER C 51610 $952.00 INJECTION BENEATH SKIN OR INTO MUSCLE FOR THERAPY 96372 $256.00 INJECTION DRUG OR SUBSTANCE INTO A VEIN FOR THERAP 96374 $342.00 INJECTION FOR X-RAY IMAGING OF AORTA ABOVE HEART V 93567 $986.00 INJECTION FOR X-RAY IMAGING OF LEFT UPPER OR LOWER 93565 $320.00 INJECTION FOR X-RAY IMAGING OF PULMONARY (LUNG) AR 93568 $320.00 INJECTION FOR X-RAY IMAGING OF RIGHT UPPER OR LOWE 93566 $352.00 INJECTION FOR X-RAY IMAGING PROCEDURE ON VEINS OF 36005 $335.00 INJECTION OF ABNORMAL MUSCLE DRAINAGE TRACT FOR X- 20501 $936.00 INJECTION OF ALLERGENIC EXTRACTS INTO SKIN FOR IMM 95024 $120.00 INJECTION OF ALLERGENIC EXTRACTS INTO SKIN WITH DE 95028 $120.00 INJECTION OF ALLERGENIC EXTRACTS INTO SKIN, ACCESS 95004 $1,223.00 INJECTION OF ANESTHETIC AGENT, GREATER OCCIPITAL N 64405 $1,078.00 INJECTION OF ANESTHETIC AGENT, OTHER PERIPHERAL NE 64450 $1,351.00 INJECTION OF ANESTHETIC AGENT, TRIGEMINAL NERVE 64400 $615.00 INJECTION OF BLADDER AND URINARY DUCT (URETER) FOR 50690 $952.00 INJECTION OF BLOOD OR BLOOD CLOT INTO SPINAL CANAL 62273 $2,282.00 INJECTION OF CARPAL TUNNEL 20526 $758.00 INJECTION OF CHEMICAL FOR DESTRUCTION OF NERVE MUS 64612 $1,002.00 INJECTION OF CONTRAST FOR X-RAY IMAGING OF TEAR SA 68850 $477.00 INJECTION OF CONTRAST THROUGH ABDOMINAL CAVITY CAT 49424 $361.00 INJECTION OF DILATED VEINS OF STOMACH AND/OR ESOPH 43243 $6,589.00 INJECTION OF DRUG INTO ERECTILE TISSUE AT SIDES AN 54220 $706.00 INJECTION OF DYE FOR X-RAY IMAGING OF ELBOW JOINT 24220 $635.00 INJECTION OF DYE FOR X-RAY IMAGING OF HIP JOINT 27093 $897.00 INJECTION OF DYE FOR X-RAY IMAGING OF SHOULDER JOI 23350 $427.00 INJECTION OF DYE FOR X-RAY IMAGING OF WRIST JOINT 25246 $854.00 INJECTION OF DYE FOR X-RAY OF SALIVARY GLANDS 42550 $164.00 INJECTION OF INCREMENTAL DOSAGES OF ALLERGEN 95115 $131.00 INJECTION OF INCREMENTAL DOSAGES OF ALLERGEN, 2 OR 95117 $131.00 INJECTION OF MORE THAN 7 SKIN GROWTHS 11901 $264.00 INJECTION OF RADIOACTIVE DYE FOR X-RAY IDENTIFICAT 38792 $2,155.00 INJECTION OF UP TO 7 SKIN GROWTHS 11900 $959.00 INJECTION PROCEDURE FOR X-RAY IMAGING OF THE BLADD 51600 $635.00 INJECTION PROCEDURE TO INDUCE ERECTION 54235 $251.00 INJECTIONS ESOPHAGUS, STOMACH, AND/OR UPPER SMALL 43236 $3,819.00 INJECTIONS INTO LARGE BOWEL USING AN ENDOSCOPE 45335 $2,392.00 INJECTIONS OF TENDON ATTACHMENT TO BONE 20551 $675.00 INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE M 20550 $518.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge INJECTIONS OF TRIGGER POINTS IN 1 OR 2 MUSCLES 20552 $631.00 INJECTIONS OF TRIGGER POINTS IN 3 OR MORE MUSCLES 20553 $1,040.00 INSERT ACETABULAR ADM MDM MOBILE BEARING HIP X3 H9 C1776 $4,582.50 INSERT ARTERIAL CATHETER FOR BLOOD SAMPLE OR INFUS 36620 $313.00 INSERT ARTICULAR NEXGEN ZIMALOY UHMWPE 2-6 C L64 M C1776 $11,537.50 INSERT ARTICULAR PERSONA POLYETHYLENE 6-9 CD H11 M C1776 $3,250.00 INSERT ARTICULAR PERSONA POLYETHYLENE 7-12 G-H H12 C1776 $3,250.00 INSERT ARTICULAR PERSONA VIVACIT-E 8-9 C-D H12 MM C1776 $5,850.00 INSERT CATHETER FOR RECORDING AND PACING RIGHT UPP 93619 $16,745.00 INSERT CATHETER HEART CHAMBERS FOR EVALUATION OF C 93532 $13,955.00 INSERT CATHETER HEART CHAMBERS FOR EVALUATION OF C 93533 $15,866.00 INSERT CATHETER IN RIGHT HEART FOR X-RAY IMAGING O 93456 $7,935.00 INSERT CATHETER INTO HEART CHAMBERS FOR EVAL OF CO 93531 $7,729.00 INSERT CATHETER LEFT HEART IMAGING BLOOD VESSELS/G 93458 $7,935.00 INSERT CATHETER RIGHT & LEFT HEART IMAG BLOOD VESS 93460 $7,935.00 INSERT CATHETER RIGHT UPPER HEART CHAMBER EVALUATI 93530 $7,256.00 INSERT CATHETERS ASSESS HEART PACING REC OR ATTEMP 93624 $13,395.00 INSERT CATHETERS FOR RECORD PACE & ATTEMPTED INDUC 93621 $3,036.00 INSERT CATHETERS FOR RECORD PACE & ATTEMPTED INDUC 93620 $13,311.00 INSERT CATHETERS FOR RECORDING PACE & ATTEMPTED IN 93622 $3,036.00 INSERT CATHETERS INTO MAIN & ACCESSORY ARTERIES OF 36252 $19,500.00 INSERT CATHETERS INTO MAIN AND ACCESSORY ARTERIES 36251 $19,500.00 INSERT CENTRAL VENOUS CATHETER & IMPLANTED DEVICE 36561 $7,459.00 INSERT DEVICE INTO ABDOMEN WITH MEASUREMENT OF PRE 51797 $631.00 INSERT ELECTRONIC DEVICE INTO BLADDER W/MEASUREMEN 51726 $2,403.00 INSERT ELECTRONIC DEVICE INTO BLADDER W/VOID & BLA 51729 $800.00 INSERT INTRAVASCULAR STENTS IN ARTERY OPEN OR ACCE 37237 $7,142.00 INSERT INTRAVASCULAR STENTS IN ARTERY OPEN OR ACCE 37236 $10,778.00 INSERT INTRAVASCULAR STENTS IN VEIN OPEN OR ACCESS 37239 $7,142.00 INSERT INTRAVASCULAR STENTS IN VEIN OPEN OR ACCESS 37238 $10,778.00 INSERT LARGE BOWEL TUBE 49442 $3,832.00 INSERT LEFT HEART ELECTRODE W/ATTACHMENT PACEMKR/P 33224 $52,185.00 INSERT NEEDLES & SKIN ELECTRODES FOR MEASUREMENT & 95938 $9,321.00 INSERT NEEDLES & SKIN ELECTRODES MEASURE & REC STI 95939 $2,248.00 INSERT NEEDLES & SKIN ELECTRODES MEASURE & REC STI 95926 $4,835.00 INSERT NEW/REPLACEMENT PERMANENT PACEMKR W/UPPER & 33208 $27,261.00 INSERT PROBE IN ESOPHAGUS FOR CONGENITAL HEART ULT 93315 $1,339.00 INSERT PROBE IN ESOPHAGUS FOR HEART ULTRASOUND EXA 93312 $2,414.00 INSERT PROBE INTO ESOPHAGUS FOR RECORD & PACE UPPE 93616 $2,766.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge INSERT PROBE INTO ESOPHAGUS FOR RECORD OF ELECTRIC 93615 $2,766.00 INSERT SCREW HOLE LISS TITANIUM L5 MM FEMORAL C1713 $676.16 INSERT TIBIAL ATTUNE AOX 3 H20 MM KNEE POSTERIOR S C1776 $4,550.00 INSERT TIBIAL ATTUNE AOX 4 H6 MM KNEE CRUCIATE RET C1776 $3,900.00 INSERT TIBIAL ATTUNE AOX 5 H6 MM KNEE CRUCIATE RET C1776 $4,800.00 INSERT TIBIAL ATTUNE AOX 6 H7 MM KNEE CRUCIATE RET C1776 $4,800.00 INSERT TIBIAL ATTUNE AOX 7 H5 MM KNEE CRUCIATE RET C1776 $3,900.00 INSERT TIBIAL GMK 3 H14 MM KNEE FIXED REVISION SEM C1776 $7,800.00 INSERT TIBIAL GMK 4 H12 MM LEFT FIXED SPHERE FLEX C1776 $4,550.00 INSERT TIBIAL GMK 4 H14 MM RIGHT FIXED SPHERE FLEX C1776 $4,550.00 INSERT TIBIAL GMK 5 H23 MM KNEE FIXED REVISION SEM C1776 $7,800.00 INSERT TIBIAL GMK HINGE 4 H17 MM FIXED BEARING NON C1776 $11,736.73 INSERT TIBIAL GMK THK13 MM 2 SPHERE LEFT FLEXIBLE C1776 $4,550.00 INSERT TIBIAL OPTETRAK LOGIC 1.5 NEUTRAL H15 MM KN C1776 $3,900.00 INSERT TIBIAL OPTETRAK LOGIC 5 NEUTRAL H13 MM KNEE C1776 $3,900.00 INSERT TIBIAL OPTETRAK LOGIC 6 NEUTRAL H13 MM KNEE C1776 $3,900.00 INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 2.5 H13 MM C1776 $3,900.00 INSERT TIBIAL PFC SIGMA TC3 UHMWPE 2.5 H17.5 MM KN C1776 $8,775.00 INSERT TIBIAL PFC SIGMA XLK 3 H10 MM KNEE FIX BEAR C1776 $3,900.00 INSERT TIBIAL SIGMA TC3 GVF UHMWPE 3 H12.5 MM KNEE C1776 $10,848.50 INSERT TIBIAL SIGMA TC3 GVF UHMWPE 3 H17.5 MM KNEE C1776 $10,848.50 INSERT TIBIAL TRIATHLON X3 1 H9 MM KNEE CONDYLAR S C1776 $3,900.00 INSERT TIBIAL TRIATHLON X3 7 H11 MM KNEE CRUCIATE C1776 $3,900.00 INSERTION CATHETER FOR RECORDING TO IDENTIFY ORIGI 93609 $3,795.00 INSERTION CATHETERS FOR 3D MAPPING OF ELECTRICAL I 93613 $3,795.00 INSERTION CENTRAL VENOUS CATHETER FOR INFUSION PAT 36555 $4,479.00 INSERTION DILATOR DEVICE INTO CERVIX 59200 $603.00 INSERTION ELECTRODE FOR PERMANENT PACEMAKER OR PAC 33216 $12,513.00 INSERTION NEEDLE INTO UPPER LEG OR NECK VEIN, PATI 36400 $42.00 INSERTION OF CATHETER FOR DIAGNOSTIC EVALUATION OF 93451 $7,935.00 INSERTION OF CATHETER FOR IMAGING OF HEART BLOOD V 93454 $7,738.00 INSERTION OF CATHETER FOR RECORDING OF RIGHT LOWER 93603 $4,130.00 INSERTION OF CATHETER FOR RECORDING UPPER HEART RH 93600 $14,615.00 INSERTION OF CATHETER FOR SUCTION OF SECRETIONS 31720 $189.00 INSERTION OF CATHETER INTO ARTERY FOR DRUG INFUSIO 37211 $5,016.00 INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSI 93452 $7,540.00 INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSI 93462 $8,333.00 INSERTION OF CATHETER INTO RIGHT AND LEFT HEART FO 93453 $7,935.00 INSERTION OF CATHETER INTO VEIN FOR DRUG INFUSION 37212 $5,016.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge INSERTION OF CATHETER INTO VEIN WITH COLLECTION OF 36500 $2,194.00 INSERTION OF CATHETER OR TUBE IN ESOPHAGUS STOMACH 43241 $3,562.00 INSERTION OF CATHETERS FOR CREATION OF COMPLETE HE 93650 $13,395.00 INSERTION OF CATHETERS FOR TREATMENT OF ABNORMAL H 93655 $13,393.00 INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, 36569 $2,096.00 INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, 36556 $3,251.00 INSERTION OF DRUG DELIVERY IMPLANT INTO TISSUE 11981 $959.00 INSERTION OF ELECTRONIC DEVICE INTO BLADDER WITH V 51728 $2,403.00 INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS 43248 $3,562.00 INSERTION OF INDWELLING BLADDER CATHETER 51702 $119.00 INSERTION OF INDWELLING BLADDER CATHETER 51703 $336.00 INSERTION OF LEFT HEART ELECTRODE FOR PACING DEFIB 33225 $52,185.00 INSERTION OF NASAL OR ORAL STOMACH TUBE USING FLUO 43752 $792.00 INSERTION OF NEEDLE FOR INFUSION INTO BONE 36680 $422.00 INSERTION OF NEEDLE INTO SCALP VEIN, PATIENT YOUNG 36405 $42.00 INSERTION OF NEEDLE INTO VEIN, PATIENT 3 YEARS OR 36410 $42.00 INSERTION OF NEEDLE INTO VEIN, PATIENT YOUNGER THA 36406 $42.00 INSERTION OF NEEDLE OR CATHETER INTO A VEIN 36000 $173.00 INSERTION OF PACEMAKER PULSE GENERATOR WITH EXISTI 33212 $25,095.00 INSERTION OF PACEMAKER PULSE GENERATOR WITH EXISTI 33213 $27,654.00 INSERTION OF PACING DEFIBRILLATOR PULSE GENERATOR 33240 $70,803.00 INSERTION OF PACING DEFIBRILLATOR PULSE GENERATOR 33230 $73,640.00 INSERTION OF PROBE IN ESOPHAGUS FOR HEART ULTRASOU 93355 $2,749.00 INSERTION OF PROBE INTO THE TEAR DUCT 68810 $856.00 INSERTION OF STOMACH TUBE AND ASPIRATIONS OF GASTR 43753 $586.00 INSERTION OF STOMACH TUBE USING AN ENDOSCOPE 43246 $9,189.00 INSERTION OF TEMPORARY BLADDER CATHETER 51701 $144.00 INSERTION OF VENA CAVA FILTER BY ENDOVASCULAR APPR 37191 $13,184.00 INSERTION OR REPLACEMENT PERMANENT PACEMAKER AND L 33207 $30,394.00 INSERTION OR REPLACEMENT PERMANENT PACEMAKER AND U 33206 $30,394.00 INSERTION OR REPLACEMENT SINGLE OR DUAL CHAMBER PA 33249 $89,609.00 INSERTION PACING DEFIBRILLATOR PULSE GENERATOR WIT 33231 $76,478.00 INSERTION PICC W/RS&I 5 YR/> 31648 $5,808.00 INSERTION SPHENOIDAL ELECTRODES EEG PHYS/QHP 95830 $694.00 INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG 33285 $20,362.00 INSERTION TEMPORARY PACEMAKER ELECTRODE FOR DIAGNO 93610 $14,018.00 INSERTION TEMPORARY PACEMAKER ELECTRODE FOR DIAGNO 93612 $14,018.00 INSTRUMENT BASED EYE SCREENING OF BOTH EYES 99174 $21.00 INSULIN ANTIBODY MEASUREMENT 86337 $357.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge INSULIN MEASUREMENT 83525 $152.00 INSULIN TOLERANCE PANEL FOR ACTH (ADRENAL GLAND HO 80434 $785.00 INSULIN TOLERANCE PANEL FOR GROWTH HORMONE DEFICIE 80435 $800.00 INSULIN, RANDOM TEST 83525 $152.00 INSULIN-INDUCED C-PEPTIDE (PROTEIN) SUPPRESSION PA 80432 $1,048.00 INTACT PARATHYROID 83970 $478.00 INTERACTIVE COMPLEXITY 90785 $275.00 INTERNAL SHOCK TO HEART TO REGULATE HEART BEAT 92961 $1,410.00 INTERPRETATION AND REPORT OF GENETIC TESTING 88291 $231.00 INTESTINE IMAGING 78290 $1,795.00 INTRAOPERATIVE NEUROPHYSIOLOGY MONITORING G0453 $285.00 INTRINSIC FACTOR (STOMACH PROTEIN) ANTIBODY MEASUR 86340 $343.00 INTRINSIC FACTOR (STOMACH PROTEIN) LEVEL 83528 $124.00 INTRODUCER CATHETER PTFE L13 CM OD8 FR PERCUTANEOU C1894 $720.00 INTRODUCER SHEATH AVANTI+ MINI L23 CM OD11 FR ENDO C1894 $299.00 INTRODUCER SHEATH AVANTI+ MINI L23 CM OD7 FR ENDOV C1894 $1,225.00 INTRODUCER SHEATH CORDIS AVANTI+ SLIX MID LENGTH L C1894 $52.00 INTRODUCER SHEATH CORDIS AVANTI+ STANDARD LENGTH L C1894 $260.00 INTRODUCER SHEATH FAST-CATH SWARTZ .032 IN L180 CM C1893 $720.00 INTRODUCER SPINAL VEPTR II CRADLE NONSTERILE $3,352.00 INTRODUCTION OF CATHETER INTO THE UPPER OR LOWER M 36010 $2,250.00 INVITAE PRIMARY IMMUNODEFICIENCY PANEL 81479 $4,320.00 IRON BINDING CAPACITY 83550 $97.00 IRON, SERUM 83540 $196.00 IRRADIATION OF BLOOD PRODUCT, EACH UNIT 86945 $172.00 IRRIGATION OF ABDOMINAL CAVITY 49084 $2,906.00 IRRIGATOR SUCTION DA VINCI SI ENDOWRIST ONE OD8 MM $1,430.00 ISLET CELL AB, IGG 86341 $292.00 ISOCITRIC DEHYDROGENASE (ENZYME) LEVEL 83570 $68.00 ITE HEARING AID BINAURAL V5130 $4,546.00 ITE HEARING AID MONAURAL V5050 $2,275.00 JOINT EXTERNAL FIXATION LARGE COMPOSITE HINGE $5,283.60 KETONE BODIES ANALYSIS 82010 $90.00 KIDNEY ACQUISITION $69,899.00 KIDNEY TRANSPLANT $99,211.00 KIT ACCESSORY ADVANCE POLYPROPYLENE MALE SUBURETHR C1771 $29,478.09 KIT ARTHROSCOPIC FIXATION JUGGERKNOT CURVE OD1.5 M $1,524.90 KIT ARTHROSCOPIC FIXATION TIGHTROPE STAINLESS STEE $5,720.00 KIT BONE GRAFT EQUIVABONE DEMINERALIZED BONE MATRI $13,800.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge KIT CATHETER CHOICE-PAK PRO-FLO OD7 FR SOFT TIP LA $411.13 KIT CATHETER PLEURX PERITONEAL C1729 $3,542.50 KIT EMBOLIC PROTECTION CORDIS TRAPEASE NITINOL L55 C1880 $3,000.00 KIT EXERCISE ANKLE DELUXE DOOR STRAP TUBING $598.00 KIT EXTERNAL DRAINAGE ID1.9 MM VENTRICULAR C1729 $514.50 KIT INTRAMEDULLARY NAIL GAMMA TITANIUM 125 D LONG $9,750.00 KIT INTRODUCER GLIDESHEATH SLENDER PLASTIC .021 IN C1894 $583.38 KIT MICROINTRODUCER VSI STAINLESS STEEL .018 IN TA C1894 $53.85 KIT NEUROSTIMULATOR QUATTRODE L60 CM 4 CHANNEL TRI C1897 $3,900.00 KIT NEUROSTIMULATOR SAFESHEATH II OD12.5 FR $1,690.00 KIT OCCULT BLOOD TEST HEMOCCULT II DISPENSAPAK PLU $622.77 KIT PEG MIC SECUR-LOK SILICONE OD20 FR PULL METHOD $350.00 KIT PERICARDIOCENTESIS 11 PIGTAIL SPIRAL L60 CM OD C1729 $474.30 KIT SNARE AMPLATZ GOOSENECK NITINOL L120 CM L102 C C1773 $1,325.00 KIT SNARE AMPLATZ GOOSENECK NITINOL TUNGSTEN GOLD $3,150.00 KIT SNARE ATRIEVE VASCULAR SNARE NITINOL PLATINUM C1773 $2,800.00 KIT SPINAL XLIF NEUROVISION DILATOR DISPOSABLE M5 $5,844.74 KIT SURGICAL CARDIOVASCULAR STERILE LATEX DISPOSAB $3,802.50 KIT SUTURE FIBERLOOP OD3.2 MM DRILL PIN NEEDLE SHO $4,387.50 KIT TISSUE CLOSURE DUO TISSEEL 4 ML LATEX FREE $1,925.04 LABCORP 5-HIAA 83497 $155.00 LABCORP ACETYLCHOLINESTERASE 82013 $86.00 LABCORP ACTIVATED PROTEIN C RESISTANCE ASSAY 85307 $446.00 LABCORP ADENOVIRUS ANTIGEN INFECTIOUS AGENT IMMUNO 87301 $130.00 LABCORP AFB BY ID DNA PROBE 87149 $237.00 LABCORP AG DETECT LEGIONELLA EIA, URINE 87449 $702.00 LABCORP ALDOLASE 82085 $203.00 LABCORP ALKALINE PHOSPHATASE 84075 $161.00 LABCORP ALKALINE PHOSPHATASE ISOENZYME 84080 $212.00 LABCORP ALLERGEN 86003 $96.00 LABCORP ALPHA FETOPROTEIN AMNIOTIC 82106 $136.00 LABCORP ALPHA FETOPROTEIN, TUMOR MARKER 82105 $422.00 LABCORP ALPHA-1 ANTITRYPSIN 82104 $219.00 LABCORP ALPHA-1 ANTITRYPSIN 82103 $246.00 LABCORP ALUMINUM 82108 $273.00 LABCORP AMIKACIN - PEAK 80150 $328.00 LABCORP AMIKACIN - RANDOM 80150 $328.00 LABCORP AMIKACIN - TROUGH 80150 $328.00 LABCORP AMIODARONE 80299 $395.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP AMITRIPTYLINE AND NORTRIPTYLINE 80335 $288.00 LABCORP AMYLASE ISOENZYMES 82150 $226.00 LABCORP ANDROSTENEDIONE 82157 $348.00 LABCORP ANTIMYOCARDIAL AB 86256 $111.00 LABCORP ANTINUCLEAR ANTIBODY SCREEN 86038 $241.00 LABCORP ANTISTREPTOLYSIN O 86060 $348.00 LABCORP ANTITHROMBIN III ACTIVITY 85300 $383.00 LABCORP ARSENIC 82175 $56.00 LABCORP ARSENIC URINE 82175 $56.00 LABCORP B2 GLYCOPROTEIN AB IGA 86146 $367.00 LABCORP B2 GLYCOPROTEIN AB IGG 86146 $367.00 LABCORP B2 GLYCOPROTEIN AB IGM 86146 $367.00 LABCORP BARTONELLA ANTIBODY (CAT SCRATCH) 86611 $48.00 LABCORP BETA-2 MICROGLOBULIN 82232 $208.00 LABCORP BILE ACIDS 82239 $699.00 LABCORP BIOTINIDASE 82261 $401.00 LABCORP BK VIRUS 87799 $678.00 LABCORP BK VIRUS URINE 87799 $678.00 LABCORP BLASTOMYCES ANTIBODY 86612 $273.00 LABCORP BRUCELLA ANTIBODY 86622 $119.00 LABCORP C. DIFF TOXIN AG 87324 $236.00 LABCORP C1 ESTERASE INHIBITOR 86160 $174.00 LABCORP CA 125 86304 $273.00 LABCORP CA 19 9 86301 $71.00 LABCORP CADMIUM 82300 $180.00 LABCORP CADMIUM URINE 82300 $180.00 LABCORP CAFFEINE THERAPUTIC DRUG ANALYSIS 80155 $194.00 LABCORP CALCITONIN 82308 $481.00 LABCORP CALCIUM IONIZED 82330 $114.00 LABCORP CARBAMAZEPINE 80156 $305.00 LABCORP CAROTENE 82380 $342.00 LABCORP CATECHOLAMINES FRACTION 82384 $309.00 LABCORP CATECHOLAMINES FRACTION URINE 82384 $309.00 LABCORP CEA CARCINOEMBRYONIC ANTIG 82378 $305.00 LABCORP CHLAMYDIA ANTIBODY IGG 86631 $54.00 LABCORP CHLAMYDIA ANTIBODY IGM 86632 $58.00 LABCORP CLOMIPRAMINE 80335 $288.00 LABCORP CLONAZEPAM LEVEL 80346 $471.00 LABCORP CLOZAPINE (CLOZARIL) 80159 $333.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP COAGULATION/FIBRINOLYSIS EA ANALYTE 85397 $612.00 LABCORP COLD AGGLUTININ TITER 86157 $270.00 LABCORP COMPLEMENT C1Q 86160 $174.00 LABCORP COMPLEMENT C2 86160 $174.00 LABCORP COMPLEMENT C3 86160 $174.00 LABCORP COMPLEMENT C5 86160 $174.00 LABCORP COMPLEMENT C6 86160 $174.00 LABCORP COMPLEMENT TOTAL 86162 $369.00 LABCORP COMPLIMENT C8 86160 $174.00 LABCORP CORTISOL FREE, URINE 82530 $72.00 LABCORP CORTISOL LC/MS 82533 $385.00 LABCORP CORTISOL, AM 82533 $385.00 LABCORP CORTISOL, PM 82533 $385.00 LABCORP C-PEPTIDE 84681 $276.00 LABCORP C-REACTIVE PROTEIN 86140 $224.00 LABCORP C-REACTIVE PROTEIN HIGH SENSITIVITY 86141 $262.00 LABCORP CREATINE KINASE (CK) ISOENZYME 82552 $255.00 LABCORP CREATINE KINASE (CPK) 82550 $190.00 LABCORP CREATININE URINE 82570 $74.00 LABCORP CRYOGLOBULIN 82595 $29.00 LABCORP CRYPTOCOCCUS ANTIGEN CSF 87899 $114.00 LABCORP CRYPTOCOCCUS ANTIGEN TITER CSF 87449 $702.00 LABCORP CULTURE AFB 87116 $321.00 LABCORP CULTURE AFB 87116 $450.00 LABCORP CULTURE CMV 87254 $450.00 LABCORP CULTURE FUNGUS 87101 $244.00 LABCORP CULTURE FUNGUS BLOOD 87103 $302.00 LABCORP CULTURE STOOL 87045 $119.00 LABCORP CULTURE STOOL ADDITIONAL 87046 $83.00 LABCORP CULTURE VIRUS 87252 $450.00 LABCORP CYCLIC CITRUL PEPTIDE (CCP) ANTIBODY 86200 $122.00 LABCORP CYCLOSPORA SMEAR 87206 $143.00 LABCORP CYCLOSPORINE 80158 $395.00 LABCORP CYSTINE URINE 24 HOUR 82131 $223.00 LABCORP CYTOMEGALOVIRUS AB IGG 86644 $62.00 LABCORP CYTOMEGALOVIRUS AB IGM 86645 $148.00 LABCORP CYTOMEGALOVIRUS NUCLEIC ACID PROBE AMPLIFI 87496 $228.00 LABCORP CYTOMEGALOVIRUS QUANTITATIVBE NUCLEIC ACID 87497 $828.00 LABCORP DEOXYRIBONUCLEASE ANTIBODY 86215 $53.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP DHEA-S 82627 $298.00 LABCORP DRUG TEST PRESUMPTIVE 80307 $706.00 LABCORP DS DNA AB 86225 $216.00 LABCORP EBV AB VCA IGG 86665 $252.00 LABCORP EBV AB VCA IGM 86665 $252.00 LABCORP ECHINOCOCCUS AB IGG 86682 $193.00 LABCORP EOSINOPHIL URINE 87205 $102.00 LABCORP ERYTHROPOIETIN 82668 $273.00 LABCORP ESTRADIOL 82670 $481.00 LABCORP ESTRIOL 82677 $201.00 LABCORP ETHOSUXIMIDE 80168 $217.00 LABCORP F5 (COAGULATION FACTOR V) GENE LEIDEN VARI 81241 $449.00 LABCORP F-ACTIN AB IGG 83516 $160.00 LABCORP FACTOR 9 ASSAY 85250 $239.00 LABCORP FACTOR VII STABLE FACTOR 85230 $440.00 LABCORP FACTOR VIII ASSAY 85240 $397.00 LABCORP FACTOR X STUART PROWER 85260 $279.00 LABCORP FACTOR XI ASSAY 85270 $306.00 LABCORP FAT QUALITATIVE FECES 82705 $114.00 LABCORP FAT QUANTITATIVE FECES 82710 $262.00 LABCORP FDP/FSP AGGLUTINATION SEMIQUANTITATIVE 85362 $291.00 LABCORP FELBAMATE 80339 $244.00 LABCORP FERRITIN 82728 $253.00 LABCORP FLOW CYTOMETRY 2 TO 8 MARKERS, INTERP 88187 $166.00 LABCORP FLUOR AB SCR ADRENAL AB 86255 $287.00 LABCORP FLUOXETINE 80332 $244.00 LABCORP FOLIC ACID 82746 $224.00 LABCORP FOLIC ACID RBC 82747 $53.00 LABCORP FREE LIGHT CHAIN, SERUM 83883 $282.00 LABCORP FSH 83001 $365.00 LABCORP G6-PD QUANT 82955 $160.00 LABCORP GABAPENTIN BLD/SRM/PLASMA THERAPUTIC DRUG 80171 $65.00 LABCORP GASTRIN 82941 $294.00 LABCORP GENTAMICIN THERAPEUTIC DRUG ANALYSIS - PEA 80170 $328.00 LABCORP GENTAMICIN THERAPEUTIC DRUG ANALYSIS - TRO 80170 $328.00 LABCORP GGT (GLUTAMYLTRANSFERASE GAMMA) 82977 $195.00 LABCORP GIARDIA ANTIGEN 87329 $140.00 LABCORP GLUCAGON 82943 $350.00 LABCORP GLUCOSE BODY FLUID 82945 $116.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP GLUTAMIC ACID DECARBOXYLASE AB 83516 $160.00 LABCORP GROWTH HORMONE 83003 $194.00 LABCORP H PYLORI ANTIBODY IGA 86677 $180.00 LABCORP H PYLORI ANTIBODY IGG 86677 $180.00 LABCORP H PYLORI ANTIBODY IGM 86677 $180.00 LABCORP HAPTOGLOBIN QUANT 83010 $242.00 LABCORP HCG QUANTITATIVE TUMOR MARKER 84702 $151.00 LABCORP HEMATOCRIT 85014 $384.00 LABCORP HEMOGLOBIN CHROMATOGRAPHY 83021 $171.00 LABCORP HEP A AB, IGM 86709 $48.00 LABCORP HEP B SURF ANTIGEN CONFIRM 87341 $74.00 LABCORP HEP B SURFACE AB 86706 $48.00 LABCORP HEPARIN ASSAY 85520 $548.00 LABCORP HEPATITIS A (HAAB) ANTIBODY 86708 $239.00 LABCORP HEPATITIS B CORE AB IGM 86705 $364.00 LABCORP HEPATITIS B CORE ANTIBODY TOTAL 86704 $70.00 LABCORP HEPATITIS B QUANTATIVE NUCLEIC ACID PROBE 87517 $531.00 LABCORP HEPATITIS BE ANTIBODY 86707 $48.00 LABCORP HEPATITIS BE ANTIGEN INFECTIOUS AGENT IMMU 87350 $85.00 LABCORP HEPATITIS C AB 86803 $249.00 LABCORP HERPES (HSV) NUCLEIC ACID PROBE AMPLIFIED 87529 $716.00 LABCORP HERPES SIMPLEX TYPE 2 ANTIBODY 86696 $82.00 LABCORP HGB A2 83021 $171.00 LABCORP HGB LCA INTERP 85660 $84.00 LABCORP HISTOPLASMA AG 87385 $388.00 LABCORP HISTOPLASMA ANTIBODY 86698 $330.00 LABCORP HIV 1 ANTIBODY???????????????????????????? 86701 $289.00 LABCORP HIV 2 ANTIBODY???????????????????????????? 86702 $82.00 LABCORP HIV GENOTYPE ANALYSIS BY DNA OR RNA 87901 $1,101.00 LABCORP HIV PHENOTYPE W/CULTURE 87903 $2,115.00 LABCORP HIV PHENOTYPE W/CULTURE ADDITIONAL 87904 $169.00 LABCORP HIV1 NUCLEIC ACID PROBE AMPLIFIED 87535 $855.00 LABCORP HIV1 QNT PCR 87536 $514.00 LABCORP HOMOCYSTEIN 83090 $119.00 LABCORP HSV 1 AB IGG 86695 $51.00 LABCORP HSV 1/2 AB IGM 86694 $109.00 LABCORP HSV 1/2 AB IGM CSF 86694 $109.00 LABCORP IGE GAMMAGLOBULIN 82785 $273.00 LABCORP IGH/BCL2 FISH 88366 $1,929.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP IMIPRAMINE 80335 $288.00 LABCORP IMMUNOGLOBULIN A 82784 $141.00 LABCORP IMMUNOGLOBULIN G 82784 $141.00 LABCORP IMMUNOGLOBULIN M 82784 $141.00 LABCORP INSULIN ANTIBODY 86337 $357.00 LABCORP INTRINSIC FACTOR ANTIBODY 86340 $343.00 LABCORP IRON 83540 $196.00 LABCORP KOH SMEAR FLUORESCENT/ACID STAIN 87206 $143.00 LABCORP LACTATE DEHYDROGENASE (LDH) 83615 $237.00 LABCORP LAMOTRIGINE (LAMICTAL) 80175 $220.00 LABCORP LD BLOOD 83615 $237.00 LABCORP LD ISOENZYME 83625 $311.00 LABCORP LEAD BLOOD 83655 $133.00 LABCORP LEAD URINE 83655 $133.00 LABCORP LEAD WHOLE BLOOD 83655 $133.00 LABCORP LEGIONELLA ANTIBODY 86713 $318.00 LABCORP LEVETIRACETAM (KEPRA) 80177 $220.00 LABCORP LIDOCAINE 80176 $225.00 LABCORP LIPASE 83690 $209.00 LABCORP LIPOPROTEIN (A) 83695 $61.00 LABCORP LITHIUM 80178 $228.00 LABCORP LIVER KIDNEY MICROSOME AB 86376 $228.00 LABCORP LUTEINIZING HORMONE 83002 $314.00 LABCORP LYME DISEASE AB CONFIRM 86617 $578.00 LABCORP LYSOZYME (MURAMIDASE) 85549 $270.00 LABCORP M MARINUM SUSC 87186 $160.00 LABCORP MAC SUSC 87186 $160.00 LABCORP MAGNESIUM URINE 83735 $141.00 LABCORP MATERNAL SCREEN QUAD 81511 $586.00 LABCORP METANEPHRINE FRACTIONATED 83835 $310.00 LABCORP METANEPHRINE FRACTIONATED, URINE 83835 $310.00 LABCORP MEXILETINE 80299 $395.00 LABCORP MIC PER PLATE 87186 $160.00 LABCORP MIC PER PLATE RAPID 87186 $160.00 LABCORP MIC PER PLATE SLOW 87186 $160.00 LABCORP MICROALBUMIN URINE QUANTITATIVE 82043 $43.00 LABCORP MITOCHONDRIAL M2 AB IGG 83516 $160.00 LABCORP MMA URINE 83921 $291.00 LABCORP MOLECULAR CYTO HER-2/NEU 88271 $241.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP MTB AST CONFIRM 87190 $44.00 LABCORP MTB SUSC BROTH 87188 $160.00 LABCORP MTHFR (5,10-METHYLENETETRAHYDROFOLATE REDU 81291 $526.00 LABCORP MUMPS ANTIBODY IGG 86735 $90.00 LABCORP MUMPS ANTIBODY IGM 86735 $90.00 LABCORP MYCO TB PROBE 87556 $450.00 LABCORP MYCOBACTERIA TB NUCLEIC ACID PROBE AMPLIFI 87556 $775.00 LABCORP MYCOPLASMA PNEUMONIA, IGG 86738 $227.00 LABCORP MYCOPLASMA PNEUMONIA, IGM 86738 $348.00 LABCORP NORTRIPTYLINE 80335 $288.00 LABCORP ORGANISM ID 87153 $548.00 LABCORP OSMOLALITY 83930 $263.00 LABCORP OSMOLALITY STOOL 84999 $333.00 LABCORP OSMOLALITY, URINE 83935 $261.00 LABCORP OVA AND PARASITE FECAL 87177 $133.00 LABCORP OXALATE, URINE 24 HOUR 83945 $52.00 LABCORP OXCARBAZEPINE (TRILEPTAL) 80183 $220.00 LABCORP PARIETAL CELL ANTIBODY IGG 83516 $160.00 LABCORP PARTIAL THROMBOPLASTIN SUBSTITUTION 85732 $272.00 LABCORP PARVOVIRUS B19 IGG 86747 $86.00 LABCORP PARVOVIRUS B19 IGM 86747 $86.00 LABCORP PH STOOL 83986 $113.00 LABCORP PHENOTYPE PREDICT 87900 $766.00 LABCORP PHOSPHOROUS URINE 84105 $30.00 LABCORP PINWORM EXAM 87172 $192.00 LABCORP PLASMINOGEN ASSAY 85420 $343.00 LABCORP PLT AB PROFILE 86022 $650.00 LABCORP PNEUMOCYSTIS CARINII ANTIGEN IMMUNOFLUORES 87281 $80.00 LABCORP PORPHOBILINOGEN URINE QUANTITATIVE 84110 $221.00 LABCORP PORPHYRIN 84311 $527.00 LABCORP PORPHYRINS URINE QUANTITATIVE FRACTIONATIO 84120 $339.00 LABCORP PRIMIDONE 80188 $176.00 LABCORP PROCALCITONIN 84145 $855.00 LABCORP PROGESTERONE 84144 $240.00 LABCORP PROLACTIN 84146 $354.00 LABCORP PROTEIN C ACTIVITY 85303 $291.00 LABCORP PROTEIN C ANTIGEN 85302 $404.00 LABCORP PROTEIN ELECTROPHORESIS 84165 $220.00 LABCORP PROTEIN ELECTROPHORESIS URINE 84166 $227.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP PROTEIN S FREE 85306 $482.00 LABCORP PROTEIN S FUNCTIONAL 85306 $482.00 LABCORP PROTEIN S TOTAL 85305 $336.00 LABCORP PROTEIN TOTAL 84155 $174.00 LABCORP PROTEIN TOTAL URINE 84156 $227.00 LABCORP PSA SCREEN 84153 $185.00 LABCORP PSA TOTAL 84153 $185.00 LABCORP PTH INTACT 83970 $478.00 LABCORP PTT-LA MIX 85730 $195.00 LABCORP PYRUVATE 84210 $297.00 LABCORP PYRUVATE KINASE 84220 $129.00 LABCORP QUINIDINE 80194 $269.00 LABCORP RBC COUNT AUTOMATED ONLY 85041 $160.00 LABCORP RENIN 84244 $437.00 LABCORP RETIC COUNT AUTOMATED 85045 $29.00 LABCORP RHEUMATOID FACTOR QUANT 86431 $284.00 LABCORP RMSF IGG 86757 $324.00 LABCORP RMSF IGM 86757 $324.00 LABCORP ROTAVIRUS ANTIGEN INFECTIOUS AGENT IMMUNOA 87425 $130.00 LABCORP RUBELLA ANTIBODY IGG 86762 $104.00 LABCORP RUBELLA ANTIBODY IGM 86762 $104.00 LABCORP RUBEOLA AB, IGG 86765 $220.00 LABCORP RUSSELL VIPER VENOM DILUTED 85613 $144.00 LABCORP SHIGA LIKE TOXIN 87427 $31.00 LABCORP SICKLE CELL RBC 85660 $84.00 LABCORP SIROLIMUS (RAPAMYCIN) 80195 $337.00 LABCORP SMEAR FLUORESCENT/ACID STAIN 87206 $143.00 LABCORP SMEAR FLUORESCENT/ACID STAIN 87015 $237.00 LABCORP SS-A IGG 86235 $95.00 LABCORP SS-B IGG 86235 $94.00 LABCORP SSDNA AB 84156 $227.00 LABCORP STOOL WBC STAIN 87205 $102.00 LABCORP STREP GROUP B W/DIRECT OPTICAL OBSERVATION 87802 $93.00 LABCORP STREP PNEUMO AG 87899 $114.00 LABCORP STREP PNEUMONIAE ANTIGEN 87899 $114.00 LABCORP T GONDII AB IGG 86777 $355.00 LABCORP T GONDII AB IGM 86778 $56.00 LABCORP T3 REVERSE 84482 $260.00 LABCORP T3 TOTAL 84480 $203.