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 Charge17-HYDROXYPREGNENOLONE (HORMONE) LEVEL 84143 $144.003D REPORT WITH WORKSTATION 76377 $5,057.003D REPORT WITHOUT WORKSTATION 76376 $4,349.00ABDOMINAL ASPIRATION OF FLUID SURROUNDING FETUS FO 59000 $863.00ABDOMINAL ASPIRATION TO REDUCE AMOUNT OF FLUID SUR 59001 $1,838.00ABDOMINAL DRAINAGE OF OVARIAN ABSCESS 58822 $3,249.00ABDOMINAL ULTRASOUND OF PREGNANT UTERUS 76812 $312.00ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 76802 $311.00ABDOMINAL ULTRASOUND OF PREGNANT UTERUS SINGLE OR 76801 $480.00ABDOMINAL ULTRASOUND OF PREGNANT UTERUS SINGLE OR 76805 $478.00ABDOMINAL ULTRASOUND OF PREGNANT UTERUS SINGLE OR 76811 $747.00ABDOMINAL ULTRASOUND PREGNANT UTERUS (GREATER OR E 76810 $478.00ABUTMENT HEALING BAHA TITANIUM OD9 MM STERILE BA30 L8693 $9,973.28ABUTMENT SUPPORTED PORCELAIN/NOBLE METAL D6061 $2,214.00ACAMPROSATE 333 MG TBEC 180 EACH BOTTLE $3.06ACCESS PORT GASTRIC BAND LAP-BAND TITANIUM KIT HIG $5,362.50ACETYLCHOLINESTERASE (ENZYME) LEVEL 82013 $86.00ACNE SURGERY 10040 $264.00ACTIVATED PROTEIN RESISTANCE ASSAY 85307 $110.00ACUTE DIGESTIVE TRACT BLOOD LOSS IMAGING 78278 $1,132.00ACUTE HEPATITIS PANEL 80074 $462.00ACYCLOVIR 5 % CREA 5 G TUBE $10.05ACYCLOVIR 5 % OINT 15 G TUBE $1,385.38ACYCLOVIR 5 % OINT 30 G TUBE $10.30ADAPTER CECOSTOMY CONNECT TUBE LOW PROFILE CHAIT A C1758 $232.00ADAPTER EXTERNAL FIXATION ADD A RING $814.24ADAPTER EXTERNAL FIXATION LARGE BALL JOINT $4,630.80ADAPTER EXTERNAL FIXATION MALE RING $2,381.60ADAPTER EXTERNAL FIXATION MONOTUBE TRIAX T OD15 MM $2,757.12ADAPTER EXTERNAL FIXATION TITANIUM ROTATIONAL SMAL $5,141.76ADAPTER EXTERNAL FIXATION XS FEMALE MAC SYSTEM $3,307.20ADAPTER EXTERNAL FIXATION XS RING MALE MAC SYSTEM $3,307.20ADAPTER FEMORAL COMPRESS OSS TAPER L5 MM KNEE C1776 $7,568.00ADAPTER FEMORAL GMK 3 MM OFFSET KNEE REVISION CONN C1776 $4,550.00ADAPTER FEMORAL GMK 5 MM OFFSET KNEE REVISION CONN C1776 $4,550.00ADAPTER FEMORAL PFC SIGMA +2/-2 OFFSET KNEE BOLT S C1776 $1,365.00ADAPTER FEMORAL PFC SIGMA 5 D KNEE BOLT STERILE C1776 $10,075.00ADAPTER FEMORAL PFC SIGMA NEUTRAL KNEE BOLT STERIL C1776 $1,365.00ADAPTER FEMORAL TRIATHLON 2 MM OFFSET KNEE TOTAL S C1776 $5,394.48

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 ChargeADAPTER FEMORAL VANGUARD 360 2.5 MM OFFSET KNEE RE C1776 $6,120.00ADAPTER FEMORAL VANGUARD 360 5 MM OFFSET KNEE REVI C1776 $6,120.00ADAPTER HEAD -4 MM HIP FEMORAL UNIPOLAR C1776 $325.00ADAPTER HEAD ACUMATCH +3.5 MM 12/14 HIP UNIPOLAR S C1776 $325.00ADAPTER HEAD ACUMATCH +7 MM 12/14 HIP UNIPOLAR SLE C1776 $325.00ADAPTER HEAD BIO-MOORE ENDO II +6 MM TAPER HIP FEM C1776 $325.00ADAPTER HEAD BIO-MOORE ENDO II 3+ MM TAPER HIP FEM C1776 $325.00ADAPTER HEAD BIO-MOORE ENDO II STANDARD TAPER HIP C1776 $325.00ADAPTER HEAD COMPREHENSIVE VERSA-DIAL TITANIUM STA C1776 $325.00ADAPTER HEAD LEGACY +0 MM HIP FEMUR UNIPOLAR C1776 $325.00ADAPTER HEAD LEGACY +4 MM HIP FEMUR UNIPOLAR C1776 $325.00ADAPTER HEAD LEGACY +8 MM HIP FEMUR UNIPOLAR C1776 $325.00ADAPTER INTRODUCER SAFESHEATH LONG OD9 FR VASCULAR C1892 $220.00ADAPTER LEAD EXTENDER C1883 $1,608.75ADAPTER LEAD GOLD PROBE SILICONE 3.2-5 MM L210 CM C1883 $3,332.40ADAPTER LEAD PRECISION S8 PLATINUM IRIDIUM MP35N P C1883 $3,250.00ADAPTER LEAD ST JUDE MEDICAL 8 CHANNEL B $4,238.00ADAPTER NECK STAGEONE SELECT +6 MM HIP SPACER MOLD C1776 $1,495.00ADAPTER SPINAL VEPTR TITANIUM NONSTERILE $9,619.20ADDING WALKER TO PREVIOUSLY APPLIED CAST 29440 $349.00ADENOVIRUS AB 86603 $100.00ADENOVIRUS ANTIGEN IMMUNOFLUORESCENT 87260 $93.00ADH (ANTIDIURETIC HORMONE) LEVEL 84586 $223.00ADH (ANTIDIURETIC HORMONE) LEVEL 84588 $214.00ADHESIVE SKIN CLOSURE DERMABOND PRINEO 2-OCTYL CYA $483.73ADHESIVE SURGICAL BIOGLUE BOVINE SERUM ALBUMIN GLU $4,735.90ADJUNCTIVE BLUE LIGHT CYSTOSCOPY WITH FLUORESCENT C9738 $2,263.00ADMINISTRATION FLU VIRUS VACCINATION 90471 $35.00ADMINISTRATION HEPATITIS B VACCINATION 90471 $35.00ADMINISTRATION OF 1 NASAL OR ORAL VACCINE 90473 $50.00ADMINISTRATION OF 1 VACCINE 90471 $50.00ADMINISTRATION OF INFLUENZA VIRUS VACCINE SUBSEQUE 90472 $152.00ADMINISTRATION OF MEDICATION THROUGH BREATHING TUB 94610 $157.00ADMINISTRATION OF MEDICATION TO INDUCE VOMITING 99175 $186.00ADMINISTRATION OF NASAL OR ORAL VACCINE 90474 $26.00ADMINISTRATION OF VACCINE 90472 $152.00ADMINISTRATION PNEUMOCOCCAL VACCINATION 90471 $35.00ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL 82024 $237.00ADVANCER BURR ROTABLATOR ROTALINK C1894 $1,480.00

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 ChargeAFB ID BY SEQUENCING 87118 $66.00AGENT BULKING MACROPLASTIQUE POLYDIMETHYLSILOXANE L8606 $3,217.50AGENT HEMOSTATIC D-STAT FLOWABLE STERILE $2,825.00AGENT HEMOSTATIC FLOSEAL GELATIN MATRIX NEEDLE FRE $7,769.06AGENT HEMOSTATIC FLOSEAL HUMAN THROMBIN GELATIN MA $7,680.00AGENT HEMOSTATIC INSTAT MICROFIBRILLAR COLLAGEN 1 $3,664.83AGENT HEMOSTATIC SURGIFLO 8 ML MATRIX $731.32AGENT HEMOSTATIC SURGIFLO EVITHROM GELATIN 8 ML TO $1,028.82AGENT HEMOSTATIC SURGIFLO THROMBIN 8 ML KIT MATRIX $1,028.82AGNA-1 86255 $88.00AID HEARING PONTO STREAMER BLACK $2,054.00AID HEARING PONTO STREAMER GATEWAY SOUND PROCESSOR $2,387.78AID SPEECH LIBERTY EXTERNAL VOLUME PITCH ELECTRONI $1,200.00AIR AND BONE CONDUCTION ASSESSMENT OF HEARING LOSS 92557 $428.00AIR TONE CONDUCTION HEARING ASSESSMENT SCREENING 92551 $83.00AIRWAY ESOPHAGEAL COMBITUBE ADULT 2 LUMEN SUCTION $327.34AIRWAY ESOPHAGEAL LMA FASTRACH 4 ID7.5 MM 30- ML L $714.00AIRWAY ESOPHAGEAL LMA UNIQUE 1.5 7- ML PLUS PACK S $390.00AIRWAY ESOPHAGEAL LMA UNIQUE CUFF PILOT SILICONE 4 $300.00AIRWAY ESOPHAGEAL LMA UNIQUE CUFF PILOT SILICONE 5 $337.50AIRWAY ESOPHAGEAL LMA UNIQUE INFANT 1 1/2 ID4 MM I $718.25AIRWAY ESOPHAGEAL LMA UNIQUE INFANT 1 1/2 STANDARD $480.00AIRWAY ESOPHAGEAL LMA UNIQUE PEDIATRIC 2 1/2 STAND $180.00AIRWAY ESOPHAGEAL LMA UNIQUE PEDIATRIC 2 ID4.5 MM $718.25AIRWAY ESOPHAGEAL LMA UNIQUE PEDIATRIC 2 STANDARD $217.50AIRWAY ESOPHAGEAL LMA UNIQUE PEDIATRIC 3 ID6 MM ID $654.84AIRWAY PHARYNGEAL I-GEL THERMOPLASTIC ELASTOMER PO $1,535.63AKI RISK SCORE 84999 $419.00ALBUMIN SERUM PLASMA WHOLE BLD 82040 $48.00ALCOHOLS LEVELS 80307 $244.00ALDOLASE (ENZYME) LEVEL 82085 $76.00ALDOSTERONE HORMONE LEVEL 82088 $316.00ALKALOIDS LEVELS 80323 $244.00ALLERGENS,EA(RAST) 86003 $34.00ALLERGY TESTING W/DRUGS/BIOLOGICALS SKIN IMMEDIATE 95018 $120.00ALLERGY TESTING W/VENOMS SKIN IMMEDIATE REACTION W 95017 $120.00ALPHA-1-ANTITRYPSIN (PROTEIN) BLOOD TEST 82103 $104.00ALPHA-1-ANTITRYPSIN (PROTEIN) BLOOD TEST 82104 $90.00ALPHA-2 ANTIPLASMIN (FACTOR INHIBITOR) MEASUREMENT 85410 $55.00