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP T3 UPTAKE 84479 $144.00 LABCORP T3, FREE 84481 $547.00 LABCORP TACROLIMUS 80197 $260.00 LABCORP TESTOSTERONE 84403 $435.00 LABCORP TESTOSTERONE FREE 84402 $382.00 LABCORP TETANUS/DIPHTHERIA AB 86317 $67.00 LABCORP THROMBIN CLOTTING TIME 85670 $165.00 LABCORP THYROGLOBULIN 84432 $348.00 LABCORP THYROGLOBULIN ANTIBODY 86800 $227.00 LABCORP THYROID STIMULATING IMMUNOGLOBULINS 84445 $514.00 LABCORP THYROXINE BINDING GLOBULIN (TBG) 84442 $351.00 LABCORP TISSUE GRINDING 87176 $46.00 LABCORP TOBRAMYCIN PEAK 80200 $324.00 LABCORP TOBRAMYCIN TROUGH 80200 $324.00 LABCORP TOXOPLASMA GONDII AB, IGG, CSF 86777 $355.00 LABCORP TRANSFERRIN 84466 $207.00 LABCORP TREPONEMA PALLIDUM ANTIBODY 86780 $205.00 LABCORP TREPONEMA PALLIDUM FTA ABS 86780 $205.00 LABCORP TROFILE CO-RECEPTOR 87906 $892.00 LABCORP TROFILE DNA PDF 87901 $1,101.00 LABCORP URIC ACID URINE 84560 $231.00 LABCORP URINE 82570 $74.00 LABCORP VALPROIC ACID TOTAL 80164 $349.00 LABCORP VANILLYMANDELIC ACID (VMA) URINE 84585 $298.00 LABCORP VARICELLA ZOSTER ANTIBODY IGG 86787 $243.00 LABCORP VDRL CSF 86592 $95.00 LABCORP VITAMIN A 84590 $227.00 LABCORP VITAMIN B-1 (THIAMINE) 84425 $274.00 LABCORP VITAMIN B12 82607 $243.00 LABCORP VITAMIN B-2 (RIBOFLAVIN) 84252 $161.00 LABCORP VITAMIN B6 (PYRIDOXINE) 84207 $518.00 LABCORP VITAMIN C (ASCORBIC ACID) 82180 $282.00 LABCORP VITAMIN D (1 25 HYDROXY) 82652 $489.00 LABCORP VITAMIN D-3 25-OH 82306 $474.00 LABCORP VITAMIN E (ALPHA TOCOPHEROL) 84446 $227.00 LABCORP VON WILLEBRAND FACTOR AG 85246 $388.00 LABCORP VONWILLEBRAND FACTOR ACT 85245 $431.00 LABCORP WET PREP 87210 $136.00 LABCORP ZINC 84630 $171.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LABCORP ZINC URINE 84630 $171.00 LABCORP ZONISAMIDE (ZONEGRAN) THERAPUTIC DRUG ANAL 80203 $168.00 LABCORPISLET CELL ANTIBODY 86341 $292.00 LABCORP-THYROID PEROXIDASE TPO AB 86376 $228.00 LACOSAMIDE 10 MG/ML SOLN 200 ML BOTTLE $57.55 LACOSAMIDE 50 MG TAB 60 EACH BLIST PACK $32.63 LACTATE DEHYDROGENASE (ENZYME) MEASUREMENT 83625 $311.00 LACTIC ACID 83605 $257.00 LACTIC ACID BODY FLUID 83605 $257.00 LACTIC ACID LEVEL 83605 $257.00 LAMELLAR BODY DENSITY SENDOUT 83664 $147.00 LARYNGOSCOPY DIRECT WITH OR WITHOUT TRACHEOSCOPY W 31527 $7,487.00 LARYNGOSCOPY FLEXIBLE FIBEROPTIC WITH REMOVAL OF F 31577 $1,246.00 LARYNGOSCOPY INDIRECT WITH REMOVAL OF FOREIGN BODY 31511 $528.00 LDH-BLOOD 83615 $237.00 LDH-MISC 83615 $237.00 LEAD DEFIBRILLATOR ENDOTAK RELIANCE S STEROID SILI C1777 $22,750.00 LEAD LEVEL 83655 $133.00 LEAD PACING ATTAIN ABILITY PLUS STEROID ELUTING PO C1900 $11,225.00 LEAD PACING ATTAIN STEROID ELUTING ANGLE L88 CM OD C1900 $7,153.85 LEAD PACING CELERITY SILICONE 2D L87 CM LEFT VENTR C1900 $13,260.00 LEAD, BLOOD 83655 $133.00 LEGIONELLA AB,IGG 86713 $318.00 LENGTHING MAGNETIC RODS; CONTROLLED GROWTH RODS UN 22899 $591.00 LENS INTRAOCULAR ACRYSOF IQ NATURAL STABLEFORCE AC V2632 $1,192.00 LENS INTRAOCULAR ACRYSOF IQ RESTOR STABLEFORCE ACR V2788 $5,817.50 LEPTIN 83520 $348.00 LEUCINE AMINOPEPTIDASE (ENZYME) LEVEL 83670 $71.00 LIDOCAINE 2 % SOLN 15 ML CUP $3.00 LIDOCAINE LEVEL 80176 $225.00 LIDOCAINE-EPINEPHRINE 1 %-1:100,000 SOLN 20 ML VIA $20.06 LINER ACETABULAR G7 COCR G ID46 MM HIP 2 MOBILITY C1776 $4,225.00 LINER ACETABULAR MAX-ROM E-POLY +3 MM 25 ID40 MM H C1776 $4,225.00 LINER ACETABULAR OPTI-FIX XLPE 20 D OD56-62 MM ID3 C1776 $3,900.00 LINER ACETABULAR PINNACLE ALTRX 10 D +4 MM OD46 MM C1776 $7,039.89 LINER ACETABULAR PINNACLE ALTRX 10 D +4 MM OD60 MM C1776 $3,900.00 LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD56 MM ID C1776 $3,900.00 LINER ACETABULAR TRILOGY LONGEVITY STANDARD H9.9 M C1776 $4,225.00 LINER HUMERAL EQUINOXE +0 MM OD38 MM SHOULDER REVE C1776 $4,550.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge LINER HUMERAL EQUINOXE +2.5 MM OD42 MM SHOULDER RE C1776 $4,550.00 LIPASE, SERUM 83690 $209.00 LIPOPROTEIN (A) LEVEL 83695 $61.00 LIPOPRTN DIR MEAS SD LDL CHL 83722 $227.00 LITHIUM LEVEL 80178 $228.00 LIVER ENZYME (SGOT), LEVEL 84450 $228.00 LIVER ENZYME (SGPT), LEVEL 84460 $215.00 LIVER FUNCTION BLOOD TEST PANEL 80076 $586.00 LIVER TRANSPLANT $126,096.00 M PNEUMONIAE IGM 86738 $227.00 M.I.C. SENS 87186 $160.00 MAGNESIUM, SERUM 83735 $141.00 MAGNESIUM, URINE 83735 $141.00 MAGNETIC RESONANCE IMAGING OF FETUS, EACH ADDITION 74713 $2,845.00 MAGNETIC RESONANCE IMAGING OF FETUS, SINGLE OR FIR 74712 $2,845.00 MALARIA SMEAR 87207 $221.00 MALATE DEHYDROGENASE (ENZYME) LEVEL 83775 $58.00 MAMMOGRAPJY ? REVENUE CODE 401 G0378 $185.00 MANGANESE (HEAVY METAL) LEVEL 83785 $82.00 MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE 97140 $111.00 MANUAL MANEUVERS TO CHEST WALL TO ASSIST MOVEMENT 94668 $135.00 MANUAL URINALYSIS TEST WITH EXAMINATION USING MICR 81000 $38.00 MANUAL URINALYSIS TEST WITH EXAMINATION USING MICR 81001 $166.00 MANUAL WHITE BLOOD CELL COUNT AND EVALUATION 85009 $27.00 MAPPING ELECTRCL BRAIN WAVE ACTIV PROV SEIZR ACTIV 95962 $433.00 MAPPING ELECTRCL BRAIN WAVE ELCTRDS SURF PROV SEIZ 95961 $2,044.00 MARIJUANA CONF MEC 80349 $116.00 MASS SPECTOMETRY QN 83789 $129.00 MASS SPECTROMETRY (LABORATORY TESTING METHOD) 83789 $129.00 MASSAGE OF HEART MUSCLE THROUGH CHEST CAVITY 32160 $3,566.00 MATRIX TISSUE ALLODERM ACELLULAR DERMIS MEDIUM L7 Q4116 $174.57 MATRIX TISSUE ALLODERM ACELLULAR DERMIS THK.53-1.0 Q4116 $2,814.50 MATRIX TISSUE ALLODERM SELECT THK.4-2.4 MM THICK L Q4116 $178.14 MATRIX TISSUE STRATTICE PORCINE DERMIS L16 CM X W5 Q4130 $11,706.50 MAYO MYELIN OLIGO. GLYCOPROTEIN FACS,S-MOGFS 86255 $287.00 MEASURE & GRAPHIC RECORDINGS SPEED OF BREATHED AIR 94070 $1,739.00 MEASURE & RECORD OF BRAIN WAVE (EEG) ACTIVITY CERE 95824 $1,391.00 MEASURE LARGEST AMOUNT OF AIR BREATHED IN AN OUT O 94200 $392.00 MEASUREMENT & GRAPHIC REC AMOUNT&SPEED BREATHED AI 94060 $910.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge MEASUREMENT & REC NERVE CONDUCTION PATTERNS USING 95930 $375.00 MEASUREMENT & RECORDING ELECTRCL BRAIN WAVE ACTIV 95958 $2,174.00 MEASUREMENT AND GRAPHIC RECORDING OF TOTAL AND TIM 94010 $496.00 MEASUREMENT AND GRAPHIC RECORDING OF TOTAL AND TIM 94012 $1,230.00 MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTI 95816 $976.00 MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTI 95819 $1,006.00 MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTI 95822 $1,552.00 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF IN 86140 $224.00 MEASUREMENT FOR STREP ANTIBODY (STREP THROAT) 86060 $348.00 MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANC 86003 $96.00 MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMU 86235 $94.00 MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMU 86039 $97.00 MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS A 86200 $122.00 MEASUREMENT OF ANTIBODY TO NONINFECTIOUS AGENT 86256 $111.00 MEASUREMENT OF ANTIBODY TO STREPTOKINASE (ENZYME) 86590 $44.00 MEASUREMENT OF BILIRUBIN 88720 $25.00 MEASUREMENT OF BRAIN ACTIVITY (EEG) DURING SURGERY 95829 $2,859.00 MEASUREMENT OF BRAIN WAVE (EEG) ACTIVITY GREATER T 95813 $2,475.00 MEASUREMENT OF BRAIN WAVE (EEG) ACTIVITY, 41-60 MI 95812 $1,974.00 MEASUREMENT OF COLD AGGLUTININ (PROTEIN) TO DETECT 86157 $270.00 MEASUREMENT OF COLON MOVEMENT, MINIMUM 6 HOURS CON 91117 $934.00 MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS) 86160 $174.00 MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS) 86162 $369.00 MEASUREMENT OF COMPLEMENT FUNCTION (IMMUNE SYSTEM 86161 $489.00 MEASUREMENT OF CURVATURE OF BOTH CORNEAS WITH CONT 92310 $386.00 MEASUREMENT OF DNA ANTIBODY 86225 $216.00 MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT 91010 $641.00 MEASUREMENT OF EYE MUSCLES TO DETECT DEVIATION OF 92060 $235.00 MEASUREMENT OF FIELD OF VISION DURING DAYLIGHT CON 92083 $124.00 MEASUREMENT OF FIELD OF VISION DURING DAYLIGHT CON 92081 $235.00 MEASUREMENT OF FIELD OF VISION DURING DAYLIGHT CON 92082 $235.00 MEASUREMENT OF GROWTH HORMONE ANTIBODY 86277 $123.00 MEASUREMENT OF HEPATITIS A ANTIBODY (IGM) 86709 $48.00 MEASUREMENT OF HYDROGEN IN BREATH TO TEST FOR GI S 91065 $286.00 MEASUREMENT OF IMMUNE SUBSTANCE (OLIGOCLONAL BANDS 83916 $235.00 MEASUREMENT OF IMMUNE SYSTEM PROTEIN 86280 $64.00 MEASUREMENT OF INHALED NITRIC OXIDE GAS 95012 $214.00 MEASUREMENT OF LARGEST AMOUNT OF AIR EXHALED FROM 94150 $131.00 MEASUREMENT OF LUNG DIFFUSING CAPACITY 94729 $859.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge MEASUREMENT OF OXYGEN SATURATION IN BLOOD USING EA 94760 $87.00 MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQ 83519 $445.00 MEASUREMENT OF URINE FLOW IN KIDNEYS AND URINARY D 50396 $1,547.00 MEASUREMENT REMAINING AIR/LUNG CAPACITY AFT EXHAL 94013 $940.00 MECHANICAL REMOVE OBSTRUCTIVE MATERIAL IN STOMACH 49460 $2,095.00 MECHANICAL SEPARATION OF PLASMA AND ABNORMAL ANTIB 36516 $12,910.00 MECHANICAL SEPARATION OF PLASMA FROM OPENING BLOOD 36514 $3,396.00 MECHANICAL SEPARATION OF PLATELET CELLS FROM BLOOD 36513 $3,396.00 MECHANICAL SEPARATION OF RED BLOOD CELLS FROM BLOO 36512 $4,245.00 MECHANICAL SEPARATION OF WHITE BLOOD CELLS FROM TH 36511 $3,396.00 MECONIUM-PREP, DRUG SCREEN 80307 $706.00 MEDICAL NUTRITION THERAPY G0271 $77.00 MEDICAL NUTRITION THERAPY RE-ASSESSMENT AND INTERV 97803 $61.00 MEDICAL NUTRITION THERAPY, ASSESSMENT AND INTERVEN 97802 $61.00 MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL $0.01 MENINGOCOCCAL RECOMBINANT PROTEIN AND OUTER MEMBRA 90620 $498.00 MERCURY LEVEL 83825 $34.00 MESH CRANIAL MATRIXNEURO TITANIUM CIRCLE H.6 MM OD C1713 $14,354.80 MESH SURGICAL PARIETEX POLYESTER COLLAGEN HYDROPHI C1781 $3,152.50 MESH SURGICAL PARIETEX POLYESTER COLLAGEN ROUND OD C1781 $3,246.75 MESH SURGICAL PROLENE 3 IN 3D MEDIUM L3 15/16 IN X C1781 $1,655.14 MESH SURGICAL PROLENE FLAT L6 IN X W3 IN SOFT KNIT C1781 $834.98 MESH SURGICAL UPSYLON THK200 UM 2.8 SQ MM Y L35.4 C1763 $4,914.00 METANEPHRINES FREE PLASMA 83835 $310.00 METANEPHRINES LEVEL 83835 $310.00 METHEMALBUMIN (PROTEIN) LEVEL 83857 $83.00 METHEMOGLOBIN (HEMOGLOBIN) ANALYSIS 83045 $38.00 METHOTREXATE 80299 $395.00 METHYLATION ANALYSIS (SM NUCLR RIBONCLEOPRT PLYPP 81331 $16.00 METHYLATION ANALYSIS FOR PRADER WILLI 81331 $216.00 METHYLMALONIC ACID 83921 $291.00 METHYLPHENIDATE HCL 5 MG TAB 100 EACH BOTTLE $3.41 METYRAPONE (HORMONE ANTIBODY) PANEL 80436 $708.00 MICROALBUMIN, 24 HRS 82043 $43.00 MICROALBUMIN, URINE, RANDOM 82043 $43.00 MICROBE SUSCEPTIBLE MIC 87186 $160.00 MICROBIAL TOXIN OR ANTITOXIN ASSAY 87230 $200.00 MICROCATHETER INFUSION ASAHI CORSAIR POLYMER HYDRO C1887 $4,250.00 MICROCATHETER PRESSURE NAVVUS 11-15 PSI L335 CM L1 $4,550.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge MICROSCOPIC EXAMINATION FOR WHITE BLOOD CELLS 85008 $16.00 MICROSCOPIC EXAMINATION FOR WHITE BLOOD CELLS WITH 85007 $51.00 MICROSCOPIC GENETIC EXAMINATION MANUAL 88369 $1,063.00 MICROSCOPIC GENETIC EXAMINATION USING COMPUTER-ASS 88373 $381.00 MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT 86376 $228.00 MIDAZOLAM (PF) 1 MG/ML SOLN 2 ML VIAL J2250 $20.08 MODERATE SEDATION SERVICES OTHER MD ADDITIONAL 15 99157 $70.00 MODERATE SEDATION SERVICES OTHER MD INITIAL 15 MIN 99155 $172.00 MODERATE SEDATION SERVICES OTHER MD INITIAL 15 MIN 99156 $172.00 MODERATE SEDATION SERVICES SAME MD ADDITIONAL 15 M 99153 $237.00 MODERATE SEDATION SERVICES SAME MD INITIAL 15 MIN 99152 $472.00 MODERATE SEDATION SERVICES SAME MD INITIAL 15 MIN 99151 $558.00 MOLECULAR GENOTYPE 81479 $400.00 MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 81400 $996.00 MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 81401 $1,258.00 MONAURAL BODY AID AIR V5030 $2,023.00 MONAURAL BODY AID BONE V5040 $2,149.00 MONITOR & RECORD GASTROESOPHAGEAL REFLUX THROUGH N 91034 $1,626.00 MONITOR & RECORD GASTROESOPHAGEAL REFLUX WITH PH E 91035 $3,387.00 MONITORING & LOCALIZATION SEIZURE ACTIV OVER 24-HR 95951 $4,946.00 MOPATH PROCEDURE LEVEL 5 81404 $2,083.00 MOPATH PROCEDURE LEVEL 6 81405 $4,945.00 MR ANGIOGRAPHY ABDOMEN WITH & WITHOUT CONTRAST 74185 $2,522.00 MR ANGIOGRAPHY ABDOMEN WITH CONTRAST 74185 $2,522.00 MR ANGIOGRAPHY ABDOMEN WITHOUT CONTRAST 74185 $2,522.00 MR ANGIOGRAPHY CHEST WITH & WITHOUT CONTRAST 71555 $2,653.00 MR ANGIOGRAPHY CHEST WITH CONTRAST 71555 $2,653.00 MR ANGIOGRAPHY CHEST WITHOUT CONTRAST 71555 $2,653.00 MR ANGIOGRAPHY LOWER EXTREMITY WITH & WITHOUT CONT 73725 $1,383.00 MR ANGIOGRAPHY LOWER EXTREMITY WITH CONTRAST 73725 $1,383.00 MR ANGIOGRAPHY LOWER EXTREMITY WITHOUT CONTRAST 73725 $1,383.00 MR ANGIOGRAPHY PELVIS WITH & WITHOUT CONTRAST 72198 $586.00 MR ANGIOGRAPHY PELVIS WITH CONTRAST 72198 $586.00 MR ANGIOGRAPHY PELVIS WITHOUT CONTRAST 72198 $586.00 MR ANGIOGRAPHY SPINE 72159 $2,653.00 MR ANGIOGRAPHY UPPER EXTREMITY 73225 $2,731.00 MRA SCAN OF HEAD BLOOD VESSELS 70544 $2,934.00 MRA SCAN OF HEAD BLOOD VESSELS BEFORE AND AFTER CO 70546 $1,255.00 MRA SCAN OF HEAD BLOOD VESSELS WITH CONTRAST 70545 $696.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge MRA SCAN OF NECK BLOOD VESSELS 70547 $639.00 MRA SCAN OF NECK BLOOD VESSELS BEFORE AND AFTER CO 70549 $1,255.00 MRA SCAN OF NECK BLOOD VESSELS WITH CONTRAST 70548 $696.00 MRI ? REVENUE CODE 61X G0378 $185.00 MRI GUIDANCE FOR DESTRUCTION OF TISSUE 77022 $718.00 MRI OF HEART 75557 $6,568.00 MRI OF HEART BEFORE AND AFTER CONTRAST 75561 $5,833.00 MRI OF HEART BEFORE AND AFTER CONTRAST WITH STRESS 75563 $2,659.00 MRI SCAN BONES OF THE EYE, FACE, AND/OR NECK 70540 $4,174.00 MRI SCAN BONES OF THE EYE, FACE, AND/OR NECK BEFOR 70543 $6,353.00 MRI SCAN BONES OF THE EYE, FACE, AND/OR NECK WITH 70542 $1,255.00 MRI SCAN BRAIN 70551 $4,344.00 MRI SCAN OF ABDOMEN 74181 $2,750.00 MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST 74183 $3,773.00 MRI SCAN OF ABDOMEN WITH CONTRAST 74182 $2,888.00 MRI SCAN OF ARM 73218 $2,087.00 MRI SCAN OF ARM BEFORE AND AFTER CONTRAST 73220 $3,117.00 MRI SCAN OF ARM JOINT 73221 $639.00 MRI SCAN OF ARM JOINT BEFORE AND AFTER CONTRAST 73223 $4,332.00 MRI SCAN OF ARM JOINT WITH CONTRAST 73222 $2,922.00 MRI SCAN OF ARM WITH CONTRAST 73219 $2,645.00 MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST 70553 $6,428.00 MRI SCAN OF BRAIN WITH CONTRAST 70552 $696.00 MRI SCAN OF CHEST 71550 $639.00 MRI SCAN OF CHEST BEFORE AND AFTER CONTRAST 71552 $3,864.00 MRI SCAN OF CHEST WITH CONTRAST 71551 $6,470.00 MRI SCAN OF JAW JOINTS 70336 $2,126.00 MRI SCAN OF LEG 73718 $1,577.00 MRI SCAN OF LEG BEFORE AND AFTER CONTRAST 73720 $1,992.00 MRI SCAN OF LEG JOINT 73721 $2,564.00 MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST 73723 $4,429.00 MRI SCAN OF LEG JOINT WITH CONTRAST 73722 $2,782.00 MRI SCAN OF LEG WITH CONTRAST 73719 $696.00 MRI SCAN OF LOWER SPINAL CANAL 72148 $3,065.00 MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CO 72158 $3,773.00 MRI SCAN OF LOWER SPINAL CANAL WITH CONTRAST 72149 $3,163.00 MRI SCAN OF MIDDLE SPINAL CANAL 72146 $2,624.00 MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER C 72157 $3,633.00 MRI SCAN OF MIDDLE SPINAL CANAL WITH CONTRAST 72147 $2,717.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge MRI SCAN OF PELVIS 72195 $2,475.00 MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST 72197 $3,686.00 MRI SCAN OF PELVIS WITH CONTRAST 72196 $2,750.00 MRI SCAN OF UPPER SPINAL CANAL 72141 $3,706.00 MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CO 72156 $3,845.00 MRI SCAN OF UPPER SPINAL CANAL WITH CONTRAST 72142 $2,583.00 MRI STUDY 76390 $2,583.00 MT ASSESSMENT $99.00 MT RX INDIVIDUAL $76.00 MUCOPOLYSACCHARIDES (PROTEIN) LEVEL 83864 $561.00 MULTIFOCAL ELECTRORETINOGRAPHY W/I&R 92274 $374.00 MULTIPLE MEASUREMENTS EYE FLUID PRESSURE EXTENDED 92100 $150.00 MULTIPLE MEASUREMENTS OXYGEN SATURATION IN BLOOD U 94761 $472.00 MUMPS AB,IGM 86735 $90.00 MYCOPLASMA PNEUMONIA,IGG 86738 $227.00 MYCOPLASMA PNEUMONIAE NUCLEIC ACID PROBE AMPLIFIED 87581 $70.00 MYELIN BASIC PROTEIN (NERVE PROTEIN) LEVEL, SPINAL 83873 $325.00 MYOGLOBIN (MUSCLE PROTEIN) LEVEL - LABCORP 83874 $238.00 MYOGLOBIN, SERUM 83874 $238.00 NAIL INTRAMEDULLARY 125 D LONG GLINDING C1713 $12,117.60 NAIL INTRAMEDULLARY 125 D SMALL L22 CM OD17-11 MM C1713 $9,363.60 NAIL INTRAMEDULLARY 135 D STANDARD GLINDING C1713 $9,363.60 NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L380 MM OD1 C1713 $11,759.28 NAIL INTRAMEDULLARY ENDER L22 CM OD3.5 MM HUMERUS C1713 $2,090.72 NAIL INTRAMEDULLARY ENDER L33 CM OD3.5 MM HUMERUS C1713 $2,090.72 NAIL INTRAMEDULLARY EXPERT TITANIUM FLUTE BARREL B C1713 $9,051.32 NAIL INTRAMEDULLARY EXPERT TITANIUM FLUTE BARREL B C1713 $9,644.12 NAIL INTRAMEDULLARY EXPERT TITANIUM FLUTE L375 MM C1713 $7,928.70 NAIL INTRAMEDULLARY EXPERT TITANIUM FLUTE L460 MM C1713 $11,482.08 NAIL INTRAMEDULLARY EXPERT TITANIUM HELICAL FLUTE C1713 $10,811.76 NAIL INTRAMEDULLARY EXPERT TITANIUM HELICAL FLUTE C1713 $13,761.60 NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD16 M C1713 $11,514.00 NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD14 M C1713 $11,514.00 NAIL INTRAMEDULLARY EXPERT TITANIUM L380 MM OD15 M C1713 $11,514.00 NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD9 MM C1713 $10,811.76 NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD9 MM C1713 $13,761.60 NAIL INTRAMEDULLARY EXPERT TITANIUM L440 MM OD9 MM C1713 $10,811.76 NAIL INTRAMEDULLARY EXPERT TITANIUM L480 MM OD16 M C1713 $11,514.00 NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND L255 MM C1713 $8,199.17 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND L280 MM C1713 $10,355.48 NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND L300 MM C1713 $11,140.08 NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND L360 MM C1713 $7,928.70 NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND L405 MM C1713 $9,758.40 NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L300 C1713 $12,308.80 NAIL INTRAMEDULLARY FASSIER-DUVAL TELESCOPIC IM SY C1713 $11,480.00 NAIL INTRAMEDULLARY GAMMA3 TITANIUM 130 D LONG L32 C1713 $9,750.00 NAIL INTRAMEDULLARY L260 MM OD7.5 MM TIBIA LOCK C1713 $9,957.12 NAIL INTRAMEDULLARY L320 MM OD10.5 MM TIBIAL STERI C1713 $9,957.12 NAIL INTRAMEDULLARY L380 MM OD10.5 MM FEMUR RETROG C1713 $11,735.04 NAIL INTRAMEDULLARY MULTILOC TITANIUM ALUMINUM NIO C1713 $10,700.04 NAIL INTRAMEDULLARY NAIL-EX TITANIUM L24 CM OD10 M C1713 $10,360.32 NAIL INTRAMEDULLARY NAIL-EX TITANIUM L24 CM OD12 M C1713 $10,360.32 NAIL INTRAMEDULLARY NAIL-EX TITANIUM L24 CM OD15 M C1713 $11,518.56 NAIL INTRAMEDULLARY NAIL-EX TITANIUM L26 CM OD13 M C1713 $11,140.08 NAIL INTRAMEDULLARY NONSTERILE C1713 $2,880.16 NAIL INTRAMEDULLARY PHOENIX 340 MM OD13.5 MM FEMUR C1713 $14,446.08 NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L380 C1713 $11,735.04 NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L440 C1713 $11,735.04 NAIL INTRAMEDULLARY PHOENIX L260 MM OD10.5 MM FEMU C1713 $11,735.04 NAIL INTRAMEDULLARY PHOENIX L260 MM OD10.5 MM TIBI C1713 $9,957.12 NAIL INTRAMEDULLARY PHOENIX L320 MM OD12 MM LEFT P C1713 $10,755.84 NAIL INTRAMEDULLARY PHOENIX L320 MM OD15 MM RIGHT C1713 $14,446.08 NAIL INTRAMEDULLARY PHOENIX L340 MM OD12 MM FEMUR C1713 $14,446.08 NAIL INTRAMEDULLARY PHOENIX L36 MM OD9 MM PIRIFORM C1713 $10,755.84 NAIL INTRAMEDULLARY PHOENIX L360 MM OD12 MM LEFT P C1713 $10,755.84 NAIL INTRAMEDULLARY PHOENIX L360 MM OD13.5 MM LEFT C1713 $10,755.84 NAIL INTRAMEDULLARY PHOENIX L380 MM OD10.5 MM LEFT C1713 $10,755.84 NAIL INTRAMEDULLARY PHOENIX L380 MM OD13.5 MM FEMU C1713 $14,446.08 NAIL INTRAMEDULLARY PHOENIX L380 MM OD15 MM RIGHT C1713 $10,755.84 NAIL INTRAMEDULLARY PHOENIX L380 MM OD7.5 MM TIBIA C1713 $9,957.12 NAIL INTRAMEDULLARY PHOENIX L400 MM OD13.5 MM FEMU C1713 $14,446.08 NAIL INTRAMEDULLARY PHOENIX L400 MM OD15 MM RIGHT C1713 $10,755.84 NAIL INTRAMEDULLARY PHOENIX L440 MM OD15 MM FEMUR C1713 $14,446.08 NAIL INTRAMEDULLARY PHOENIX L460 MM OD13.5 MM FEMU C1713 $14,446.08 NAIL INTRAMEDULLARY PHOENIX L480 MM OD10.5 MM LEFT C1713 $10,755.84 NAIL INTRAMEDULLARY STAINLESS STEEL OLECRANON OSTE C1713 $2,503.44 NAIL INTRAMEDULLARY STAINLESS STEEL UNIVERSAL L320 C1713 $7,756.56 NAIL INTRAMEDULLARY STAINLESS STEEL UNIVERSAL L360 C1713 $7,419.12 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge NAIL INTRAMEDULLARY STAINLESS STEEL UNIVERSAL L360 C1713 $8,335.68 NAIL INTRAMEDULLARY STAINLESS STEEL UNIVERSAL L440 C1713 $7,756.56 NAIL INTRAMEDULLARY T2 TITANIUM L360 MM OD14 MM SU C1713 $9,878.90 NAIL INTRAMEDULLARY T2 TITANIUM L440 MM OD13 MM FE C1713 $9,691.31 NAIL INTRAMEDULLARY T2 TITANIUM STANDARD L345 MM O C1713 $7,528.95 NAIL INTRAMEDULLARY TFN-ADVANCED LATERAL RELIEF CU C1713 $10,189.98 NAIL INTRAMEDULLARY TITANIUM 125 D LONG L300 MM OD C1713 $10,886.72 NAIL INTRAMEDULLARY TITANIUM 125 D LONG L360 MM OD C1713 $10,886.72 NAIL INTRAMEDULLARY TITANIUM 125 D SHORT L235 MM O C1713 $8,274.24 NAIL INTRAMEDULLARY TITANIUM 130 D LONG L340 MM OD C1713 $10,886.72 NAIL INTRAMEDULLARY TITANIUM 130 D LONG L360 MM OD C1713 $11,593.92 NAIL INTRAMEDULLARY TITANIUM 130 D LONG L460 MM OD C1713 $11,593.92 NAIL INTRAMEDULLARY TITANIUM 135 D LONG L360 MM OD C1713 $10,886.72 NAIL INTRAMEDULLARY TITANIUM 135 D LONG L440 MM OD C1713 $10,886.72 NAIL INTRAMEDULLARY TITANIUM L20 CM OD10 MM FEMUR C1713 $14,032.32 NAIL INTRAMEDULLARY TITANIUM L22 CM OD12 MM FEMUR C1713 $14,032.32 NAIL INTRAMEDULLARY TITANIUM L25.5 CM OD10 MM TIBI C1713 $7,680.40 NAIL INTRAMEDULLARY TITANIUM L25.5 CM OD10 MM TIBI C1713 $9,318.40 NAIL INTRAMEDULLARY TITANIUM L29.5 CM OD7.5 MM HUM C1713 $12,409.60 NAIL INTRAMEDULLARY TITANIUM L30 CM OD10 MM FEMUR C1713 $11,061.92 NAIL INTRAMEDULLARY TITANIUM L300 MM OD11 MM TIBIA C1713 $9,452.80 NAIL INTRAMEDULLARY TITANIUM L34 CM OD12 MM FEMUR C1713 $8,745.76 NAIL INTRAMEDULLARY TITANIUM L34.5 CM OD10 MM TIBI C1713 $7,680.40 NAIL INTRAMEDULLARY TITANIUM L34.5 CM OD10 MM TIBI C1713 $9,318.40 NAIL INTRAMEDULLARY TITANIUM L34.5 CM OD11 MM TIBI C1713 $9,452.80 NAIL INTRAMEDULLARY TITANIUM L36 CM OD10 MM FEMUR C1713 $14,032.32 NAIL INTRAMEDULLARY TITANIUM L36 CM OD12 MM FEMUR C1713 $11,061.92 NAIL INTRAMEDULLARY TITANIUM L36 CM OD12 MM FEMUR C1713 $14,032.32 NAIL INTRAMEDULLARY TITANIUM L36 CM OD8 MM TIBIA S C1713 $9,318.40 NAIL INTRAMEDULLARY TITANIUM L38 CM OD9 MM TIBIA S C1713 $9,318.40 NAIL INTRAMEDULLARY TITANIUM L40 CM OD10 MM FEMUR C1713 $14,032.32 NAIL INTRAMEDULLARY TITANIUM L42 CM OD11 MM TIBIA C1713 $9,452.80 NAIL INTRAMEDULLARY TITANIUM L44 CM OD13 MM FEMUR C1713 $11,061.92 NAIL INTRAMEDULLARY TITANIUM L46 CM OD12 MM FEMUR C1713 $7,812.00 NAIL INTRAMEDULLARY TITANIUM L46 CM OD14 MM FEMUR C1713 $11,061.92 NAIL INTRAMEDULLARY TITANIUM L460 MM OD12 MM FEMUR C1713 $9,788.80 NAIL INTRAMEDULLARY TITANIUM L48 CM OD11 MM FEMUR C1713 $8,745.76 NAIL INTRAMEDULLARY TITANIUM OD4 MM ORTHOPEDIC CAN C1713 $1,251.20 NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L440 MM OD2 C1713 $1,904.40 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L160 MM OD1 C1713 $12,308.80 NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L180 MM OD1 C1713 $11,837.76 NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L360 MM OD1 C1713 $9,788.80 NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L380 MM OD1 C1713 $9,788.80 NASAL SMEAR FOR EOSINOPHILS (ALLERGY RELATED WHITE 89190 $123.00 NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEI 83880 $167.00 NEEDLE BIOPSY OF ABDOMINAL CAVITY GROWTH, ACCESSED 49180 $2,336.00 NEEDLE BIOPSY OF KIDNEY, ACCESSED THROUGH THE SKIN 50200 $2,485.00 NEEDLE BIOPSY OF LIVER, ACCESSED THROUGH THE SKIN 47000 $2,529.00 NEEDLE BIOPSY OF LUNG OR CHEST TISSUE, ACCESSED TH 32405 $1,782.00 NEEDLE BIOPSY OF MUSCLE, ACCESSED THROUGH THE SKIN 20206 $3,708.00 NEEDLE BIOPSY OF SALIVARY GLAND 42400 $2,190.00 NEEDLE BIOPSY OF THYROID, ACCESSED THROUGH THE SKI 60100 $1,759.00 NEEDLE ENDOSCOPIC ECHOTIP ULTRA L8- CM OD22 GA ODS $1,000.00 NEEDLE MEASURE & RECORD ELECTRICL ACTIVITY OF MUSC 51785 $861.00 NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY OF 95864 $375.00 NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY OF 95887 $683.00 NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY OF 95860 $914.00 NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY OF 95861 $1,183.00 NEEDLE MEASUREMENT & REC ELECTRCL ACTIV CRANIAL NR 95867 $375.00 NEEDLE MEASUREMENT & REC ELECTRCL ACTIV CRANIAL NR 95868 $375.00 NEEDLE MEASUREMENT & REC ELECTRCL ACTIV MUSCLE ARM 95870 $154.00 NEEDLE MEASUREMENT & REC ELECTRCL ACTIV MUSCLES AR 95886 $576.00 NEEDLE MEASUREMENT & REC ELECTRCL ACTIV MUSCLES AR 95885 $982.00 NEEDLE MEASUREMENT & RECORD OF ELECTRICAL ACTIVITY 95865 $319.00 NEEDLE MEASUREMENT AND RECORDING OF ELECTRICAL ACT 95874 $536.00 NEEDLE OR TROCAR BONE MARROW BIOPSY 38221 $2,053.00 NEEDLE TRANSSEPTAL NRG CURVE C1 L71 CM RADIOFREQUE $3,087.50 NEGATIVE PRESSURE WOUND THERAPY SURFACE AREA < OR 97605 $400.00 NEGATIVE PRESSURE WOUND THERAPY SURFACE AREA GREAT 97606 $855.00 NERVE TRANSMISSION STUDIES, 11-12 STUDIES 95912 $4,507.00 NERVE TRANSMISSION STUDIES, 1-2 STUDIES 95907 $375.00 NERVE TRANSMISSION STUDIES, 13 OR MORE STUDIES 95913 $1,223.00 NERVE TRANSMISSION STUDIES, 3-4 STUDIES 95908 $1,509.00 NERVE TRANSMISSION STUDIES, 5-6 STUDIES 95909 $685.00 NERVE TRANSMISSION STUDIES, 7-8 STUDIES 95910 $685.00 NERVE TRANSMISSION STUDIES, 9-10 STUDIES 95911 $4,218.00 NEUROBEHAVIORAL STATUS EXAM INTERP & REP PSYCHOLOG 96116 $527.00 NEUROFUNCTIONAL TESTING DURING FUNCTIONAL MRI OF T 96020 $699.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge NEURONAL VGKC AUTOANTIBODY 83519 $445.00 NEUROPSYCHOLOGICAL TESTING COMPUTER W/INTERP & REP 96120 $324.00 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99201 $50.00 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99202 $60.00 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99203 $70.00 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99204 $80.00 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99205 $100.00 NFCT DS CHRNC HCV 6 ASSAYS 81596 $199.00 NICARDIPINE 25 MG/10 ML SOLN 10 ML VIAL $54.15 NITRIC OXIDE INHALED PER DAY $8,739.00 NIVOLUMAB 40 MG/4 ML SOLN 4 ML VIAL J9299 $4,846.00 N-METH-D-ASP RECPT AB IGG 86255 $287.00 NON-CARDIAC VASCULAR FLOW IMAGING 78445 $1,608.00 NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY BENEATH 96401 $410.00 NONINTEFACED LEAD URINE 83655 $133.00 NON-NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY 51784 $631.00 N-TYPE CALCIUM CHANNEL AB 83519 $445.00 NUCLEAR MEDICINE ? REVENUE CODE 34X G0378 $185.00 NUCLEAR MEDICINE ADDITIONAL STUDIES FOR THYROID CA 78016 $1,129.00 NUCLEAR MEDICINE BACKWASH OF URINE INTO KIDNEY 78740 $1,625.00 NUCLEAR MEDICINE IMAGING FOR THYROID UPTAKE MEASUR 78012 $1,199.00 NUCLEAR MEDICINE IMAGING FOR THYROID UPTAKE MEASUR 78014 $1,729.00 NUCLEAR MEDICINE IMAGING OF THYROID 78013 $1,525.00 NUCLEAR MEDICINE KIDNEY FUNCTION STUDY 78725 $2,687.00 NUCLEAR MEDICINE STUDY HEART MUSCLE FOLLOW HEART A 78468 $2,518.00 NUCLEAR MEDICINE STUDY HEART WALL MOTION REST/STRE 78472 $3,365.00 NUCLEAR MEDICINE STUDY OF BLOOD CIRCULATION IN THE 78580 $2,211.00 NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT 78320 $1,517.00 NUCLEAR MEDICINE STUDY OF BRAIN 78607 $2,621.00 NUCLEAR MEDICINE STUDY OF KIDNEY 78710 $1,533.00 NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT O 78707 $1,433.00 NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT O 78708 $1,553.00 NUCLEAR MEDICINE STUDY OF LUNG VENTILATION 78579 $2,411.00 NUCLEAR MEDICINE STUDY OF LUNG VENTILATION & BLOOD 78582 $2,746.00 NUCLEAR MEDICINE STUDY OF RADIOACTIVE MATERIAL DIS 78803 $1,214.00 NUCLEAR MEDICINE STUDY OF SALIVARY GLAND 78232 $2,294.00 NUCLEAR MEDICINE STUDY OF TESTICLES AND BLOOD VESS 78761 $1,897.00 NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78801 $766.00 NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78807 $1,502.