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 ChargeALPHA-FETOPROTEIN (AFP) ANALYSIS 82107 $100.00ALPHA-FETOPROTEIN (AFP) LEVEL, AMNIOTIC FLUID 82106 $130.00ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM 82105 $130.00ALUMINUM LEVEL 82108 $66.00ALVEOLOPLASTY 1-3 TEETH D7321 $1,291.00ALVEOLOPLASTY 4 OR MORE TEETH D7320 $720.00ALVEOLOPLASTY WITH EXTRACTIONS 1-3 TEETH D7311 $376.00ALVEOLOPLASTY WITH EXTRACTIONS 4 OR MORE TEETH D7310 $517.00AMALGAM 4 OR MORE SURFACES D2161 $433.00AMALGAM ONE SURFACE D2140 $240.00AMALGAM THREE SURFACES D2160 $367.00AMALGAM TWO SURFACES D2150 $303.00AMIKACIN (ANTIBIOTIC) LEVEL 80150 $73.00AMMONIA LEVEL 82140 $113.00AMPHETAMINES LEVELS 80324 $104.00AMPUTATION OF FINGER OR THUMB 26951 $4,374.00AMPUTATION OF FINGER OR THUMB 26952 $10,581.00AMPUTATION OF FOOT 28810 $7,304.00AMPUTATION OF FOOT 28820 $3,633.00AMPUTATION OF FOOT 28825 $3,714.00AMPUTATION ROOT D3450 $922.00AMYLASE (ENZYME) LEVEL 82150 $64.00AMYLASE ISO PANCREATIC 82150 $64.00AMYLASE, BODY FLUID 82150 $64.00AMYLASE, URINE 82150 $64.00ANALGESIA D9230 $142.00ANALGESICS LEVELS 80329 $244.00ANALYSIS & PROGRAMMING INNER EAR (COCHLEAR) IMPLAN 92601 $565.00ANALYSIS & REPORT OF EXTERNAL EKG RECORDING MORE T 0297T $458.00ANALYSIS & REPROGRAMMING INNER EAR (COCHLEAR) IMPL 92602 $565.00ANALYSIS & REPROGRAMMING INNER EAR (COCHLEAR) IMPL 92603 $565.00ANALYSIS & REPROGRAMMING INNER EAR (COCHLEAR) IMPL 92604 $57.00ANALYSIS ANTIBODY FRANCISELLA TULARENSIS (BACTERIA 86668 $81.00ANALYSIS ANTIBODY LA CROSSE (CALIFORNIA) VIRUS (EN 86651 $102.00ANALYSIS FOR ANTIBODY (IGM) TO CHLAMYDIA (BACTERIA 86632 $98.00ANALYSIS FOR ANTIBODY (IGM) TO CYTOMEGALOVIRUS (CM 86645 $131.00ANALYSIS FOR ANTIBODY (IGM) TO TOXOPLASMA (PARASIT 86778 $96.00ANALYSIS FOR ANTIBODY (IGM) TO WEST NILE VIRUS 86788 $131.00ANALYSIS FOR ANTIBODY BACTERIA 86609 $32.00

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 ChargeANALYSIS FOR ANTIBODY TO ADENOVIRUS (RESPIRATORY V 86603 $100.00ANALYSIS FOR ANTIBODY TO ASPERGILLUS (FUNGUS) 86606 $117.00ANALYSIS FOR ANTIBODY TO BRUCELLA (BACTERIA) 86622 $69.00ANALYSIS FOR ANTIBODY TO CRYPTOCOCCUS (YEAST) 86641 $112.00ANALYSIS FOR ANTIBODY TO CYTOMEGALOVIRUS (CMV) IGG 86644 $112.00ANALYSIS FOR ANTIBODY TO EASTERN EQUINE VIRUS (VIR 86652 $84.00ANALYSIS FOR ANTIBODY TO EHRLICHIA (BACTERIA TRANS 86666 $79.00ANALYSIS FOR ANTIBODY TO ENTEROVIRUS (GASTROINTEST 86658 $101.00ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONON 86663 $82.00ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONON 86664 $118.00ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONON 86665 $138.00ANALYSIS FOR ANTIBODY TO FUNGUS 86671 $86.00ANALYSIS FOR ANTIBODY TO HELICOBACTER PYLORI (GAST 86677 $113.00ANALYSIS FOR ANTIBODY TO HELMINTH (INTESTINAL WORM 86682 $82.00ANALYSIS FOR ANTIBODY TO HEPATITIS D VIRUS 86692 $81.00ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS 86694 $90.00ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYP 86695 $121.00ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYP 86696 $177.00ANALYSIS FOR ANTIBODY TO HIV-1 AND HIV-2 VIRUS 86703 $82.00ANALYSIS FOR ANTIBODY TO HIV-2 VIRUS 86702 $82.00ANALYSIS FOR ANTIBODY TO HUMAN T-CELL LYMPHOTROPIC 86687 $65.00ANALYSIS FOR ANTIBODY TO HUMAN T-CELL LYMPHOTROPIC 86688 $82.00ANALYSIS FOR ANTIBODY TO LEPTOSPIRA 86720 $84.00ANALYSIS FOR ANTIBODY TO MUMPS VIRUS 86735 $85.00ANALYSIS FOR ANTIBODY TO MYCOPLASMA (BACTERIA) 86738 $372.00ANALYSIS FOR ANTIBODY TO PARVOVIRUS 86747 $93.00ANALYSIS FOR ANTIBODY TO RICKETTSIA (BACTERIA) 86757 $150.00ANALYSIS FOR ANTIBODY TO SALMONELLA (INTESTINAL BA 86768 $102.00ANALYSIS FOR ANTIBODY TO ST. LOUIS VIRUS (VIRAL EN 86653 $84.00ANALYSIS FOR ANTIBODY TO TRICHINELLA (WORM PARASIT 86784 $36.00ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (C 86787 $110.00ANALYSIS FOR ANTIBODY TO VIRUS 86790 $75.00ANALYSIS FOR ANTIBODY TO WEST NILE VIRUS 86789 $90.00ANALYSIS FOR ANTIBODY TO WESTERN EQUINE VIRUS (VIR 86654 $84.00ANALYSIS FOR ANTIBODY TO ZIKA VIRUS 86794 $94.00ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM 86780 $129.00ANALYSIS FOR DETECTION OF TUMOR MARKER 86316 $162.00ANALYSIS OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE 86005 $62.00ANALYSIS OF GENETIC MATERIAL 88365 $215.00

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 ChargeANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE 83516 $89.00ANALYSIS OF URINE 81005 $17.00ANALYSIS TEST FOR HEPATITIS C VIRUS 87902 $1,697.00ANALYSIS TEST FOR HIV-1 VIRUS 87901 $1,697.00ANALYSIS TEST FOR HIV-1 VIRUS 87903 $3,070.00ANALYSIS TEST FOR HIV-1 VIRUS 87904 $202.00ANALYSIS TEST FOR HIV-1 VIRUS 87906 $998.00ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT A 82397 $36.00ANCHOR BIOABSORBABLE ALLTHREAD LACTOSORB OD5.5 MM C1713 $2,488.64ANCHOR LEAD CLIKX STERILE DISPOSABLE $650.00ANCHOR LEAD SWIFT-LOCK C1883 $148.20ANCHOR SUTURE BIO-CORKSCREW FIBERWIRE POLY L LACTI C1713 $1,917.50ANCHOR SUTURE BIO-SUTURETAK FIBERWIRE RAYON 2-0 MI C1713 $2,112.50ANCHOR SUTURE BIOZIP FORCE FIBER PLLA POLYESTER 2 C1713 $1,721.86ANCHOR SUTURE CORKSCREW BIOCOMPOSITE 1 FULL THREAD C1713 $2,992.00ANCHOR SUTURE CORKSCREW FIBERWIRE 2-0 3/8 CIRCLE M C1713 $1,852.50ANCHOR SUTURE CORKSCREW FIBERWIRE BIOCOMPOSITE 2 F C1713 $2,720.00ANCHOR SUTURE CORKSCREW FIBERWIRE PEEK 2 FULL THRE C1713 $2,177.50ANCHOR SUTURE CORKSCREW SUTURETAPE BIOCOMPOSITE FU C1713 $3,302.00ANCHOR SUTURE CORKSCREW TIGERTAIL BIOCOMPOSITE 2 S C1713 $1,035.00ANCHOR SUTURE CROSSFT BC 2 OD4.5 MM C1713 $2,268.50ANCHOR SUTURE CROSSFT BC 3 OD4.5 MM C1713 $1,859.00ANCHOR SUTURE CROSSFT BC 3 OD6.5 MM INSTRUMENTATIO C1713 $1,859.00ANCHOR SUTURE CROSSFT BC HI-FI BIOCOMPOSITE BTCP 9 C1713 $1,924.00ANCHOR SUTURE DX SWIVELOCK SL L8.5 MM OD3.5 MM FOR C1713 $2,762.50ANCHOR SUTURE ETHIBOND QUICKANCHOR PLUS 2 CP-2 C1713 $1,982.50ANCHOR SUTURE FASTIN 2 OD5.2 MM THREAD STERILE C1713 $1,534.00ANCHOR SUTURE FIBERTAK OD1.6 MM CURVE SPEAR OBTURA C1713 $1,267.50ANCHOR SUTURE FIBERTAK SUTURETAPE 1.3 MM 2 LOAD BL C1713 $2,405.00ANCHOR SUTURE GENESYS CROSSFT PEEK OD4.5 MM 3 LOAD C1713 $1,924.00ANCHOR SUTURE GENESYS CROSSFT PEEK OD6.5 MM 3 LOAD C1713 $2,424.24ANCHOR SUTURE GII QUICKANCHOR PLUS ETHIBOND 2 CP-2 C1713 $2,408.00ANCHOR SUTURE HEALICOIL REGENESORB ULTRATAPE ULTRA C1713 $1,275.00ANCHOR SUTURE HEALIX ADVANCE PERMACORD PEEK OD4.5 C1713 $2,632.00ANCHOR SUTURE ICONIX FORCE FIBER 2 OD2.3 MM 2 STRA C1713 $1,950.00ANCHOR SUTURE ICONIX XBRAID TITANIUM OD2.3 MM 2 ST C1713 $2,945.80ANCHOR SUTURE INTRALINE PEEK-OPTIMA 2 OD5.5 MM CIR C1713 $2,095.92ANCHOR SUTURE JUGGERKNOT 1 C1713 $16,152.50ANCHOR SUTURE JUGGERKNOT MAXBRAID 2 OD1.5 MM 1 LOA C1713 $1,876.88

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 ChargeANCHOR SUTURE JUGGERKNOT MAXBRAID 2 OD2.9 MM 2 LOA C1713 $351.00ANCHOR SUTURE JUGGERKNOT OD1.4 MM SOFT TISSUE 1 LO C1713 $1,615.25ANCHOR SUTURE JUGGERKNOT POLYESTER 2-0 MINI OD1 MM C1713 $1,751.75ANCHOR SUTURE JUGGERKNOT POLYESTER SHORT OD1.4 MM C1713 $493.35ANCHOR SUTURE LUPINE BR ORTHOCORD DS C1713 $2,576.00ANCHOR SUTURE LUPINE LOOP PLUS ORTHOCORD C1713 $2,584.00ANCHOR SUTURE MAINSTAY TITANIUM OD2.7 MM ZIP ARTHR C1713 $1,268.00ANCHOR SUTURE MAINSTAY TITANIUM OD3.5 MM ZIP HANDL C1713 $1,412.00ANCHOR SUTURE MAINSTAY TITANIUM OD4.5 MM ZIP ARTHR C1713 $1,845.57ANCHOR SUTURE MICROFIX 4-0 C-1 OD1.3 MM DRILL BIT C1713 $2,242.50ANCHOR SUTURE MICROMAX LONG CURVE OD2.9 MM FLEXIBL C1713 $1,760.85ANCHOR SUTURE MICROMAX OD2.9 MM SHOULDER FLEXIBLE C1713 $2,152.15ANCHOR SUTURE MICROMAX STRAIGHT KIT DISPOSABLE C1713 $1,760.85ANCHOR SUTURE MINILOK QUICKANCHOR PLUS ORTHOCORD 0 C1713 $2,242.50ANCHOR SUTURE MULTIFIX S ULTRA PEEK OD5.5 MM KNOTL C1713 $1,125.00ANCHOR SUTURE ORTHOCORD 2 MO-7 BLUE VIOLET C1713 $213.42ANCHOR SUTURE OSTEORAPTOR ULTRABRAID 2 OD2.3 MM CO C1713 $2,624.00ANCHOR SUTURE OSTEORAPTOR ULTRABRAID HA PLLA 2 CUR C1713 $2,312.70ANCHOR SUTURE OSTEORAPTOR ULTRABRAID PLLA-HA 2 OD2 C1713 $2,624.00ANCHOR SUTURE PANALOK PANACRYL 2 CP-2 C1713 $2,608.00ANCHOR SUTURE PARCUS BRAID POLYETHYLENE 5 L36 IN O C1713 $146.64ANCHOR SUTURE PEEK CARBON FIBER 55 KNOTLESS PUSH I C1713 $2,392.00ANCHOR SUTURE PEEK-OPTIMA CARBON FIBER OD4.5 MM KN C1713 $2,392.00ANCHOR SUTURE PEEK-OPTIMA CARBON FIBER UHMWPE 28 K C1713 $2,600.00ANCHOR SUTURE PEEK-OPTIMA CARBON FIBER UHMWPE POLY C1713 $2,392.00ANCHOR SUTURE POPLOK HI-FI PEEK-OPTIMA 2 L11 MM OD C1713 $1,947.40ANCHOR SUTURE PRESSFT HI-FI GENESYS PEEK-OPTIMA 0 C1713 $1,878.50ANCHOR SUTURE PRESSFT HI-FI GENESYS PEEK-OPTIMA 2 C1713 $1,898.00ANCHOR SUTURE PUSHLOCK BIOCOMPOSITE L15.5 MM OD2.9 C1713 $2,600.00ANCHOR SUTURE PUSHLOCK BIOCOMPOSITE L19.5 MM OD3.5 C1713 $3,200.00ANCHOR SUTURE PUSHLOCK PEEK MINI L8 MM OD2.5 MM ST C1713 $2,340.00ANCHOR SUTURE Q-FIX OD1.8 MM C1713 $1,217.23ANCHOR SUTURE QUICKANCHOR PLUS ETHIBOND 2 CP-2 ROT C1713 $2,480.00ANCHOR SUTURE QUICKANCHOR PLUS ETHIBOND 2-0 V-5 MI C1713 $1,956.50ANCHOR SUTURE QUICKANCHOR PLUS ETHIBOND 3-0 V-4 MI C1713 $1,859.00ANCHOR SUTURE QUICKANCHOR PLUS ORTHOCORD NITINOL 2 C1713 $2,544.00ANCHOR SUTURE QUICKANCHOR PLUS PANACRYL 2-0 RB-1 D C1713 $2,151.50ANCHOR SUTURE QUICKANCHOR PLUS PANALOK RC ORTHOCOR C1713 $2,688.00ANCHOR SUTURE QUICKANCHOR PLUS PANALOK RC PANACRYL C1713 $2,688.00

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 ChargeANCHOR SUTURE RAPIDLOC PANACRYL PDS PLA 0 D 2-0 ME C1713 $1,912.00ANCHOR SUTURE RAPIDLOC PANACRYL PDS PLA 12 D 2-0 C C1713 $1,912.00ANCHOR SUTURE RAPIDLOC PANACRYL PDS PLA 27 D 2-0 M C1713 $1,880.00ANCHOR SUTURE REELX STT KNOTLESS SHARP TIP C1713 $2,210.00ANCHOR SUTURE REELX STT PEEK METAL OD4.5 MM KNOTLE C1713 $2,210.00ANCHOR SUTURE REGENESORB ULTRATAPE ULTRABRAID 2 OD C1713 $1,275.00ANCHOR SUTURE SHOULDER RESTORATION SYSTEM Y-KNOT F C1713 $1,446.90ANCHOR SUTURE SONICANCHOR 0 C-2 L10 MM OD2.5 MM KI C1713 $3,094.00ANCHOR SUTURE SONICANCHOR L10 MM OD2.5 MM KIT STER C1713 $3,094.00ANCHOR SUTURE STATAK TIVANIUM POLYESTER 0 L8.67 MM C1713 $1,394.64ANCHOR SUTURE STATAK TIVANIUM POLYESTER 2 L13 MM O C1713 $1,394.64ANCHOR SUTURE STATAK TIVANIUM POLYESTER 2 L9.04 MM C1713 $1,394.64ANCHOR SUTURE SUTURETAK BIOCOMPOSITE 1 DIAMOND POI C1713 $2,112.50ANCHOR SUTURE SUTURETAK FIBERWIRE BIOCOMPOSITE 2 L C1713 $1,982.50ANCHOR SUTURE SUTURETAK TIGERTAIL BIOCOMPOSITE 2 L C1713 $1,700.00ANCHOR SUTURE SWIVELOCK BIOCOMPOSITE L19.5 MM OD7 C1713 $2,827.50ANCHOR SUTURE SWIVELOCK C BIOCOMPOSITE L19.1 MM OD C1713 $3,055.00ANCHOR SUTURE SWIVELOCK C BIOCOMPOSITE PEEK L19.1 C1713 $1,200.00ANCHOR SUTURE SWIVELOCK C PEEK-OPTIMA L19.1 MM OD5 C1713 $2,437.50ANCHOR SUTURE SWIVELOCK SP BIOCOMPOSITE PEEK L24.5 C1713 $2,730.00ANCHOR SUTURE SWIVELOCK TENODESIS BIOCOMPOSITE L19 C1713 $2,827.50ANCHOR SUTURE SWIVELOCK TIGERWIRE ARTHREX BIOCOMPO C1713 $2,710.50ANCHOR SUTURE TENOLOK TENODESIS HI-FI 2 OD5 MM C1713 $1,930.11ANCHOR SUTURE VERSALOK ORTHOCORD 2 L36 IN LATEX FR C1713 $2,672.00ANCHOR SUTURE XBRAID TT UHMWPE W2 MM COBRAID STERI C1713 $994.50ANCHOR SUTURE Y-KNOT 2 OD1.3 MM 1 LOADED 1 STRAND C1713 $1,664.00ANCHOR SUTURE Y-KNOT 2 OD1.8 MM 2 LOADED 2 STRAND C1713 $1,735.50ANCHOR SUTURE Y-KNOT HI-FI 360 D 2 2 LOAD 2 STRAND C1713 $1,937.00ANCHOR SUTURE Y-KNOT HI-FI 360 D 2 3 LOAD 2 STRAND C1713 $2,002.00ANCHOR SUTURE Y-KNOT OD1.3 MM PERCUTANEOUS PACK T C1713 $1,339.00ANCHOR SUTURE Y-KNOT RC HI-FI 2 3 LOAD SELF PUNCH C1713 $4,673.50ANDROSTENEDIONE (HORMONE) LEVEL 82157 $193.00ANESTHESIA GENERAL 1ST 15 MINUTES $3,499.00ANESTHESIA GENERAL EACH ADDITIONAL 15 MINUTES $196.00ANESTHESIA MAC 1ST 15 MINUTES $2,333.00ANESTHESIA MAC EACH ADDITIONAL 15 MINUTES $402.00ANESTHESIA REGIONAL 1ST 15 MINUTES $1,166.00ANESTHESIA REGIONAL EACH ADDITIONAL 15 MINUTES $154.00ANGIOGRAPHY ILIAC DURING CARDIAC CATH G0278 $32.00

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 ChargeANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL 82164 $113.00ANTENNA NEUROSTIMULATOR EXTERNAL TELEMETRY NONSTER $507.00ANTIBODY IDENTIFICATION TEST FOR PLATELET ANTIBODI 86022 $143.00ANTIBODY IDENTIFICATION TEST FOR PLATELET ANTIBODI 86023 $97.00ANTIBODY LEVEL MEASUREMENT 86406 $82.00ANTI-CLOTTING MANAGEMENT FOR PATIENT TAKING WARFAR 93793 $49.00ANTICOAGULANT CITRATE PHOSPHATE DEXTROSE 2.63-222 $100.00ANTIDEPRESSANTS LEVELS 80335 $244.00ANTIDEPRESSANTS LEVELS 80336 $244.00ANTIDEPRESSANTS LEVELS 80338 $244.00ANTIDEPRESSANTS LEVELS 80332 $244.00ANTIEPILEPTICS LEVELS 80339 $244.00ANTIGEN SCREEN- R0R0 86902 $375.00ANTIHEMOPHILIC FACTOR VIII (RECOMB) 3,000 (+/-) UN J7192 $14,819.65ANTIMICROBIAL STUDY, MYCOBACTERIA (TB ORGANISM FAM 87190 $44.00ANTIPSYCHOTICS LEVELS 80342 $244.00ANTISTREPTOLYSIN O 86060 $56.00ANTITHROMBIN III ANTIGEN (CLOTTING INHIBITOR) ACTI 85300 $85.00APICALLY POSITIONED FLAP D4245 $443.00APICOECTOMY D3410 $1,383.00APICOECTOMY/PERIADICULAR D3421 $1,194.00APICOECTOMY/PERIADICULAR D3425 $1,194.00APICOECTOMY/PERIADICULAR D3426 $474.00APIXABAN 2.5 MG TAB 100 EACH BLIST PACK $19.87APIXABAN 2.5 MG TAB 60 EACH BOTTLE $19.87APIXABAN 5 MG TAB 100 EACH BLIST PACK $9.93APOLIPOPROTEIN LEVEL 82172 $120.00APOLIPROTEIN B 82172 $120.00APPLIANCE REMOVAL D7997 $499.00APPLICATION AND REMOVAL OF DENTAL FIXATION DEVICE 21110 $4,553.00APPLICATION LIGHT USING ENDOSCOPE DESTRUCTION ABNO 96570 $131.00APPLICATION MEDICATION THROUGH SKIN USING ELECTRIC 97033 $115.00APPLICATION OF ALLERGENIC EXTRACT SKIN PATCH WITH 95044 $1,778.00APPLICATION OF BLOOD VESSEL COMPRESSION/DECOMPRESS 97016 $66.00APPLICATION OF BODY CAST SHOULDER TO HIPS 29035 $697.00APPLICATION OF BODY CAST SHOULDER TO HIPS INCLUDIN 29044 $697.00APPLICATION OF BODY CAST SHOULDER TO HIPS INCLUDIN 29046 $697.00APPLICATION OF CAST SHOULDER TO HAND (LONG ARM) 29065 $785.00APPLICATION OF CAST TO FINGER 29086 $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 ChargeAPPLICATION OF CAST TO HAND AND LOWER FOREARM 29085 $349.00APPLICATION OF CAST, ELBOW TO FINGER (SHORT ARM) 29075 $785.00APPLICATION OF CHEMICAL AGENT TO EXCESSIVE WOUND T 17250 $395.00APPLICATION OF CRANIAL TONGS (STABILIZATION DEVICE 20660 $1,471.00APPLICATION OF CYLINDER CAST (THIGH TO ANKLE) 29365 $697.00APPLICATION OF ELECTRICAL STIMULATION TO 1 OR MORE 97032 $65.00APPLICATION OF HEADFRAME FOR STEREOTACTIC RADIOSUR 61800 $3,515.00APPLICATION OF HEAT WAVE THERAPY TO 1 OR MORE AREA 97024 $22.00APPLICATION OF HIP SPICA CAST ON ONE LEG 29305 $697.00APPLICATION OF HIP SPICA CAST, ONE AND ONE-HALF HI 29325 $697.00APPLICATION OF HOT OR COLD PACKS TO 1 OR MORE AREA 97010 $84.00APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS 97018 $39.00APPLICATION OF KNEE CAP TENDON BEARING CAST 29435 $697.00APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND) 29105 $392.00APPLICATION OF LONG LEG CAST (THIGH TO TOES) 29345 $697.00APPLICATION OF LONG LEG CAST (THIGH TO TOES), WALK 29355 $697.00APPLICATION OF LONG LEG CAST BRACE 29358 $697.00APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR 29505 $349.00APPLICATION OF LONG OR SHORT LEG CLUBFOOT CAST 29450 $349.00APPLICATION OF LOW ENERGY HEAT (INFRARED) TO 1 OR 97026 $21.00APPLICATION OF MECHANICAL TRACTION TO 1 OR MORE AR 97012 $70.00APPLICATION OF MOVEABLE, HINGED FINGER SPLINT 29131 $224.00APPLICATION OF MOVEABLE, HINGED SHORT ARM SPLINT ( 29126 $349.00APPLICATION OF MULTIPLANE EXTERNAL BONE FIXATION S 20697 $3,018.00APPLICATION OF NON-MOVEABLE HINGED FINGER SPLINT 29130 $224.00APPLICATION OF NON-MOVEABLE, SHORT ARM SPLINT (FOR 29125 $380.00APPLICATION OF ORGAN CAVITY RADIATION SOURCE, COMP 77763 $1,947.00APPLICATION OF ORGAN CAVITY RADIATION SOURCE, INTE 77762 $1,947.00APPLICATION OF ORGAN CAVITY RADIATION SOURCE, SIMP 77761 $1,947.00APPLICATION OF PLASTER VELPEAU CAST 29058 $943.00APPLICATION OF RADIATION SOURCE, COMPLEX 77778 $4,685.00APPLICATION OF RIGID TOTAL CONTACT LEG CAST 29445 $697.00APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) 29405 $697.00APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) 29515 $349.00APPLICATION OF SHOULDER SPICA CAST 29055 $697.00APPLICATION OF SKIN SUBSTITUTE TO TRUNK ARMS OR LE 15273 $10,209.00APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 97035 $42.00APPLICATION OF ULTRAVIOLET LIGHT TO 1 OR MORE AREA 97028 $26.00APPLICATION OF ULTRAVIOLET LIGHT TO SKIN 96900 $193.00