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78802 $2,051.00 NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78804 $2,188.00 NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78806 $2,510.00 NUCLEAR MEDICINE STUDY VESSELS OF HEART USING DRUG 78451 $3,253.00 NUCLEAR MEDICINE STUDY VESSELS OF HEART USING DRUG 78452 $3,253.00 NUCLEAR MEDICINE STUDY WITH MEASUREMENT OF BLOOD C 78597 $1,771.00 NUCLEAR MEDICINE WHOLE BODY STUDY FOR THYROID CANC 78018 $1,919.00 NUCLEIC ACID PROBE QN INFECTIOUS 87799 $678.00 NUT EXTERNAL FIXATION SQUARE MRI SAFE $584.16 OBS CARVEOUT RC 48X G0378 $185.00 OBS CARVEOUT RC 921 G0378 $185.00 OCCLUSION OF ARTERY 37242 $3,274.00 OCCUPATIONAL THERAPY ? REVENUE CODE 43X G0378 $185.00 OMEGA HEPATITIS B SURFACE ANTIGEN 87340 $157.00 OMEGA HEPATITIS C AB 86803 $249.00 OMEGA T VAGINALIS PCR 87661 $357.00 OMEGA-C TRACH N GONN DNA PROBE 87491 $81.00 OMEGA-PRO BNP NT 83880 $167.00 OMEGA-RPR 86592 $95.00 OMEGA-VITAMIN D 25 HYDROXY 82306 $474.00 OPEN TREATMENT OF BROKEN FOREARM BONE AT ELBOW 24655 $3,569.00 OPIATES LEVELS 80361 $359.00 OPIOIDS LEVELS 80362 $244.00 OPIOIDS LEVELS 80363 $244.00 OR LEVEL 1 1ST 15 MINUTES $2,052.00 OR LEVEL 1 EACH ADDITIONAL 15 MINUTES $613.00 OR LEVEL 2 1ST 15 MINUTES $4,077.00 OR LEVEL 2 EACH ADDITIONAL 15 MINUTES $773.00 OR LEVEL 3 1ST 15 MINUTES $6,130.00 OR LEVEL 3 EACH ADDITIONAL 15 MINUTES $800.00 OR LEVEL 4 1ST 15 MINUTES $8,182.00 OR LEVEL 4 EACH ADDITIONAL 15 MINUTES $826.00 OR LEVEL 5 1ST 15 MINUTES $10,207.00 OR LEVEL 5 EACH ADDITIONAL 15 MINUTES $906.00 OR LEVEL 6 1ST 15 MINUTES $12,259.00 OR LEVEL 6 EACH ADDITIONAL 15 MINUTES $986.00 OR LEVEL 7 1ST 15 MINUTES $14,311.00 OR LEVEL 7 EACH ADDITIONAL 15 MINUTES $1,093.00 OR LEVEL 8 1ST 15 MINUTES $16,336.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge OR LEVEL 8 EACH ADDITIONAL 15 MINUTES $1,199.00 OR ROBOTICS/HIGH TECH $4,959.00 ORAL ADMINISTRATION OF RADIOACTIVE MATERIAL THERAP 79005 $1,440.00 ORAL INTRODUCTION OF LONG DRAINAGE TUBE INTO SMALL 44500 $714.00 ORAL TYPHOID VACCINE 90690 $630.00 ORGANIC ACIDS LEVEL 83918 $394.00 OSMOLALITY, SERUM 83930 $263.00 OSTEOCALCIN (BONE PROTEIN) LEVEL 83937 $115.00 OTHER THERAPEUTIC ? REVENUE CODE 940 G0378 $185.00 OVERNIGHT MEASUREMENT OXYGEN SATURATION IN BLOOD U 94762 $521.00 OVULATION TESTS 84830 $78.00 OXALATE LEVEL 83945 $52.00 OXFORD TSPOT TB 86481 $521.00 OXYCODONE LEVELS 80365 $244.00 P/Q TYPE CALCIUM CHANNEL AB 83519 $445.00 PACEMAKER CARDIAC INGENIO RYTHMIQ THK.3 IN MODIFY C1785 $23,660.00 PACEMAKER CARDIAC MICRONY II SR+ BEAT-BY-BEAT AUTO C1786 $19,440.00 PACEMAKER CARDIAC VIVA CRT-P L12 MM X H6 MM 2 CHAM C2621 $42,250.00 PACK SURGICAL CDS OR GYN ROBOTIC UROLOGY NONSTERIL $1,293.68 PACK SURGICAL CORONARY ANGIOGRAM STERILE LATEX FRE $523.52 PACK SURGICAL EYE CUSTOM $1,273.20 PACK SURGICAL TOTAL JOINT $618.80 PANCREATIC ELASTASE (ENZYME) MEASUREMENT 82656 $72.00 PANCREATIC ELASTASE STOOL 83520 $348.00 PAP TEST 88174 $113.00 PAP TEST (PAP SMEAR) 88147 $225.00 PAP TEST (PAP SMEAR) 88141 $425.00 PARANEOPLASTIC AB BY IFA 86255 $287.00 PARIETAL CELL AB,IGG 83516 $160.00 PARTIAL PROTHROMBIN TIME LA 85730 $195.00 PARTICLES EMBOLIZATION CONTOUR PVA 355-500 UM 2 VI $778.05 PARVOVIRUS BY PCR 87798 $96.00 PATCH CARDIOVASCULAR HEMACAROTID INTERVASCULAR COL C1768 $534.95 PATCH DURAL PRECLUDE MVP GORE-TEX L12 CM X W10 CM Q4100 $9,760.00 PATCH SURGICAL EVARREST FIBRIN L4 IN X W2 IN SEALA $5,037.50 PATHOLOGY EXAM OF TISSUE USING A MICROSCOPE MODERA 88304 $141.00 PATHOLOGY EXAM OF TISSUE USING A MICROSCOPE MODERA 88307 $755.00 PATHOLOGY EXAMINATION OF SPECIMEN DURING SURGERY 88332 $49.00 PATHOLOGY EXAMINATION OF TISSUE DURING SURGERY 88331 $198.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PATHOLOGY EXAMINATION OF TISSUE SPECIMEN DURING SU 88333 $383.00 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE 88300 $48.00 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE 88302 $89.00 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE 88305 $241.00 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE 88309 $1,535.00 PATTERN ELECTRORETINOGRAPHY W/I&R 0509T $374.00 PEG FIXATION ACU-LOC TITANIUM L24 MM OD2.3 MM CORT C1713 $494.00 PELVIC EXAMINATION UNDER ANESTHESIA 57410 $8,288.00 PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRA 27756 $15,418.00 PERIPHERAL VEIN RENIN (KIDNEY ENZYME) STIMULATION 80417 $341.00 PERITONEAL DIALYSIS CAPD 90945 $2,230.00 PERITONEAL DIALYSIS CCPD 90945 $2,230.00 PERITONEAL DIALYSIS NON-CAPD 90945 $2,230.00 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 43762 $320.00 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 43762 $637.00 PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC 43763 $637.00 PET ? REVENUE CODE 404 G0378 $185.00 PH STOOL 83986 $113.00 PH URINE 83986 $113.00 PH, BODY FLUID, EXCEPT BLOOD 83986 $113.00 PHENCYCLIDINE (PCP), URINE 83992 $321.00 PHENOBARBITAL LEVEL 80184 $126.00 PHENYLALANINE, PKU (AMINO ACID) LEVEL 84030 $247.00 PHENYTOIN LEVEL 80185 $216.00 PHENYTOIN LEVEL 80186 $296.00 PHOSPHATASE (ENZYME) LEVEL 84075 $212.00 PHOSPHATASE (ENZYME) MEASUREMENT 84080 $161.00 PHOSPHATE LEVEL 84100 $174.00 PHOSPHORUS URINE 84105 $30.00 PHOTOGRAPHY OF CONTENT OF EYES 92285 $235.00 PHOTOGRAPHY OF THE RETINA 92250 $244.00 PHYSICAL THERAPY ? REVENUE CODE 42X G0378 $185.00 PHYTONADIONE (VITAMIN K1) 5 MG TAB 100 EACH BOTTLE $3.00 PIN FIXATION APEX STAINLESS STEEL L180 MM L60 MM O $976.00 PIN FIXATION JET-X TITANIUM NITRIDE LONG L40 MM L1 $1,031.12 PIN FIXATION L125 MM HIP CANNULATED $2,140.96 PIN FIXATION L30 MM DISTAL LOCK $1,669.41 PIN FIXATION LCP TITANIUM L18 MM OD1.8 MM BUTTRESS $678.16 PIN FIXATION RUSH STAINLESS STEEL A L10.2 CM OD3.2 C1713 $540.80 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PIN FIXATION RUSH STAINLESS STEEL L L24.1 CM OD3.2 C1713 $540.80 PIN FIXATION STEINMANN L300 MM OD4.5 MM ODSEC5 MM $975.20 PIN FIXATION STEINMANN STAINLESS STEEL CENTRAL THR $792.35 PIN FIXATION STEINMANN STAINLESS STEEL L120 MM OD4 $579.60 PIN FIXATION STEINMANN STAINLESS STEEL L2.5 IN OD1 $325.00 PIN FIXATION STEINMANN STAINLESS STEEL L275 MM OD4 $579.60 PIN FIXATION STEINMANN STAINLESS STEEL L300 MM OD5 $579.60 PIN HALF APEX HOFFMANN II STAINLESS STEEL BLUNT L2 C1713 $976.00 PIN HALF APEX HOFFMANN STAINLESS STEEL L120 MM L50 $976.00 PIN HALF HA L200 MM L50 MM OD6 MM EXTERNAL FIXATIO $1,037.84 PIN HALF ILIZAROV ID150 MM ORTHOPEDIC CIRCULAR EXT $7,048.80 PIN HALF JET-X STAINLESS STEEL PEDIATRIC L200 MM L $2,139.36 PIN HALF JET-X TITANIUM L20 MM OD3 MM ORTHOPEDIC E $725.04 PIN HALF JET-X TITANIUM LONG L40 MM ORTHOPEDIC C1713 $953.20 PIN HALF JET-X TITANIUM NITRIDE SHORT L45 MM OD6 M $1,021.92 PIN HALF JET-X TITANIUM NITRIDE XSHORT L35 MM OD5 $527.52 PIN HALF STAINLESS STEEL L200 MM L20 MM OD6 MM ORT $2,139.36 PINWORM TEST 87172 $192.00 PLACE EAR PROBE COMPUTERIZED MEASURE SOUND W/INTER 92587 $337.00 PLACE SCALP ELECTRODES ASSESS&REC RESPONSE SEVRL A 92586 $875.00 PLACE SCALP ELECTRODES ASSESS&REC RESPONSE SEVRL A 92585 $1,714.00 PLACEMENT EAR PROBE FOR COMPUTERIZED COCHLEAR ASSE 92588 $370.00 PLACEMENT OF CATHETER OF KIDNEY ACCESSED THROUGH T 50432 $4,694.00 PLACEMENT OF INTRA-UTERINE DEVICE (IUD) FOR PREGNA 58300 $637.00 PLACEMENT OF TEMPORARY PACEMAKER LEADS 33210 $12,513.00 PLASMIN (FIBRINOLYTIC FACTOR) MEASUREMENT 85400 $63.00 PLATE BONE 1/3 TUBULAR L47 MM 4 HOLE STERILE C1713 $1,579.50 PLATE BONE 135 D L62 MM ANKLE 2 HOLE C1713 $1,625.00 PLATE BONE 140 D L78 MM ANKLE 4 HOLE C1713 $2,112.50 PLATE BONE 2 X 36 HOLE STRUT SCALLOPED RAPID RESOR C1713 $7,944.00 PLATE BONE ACU-LOC 2 NARROW L51 MM X W22 MM RADIUS C1713 $5,863.00 PLATE BONE ANODYNE H28 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00 PLATE BONE ANODYNE H34 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00 PLATE BONE ANODYNE H44 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00 PLATE BONE ANODYNE H48 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00 PLATE BONE ANODYNE L14 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00 PLATE BONE ANTARES CROSSLINK CD HORIZON TITANIUM L C1713 $13,030.08 PLATE BONE ASSURE TITANIUM L16 MM SPINE CERVICAL A C1713 $5,850.00 PLATE BONE CHS STAINLESS STEEL PEDIATRIC 140 D L76 C1713 $4,346.56 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PLATE BONE CPS BABY TITANIUM PEDIATRIC CRANIOMAXIL C1713 $1,900.80 PLATE BONE CPS TITANIUM PEDIATRIC CRANIOMAXILLOFAC C1713 $1,900.80 PLATE BONE CRANIOMAXILLOFACIAL 4 HOLE STRAIGHT RES C1713 $1,440.00 PLATE BONE CROSSLINK L30 MM SPINE C1713 $8,344.00 PLATE BONE CSLP TITANIUM SMALL STATURE NARROW WIDT C1713 $4,550.00 PLATE BONE DCP CAPOS STAINLESS STEEL PEDIATRIC 100 C1713 $3,583.36 PLATE BONE DCP CAPOS STAINLESS STEEL PEDIATRIC 100 C1713 $3,923.76 PLATE BONE DCP STAINLESS STEEL 130 D L104 MM L60 M C1713 $4,135.36 PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L90 MM C1713 $3,500.56 PLATE BONE DCP STAINLESS STEEL 130 D L90 MM ORTHOP C1713 $3,739.76 PLATE BONE DCP STAINLESS STEEL 130 D L90 MM ORTHOP C1713 $4,310.16 PLATE BONE DCP STAINLESS STEEL 3.5 MM L37 MM X W10 C1713 $942.96 PLATE BONE DCP STAINLESS STEEL 90 D 20 MM DISPLACE C1713 $4,089.36 PLATE BONE DCP STAINLESS STEEL 95 D L124 MM L40 MM C1713 $3,978.96 PLATE BONE DCP STAINLESS STEEL 95 D L60 MM CONDYLE C1713 $7,277.20 PLATE BONE DCP STAINLESS STEEL 95 D L70 MM L267 MM C1713 $6,936.80 PLATE BONE DCP STAINLESS STEEL 95 D L80 MM CONDYLE C1713 $7,277.20 PLATE BONE DCP STAINLESS STEEL ADULT 90 D 10 MM L7 C1713 $3,748.96 PLATE BONE DCP STAINLESS STEEL BROAD L103 MM X W16 C1713 $1,545.60 PLATE BONE DCP STAINLESS STEEL L100 MM OD2.0 MM OR C1713 $1,545.60 PLATE BONE DCP STAINLESS STEEL L176 MM ORTHOPEDIC C1713 $6,086.08 PLATE BONE DCP STAINLESS STEEL L22 MM OD2 MM ORTHO C1713 $1,159.20 PLATE BONE DCP STAINLESS STEEL L27 MM X W5 MM 5 HO C1713 $1,200.56 PLATE BONE DCP STAINLESS STEEL NARROW L135 MM X W1 C1713 $1,159.20 PLATE BONE DCP STAINLESS STEEL NARROW L71 MM X W12 C1713 $1,021.20 PLATE BONE DCP STAINLESS STEEL PEDIATRIC 95 D L92 C1713 $3,818.00 PLATE BONE DCP STAINLESS STEEL T L50 MM 4 HOLE HEA C1713 $1,453.60 PLATE BONE DCP TITANIUM ADULT 90 D 20 MM DISPLACEM C1713 $4,130.80 PLATE BONE DCP TITANIUM ANGLE CONTOUR L43 MM X W5 C1713 $3,225.60 PLATE BONE DCP TITANIUM L26 MM X W8 MM X H2.5 MM O C1713 $1,932.00 PLATE BONE DCP TITANIUM MINI L22 MM CRANIOFACIAL 4 C1713 $1,985.60 PLATE BONE DCS DCP STAINLESS STEEL 95 D SHORT BARR C1713 $6,784.96 PLATE BONE DCS DCP STAINLESS STEEL 95 D SHORT BARR C1713 $7,760.16 PLATE BONE DCS STAINLESS STEEL 95 D BARREL L370 MM C1713 $10,676.56 PLATE BONE DCS STAINLESS STEEL 95 D SHORT BARREL L C1713 $6,784.96 PLATE BONE DHS DCP STAINLESS STEEL 135 D STANDARD C1713 $3,303.95 PLATE BONE DHS DCP STAINLESS STEEL 135 D STANDARD C1713 $3,726.00 PLATE BONE DHS DCP STAINLESS STEEL 135 D STANDARD C1713 $4,949.60 PLATE BONE DHS STAINLESS STEEL 130 D STANDARD BARR C1713 $4,949.60 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PLATE BONE DHS STAINLESS STEEL 145 D STANDARD BARR C1713 $4,949.60 PLATE BONE DHS/DCP STAINLESS STEEL 135 D SHORT BAR C1713 $4,066.40 PLATE BONE DHS/DCP STAINLESS STEEL 140 D STANDARD C1713 $3,726.00 PLATE BONE DYNAFIX VS L8.75 MM RIGHT ORTHOPEDIC 4 C1713 $7,392.32 PLATE BONE GRIFFIN LINDORF TITANIUM L3 MM CHIN MOD C1713 $1,266.88 PLATE BONE GRIFFIN LINDORF TITANIUM L3 MM CHIN MOD C1713 $1,433.60 PLATE BONE H1.2 MM OD50 MM CRANIOMAXILLOFACIAL CON C1713 $11,424.00 PLATE BONE H2 MM MANDIBLE 17 HOLE PRIMARY RECONSTR C1713 $19,430.32 PLATE BONE HELIX R L34 MM SPINE 2 LEVEL NONSTERILE C1713 $5,200.00 PLATE BONE HUMERAL DISTAL MEDIAL 8 HOLE MOLD C1713 $344.50 PLATE BONE HYBRID MMF SMALL MAXILLOMANDIBULAR 9 HO C1713 $2,340.00 PLATE BONE L17.5 MM LEFT ORTHOPEDIC 6 HOLE C1713 $7,392.32 PLATE BONE L48 MM X W48 MM X H1.2 MM CRANIOMAXILLO C1713 $10,456.00 PLATE BONE LC-DCP STAINLESS STEEL BROAD L116 MM X C1713 $1,759.68 PLATE BONE LC-DCP STAINLESS STEEL BROAD L124 MM X C1713 $1,968.80 PLATE BONE LC-DCP STAINLESS STEEL BROAD L155 MM X C1713 $2,165.76 PLATE BONE LC-DCP STAINLESS STEEL BROAD L286 MM X C1713 $2,668.00 PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L88 M C1713 $2,116.00 PLATE BONE LC-DCP STAINLESS STEEL CURVE L142 MM X C1713 $3,454.56 PLATE BONE LC-DCP STAINLESS STEEL L95 MM X H2.6 MM C1713 $1,182.16 PLATE BONE LC-DCP STAINLESS STEEL NARROW L70 MM X C1713 $1,186.80 PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L125 MM C1713 $3,210.80 PLATE BONE LC-DCP STAINLESS STEEL T RIGHT ANGLE L7 C1713 $1,191.36 PLATE BONE LC-DCP STAINLESS STEEL T RIGHT ANGLE L9 C1713 $1,531.76 PLATE BONE LC-DCP TITANIUM BROAD L286 MM X W17.5 M C1713 $2,663.36 PLATE BONE LC-DCP TITANIUM CRESCENT L38 MM X W6.5 C1713 $4,596.80 PLATE BONE LC-DCP TITANIUM L39 MM X W6.5 MM X H1.6 C1713 $4,515.20 PLATE BONE LC-DCP TITANIUM RIGHT ANGLE T L56 MM X C1713 $924.56 PLATE BONE LC-DCP TITANIUM T L148 MM 8 HOLE SHAFT C1713 $3,312.00 PLATE BONE LCP COMBI STAINLESS STEEL BROAD CURVE L C1713 $6,536.56 PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L119 C1713 $10,050.96 PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L151 C1713 $4,609.20 PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L178 C1713 $10,184.40 PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L185 C1713 $10,418.96 PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L275 C1713 $11,605.76 PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L286 C1713 $10,529.36 PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L301 C1713 $11,973.76 PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L93 M C1713 $9,581.76 PLATE BONE LCP COMBI STAINLESS STEEL CURVE L242 MM C1713 $11,108.96 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PLATE BONE LCP COMBI STAINLESS STEEL CURVE L458 MM C1713 $13,183.60 PLATE BONE LCP COMBI STAINLESS STEEL D12 MM L85 MM C1713 $5,561.36 PLATE BONE LCP COMBI STAINLESS STEEL L122 MM HUMER C1713 $6,996.60 PLATE BONE LCP COMBI STAINLESS STEEL L163 MM HUMER C1713 $6,918.34 PLATE BONE LCP COMBI STAINLESS STEEL L168 MM X W13 C1713 $10,418.96 PLATE BONE LCP COMBI STAINLESS STEEL L173 MM HUMER C1713 $6,707.42 PLATE BONE LCP COMBI STAINLESS STEEL L173 MM TIBIA C1713 $12,429.20 PLATE BONE LCP COMBI STAINLESS STEEL L213 MM TIBIA C1713 $7,945.93 PLATE BONE LCP COMBI STAINLESS STEEL L247 MM FEMUR C1713 $8,360.76 PLATE BONE LCP COMBI STAINLESS STEEL L262 MM TIBIA C1713 $11,421.76 PLATE BONE LCP COMBI STAINLESS STEEL L266 MM HUMER C1713 $10,143.58 PLATE BONE LCP COMBI STAINLESS STEEL L55 MM RADIUS C1713 $5,921.24 PLATE BONE LCP COMBI STAINLESS STEEL L55 MM X W11 C1713 $7,507.20 PLATE BONE LCP COMBI STAINLESS STEEL L58 MM X W11 C1713 $6,246.80 PLATE BONE LCP COMBI STAINLESS STEEL L65 MM X W11 C1713 $6,246.80 PLATE BONE LCP COMBI STAINLESS STEEL L65 MM X W11 C1713 $7,166.80 PLATE BONE LCP COMBI STAINLESS STEEL L69 MM CLAVIC C1713 $6,200.80 PLATE BONE LCP COMBI STAINLESS STEEL L90 MM X W11 C1713 $7,277.20 PLATE BONE LCP COMBI STAINLESS STEEL LOW BEND L161 C1713 $8,054.28 PLATE BONE LCP COMBI STAINLESS STEEL NARROW L262 M C1713 $9,176.96 PLATE BONE LCP COMBI STAINLESS STEEL NARROW L62 MM C1713 $2,226.40 PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE LEFT C1713 $2,511.60 PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE RIGHT C1713 $2,838.16 PLATE BONE LCP COMBI STAINLESS STEEL T L83 MM 4 HO C1713 $4,107.76 PLATE BONE LCP COMBI TITANIUM BROAD L260 MM X W17. C1713 $5,382.00 PLATE BONE LCP COMBI TITANIUM CONTOUR L119 MM TIBI C1713 $10,050.96 PLATE BONE LCP COMBI TITANIUM CONTOUR L145 MM TIBI C1713 $10,166.00 PLATE BONE LCP COMBI TITANIUM CONTOUR L190 MM TIBI C1713 $9,954.40 PLATE BONE LCP COMBI TITANIUM CONTOUR L211 MM TIBI C1713 $10,184.40 PLATE BONE LCP COMBI TITANIUM CONTOUR L211 MM TIBI C1713 $10,524.80 PLATE BONE LCP COMBI TITANIUM CONTOUR L216 MM OLEC C1713 $7,263.36 PLATE BONE LCP COMBI TITANIUM CONTOUR L250 MM TIBI C1713 $10,078.56 PLATE BONE LCP COMBI TITANIUM CONTOUR L301 MM TIBI C1713 $11,596.56 PLATE BONE LCP COMBI TITANIUM CONTOUR L322 MM TIBI C1713 $10,626.00 PLATE BONE LCP COMBI TITANIUM CONTOUR L81 MM TIBIA C1713 $9,609.36 PLATE BONE LCP COMBI TITANIUM CONTOUR L82 MM TIBIA C1713 $9,618.56 PLATE BONE LCP COMBI TITANIUM D15 MM L112 MM CLAVI C1713 $6,131.76 PLATE BONE LCP COMBI TITANIUM L108 MM CLAVICLE RIG C1713 $6,122.56 PLATE BONE LCP COMBI TITANIUM L135 MM CLAVICLE RIG C1713 $6,444.56 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PLATE BONE LCP COMBI TITANIUM L138 MM X W11 MM X H C1713 $6,633.20 PLATE BONE LCP COMBI TITANIUM L164 MM X W11 MM X H C1713 $8,698.56 PLATE BONE LCP COMBI TITANIUM L182 MM X W10.1 MM X C1713 $4,600.00 PLATE BONE LCP COMBI TITANIUM L266 MM HUMERUS RIGH C1713 $12,484.40 PLATE BONE LCP COMBI TITANIUM L302 MM HUMERUS LEFT C1713 $13,712.56 PLATE BONE LCP COMBI TITANIUM L55 MM X W11 MM X H2 C1713 $6,462.96 PLATE BONE LCP COMBI TITANIUM L62 MM FIBULA RADIUS C1713 $4,020.40 PLATE BONE LCP COMBI TITANIUM L66 MM X W6.3 MM X H C1713 $7,369.60 PLATE BONE LCP COMBI TITANIUM L83 MM X W11 MM X H2 C1713 $7,166.80 PLATE BONE LCP COMBI TITANIUM L94 MM CLAVICLE LEFT C1713 $6,462.96 PLATE BONE LCP COMBI TITANIUM STRAIGHT L75 MM 4 HO C1713 $2,934.80 PLATE BONE LCP STAINLESS STEEL 0 D SMALL L42 MM FI C1713 $6,872.32 PLATE BONE LCP STAINLESS STEEL 10 D MEDIUM L52 MM C1713 $6,872.32 PLATE BONE LCP STAINLESS STEEL 4.5 MM FEMUR DISTAL C1713 $3,716.80 PLATE BONE LCP STAINLESS STEEL L L32 MM LEFT 2 HOL C1713 $2,658.80 PLATE BONE LCP STAINLESS STEEL L118 MM WRIST FUSIO C1713 $9,500.73 PLATE BONE LCP STAINLESS STEEL L140 MM TIBIA LEFT C1713 $10,897.36 PLATE BONE LCP STAINLESS STEEL L260 MM TIBIA LEFT C1713 $11,550.56 PLATE BONE LCP STAINLESS STEEL L73 MM TIBIAL LEFT C1713 $8,017.76 PLATE BONE LCP STAINLESS STEEL NARROW L404 MM X W1 C1713 $9,448.40 PLATE BONE LCP STAINLESS STEEL PEDIATRIC 150 D L58 C1713 $4,070.96 PLATE BONE LCP STAINLESS STEEL RADIUS LEFT DISTAL C1713 $8,032.57 PLATE BONE LCP TITANIUM CONTOUR L50.5 MM RADIUS RI C1713 $4,829.44 PLATE BONE LCP TITANIUM CONTOUR L59.5 MM RADIUS RI C1713 $4,982.32 PLATE BONE LCP TITANIUM L156 MM FEMUR RIGHT DISTAL C1713 $10,897.36 PLATE BONE LCP TITANIUM L196 MM FEMUR RIGHT DISTAL C1713 $10,768.56 PLATE BONE LCP TITANIUM L208 MM X W11 MM X H4.2 MM C1713 $8,786.00 PLATE BONE LCP TITANIUM L236 MM FEMUR LEFT DISTAL C1713 $10,998.56 PLATE BONE LCP TITANIUM L260 MM TIBIA RIGHT PROXIM C1713 $11,831.20 PLATE BONE LCP TITANIUM L300 MM TIBIA LEFT PROXIMA C1713 $11,720.80 PLATE BONE LCP TITANIUM L39 MM X W5 MM X H1.2 MM C C1713 $2,208.00 PLATE BONE LCP TITANIUM L72 MM X W11 MM X H3.4 MM C1713 $1,987.20 PLATE BONE LCP TITANIUM L85 MM X W11 MM X H3.4 MM C1713 $2,116.00 PLATE BONE LCP TITANIUM NARROW L242 MM X W13.5 MM C1713 $4,563.20 PLATE BONE LCP TITANIUM RADIUS LEFT DISTAL VOLAR 1 C1713 $9,996.00 PLATE BONE LCP TITANIUM RADIUS LEFT DISTAL VOLAR 9 C1713 $9,419.76 PLATE BONE LEGACY X10 CROSSLINK CD HORIZON MULTI-S C1713 $4,800.00 PLATE BONE LEIBINGER UNIVERSAL 2 TITANIUM SMALL WI C1713 $2,327.91 PLATE BONE LEIBINGER UNIVERSAL 2 TITANIUM STANDARD C1713 $1,765.28 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM 90 D M C1713 $1,089.28 PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM L43 MM C1713 $3,735.52 PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI L C1713 $1,089.28 PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI X C1713 $2,563.36 PLATE BONE LONG CALCANEUS MOLD C1713 $344.50 PLATE BONE M3-X TITANIUM L LEFT 2 X 4 HOLE COMPRES C1713 $2,640.00 PLATE BONE MATRIXMANDIBLE TITANIUM BROAD CRESCENT C1713 $4,848.00 PLATE BONE MATRIXMANDIBLE TITANIUM H1 MM MANDIBLE C1713 $4,708.80 PLATE BONE MATRIXMANDIBLE TITANIUM STRAIGHT H2 MM C1713 $4,949.10 PLATE BONE MATRIXMIDFACE MATRIXORBITAL TITANIUM LA C1713 $9,402.90 PLATE BONE MATRIXMIDFACE TITANIUM H.2 MM ORBITAL F C1713 $7,012.20 PLATE BONE MATRIXMIDFACE TITANIUM STANDARD LARGE T C1713 $1,761.60 PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MEDIUM C1713 $3,552.90 PLATE BONE MATRIXNEURO TITANIUM L200 MM X W200 MM C1713 $76,901.20 PLATE BONE MATRIXORTHOGNATHIC TITANIUM CURVE L12 M C1713 $2,491.20 PLATE BONE MATRIXORTHOGNATHIC TITANIUM STRAIGHT L6 C1713 $2,452.80 PLATE BONE MULTI-SPAN CROSSLINK STAINLESS STEEL LO C1713 $8,562.24 PLATE BONE NEURO LOW PROFILE TITANIUM BOX L16 MM X C1713 $1,083.60 PLATE BONE NEURO LOW PROFILE TITANIUM H.4 MM OD70 C1713 $13,566.00 PLATE BONE NEURO LOW PROFILE TITANIUM H.6 MM OD100 C1713 $16,911.60 PLATE BONE PEANUT TITANIUM ARCH L16 MM EPIPHYSIS L C1713 $2,084.16 PLATE BONE PEDIATRIC 100 D L1 7/8 IN HIP 2 HOLE OS C1713 $3,032.40 PLATE BONE PEDIPLATES STAINLESS STEEL PEDIATRIC O C1713 $4,384.00 PLATE BONE PIRANHA TITANIUM ALUMINUM VANADIUM LORD C1713 $4,550.00 PLATE BONE PROLOCK II TITANIUM PRECONTOUR L63 MM R C1713 $1,924.65 PLATE BONE PROLOCK LONG L32 MM RADIAL RIGHT STYLOI $1,877.66 PLATE BONE PRO-PAK TITANIUM STRAIGHT L71 MM X W5 M C1713 $1,528.61 PLATE BONE RAPIDSORB STRAIGHT L18 MM X W6 MM X H.8 C1713 $840.00 PLATE BONE ROI-C STANDARD H5-7 MM SPINE LEVEL 2 LO C1713 $4,712.50 PLATE BONE SMALL T OBLIQUE ANGLE L39 MM 3 HOLE HEA C1713 $971.75 PLATE BONE SNOWCAP TITANIUM PRECONTOUR L72 MM X W1 C1713 $5,200.00 PLATE BONE STAINLESS STEEL 108 MM RADIUS L208 MM P C1713 $4,278.00 PLATE BONE STAINLESS STEEL 88 MM RADIUS J L130 MM C1713 $3,445.36 PLATE BONE STAINLESS STEEL 88 MM RADIUS J L156 MM C1713 $3,716.80 PLATE BONE STAINLESS STEEL 90 D L40 MM ORTHOPEDIC C1713 $6,237.60 PLATE BONE STAINLESS STEEL 90 D L60 MM ORTHOPEDIC C1713 $8,174.16 PLATE BONE STAINLESS STEEL 90 D L80 MM L40 MM X W9 C1713 $6,495.20 PLATE BONE STAINLESS STEEL ADULT 130 D L70 MM STER C1713 $4,089.36 PLATE BONE STAINLESS STEEL CUBOID LOW PROFILE CUT C1713 $2,534.56 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PLATE BONE STAINLESS STEEL L111 MM TIBIAL LEFT PRO C1713 $8,348.96 PLATE BONE STAINLESS STEEL L176 MM STERNUM 22 HOLE C1713 $9,560.00 PLATE BONE STAINLESS STEEL L192 MM STERNUM 24 HOLE C1713 $9,800.00 PLATE BONE STAINLESS STEEL L73 MM RIGHT PROXIMAL T C1713 $8,358.16 PLATE BONE STAINLESS STEEL LONG L148 MM NONSTERILE C1713 $3,877.76 PLATE BONE STAINLESS STEEL SEMITUBULAR L135 MM X W C1713 $708.40 PLATE BONE STAINLESS STEEL T L96 MM 5 HOLE SHAFT B C1713 $3,575.04 PLATE BONE STAINLESS STEEL TIBIA DISTAL 5 HOLE SCA C1713 $1,968.80 PLATE BONE STAINLESS STEEL WIDE ANGLE LOW PROFILE C1713 $3,413.20 PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L52 C1713 $2,295.36 PLATE BONE STRAIGHT 4 HOLE MOLD C1713 $344.50 PLATE BONE THORP TITANIUM MAXILLOFACIAL 8 HOLE NON C1713 $6,304.00 PLATE BONE TIMESH TITANIUM STRAIGHT L4 MM CRANIUM C1713 $317.42 PLATE BONE TITANIUM 1/3 TUBULAR 2 ROUND HOLE 3.5 M C1713 $581.75 PLATE BONE TITANIUM 1/4 TUBULAR L41 MM 5 ROUND HOL C1713 $646.75 PLATE BONE TITANIUM 100 D L L8 MM X H.6 MM MID FAC C1713 $1,459.76 PLATE BONE TITANIUM 100 D MICRO LONG L H.6 MM FRON C1713 $1,231.36 PLATE BONE TITANIUM 4.5 MM SPACE L L22 MM X W4 MM C1713 $1,560.00 PLATE BONE TITANIUM 5 MM SPACE OBLIQUE LEFT L L31 C1713 $1,849.60 PLATE BONE TITANIUM 90 D L L17 MM LEFT CRANIOMAXIL C1713 $1,632.00 PLATE BONE TITANIUM 90 D L L19 MM X W4.8 MM X H.6 C1713 $1,353.60 PLATE BONE TITANIUM 90 D L20 MM LEFT CRANIOMAXILLO C1713 $1,736.00 PLATE BONE TITANIUM 90 D L30 MM ORTHOPEDIC 5 HOLE C1713 $6,398.56 PLATE BONE TITANIUM 90 D L60 MM ORTHOPEDIC 12 HOLE C1713 $8,142.00 PLATE BONE TITANIUM ANGLE L56 MM X W8 MM X H2.5 MM C1713 $26,630.40 PLATE BONE TITANIUM ANGLE STERNUM 12 HOLE LOCK STE C1713 $9,005.75 PLATE BONE TITANIUM BROAD L137 MM 8 HOLE ACTIVE CO C1713 $1,946.75 PLATE BONE TITANIUM H.75 MM LEFT MAXILLOFACIAL 9 H C1713 $1,103.60 PLATE BONE TITANIUM L L29 MM X W4.8 MM X H.9 MM L1 C1713 $1,348.80 PLATE BONE TITANIUM L STRAIGHT RIGHT 4 ROUND HOLE C1713 $646.75 PLATE BONE TITANIUM L100 MM X W100 MM X H.2 MM CRA C1713 $5,951.40 PLATE BONE TITANIUM L102 MM X W11-14 MM X H3.5 MM C1713 $2,427.75 PLATE BONE TITANIUM L125 MM TIBIA LEFT DISTAL MEDI C1713 $4,677.44 PLATE BONE TITANIUM L159 MM TIBIA LEFT PROXIMAL 10 C1713 $9,945.20 PLATE BONE TITANIUM L17 MM 3 ROUND HOLE 2 MM SCREW C1713 $646.75 PLATE BONE TITANIUM L251 MM TIBIA LEFT DISTAL MEDI C1713 $8,535.20 PLATE BONE TITANIUM L31 MM X W7 MM X H1 MM H.3 MM C1713 $579.60 PLATE BONE TITANIUM L68 MM X W11 MM CLAVICLE RIGHT C1713 $6,968.00 PLATE BONE TITANIUM L95 MM TIBIA RIGHT DISTAL MEDI C1713 $4,293.92 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PLATE BONE TITANIUM MICRO L36 MM X W32 MM X H.5 MM C1713 $9,600.00 PLATE BONE TITANIUM RADIUS LEFT DISTAL DORSAL C1713 $7,392.16 PLATE BONE TITANIUM RECTANGLE L45 MM X W38 MM X H. C1713 $10,744.00 PLATE BONE TITANIUM SMALL ARC H.4 MM CRANIOFACIAL C1713 $6,288.00 PLATE BONE TITANIUM SMALL L68 MM 8 HOLE ACTIVE COM C1713 $1,784.25 PLATE BONE TITANIUM STRAIGHT MANDIBLE 16 HOLE MICR C1713 $8,216.00 PLATE BONE TITANIUM STRAIGHT W6.5 MM X H2 MM MANDI C1713 $8,500.00 PLATE BONE TITANIUM T FOOT METATARSAL 4 HOLE LOW P C1713 $4,517.50 PLATE BONE TITANIUM T L44 MM 4 HOLE HEAD 4 HOLE SH C1713 $809.25 PLATE BONE TITANIUM UNIVERSAL ANGLE L25 MM X W6.5 C1713 $7,520.80 PLATE BONE TITANIUM Y L27 MM X W15 MM X H.5 MM CRA C1713 $1,761.20 PLATE BONE UNIVERSAL NEURO III TITANIUM STRAIGHT H C1713 $1,234.24 PLATE BONE VARIAX BROAD STRAIGHT L103 MM 8 HOLE CO C1713 $3,001.05 PLATE BONE VARIAX TITANIUM L101 MM X W10 MM X H2 M C1713 $3,235.44 PLATE BONE VARIAX TITANIUM L116 MM HUMERUS DISTAL C1713 $5,234.29 PLATE BONE VARIAX TITANIUM L77 MM X W10 MM X H2 MM C1713 $3,235.44 PLATE BONE VHS ORTHOPEDIC 2 HOLE KEYLESS C1713 $3,660.80 PLATE BONE WIDE HUMERAL 4 HOLE HEAD MOLD C1713 $455.00 PLATE BONE X10 CROSSLINK TITANIUM L28-30 MM SPINE C1713 $4,800.00 PLATE BONE X10 CROSSLINK TITANIUM L31 MM SPINE 4.5 C1713 $4,800.00 PLATE BONE X10 CROSSLINK TITANIUM L41-56 MM SPINE C1713 $4,800.00 PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L22 MM C1713 $4,800.00 PLATE BONE XS H4 MM OD2.4 MM C1713 $5,423.36 PLATE BONE XTEND L30 MM SPINE CERVICAL ANTERIOR 2 C1713 $6,175.00 PLATE BONE XTEND L46 MM SPINE CERVICAL ANTERIOR 2 C1713 $6,175.00 PLATE BONE XTEND L81 MM SPINE CERVICAL ANTERIOR 4 C1713 $6,825.00 PLATE BONE XTEND L92 MM SPINE CERVICAL ANTERIOR 5 C1713 $7,150.00 PLATE BONE XTEND L93 MM SPINE CERVICAL ANTERIOR 4 C1713 $6,825.00 PLATE BONE ZEVO TITANIUM L41 MM SPINE CERVICAL ANT C1713 $4,550.00 PLATE EXTERNAL FIXATION CIRCULAR 3 HOLE HALF RING $1,924.24 PLATE EXTERNAL FIXATION ILIZAROV CARBON FIBER EPOX $2,003.68 PLATE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL A $1,788.16 PLATE EXTERNAL FIXATION SHORT CIRCULAR L47 MM 4 HO $1,298.32 PLATE EXTERNAL FIXATION SPATIAL FRAME ILIZAROV ALU $12,508.48 PLATE EXTERNAL FIXATION SPATIAL FRAME U ID80 MM $7,078.80 PLATE EXTERNAL FIXATION TITANIUM 90 D ARCH L240 MM $7,866.00 PLATELET AGGEGATION 85576 $184.00 PLATELET ANTIBODY 86022 $650.00 PLATELET ASSOC ANTIBODY ID 86023 $320.