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 ChargeAPPLICATION OF WHIRLPOOL THERAPY TO 1 OR MORE AREA 97022 $78.00APPLICATION SHORT LEG CAST (BELOW KNEE TO TOES) WA 29425 $697.00APPLICATION SKIN SUBSTITUTE FACE SCALP EYELID MOUT 15275 $6,745.00APPLICATION SKIN SUBSTITUTE FACE SCALP EYELID MOUT 15276 $3,373.00APPLICATION SKIN SUBSTITUTE FACE SCALP EYELID MOUT 15277 $6,745.00APPLICATION SKIN SUBSTITUTE TO TRUNK ARMS OR LEGS 15271 $6,745.00APPLICATION SKIN SUBSTITUTE TO TRUNK ARMS OR LEGS 15272 $6,745.00APPLICATION SKIN SUBSTITUTE TO TRUNK ARMS OR LEGS 15274 $6,573.00APPLICATION VEIN WOUND COMPRESSION SYST LOWER LEG 29581 $457.00APPLIER EXTERNAL CLIP CODMAN PLASTIC SCALP PRELOAD $3,795.04APPLIER INTERNAL CLIP ACUCLIP RIGHT ANGLE MULTIPLE $815.23APPLIER INTERNAL CLIP ATRICLIP PRO2 GILLINOV-COSGR $22,750.00APPLIER INTERNAL CLIP DIRECT DRIVE 10 MM L32 CM LA $552.50APPLIER INTERNAL CLIP ENDO CLIP II SUPER INTERLOCK $498.29APPLIER INTERNAL CLIP ENDO CLIP III SUPER INTERLOC $1,034.41APPLIER INTERNAL CLIP ENDO CLIP SUPER INTERLOCK TI $498.29APPLIER INTERNAL CLIP EPIX TIGOLD 20 M/L UNIVERSAL $455.00APPLIER INTERNAL CLIP GEM MICROCLIP L15 CM $747.50APPLIER INTERNAL CLIP LAPRO-CLIP METAL SHORT L11 C $9,867.00APPLIER INTERNAL CLIP LAPRO-CLIP METAL STANDARD L2 $5,791.50APPLIER INTERNAL CLIP LIGACLIP TITANIUM 30 D MEDIU $262.04APPLIER INTERNAL CLIP LIGAMAX LIGACLIP TITANIUM LA $599.31APPLIER INTERNAL CLIP LIGAMAX LIGACLIP TITANIUM ME $468.91APPLIER INTERNAL CLIP LIGAMAX MEDIUM LARGE OD5 MM $821.17APPLIER INTERNAL CLIP LIGAMAX TITANIUM MEDIUM LARG $821.17APPLIER INTERNAL CLIP PREMIUM SURGICLIP SUPER INTE $349.44APPLIER INTERNAL CLIP PREMIUM SURGICLIP TITANIUM S $840.83APPLIER INTERNAL CLIP SURGICLIP LACTOMER POLYMER M $396.50APPLY SKIN SUBSTITUTE TO FACE SCALP EYELID MOUTH N 15278 $8,006.00ARCH EXTERNAL FIXATION ILIZAROV ADULT 120 D 1/3 LA $9,339.92ARCH EXTERNAL FIXATION ILIZAROV ADULT 90 D 1/4 LAR $9,140.32ARCH EXTERNAL FIXATION ILIZAROV CARBON FIBER EPOXY $7,479.92ARCH EXTERNAL FIXATION ILIZAROV COMPASS 90 D UNIVE $5,228.64ARCH EXTERNAL FIXATION SLOT $2,889.60ARM EXTERNAL FIXATION OPTIROM ELBOW PROXIMAL $14,304.00ARSENIC LEVEL 82175 $119.00ARTERIAL PUNCTURE WITHDRAWL OF BLOOD FOR DIAGNOSIS 36600 $112.00ARTHROCENTESIS TMJ D7870 $675.00ARTHROGRAPHY INJECTION SACROILIAC JOINT 27096 $2,087.00

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 ChargeARUP - ADENOVIRUS BY PCR QUANTITATIVE 87799 $281.00ARUP - AMPHET CONFIRM QUANT MECONIUM 80324 $104.00ARUP COCAINE QUANT BLOOD 80353 $101.00ARUP - DEXAMETHASONE 80299 $86.00ARUP ACANTHAMOEBA AND NAEGLERIA CULTURE 87081 $51.00ARUP ACETONE QUANTITATIVE SERUM 80320 $244.00ARUP ACETYLCHOLINESTERASE 82013 $86.00ARUP ACYLCARNITINES QUANTITATIVE 82017 $131.00ARUP ADENOVIRUS ANTIGEN EIA 87301 $93.00ARUP ALCOHOL URINE 80320 $244.00ARUP ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT 86008 $100.00ARUP ALPHA FETOPROTEIN AMNIOTIC 82106 $130.00ARUP ALT 84460 $42.00ARUP AMINO ACIDS 6 OR MORE QUANTITATIVE 82139 $131.00ARUP AMITRIPTYLINE AND NORTRIPTYLINE 80335 $244.00ARUP ANCA TITER 86256 $94.00ARUP ANTITHROMBIN III ANTIGEN 85301 $78.00ARUP AQUAPORIN 4 RECEPTOR AB IGG, CSF W/ REFLEX 86255 $88.00ARUP ASSAY C-D TRANSFER MEASURE 82373 $139.00ARUP AST/SGOT 84450 $50.00ARUP BARBITURATES CONF URINE 80345 $75.00ARUP BARBITURATES CONFIRMATION 80345 $75.00ARUP BCR/ABL1 TA MAJOR BREAKPOINT QL/QN 81206 $497.00ARUP BCR/ABL1 TA MINOR BREAKPOINT QL/QN 81207 $414.00ARUP BENZODIAZEPINES QUANT 1-12, MECONIUM 80346 $124.00ARUP BETA-2 TRANSFERRIN 86335 $228.00ARUP BETHESDA 85335 $93.00ARUP BILE ACIDS 82239 $109.00ARUP BIOTINIDASE 82261 $131.00ARUP BK VIRUS URINE 87799 $281.00ARUP BLASTOMYCES ANTIBODY 86612 $100.00ARUP BUN, SERUM 84520 $31.00ARUP C1 ESTERASE INHIBITOR 86160 $93.00ARUP CAFFEINE THERAPUTIC DRUG ANALYSIS 80155 $232.00ARUP CARBAMAZEPINE FREE THERAPUTIC DRUG ANALYSIS 80157 $102.00ARUP CARBOXYHEMOGLOBIN QUANTITATIVE 82375 $85.00ARUP CELL FUNCTION ASSAY W/STIMULATION 86352 $652.00ARUP CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCT R 81223 $207.00ARUP CHLAMYDIA ANTIBODY 86631 $92.00

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 ChargeARUP CHOLINESTERASE RBC 82482 $60.00ARUP CHROMOSOME COUNT 15-20/2 88262 $904.00ARUP CHROMOSOME COUNT 20-25 88264 $725.00ARUP CHROMOSOME COUNT AMNIO IN SITU 88269 $1,289.00ARUP CHROMOSOME COUNT AMNIO IN SITU 88237 $495.00ARUP CLONAZEPAM LEVEL 80346 $124.00ARUP COCCIDIOIDES ANTIBODY 86635 $89.00ARUP COMPLEMENT C1Q BINDING 86332 $188.00ARUP COMPLEMENT C6 86160 $93.00ARUP COMPLEX SPEC STAIN OP TRIC 87209 $90.00ARUP COMPOUND S SPECIFIC 82634 $227.00ARUP CONCENTRATION INFECTION AGENTS ANY TYPE 87015 $52.00ARUP CORTISOL FREE, 24 HR URINE 82530 $105.00ARUP CORTISOL FREE, SERUM 82530 $105.00ARUP CULTURE FUNGUS DEFINITIVE ID MOLD 87107 $69.00ARUP CULTURE VIRUS SHELL VIAL 87254 $151.00ARUP CYCLIC CITRULLINATED PEPTIDE TEST 86200 $100.00ARUP CYSTINE URINE 24 HOUR 82131 $106.00ARUP CYTOGENETICS AND MOLECULAR CYTOGENETICS INTER 88291 $150.00ARUP CYTOGENOMIC CONSTITUTIONAL (GENOME-WIDE) MICR 81229 $6,708.00ARUP DEOXYRIBONUCLEASE ANTIBODY 86215 $102.00ARUP DESOXYCORTICOSTERONE-11 82633 $240.00ARUP DHEA (DEHYDROEPIANDROSTERONE) 82626 $160.00ARUP DSDNA AB IGG 86225 $106.00ARUP ESTRADIOL ULTRASENSITIVE 82670 $216.00ARUP ETHOSUXIMIDE 80168 $127.00ARUP FACTOR 9 ACTIVITY 85250 $111.00ARUP FACTOR II PROTHROMBIN 85210 $42.00ARUP FACTOR V ASSAY 85220 $82.00ARUP FACTOR VII STABLE FACTOR 85230 $85.00ARUP FACTOR VIII VON WILLEBRAND FACTOR MULTIMETRIC 85247 $134.00ARUP FACTOR X STUART PROWER 85260 $82.00ARUP FACTOR XIII FIBRIN STABILIZING 85290 $101.00ARUP FANCC (FANCONI ANEMIA, COMPLEMENTATION GROUP 81242 $176.00ARUP FAT QUANTITATIVE FECES 82710 $130.00ARUP FATTY ACIDS VERY LONG CHAIN 82726 $139.00ARUP FELBAMATE 80339 $244.00ARUP FETAL CONGENITAL ABNORMALITIES FOUR ANALYTES 81511 $82.00ARUP FETAL CONGENITAL ABNORMALITIES TWO PROTEINS ( 81508 $225.00