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PLATELET COUNT, AUTOMATED TEST 85049 $143.00 PLATELET FUNCTION ANALYSIS/ADP 85576 $184.00 PLATELET FUNCTION TEST 85597 $247.00 PLATELET RECEP INHIB-ASPIRIN 85576 $184.00 PLATELET RECEP INHIB-P2Y12 85576 $184.00 PLUG CARDIOVASCULAR AMPLATZER NITINOL MESH .098 IN $4,160.00 PLUG SPINAL POLARIS TITANIUM OD5.5 MM DEROTATION H C1713 $400.00 PNEUMOCOCCAL VACCINE 25 MCG/0.5 ML SYRG 0.5 ML SYR 90732 $329.12 PNEUMOCOCCAL VACCINE FOR INJECTION INTO MUSCLE 90670 $541.00 POCT BLOOD CREATININE LEVEL 82565 $228.00 POCT BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND- 82962 $49.00 POCT BMP W IONIZED CA 80047 $427.00 POCT CHLORIDE 82435 $115.00 POCT COAGULATION TIME ACTIVATED 85347 $139.00 POCT GLUCOSE 82947 $65.00 POCT HEMATOCRIT 85014 $53.00 POCT HEMOGLOBIN 85018 $50.00 POCT HEMOGLOBIN A1C 83036 $213.00 POCT IONIZED CALCIUM 82330 $114.00 POCT POTASSIUM 84132 $118.00 POCT PREGNANCY TEST URINE 81025 $210.00 POCT SODIUM 84295 $94.00 POCT TCO2 82374 $120.00 POOLING OF PLATELETS OR OTHER BLOOD PRODUCTS 86965 $356.00 PORPHOBLGN UR QUANT 84110 $221.00 PORT HAND ACCESS DA VINCI SI SINGLE-SITE OD8.5 MM $1,060.00 PORT IMPLANTABLE INFUSION PRO-FUSE PLASTIC C1788 $2,600.00 PORT IMPLANTABLE INFUSION SLIMPORT CHRONOFLEX TITA C1788 $1,760.00 POST COITAL MUCOUS EXAM Q0115 $106.00 POTASSIUM STOOL 84999 $333.00 POTASSIUM, BODY FLUID 84133 $195.00 POTASSIUM, URINE 84133 $195.00 POUCH SPECIMEN RETRIEVAL ENDO CATCH II METAL POLYU $636.74 PREALBUMIN (PROTEIN) LEVEL 84134 $191.00 PREGNANEDIOL (REPRODUCTIVE HORMONE) LEVEL 84135 $148.00 PREGNENOLONE (REPRODUCTIVE HORMONE) LEVEL 84140 $303.00 PREPARATION & PROVISION OF SINGLE STINGING INSECT 95145 $131.00 PREPARATION & PROVISION SINGLE-DOSE VIALS ALLERGEN 95144 $190.00 PREPARATION OF SPECIMEN USING LASER 88380 $349.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PREPARATION OF STEM CELLS FOR TRANSPLANTATION 38214 $1,065.00 PREPARATION OF STEM CELLS FOR TRANSPLANTATION WITH 38212 $1,065.00 PREPARATION OF TISSUE FOR EXAMINATION BY REMOVING 88311 $23.00 PREPARE & PROVISION SINGLE OR MULTIPLE ANTIGENS FO 95165 $123.00 PRETREATMENT RED BLOOD CELLS FOR USE IN ANTIBODY A 86971 $593.00 PRIMIDONE LEVEL 80188 $176.00 PROBRAIN NAT PEPTIDE NT 83880 $167.00 PROCALCITONIN (HORMONE) LEVEL 84145 $855.00 PROCESSING AND STORAGE OF BLOOD UNIT OR COMPONENT 86890 $292.00 PROCESSOR SOUND PONTO PLUS POWER LEFT CHROMA BEIGE L8691 $20,055.75 PROCESSOR SOUND PONTO PLUS POWER RIGHT WHITE SILVE L8691 $20,055.75 PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL 84144 $240.00 PROGESTERONE (REPRODUCTIVE HORMONE) RECEPTOR ANALY 84234 $378.00 PROGRAM BTE BINAURAL V5253 $9,085.00 PROGRAM BTE MONAURAL V5247 $4,546.00 PROGRAM ITE BINAURAL V5252 $9,588.00 PROGRAM ITE MONAURAL V5246 $4,796.00 PROGRAMMED HEART RHYTHM STIMULATION AFTER DRUG INF 93623 $3,230.00 PROGRAMMER NEUROSTIMULATOR AXIUM LITHIUM ION THK2 C1787 $9,795.50 PROINSULIN (PANCREATIC HORMONE) LEVEL 84206 $212.00 PROLACTIN (MILK PRODUCING HORMONE) LEVEL 84146 $354.00 PROLONGED CHEMOTHERAPY INFUSION INTO VEIN PORT/IMP 96416 $1,158.00 PROSTATE SPEC ANTIGEN (PSA),TOTAL 84153 $185.00 PROSTATE SPECIFIC, PSA TOTAL SCREENING 84153 $185.00 PROSTHESIS OSSICULAR ALTO TITANIUM L3-7 MM OD3 MM L8613 $2,163.85 PROSTHESIS OSSICULAR GOLDENBERG PLASTI-PORE HA L5. L8613 $3,006.00 PROSTHESIS PENILE TITAN LOCK-OUT BIOFLEX SILICONE C1813 $44,622.50 PROSTHESIS PENILE TITAN LOCK-OUT BIOFLEX SILICONE C1813 $54,920.00 PROT TOTAL SERUM PLASMA WHOLE BLOOD 84155 $174.00 PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH I 88372 $177.00 PROTEIN ANALYSIS OF TISSUE WITH INTERPRETATION AND 88371 $173.00 PROTEIN C ANTIGEN (CLOTTING INHIBITOR) MEASUREMENT 85303 $291.00 PROTEIN C, (CLOTTING INHIBITOR) ACTIVITY 85302 $404.00 PROTEIN ELECT URINE 84166 $227.00 PROTEIN ELECT, SERUM 84165 $220.00 PROTEIN MEASUREMENT, BODY FLUID 84166 $227.00 PROTEIN MEASUREMENT, SERUM 84165 $220.00 PROTEIN S (CLOTTING INHIBITOR) LEVEL 85305 $336.00 PROTEIN S FREE 85306 $482.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge PROTEIN S FUNCTIONAL 85306 $482.00 PROTEIN TEST FOR DIAGNOSIS AND MONITORING OF BLADD 86386 $124.00 PROTEIN, TOTAL BODY FLUID 84157 $108.00 PROTEIN, TOTAL, CSF 84157 $108.00 PROTEINASE-3 ANTIBODY 83520 $348.00 PROTHROMBIN TIME 85610 $165.00 PROTOPORPHYRIN (METABOLISM SUBSTANCE) SCREENING TE 84203 $67.00 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT 84152 $143.00 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT 84153 $185.00 PSA ULTRA SENSITIVE 84153 $185.00 PSYCHIATRIC DIAGNOSTIC EVALUATION 90791 $501.00 PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SER 90792 $533.00 PSYCHOTHERAPY FOR CRISIS ADDITIONAL 30 MINUTES 90840 $335.00 PSYCHOTHERAPY, 30 MINUTES 90832 $401.00 PSYCHOTHERAPY, 30 MINUTES 90833 $631.00 PSYCHOTHERAPY, 45 MINUTES 90834 $533.00 PSYCHOTHERAPY, 45 MINUTES 90836 $826.00 PSYCHOTHERAPY, 60 MINUTES 90838 $466.00 PSYCHOTHERAPY, 60 MINUTES 90837 $533.00 PT/INR 85610 $165.00 PTH PEPTIDE 82397 $36.00 PTH RELATED PEPTIDE 82542 $324.00 PTT 85730 $195.00 PULMONARY EXERCISE TESTING 94618 $289.00 PULMONARY EXERCISE TESTING 94621 $1,934.00 PULMONARY SERVICE OR OPERATION 94799 $159.00 PUNCH ENDOSCOPIC HOSEMANN 70 D L13 CM OD5.5 MM FRO $8,632.26 PUNCTURE OF SKIN FOR COLLECTION OF BLOOD SAMPLE 36416 $30.00 PURE TONE AIR AND BONE CONDUCTION HEARING ASSESSME 92553 $298.00 PURE TONE AIR CONDUCTION THRESHOLD HEARING ASSESSM 92552 $251.00 PYRUVATE KINASE (ENZYME) LEVEL 84220 $129.00 QUALITATIVE FECES 82705 $114.00 QUANTITATION OF THERAPEUTIC DRUG 80299 $395.00 QUINIDINE LEVEL 80194 $269.00 QUININE (DRUG) LEVEL 84228 $91.00 RADIOLOGICAL S & I IMAGING OF LUNG ARTERY CONTRAST 75746 $4,182.00 RADIOLOGICAL SUPERVISION & INTERP IMAGING OF LIVER 75887 $4,182.00 RADIOLOGICAL SUPERVISION & INTERP OF DRAWING BLOOD 75893 $11,504.00 RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF AR 75710 $4,904.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF AR 75743 $11,791.00 RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF VE 75820 $3,277.00 RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF VE 75822 $4,908.00 RADIOLOGICAL SUPERVISION & INTERP OF INSERT CATHET 74328 $781.00 RADIOLOGICAL SUPERVISION & INTERP OF MRI GUIDANCE 77021 $1,112.00 RADIOLOGICAL SUPERVISION & INTERP OF OBSTRUCT OF B 75894 $3,274.00 RADIOLOGICAL SUPERVISION & INTERP OF PLACEMENT CAT 75989 $2,250.00 RADIOLOGICAL SUPERVISION & INTERP PLACEMENT LONG S 74340 $843.00 RADIOLOGICAL SUPERVISION & INTERP REMOVAL OF FOREI 74235 $847.00 RADIOLOGICAL SUPERVISION & INTERP X-RAY OF BILE AN 74300 $726.00 RADIOLOGICAL SUPERVISION & INTERP X-RAY OF TEAR DR 70170 $975.00 RADIOLOGICAL SUPERVISION & INTERP X-RAY OF URINARY 74450 $1,019.00 RADIOLOGICAL SUPERVISION & INTERP X-RAY OF URINARY 74430 $1,233.00 RADIOLOGICAL SUPERVISION & INTERP X-RAY OF URINARY 74455 $2,469.00 RADIOLOGICAL SUPERVISION & INTERPRETATION CHANGE O 75984 $1,427.00 RADIOLOGICAL SUPERVISION & INTERPRETATION IMAGING 75809 $2,417.00 RADIOLOGICAL SUPERVISION & INTERPRETATION IMAGING 75825 $8,846.00 RADIOLOGICAL SUPERVISION & INTERPRETATION OF CT GU 77012 $4,463.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION IMAGIN 75741 $11,791.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75827 $3,138.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75756 $4,182.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75736 $11,791.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73040 $699.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73580 $963.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 70390 $1,237.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73085 $1,464.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73525 $1,807.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 74425 $1,918.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73115 $2,041.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 72265 $2,169.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 72240 $2,456.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 72255 $2,456.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73615 $2,467.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 75605 $11,791.00 RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 75625 $11,791.00 RADIOLOGY DIAGNOSTIC RADIOLOGY ? REVENUE CODE 32X G0378 $185.00 RAIL EXTERNAL FIXATION SMALL ROTATIONAL T CLAMP $5,912.40 RECONSTRUCT EXTRA FINGER 26587 $7,215.00 RECOVERY PHASE 1 1ST 15 MINUTES $1,699.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge RECOVERY PHASE 1 EACH ADDITIONAL 15 MINUTES $235.00 RECOVERY PHASE 2 1ST 15 MINUTES $850.00 RECOVERY PHASE 2 EACH ADDITIONAL 15 MINUTES $117.00 RED BLOOD CELL ANTIBODY DETECTION TEST 86880 $99.00 RED BLOOD CELL ANTIBODY LEVEL 86886 $398.00 RED BLOOD CELL ANTIBODY SCREENING TEST 86940 $130.00 RED BLOOD CELL CONCENTRATION MEASUREMENT 85014 $53.00 RED BLOOD CELL FRAGILITY MEASUREMENT 85547 $62.00 RED BLOOD CELL FRAGILITY MEASUREMENT 85557 $345.00 RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLA 85651 $156.00 RED BLOOD COUNT AUTOMATED, WITH ADDITIONAL CALCULA 85046 $126.00 REDUCING SUBSTANCES, URINE 81002 $17.00 RE-EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED 97168 $400.00 RE-EVALUATION OF PHYSICAL THERAPY TYPICALLY 20 MIN 97164 $511.00 REFERENCE CHLORIDE, OTHER SOURCE 82438 $184.00 RELOAD STAPLER ECHELON ENDOPATH ECHELON FLEX TITAN $896.14 RELOAD STAPLER ECHELON FLEX ENDOPATH STAINLESS STE $839.49 RELOAD STAPLER EEA STAINLESS STEEL L25 MM $1,706.77 RELOAD STAPLER ENDO GIA TITANIUM 4 MM 4.5 MM 5 MM $4,246.75 RELOAD STAPLER ENDOPATH ECHELON FLEX TITANIUM L60 $975.17 RELOAD STAPLER L45 MM MESENTERY THIN TISSUE CURVE $1,345.70 RELOCATION OF DEFIBRILLATOR DEVICE SKIN POCKET 33223 $4,106.00 RELOCATION OF PACEMAKER GENERATOR SKIN POCKET 33222 $4,106.00 REMOTE EVALUATIONS DEFIB TRANSM TECHN REV SUPP & D 93296 $138.00 REMOTE EVALUATIONS IMPLANT HEART REC SYST TECHN RE 93299 $138.00 REMOVAL AND REPLACEMENT MULTIPLE LEAD PERMANENT PA 33229 $36,079.00 REMOVAL AND REPLACEMENT OF DEFIBRILLATOR PULSE GEN 33262 $76,668.00 REMOVAL AND REPLACEMENT OF DEFIBRILLATOR PULSE GEN 33263 $79,505.00 REMOVAL AND REPLACEMENT OF DEFIBRILLATOR PULSE GEN 33264 $82,344.00 REMOVAL AND REPLACEMENT OF DUAL LEAD PERMANENT PAC 33228 $33,520.00 REMOVAL AND REPLACEMENT OF SINGLE LEAD PERMANENT P 33227 $30,961.00 REMOVAL GROWTH (0.5 CM OR LESS) OF THE FACE EAR EY 11440 $2,071.00 REMOVAL GROWTH (0.5 CM OR LESS) OF THE SCALP NECK 11420 $3,624.00 REMOVAL GROWTH (0.6 TO 1.0 CM) OF THE FACE EARS EY 11441 $2,301.00 REMOVAL GROWTH (0.6 TO 1.0 M) OF THE SCALP NECK HA 11421 $2,148.00 REMOVAL OF ANTIBODIES FROM SURFACE OF RED BLOOD CE 86860 $127.00 REMOVAL OF BLOOD ACCUMULATION BETWEEN NAIL AND NAI 11740 $162.00 REMOVAL OF BONE IMPLANT 20670 $959.00 REMOVAL OF BRAIN AND SPINAL FLUID SHUNT SYSTEM 62256 $1,794.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge REMOVAL OF DEEP FOREIGN BODY IN MUSCLE OR TENDON 20525 $6,467.00 REMOVAL OF DEFIBRILLATOR ELECTRODES 33244 $5,867.00 REMOVAL OF DEFIBRILLATOR PULSE GENERATOR 33241 $5,867.00 REMOVAL OF DRUG DELIVERY IMPLANT FROM TISSUE 11982 $959.00 REMOVAL OF ELECTRODE FROM RIGHT HEART 33234 $5,867.00 REMOVAL OF ELECTRODES FROM RIGHT HEART 33235 $5,867.00 REMOVAL OF ENGORGED HEMORRHOID 46320 $5,227.00 REMOVAL OF EXTERNAL FEMALE GENITAL SCAR TISSUE 56441 $5,707.00 REMOVAL OF FLUID FROM BETWEEN LUNG AND CHEST CAVIT 32551 $1,318.00 REMOVAL OF FLUID FROM CHEST CAVITY 32554 $1,433.00 REMOVAL OF FLUID FROM CHEST CAVITY WITH IMAGING GU 32555 $2,113.00 REMOVAL OF FLUID FROM CHEST CAVITY WITH INSERT IND 32556 $1,433.00 REMOVAL OF FLUID FROM CHEST CAVITY WITH INSERT IND 32557 $2,250.00 REMOVAL OF FOREIGN BODIES IN ESOPHAGUS USING AN EN 43215 $3,500.00 REMOVAL OF FOREIGN BODIES IN LARGE BOWEL USING AN 45332 $2,327.00 REMOVAL OF FOREIGN BODIES IN LARGE BOWEL USING AN 45379 $3,606.00 REMOVAL OF FOREIGN BODIES OF ESOPHAGUS STOMACH AND 43247 $3,819.00 REMOVAL OF FOREIGN BODY FROM EAR CANAL 69200 $215.00 REMOVAL OF FOREIGN BODY FROM EAR CANAL UNDER ANEST 69205 $4,814.00 REMOVAL OF FOREIGN BODY FROM THROAT 42809 $348.00 REMOVAL OF FOREIGN BODY FROM TISSUE, ACCESSED BENE 10120 $747.00 REMOVAL OF FOREIGN BODY FROM TISSUE, ACCESSED BENE 10121 $1,357.00 REMOVAL OF FOREIGN BODY IN EXTERNAL EYE, CONJUNCTI 65205 $349.00 REMOVAL OF FOREIGN BODY IN EXTERNAL EYE, CONJUNCTI 65210 $958.00 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON 20520 $3,708.00 REMOVAL OF FOREIGN BODY IN NOSE 30300 $561.00 REMOVAL OF FOREIGN BODY OF FOOT TISSUE, ACCESSED B 28190 $1,436.00 REMOVAL OF FOREIGN BODY, EXTERNAL EYE, CORNEA 65220 $908.00 REMOVAL OF FOREIGN BODY, EXTERNAL EYE, CORNEA WITH 65222 $434.00 REMOVAL OF FORESKIN OF USING CLAMP OR DEVICE 54150 $4,598.00 REMOVAL OF GROWTH (0.5 CENTIMETERS OR LESS) OF THE 11400 $1,753.00 REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE 11401 $2,071.00 REMOVAL OF GROWTH OF TONGUE 41110 $4,634.00 REMOVAL OF IMPACT EAR WAX, ONE EAR 69210 $145.00 REMOVAL OF IMPACTED EAR WAX BY WASHING 69209 $145.00 REMOVAL OF IMPACTED STOOL OR FOREIGN BODY UNDER AN 45915 $2,693.00 REMOVAL OF IMPLANT FROM FINGER OR HAND 26320 $3,708.00 REMOVAL OF INFLAMED OR INFECTED SKIN, UP TO 10% OF 11000 $1,343.00 REMOVAL OF INTRA-UTERINE DEVICE (IUD) FOR PREGNANC 58301 $441.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge REMOVAL OF NAIL 11750 $2,041.00 REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR 33233 $20,271.00 REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS STOMACH 43250 $3,562.00 REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING 45385 $3,145.00 REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING 45338 $5,074.00 REMOVAL OF ROD WITH TENDON GRAFT AT HAND OR FINGER 26418 $3,843.00 REMOVAL OF SCAR TISSUE FOLLOWING PENILE FORESKIN R 54162 $5,707.00 REMOVAL OF SINGLE THICKENED SKIN GROWTH 11055 $279.00 REMOVAL OF SKIN AND BONE FIRST 20 SQ CM OR LESS 11044 $6,474.00 REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS 11042 $2,561.00 REMOVAL OF SKIN OF FINGER OR TOE NAIL 11765 $855.00 REMOVAL OF SKIN SUTURE WITH CHANGE OF BLADDER TUBE 51705 $793.00 REMOVAL OF SKIN TAGS 11201 $264.00 REMOVAL OF SUTURES UNDER ANESTHESIA BY OTHER SURGE 15851 $4,314.00 REMOVAL OF SUTURES UNDER ANESTHESIA BY SAME SURGEO 15850 $392.00 REMOVAL OF TISSUE FROM WOUNDS PER SESSION 97597 $208.00 REMOVAL OF TISSUE FROM WOUNDS PER SESSION 97602 $208.00 REMOVAL OF TISSUE FROM WOUNDS PER SESSION 97598 $245.00 REMOVAL OF UP TO AND INCLUDING 15 SKIN TAGS 11200 $360.00 REMOVAL OF VENA CAVA FILTER BY ENDOVASCULAR APPROA 37193 $9,047.00 REMOVAL OR BIVALVING OF FULL ARM OR LEG CAST 29705 $249.00 REMOVAL OR BIVALVING OF GAUNTLET, BOOT, OR BODY CA 29700 $647.00 REMOVAL WITH REINSERTION OF DRUG DELIVERY IMPLANT 11983 $943.00 RENAL VEIN RENIN (KIDNEY ENZYME) STIMULATION PANEL 80416 $1,024.00 RENIN (KIDNEY ENZYME) LEVEL 84244 $437.00 REPAIR OF FINGER OR TOE NAIL BED 11760 $1,207.00 REPAIR OF HAND TENDON 26410 $3,507.00 REPAIR OF LACERATION TO FLOOR OF MOUTH AND/OR TONG 41250 $289.00 REPAIR OF LACERATION TO FLOOR OF MOUTH AND/OR TONG 41252 $2,034.00 REPAIR OF LIP AND BORDER 40650 $1,848.00 REPAIR OF SEPARATION OF WOUND CLOSURE WITH INSERTI 12021 $504.00 REPAIR OF SPICA, BODY CAST, OR JACKET 29720 $373.00 REPAIR OF VERTICAL LIP WOUND EXTENDING TO HALF OF 40652 $1,794.00 REPAIR OF VERTICAL LIP WOUND EXTENDING TO OVER HAL 40654 $1,794.00 REPAIR OF WOUND SCALP HAND FOOT OVER 30CM 12007 $998.00 REPAIR OF WOUND (1.1 TO 2.5 CENTIMETERS) EYELIDS, 13151 $1,294.00 REPAIR OF WOUND (2.5 CM OR LESS) OF FACE EARS EYEL 12051 $747.00 REPAIR OF WOUND (2.6 TO 5.0 CM) OF FACE EARS EYELI 12052 $747.00 REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) EYELIDS, 13152 $2,464.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF NECK H 12042 $747.00 REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF SCALP, 13121 $791.00 REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF TRUNK 13101 $915.00 REPAIR OF WOUND (5.1 TO 7.5 CM) OF FACE EARS EYELI 12053 $747.00 REPAIR OF WOUND (7.6 TO 12.5 CM) OF FACE EARS EYEL 12054 $386.00 REPAIR OF WOUND FACE EAR EYE NOSE LIP 12.6CM TO 2 12016 $516.00 REPAIR OF WOUND FACE EAR EYE NOSE LIP 7.6CM TO 12 12015 $487.00 REPAIR OF WOUND FACE EAR EYE NOSE LIP 5.1CM TO 7.5 12014 $998.00 REPAIR OF WOUND FACE EAR EYE NOSE LIP OVER 30CM 12018 $928.00 REPAIR OF WOUND FACE EAR EYE NOSE LIP OVER 30CM 12057 $928.00 REPAIR OF WOUND OF EYELIDS, NOSE, EARS, AND/OR LIP 13153 $1,392.00 REPAIR OF WOUND OF SCALP, ARMS, AND/OR LEGS 13122 $417.00 REPAIR OF WOUND OF TRUNK 13102 $698.00 REPAIR WOUND (1.1 TO 2.5 CM) FACE MOUTH NECK UNDER 13131 $789.00 REPAIR WOUND (12.6 TO 20.0 CENTIMETERS) OF NECK HA 12045 $1,177.00 REPAIR WOUND (12.6 TO 20.0 CM) OF FACE EARS EYELID 12055 $928.00 REPAIR WOUND (12.6 TO 20.0 CM) OF SCALP NECK UNDER 12005 $998.00 REPAIR WOUND (12.6 TO 20.0 CM) OF THE SCALP UNDERA 12035 $1,044.00 REPAIR WOUND (2.5 CENTIMETERS OR LESS) OF NECK HAN 12041 $747.00 REPAIR WOUND (2.5 CM OR LESS) OF FACE EAR EYELID N 12011 $998.00 REPAIR WOUND (2.5 CM OR LESS) OF SCALP NECK UNDERA 12001 $747.00 REPAIR WOUND (2.5 CM OR LESS) OF THE SCALP UNDERAR 12031 $747.00 REPAIR WOUND (2.6 TO 5.0 CM) OF FACE EAR EYELID NO 12013 $998.00 REPAIR WOUND (2.6 TO 7.5 CM) FACE MOUTH NECK UNDER 13132 $1,235.00 REPAIR WOUND (2.6 TO 7.5 CM) OF SCALP NECK UNDERAR 12002 $747.00 REPAIR WOUND (2.6 TO 7.5 CM) OF THE SCALP UNDERARM 12032 $747.00 REPAIR WOUND (20.1 TO 30.0 CENTIMETERS) OF NECK HA 12046 $928.00 REPAIR WOUND (20.1 TO 30.0 CM) OF FACE EARS EYELID 12056 $928.00 REPAIR WOUND (20.1 TO 30.0 CM) OF SCALP NECK UNDER 12006 $749.00 REPAIR WOUND (20.1 TO 30.0 CM) OF THE SCALP UNDERA 12036 $998.00 REPAIR WOUND (7.6 TO 12.5 CENTIMETERS) OF NECK HAN 12044 $903.00 REPAIR WOUND (7.6 TO 12.5 CM) OF SCALP NECK UNDERA 12004 $747.00 REPAIR WOUND (7.6 TO 12.5 CM) OF THE SCALP UNDERAR 12034 $747.00 REPAIR WOUND OF FOREHEAD CHEEK CHIN MOUTH NECK UND 13133 $1,211.00 REPAIR/MODIFICATION HEARING AID V5014 $54.00 REPLACEMENT OF SMALL BOWEL TUBE 49451 $1,442.00 REPLACEMENT OF STOMACH OR LARGE BOWEL TUBE 49450 $1,442.00 REPLACEMENT OF STOMACH TO SMALL BOWEL TUBE 49452 $1,442.00 REPOSITIONING MANEUVERS FOR TREATMENT OF VERTIGO, 95992 $98.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge REPOSITIONING OF FORESKIN INCLUDING SCAR TISSUE RE 54450 $1,748.00 REPOSITIONING OF IMPLANTED LEFT HEART ELECTRODE 33226 $5,867.00 REPOSITIONING OF IMPLANTED PACEMAKER OR DEFIBRILLA 33215 $5,867.00 REPOSITIONING OF VENA CAVA FILTER BY ENDOVASCULAR 37192 $9,047.00 REPRODUCTIVE HORMONE PANEL (ESTRADIOL) 80415 $434.00 REPRODUCTIVE HORMONE PANEL (TESTOSTERONE) 80414 $401.00 REPROGRAMMING OF PROGRAMMABLE BRAIN AND SPINAL FLU 62252 $286.00 RESP BLOOD GAS 02 SAT ONLY 82810 $45.00 RESP BLOOD GAS PH 82800 $265.00 RESP BLOOD GAS W 02 SAT 82805 $478.00 RESP CARBOXYHEMOGLOBIN QUANT 82375 $142.00 RESP CHLORIDE 82435 $115.00 RESP GLUCOSE 82947 $94.00 RESP HEMOGLOBIN 85018 $97.00 RESP LACTIC ACID 83605 $65.00 RESP METHEMOGLOBIN QUANT 83050 $90.00 RESP POTASSIUM 84132 $118.00 RESP SODIUM 84295 $94.00 RESPIRATORY CULT 87070 $171.00 RESPIRATORY INHALED AEROSOL TREATMENT TO RELIEVE A 94644 $352.00 RESPIRATORY INHALED AEROSOL TREATMENT TO RELIEVE A 94645 $352.00 RESPIRATORY INHALED PRESSURE/NONPRESSURE TREATM RE 94640 $184.00 RESPIRATORY SYNCYTIAL VIRUS ANTIBODY INJECTION INT 90378 $3,314.00 RETIC COUNT, MANUAL 85044 $84.00 RETICULATED (YOUNG) PLATELET MEASUREMENT 85055 $144.00 RETRIEVAL OF FOREIGN BODY OF BLOOD VESSELS ACCESSE 37197 $6,028.00 REVISION OF HEART CHAMBER 33735 $3,830.00 REVISION OR REMOVAL OF BRAIN NEUROSTIMULATOR ELECT 61880 $7,919.00 RHEUMATOID FACTOR ANALYSIS 86430 $256.00 RIBOSOMAL P IGG 86235 $94.00 RICKETTSIA 86757 $324.00 RING ANASTOMOSIS VALTRAC 2 MM OD34 MM BOWEL RADIOP $1,860.30 RING ANNULOPLASTY CARPENTIER-EDWARDS CLASSIC TITAN $8,832.00 RING ANNULOPLASTY OD28 MM TRIAD $12,350.00 RING ANNULOPLASTY TRI-AD OD34 MM TRICUSPID LOW PRO $12,350.00 RING EXTERNAL FIXATION CARBON FIBER ID200 MM FULL $9,664.56 RING EXTERNAL FIXATION DFS STAINLESS STEEL ID220 M $3,237.12 RING EXTERNAL FIXATION ID100 MM ROTATE $12,218.88 RING EXTERNAL FIXATION ID230 MM 1/2 RING CIRCULAR $7,178.64 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge RING EXTERNAL FIXATION ID230 MM FULL RING CIRCULAR $6,364.80 RING EXTERNAL FIXATION ILIZAROV 5/8 ID180 MM 5/8 R $6,402.16 RING EXTERNAL FIXATION ILIZAROV CARBON FIBER EPOXY $3,384.72 RING EXTERNAL FIXATION ILIZAROV STAINLESS STEEL ID $4,741.76 RING EXTERNAL FIXATION STAINLESS STEEL ID60 MM 1/2 $2,410.80 RING EXTERNAL FIXATION TITANIUM 5/8 OD200 MM NONST $6,044.40 RING EXTERNAL FIXATION TITANIUM SHORT OD140 MM FOO $7,134.56 RISPERDAL (RISPERIDONE) 80299 $395.00 RMSF AB IGG 86757 $324.00 RNP (ENA) AB EACH 86235 $94.00 ROD EXTERNAL FIXATION CARBON FIBER 135 D L499 MM O $2,801.36 ROD EXTERNAL FIXATION CARBON FIBER L250 MM OD11 MM $1,644.50 ROD EXTERNAL FIXATION DYNAFIX VISION CARBON L150 M $1,113.60 ROD EXTERNAL FIXATION HOFFMANN 3 SEMICIRCLE L220 M $2,300.35 ROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER L30 $1,497.60 ROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER L50 $1,839.36 ROD EXTERNAL FIXATION HOFFMANN II COMPACT MRI CARB $552.24 ROD SPINAL CD HORIZON COCRMO CURVE L40 MM OD5.5 MM C1713 $1,137.50 ROD SPINAL CD HORIZON LEGACY STAINLESS STEEL PREBE C1713 $1,600.00 ROD SPINAL CD HORIZON SEXTANT TITANIUM STANDARD CO C1713 $1,300.00 ROD SPINAL CHROMALOY PLUS CURVE L45 MM OD5.5 MM C1713 $1,600.00 ROD SPINAL COCR 2 HEXAGON STRAIGHT L300 MM OD4.5 M C1713 $1,400.00 ROD SPINAL CREO TITANIUM CURVE L150 MM OD5.5 MM NO C1713 $1,300.00 ROD SPINAL CREO TITANIUM CURVE L60 MM OD5.5 MM NON C1713 $1,300.00 ROD SPINAL DENALI STRAIGHT L500 MM OD5.5 MM HEXAGO C1713 $1,400.00 ROD SPINAL ELLIPSE TITANIUM TAPER L350 MM OD3.5-6. C1713 $1,300.00 ROD SPINAL EXPEDIUM PEEK BASO4 LORDOTIC L70 MM OD5 C1713 $5,145.60 ROD SPINAL EXPEDIUM STAINLESS STEEL OD4.5-5.5 MM 2 C1713 $1,400.00 ROD SPINAL L150 MM OD5.5 MM HEXAGONAL END CONTOURE C1713 $1,600.00 ROD SPINAL L300 MM OD4.5 MM ULTRA STRENGTH HEXAGON C1713 $1,400.00 ROD SPINAL L85 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00 ROD SPINAL LEGACY CD HORIZON L20 IN OD4.5 MM ANTER C1713 $1,600.00 ROD SPINAL LONGITUDE II CCM STRAIGHT L500 MM OD5.5 C1713 $1,300.00 ROD SPINAL MAGEC OFFSET L70 MM OD4.5 MM ACTUATOR S C1713 $140,000.00 ROD SPINAL PEEK-OPTIMA L80 MM OD6.35 MM PEDICLE C1713 $1,137.50 ROD SPINAL POLARIS TITANIUM L120 MM C1713 $1,000.00 ROD SPINAL POLARIS TITANIUM PRECURVE L70 MM OD5.5 C1713 $1,000.00 ROD SPINAL REFORM TITANIUM STRAIGHT L500 MM OD5.5 C1713 $812.50 ROD SPINAL SAVANNAH-T TITANIUM ALUMINUM VANADIUM C C1713 $812.50 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ROD SPINAL SEXTANT CD HORIZON TITANIUM PREBENT L35 C1713 $1,300.00 ROD SPINAL SOLERA CD HORIZON COCR MOLYBDENUM CURVE C1713 $5,040.00 ROD SPINAL STAINLESS STEEL L500 MM OD5 MM HARD NON C1713 $1,400.00 ROD SPINAL TIGER 100 D OD3.5 MM OCCIPITAL NONSTERI C1713 $1,300.00 ROD SPINAL TITANIUM L90 MM OD5.5 MM CONTOUR C1713 $812.50 ROD SPINAL TITANIUM STRAIGHT 2 HEXAGON L200 MM OD5 C1713 $1,000.00 ROD SPINAL USS STAINLESS STEEL SMALL STATURE L150 C1713 $2,496.00 ROOM & BOARD GENERAL ISOLATION $5,500.00 ROOM & BOARD ISOLATION $8,823.00 ROOM & BOARD NEONATAL INTENSIVE CARE UNIT $8,700.00 ROOM & BOARD PEDIATRIC INTENSIVE CARE UNIT $8,700.00 ROOM & BOARD PEDIATRICS SEMI PRIVATE $5,000.00 ROOM & BOARD PSYCHIATRIC SEMI PRIVATE $3,800.00 ROUTINE EKG USING AT LEAST 12 LEADS INCLUDING INTE 93000 $69.00 ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING 93005 $227.00 RPR W/RFLX 86592 $95.00 RT ASSESSMENT $99.00 RT CALCIUM IONIZED 82330 $114.00 RT RX INDIVIDUAL $70.00 RUBELLA AB 86762 $104.00 RUBELLA ANTIBODY, IGG 86762 $104.00 RUBELOA AB,IGG 86765 $220.00 RUBEOLA ANTIBODY, IGG 86765 $220.00 SALICYLATE-SERUM 80307 $346.00 SCREEN QUAD 81511 $586.00 SCREENING PAPANICOLAOU SMEAR CERVICAL OR VAGINAL U P3000 $84.00 SCREENING TEST FOR COMPATIBLE BLOOD UNIT 86902 $75.00 SCREENING TEST FOR MONONUCLEOSIS (MONO) 86308 $260.00 SCREENING TEST FOR PATHOGENIC ORGANISMS 87081 $311.00 SCREENING TEST FOR PATHOGENIC ORGANISMS WITH COLON 87084 $67.00 SCREENING TEST FOR RED BLOOD CELL ANTIBODIES 86850 $99.00 SCREENING TEST FOR STREP ANTIBODY (STREP THROAT) 86063 $260.00 SCREW BONE 3.5 MM HEAD L40 MM OD2.3 MM CORTICAL SE C1713 $430.08 SCREW BONE 4 MM TAPER L80 MM L35 MM OD3 MM ODSEC2. C1713 $957.44 SCREW BONE 4 MM TAPER L90 MM L40 MM OD3 MM ODSEC2. C1713 $957.44 SCREW BONE 6 MM L100 MM L30 MM OD6/5 MM CORTICAL T C1713 $957.44 SCREW BONE ALPS PARTIAL THREAD L35 MM OD4 MM TIBIA C1713 $256.88 SCREW BONE ANODYNE L14 MM OD4.5 MM SPINE CERVICAL C1713 $487.50 SCREW BONE ANODYNE L16 MM OD4 MM SPINE CERVICAL SE C1713 $487.50 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE ASNIS III STAINLESS STEEL FULL THREAD L C1713 $1,470.95 SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L16 C1713 $1,080.30 SCREW BONE ASSURE TITANIUM STANDARD L18 MM OD4.5 M C1713 $975.00 SCREW BONE ASSURE TITANIUM STANDARD L20 MM OD4 MM C1713 $975.00 SCREW BONE ATLANTIS TITANIUM L15 MM OD4.5 MM SPINE C1713 $600.00 SCREW BONE ATOLL L10 MM OD4 MM SPINE OCCIPITAL SEL C1713 $812.50 SCREW BONE AUTOFIX STAINLESS STEEL T7 L30 MM OD2.5 C1713 $1,750.32 SCREW BONE AXSOS STAINLESS STEEL 2.5 MM PARTIAL TH C1713 $116.94 SCREW BONE AXSOS STAINLESS STEEL T20 L34 MM OD5 MM C1713 $583.05 SCREW BONE BIOMET DFS HA L6 MM TAPER L180 MM L30 M C1713 $1,105.92 SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L20 M C1713 $5,200.00 SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L30 M C1713 $5,200.00 SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L40 M C1713 $5,200.00 SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L55 M C1713 $5,200.00 SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L25 MM C1713 $5,200.00 SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L30 MM C1713 $4,800.00 SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L40 MM C1713 $5,200.00 SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L60 MM C1713 $3,900.00 SCREW BONE CD HORIZON LEGACY TITANIUM L30 MM OD4.5 C1713 $5,200.00 SCREW BONE CD HORIZON M8 STAINLESS STEEL L30 MM OD C1713 $3,200.00 SCREW BONE CD HORIZON TITANIUM L25 MM OD5.5 MM SPI C1713 $3,200.00 SCREW BONE CD HORIZON TITANIUM L30 MM OD4 MM SPINE C1713 $3,200.00 SCREW BONE CD HORIZON TITANIUM L40 MM OD4 MM SPINE C1713 $3,200.00 SCREW BONE CD HORIZON TITANIUM L40 MM OD5.5 MM SPI C1713 $3,900.00 SCREW BONE CD HORIZON TITANIUM L50 MM OD8.5 MM SPI C1713 $4,800.00 SCREW BONE CENTRE-DRIVE TITANIUM MICRO L3 MM OD1 M C1713 $2,349.60 SCREW BONE CENTRE-DRIVE TITANIUM MICRO L4 MM OD1 M C1713 $384.48 SCREW BONE CENTRE-DRIVE TITANIUM MICRO L5 MM OD1 M C1713 $462.80 SCREW BONE COCR L25 MM OD6 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00 SCREW BONE COCR L40 MM OD6 MM SPINE MULTIAXIAL 5.5 C1713 $4,800.00 SCREW BONE COCR L45 MM OD6 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00 SCREW BONE CORTICAL C1713 $552.63 SCREW BONE CREO L50 MM OD5.5 MM SPINE PREASSEMBLE C1713 $5,037.50 SCREW BONE CREO L60 MM OD7.5-6 MM SPINE 2 OUTER DI C1713 $6,500.00 SCREW BONE DART-FIRE TITANIUM PARTIAL THREAD L36 M C1713 $812.50 SCREW BONE DCP LC-DCP STAINLESS STEEL 5 MM L20 MM C1713 $157.52 SCREW BONE DCP LC-DCP STAINLESS STEEL L140 MM OD6. C1713 $358.80 SCREW BONE DCP LC-DCP STAINLESS STEEL STANDARD L32 C1713 $127.68 SCREW BONE DCP STAINLESS STEEL STANDARD L28 MM OD2 C1713 $236.88 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE DCP STAINLESS STEEL STANDARD L38 MM W2. C1713 $236.88 SCREW BONE DENALI L25 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00 SCREW BONE DENALI L25 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00 SCREW BONE DENALI L35 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00 SCREW BONE DENALI L40 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00 SCREW BONE DENALI L40 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00 SCREW BONE DHS DCS STAINLESS STEEL L110 MM L22 MM C1713 $1,932.26 SCREW BONE DHS DCS STAINLESS STEEL L110 MM L22 MM C1713 $2,208.83 SCREW BONE DHS DCS STAINLESS STEEL L115 MM L22 MM C1713 $3,022.16 SCREW BONE DHS DCS STAINLESS STEEL L120 MM L22 MM C1713 $2,208.83 SCREW BONE DHS DCS STAINLESS STEEL L60 MM L22 MM O C1713 $2,208.83 SCREW BONE DHS DCS STAINLESS STEEL L90 MM L22 MM O C1713 $2,718.56 SCREW BONE DHS/DCS STAINLESS STEEL L125 MM L22 MM C1713 $2,681.76 SCREW BONE DHS/DCS STAINLESS STEEL L60 MM L22 MM O C1713 $2,681.76 SCREW BONE DHS/DCS STAINLESS STEEL L65 MM L12.7 MM C1713 $2,718.56 SCREW BONE DHS/DCS STAINLESS STEEL L70 MM L22 MM O C1713 $2,681.76 SCREW BONE DRILL-FREE MAXDRIVE TITANIUM MICRO L7 M C1713 $384.80 SCREW BONE DURANGO TITANIUM L25 MM OD5 MM SPINE SE C1713 $1,300.00 SCREW BONE DVR L14 MM OD2.7 MM CORTICAL LOCK NONST C1713 $503.62 SCREW BONE DYNAFIX VS DFS TITANIUM L60 MM OD6 MM N C1713 $906.88 SCREW BONE DYNAFIX VS DFS TITANIUM L70 MM OD6 MM O C1713 $906.88 SCREW BONE DYNAFIX WRISTFIX STAINLESS STEEL 4 MM S C1713 $957.44 SCREW BONE ELLIPSE TITANIUM L34 MM OD4.5 MM SPINE C1713 $5,037.50 SCREW BONE EVEREST L50 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00 SCREW BONE EXPEDIUM L55 MM OD6.5 MM SPINE POLYAXIA C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L25 MM OD4 MM C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD4 MM C1713 $2,400.00 SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD6.5 M C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD7 MM C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD4.35 C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD7 MM C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD6 MM C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD8 MM C1713 $2,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD6 MM C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L60 MM OD8 MM C1713 $4,800.00 SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD5 MM C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L100 MM OD9 MM SPINE C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L20 MM OD4.35 MM SPIN C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L22.5 MM OD4 MM SPINE C1713 $2,400.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE EXPEDIUM TITANIUM L30 MM OD4.35 MM SPIN C1713 $2,400.00 SCREW BONE EXPEDIUM TITANIUM L30 MM OD4.35 MM SPIN C1713 $2,800.00 SCREW BONE EXPEDIUM TITANIUM L30 MM OD5 MM SPINE M C1713 $2,800.00 SCREW BONE EXPEDIUM TITANIUM L30 MM OD7.5 MM SPINE C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L35 MM OD4 MM SPINE U C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L40 MM OD8 MM SPINE P C1713 $2,800.00 SCREW BONE EXPEDIUM TITANIUM L45 MM OD4.35 MM SPIN C1713 $2,800.00 SCREW BONE EXPEDIUM TITANIUM L50 MM OD7 MM SPINE 1 C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L55 MM OD10 MM SPINE C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L60 MM OD5.5 MM SPINE C1713 $10,803.20 SCREW BONE EXPEDIUM TITANIUM L60 MM OD7.5 MM SPINE C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L65 MM OD5 MM SPINE P C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L70 MM OD5 MM SPINE 2 C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L75 MM OD6 MM SPINE P C1713 $4,800.00 SCREW BONE EXPEDIUM TITANIUM L75 MM OD7.5 MM SPINE C1713 $4,800.00 SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUN C1713 $1,212.96 SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUN C1713 $1,336.08 SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUN C1713 $1,719.20 SCREW BONE FIXOS TITANIUM L34 MM OD4 MM MIDFOOT RE C1713 $2,062.32 SCREW BONE FIXOS TWIST-OFF TITANIUM L12 MM OD2 MM C1713 $2,096.64 SCREW BONE FULL THREAD L14 MM OD4 MM CANNULATED C1713 $780.00 SCREW BONE FULL THREAD L17 MM OD3 MM CANNULATED C1713 $1,656.24 SCREW BONE FULL THREAD L20 MM OD3.5 MM CANNULATED C1713 $780.00 SCREW BONE FULL THREAD L22 MM OD3.5 MM CANNULATED C1713 $780.00 SCREW BONE FULL THREAD L24 MM OD4.5 MM CANNULATED C1713 $809.25 SCREW BONE FULL THREAD L28 MM OD3.5 MM CANNULATED C1713 $780.00 SCREW BONE FULL THREAD L28 MM OD4 MM CANNULATED C1713 $780.00 SCREW BONE FULL THREAD L36 MM OD3.5 MM CANNULATED C1713 $780.00 SCREW BONE FULL THREAD L38 MM OD3 MM CANNULATED C1713 $1,656.24 SCREW BONE FULL THREAD L42 MM OD4 MM CANNULATED C1713 $780.00 SCREW BONE FULL THREAD L44 MM OD4 MM CANNULATED C1713 $780.00 SCREW BONE FULL THREAD L46 MM OD3.5 MM CANNULATED C1713 $1,656.24 SCREW BONE FULL THREAD L60 MM OD4.5 MM CANNULATED C1713 $809.25 SCREW BONE FULL THREAD L72 MM OD4.5 MM CANNULATED C1713 $809.25 SCREW BONE GAMMA3 TITANIUM L95 MM OD10.5 MM LAG ST C1713 $2,660.19 SCREW BONE HELIX WIRE TITANIUM L46 IN OD4 MM CANCE C1713 $659.04 SCREW BONE HEXALOBE L110 MM OD4.3 MM PELVIS COLUMN C1713 $435.50 SCREW BONE HYDROXYAPATITE L250 MM L30 MM OD6/5 MM C1713 $1,105.92 SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L105 MM C1713 $1,566.24 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L70 MM L C1713 $1,566.24 SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L95 MM L C1713 $1,566.24 SCREW BONE INDEPENDENCE HA L20 MM OD5.5 MM SPINE V C1713 $1,950.00 SCREW BONE L105 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75 SCREW BONE L12 MM OD1.2 MM LAG NONSTERILE C1713 $560.00 SCREW BONE L12 MM OD3.6 MM SPINE FIX ANGLE SELF TA C1713 $1,462.50 SCREW BONE L14 MM OD4 MM CERVICAL SPINE C1713 $3,900.00 SCREW BONE L16 MM L7 MM OD4.5 MM CANNULATED C1713 $809.25 SCREW BONE L16 MM OD3.5 MM ELBOW NONLOCKING HEXALO C1713 $435.50 SCREW BONE L160 MM L50 MM OD6.5 MM CORTICAL TAPERE C1713 $957.44 SCREW BONE L20 MM L7 MM OD3.5 MM CANNULATED C1713 $780.00 SCREW BONE L20 MM OD4.75 MM MULTIAXIAL C1713 $4,800.00 SCREW BONE L200 MM L80 MM CORTICAL SELF TAPPING SE C1713 $916.48 SCREW BONE L22 MM OD2.5 MM FOOT ANKLE SELF TAP THR C1713 $585.00 SCREW BONE L22 MM OD3.5 MM CORTICAL C1713 $162.96 SCREW BONE L26 MM L12 MM OD4 MM CANNULATED C1713 $780.00 SCREW BONE L26 MM OD5 MM ODSEC3.5 MM HIP CORTICAL C1713 $939.12 SCREW BONE L28 MM OD2.7 MM FULLY THREADED C1713 $1,144.00 SCREW BONE L30 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75 SCREW BONE L32 MM L15 MM OD4 MM CANNULATED C1713 $780.00 SCREW BONE L32 MM OD4 MM SPINE C1713 $3,900.00 SCREW BONE L35 MM OD4.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00 SCREW BONE L40 MM L16 MM OD4 MM CANNULATED C1713 $780.00 SCREW BONE L44 MM OD3.5 MM ORTHOPEDIC WOODRUFF COR C1713 $288.00 SCREW BONE L5 MM OD1.5 MM CORTICAL CRANIOMAXILLOFA C1713 $6,240.00 SCREW BONE L50 MM OD5.5 MM SPINE POLYAXIAL CANNULA C1713 $6,400.00 SCREW BONE L54 MM L18 MM OD4.5 MM CANNULATED C1713 $809.25 SCREW BONE L55 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75 SCREW BONE L58 MM OD2.3 MM OD3.5 MM CORTICAL HEAD C1713 $430.08 SCREW BONE L6 MM OD2.7 MM HEXALOBE C1713 $422.50 SCREW BONE L60 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75 SCREW BONE L65 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50 SCREW BONE L80 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75 SCREW BONE LC-DCP DCP STAINLESS STEEL 5 MM HEAD L3 C1713 $157.52 SCREW BONE LC-DCP DHS DCS STAINLESS STEEL L52 MM O C1713 $148.96 SCREW BONE LC-DCP STAINLESS STEEL L110 MM OD4.5 MM C1713 $293.28 SCREW BONE LC-DCP STAINLESS STEEL L115 MM OD4.5 MM C1713 $313.92 SCREW BONE LC-DCP TITANIUM FULL THREAD L75 MM OD6. C1713 $264.48 SCREW BONE LC-DCP TITANIUM L72 MM OD4.5 MM CORTICA C1713 $131.04 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE LC-DCP TITANIUM L76 MM OD4.5 MM ORTHOPE C1713 $172.48 SCREW BONE LC-DCP TITANIUM L90 MM OD4.5 MM CORTICA C1713 $218.88 SCREW BONE LCP STAINLESS STEEL CURVE L110 MM OD4.5 C1713 $1,687.40 SCREW BONE LCP STAINLESS STEEL L34 MM OD3.5 MM CLA C1713 $317.40 SCREW BONE LCP STAINLESS STEEL L44 MM OD3.5 MM CLA C1713 $317.40 SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L70 C1713 $124.74 SCREW BONE LCP STAINLESS STEEL T25 L18 MM OD5 MM C C1713 $1,729.59 SCREW BONE LCP TITANIUM FULL THREAD L30 MM OD3.5 M C1713 $172.48 SCREW BONE LCP TITANIUM FULL THREAD L45 MM OD3.5 M C1713 $172.48 SCREW BONE LCP TITANIUM L13 MM OD2.4 MM CORTICAL S C1713 $323.36 SCREW BONE LCP TITANIUM L14 MM OD2 MM CORTICAL T6 C1713 $224.77 SCREW BONE LCP TITANIUM L38 MM OD2.7 MM SELF TAPPI C1713 $804.96 SCREW BONE LCP TITANIUM L40 MM OD2 MM CORTICAL SEL C1713 $224.77 SCREW BONE LCP TITANIUM L44 MM OD2.7 MM SELF TAPPI C1713 $804.96 SCREW BONE LCP TITANIUM L75 MM OD5 MM PERIARTICULA C1713 $1,329.36 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL 20 D C1713 $2,275.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL 20 D C1713 $3,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L20 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L25 M C1713 $4,800.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L25 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L30 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L35 M C1713 $4,800.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L40 M C1713 $2,275.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L40 M C1713 $2,800.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L40 M C1713 $3,900.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L40 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L45 M C1713 $3,900.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L45 M C1713 $4,800.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L45 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L50 M C1713 $3,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L50 M C1713 $4,800.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L50 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L55 M C1713 $4,800.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L55 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L60 M C1713 $4,800.00 SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L60 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L45 MM C1713 $2,800.00 SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L70 MM C1713 $2,800.00 SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L80 MM C1713 $2,275.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L35 MM C1713 $2,800.00 SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L40 MM C1713 $3,200.00 SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L55 MM C1713 $2,800.00 SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L80 MM C1713 $3,200.00 SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L30 MM C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L40 MM C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L60 MM C1713 $4,800.00 SCREW BONE LEGACY CD HORIZON TITANIUM L20 MM OD4 M C1713 $12,936.00 SCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD4 M C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD4.5 C1713 $5,200.00 SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD6.5 C1713 $2,800.00 SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD6.5 C1713 $3,900.00 SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD8.5 C1713 $5,200.00 SCREW BONE LEGACY L40 MM OD4 MM SPINE FIX ANGLE 3. C1713 $3,200.00 SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L12 MM O C1713 $502.40 SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L12 MM O C1713 $767.20 SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L3 MM OD C1713 $387.04 SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L7 MM OD C1713 $387.04 SCREW BONE LISS STAINLESS STEEL L30 MM OD5 MM FEMU C1713 $1,476.56 SCREW BONE LOW PROFILE SCREWS TITANIUM PARTIAL THR C1713 $1,137.50 SCREW BONE LOW PROFILE SCREWS TITANIUM PARTIAL THR C1713 $5,167.50 SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL TH C1713 $390.00 SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL TH C1713 $552.50 SCREW BONE LOW PROFILE SCREWS TITANIUM T8 FULL THR C1713 $812.50 SCREW BONE MALIBU TITANIUM L55 MM OD6.5 MM SPINE T C1713 $3,900.00 SCREW BONE MARINER L50 MM OD5.5 MM SPINE SOLID NON C1713 $1,300.00 SCREW BONE MATRIXMANDIBLE TITANIUM L10 MM OD2.4 MM C1713 $638.40 SCREW BONE MATRIXMANDIBLE TITANIUM L14 MM OD2 MM M C1713 $444.00 SCREW BONE MATRIXMANDIBLE TITANIUM L14 MM OD2 MM M C1713 $830.40 SCREW BONE MATRIXMANDIBLE TITANIUM L18 MM OD2 MM M C1713 $444.00 SCREW BONE MATRIXMANDIBLE TITANIUM L18 MM OD2 MM M C1713 $830.40 SCREW BONE MATRIXMANDIBLE TITANIUM L5 MM OD2 MM MA C1713 $830.40 SCREW BONE MATRIXMANDIBLE TITANIUM L6 MM OD2 MM MA C1713 $830.40 SCREW BONE MATRIXMANDIBLE TITANIUM L6 MM OD2.4 MM C1713 $638.40 SCREW BONE MATRIXMANDIBLE TITANIUM L8 MM OD2 MM MA C1713 $444.00 SCREW BONE MATRIXMANDIBLE TITANIUM L8 MM OD2.4 MM C1713 $638.40 SCREW BONE MATRIXMIDFACE TITANIUM L10 MM OD1.55 MM C1713 $556.80 SCREW BONE MATRIXMIDFACE TITANIUM L14 MM OD1.85 MM C1713 $576.00 SCREW BONE MATRIXMIDFACE TITANIUM L4 MM OD1.55 MM C1713 $556.80 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE MATRIXNEURO TITANIUM L4 MM OD1.55 MM OD C1713 $285.60 SCREW BONE MATRIXORTHOGNATHIC TITANIUM L10 MM OD1. C1713 $556.80 SCREW BONE MATRIXORTHOGNATHIC TITANIUM L16 MM OD2. C1713 $580.80 SCREW BONE MATRIXORTHOGNATHIC TITANIUM L4 MM OD1.8 C1713 $556.80 SCREW BONE MATRIXORTHOGNATHIC TITANIUM L6 MM OD1.8 C1713 $580.80 SCREW BONE MEDIUM THREAD L32 MM OD3.5 MM CANNULATE C1713 $1,549.12 SCREW BONE MEDIUM THREAD L44 MM OD3.5 MM CANNULATE C1713 $1,549.12 SCREW BONE MESA 2 L30 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00 SCREW BONE MESA 2 L40 MM OD5 MM SPINE POLYAXIAL NO C1713 $5,200.00 SCREW BONE MESA 2 L45 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00 SCREW BONE MESA L45 MM OD5.5 MM SPINE FOUNDATION C1713 $5,200.00 SCREW BONE MESA L60 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00 SCREW BONE MESA L75 MM OD6.5 MM SPINE FOUNDATION N C1713 $5,200.00 SCREW BONE MESA SMALL STATURE L25 MM OD7.5 MM SPIN C1713 $5,200.00 SCREW BONE MESA SMALL STATURE L80 MM OD7.5 MM SPIN C1713 $5,200.00 SCREW BONE MESA TITANIUM L30 MM OD4.5 MM SPINE POL C1713 $5,200.00 SCREW BONE MINI L50 MM L18 MM OD3 MM CORTICAL TAPE C1713 $844.80 SCREW BONE MPACT L25 MM OD6.5 MM CANCELLOUS HIP FL C1713 $162.50 SCREW BONE NAIL-EX TITANIUM L74 MM OD4 MM HUMERUS C1713 $1,550.40 SCREW BONE OMEGA3 STAINLESS STEEL STANDARD L95 MM C1713 $1,392.30 SCREW BONE OP RESPONSE L60 MM OD7 MM SPINE UNIAXIA C1713 $5,200.00 SCREW BONE OP RESPONSE L80 MM OD7 MM SPINE UNIAXIA C1713 $5,200.00 SCREW BONE OVERWATCH DUALFIX STANDARD L35 MM OD5.5 C1713 $3,900.00 SCREW BONE PANGEA TITANIUM T25 L25 MM L11.5 MM OD5 C1713 $2,800.00 SCREW BONE PANGEA TITANIUM T25 L35 MM L11.5 MM OD8 C1713 $2,800.00 SCREW BONE PANGEA TITANIUM T25 L55 MM OD7 MM SPINE C1713 $4,800.00 SCREW BONE PASS LP L45 MM OD4.5 MM SPINE PEDICLE P C1713 $4,800.00 SCREW BONE PASS LP L50 MM OD6.5 MM SPINE SACRAL NO C1713 $4,800.00 SCREW BONE PEANUT TITANIUM PEDIATRIC L16 MM OD4.5 C1713 $728.00 SCREW BONE PEDILOC STAINLESS STEEL FULL THREAD L46 C1713 $1,648.00 SCREW BONE PERI-LOC STAINLESS STEEL 2.5 MM FLUTE L C1713 $1,128.00 SCREW BONE PHOENIX THREADED L20 MM OD4 MM 2 LEAD C1713 $1,071.36 SCREW BONE POLARIS L45 MM OD6.5 MM SPINE PEDICLE M C1713 $4,800.00 SCREW BONE POLARIS STAINLESS STEEL L20 MM OD4.75 M C1713 $2,800.00 SCREW BONE POLARIS STAINLESS STEEL L70 MM OD8.5 MM C1713 $4,800.00 SCREW BONE POLARIS TITANIUM L40 MM OD4.75 MM SPINE C1713 $2,800.00 SCREW BONE POLARIS TITANIUM L50 MM OD5.5 MM SPINE C1713 $4,800.00 SCREW BONE POLARIS TITANIUM L55 MM OD5.5 MM SPINE C1713 $4,800.00 SCREW BONE POLARIS TITANIUM L80 MM OD6.5 MM SPINE C1713 $4,800.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE POLARIS TITANIUM UNIVERSAL L40 MM OD7.5 C1713 $2,800.00 SCREW BONE POLARIS TITANIUM UNIVERSAL L50 MM OD8.5 C1713 $2,800.00 SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD L3 C1713 $975.00 SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD HEX C1713 $942.50 SCREW BONE RAPIDSORB L4 MM OD1.5 MM CRANIOMAXILLOF C1713 $547.68 SCREW BONE REFORM 30 D L45 MM OD7.5 MM SPINE PEDIC C1713 $3,900.00 SCREW BONE REFORM L50 MM OD7.5 MM SPINE PEDICLE MO C1713 $2,080.00 SCREW BONE REFORM L70 MM OD9.5 MM SPINE PEDICLE MO C1713 $2,080.00 SCREW BONE RESPONSE L45 MM OD5 MM SPINE UNIAXIAL C1713 $5,200.00 SCREW BONE RESPONSE L50 MM OD5 MM SPINE POLYAXIAL C1713 $5,200.00 SCREW BONE SERENGETI TITANIUM L40 MM OD6.5 MM SPIN C1713 $6,400.00 SCREW BONE SHORT THREAD L17 MM L5 MM OD2 MM CANNUL C1713 $549.25 SCREW BONE SHORT THREAD L50 MM OD3.5 MM CANNULATED C1713 $1,549.12 SCREW BONE SILVERTON TITANIUM L50 MM OD7.5 MM SPIN C1713 $3,900.00 SCREW BONE SOLERA CD HORIZON COCR L55 MM OD6.5 MM C1713 $3,900.00 SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM CO C1713 $3,200.00 SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM CO C1713 $4,800.00 SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM CO C1713 $5,200.00 SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM SM C1713 $3,200.00 SCREW BONE STAINLESS STEEL 1/2 THREAD REVERSE CUT C1713 $1,139.91 SCREW BONE STAINLESS STEEL 1/3 THREAD REVERSE CUT C1713 $1,166.10 SCREW BONE STAINLESS STEEL 1/3 THREAD REVERSE CUT C1713 $1,402.96 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L100 C1713 $205.84 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 C1713 $113.95 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 C1713 $199.94 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 C1713 $130.35 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 C1713 $199.94 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 C1713 $196.64 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L70 C1713 $205.84 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L80 C1713 $205.84 SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD REVE C1713 $1,380.00 SCREW BONE STAINLESS STEEL 2.5 MM L40 MM OD3.5 MM C1713 $855.60 SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L35 MM OD5 C1713 $1,395.94 SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L28 C1713 $136.50 SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L75 C1713 $264.48 SCREW BONE STAINLESS STEEL 3.5 MM L115 MM L32 MM O C1713 $291.53 SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM C1713 $132.67 SCREW BONE STAINLESS STEEL 3.5 MM L80 MM L32 MM OD C1713 $214.89 SCREW BONE STAINLESS STEEL 3.5 MM L85 MM L16 MM OD C1713 $232.18 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE STAINLESS STEEL 3.5 MM PARTIAL THREAD L C1713 $246.08 SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L130 M C1713 $1,117.48 SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L35 MM C1713 $1,607.13 SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L70 MM C1713 $1,080.11 SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L50 C1713 $956.80 SCREW BONE STAINLESS STEEL CONE L16 MM L8 MM OD3.7 C1713 $1,136.16 SCREW BONE STAINLESS STEEL CONE L38 MM L25 MM OD3. C1713 $1,136.16 SCREW BONE STAINLESS STEEL FULL THREAD L100 MM OD3 C1713 $135.46 SCREW BONE STAINLESS STEEL FULL THREAD L110 MM OD3 C1713 $166.72 SCREW BONE STAINLESS STEEL FULL THREAD L36 MM OD4 C1713 $116.94 SCREW BONE STAINLESS STEEL FULL THREAD REVERSE CUT C1713 $1,495.00 SCREW BONE STAINLESS STEEL FULL THREAD REVERSE CUT C1713 $1,886.00 SCREW BONE STAINLESS STEEL L100 MM L16 MM OD6.5 MM C1713 $2,470.16 SCREW BONE STAINLESS STEEL L105 MM L16 MM OD6.5 MM C1713 $2,810.56 SCREW BONE STAINLESS STEEL L105 MM OD3.5 MM CLAVIC C1713 $311.22 SCREW BONE STAINLESS STEEL L125 MM L16 MM OD6.5 MM C1713 $2,470.16 SCREW BONE STAINLESS STEEL L14 MM OD2.7 MM OLECRAN C1713 $1,016.88 SCREW BONE STAINLESS STEEL L14 MM OD4.5 MM STERNUM C1713 $720.00 SCREW BONE STAINLESS STEEL L15 MM OD3.5 MM SPINE F C1713 $3,200.00 SCREW BONE STAINLESS STEEL L150 MM L35 MM OD4 MM S C1713 $1,170.00 SCREW BONE STAINLESS STEEL L16 MM OD2 MM ODSEC3.5 C1713 $243.76 SCREW BONE STAINLESS STEEL L160 MM OD7.3 MM CANNUL C1713 $1,532.38 SCREW BONE STAINLESS STEEL L200 MM L60 MM OD5 MM T C1713 $1,170.00 SCREW BONE STAINLESS STEEL L24 MM L7 MM OD4.5 MM H C1713 $2,276.11 SCREW BONE STAINLESS STEEL L24 MM OD3.5 MM CLAVICL C1713 $311.22 SCREW BONE STAINLESS STEEL L26 MM L7 MM OD4.5 MM H C1713 $2,276.11 SCREW BONE STAINLESS STEEL L34 MM OD2.7 MM OLECRAN C1713 $679.44 SCREW BONE STAINLESS STEEL L34 MM OD2.7 MM OLECRAN C1713 $1,016.88 SCREW BONE STAINLESS STEEL L35 MM OD5.5 MM SPINE M C1713 $9,853.60 SCREW BONE STAINLESS STEEL L44 MM L9 MM OD4.5 MM H C1713 $2,276.11 SCREW BONE STAINLESS STEEL L46 MM OD2.7 MM OLECRAN C1713 $1,016.88 SCREW BONE STAINLESS STEEL L50 MM OD2.7 MM OLECRAN C1713 $1,016.88 SCREW BONE STAINLESS STEEL L55 MM L32 MM OD6.5 MM C1713 $2,810.56 SCREW BONE STAINLESS STEEL L60 MM L32 MM OD6.5 MM C1713 $2,810.56 SCREW BONE STAINLESS STEEL L60 MM OD2.4 MM FOREFOO C1713 $770.84 SCREW BONE STAINLESS STEEL L68 MM OD3.5 MM CLAVICL C1713 $201.31 SCREW BONE STAINLESS STEEL L75 MM L16 MM X W4 MM O C1713 $1,532.38 SCREW BONE STAINLESS STEEL L8 MM OD2 MM MANDIBLE S C1713 $756.00 SCREW BONE STAINLESS STEEL L9 MM OD1.3 MM ODSEC2.4 C1713 $524.40 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE STAINLESS STEEL LONG THREAD L52 MM OD4 C1713 $1,139.91 SCREW BONE STAINLESS STEEL PARTIAL THREAD L50 MM L C1713 $266.00 SCREW BONE STAINLESS STEEL PARTIAL THREAD L70 MM O C1713 $1,435.20 SCREW BONE STAINLESS STEEL PEDIATRIC T8 L22 MM OD2 C1713 $223.44 SCREW BONE STAINLESS STEEL PEDIATRIC T8 L34 MM OD2 C1713 $223.44 SCREW BONE STAINLESS STEEL PEDIATRIC T8 L55 MM OD2 C1713 $223.44 SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L105 C1713 $1,495.00 SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L125 C1713 $1,495.00 SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L150 C1713 $1,483.76 SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L40 M C1713 $1,483.76 SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L85 M C1713 $1,483.76 SCREW BONE STAINLESS STEEL SMALL STATURE L55 MM OD C1713 $2,800.00 SCREW BONE STAINLESS STEEL STANDARD L34 MM OD4.5 M C1713 $131.04 SCREW BONE STAINLESS STEEL STANDARD L8 MM OD2 MM O C1713 $223.04 SCREW BONE STAINLESS STEEL STANDARD L95 MM OD4.5 M C1713 $218.88 SCREW BONE STAINLESS STEEL T10 FULL THREAD L20 MM C1713 $227.50 SCREW BONE STAINLESS STEEL T10 FULL THREAD L28 MM C1713 $227.50 SCREW BONE STAINLESS STEEL T15 FULL THREAD L36 MM C1713 $695.18 SCREW BONE STAINLESS STEEL T15 FULL THREAD L44 MM C1713 $172.48 SCREW BONE STAINLESS STEEL T15 FULL THREAD L48 MM C1713 $1,297.20 SCREW BONE STAINLESS STEEL T15 FULL THREAD L55 MM C1713 $695.18 SCREW BONE STAINLESS STEEL T15 FULL THREAD L60 MM C1713 $1,297.20 SCREW BONE STAINLESS STEEL T15 FULL THREAD L90 MM C1713 $1,297.20 SCREW BONE STAINLESS STEEL T15 L24 MM OD3.5 MM COR C1713 $203.26 SCREW BONE STAINLESS STEEL T15 L36 MM OD3.5 MM SEL C1713 $855.21 SCREW BONE STAINLESS STEEL T15 L54 MM OD3.5 MM COR C1713 $203.26 SCREW BONE STAINLESS STEEL T15 L75 MM OD3.5 MM COR C1713 $203.26 SCREW BONE STAINLESS STEEL T15 L90 MM OD3.5 MM SEL C1713 $855.21 SCREW BONE STAINLESS STEEL T15 L95 MM OD3.5 MM SEL C1713 $855.21 SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L65 C1713 $1,136.16 SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L90 C1713 $758.68 SCREW BONE STAINLESS STEEL T15 SHORT THREAD L32 MM C1713 $1,999.53 SCREW BONE STAINLESS STEEL T15 SHORT THREAD L42 MM C1713 $1,999.53 SCREW BONE STAINLESS STEEL T15 SHORT THREAD L50 MM C1713 $1,999.53 SCREW BONE STAINLESS STEEL T15 SHORT THREAD L70 MM C1713 $1,999.53 SCREW BONE STAINLESS STEEL T25 FULL THREAD L30 MM C1713 $792.35 SCREW BONE STAINLESS STEEL T25 L12 MM OD5 MM ID4.4 C1713 $1,439.76 SCREW BONE STAINLESS STEEL T25 L34 MM OD5 MM SELF C1713 $1,031.62 SCREW BONE STAINLESS STEEL T25 L42 MM OD5 MM SELF C1713 $1,031.62 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE STAINLESS STEEL T4 L6 MM OD1.5 MM CORTE C1713 $248.50 SCREW BONE STAINLESS STEEL T6 L12 MM OD2 MM CORTEX C1713 $224.77 SCREW BONE STAINLESS STEEL T6 L13 MM OD2 MM CORTEX C1713 $224.77 SCREW BONE STAINLESS STEEL T8 FULL THREAD L7 MM OD C1713 $678.16 SCREW BONE STAINLESS STEEL T8 L13 MM OD2.4 MM ODSE C1713 $264.36 SCREW BONE STAINLESS STEEL T8 L26 MM OD2.7 MM SELF C1713 $805.35 SCREW BONE STAINLESS STEEL T8 L28 MM OD2.7 MM SELF C1713 $805.35 SCREW BONE STAINLESS STEEL T8 L38 MM OD2.7 MM SELF C1713 $805.35 SCREW BONE STAINLESS STEEL T8 L55 MM OD2.7 MM ID2. C1713 $804.96 SCREW BONE STAINLESS STEEL T8 L8 MM OD2.4 MM ODSEC C1713 $325.36 SCREW BONE STAINLESS STEEL T8 LONG THREAD FLUTE L2 C1713 $1,984.58 SCREW BONE STAINLESS STEEL T8 LONG THREAD REVERSE C1713 $1,151.15 SCREW BONE STAINLESS STEEL T8 SHORT THREAD FLUTE L C1713 $1,984.58 SCREW BONE STANDARD L50 MM OD3.5 MM ODSEC6 MM CORT C1713 $127.68 SCREW BONE STARDRIVE LCP TITANIUM ALLOY L11 MM OD1 C1713 $248.50 SCREW BONE T10 FULL THREAD L18 MM OD3.5 MM STARDRI C1713 $533.00 SCREW BONE TFN-ADVANCED TITANIUM L100 MM OD10.35 M C1713 $3,488.16 SCREW BONE THORP TITANIUM L16 MM OD3.2 MM MAXILLOF