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 ChargeARUP FLUCONAZOLE 80299 $86.00ARUP FLUCONAZOLE SUSCEPTIBILITY 87181 $36.00ARUP FLUORESCENT ANTIBODY SCREEN 86255 $88.00ARUP FLUOXETINE 80332 $244.00ARUP FMR1 (FRAGILE X MENTAL RETARDATION 1) GENE DE 81243 $508.00ARUP GABAPENTIN 80171 $81.00ARUP GENOTYPE CYTOMEGALOVIRUS 87910 $1,995.00ARUP GGT 82977 $70.00ARUP GHB CONFIRMATION, URINE 80375 $244.00ARUP GHB SCREEN, URINE 80307 $382.00ARUP HAEMOPHILIUS INFLUENZA B AB IGG 86317 $116.00ARUP HEMOGLOBIN F (FETAL) 83033 $46.00ARUP HEPATITIS C AB 86803 $111.00ARUP HFE (HEMOCHROMATOSIS) GENE COMMON VARIANTS 81256 $323.00ARUP HISTOPLASMA AG 87385 $80.00ARUP HIT PF4 IGG 86022 $143.00ARUP HIV-1 QUANTIFICATION NUCLEIC ACID PROBE 87536 $659.00ARUP HLA-B5701 81381 $733.00ARUP HUMAN PAPILLOMAVIRUS (HPV) NUCLEIC ACID PROBE 87625 $264.00ARUP IGA IGG IGM GAMMAGLOBULIN 82784 $72.00ARUP IL28B UNLISTED MOLECULARE PATH 81479 $1,107.00ARUP IMMUNOASSAY NON INF AGENT QUALITATIVE/SEMIQUA 83516 $89.00ARUP IMMUNOGLOBULIN D 82784 $72.00ARUP IMMUNOGLOBULIN G CSF 82787 $37.00ARUP IN SITU HYBRIDIZATION PER SPECIMEN MAN EA ADD 88377 $1,017.00ARUP INDIA INK 87210 $33.00ARUP INHIBIN B 83520 $86.00ARUP INSULIN FASTING 83525 $112.00ARUP INSULIN FREE 83527 $100.00ARUP IRON 83540 $42.00ARUP JAK2 GENE V671F MUT QUAL 81270 $474.00ARUP KRAS (KIRSTEN RAT SARCOMA) GENE ANALYSIS EXON 81275 $1,391.00ARUP LACTOFERRIN FECES QUALITATIVE 83630 $152.00ARUP LD BLOOD 83615 $47.00ARUP LD ISOENZYME 83625 $71.00ARUP LDH 83615 $47.00ARUP LYME DISEASE AB 86618 $132.00ARUP LYME DISEASE AB CONFIRM, IGG 86617 $120.00ARUP LYME DISEASE AB CONFIRM, IGG CSF 86617 $120.00

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 ChargeARUP LYME DISEASE AB CONFIRM, IGM CSF 86617 $120.00ARUP LYME DISEASE AB, CSF 86618 $132.00ARUP MANGANESE 83785 $165.00ARUP MDA/MDEA/MDMA DEFIN ASSAY MECONIUM 80359 $244.00ARUP MIC PER PLATE 87186 $85.00ARUP MOLECULAR CYTO DNA PROBE FISH 88271 $166.00ARUP MOLECULAR CYTO DNA PROBE FISH PML-RARA 88271 $166.00ARUP MOLECULAR CYTO HER-2/NEU 88271 $166.00ARUP MOLECULAR CYTO MDS PANEL 88271 $166.00ARUP MOLECULAR CYTO MM FISH 88271 $166.00ARUP MOLECULAR CYTOGENETICS IN SITU HYBRIDIZATION 88275 $303.00ARUP MUSK ANTIBODY 83519 $36.00ARUP MYELOPEROXIDASE AB 83520 $86.00ARUP NEURONAL NUCLEAR ANTIBODIES 83516 $89.00ARUP NORTRIPTYLINE 80335 $244.00ARUP NUCLEOTIDASE 5 83915 $86.00ARUP OPIATES CONFIRM MECONIUM 80361 $130.00ARUP OXALATE, BLOOD 83945 $100.00ARUP OXYCODONE CONFIRM MECONIUM 80365 $244.00ARUP OXYCODONE CONFIRM URINE 80365 $244.00ARUP P JIROVECI QNT PCR 87798 $232.00ARUP PARVO QNT PCR 87799 $281.00ARUP PINWORM EXAM 87172 $27.00ARUP PLASMINOGEN ACTIVATOR INHIBITORS 85415 $124.00ARUP PROPOXYPHENE DEFINITIVE ASSAY 80367 $244.00ARUP PROTEIN TOTAL URINE 84156 $94.00ARUP PROTEIN WESTERN BLOT BAND ID 84182 $139.00ARUP PSEUDOCHOLINESTERASE 82480 $61.00ARUP PYRUVATE 84210 $84.00ARUP RAST ALLERGEN QUALITATIVE MULTI SCR 86005 $62.00ARUP REPTILASE TEST 85635 $70.00ARUP ROTAVIRUS ANTIGEN INFECTIOUS AGENT IMMUNOASSA 87425 $77.00ARUP RPR TITER 86593 $34.00ARUP RUFINAMIDE 80339 $244.00ARUP SEROTONIN 84260 $196.00ARUP SEROTONIN RELEASE HEPARIN DEPENDENT PLT AB 86022 $82.00ARUP SMEAR SPECIAL STAIN INCLUSION BODIES 87207 $38.00ARUP SSDNA AB 84156 $29.00ARUP STREP PNEUMONIAE ANTIGEN URINE 87899 $73.00

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 ChargeARUP T GONDII AB IGG 86777 $112.00ARUP T GONDII AB IGM 86778 $96.00ARUP T3 UPTAKE 84479 $36.00ARUP T4 TOTAL 84436 $37.00ARUP TAY-SACHS DISEASE 81255 $232.00ARUP TCA CONFIRMATION 80337 $244.00ARUP THC METABOLITE SERUM QUANT 80349 $244.00ARUP THROMBIN CLOTTING TIME 85670 $34.00ARUP THROMBIN MIXING STUDY 85670 $34.00ARUP THYROGLOBULIN ANTIBODY 86800 $124.00ARUP TISSUE CULTURE AMNIOTIC 88235 $495.00ARUP TISSUE CULTURE AMNIOTIC 88264 $725.00ARUP TISSUE CULTURE LYMPHOCYTE 88230 $495.00ARUP TISSUE CULTURE NEOPLASTIC DISORDERS 88237 $495.00ARUP TISSUE CULTURE SKIN 88230 $495.00ARUP TISSUE CULTURE SOLID TUMOR 88239 $495.00ARUP TSH 84443 $130.00ARUP TYROSINE 84510 $81.00ARUP UREA NITROGEN URINE 84540 $36.00ARUP VARICELLA ZOSTER AG IMMUNOFLUORESCENT 87290 $93.00ARUP VIMPAT (LACOSAMIDE) 80339 $244.00ARUP VOLATILES GC QUANT 84600 $244.00ARUP WEST NILE AB SER 86789 $84.00ARUP WNV AB IGM 86788 $90.00ARUP ZIKA VIRUS NUCLEIC ACID PROBE AMPLIFIED 87798 $232.00ARUP-ALPHA GALACTOSIDASE 82657 $114.00ARUP-CARNITINE,SERUM OR PLASMA 83789 $109.00ARUP-ENCEPH AB,CALIF IGG SER 86651 $102.00ARUP-ENCEPH AB,CALIF IGM SER 86651 $102.00ARUP-ENCEPH AB,E EQUINE IGG SER 86652 $84.00ARUP-ENCEPH AB,E EQUINE IGM SER 86652 $84.00ARUP-ENCEPH AB,ST.LOUIS IGG SER 86653 $84.00ARUP-ENCEPH AB,ST.LOUIS IGM SER 86653 $84.00ARUP-ENCEPH AB,W EQUINE IGG SER 86654 $84.00ARUP-ENCEPH AB,W EQUINE IGM SER 86654 $84.00ARUP-FREE LIGHT CHAIN, SERUM 83883 $36.00ARUP-INF AGT ASPERGILLUS 87305 $80.00ARUP-MUMPS RNA QUAL BY PCR 87798 $232.00ARUP-ZINC TRANSPORTER 8 AB 86341 $153.00

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 ChargeASCORBIC ACID (VITAMIN C) LEVEL, BLOOD 82180 $56.00ASENAPINE 5 MG SUBL 100 EACH BLIST PACK $48.63ASPERGILLUS ANTIBODY 86606 $117.00ASPIRATION AND INJECTION TREATMENT OF BONE CYST 20615 $2,292.00ASPIRATION AND/OR INJECT OF MAJOR JOINT OR JOINT C 20611 $1,039.00ASPIRATION AND/OR INJECT OF SMALL JOINT OR JOINT C 20604 $1,039.00ASPIRATION AND/OR INJECTION KIDNEY CYST, ACCESSED 50390 $2,565.00ASPIRATION AND/OR INJECTION OF CYSTS 20612 $674.00ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOIN 20610 $674.00ASPIRATION AND/OR INJECTION OF MEDIUM JOINT OR JOI 20605 $674.00ASPIRATION AND/OR INJECTION OF SMALL JOINT OR JOIN 20600 $757.00ASPIRATION AND/OR INJECTION OF THYROID CYST 60300 $1,543.00ASPIRATION INJECTION INTERMEDIATE JOINT OR JOINT C 20606 $1,039.00ASPIRATION OF ABDOMINAL CAVITY FLUID THROUGH THE V 57020 $9,092.00ASPIRATION OF ABSCESS, BLOOD ACCUMULATION, BLISTER 10160 $463.00ASPIRATION OF BLADDER USING CATHETER OR TROCAR 51101 $3,612.00ASPIRATION OF BLADDER WITH INSERTION OF BLADDER TU 51102 $5,200.00ASPIRATION OF BLOOD FROM EYE 65815 $7,484.00ASPIRATION OF BLOOD FROM SCALP OF FETUS 59030 $1,132.00ASPIRATION OF BREAST CYST 19000 $1,274.00ASPIRATION OF BREAST CYST 19100 $1,274.00ASPIRATION OF EYE FLUID 65800 $2,382.00ASPIRATION OF EYE FLUID 65810 $7,484.00ASPIRATION OF FETAL FLUID USING ULTRASOUND GUIDANC 59074 $863.00ASPIRATION OF FLUID COLLECTION IN TESTICLE AND SPE 55000 $1,594.00ASPIRATION OF FLUID FROM SAC THAT COVERS THE HEART 33010 $2,117.00ASPIRATION OF FLUID FROM SAC THAT COVERS THE HEART 33011 $3,932.00ASPIRATION OF LOWER SPINE DISC, ACCESSED THROUGH T 62287 $11,077.00ASPIRATION OF LUNG SECRETIONS FROM LUNG AIRWAYS US 31645 $3,410.00ASPIRATION OF LUNG SECRETIONS FROM LUNG AIRWAYS US 31646 $1,502.00ASPIRATION OR INJECTION OF CEREBROSPINAL FLUID SHU 61070 $1,962.00ASPIRATION OR RELEASE OF EYE FLUID BETWEEN THE LEN 67015 $7,642.00ASPIRATION SPINAL CORD CYST OR FLUID-FILLED CAVITY 62268 $2,525.00ASSAY OF BLOOD CHLORIDE 82435 $31.00ASSAY OF CALPROTECTIN FECAL 83993 $900.00ASSAY OF SERUM POTASSIUM 84132 $35.00ASSAY OF SERUM SODIUM 84295 $37.00ASSEMBLY CABLE PIN ZIMMER CABLE-READY COCR L91 CM $1,943.50ASSEMBLY EXTERNAL FIXATION OPTIROM ELBOW TARGET DI $1,267.50