C1713 $3,340.00 SCREW BONE THORP TITANIUM L8 MM OD3.2 MM MAXILLOFA C1713 $3,340.00 SCREW BONE THREADLOCK TS LEVEL ONE MAXDRIVE TITANI C1713 $337.44 SCREW BONE THREADLOCK TS LEVEL ONE MAXDRIVE TITANI C1713 $444.00 SCREW BONE THREADLOCK TS LEVEL ONE MAXDRIVE TITANI C1713 $757.76 SCREW BONE THREADLOCK TS LEVEL ONE MAXDRIVE TITANI C1713 $834.72 SCREW BONE THREADLOCK TS TITANIUM L7 MM OD2.7 MM M C1713 $917.60 SCREW BONE TIAL6V4 ELI L60 MM OD4 MM CANCELLOUS CA C1713 $673.14 SCREW BONE TIAL6V4 L44 MM OD3.5 MM CORTICAL NONSTE C1713 $233.81 SCREW BONE TIGER L28 MM OD3.5 MM SPINE LONG SHANK C1713 $3,900.00 SCREW BONE TIGER L32 MM OD4 MM SPINE LONG SHANK NO C1713 $3,900.00 SCREW BONE TIGER L34 MM OD3.5 MM SPINE LONG SHANK C1713 $3,900.00 SCREW BONE TITANIUM 1/2 THREAD L50 MM OD4 MM ODSEC C1713 $1,402.96 SCREW BONE TITANIUM 1/2 THREAD L54 MM OD4 MM ODSEC C1713 $1,444.40 SCREW BONE TITANIUM 1/3 THREAD L20 MM OD4 MM ODSEC C1713 $1,402.96 SCREW BONE TITANIUM 1/3 THREAD L38 MM OD4 MM ODSEC C1713 $1,402.96 SCREW BONE TITANIUM 1/3 THREAD L68 MM OD4 MM ODSEC C1713 $1,444.40 SCREW BONE TITANIUM 2.5 MM FULL THREAD L10 MM OD2. C1713 $246.08 SCREW BONE TITANIUM 2.5 MM FULL THREAD L30 MM OD4 C1713 $140.24 SCREW BONE TITANIUM 2.5 MM FULL THREAD L50 MM OD4 C1713 $140.24 SCREW BONE TITANIUM 3.5 MM FULL THREAD L28 MM OD5 C1713 $1,212.96 SCREW BONE TITANIUM 3.5 MM FULL THREAD L46 MM OD5 C1713 $1,212.96 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE TITANIUM 3.5 MM FULL THREAD L48 MM OD4 C1713 $1,550.40 SCREW BONE TITANIUM 3.5 MM FULL THREAD L64 MM OD5 C1713 $1,550.40 SCREW BONE TITANIUM 3.5 MM FULL THREAD L68 MM OD5 C1713 $1,212.96 SCREW BONE TITANIUM 3.5 MM L65 MM OD5 MM ID4.4 MM C1713 $1,494.96 SCREW BONE TITANIUM 3.5 MM STANDARD L32 MM OD4.5 M C1713 $131.04 SCREW BONE TITANIUM DOME L30 MM OD6.5 MM HIP ACETA C1713 $162.50 SCREW BONE TITANIUM FLUTE L6 MM OD1 MM ODSEC1.6 MM C1713 $542.40 SCREW BONE TITANIUM FULL THREAD L110 MM OD7.3 MM O C1713 $1,826.16 SCREW BONE TITANIUM FULL THREAD L16 MM OD4 MM CANC C1713 $94.25 SCREW BONE TITANIUM FULL THREAD L16 MM OD4.5 MM OD C1713 $163.28 SCREW BONE TITANIUM FULL THREAD L22 MM OD4.5 MM OD C1713 $132.67 SCREW BONE TITANIUM FULL THREAD L30 MM OD4.5 MM OD C1713 $163.28 SCREW BONE TITANIUM FULL THREAD L30 MM OD7.3 MM FE C1713 $1,826.16 SCREW BONE TITANIUM FULL THREAD L35 MM OD6.5 MM OD C1713 $264.48 SCREW BONE TITANIUM FULL THREAD L40 MM OD6.5 MM CA C1713 $224.25 SCREW BONE TITANIUM FULL THREAD L45 MM OD6.5 MM CA C1713 $224.25 SCREW BONE TITANIUM FULL THREAD L50 MM OD6.5 MM OD C1713 $264.48 SCREW BONE TITANIUM FULL THREAD L68 MM OD4.5 MM OD C1713 $1,472.00 SCREW BONE TITANIUM FULL THREAD L70 MM OD7.3 MM FE C1713 $1,826.16 SCREW BONE TITANIUM FULL THREAD L85 MM OD7.3 MM OR C1713 $1,826.16 SCREW BONE TITANIUM L10 MM OD2.4 MM ODSEC3.5 MM MA C1713 $441.60 SCREW BONE TITANIUM L10 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00 SCREW BONE TITANIUM L100 MM L16 MM OD6.5 MM THREAD C1713 $2,470.16 SCREW BONE TITANIUM L100 MM L32 MM OD6.5 MM THREAD C1713 $2,470.16 SCREW BONE TITANIUM L100 MM OD4.5 MM CORTICAL SELF C1713 $256.75 SCREW BONE TITANIUM L100 MM OD6.5 MM FEMUR LAG CAN C1713 $1,201.59 SCREW BONE TITANIUM L11 MM L4 MM OD3 MM ODSEC4 MM C1713 $1,444.40 SCREW BONE TITANIUM L115 MM OD5 MM FEMUR SHAFT STE C1713 $1,971.20 SCREW BONE TITANIUM L12 MM OD1.3 MM ODSEC2.4 MM CO C1713 $426.08 SCREW BONE TITANIUM L12 MM OD2.4 MM ODSEC3.5 MM MA C1713 $388.80 SCREW BONE TITANIUM L12 MM OD3.5 MM CORTICAL NONLO C1713 $481.00 SCREW BONE TITANIUM L12 MM OD5 MM PERIARTICULAR SE C1713 $1,439.76 SCREW BONE TITANIUM L120 MM OD11 MM HIP LAG TELESC C1713 $3,350.88 SCREW BONE TITANIUM L120 MM OD5 MM FEMUR SELF TAP C1713 $1,971.20 SCREW BONE TITANIUM L125 MM L16 MM OD5 MM FEMUR SE C1713 $1,635.20 SCREW BONE TITANIUM L14 MM OD1.5 MM CORTICAL C1713 $110.50 SCREW BONE TITANIUM L14 MM OD1.5 MM CRANIOFACIAL S C1713 $393.60 SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3.5 MM MAXI C1713 $374.40 SCREW BONE TITANIUM L14 MM OD2.4 MM ODSEC4 MM MAND C1713 $604.80 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE TITANIUM L14 MM OD2.4 MM ODSEC4 MM MAND C1713 $667.20 SCREW BONE TITANIUM L14 MM OD2.7 MM RADIUS CORTICA C1713 $146.25 SCREW BONE TITANIUM L140 MM L16 MM OD6.5 MM HEADLE C1713 $2,810.56 SCREW BONE TITANIUM L140 MM L16 MM OD6.5 MM ORTHOP C1713 $1,840.00 SCREW BONE TITANIUM L150 MM L40 MM OD5 MM TROCAR T C1713 $1,170.00 SCREW BONE TITANIUM L16 MM OD1.3 MM CORTICAL SELF C1713 $518.40 SCREW BONE TITANIUM L16 MM OD2 MM ODSEC2.9 MM CRAN C1713 $398.40 SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3 MM CRANIO C1713 $391.20 SCREW BONE TITANIUM L16 MM OD2.4 MM ODSEC3.5 MM MA C1713 $388.80 SCREW BONE TITANIUM L18 MM OD1.5 MM LOCK MULTI VAR C1713 $500.50 SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3.5 MM CORT C1713 $199.94 SCREW BONE TITANIUM L2 MM OD1 MM ODSEC1.6 MM CRANI C1713 $576.00 SCREW BONE TITANIUM L2 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $576.00 SCREW BONE TITANIUM L20 MM OD1.5 MM CORTICAL C1713 $110.50 SCREW BONE TITANIUM L20 MM OD6 MM SPINE UNIAXIAL C1713 $4,800.00 SCREW BONE TITANIUM L200 MM L40 MM OD5 MM TROCAR T C1713 $1,170.00 SCREW BONE TITANIUM L22 MM OD2 MM ODSEC3.5 MM CRAN C1713 $415.20 SCREW BONE TITANIUM L22 MM OD3.5 MM CORTICAL LOCK C1713 $552.63 SCREW BONE TITANIUM L25 MM OD4.5 MM SPINE UNIAXIAL C1713 $5,200.00 SCREW BONE TITANIUM L25 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00 SCREW BONE TITANIUM L26 MM L12 MM OD4 MM CANCELLOU C1713 $94.25 SCREW BONE TITANIUM L27 MM L12 MM OD3 MM ODSEC4 MM C1713 $1,444.40 SCREW BONE TITANIUM L28 MM L14 MM OD4 MM CANCELLOU C1713 $94.25 SCREW BONE TITANIUM L3 MM OD1 MM ODSEC1.6 MM CRANI C1713 $556.80 SCREW BONE TITANIUM L3 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $566.40 SCREW BONE TITANIUM L30 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00 SCREW BONE TITANIUM L32 MM OD2.4 MM ODSEC4 MM SMAL C1713 $323.36 SCREW BONE TITANIUM L32.5 MM OD4.5 MM SPINE FIX AN C1713 $3,200.00 SCREW BONE TITANIUM L35 MM OD7.5 MM SPINE POSTERIO C1713 $5,200.00 SCREW BONE TITANIUM L36 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96 SCREW BONE TITANIUM L38 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76 SCREW BONE TITANIUM L38 MM OD4 MM SELF TAP LOCK NO C1713 $965.06 SCREW BONE TITANIUM L4 MM OD1.7 MM ODSEC2.4 MM CRA C1713 $537.60 SCREW BONE TITANIUM L4 MM OD2 MM ODSEC3 MM CRANIOF C1713 $391.20 SCREW BONE TITANIUM L40 MM OD5 MM SPINE UNIAXIAL C1713 $4,800.00 SCREW BONE TITANIUM L40 MM OD6 MM SPINE UNIAXIAL C1713 $4,800.00 SCREW BONE TITANIUM L40 MM OD8.5 MM SPINE POSTERIO C1713 $5,200.00 SCREW BONE TITANIUM L44 MM OD4.5 MM ODSEC8 MM CORT C1713 $163.28 SCREW BONE TITANIUM L5 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $576.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE TITANIUM L5 MM OD1.6 MM ODSEC2.9 MM CRA C1713 $268.72 SCREW BONE TITANIUM L5 MM OD2.4 MM ODSEC3.3 MM CRA C1713 $439.20 SCREW BONE TITANIUM L50 MM OD5.5 MM SPINE POSTERIO C1713 $5,200.00 SCREW BONE TITANIUM L55 MM OD5 MM ORTHOPEDIC SELF C1713 $1,476.56 SCREW BONE TITANIUM L55 MM OD6 MM SPINE C1713 $906.88 SCREW BONE TITANIUM L55 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00 SCREW BONE TITANIUM L6 MM CONNECTING STARDRIVE REC C1713 $1,099.36 SCREW BONE TITANIUM L6 MM OD1.9 MM ODSEC2.9 MM CRA C1713 $268.72 SCREW BONE TITANIUM L6 MM OD2.1 MM HAND CRUCIFORM C1713 $234.00 SCREW BONE TITANIUM L60 MM L16 MM OD6.5 MM CANCELL C1713 $159.25 SCREW BONE TITANIUM L65 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00 SCREW BONE TITANIUM L66 MM OD4.5 MM ODSEC8 MM CORT C1713 $163.28 SCREW BONE TITANIUM L7 MM OD1.5 MM ODSEC2.9 MM CRA C1713 $2,300.00 SCREW BONE TITANIUM L7 MM OD1.5 MM ODSEC3 MM CORTE C1713 $201.83 SCREW BONE TITANIUM L70 MM L32 MM OD6.5 MM THREADE C1713 $2,470.16 SCREW BONE TITANIUM L70 MM OD6.5 MM CANCELLOUS NON C1713 $993.60 SCREW BONE TITANIUM L8 MM OD1.2 MM CRANIOFACIAL EM C1713 $566.40 SCREW BONE TITANIUM L8 MM OD2 MM CRANIOMAXILLOFACI C1713 $504.00 SCREW BONE TITANIUM L80 MM OD5 MM FEMUR DISTAL SEL C1713 $1,453.60 SCREW BONE TITANIUM L85 MM L32 MM OD6.5 MM THREADE C1713 $2,470.16 SCREW BONE TITANIUM L90 MM L16 MM OD6.5 MM HEADLES C1713 $2,470.16 SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L150 C1713 $1,826.16 SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L55 M C1713 $1,826.16 SCREW BONE TITANIUM LONG THREAD L15 MM OD3 MM CANN C1713 $1,444.40 SCREW BONE TITANIUM LONG THREAD L18 MM OD3 MM ORTH C1713 $2,442.56 SCREW BONE TITANIUM LONG THREAD L20 MM L9 MM OD3 M C1713 $1,444.40 SCREW BONE TITANIUM LONG THREAD L21 MM L8 MM OD2.4 C1713 $2,447.20 SCREW BONE TITANIUM LONG THREAD L25 MM L8 MM OD2.4 C1713 $2,447.20 SCREW BONE TITANIUM LONG THREAD L27 MM OD3 MM ORTH C1713 $2,442.56 SCREW BONE TITANIUM LONG THREAD L29 MM OD3 MM ORTH C1713 $2,442.56 SCREW BONE TITANIUM LONG THREAD L30 MM L12 MM OD4. C1713 $2,801.36 SCREW BONE TITANIUM LONG THREAD L32 MM L12 MM OD4. C1713 $2,460.96 SCREW BONE TITANIUM LONG THREAD L50 MM L20 MM OD4. C1713 $2,460.96 SCREW BONE TITANIUM PARTIAL THREAD L40 MM OD5.5 MM C1713 $5,167.50 SCREW BONE TITANIUM PARTIAL THREAD L90 MM L32 MM O C1713 $285.76 SCREW BONE TITANIUM PARTIAL THREAD REVERSE CUT FLU C1713 $1,840.00 SCREW BONE TITANIUM PEDIATRIC T25 PARTIAL THREAD L C1713 $1,536.40 SCREW BONE TITANIUM REVERSE CUT FLUTE L85 MM L32 M C1713 $1,826.16 SCREW BONE TITANIUM SHORT THREAD L25 MM L5 MM OD2. C1713 $2,447.20 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE TITANIUM SHORT THREAD L34 MM L7 MM OD4. C1713 $2,460.96 SCREW BONE TITANIUM SHORT THREAD L40 MM L8 MM OD4. C1713 $2,460.96 SCREW BONE TITANIUM SHORT THREAD L42 MM L12 MM OD4 C1713 $2,801.36 SCREW BONE TITANIUM SHORT THREAD L46 MM L9 MM OD4. C1713 $2,460.96 SCREW BONE TITANIUM SHORT THREAD L70 MM L14 MM OD4 C1713 $2,460.96 SCREW BONE TITANIUM STANDARD FULL THREAD L40 MM OD C1713 $1,917.50 SCREW BONE TITANIUM T10 FULL THREAD L14 MM OD3 MM C1713 $715.00 SCREW BONE TITANIUM T10 FULL THREAD L24 MM OD3.5 M C1713 $400.40 SCREW BONE TITANIUM T10 L18 MM OD3.5 MM ODSEC5 MM C1713 $686.40 SCREW BONE TITANIUM T15 FULL THREAD L30 MM OD3.5 M C1713 $552.50 SCREW BONE TITANIUM T15 FULL THREAD L36 MM OD3.5 M C1713 $695.18 SCREW BONE TITANIUM T25 FULL THREAD L14 MM OD4 MM C1713 $975.20 SCREW BONE TITANIUM T25 FULL THREAD L32 MM OD5 MM C1713 $993.60 SCREW BONE TITANIUM T25 FULL THREAD L44 MM OD5 MM C1713 $1,518.48 SCREW BONE TITANIUM T25 FULL THREAD L48 MM OD6 MM C1713 $1,233.77 SCREW BONE TITANIUM T25 FULL THREAD L50 MM OD5 MM C1713 $1,340.64 SCREW BONE TITANIUM T25 FULL THREAD L58 MM OD6 MM C1713 $959.60 SCREW BONE TITANIUM T25 FULL THREAD L60 MM OD6 MM C1713 $1,233.77 SCREW BONE TITANIUM T25 FULL THREAD L65 MM OD5 MM C1713 $1,363.44 SCREW BONE TITANIUM T25 FULL THREAD L76 MM OD6 MM C1713 $959.60 SCREW BONE TITANIUM T25 FULL THREAD L85 MM OD6 MM C1713 $1,233.77 SCREW BONE TITANIUM T25 L130 MM OD6.5 MM FEMORAL L C1713 $1,000.35 SCREW BONE TITANIUM T8 FULL THREAD L16 MM OD2.4 MM C1713 $715.00 SCREW BONE TITANIUM T8 L18 MM OD2.4 MM ODSEC4 MM C C1713 $323.36 SCREW BONE TITANIUM T8 L24 MM OD2.7 MM ID2.1 MM SE C1713 $804.96 SCREW BONE TITANIUM T8 LONG THREAD FLUTE L20 MM L7 C1713 $2,447.20 SCREW BONE TK2 TIMAX OBLIQUE FULL THREAD L38 MM OD C1713 $209.56 SCREW BONE TOMOFIX TITANIUM L55 MM OD5 MM SELF TAP C1713 $1,453.60 SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87 SCREW BONE TRIDENT II L30 MM OD6.5 MM LOW PROFILE C1713 $162.50 SCREW BONE TRIDENT TITANIUM HEMISPHERE L20 MM OD6. C1713 $162.50 SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM LONG L C1713 $2,400.00 SCREW BONE UNILOCK TITANIUM L16 MM OD2.4 MM MANDIB C1713 $1,022.40 SCREW BONE UNIVERSAL NEURO III L5 MM OD1.5 MM CRAN C1713 $792.00 SCREW BONE VARIAX TITANIUM T10 FULL THREAD L12 MM C1713 $354.90 SCREW BONE VARIAX TITANIUM T10 FULL THREAD L14 MM C1713 $354.90 SCREW BONE VERSANAIL TK2 TIMAX FULL THREAD L34 MM C1713 $166.40 SCREW BONE VERTEX MAX TITANIUM L16 MM OD3.5 MM THO C1713 $11,344.48 SCREW BONE VHS STAINLESS STEEL L100 MM OD12.7 MM H C1713 $2,071.68 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SCREW BONE VHS STAINLESS STEEL L54 MM OD4.5 MM COR C1713 $213.20 SCREW BONE VHS STAINLESS STEEL L80 MM OD12.7 MM HI C1713 $2,071.68 SCREW BONE VIRAGE TITANIUM L20 MM OD4.5 MM SPINE S C1713 $3,900.00 SCREW BONE VISIDISK OD1 MM LAG M3X C1713 $826.56 SCREW BONE VISION DYNAFIX HA 3.2 MM TAPER L110 MM C1713 $957.44 SCREW BONE VISION DYNAFIX HA 3.2 MM TAPER L130 MM C1713 $1,029.12 SCREW BONE VISION XFIX DYNAFIX 4 MM TAPER L80 MM L C1713 $957.44 SCREW BONE XIA TITANIUM L30 MM OD5.5 MM SPINE THOR C1713 $2,800.00 SCREW BONE XIA TITANIUM L50 MM OD5.5 MM SPINE THOR C1713 $2,800.00 SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL HA $961.36 SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL SHO $574.96 SCREW EXTERNAL FIXATION SCHANZ TITANIUM L200 MM L8 $1,188.53 SCREW INTERFERENCE BIOCOMPOSITE DELTA TAPER L28 MM C1713 $1,880.00 SCREW INTERFERENCE BIO-INTERFERENCE POLY L LACTIC C1713 $1,624.00 SCREW INTERFERENCE BIO-INTERFERENCE POLY L LACTIC C1713 $2,224.00 SCREW INTERFERENCE BIO-INTERFERENCE POLY-L-LACTIC C1713 $1,624.00 SCREW INTERFERENCE PARCUS TITANIUM FULL THREAD L25 C1713 $1,008.00 SCREW INTERFERENCE PEEK-OPTIMA CARBON FIBER L35 MM C1713 $1,792.00 SCREW INTERFERENCE RETROSCREW POLY-L-LACTIC ACID L C1713 $1,261.00 SCREW SET CD HORIZON LEGACY STAINLESS STEEL L100 M C1713 $1,143.84 SCREW SET CD HORIZON LEGACY STAINLESS STEEL SPINE C1713 $1,183.52 SCREW SET LEGACY CD HORIZON TITANIUM SPINE NONBREA C1713 $400.00 SCREW SET OVERWATCH SPINE NONSTERILE C1713 $325.00 SCREW SET RESPONSE LARGE SPINE PEDICLE OPEN HOOK C1713 $760.00 SCREW SET STAINLESS STEEL SPINE BREAKOFF C1713 $400.00 SCREW THUMB PHOENIX TIBIAL NAIL SYSTEM $770.64 SCROTOPLASTY, SIMPLE 55175 $8,049.00 SEALER BIPOLAR ENSEAL X1 L20 CM OD13 MM CURVE LARG $3,360.50 SEALER/DIVIDER LAPAROSCOPIC L37 CM OD5 MM BLUNT TI $1,600.00 SEEKER SURGICAL NUVENT L17 MM OD6 MM SPHENOID SINU C1726 $1,906.84 SELENIUM (VITAMIN) LEVEL 84255 $249.00 SELF-CARE OR HOME MANAGEMENT TRAINING, EACH 15 MIN 97535 $111.00 SEMEN ANALYSIS FOR SPERM PRESENCE 89321 $86.00 SEMEN ANALYSIS PRESENCE AND/OR MOTILITY OF SPERM 89300 $64.00 SEMEN FRUCTOSE (CARBOHYDRATE) LEVEL 82757 $134.00 SENNA LEAF EXTRACT 176 MG/5 ML SYRP 15 ML CUP $3.00 SENSOR FLOW INFINITY ABS NEONATE IDENTIFICATION HO $683.15 SENSORY TECHNIQUE ENHANCE PROCESS & ADAPT ENVIRONM 97533 $111.00 SEPARATION OF NAIL PLATE FROM NAIL BED 11730 $184.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SEPARATION OF NAIL PLATE FROM NAIL BED 11732 $264.00 SEPT9 (SEPTIN9) METHYLATION ANALYSIS 81327 $402.00 SEROTONIN (HORMONE) LEVEL 84260 $441.00 SET ARTERIAL LINE POLYETHYLENE .018 IN STRAIGHT L8 C1751 $187.60 SET CATHETER COOK TPN OD12 FR 2 LUMEN REPAIR STERI C1751 $816.00 SET CATHETERIZATION BUSH SL L80 CM L130 CM OD5 FR C1729 $994.50 SET IMPLANT 4 MM CANNULATED DRILL GUIDEPIN RULER S C1713 $3,867.50 SET INFUSION DIGNITY PLASTIC POLYURETHANE MID SIZE C1894 $2,400.00 SET INSTRUMENT GMK SPHERE I4R-T4 INSERT $650.00 SET INTRODUCER PULL-APART .038 IN OD10 FR SHEATH S C1892 $241.42 SET NEEDLE EZ-IO EZ-CONNECT NEEDLE VISE STAINLESS $644.00 SET NEPHROSTOMY SOF-FLEX PEDIATRIC 2 PIGTAIL CURVE C2617 $879.12 SET STENT POLYURETHANE .035 IN 2 PIGTAIL CURVE L10 C2617 $795.60 SET STENT SALLE SILICONE .038 IN L12-18 CM L145 CM C2625 $624.00 SET STENT UNIVERSA AQ 2 PIGTAIL CURVE L22 CM OD5 F C2617 $580.00 SEX HORMONE BINDING GLOBULIN (PROTEIN) LEVEL 84270 $225.00 SEX IDENTIFICATION 88140 $62.00 SEX IDENTIFICATION 88130 $117.00 SGPT ALT 84460 $215.00 SHAVING OF 0.5 CENTIMETERS OR LESS SKIN GROWTH OF 11300 $264.00 SHEATH GUIDING FLEXOR CHECK-FLO STRAIGHT L55 CM OD C1894 $362.20 SHEATH GUIDING FLEXOR TUOHY-BORST BALKIN CURVE L45 C1894 $524.52 SHEATH GUIDING PINNACLE DESTINATION TUOHY-BORST ST C1894 $420.00 SHEATH INTRODUCER PINNACLE STAINLESS STEEL HYDROPH C1894 $445.00 SHELL ACETABULAR G7 OSSEOTI G HEMISPHERICAL OD58 M C1776 $13,000.00 SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 J HEMISP C1776 $14,302.47 SHELL ACETABULAR PINNACLE GRIPTION OD52 MM HIP STE C1776 $6,500.00 SHELL ACETABULAR PINNACLE GRIPTION OD54 MM HIP SEC C1776 $5,850.00 SHELL ACETABULAR PINNACLE GRIPTION OD54 MM HIP STE C1776 $5,850.00 SHELL ACETABULAR TRIDENT II TRITANIUM D OD50 MM HI C1776 $15,715.90 SHOE POSTOPERATIVE ORTHOWEDGE 7.5-10 6-8 SMALL ANK L3260 $75.65 SIDEPLATE BONE LCP DHHS STAINLESS STEEL 135 D STAN C1713 $4,038.80 SIDEPLATE BONE LCP DHHS STAINLESS STEEL 135 D STAN C1713 $6,909.20 SIDEPLATE BONE LCP DHHS STAINLESS STEEL 140 D STAN C1713 $4,038.80 SILICA (SILICON) LEVEL 84285 $182.00 SIMPLE CONTROL OF NOSE BLEED 30901 $561.00 SIROLIMUS (RAPAMYCIN) 80195 $337.00 SIROLIMUS LEVEL 80195 $337.00 SKELETAL MUSCLE RELAXANTS LEVELS 80370 $244.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SKIN APPLICATION OF TAR AND ULTRAVIOLET B OR PETRO 96910 $180.00 SKIN TEST FOR TUBERCULOSIS 86580 $37.00 SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN 95810 $6,145.00 SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN 95811 $8,378.00 SLEEP MONITORING OF PATIENT (YOUNGER THAN 6 YEARS) 95783 $2,511.00 SLEEP MONITORING OF PATIENT (YOUNGER THAN 6 YEARS) 95782 $6,981.00 SLEEP MONITORING OF PATIENT IN SLEEP LAB 95808 $3,603.00 SLEEVE ADAPTER V40 TITANIUM +0 MM OFFSET UNIVERSAL C1776 $325.00 SLEEVE CENTERING COMPRESS OD14 MM HIP $3,080.00 SLEEVE RIB VEPTR TITANIUM 4 220 MM RADIUS NONSTERI C1713 $9,475.20 SLEEVE TIBIAL MBT POROUS L37 MM X W27 MM X H40 MM C1776 $12,350.00 SMEAR FOR INFECTIOUS AGENTS 87210 $136.00 SMEAR FOR PARASITES 87177 $133.00 SMOKING & TOBACCO USE INTERMEDIATE COUNSEL > THAN 99406 $37.00 SMOKING AND TOBACCO USE INTENSIVE COUNSELING, GREA 99407 $67.00 SODIUM BODY FLUID 84302 $335.00 SODIUM CHLORIDE 0.9 % SOLP 1,000 ML FLEX CONT J7030 $100.00 SODIUM URINE 84300 $208.00 SODIUM, URINE 84300 $208.00 SODIUM,URINE 24HR 84300 $208.00 SOL TRANSFERRIN RECEP ASSAY 84238 $650.00 SOLUTION OPHTHALMIC SILIKON 1000 POLYDIMETHYLSILOX C1814 $3,893.68 SP GRAVITY-URINE 81003 $17.00 SPACER ALLOGRAFT CORTICAL 5 D OVAL L12 MM X W14 MM $4,875.00 SPACER ALLOGRAFT FORGE LORDOTIC L12 MM X W14 MM X C1821 $5,850.00 SPACER FEMORAL CATHCART ARTICUL/EZE +0 MM 12/14 TA C1776 $325.00 SPACER SPINAL CALIBER-L LORDOTIC L50 MM X W18 MM X C1821 $34,125.00 SPACER SPINAL CAPSTONE CONTROL PEEK 12 D L22 MM X C1821 $7,475.00 SPACER SPINAL CAPSTONE CONTROL PEEK 6 D L22 MM X H C1821 $7,475.00 SPACER SPINAL CAPSTONE PTC PEEK L26 MM X H9 MM STE C1821 $14,950.00 SPACER SPINAL COLONIAL PEEK 7 D LORDOTIC D12 MM LA C1821 $5,460.00 SPACER SPINAL HOLLYWOOD VI NANOMETALENE LORDOTIC L C1821 $14,950.00 SPACER SPINAL REDONDO-L PEEK-OPTIMA 8 D LORDOTIC L C1821 $22,750.00 SPACER SPINAL TRANSCONTINENTAL PEEK 10 D LORDOTIC C1821 $25,025.00 SPACER SPINAL XPAND TITANIUM -8 D D25 MM LARGE W32 C1821 $48,750.00 SPECIAL STAIN FOR MICROORGANISM 87205 $102.00 SPECIAL STAIN FOR MICROORGANISM 87206 $143.00 SPECIAL STAIN FOR PARASITES 87209 $130.00 SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE 88341 $130.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE 88313 $172.00 SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE 88314 $185.00 SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE 88344 $307.00 SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANI 88312 $130.00 SPECIMEN ANALYSIS FOR BLOOD 82271 $132.00 SPEECH THERAPY ? REVENUE CODE 44X G0378 $185.00 SPERM ISOLATION WITH SEMEN ANALYSIS FOR FERTILIZAT 89260 $215.00 SPHERE EMBOLIZATION EMBOSPHERE TRISACRYL GELATIN 1 $1,225.00 SPHERE EYE MEDPOR SST-EZ POROUS OD18 MM SUTURE HOL L8610 $5,519.36 SPINAL TAP FOR DIAGNOSIS 62270 $2,044.00 SPINAL TAP WITH DRAINAGE OF SPINAL FLUID 62272 $2,403.00 SPINDLE ORTHOPEDIC COMPRESS C600 LB SMALL STANDARD C1776 $30,448.00 SPLINT ORTHOPEDIC COTTON LARGE L8 IN LEFT WRIST HO L3908 $32.63 SPLINT ORTHOPEDIC LMB WIRE-FOAM LARGE L3 1/2 IN FI L3925 $80.82 SPLINT ORTHOPEDIC ORTHO-GLASS SYNTHETIC L15 FT X W $440.32 SPLINT ORTHOPEDIC PROCARE THERMOPLASTIC LARGE H13. L1930 $88.90 SPLINT ORTHOPEDIC PROCARE THERMOPLASTIC LARGE H13. L1930 $91.65 SPLINT ORTHOPEDIC PROCARE THERMOPLASTIC XL H14 IN L1930 $88.90 SPLITTING OF BLOOD OR BLOOD PRODUCTS 86985 $79.00 SPUTUM SPECIMEN COLLECTION 89220 $136.00 SSA (ENA) AB EACH 86235 $94.00 STAIN FOR PARASITES 87207 $221.00 STAPLE BONE LEGACY CD HORIZON M8 TITANIUM SMALL L2 C1713 $4,800.00 STAPLER INTERNAL POLY GIA LACTOMER TITANIUM L75 MM $1,937.85 STAPLER INTERNAL TITANIUM L30 MM X H3.5 MM REGULAR $1,107.28 STAPLER INTERNAL TITANIUM L30 MM X W3 MM VASCULAR $1,245.66 STEM CELL COLLECTION ALLO 38205 $5,174.00 STEM CELLS COUNT, TOTAL 86367 $293.00 STEM EXTENSION GMK L105 MM OD20 MM FLUTED REVISION C1776 $4,550.00 STEM EXTENSION GMK L65 MM OD13 MM CEMENTED REVISIO C1776 $4,550.00 STEM EXTENSION L65 MM OD11 MM C1776 $4,550.00 STEM FEMORAL ACCOLADE II V40 PUREFIX TITANIUM 132 C1776 $11,700.00 STEM FEMORAL ACUMATCH +0 MM 12/14 OFFSET TAPER HIP C1776 $325.00 STEM FEMORAL AMISTEM-H HA TITANIUM-NIOBIUM 3 STAND C1776 $11,700.00 STEM FEMORAL CORAIL ARTICUL/EZE TITANIUM HA 135 D C1776 $11,700.00 STEM FEMORAL ECHO BI-METRIC PPS TITANIUM 135 D STA C1776 $11,375.00 STEM FEMORAL MALLORY-HEAD POROUS 136.5 D STANDARD C1776 $11,375.00 STEM FEMORAL MINIMAX 127 D 3 HIP RIGHT CEMENTLESS C1776 $11,700.00 STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET C1776 $7,800.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge STEM FEMORAL RECLAIM TITANIUM 3 D TAPER L190 MM OD C1776 $19,145.75 STEM FEMORAL RECLAIM TITANIUM STRAIGHT TAPER L140 $21,911.11 STEM FEMORAL SOLUTION SYSTEM POROUS 12/14 LARGE ST C1776 $31,200.00 STEM FEMORAL SUMMIT 3 12/14 STANDARD OFFSET TAPER C1776 $7,800.00 STEM FEMORAL SUMMIT 7 12/14 STANDARD OFFSET TAPER C1776 $7,800.00 STEM FEMORAL TAPERLOC MICROPLASTY PPS TITANIUM 133 C1776 $11,375.00 STEM FEMORAL TAPERLOC PPS 133 D 18 STANDARD OFFSET C1776 $11,700.00 STEM FEMORAL TRI-LOCK BPS GRIPTION 1 HIGH OFFSET L C1776 $14,400.00 STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROU C1776 $27,625.00 STEM HUMERAL EQUINOXE OD12.5 MM LEFT SHOULDER FRAC C1776 $13,650.00 STEM HUMERAL GLOBAL AP POROCOAT L154 MM OD16 MM SH C1776 $13,650.00 STEM HUMERAL REUNION L128 MM OD12 MM SHOULDER PRES C1776 $15,600.00 STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 155 C1776 $23,887.50 STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 7 L1 C1776 $16,152.50 STEM TIBIAL VANGUARD 360 L80 MM OD18 MM KNEE SPLIN C1776 $5,600.00 STENT BILIARY CORDIS PALMAZ GENESIS STAINLESS STEE C1877 $3,250.00 STENT BILIARY CORDIS PALMAZ GENESIS STAINLESS STEE C1876 $3,510.00 STENT BILIARY CORDIS PALMAZ GENESIS STAINLESS STEE C1876 $11,934.00 STENT BILIARY CORDIS SMART CONTROL NITINOL L30 MM C1876 $3,250.00 STENT BILIARY CORDIS SMART CONTROL NITINOL L80 MM C1876 $3,250.00 STENT BILIARY COTTON-LEUNG POLYETHYLENE GENTLE CUR C2617 $360.00 STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL C1876 $3,510.00 STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL C1876 $3,510.00 STENT BILIARY FLEXSEGMENT PALMAZ GENESIS SLALOM ST C1876 $11,934.00 STENT BILIARY PALMAZ GENESIS SLALOM FLEXSEGMENT ST C1876 $11,934.00 STENT BILIARY PALMAZ GENESIS STAINLESS STEEL L12 M C1876 $11,934.00 STENT BILIARY PRECISE NITINOL L20 MM L135 CM OD7 M C1876 $14,586.00 STENT BILIARY PRECISE NITINOL L30 MM L135 CM OD7 M C1876 $6,500.00 STENT BILIARY VALEO TAPER L26 MM L80 CM OD8 MM ODS C1876 $3,225.00 STENT CORONARY PROMUS EVEROLIMUS COCR L18 MM L143 C1874 $14,976.00 STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE C1874 $13,145.00 STENT ENDOPROSTHESIS WALLSTENT UNISTEP PLUS METAL C1876 $6,500.00 STENT INTRACRANIAL WINGSPAN GATEWAY HYDROPHILIC L9 $38,460.50 STENT NEPHROURETEROSTOMY COPE MAC-LOC ULTRATHANE H C2625 $501.60 STENT PANCREATIC ZIMMON POLYETHYLENE PIGTAIL CURVE C2617 $292.50 STENT URETERAL POLARIS ULTRA NAUTILUS PERCUFLEX HY C2617 $850.93 STENT VASCULAR ACCULINK NITINOL STRAIGHT L20 MM L1 C1876 $15,600.00 STENT VASCULAR CORDIS SMART CONTROL NITINOL L30 MM C1876 $3,250.00 STENT VASCULAR CORDIS SMART CONTROL NITINOL L40 MM C1876 $3,250.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge STENT VASCULAR CORDIS SMART NITINOL L150 MM L120 C C1876 $2,700.00 STENT VASCULAR FLEXSEGMENT PALMAZ GENESIS SLALOM S C1876 $11,934.00 STENT VASCULAR LIFESTENT NITINOL .035 IN HELICAL L C1876 $3,740.00 STEREOISOMER (ENANTIOMER) DRUG ANALYSIS 80374 $244.00 STIMULATOR BONE OSTEOGEN MINI STRAIGHT 40 ML SPINE E0749 $36,000.00 STOMACH EMPTYING STUDY 78264 $1,902.00 STOOL ANALYSIS FOR BILIRUBIN 82252 $35.00 STOOL ANALYSIS FOR BLOOD 82272 $13.00 STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMOR 82270 $120.00 STOOL CALPROTECTIN (PROTEIN) LEVEL 83993 $802.00 STOOL CULTURE 87045 $119.00 STOOL FAT MEASUREMENT 82715 $133.00 STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS 83630 $109.00 STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) LEVEL 83631 $152.00 STOOL WBC STAIN 87205 $102.00 STORAGE OF EMBRYOS, PER YEAR 89342 $305.00 STRAPPING OF ANKLE AND/OR FOOT 29540 $373.00 STRAPPING OF CHEST 29200 $199.00 STRAPPING OF ELBOW OR WRIST 29260 $215.00 STRAPPING OF HAND OR FINGER 29280 $76.00 STRAPPING OF KNEE 29530 $282.00 STRAPPING OF SHOULDER 29240 $311.00 STRAPPING OF TOES 29550 $188.00 STRAPPING, UNNA BOOT 29580 $373.00 STREP PNEUMONIAE SEROTYPE TEST 86317 $67.00 STREP TEST (STREPTOCOCCUS, GROUP A) 87880 $75.00 STRIATED MUSC ANITBODY 83520 $348.00 STUDY OF ANORECTAL PRESSURE GENERATED BY MUSCLES S 91122 $512.00 STUDY OF MOVEMENT OF THE UPPER SMALL BOWEL (DUODEN 91022 $972.00 SUBSTITUTE BONE GRAFT VITOSS BTCP COLLAGEN 5 ML VO C1713 $6,272.64 SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML 200-4 $11.95 SUPPORT EXTERNAL FIXATION OBLIQUE NONSTERILE $3,919.20 SURG PATH LEVEL 4 88305 $241.00 SURGICAL PATHOLOGY CONSULTATION AND REPORT 88323 $435.00 SUTURE ABSORBABLE PDS II 2-0 CT-1 L18 IN CONTROL R $572.04 SUTURE OF MOUTH LACERATION 2.5 CM OR LESS 40830 $472.00 SUTURE OF MOUTH LACERATION OVER 2.5 CM 40831 $1,842.00 SWIM MOLDS FAC BINAURAL $221.00 SWIM MOLDS HOSP BINAURAL $128.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SWIM MOLDS HOSP MONAURAL $82.00 SYPHILIS TEST NON-TREP QUAL, RPR 86592 $95.00 SYSTEM BILIARY STENT NAVIFLEX L202.5 CM OD10 FR RA C2625 $805.35 SYSTEM COMPRESSION LUCAS CHEST AIR PRESSURE REGULA $3,240.32 SYSTEM CORONARY STENT INTEGRITY MICROTRAC FULCRUM C1876 $2,000.00 SYSTEM CORONARY STENT INTEGRITY MICROTRAC FULCRUM C1876 $2,875.00 SYSTEM CORONARY STENT ION CLIPIT MONORAIL TRANSLUT C1874 $14,976.00 SYSTEM CORONARY STENT MULTI-LINK 8 LL COCR L33 MM C1876 $4,640.00 SYSTEM CORONARY STENT MULTI-LINK MINI VISION COCR C1876 $2,437.50 SYSTEM CORONARY STENT MULTI-LINK VISION COCR L15 M C1876 $2,437.50 SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC C1874 $4,125.00 SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC C1874 $5,362.50 SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC C1874 $6,600.00 SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTARO C1874 $5,850.00 SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTARO C1874 $7,200.00 SYSTEM CORONARY STENT XIENCE PRIME EVEROLIMUS COCR C1874 $10,400.00 SYSTEM CORONARY STENT XIENCE SIERRA EVEROLIMUS L12 C1874 $6,360.00 SYSTEM CORONARY STENT XIENCE SIERRA EVEROLIMUS L28 C1874 $6,360.00 SYSTEM CORONARY STENT XIENCE SIERRA EVEROLIMUS L8 C1874 $6,360.00 SYSTEM CORONARY STENT XIENCE V EVEROLIMUS COCR L15 C1874 $10,400.00 SYSTEM DIAGNOSTIC CATHETER RELIEVA SPIN RELIEVA VO C1726 $48,993.75 SYSTEM DRUG DELIVERY SILVERSOAKER ON-Q PAINBUSTER $851.50 SYSTEM EMBOLIC PROTECTION ANGIOGUARD RX NITINOL PO C1884 $13,338.00 SYSTEM EMBOLIC PROTECTION FILTERWIRE EZ NITINOL PO C1884 $7,644.00 SYSTEM EMBOLIC PROTECTION GUNTHER TULIP CONICHROME C1880 $6,800.00 SYSTEM EMBOLIC TRUFILL 1 GM KIT LIQUID $18,232.50 SYSTEM EMBOLIZATION AZUR HYDROCOIL L20 CM OD5 MM O $6,000.00 SYSTEM ENDOPROSTHESIS STENT TRIVASCULAR OVATION PR $50,700.00 SYSTEM GLAUCOMA XEN PORCINE DERMIS INJECTOR STERIL L8612 $13,325.00 SYSTEM SPINAL FIXATION IFUSE IMPLANT SYSTEM L60 MM C1713 $18,850.00 TACK FIXATION RAPIDSORB L4 MM OD1.5 MM CRANIOMAXIL C1713 $2,656.00 TACROLIMUS 80197 $260.00 TACROLIMUS LEVEL 80197 $260.00 TAP BLOCK UNIL BY INJECTION 64486 $3,842.00 TAP SURGICAL DELTA OD1.7 MM SELF DRILLING $1,439.36 TAPENTADOL LEVEL 80372 $244.00 TBC MOLECULAR PHENOTYPE 81403 $609.00 TC 99M-PENTETIC ACID 20 MG SOLR 30 EACH VIAL A9539 $717.50 TELEPHONIC EVALUATION SNGL/DUAL/MULT LD PACEMKR HE 93293 $164.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge TEMPLATE SIZING DELTA SYSTEM 2.2 MM CRANIOMAXILLOF $896.00 TEST DETECTING NUCLEIC ACID OF ORGANISM CAUSING IN 87483 $1,030.00 TEST FOR DETECTING GENES ASSOCIATED WITH BLOOD REL 81450 $2,089.00 TEST FOR DETECTING GENES ASSOCIATED WITH DISEASES 81415 $11,520.00 TEST FOR TETECTING GENES ASSOCIATED WITH DISEASE 81416 $5,472.00 TESTING FOR PRESENCE OF DRUG 80305 $86.00 TESTING FOR PRESENCE OF DRUG 80306 $96.00 TESTING FOR PRESENCE OF DRUG 80307 $706.00 TESTING OF NERVE FROM EAR TO BRAIN (COCHLEAR) 92584 $623.00 TESTING OF TONE AND SENSATION OF RECTUM AND ANUS 91120 $439.00 TESTING WITH STIMULATION FOR ASSESSMENT FUNCTION A 95937 $552.00 TESTOSTERONE (HORMONE) LEVEL 84403 $435.00 TESTOSTERONE FREE 84402 $382.00 THAWING OF PREVIOUSLY FROZEN STEM CELLS FOR TRANSP 38208 $1,053.00 THC METABOLITE URINE QUANT 80349 $219.00 THEOPHYLLINE- LEV 80198 $156.00 THEOPHYLLINE LEVEL 80198 $156.00 THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION EACH 15 97530 $111.00 THERAPEUTIC EXERCISE DEV STRENGTH ENDUR RNG OF MTN 97110 $111.00 THERAPEUTIC MASSAGE TO 1 OR MORE AREAS, EACH 15 MI 97124 $111.00 THERAPEUTIC PROCEDURE RE-EDUCATE BRAIN-TO-NERVE-TO 97112 $111.00 THERAPEUTIC SERVICES FOR USE OF SPEECH-GENERATING 92609 $252.00 THERMOLABILE (HEAT SENSITIVE) HEMOGLOBIN LEVEL 83065 $53.00 THROMBIN TIME, FIBRINOGEN SCREENING TEST 85675 $49.00 THROMBIN TIME, FIBRINOGEN SCREENING TEST 85670 $165.00 THROMBOMODULIN (COAGULATION PROTEIN) MEASUREMENT 85337 $75.00 THROMBOPLASTIN INHIBITION (CIRCULATING ANTICOAGULA 85705 $49.00 THYROGLOBULIN 84432 $348.00 THYROID HORMONE EVALUATION 84479 $144.00 THYROID HORMONE, T3 MEASUREMENT 84482 $124.00 THYROID HORMONE, T3 MEASUREMENT 84480 $203.00 THYROID HORMONE, T3 MEASUREMENT 84481 $547.00 THYROID PEROXIDASE AB 86376 $228.00 THYROTROPIN RELEASING HORMONE STIMULATION PANEL 2 80439 $521.00 THYROXINE (THYROID CHEMICAL) LEVEL 84437 $50.00 THYROXINE (THYROID CHEMICAL) MEASUREMENT 84439 $116.00 THYROXINE (THYROID CHEMICAL) MEASUREMENT 84436 $154.00 THYROXINE BINDING GLOBULIN (THYROID RELATED PROTEI 84442 $351.00 TIMED ASSESSMENT OF BLADDER EMPTYING 51736 $255.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge TISSUE CULTURE FOR TUMOR DISORDERS 88239 $691.00 TISSUE CULTURE FOR TUMOR DISORDERS OF BONE MARROW 88237 $683.00 TISSUE CULTURE FOR VIRUS ISOLATION 87253 $450.00 TISSUE CULTURE INOCULATION FOR VIRUS ISOLATION 87252 $450.00 TISSUE CULTURE TO IDENTIFY SKIN DISORDERS 88233 $605.00 TISSUE CULTURE TO IDENTIFY WHITE BLOOD CELL DISORD 88230 $480.00 TISSUE FUNGI OR PARASITES 87220 $117.00 TISSUE OR CELL ANALYSIS BY IMMUNOLOGIC TECHNIQUE 88342 $111.00 TISSUE TRANSFER REPAIR WND (10 SQ CM OR <) FACE UN 14040 $2,540.00 TISSUE TRANSFER REPAIR WOUND (10 SQ CM OR LESS) OF 14060 $4,263.00 TOBRAMYCIN (ANTIBIOTIC) LEVEL 80200 $324.00 TOBRAMYCIN 0.3 % DROP 5 ML DROP BTL $47.88 TOBRAMYCIN 40 MG/ML SOLN 2 ML VIAL $3.97 TOBRAMYCIN-PEAK 80200 $324.00 TOBRAMYCIN-RANDOM 80200 $324.00 TOBRAMYCIN-TROUGH 80200 $324.00 TOOL DISSECTING XMAX MICROMAX EMAX 2 PLUS LONG FLU $705.58 TOPIRAMATE LEVEL 80201 $157.00 TOTAL PROTEIN LEVEL, BODY FLUID 84157 $108.00 TOXOCARA ANTIBODY 86682 $193.00 TOXOPLASMA AB 86777 $355.00 TOXOPLASMA ANTIBODY IGG 86777 $355.00 TRACH/LARYN TUBE CUFFED A7521 $495.00 TRACH/LARYN TUBE NON-CUFFED A7520 $495.00 TRACHEAL PUNCTURE PERCUTANEOUS WITH TRANSTRACHEAL 31612 $12,111.00 TRACHEOSTOMA REVISION SIMPLE WITHOUT FLAP ROTATION 31613 $6,648.00 TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL 31603 $2,301.00 TRACING OF ELECTRICAL ACTIVITY OF THE HEART USING 93041 $82.00 TRAINING IN USE OF ORTHOTICS FOR ARMS LEGS AND/OR 97760 $111.00 TRAINING IN USE OF PROSTHESIS FOR ARMS AND/OR LEGS 97761 $111.00 TRANSCONNECTOR ROD PANGEA USS II TITANIUM L33-36.5 C1713 $4,000.00 TRANSCONNECTOR ROD PANGEA USS II TITANIUM L38.5-48 C1713 $4,000.00 TRANSCONNECTOR ROD PANGEA USS II TITANIUM L49-69 M C1713 $4,000.00 TRANSFERRIN (IRON BINDING PROTEIN) LEVEL 84466 $207.00 TRANSFUSION OF BLOOD OR BLOOD PRODUCTS 36430 $2,522.00 TRANSPLANT ANTIBODY MEASUREMENT 86808 $230.00 TRANSTHORACIC INSERT CATHETER FOR STENT W/CATH REM 33621 $33,484.00 TRAUMA RESPONSE TEAM G0390 $1,089.00 TRAY CATHETER ARGYLE SWAN NECK CURL CATH L122.3 CM $3,600.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge TRAY CATHETER SPECTRUM POLYURETHANE MINOCYCLINE RI C1751 $828.48 TRAY CATHETER SPECTRUM POLYURETHANE PEDIATRIC .025 C1751 $854.32 TRAY SUTURE VERSASTEP LARGE REPOSABLE 9 PORT VERSA $5,382.20 TRAY TIBIAL OXFORD B LEFT MEDIAL UNICOMPARTMENTAL C1776 $7,800.00 TRAY TIBIAL VANGUARD 360 POROUS L67 MM KNEE REVISI C1776 $14,400.00 TREAT CLAVICLE FRACTURE 23500 $561.00 TREAT DISLOCATED ELBOW 24640 $561.00 TREAT FINGER FRACTURE 26720 $532.00 TREAT FINGER FRACTURE 26750 $532.00 TREATMENT OF BROKEN FOOT BONE 28450 $494.00 TREATMENT OF DISLOCATED ELBOW UNDER ANESTHESIA 24605 $4,797.00 TREATMENT OF ELBOW DISLOCATION 24600 $570.00 TREATMENT OF HIP DISLOCATION 27250 $617.00 TREATMENT OF INCOMPLETE ABORTION 59812 $2,461.00 TREATMENT OF SWALLOWING AND/OR ORAL FEEDING FUNCTI 92526 $263.00 TREATMENT SPEECH LANGUAGE VOICE COMM/HEARING PROCE 92507 $212.00 TRICYCLICS, DRUG SCREEN 80307 $706.00 TRIGLYCERIDES LEVEL 84478 $173.00 TRIGLYCERIDES, FLUID 84478 $173.00 TRIMMING OF FINGERNAILS OR TOENAILS 11719 $134.00 TROPONIN (PROTEIN) ANALYSIS 84484 $328.00 TRYPSIN (PANCREATIC ENZYME) MEASUREMENT, INTESTINA 84485 $59.00 TUBE GASTROSTOMY MIC SECUR-LOK SILICONE STANDARD O B4087 $88.80 TUBE GASTROSTOMY OD14 FR 5 ML BALLOON REPLACEMENT B4087 $204.80 TUBE JEJUNOSTOMY MIC LUER-LOK SILICONE OD14 FR ID9 B4087 $1,455.60 TUBE JEJUNOSTOMY MIC SECUR-LOK SILICONE L45 CM OD1 $844.35 TUBE JEJUNOSTOMY MIC SECUR-LOK SILICONE OD16 FR 7- B4087 $807.63 TUBE NASOGASTRIC ARGYLE KANGAROO INDWELL SENTINEL B4082 $23.16 TUBE NASOGASTRIC CORTRAK 2 POLYURETHANE L43 IN OD1 B4081 $291.20 TUBE NASOGASTRIC CURITY KANGAROO PVC PEDIATRIC L15 B4082 $6.00 TUBE TRACHEOSTOMY SHILEY XLT ADULT L38 MM L34 MM E $176.70 TUBERCULOSIS ANTIGEN RESPONSE GAMMA INTERFERON 86480 $168.00 TUBERCULOSIS TEST 86480 $168.00 TYING OF DILATED VEINS OF STOMACH AND/OR ESOPHAGUS 43244 $10,210.00 TYROSINE (AMINO ACID) LEVEL 84510 $103.00 UCSF METAGENOMIC NEXT GENERATION SEQUENCING 81479 $6,840.00 ULTRASONIC GUIDANCE DURING SURGERY 76998 $1,966.00 ULTRASONIC GUIDANCE IMAGING SUPERVISION & INTERP F 76942 $1,884.00 ULTRASOUND ? REVENUE CODE 402 G0378 $185.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ULTRASOUND BEHIND ABDOMINAL CAVITY 76770 $669.00 ULTRASOUND EVALUATION OF HEART BLOOD VESSEL 93662 $9,011.00 ULTRASOUND EXAM HEART INCLUDING COLOR BLOOD FLOW R 93306 $2,695.00 ULTRASOUND EXAMINATION OF CONGENITAL HEART DEFECT 93303 $905.00 ULTRASOUND GUIDANCE FOR ACCESSING INTO BLOOD VESSE 76937 $1,777.00 ULTRASOUND LIMITED SCAN ABDOMINAL PELVIC/SCROTAL A 93976 $315.00 ULTRASOUND LIMITED SCAN OF PENILE ARTERIAL INFLOW 93981 $315.00 ULTRASOUND LIMITED SCANNING OF HEAD AND NECK BLOOD 93888 $1,778.00 ULTRASOUND MEASUREMENT OF BLADDER CAPACITY AFTER V 51798 $193.00 ULTRASOUND OF ABDOMEN 76705 $676.00 ULTRASOUND OF ABDOMEN 76700 $925.00 ULTRASOUND OF ARM OR LEG 76882 $574.00 ULTRASOUND OF BRAIN 76506 $639.00 ULTRASOUND OF CHEST 76604 $669.00 ULTRASOUND OF CORNEAL STRUCTURE AND MEASUREMENT 76514 $49.00 ULTRASOUND OF DIALYSIS ACCESS 93990 $315.00 ULTRASOUND OF FETAL HEART 76827 $521.00 ULTRASOUND OF FETAL HEART BLOOD FLOW 76825 $521.00 ULTRASOUND OF HEAD AND NECK 76536 $753.00 ULTRASOUND OF HIPS WITH MANIPULATION, INFANT 76885 $797.00 ULTRASOUND OF HIPS, INFANT 76886 $312.00 ULTRASOUND OF LEG OR ARM 76881 $786.00 ULTRASOUND OF ONE BREAST 76642 $640.00 ULTRASOUND OF PELVIS 76856 $649.00 ULTRASOUND OF PELVIS 76857 $724.00 ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES) 76815 $762.00 ULTRASOUND OF SCROTUM 76870 $795.00 ULTRASOUND OF SPINAL CANAL 76800 $612.00 ULTRASOUND OF TRANSPLANTED KIDNEY 76776 $1,228.00 ULTRASOUND PELVIS THROUGH VAGINA 76830 $696.00 ULTRASOUND SCAN ABDOMINAL PELVIC/SCROTAL ARTERIAL 93975 $1,956.00 ULTRASOUND SCAN BLOOD FLOW AORTA VENA CAVA BYPASS 93979 $481.00 ULTRASOUND SCAN OF VENA CAVA OR GROIN GRAFT OR VES 93978 $2,609.00 ULTRASOUND SCAN VEINS 1 ARM/LEG/LTD W/ASSESS COMPR 93971 $1,263.00 ULTRASOUND SCAN VEINS BOTH ARMS/LEGS W/ASSESS COMP 93970 $1,410.00 ULTRASOUND SCANNING BLOOD FLOW (OUTSIDE OF BRAIN) 93882 $790.00 ULTRASOUND SCANNING OF BLOOD FLOW ON BOTH SIDES OF 93880 $1,610.00 ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS O 93931 $315.00 ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS O 93925 $1,520.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS O 93930 $1,520.00 ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS O 93926 $1,855.00 ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS 93923 $375.00 ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS 93922 $778.00 UNATTENDED SLEEP STUDY W/RECORDING HEART RATE OXYG 95806 $772.00 UNIV IOWA MOLECULAR OTO-HEARING LOSS DUP/DEL ANALY 81431 $2,376.00 UNIV IOWA MOLECULAR OTO-HEARING LOSS GENOMIC SEQ A 81430 $2,376.00 UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE 93799 $375.00 UNLISTED CHEM PROCEDURE 84999 $333.00 UNLISTED MOLECULAR PATH PROC 81479 $400.00 UREA NITROGEN , FLUID 84520 $178.00 UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION 84540 $22.00 UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION 84525 $29.00 UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION 84520 $178.00 UREASE ACTIVITY 83013 $522.00 URIC ACID 84560 $231.00 URIC ACID BODY FLUID 84560 $231.00 URIC ACID LEVEL, BLOOD 84550 $196.00 URINALYSIS USING MICROSCOPE 81015 $100.00 URINALYSIS, 2 OR 3 GLASS TEST 81020 $29.00 URINALYSIS, AUTO POCT 81003 $52.00 URINALYSIS, MANUAL TEST 81002 $135.00 URINE ALBUMIN (PROTEIN) LEVEL 82042 $125.00 URINE CALCIUM LEVEL 82340 $133.00 URINE LACTOSE (CARBOHYDRATE) ANALYSIS 83633 $43.00 URINE MICROALBUMIN (PROTEIN) ANALYSIS 82044 $23.00 URINE OSMOLALITY (CONCENTRATION) MEASUREMENT 83935 $261.00 URINE POTASSIUM LEVEL 84133 $195.00 URINE PREGNANCY TEST 81025 $210.00 UROBILINOGEN (METABOLISM SUBSTANCE) ANALYSIS, URIN 84578 $26.00 UROBILINOGEN (METABOLISM SUBSTANCE) LEVEL, STOOL 84577 $97.00 UROBILINOGEN (METABOLISM SUBSTANCE) MEASUREMENT, U 84583 $39.00 VACCINE FOR DIPHTHERIA AND TETANUS TOXOIDS INJECT 90702 $326.00 VACCINE FOR DIPHTHERIA TETANUS TOXOIDS PERTUSSIS & 90700 $95.00 VACCINE FOR DIPHTHERIA TETANUS TOXOIDS PERTUSSIS & 90696 $153.00 VACCINE FOR DIPHTHERIA TETANUS TOXOIDS PERTUSSIS H 90723 $231.00 VACCINE FOR DTAP-IPV/HIB 90698 $290.00 VACCINE FOR HEMOPHILUS INFLUENZA B (3 DOSE) INJECT 90647 $79.00 VACCINE FOR HEMOPHILUS INFLUENZA B (4 DOSE) INJECT 90648 $51.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge VACCINE FOR HEPATITIS A INJECTION INTO MUSCLE ADUL 90632 $201.00 VACCINE FOR HEPATITIS A INJECTION INTO MUSCLE PEDI 90633 $97.00 VACCINE FOR HEPATITIS B (2 DOSE) FOR INJECTION INT 90743 $70.00 VACCINE FOR HEPATITIS B (3 DOSE) FOR INJECTION INT 90744 $70.00 VACCINE FOR HUMAN PAPILLOMA VIRUS (3 DOSE) INJECTI 90651 $615.00 VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSC 90674 $42.00 VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSC 90686 $54.00 VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSC 90685 $167.00 VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSC 90688 $167.00 VACCINE FOR INFLUENZA FOR NASAL ADMINISTRATION 90672 $75.00 VACCINE FOR JAPANESE ENCEPHALITIS VIRUS INJECTION 90738 $574.00 VACCINE FOR MEASLES MUMPS AND RUBELLA INJECTION BE 90707 $213.00 VACCINE FOR MEASLES MUMPS RUBELLA AND VARICELLA IN 90710 $225.00 VACCINE FOR MENINGOCOCCUS FOR ADMINISTRATION INTO 90734 $364.00 VACCINE FOR MENINGOCOCCUS FOR INJECTION INTO MUSCL 90621 $498.00 VACCINE FOR PNEUMOCOCCAL POLYSACCHARIDE? >2YRS 90732 $284.00 VACCINE FOR POLIO INJECTION BENEATH THE SKIN OR IN 90713 $101.00 VACCINE FOR RABIES INJECTION INTO MUSCLE 90675 $781.00 VACCINE FOR ROTAVIRUS (3 DOSE SCHEDULE) FOR ORAL A 90680 $249.00 VACCINE FOR TETANUS AND DIPHTHERIA TOXOIDS INJECTI 90714 $104.00 VACCINE FOR TETANUS DIPHTHERIA TOXOIDS? ACELLULAR 90715 $134.00 VACCINE FOR VARICELLA (CHICKEN POX) INJECTION BENE 90716 $367.00 VAGINAL DELIVERY 59409 $5,101.00 VAGINAL FLUID CHEMICAL ANALYSIS FOR BACTERIA 82120 $29.00 VALPROIC ACID LEVEL 80165 $102.00 VALPROIC ACID LEVEL 80164 $349.00 VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA EA $34,125.00 VALVE AORTIC TRIFECTA GLIDE PORCINE BOVINE PERICAR $29,250.00 VALVE MITRAL HANCOCK II CINCH PORCINE 22 MM OD31 M $22,750.00 VALVE PEEP ACCU-PEEP 10 CMW L10 CM ID22 MM TRUE TH $640.00 VALVE SHUNT STRATA REGULAR MR SAFE $31,096.00 VANCOMYCIN (ANTIBIOTIC) LEVEL 80202 $322.00 VANCOMYCIN 1,000 MG SOLR 1 EACH VIAL J3370 $20.00 VANCOMYCIN-PEAK 80202 $322.00 VANOMYCIN-RANDOM 80202 $332.00 VANOMYCIN-TROUGH 80202 $332.00 VARICELLA ZOSTER ANTIBODY IGM 86787 $243.00 VDRL CSF 86592 $95.00 VENOGRAPHY FOR BLOOD CLOT IN VEINS, BOTH LEGS OR A 78458 $2,114.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge VENTILATION ASSISTANCE AND MANAGEMENT, HOSPITAL IN 94003 $2,401.00 VENTILATION ASSISTANCE AND MANAGEMENT, HOSPITAL IN 94002 $3,434.00 VESSEL MAPPING FOR HEMODIALYSIS ACCESS G0365 $745.00 VIRACOR ADENOVIRUS 87799 $678.00 VIRACOR ASPERGILLUS PCR 87798 $96.00 VIRACOR BK VIRUS QUANT 87799 $678.00 VIRACOR CMV QUANT PCR 87799 $678.00 VIRACOR EBV QUANT 87799 $678.00 VIRUS ISOLATE SHELL ID 87254 $450.00 VITAMIN A LEVEL 84590 $227.00 VITAMIN B-1 (THIAMINE) LEVEL 84425 $274.00 VITAMIN B3 (NIACIN) 84591 $96.00 VITAMIN B-6 LEVEL 84207 $518.00 VITAMIN D (1 25 DIHYDROXY) 82652 $489.00 VITAMIN D,25-HYDROXY (CALCIFEDIOL 82306 $474.00 VITAMIN K LEVEL 84597 $164.00 VOLUME REDUCTION OF BLOOD UNIT OR BLOOD PRODUCT 86960 $113.00 WALKING TRAINING TO 1 OR MORE AREAS, EACH 15 MINUT 97116 $111.00 WASHER ORTHOPEDIC ASNIS III TITANIUM 4 MM SCREW C1713 $156.00 WASHER ORTHOPEDIC STAINLESS STEEL OD10 MM NONSTERI C1713 $151.32 WASHER ORTHOPEDIC TITANIUM OD4.5 MM ID2.2 MM C1713 $39.00 WASHER SPINAL EXPEDIUM STAINLESS STEEL FLAT SPINE C1713 $400.00 WATER FOR INJECTION, STERILE SOLN 10 ML VIAL A4217 $20.00 WBC AUTOMATED 85048 $95.00 WEDGE TIBIAL 3D METAL SMALL CONE H20 MM KNEE CENTE C1776 $23,962.58 WEDGING OF CAST 29740 $653.00 WEST NILE PCR, BODY FLUID 87798 $96.00 WESTERN BLOT HIV CONFIRM 86689 $409.00 WHEELCHAIR MANAGEMENT, EACH 15 MINUTES 97542 $111.00 WHITE BLOOD CELL COUNT 85004 $47.00 WHITE BLOOD CELL ENZYME ACTIVITY MEASUREMENT 85549 $270.00 WHITE BLOOD CELL FUNCTION MEASUREMENT 86344 $62.00 WHITE BLOOD CELL FUNCTION MEASUREMENT 86353 $911.00 WHITE BLOOD CELL MEASURE, STOOL SPECIMEN 89055 $122.00 WIRE EXTERNAL FIXATION OD1.8 MM REDUCTION HALF POI $1,692.80 WIRE FIXATION KIRSCHNER T2 COCR L400 MM OD3.2 MM R $811.85 WIRE FIXATION KIRSCHNER T2 STAINLESS STEEL L285 MM $669.24 WIRE FIXATION L400 MM OD1.8 MM SMOOTH MRI SAFE NON $547.36 WIRE LOCALIZATION DUALOK L5.7 CM OD20 GA BREAST LE C1819 $105.90 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge WRENCH EXTERNAL FIXATION ALLEN 5 MM LOW PROFILE $2,271.36 XR CHEST 3 VIEWS 71047 $414.00 XR EYE DETECTION OF FOREIGN BODY UNILATERAL 70030 $223.00 XR MASTOIDS LESS THAN 3 VIEWS UNILATERAL 70120 $343.00 XR MASTOIDS MINIMUM 3 VIEWS UNILATERAL 70130 $449.00 XR RIBS W CHEST MINIMUM 4 VIEWS BILATERAL 71111 $788.00 XR RIBS W/O CHEST 3+ VIEWS BILATERAL 71110 $505.00 X-RAY ANALYSIS OF STONE 82370 $97.00 X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIE 72114 $315.00 X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIE 72120 $355.00 X-RAY LOWER SPINAL CANAL WITH RADIOLOGICAL SUPERVI 62304 $3,060.00 X-RAY LOWER SPINAL CANAL WITH RADIOLOGICAL SUPERVI 62305 $4,138.00 X-RAY OF ABDOMEN 2 VIEWS 74019 $576.00 X-RAY OF ABDOMEN, SINGLE VIEW 74018 $288.00 X-RAY OF ANKLE, 2 VIEWS 73600 $181.00 X-RAY OF ANKLE, MINIMUM OF 3 VIEWS 73610 $221.00 X-RAY OF ARM IN INFANT MINIMUM OF 2 VIEWS 73092 $239.00 X-RAY OF BONE AT BASE OF SKULL 70240 $267.00 X-RAY OF BONES 77074 $307.00 X-RAY OF BONES OF FACE, LESS THAN 3 VIEWS 70140 $505.00 X-RAY OF BONES OF FACE, MINIMUM OF 3 VIEWS 70150 $527.00 X-RAY OF BONES OF NOSE, MINIMUM OF 3 VIEWS 70160 $292.00 X-RAY OF BOTH COLLAR BONES 73050 $296.00 X-RAY OF BOTH HIPS WITH PELVIS, 2 VIEWS 73521 $358.00 X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS 73522 $757.00 X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS 73523 $876.00 X-RAY OF BREAST BONE, MINIMUM OF 2 VIEWS 71120 $355.00 X-RAY OF CHEST, 1 VIEW, FRONT 71045 $241.00 X-RAY OF CHEST, 2 VIEWS, FRONT AND SIDE 71046 $309.00 X-RAY OF CHEST, MINIMUM OF 4 VIEWS 71048 $513.00 X-RAY OF CHEST, STEREO, FRONT 71045 $308.00 X-RAY OF COLLAR BONE 73000 $288.00 X-RAY OF ELBOW, 2 VIEWS 73070 $306.00 X-RAY OF ELBOW, MINIMUM OF 3 VIEWS 73080 $343.00 X-RAY OF ESOPHAGUS 74220 $560.00 X-RAY OF EYE BONES, MINIMUM OF 4 VIEWS 70200 $536.00 X-RAY OF FEMUR, 1 VIEW 73551 $194.00 X-RAY OF FEMUR, MINIMUM 2 VIEWS 73552 $314.00 X-RAY OF FINGERS, MINIMUM OF 2 VIEWS 73140 $220.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge X-RAY OF FOOT, 2 VIEWS 73620 $258.00 X-RAY OF FOOT, MINIMUM OF 3 VIEWS 73630 $256.00 X-RAY OF FOREARM, 2 VIEWS 73090 $282.00 X-RAY OF HAND, 2 VIEWS 73120 $241.00 X-RAY OF HAND, MINIMUM OF 3 VIEWS 73130 $200.00 X-RAY OF HEEL, MINIMUM OF 2 VIEWS 73650 $293.00 X-RAY OF HIP WITH PELVIS, 1 VIEW 73501 $256.00 X-RAY OF HIP WITH PELVIS, 2-3 VIEWS 73502 $378.00 X-RAY OF HIP WITH PELVIS, MINIMUM OF 4 VIEWS 73503 $451.00 X-RAY OF INTERNAL EAR CANAL 70134 $847.00 X-RAY OF JAW JOINT ON ONE SIDE OF THE FACE 70328 $223.00 X-RAY OF JUNCTION OF BREAST AND COLLAR BONES, MINI 71130 $565.00 X-RAY OF KNEE, 1 OR 2 VIEWS 73560 $257.00 X-RAY OF KNEE, 3 VIEWS 73562 $369.00 X-RAY OF KNEE, 4 OR MORE VIEWS 73564 $389.00 X-RAY OF LARGE BOWEL WITH CONTRAST 74270 $477.00 X-RAY OF LARGE BOWEL WITH CONTRAST 74280 $788.00 X-RAY OF LEG IN INFANT MINIMUM OF 2 VIEWS 73592 $200.00 X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS 72100 $443.00 X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEW 72110 $620.00 X-RAY OF LOWER LEG, 2 VIEWS 73590 $233.00 X-RAY OF MANDIBLE, LESS THAN 4 VIEWS 70100 $378.00 X-RAY OF MANDIBLE, MINIMUM OF 4 VIEWS 70110 $491.00 X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS 72080 $443.00 X-RAY OF MIDDLE SPINAL CANAL WITH RADIOLOGICAL SUP 62303 $3,060.00 X-RAY OF MIDDLE SPINE, 3 VIEWS 72070 $437.00 X-RAY OF MIDDLE SPINE, 3 VIEWS 72072 $659.00 X-RAY OF MIDDLE SPINE, MINIMUM OF 4 VIEWS 72074 $677.00 X-RAY OF PARANASAL SINUS, COMPLETE, MINIMUM OF 3 V 70220 $374.00 X-RAY OF PARANASAL SINUS, LESS THAN 3 VIEWS 70210 $313.00 X-RAY OF PELVIS, 1 OR 2 VIEWS 72170 $443.00 X-RAY OF PELVIS, MINIMUM OF 2 VIEWS 72220 $468.00 X-RAY OF PELVIS, MINIMUM OF 3 VIEWS 72190 $559.00 X-RAY OF RIBS OF ONE SIDE OF BODY, 2 VIEWS 71100 $247.00 X-RAY OF RIBS ON ONE SIDE OF BODY INCLUDING THE CH 71101 $665.00 X-RAY OF SACROILIAC JOINTS, 3 OR MORE VIEWS 72202 $596.00 X-RAY OF SACROILIAC JOINTS, LESS THAN 3 VIEWS 72200 $223.00 X-RAY OF SALIVARY GLAND 70380 $223.00 X-RAY OF SHOULDER BLADE 73010 $289.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge X-RAY OF SHOULDER, 1 VIEW 73020 $201.00 X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS 73030 $325.00 X-RAY OF SKULL, COMPLETE, MINIMUM OF 4 VIEWS 70260 $353.00 X-RAY OF SKULL, LESS THAN 4 VIEWS 70250 $300.00 X-RAY OF SOFT TISSUE OF NECK 70360 $276.00 X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS 72040 $425.00 X-RAY OF SPINE, 1 VIEW 72020 $282.00 X-RAY OF SPINE, 1 VIEW 72081 $348.00 X-RAY OF SPINE, 2 OR 3 VIEWS 72082 $615.00 X-RAY OF SPINE, 4 OR 5 VIEWS 72083 $1,257.00 X-RAY OF SPINE, MINIMUM OF 6 VIEWS 72084 $546.00 X-RAY OF TOES, MINIMUM OF 2 VIEWS 73660 $222.00 X-RAY OF UPPER ARM, MINIMUM OF 2 VIEWS 73060 $257.00 X-RAY OF UPPER DIGESTIVE TRACT 74240 $639.00 X-RAY OF UPPER DIGESTIVE TRACT KIDNEYS URINARY DUC 74247 $1,094.00 X-RAY OF UPPER SPINE, 4 OR 5 VIEWS 72050 $574.00 X-RAY OF UPPER SPINE, 6 OR MORE VIEWS 72052 $528.00 X-RAY OF VOICE BOX OR THROAT 70370 $430.00 X-RAY OF WRIST, 2 VIEWS 73100 $230.00 X-RAY OF WRIST, MINIMUM OF 3 VIEWS 73110 $257.00 X-RAY SURVEY OF BONES, INFANT 77076 $199.00 X-RAY SURVEY OF FOREARM OR WRIST BONE DENSITY 77075 $872.00 X-RAY UPPER DIGESTIVE TRACT, KIDNEYS, URINARY DUCT 74241 $763.00 X-RAY UPPER GI SERIES, WITH SMALL BOWEL FILMS 74245 $769.00 X-RAY UPPER SPINAL CANAL WITH RADIOLOGICAL SUPERVI 62302 $3,060.00 ZINC LEVEL 84630 $171.00

DRG Description DRG Average Charges ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. 3 $1,290,625.00 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. 4 $1,362,486.00 TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W CC 12 $404,731.00 ALLOGENEIC BONE MARROW TRANSPLANT 14 $915,485.00 AUTOLOGOUS BONE MARROW TRANSPLANT W CC/MCC OR T-CELL IMMUNOTHERAPY 16 $689,882.00 AUTOLOGOUS BONE MARROW TRANSPLANT W/O CC/MCC 17 $393,171.00 CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX W MCC OR CHEMOTHERAPY23 $175,235.00 IMPLANT OR EPILEPSY W NEUROSTIMULATOR CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC 24 $119,468.00 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC 25 $231,903.00 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC 26 $146,338.00 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC 27 $93,388.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SPINAL PROCEDURES W MCC 28 $294,922.00 SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS 29 $104,720.00 SPINAL PROCEDURES W/O CC/MCC 30 $101,890.00 VENTRICULAR SHUNT PROCEDURES W MCC 31 $107,801.00 VENTRICULAR SHUNT PROCEDURES W CC 32 $85,509.00 VENTRICULAR SHUNT PROCEDURES W/O CC/MCC 33 $78,498.00 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC 40 $225,830.00 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM 41 $142,116.00 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCC 42 $74,608.00 SPINAL DISORDERS & INJURIES W CC/MCC 52 $108,030.00 SPINAL DISORDERS & INJURIES W/O CC/MCC 53 $38,467.00 NERVOUS SYSTEM NEOPLASMS W MCC 54 $143,022.00 NERVOUS SYSTEM NEOPLASMS W/O MCC 55 $37,838.00 DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC 56 $130,289.00 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC 57 $43,472.00 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC 58 $296,618.00 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC 59 $188,118.00 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC 60 $23,898.00 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC 64 $81,471.00 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS 65 $56,818.00 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC 66 $43,626.00 NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC 70 $183,298.00 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 71 $126,194.00 NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC 72 $56,729.00 CRANIAL & PERIPHERAL NERVE DISORDERS W MCC 73 $136,332.00 CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC 74 $52,031.00 VIRAL MENINGITIS W CC/MCC 75 $22,873.00 VIRAL MENINGITIS W/O CC/MCC 76 $15,943.00 NONTRAUMATIC STUPOR & COMA W MCC 80 $77,292.00 NONTRAUMATIC STUPOR & COMA W/O MCC 81 $99,734.00 TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC 82 $63,094.00 TRAUMATIC STUPOR & COMA, COMA >1 HR W CC 83 $62,376.00 TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC 84 $28,506.00 TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC 85 $1,301,645.00 TRAUMATIC STUPOR & COMA, COMA <1 HR W CC 86 $27,544.00 TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC 87 $16,287.00 CONCUSSION W MCC 88 $10,045.00 CONCUSSION W CC 89 $13,729.00 CONCUSSION W/O CC/MCC 90 $8,997.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge OTHER DISORDERS OF NERVOUS SYSTEM W MCC 91 $81,109.00 OTHER DISORDERS OF NERVOUS SYSTEM W CC 92 $63,942.00 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC 93 $20,996.00 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC 94 $96,267.00 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC 95 $67,312.00 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC 96 $103,975.00 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC 97 $174,759.00 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC 98 $66,261.00 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC 99 $25,358.00 SEIZURES W MCC 100 $33,043.00 SEIZURES W/O MCC 101 $18,702.00 HEADACHES W MCC 102 $33,952.00 HEADACHES W/O MCC 103 $19,468.00 ORBITAL PROCEDURES W/O CC/MCC 114 $46,260.00 EXTRAOCULAR PROCEDURES EXCEPT ORBIT 115 $46,330.00 INTRAOCULAR PROCEDURES W CC/MCC 116 $54,411.00 INTRAOCULAR PROCEDURES W/O CC/MCC 117 $49,219.00 ACUTE MAJOR EYE INFECTIONS W CC/MCC 121 $22,724.00 ACUTE MAJOR EYE INFECTIONS W/O CC/MCC 122 $17,036.00 NEUROLOGICAL EYE DISORDERS 123 $111,976.00 OTHER DISORDERS OF THE EYE W MCC 124 $82,266.00 OTHER DISORDERS OF THE EYE W/O MCC 125 $18,793.00 MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE 129 $100,254.00 MAJOR HEAD & NECK PROCEDURES W/O CC/MCC 130 $34,143.00 CRANIAL/FACIAL PROCEDURES W CC/MCC 131 $56,714.00 CRANIAL/FACIAL PROCEDURES W/O CC/MCC 132 $64,511.00 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC 133 $60,013.00 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC 134 $35,771.00 SINUS & MASTOID PROCEDURES W CC/MCC 135 $56,778.00 SINUS & MASTOID PROCEDURES W/O CC/MCC 136 $84,039.00 MOUTH PROCEDURES W CC/MCC 137 $43,234.00 MOUTH PROCEDURES W/O CC/MCC 138 $32,369.00 EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC 146 $131,893.00 EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCC 148 $226,661.00 EPISTAXIS W/O MCC 151 $38,500.00 OTITIS MEDIA & URI W MCC 152 $26,451.00 OTITIS MEDIA & URI W/O MCC 153 $16,838.00 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC 154 $74,255.00 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC 155 $27,295.