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 ChargeASSEMBLY FIXATION ATOLL TITANIUM SPINE LOCK SCREW C1713 $325.00ASSEMBLY TUBE L520 MM STERILE REAMER IRRIGATOR ASP $2,374.91ASSESSMENT AIR LEAK AIRWAY SIZING & INSERT BRONCHI 31651 $5,801.00ASSESSMENT AND RECORDING OF ABNORMAL EYE MOVEMENT 92546 $638.00ASSESSMENT EXPRESSIVE & RECEPTIVE SPEECH W/INTERP 96105 $287.00ASSESSMENT HEARING LOSS W/PLACE PROBE IN EAR ASSES 92568 $174.00ASSESSMENT OF EARDRUM AND MUSCLE FUNCTION 92550 $174.00ASSESSMENT OF HEARING AID FUNCTION FOR BOTH EARS 92595 $68.00ASSESSMENT OF HEARING AID FUNCTION FOR ONE EAR 92594 $252.00ASSESSMENT OF HEARING LOSS AND SPEECH RECOGNITION 92556 $174.00ASSESSMENT OF HEARING USING SPEECH TEST WITH TONE 92572 $368.00ASSESSMENT OF SIMULTANEOUS BUT DIFFERENT HEARING T 92565 $174.00ASSESSMENT OF SPEECH HEARING LOSS 92555 $174.00ASSISTIVE TECHNOLOGY ASSESS TO ENHANCE FUNCTION PE 97755 $105.00ASXL1 GENE ANALYSIS FULL GENE SEQUENCE 81175 $3,169.00ASXL1 GENE ANALYSIS TARGETED SEQ ANALYSIS 81176 $1,344.00ATHENA GEN TST INH COND 81443 $11,019.00ATROPINE 0.1 MG/ML SYRG 10 ML SYRINGE J0461 $20.00ATTACHMENT ROD MR CONDITIONAL NONSTERILE LARGE MUL $2,500.36ATTACHMENT ROD MR CONDITIONAL NONSTERILE MEDIUM MU C1713 $2,208.83ATTACHMENT WALKER VINYL ADULT D18 IN C300 LB STAND $861.76ATTEMPT TO RESTART HEART AND LUNGS 92950 $777.00ATTENTION FUNCTIONAL LIMIT CURRENT STATUS AT THERA G9165 $0.01ATTENTION FUNCTIONAL LIMITED DISCHARGE STATUS G9167 $0.01ATTENTION FUNCTIONAL LIMITED PROJECTED GOAL STATUS G9166 $0.01AUGMENT ACETABULAR TRABECULAR METAL H10 MM OD54 MM C1776 $7,800.00AUGMENT ACETABULAR TRABECULAR METAL H10 MM OD62 MM C1776 $7,800.00AUGMENT ACETABULAR TRABECULAR METAL H15 MM OD70 MM C1776 $11,700.00AUGMENT ACETABULAR TRABECULAR METAL STRAIGHT OD58 C1776 $7,800.00AUGMENT FEMORAL ASCENT LARGE H8 MM KNEE LEFT POSTE C1776 $4,550.00AUGMENT FEMORAL ASCENT MEDIUM H8 MM KNEE LEFT POST C1776 $4,550.00AUGMENT FEMORAL ASCENT XS H4 MM KNEE RIGHT MEDIAL C1776 $4,550.00AUGMENT FEMORAL NEXGEN PRECOAT C H5 MM KNEE POSTER C1776 $4,550.00AUGMENT FEMORAL NEXGEN TIVANIUM PMMA PRECOAT B H5 C1776 $4,550.00AUGMENT FEMORAL NEXGEN TIVANIUM PMMA PRECOAT C H10 C1776 $4,550.00AUGMENT FEMORAL NEXGEN TIVANIUM PMMA PRECOAT G H10 C1776 $4,550.00AUGMENT FEMORAL NEXGEN TRABECULAR METAL D H5 MM KN C1776 $12,577.50AUGMENT FEMORAL NEXGEN TRABECULAR METAL E H10 MM K C1776 $12,577.50AUGMENT FEMORAL NEXGEN TRABECULAR METAL E H5 MM KN C1776 $11,170.25

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 ChargeAUGMENT FEMORAL NEXGEN TRABECULAR METAL F H10 MM K C1776 $13,487.50AUGMENT FEMORAL NEXGEN TRABECULAR METAL F H10 MM P C1776 $11,992.50AUGMENT FEMORAL NEXGEN TRABECULAR METAL F H5 MM DI C1776 $13,487.50AUGMENT FEMORAL NEXGEN TRABECULAR METAL F H5 MM KN C1776 $11,170.25AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 2 H4 MM KNE C1776 $4,550.00AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 2 H8 MM KNE C1776 $4,550.00AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 2.5 H16 MM C1776 $4,550.00AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 2.5 H4 MM K C1776 $4,550.00AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 2.5 H8 MM K C1776 $4,550.00AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 3 H4 MM KNE C1776 $4,550.00AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 4 H4 MM KNE C1776 $4,550.00AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 4 H8 MM KNE C1776 $4,550.00AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 6 H16 MM KN C1776 $4,550.00AUGMENT FEMORAL TRIATHLON 3 H5 MM RIGHT DISTAL KNE C1776 $5,156.97AUGMENT FEMORAL VANGUARD 360 LARGE KNEE CRUCIATE W C1776 $5,600.00AUGMENT FEMORAL VANGUARD 360 SMALL KNEE CRUCIATE W C1776 $4,550.00AUGMENT TIBIAL GMK THK15 MM 3 LEFT MEDIAL RIGHT LA C1776 $4,550.00AUGMENT TIBIAL GMK THK15 MM 5 LEFT MEDIAL RIGHT LA C1776 $4,550.00AUGMENT TIBIAL GMK THK15 MM 5 RIGHT MEDIAL LEFT LA C1776 $4,550.00AUGMENT TIBIAL MBT 1 H15 MM KNEE REVISION STEP WED C1776 $6,500.00AUGMENT TIBIAL MBT 2.5 H5 MM KNEE REVISION STEP WE C1776 $6,500.00AUGMENT TIBIAL MBT 3 H10 MM KNEE REVISION STEP WED C1776 $6,500.00AUGMENT TIBIAL TRABECULAR METAL MEDIUM CONE H31 MM C1776 $26,000.00AUGMENT TIBIAL TRABECULAR METAL MEDIUM CONE H34 MM C1776 $26,000.00AUGMENT TIBIAL VANGUARD 360 L63 MM X H15 MM KNEE L C1776 $4,550.00AUTOMATED URINALYSIS TEST 81003 $17.00AUTOPSY 88000 $1,376.00AUTOPSY OF INFANT INCLUDING BRAIN AND MICROSCOPIC 88028 $446.00AUTOPSY OF INFANT WITH EXAMINATION OF BRAIN 88012 $2,979.00AUTOPSY OF STILLBORN INFANT 88016 $1,863.00AUTOPSY OF STILLBORN OR NEWBORN INFANT WITH EXAMIN 88029 $269.00AUTOPSY OF STILLBORN OR NEWBORN INFANT WITH EXAMIN 88014 $1,376.00AUTOPSY ONLY WITH BRAIN 88005 $760.00AUTOPSY WITH EXAM OF BRAIN AND MICROSCOPIC EXAM OF 88025 $163.00AUTOPSY WITH EXAM OF BRAIN AND SPINAL CORD AND MIC 88027 $153.00AUTOPSY WITH EXAMINATION OF BRAIN AND SPINAL CORD 88007 $755.00AUTOPSY WITH MICROSCOPIC EXAMINATION OF TISSUE 88020 $668.00AXLE FEMORAL GMRS SMALL KNEE C1776 $6,290.70AXLE FEMORAL OSS KNEE REDUCE SIZE C1776 $3,696.00

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 ChargeAXLE TIBIAL OSS KNEE LOW FRICTION INTERFACE C1776 $3,696.00AZITHROMYCIN 250 MG TAB 100 EACH BLIST PACK $8.62AZITHROMYCIN 600 MG TAB 30 EACH BOTTLE $4.08B CELLS TOTAL COUNT 86355 $293.00BACTERIAL COLONY COUNT, URINE 87086 $63.00BACTERIAL CULTURE 87070 $78.00BACTERIAL CULTURE 87075 $73.00BAG SPECIMEN RETRIEVAL ENDOPOUCH PLASTIC LARGE L6 $150.00BALANCED SALT SOLUTION (REGULAR) SOLN 500 ML BAG $32.50BALLOON CATHETER ENLARGEMENT OF OPENING BETWEEN TW 92992 $152.00BALLOON CATHETER OPENING OF MAJOR LUNG ARTERY 92997 $38,677.00BALLOON CATHETER OPENING OF MAJOR LUNG ARTERY 92998 $19,443.00BALLOON DILATION OF ADDITIONAL VEIN ACCESSED THROU 37249 $686.00BALLOON DILATION OF ARTERIES IN ONE LEG ENDOVASCUL 37224 $15,266.00BALLOON DILATION OF ARTERY ACCESSED THROUGH THE SK 37246 $20,541.00BALLOON DILATION OF ARTERY ACCESSED THROUGH THE SK 37247 $806.00BALLOON DILATION OF ARTERY IN ONE LEG ENDOVASCULAR 37232 $15,266.00BALLOON DILATION OF ARTERY IN ONE SIDE OF GROIN EN 37220 $14,457.00BALLOON DILATION OF ARTERY OF ONE LEG ENDOVASCULAR 37228 $15,266.00BALLOON DILATION OF BILE DUCT 47542 $240.00BALLOON DILATION OF DIALYSIS SEGMENT ACCESSED THRO 36907 $570.00BALLOON DILATION OF ESOPHAGUS STOMACH/UPPER SMALL 43233 $1,131.00BALLOON DILATION OF ESOPHAGUS USING AN ENDOSCOPE 43214 $5,710.00BALLOON DILATION OF ESOPHAGUS USING AN ENDOSCOPE 43220 $4,137.00BALLOON DILATION OF ESOPHAGUS USING AN ENDOSCOPE 43249 $4,137.00BALLOON DILATION OF FIRST VEIN ACCESSED THROUGH TH 37248 $20,541.00BALLOON DILATION OF GROIN ARTERY ENDOVASCULAR OPEN 37222 $17,959.00BALLOON DILATION OF LARGE BOWEL USING AN ENDOSCOPE 45386 $2,550.00BALLOON DILATION OF NARROWED OR BLOCKED MAJOR CORO 92920 $19,443.00BALLOON DILATION OF NARROWED OR BLOCKED MAJOR CORO 92921 $16,527.00BALLOON DILATION OF PANCREATIC OR BILE DUCT USING 43277 $8,711.00BALLOON DISSECTOR LAPAROSCOPIC PDB SPACEMAKER EXTR C1727 $1,525.55BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER 240 CC S C1727 $3,299.40BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER EXTRA VI C1727 $1,525.55BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER II 300 C C1727 $3,299.40BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER PLUS BTT C1727 $2,344.55BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER PLUS FOA C1727 $2,537.67BALLOON ENDOSCOPIC CUFF ULTRASOUND LATEX C1726 $119.81BALLOON ENDOSCOPIC L8 CM L75 CM OD30 MM ODSEC16 FR C1726 $1,500.00