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC 156 $22,666.00 DENTAL & ORAL DISEASES W MCC 157 $58,062.00 DENTAL & ORAL DISEASES W CC 158 $26,752.00 DENTAL & ORAL DISEASES W/O CC/MCC 159 $25,270.00 MAJOR CHEST PROCEDURES W MCC 163 $645,377.00 MAJOR CHEST PROCEDURES W CC 164 $91,795.00 MAJOR CHEST PROCEDURES W/O CC/MCC 165 $99,082.00 OTHER RESP SYSTEM O.R. PROCEDURES W MCC 166 $194,541.00 OTHER RESP SYSTEM O.R. PROCEDURES W CC 167 $48,124.00 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC 168 $28,653.00 PULMONARY EMBOLISM W/O MCC 176 $108,064.00 RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC 177 $128,715.00 RESPIRATORY INFECTIONS & INFLAMMATIONS W CC 178 $34,172.00 RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC 179 $24,795.00 RESPIRATORY NEOPLASMS W CC 181 $86,353.00 MAJOR CHEST TRAUMA W MCC 183 $23,447.00 PLEURAL EFFUSION W MCC 186 $51,330.00 PLEURAL EFFUSION W CC 187 $64,172.00 PULMONARY EDEMA & RESPIRATORY FAILURE 189 $42,997.00 SIMPLE PNEUMONIA & PLEURISY W MCC 193 $30,078.00 SIMPLE PNEUMONIA & PLEURISY W CC 194 $20,709.00 SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC 195 $14,432.00 INTERSTITIAL LUNG DISEASE W MCC 196 $23,381.00 INTERSTITIAL LUNG DISEASE W CC 197 $79,755.00 PNEUMOTHORAX W MCC 199 $28,487.00 PNEUMOTHORAX W CC 200 $32,629.00 PNEUMOTHORAX W/O CC/MCC 201 $34,749.00 BRONCHITIS & ASTHMA W CC/MCC 202 $22,880.00 BRONCHITIS & ASTHMA W/O CC/MCC 203 $18,405.00 RESPIRATORY SIGNS & SYMPTOMS 204 $16,769.00 OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC 205 $27,133.00 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC 206 $21,027.00 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS OR PERIPHERAL EXTRACORPOREAL207 $298,010.00 MEMBRANE OXYGENATION (ECMO) RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS 208 $56,123.00 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC 216 $408,095.00 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC 217 $302,752.00 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC 219 $219,084.00 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC 220 $184,807.00 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O CC/MCC 221 $163,170.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC 225 $245,808.00 CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC 227 $415,916.00 OTHER CARDIOTHORACIC PROCEDURES W MCC 228 $303,514.00 OTHER CARDIOTHORACIC PROCEDURES W/O MCC 229 $157,212.00 PERMANENT CARDIAC PACEMAKER IMPLANT W MCC 242 $217,490.00 OTHER VASCULAR PROCEDURES W MCC 252 $170,916.00 OTHER VASCULAR PROCEDURES W CC 253 $124,730.00 OTHER VASCULAR PROCEDURES W/O CC/MCC 254 $69,846.00 CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC 259 $81,079.00 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC 260 $156,408.00 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC 262 $39,550.00 VEIN LIGATION & STRIPPING 263 $226,885.00 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 264 $76,379.00 ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC 266 $302,532.00 ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC 267 $365,791.00 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC 268 $153,464.00 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC 269 $182,740.00 OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC 270 $333,763.00 OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC 271 $160,277.00 PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC 273 $2,018,778.00 PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC 274 $122,163.00 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC 281 $79,600.00 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC 286 $175,545.00 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC 287 $132,617.00 HEART FAILURE & SHOCK W MCC OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION291 $85,357.00(ECMO) HEART FAILURE & SHOCK W CC 292 $22,818.00 CARDIAC ARREST, UNEXPLAINED W MCC OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION296 $41,666.00 (ECMO) CARDIAC ARREST, UNEXPLAINED W/O CC/MCC 298 $16,691.00 PERIPHERAL VASCULAR DISORDERS W MCC 299 $92,791.00 PERIPHERAL VASCULAR DISORDERS W CC 300 $43,121.00 PERIPHERAL VASCULAR DISORDERS W/O CC/MCC 301 $23,288.00 ATHEROSCLEROSIS W/O MCC 303 $39,052.00 HYPERTENSION W MCC 304 $29,915.00 HYPERTENSION W/O MCC 305 $25,725.00 CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC 306 $58,708.00 CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC 307 $27,991.00 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 309 $26,024.00 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC 310 $13,736.00 SYNCOPE & COLLAPSE 312 $8,868.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge CHEST PAIN 313 $10,635.00 OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC 314 $70,205.00 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 315 $76,608.00 OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC 316 $17,057.00 STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC 326 $535,250.00 STOMACH, ESOPHAGEAL & DUODENAL PROC W CC 327 $141,091.00 STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC 328 $30,928.00 MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC 329 $146,329.00 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 330 $72,730.00 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 331 $58,778.00 PERITONEAL ADHESIOLYSIS W MCC 335 $235,580.00 PERITONEAL ADHESIOLYSIS W CC 336 $81,037.00 PERITONEAL ADHESIOLYSIS W/O CC/MCC 337 $65,094.00 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC 338 $88,513.00 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC 339 $71,997.00 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC 340 $56,197.00 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC 341 $149,184.00 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC 342 $59,512.00 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC 343 $38,139.00 MINOR SMALL & LARGE BOWEL PROCEDURES W MCC 344 $188,403.00 MINOR SMALL & LARGE BOWEL PROCEDURES W CC 345 $29,384.00 MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 346 $50,791.00 ANAL & STOMAL PROCEDURES W CC 348 $22,895.00 ANAL & STOMAL PROCEDURES W/O CC/MCC 349 $50,228.00 INGUINAL & FEMORAL HERNIA PROCEDURES W MCC 350 $115,606.00 INGUINAL & FEMORAL HERNIA PROCEDURES W CC 351 $109,578.00 INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC 352 $28,430.00 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC 353 $439,022.00 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC 354 $87,419.00 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC 355 $75,593.00 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC 356 $131,150.00 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC 357 $113,326.00 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 358 $69,827.00 MAJOR ESOPHAGEAL DISORDERS W MCC 368 $51,524.00 MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC 370 $31,972.00 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC 371 $49,154.00 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC 372 $23,132.00 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC 373 $30,613.00 G.I. HEMORRHAGE W MCC 377 $33,390.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge G.I. HEMORRHAGE W CC 378 $39,917.00 G.I. HEMORRHAGE W/O CC/MCC 379 $33,340.00 COMPLICATED PEPTIC ULCER W MCC 380 $47,948.00 COMPLICATED PEPTIC ULCER W CC 381 $152,531.00 COMPLICATED PEPTIC ULCER W/O CC/MCC 382 $58,298.00 UNCOMPLICATED PEPTIC ULCER W MCC 383 $73,303.00 UNCOMPLICATED PEPTIC ULCER W/O MCC 384 $29,453.00 INFLAMMATORY BOWEL DISEASE W MCC 385 $77,302.00 INFLAMMATORY BOWEL DISEASE W CC 386 $53,113.00 INFLAMMATORY BOWEL DISEASE W/O CC/MCC 387 $51,912.00 G.I. OBSTRUCTION W MCC 388 $57,944.00 G.I. OBSTRUCTION W CC 389 $27,397.00 G.I. OBSTRUCTION W/O CC/MCC 390 $16,071.00 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC 391 $24,978.00 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 392 $20,468.00 OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC 393 $58,875.00 OTHER DIGESTIVE SYSTEM DIAGNOSES W CC 394 $29,198.00 OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC 395 $20,589.00 PANCREAS, LIVER & SHUNT PROCEDURES W CC 406 $131,454.00 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W MCC 408 $151,473.00 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC 415 $85,632.00 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC 417 $88,798.00 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 418 $71,994.00 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC 419 $46,704.00 HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC 420 $32,465.00 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC 436 $67,324.00 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC 438 $156,714.00 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC 439 $17,934.00 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC 440 $18,143.00 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC 441 $36,868.00 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC 442 $30,658.00 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC 443 $23,032.00 DISORDERS OF THE BILIARY TRACT W MCC 444 $20,903.00 DISORDERS OF THE BILIARY TRACT W CC 445 $35,658.00 DISORDERS OF THE BILIARY TRACT W/O CC/MCC 446 $62,862.00 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC 454 $214,557.00 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC 455 $194,765.00 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC 456 $232,515.00 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC 457 $230,943.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC 458 $240,016.00 SPINAL FUSION EXCEPT CERVICAL W MCC 459 $396,457.00 SPINAL FUSION EXCEPT CERVICAL W/O MCC 460 $181,500.00 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC 463 $355,202.00 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC 464 $200,449.00 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC 465 $60,473.00 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O470 MCC$400,678.00 CERVICAL SPINAL FUSION W MCC 471 $260,850.00 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC 475 $74,583.00 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC 476 $31,781.00 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 478 $85,675.00 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 479 $68,860.00 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC 480 $81,370.00 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC 481 $72,855.00 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC 482 $48,902.00 MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES 483 $202,117.00 KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC 487 $104,755.00 KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC 488 $54,506.00 KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC 489 $43,585.00 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC 492 $44,760.00 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC 493 $34,266.00 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC 494 $37,745.00 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W MCC 495 $53,817.00 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC 496 $44,426.00 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC 497 $56,959.00 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC 498 $44,422.00 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC 499 $105,604.00 SOFT TISSUE PROCEDURES W MCC 500 $104,901.00 SOFT TISSUE PROCEDURES W CC 501 $82,943.00 SOFT TISSUE PROCEDURES W/O CC/MCC 502 $41,719.00 FOOT PROCEDURES W CC 504 $32,336.00 FOOT PROCEDURES W/O CC/MCC 505 $32,731.00 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W MCC 510 $81,459.00 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC 511 $36,229.00 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC 512 $49,494.00 HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC 513 $35,773.00 HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC 514 $27,605.00 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC 515 $160,770.00 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC 516 $137,969.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC 517 $86,515.00 BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM 518 $159,264.00 BACK & NECK PROC EXC SPINAL FUSION W CC 519 $373,849.00 BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC 520 $252,839.00 FRACTURES OF FEMUR W MCC 533 $66,831.00 FRACTURES OF FEMUR W/O MCC 534 $24,651.00 FRACTURES OF HIP & PELVIS W/O MCC 536 $22,277.00 SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC 538 $45,782.00 OSTEOMYELITIS W MCC 539 $137,543.00 OSTEOMYELITIS W CC 540 $36,578.00 OSTEOMYELITIS W/O CC/MCC 541 $25,493.00 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC 542 $135,113.00 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC 543 $263,724.00 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC 544 $10,944.00 CONNECTIVE TISSUE DISORDERS W MCC 545 $77,492.00 CONNECTIVE TISSUE DISORDERS W CC 546 $63,696.00 CONNECTIVE TISSUE DISORDERS W/O CC/MCC 547 $40,245.00 SEPTIC ARTHRITIS W CC 549 $36,110.00 SEPTIC ARTHRITIS W/O CC/MCC 550 $38,038.00 MEDICAL BACK PROBLEMS W MCC 551 $39,624.00 MEDICAL BACK PROBLEMS W/O MCC 552 $13,792.00 BONE DISEASES & ARTHROPATHIES W MCC 553 $801,864.00 BONE DISEASES & ARTHROPATHIES W/O MCC 554 $51,775.00 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC 556 $16,006.00 TENDONITIS, MYOSITIS & BURSITIS W/O MCC 558 $22,248.00 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 560 $84,649.00 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 561 $33,725.00 FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC 563 $14,296.00 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC 564 $74,132.00 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC 565 $32,720.00 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC 566 $21,484.00 SKIN DEBRIDEMENT W MCC 570 $488,410.00 SKIN DEBRIDEMENT W/O CC/MCC 572 $53,736.00 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W MCC 573 $101,253.00 SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W CC 577 $135,313.00 OTHER SKIN, SUBCUT TISS & BREAST PROC W CC 580 $27,741.00 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC 581 $29,435.00 BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC 585 $29,546.00 SKIN ULCERS W CC 593 $26,632.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge MAJOR SKIN DISORDERS W MCC 595 $159,725.00 MAJOR SKIN DISORDERS W/O MCC 596 $16,150.00 NON-MALIGNANT BREAST DISORDERS W CC/MCC 600 $33,261.00 CELLULITIS W MCC 602 $39,036.00 CELLULITIS W/O MCC 603 $20,818.00 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC 604 $8,319.00 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC 605 $16,872.00 MINOR SKIN DISORDERS W MCC 606 $39,587.00 MINOR SKIN DISORDERS W/O MCC 607 $17,808.00 ADRENAL & PITUITARY PROCEDURES W CC/MCC 614 $220,138.00 ADRENAL & PITUITARY PROCEDURES W/O CC/MCC 615 $109,962.00 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC 627 $41,673.00 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC 629 $75,675.00 DIABETES W MCC 637 $29,344.00 DIABETES W CC 638 $30,130.00 DIABETES W/O CC/MCC 639 $24,189.00 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC 640 $44,025.00 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC 641 $19,624.00 INBORN AND OTHER DISORDERS OF METABOLISM 642 $29,349.00 ENDOCRINE DISORDERS W MCC 643 $18,902.00 ENDOCRINE DISORDERS W CC 644 $34,525.00 ENDOCRINE DISORDERS W/O CC/MCC 645 $21,698.00 KIDNEY TRANSPLANT 652 $245,037.00 MAJOR BLADDER PROCEDURES W MCC 653 $513,342.00 MAJOR BLADDER PROCEDURES W CC 654 $121,757.00 MAJOR BLADDER PROCEDURES W/O CC/MCC 655 $66,226.00 KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC 657 $103,442.00 KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC 658 $103,859.00 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC 659 $549,173.00 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC 660 $47,438.00 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC 661 $47,262.00 MINOR BLADDER PROCEDURES W MCC 662 $103,230.00 MINOR BLADDER PROCEDURES W CC 663 $26,986.00 URETHRAL PROCEDURES W CC/MCC 671 $54,605.00 URETHRAL PROCEDURES W/O CC/MCC 672 $52,161.00 OTHER KIDNEY & URINARY TRACT PROCEDURES W CC 674 $137,580.00 OTHER KIDNEY & URINARY TRACT PROCEDURES W/O CC/MCC 675 $66,577.00 RENAL FAILURE W MCC 682 $51,722.00 RENAL FAILURE W CC 683 $29,251.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge RENAL FAILURE W/O CC/MCC 684 $13,098.00 KIDNEY & URINARY TRACT NEOPLASMS W CC 687 $77,437.00 KIDNEY & URINARY TRACT NEOPLASMS W/O CC/MCC 688 $20,883.00 KIDNEY & URINARY TRACT INFECTIONS W MCC 689 $25,878.00 KIDNEY & URINARY TRACT INFECTIONS W/O MCC 690 $20,315.00 URINARY STONES W/O ESW LITHOTRIPSY W/O MCC 694 $20,541.00 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC 696 $5,300.00 OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC 698 $47,486.00 OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC 699 $21,852.00 OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC 700 $20,312.00 TESTES PROCEDURES W CC/MCC 711 $42,217.00 TESTES PROCEDURES W/O CC/MCC 712 $47,767.00 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC 727 $150,243.00 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC 728 $21,610.00 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W CC/MCC 729 $36,361.00 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W/O CC/MCC 730 $54,433.00 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC 742 $44,868.00 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC 743 $49,374.00 D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC 744 $72,085.00 VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC 746 $21,462.00 VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC 747 $24,109.00 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 750 $51,575.00 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC 758 $69,702.00 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC 759 $16,310.00 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC 760 $41,752.00 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC 761 $15,782.00 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY 789 $148,734.00 EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE 790 $605,928.00 PREMATURITY W MAJOR PROBLEMS 791 $182,988.00 PREMATURITY W/O MAJOR PROBLEMS 792 $20,045.00 FULL TERM NEONATE W MAJOR PROBLEMS 793 $44,702.00 NEONATE W OTHER SIGNIFICANT PROBLEMS 794 $20,403.00 NORMAL NEWBORN 795 $9,580.00 SPLENECTOMY W/O CC/MCC 801 $37,602.00 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC 802 $119,792.00 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC 803 $42,152.00 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC 804 $49,048.00 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC 808 $120,856.00 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC 809 $42,138.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC 810 $33,467.00 RED BLOOD CELL DISORDERS W MCC 811 $50,569.00 RED BLOOD CELL DISORDERS W/O MCC 812 $25,066.00 COAGULATION DISORDERS 813 $27,854.00 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC 814 $44,590.00 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC 815 $26,614.00 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC 816 $20,183.00 LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W CC 821 $355,385.00 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W MCC 823 $490,697.00 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W CC 824 $365,040.00 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W CC 827 $50,379.00 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS W OTHER PROCEDURE829 $127,324.00 W CC/MCC MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS W OTHER PROCEDURE830 $25,907.00 W/O CC/MCC OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC 832 $33,074.00 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC 834 $364,971.00 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC 835 $207,327.00 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC 836 $46,369.00 CHEMO W ACUTE LEUKEMIA AS SDX OR W HIGH DOSE CHEMO AGENT W MCC 837 $194,414.00 CHEMO W ACUTE LEUKEMIA AS SDX W CC OR HIGH DOSE CHEMO AGENT 838 $48,549.00 CHEMO W ACUTE LEUKEMIA AS SDX W/O CC/MCC 839 $29,785.00 LYMPHOMA & NON-ACUTE LEUKEMIA W CC 841 $115,822.00 LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC 842 $15,036.00 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC 843 $70,556.00 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC 844 $35,900.00 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC 846 $51,577.00 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC 847 $46,264.00 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC 848 $37,296.00 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC 853 $275,166.00 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC 854 $94,587.00 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC 856 $178,533.00 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC 857 $151,487.00 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC 858 $40,002.00 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC 862 $55,090.00 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC 863 $17,234.00 FEVER AND INFLAMMATORY CONDITIONS 864 $24,172.00 VIRAL ILLNESS W MCC 865 $20,972.00 VIRAL ILLNESS W/O MCC 866 $18,813.00 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC 867 $39,164.00 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC 868 $53,910.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC 869 $40,799.00 SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS OR PERIPHERAL EXTRACORPOREAL MEMBRANE870 $640,848.00 OXYGENATION (ECMO) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC 871 $69,358.00 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC 872 $40,330.00 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS 876 $25,053.00 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION 880 $24,889.00 DEPRESSIVE NEUROSES 881 $27,120.00 NEUROSES EXCEPT DEPRESSIVE 882 $27,589.00 DISORDERS OF PERSONALITY & IMPULSE CONTROL 883 $32,026.00 ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY 884 $27,945.00 PSYCHOSES 885 $27,607.00 BEHAVIORAL & DEVELOPMENTAL DISORDERS 886 $27,602.00 OTHER MENTAL DISORDER DIAGNOSES 887 $26,985.00 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC 896 $18,010.00 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC 897 $22,083.00 WOUND DEBRIDEMENTS FOR INJURIES W MCC 901 $154,962.00 WOUND DEBRIDEMENTS FOR INJURIES W CC 902 $221,826.00 SKIN GRAFTS FOR INJURIES W CC/MCC 904 $79,624.00 SKIN GRAFTS FOR INJURIES W/O CC/MCC 905 $65,614.00 OTHER O.R. PROCEDURES FOR INJURIES W MCC 907 $189,493.00 OTHER O.R. PROCEDURES FOR INJURIES W CC 908 $61,083.00 OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC 909 $35,939.00 TRAUMATIC INJURY W MCC 913 $29,344.00 TRAUMATIC INJURY W/O MCC 914 $16,511.00 ALLERGIC REACTIONS W/O MCC 916 $14,281.00 POISONING & TOXIC EFFECTS OF DRUGS W MCC 917 $30,115.00 POISONING & TOXIC EFFECTS OF DRUGS W/O MCC 918 $15,276.00 COMPLICATIONS OF TREATMENT W MCC 919 $32,676.00 COMPLICATIONS OF TREATMENT W CC 920 $26,312.00 COMPLICATIONS OF TREATMENT W/O CC/MCC 921 $16,459.00 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC 922 $63,172.00 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC 923 $24,964.00 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W SKIN GRAFT 927 $183,340.00 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC/MCC 928 $140,763.00 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W/O CC/MCC 929 $53,326.00 FULL THICKNESS BURN W/O SKIN GRAFT OR INHAL INJ 934 $12,170.00 NON-EXTENSIVE BURNS 935 $12,147.00 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC 939 $482,058.00 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC 940 $61,936.00 LCMC Health is committed to helping patients understand and prepare for the cost of their care. LCMC Health provides a list of charges for services provided at our facilities; however, a patient’s out-of-pocket responsibility for these charges will vary, depending on their insurance coverage and benefit plan. We understand that it is confusing for a patient to navigate through the many factors involved in their final cost. Please contact our Financial Assistance staff at 504.702.3500 with any questions about a future service or a bill you have received. Service Description CPT/HCPCS Code Charge O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC 941 $28,682.00 REHABILITATION W CC/MCC 945 $57,603.00 SIGNS & SYMPTOMS W MCC 947 $28,456.00 SIGNS & SYMPTOMS W/O MCC 948 $21,639.00 AFTERCARE W CC/MCC 949 $183,963.00 AFTERCARE W/O CC/MCC 950 $33,758.00 OTHER FACTORS INFLUENCING HEALTH STATUS 951 $14,015.00 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 955 $259,428.00 LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA 956 $51,928.00 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC 957 $412,322.00 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W CC 958 $102,453.00 OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC 963 $127,374.00 OTHER MULTIPLE SIGNIFICANT TRAUMA W CC 964 $35,028.00 OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC 965 $15,285.00 HIV W OR W/O OTHER RELATED CONDITION 977 $43,544.00 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 981 $245,416.00 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC 982 $61,129.00 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC 983 $46,912.00 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 987 $185,012.00 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC 988 $164,016.00 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC 989 $39,101.00 UNGROUPABLE 999 $58,704.00