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 ChargeBALLOON ENDOSCOPIC L8 CM L75 CM OD35 MM ODSEC16 FR C1726 $1,500.00BALLOON ENDOSCOPIC STERILE LATEX BFUC160F C1726 $2,396.25BALLOON EXTRACTION FUSION NATURAL RUBBER .035 IN L $450.00BALLOON EXTRACTION FUSION QUATTRO NATURAL RUBBER . $500.00BALLOON OCCLUSION OF HEAD OR NECK ARTERY 61623 $34,244.00BALLOON RETRIEVAL EXTRACTOR PRO RX L200 CM OD6-7 F $1,430.52BALLOON SIZING AMPLATZER L70 CM L3.5 CM ODSEC20 MM $1,381.10BALLOON SIZING AMPLATZER L70 CM L4.5 CM OD27 MM 25 $1,381.10BALLOON SIZING AMPLATZER L70 CM L5.5 CM ODSEC40 MM $1,381.10BALLOON SIZING BARRX 360 OD47.5 MM ESOPHAGEAL STER $2,684.50BAND ANNULOPLASTY CG FUTURE OD26 MM 10 L $10,400.00BAND ANNULOPLASTY CG FUTURE OD28 MM $10,400.00BAND ANNULOPLASTY CG FUTURE OD30 MM 10 L $10,400.00BAND ANNULOPLASTY CG FUTURE OD32 MM $10,400.00BAND ANNULOPLASTY CG FUTURE OD34 MM $10,400.00BAND ANNULOPLASTY CG FUTURE OD36 MM $10,400.00BAND ANNULOPLASTY CG FUTURE OD38 MM $10,400.00BAND ANNULOPLASTY DURAN ANCORE L10 MM OD31 MM CHOR $6,500.00BAND ANNULOPLASTY DURAN ANCORE L10 MM OD35 MM CHOR $6,500.00BAND ANNULOPLASTY DURAN ANCORE L59 MM OD23 MM CHOR $6,500.00BAND ANNULOPLASTY DURAN ANCORE OD25 MM $6,500.00BAND ANNULOPLASTY DURAN ANCORE OD27 MM 10 L $6,500.00BAND ANNULOPLASTY DURAN ANCORE OD29 MM 10 L $6,500.00BAND ANNULOPLASTY DURAN ANCORE OD33 MM 10 L $6,500.00BAND SPINAL NILE W3 MM STERILE ALTERNATIVE FIXATIO C1713 $4,157.40BAND SPINAL NILE W3 MM STERILE LATEX FREE ALTERNAT C1713 $4,157.40BAND SPINAL VAIL TITANIUM L35 MM CROSS HEAD TO HEA C1713 $3,250.00BAR EXTERNAL FIXATION ALUMINUM XSHORT HEX L203 MM $3,284.40BAR EXTERNAL FIXATION BENT L220 MM $1,022.40BAR EXTERNAL FIXATION BENT L250 MM STABILIZE $1,022.40BAR EXTERNAL FIXATION BENT U L190 MM $1,022.40BAR EXTERNAL FIXATION DYNAFIX VISION L $1,730.56BAR EXTERNAL FIXATION DYNAFIX VISION L150 MM METAP $902.40BAR EXTERNAL FIXATION DYNAFIX VISION L180 MM METAP $1,109.76BAR EXTERNAL FIXATION HEX-FIX ALUMINUM LONG HEX L5 $4,263.60BAR EXTERNAL FIXATION HEX-FIX ALUMINUM MEDIUM HEX $6,956.40BAR EXTERNAL FIXATION HEX-FIX LONG HEXAGONAL L508 $6,956.40BAR EXTERNAL FIXATION HEX-FIX STAINLESS STEEL LONG $3,863.68BAR EXTERNAL FIXATION HEX-FIX Z $6,173.55

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 ChargeBAR EXTERNAL FIXATION JET-X CARBON FIBER L L160 MM $1,450.16BAR EXTERNAL FIXATION JET-X CARBON FIBER L100 MM N $1,303.92BAR EXTERNAL FIXATION JET-X CARBON FIBER L100 MM O $1,079.76BAR EXTERNAL FIXATION JET-X CARBON FIBER L150 MM N $1,343.76BAR EXTERNAL FIXATION JET-X CARBON FIBER L150 MM O $691.84BAR EXTERNAL FIXATION JET-X CARBON FIBER L200 MM N $1,376.96BAR EXTERNAL FIXATION JET-X CARBON FIBER L225 MM O $864.80BAR EXTERNAL FIXATION JET-X CARBON FIBER L250 MM N $1,416.96BAR EXTERNAL FIXATION JET-X CARBON FIBER L300 MM N $1,450.16BAR EXTERNAL FIXATION JET-X CARBON FIBER L350 MM N $1,490.16BAR EXTERNAL FIXATION JET-X CARBON FIBER L400 MM N $1,523.36BAR EXTERNAL FIXATION JET-X CARBON FIBER L50 MM OD $484.00BAR EXTERNAL FIXATION JET-X CARBON FIBER L500 MM S $1,596.56BAR EXTERNAL FIXATION JET-X CARBON FIBER L600 MM S $1,736.24BAR EXTERNAL FIXATION JET-X CARBON FIBER MINI L185 $716.00BAR EXTERNAL FIXATION JET-X CARBON FIBER MINI L75 $516.56BAR EXTERNAL FIXATION JET-X CARBON FIBER MINI OFFS $1,268.00BAR EXTERNAL FIXATION JET-X CARBON FIBER V L180 MM $1,450.16BAR EXTERNAL FIXATION L120 MM CONNECT EXTERNAL MID $1,208.00BAR EXTERNAL FIXATION L50 MM CONNECT EXTERNAL MIDF $1,208.00BAR EXTERNAL FIXATION LARGE BENT $1,003.20BAR EXTERNAL FIXATION RECLAIM TENSILE ASSEMBLY TOO $925.60BAR EXTERNAL FIXATION SMALL BENT OD6 MM $916.80BAR EXTERNAL FIXATION STAINLESS STEEL L120 MM OD8 $911.95BAR EXTERNAL FIXATION XSHORT HEX L203 MM COMPOSITE $4,120.80BAR SPINAL EXPEDIUM STAINLESS STEEL OD5.5 MM LATER C1713 $4,000.00BAR SPINAL EXPEDIUM STAINLESS STEEL STANDARD OD5.5 C1713 $4,000.00BAR SPINAL STAINLESS STEEL L15 MM OD5 MM TRANSVERS C1713 $2,000.00BAR SPINAL STAINLESS STEEL L20 MM OD5 MM TRANSVERS C1713 $2,000.00BAR SPINAL STAINLESS STEEL L200 MM OD6 MM SACRAL T C1713 $4,370.00BAR SPINAL STAINLESS STEEL L25 MM OD5 MM TRANSVERS C1713 $2,000.00BAR SPINAL STAINLESS STEEL L260 MM OD6 MM SPINE TH C1713 $4,370.00BAR SPINAL TITANIUM L20 MM OD6 MM TRANSVERSE NONST C1713 $2,000.00BAR SPINAL TITANIUM L25 MM OD6 MM TRANSVERSE NONST C1713 $2,000.00BAR SPINAL TITANIUM L30 MM OD6 MM TRANSVERSE NONST C1713 $2,000.00BAR SPINAL VEPTR II DISTRACTION LOCK REMOVAL NONST C1713 $1,960.00BAR SPINAL VEPTR II TITANIUM L15 MM OD6 MM TRANSVE C1713 $2,236.80BAR SPINAL VEPTR II TITANIUM L20 MM OD6 MM TRANSVE C1713 $2,236.80BAR SPINAL VEPTR II TITANIUM L25 MM OD6 MM TRANSVE C1713 $2,236.80

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 ChargeBAR SPINAL VEPTR II TITANIUM L30 MM OD6 MM TRANSVE C1713 $2,236.80BAR SUPPORT L10.5 IN PECTUS C1713 $9,720.00BAR SUPPORT L11.5 IN PECTUS C1713 $9,720.00BAR SUPPORT L14.5 IN PECTUS C1713 $9,720.00BAR SUPPORT L16.5 IN PECTUS C1713 $9,720.00BAR SUPPORT LORENZ L8.5 IN PECTUS C1713 $9,720.00BAR SUPPORT STAINLESS STEEL L11 IN PECTUS ROUND EN $9,720.00BAR SUPPORT STAINLESS STEEL L14 IN PECTUS ROUND EN $9,720.00BAR SUPPORT STAINLESS STEEL L34.3 CM STERNUM PECTU C1713 $9,720.00BAR SUPPORT STAINLESS STEEL L39.4 CM STERNUM PECTU C1713 $9,720.00BAR SUPPORT STAINLESS STEEL L7.5 IN PECTUS STERNUM $9,720.00BAR SUPPORT STAINLESS STEEL L9.5 IN PECTUS STERNUM C1713 $9,720.00BAR SUPPORT STAINLESS STEEL ROUND BLUNT L12 IN PEC C1713 $9,720.00BAR SUPPORT STAINLESS STEEL ROUND BLUNT L15 IN PEC C1713 $9,720.00BAR SUPPORT STAINLESS STEEL ROUND BLUNT L8 IN PECT C1713 $9,720.00BAR SUPPORT STAINLESS STEEL ROUND L10 IN PECTUS BL C1713 $9,720.00BAR SUPPORT STAINLESS STEEL ROUND L13 IN PECTUS BL C1713 $9,720.00BAR SUPPORT STAINLESS STEEL ROUND L16 IN PECTUS BL C1713 $9,720.00BAR SUPPORT STAINLESS STEEL ROUND L17 IN PECTUS BL C1713 $9,720.00BAR SUPPORT STAINLESS STEEL ROUND L7 IN PECTUS BLU C1713 $9,720.00BARBITURATES LEVELS 80345 $75.00BARRIER ADHESION GYNECARE INTERCEED L4 IN X W3 IN $1,392.98BARRIER ADHESION GYNECARE INTERCEED L6 IN X W5 IN C1765 $1,892.97BARRIER ADHESION SEPRAFILM L3 IN X W5 IN 6 HALF SH C1765 $5,421.92BARRIER ADHESION SEPRAFILM L6 IN X W5 IN STERILE L C1765 $1,748.50BARTONELLA AB IGG 86611 $79.00BARTONELLA AB IGM 86611 $79.00BASEPLATE GLENOID CALCIUM PHOSPHATE SMALL SHOULDER C1776 $11,147.50BASEPLATE GLENOID COMPREHENSIVE TITANIUM HA POROUS C1776 $6,500.00BASEPLATE GLENOID EQUINOXE 10 D 8 D SHOULDER RIGHT C1776 $10,400.00BASEPLATE GLENOID EQUINOXE 8 D SHOULDER RIGHT POST C1776 $10,400.00BASEPLATE GLENOID LARGE UNIVERSAL SHOULDER C1776 $11,147.50BASEPLATE GLENOID MEDIUM UNIVERSAL SHOULDER $11,147.50BASEPLATE GLENOID REUNION OD28 MM SHOULDER STERILE C1776 $7,962.50BASEPLATE GLENOID RSP P2 L30 MM SHOULDER STERILE L C1776 $7,800.00BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE C1776 $20,260.50BASEPLATE TIBIAL AGC INTERLOK COCR UMHWPE L80 MM X C1776 $9,100.00BASEPLATE TIBIAL ATTUNE 3 KNEE CEMENTED FIX BEARIN C1776 $5,850.00BASEPLATE TIBIAL ATTUNE 4 KNEE CEMENT REVISION FIX C1776 $16,250.00

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 ChargeBASEPLATE TIBIAL ATTUNE 4 KNEE CEMENTED FIX BEARIN C1776 $5,850.00BASEPLATE TIBIAL ATTUNE 5 KNEE CEMENTED FIX BEARIN C1776 $5,850.00BASEPLATE TIBIAL ATTUNE 5 KNEE CEMENTED ROTATE PLA C1776 $5,850.00BASEPLATE TIBIAL ATTUNE 6 KNEE CEMENT FIX BEARING C1776 $5,850.00BASEPLATE TIBIAL ATTUNE 7 KNEE CEMENT FIX BEARING C1776 $5,850.00BASEPLATE TIBIAL ATTUNE 8 KNEE CEMENT FIX BEARING C1776 $5,850.00BASEPLATE TIBIAL ATTUNE 9 KNEE CEMENT FIX BEARING C1776 $7,200.00BASEPLATE TIBIAL JOURNEY 2 KNEE RIGHT BICRUCIATE S C1776 $5,850.00BASEPLATE TIBIAL JOURNEY 3 D 2 L64 MM X W45 MM L50 C1776 $5,850.00BASEPLATE TIBIAL JOURNEY 4 KNEE RIGHT BICRUCIATE S C1776 $5,850.00BASEPLATE TIBIAL JOURNEY 5 KNEE RIGHT BICRUCIATE S C1776 $5,850.00BASEPLATE TIBIAL JOURNEY NONPOROUS 6 LEFT KNEE BIC C1776 $5,850.00BASEPLATE TIBIAL LEGION TITANIUM NONPOROUS 4 KNEE C1776 $5,850.00BASEPLATE TIBIAL NATURAL-KNEE II POROUS 3 KNEE RIG C1776 $7,150.00BASEPLATE TIBIAL OSS SHORT L63 MM KNEE NONMODULAR C1776 $27,236.00BASEPLATE TIBIAL PERSONA 5 D C KNEE RIGHT CEMENTED C1776 $5,850.00BASEPLATE TIBIAL PERSONA 5 D D KNEE LEFT CEMENTED C1776 $5,850.00BASEPLATE TIBIAL PERSONA 5 D F KNEE LEFT CEMENTED C1776 $5,850.00BASEPLATE TIBIAL PERSONA 5 D G KNEE LEFT CEMENTED C1776 $5,850.00BASEPLATE TIBIAL PERSONA 5 D H KNEE LEFT CEMENTED C1776 $5,850.00BASEPLATE TIBIAL PERSONA 5 D H KNEE RIGHT CEMENTED C1776 $5,850.00BASEPLATE TIBIAL PERSONA NATURAL TIBIA 5 D D KNEE C1776 $5,850.00BASEPLATE TIBIAL PERSONA NATURAL TIBIA 5 D E KNEE C1776 $5,850.00BASEPLATE TIBIAL PERSONA NATURAL TIBIA 5 D F KNEE C1776 $5,850.00BASEPLATE TIBIAL PERSONA TIVANIUM 5 D C KNEE LEFT C1776 $5,850.00BASEPLATE TIBIAL PERSONA TIVANIUM 5 D G KNEE RIGHT C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON 2 KNEE CEMENTED PRIMARY C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON 4 KNEE CEMENTED PRIMARY C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON 7 KNEE CEMENTED PRIMARY C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON COCR 1 UNIVERSAL KNEE C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON COCR 2 UNIVERSAL KNEE C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON COCR 5 UNIVERSAL KNEE C C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON COCR 6 UNIVERSAL KNEE C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON COCR 8 UNIVERSAL KNEE T C1776 $5,850.00BASEPLATE TIBIAL TRIATHLON TRITANIUM 4 KNEE C1776 $7,150.00BASEPLATE TIBIAL TRIATHLON TRITANIUM 5 KNEE C1776 $7,150.00

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 ChargeBASEPLATE TIBIAL VANGUARD 360 L63 MM KNEE MODULAR C1776 $11,700.00BASKET SPECIMEN RETRIEVAL FALCON L230 CM L6 CM X W $747.50BASKET SPECIMEN RETRIEVAL MINI HELIX L115 CM W11 M $2,314.00BASKET STONE RETRIEVAL BAGLEY HELICAL L90 CM OD10 $1,182.32BASKET STONE RETRIEVAL ESCAPE NITINOL L120 CM OD1. $1,473.33BASKET STONE RETRIEVAL FUSION .035 IN L208 CM L4 C $1,350.00BASKET STONE RETRIEVAL FUSION OD.035 IN L4 CM L4.2 $800.00BASKET STONE RETRIEVAL GEMINI HELICAL L120 CM OD11 $1,530.00BASKET STONE RETRIEVAL GEMINI HELICAL L90 CM OD11 $1,364.48BASKET STONE RETRIEVAL MINI L200 CM L1.3 CM OD4 FR $1,170.00BASKET STONE RETRIEVAL SEGURA HEMISPHERE PERMAFORM $1,364.49BASKET STONE RETRIEVAL THE WEB L220 CM L4 CM OD2 C $675.00BASKET STONE RETRIEVAL TRAPEZOID METAL L3.2 MM L4 $2,332.20BASKET STONE RETRIEVAL ZERO TIP NITINOL L120 CM OD $1,215.63BASKET STONE RETRIEVAL ZERO TIP NITINOL L90 CM OD1 $1,379.36BEARING HIP ACTIVE ARTICULATION ARCOMXL OD42 MM ST C1776 $4,225.00BEARING HIP ACTIVE ARTICULATION E1 OD40 MM STERILE C1776 $4,225.00BEARING HIP ACTIVE ARTICULATION E1 OD42 MM STERILE C1776 $4,225.00BEARING HIP ACTIVE ARTICULATION E1 OD44 MM STERILE C1776 $4,225.00BEARING HIP ACTIVE ARTICULATION E1 OD50 MM STERILE C1776 $4,225.00BEARING HIP ACTIVE ARTICULATION G OD46 MM ID28 MM C1776 $4,225.00BEARING HUMERAL COMPREHENSIVE ARCOMXL STANDARD OD3 C1776 $4,550.00BEARING TIBIAL OSS H12 MM KNEE LATERAL STABILIZE R C1776 $7,744.00BEARING TIBIAL OSS UHMWPE STANDARD H12 MM KNEE STE C1776 $9,196.00BEARING TIBIAL OSS UHMWPE STANDARD H16 MM KNEE STE C1776 $9,196.00BEARING TIBIAL OXFORD ARCOM LARGE H3 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H3 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H4 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H4 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H5 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H5 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H6 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H7 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H7 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H8 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H9 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM LARGE H9 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H3 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H3 MM KNEE RIGH C1776 $3,900.00

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 ChargeBEARING TIBIAL OXFORD ARCOM MEDIUM H4 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H4 MM KNEE RIGH C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H5 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H5 MM KNEE RIGH C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H6 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H6 MM KNEE RIGH C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H7 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H7 MM KNEE RIGH C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H8 MM KNEE RIGH C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H9 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM MEDIUM H9 MM KNEE RIGH C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H3 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H3 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H4 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H4 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H5 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H5 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H6 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H6 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H7 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H7 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H8 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H9 MM KNEE LEFT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM SMALL H9 MM KNEE RIGHT C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM XS H3 MM KNEE LEFT MEN C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM XS H4 MM KNEE RIGHT ME C1776 $3,900.00BEARING TIBIAL OXFORD ARCOM XS H5 MM KNEE RIGHT ME C1776 $3,900.00BEARING TIBIAL VANGUARD ARCOM 0 D L63/67 MM X H12 C1776 $3,900.00BEARING TIBIAL VANGUARD ARCOM 0 D L79/83 MM X H10 C1776 $3,900.00BEARING TIBIAL VANGUARD ARCOM 3 D STANDARD L63/67 C1776 $3,900.00BEARING TIBIAL VANGUARD ARCOM 3 D STANDARD L71/75 C1776 $3,900.00BEARING TIBIAL VANGUARD ARCOM 3 D STANDARD L79/83 C1776 $3,900.00BEARING TIBIAL VANGUARD E1 L63/67 MM X H10 MM KNEE C1776 $4,800.00BEARING TIBIAL VANGUARD E1 L71/75 MM X H10 MM KNEE C1776 $4,800.00BEARING TIBIAL VANGUARD E1 L75 MM X H10 MM KNEE AN C1776 $3,900.00BEARING TIBIAL VANGUARD E1 L79/83 MM X H10 MM KNEE C1776 $4,800.00BEARING TIBIAL VANGUARD M D4 KNEE LEFT MEDIAL RIGH C1776 $3,900.00BEARING TIBIAL VANGUARD POROUS L63/67 MM X H12 MM C1776 $3,900.00BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND R 92524 $451.00

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 ChargeBENDER PLATE 3D CUTTER TYPE A 2.3/2.7 MM $6,287.04BENDER PLATE 3D CUTTER TYPE B 2.3/2.7 MM $7,009.28BENZODIAZEPINES LEVELS 80346 $124.00BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEAS 86146 $90.00BETA-2 MICROGLOBULIN 82232 $126.00BEVACIZUMAB 25 MG/ML SOLN 0.2 ML SYRINGE C9257 $47.38BILIRUBIN LEVEL 82247 $34.00BILIRUBIN LEVEL 82248 $34.00BIOFEEDBACK TRAINING 90901 $396.00BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL 90911 $396.00BIOPSIES OF ANUS WITH MAGNIFICATION AND CHEMICAL A 46607 $4,070.00BIOPSIES OF LARGE BOWEL 44389 $3,086.00BIOPSY AND SCRAPING OF THE CERVIX USING AN ENDOSCO 57454 $863.00BIOPSY AND/OR REMOVAL OF POLYP OF THE UTERUS USING 58558 $548.00BIOPSY OF ABDOMEN USING AN ENDOSCOPE 49321 $18,384.00BIOPSY OF ANUS USING AN ENDOSCOPE 46606 $3,459.00BIOPSY OF BACK OF THROAT 42800 $4,233.00BIOPSY OF BILE DUCT OR LIVER DUCT 47543 $375.00BIOPSY OF BILE DUCTS USING AN ENDOSCOPE, ACCESSED 47553 $9,052.00BIOPSY OF BLOOD VESSEL VIA CATHETER 37200 $7,459.00BIOPSY OF BONE USING NEEDLE OR TROCAR 20220 $2,153.00BIOPSY OF BONE, OPEN PROCEDURE 20240 $6,128.00BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH MR 19085 $2,554.00BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH MR 19086 $1,586.00BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH ST 19081 $2,554.00BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH UL 19083 $3,172.00BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH UL 19084 $1,586.00BIOPSY OF CERVIX OR EXCISION OF LOCAL GROWTHS 57500 $2,066.00BIOPSY OF CERVIX USING AN ENDOSCOPE 57455 $863.00BIOPSY OF CERVIX USING AN ENDOSCOPE 57460 $5,366.00BIOPSY OF EAR 69100 $848.00BIOPSY OF EAR CANAL 69105 $4,233.00BIOPSY OF ESOPHAGUS USING AN ENDOSCOPE 43202 $2,300.00BIOPSY OF ESOPHAGUS USING AN ENDOSCOPE 43193 $5,710.00BIOPSY OF EXTENSIVE AREA OF VAGINAL MUCOUS MEMBRAN 57105 $5,366.00BIOPSY OF EXTERNAL FEMALE GENITALS 56605 $863.00BIOPSY OF EXTERNAL FEMALE GENITALS 56606 $438.00BIOPSY OF EYELID 67810 $855.00BIOPSY OF FINGER OR TOE NAIL 11755 $1,241.00

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 ChargeBIOPSY OF FLOOR OF MOUTH 41108 $5,393.00BIOPSY OF GALLBLADDER, PANCREATIC, LIVER, AND BILE 43261 $5,783.00BIOPSY OF LARGE BOWEL USING AN ENDOSCOPE 45331 $1,801.00BIOPSY OF LARGE BOWEL USING AN ENDOSCOPE 45380 $3,189.00BIOPSY OF LINING OF NOSE 30100 $1,840.00BIOPSY OF LIP 40490 $848.00BIOPSY OF LUNG AIRWAYS USING AN ENDOSCOPE 31625 $3,243.00BIOPSY OF LUNG USING AN ENDOSCOPE 31632 $3,410.00BIOPSY OF MOUTH 40808 $848.00BIOPSY OF MUSCLE 20200 $4,139.00BIOPSY OF ONE LOBE OF LUNG USING AN ENDOSCOPE 31628 $2,965.00BIOPSY OF PENIS 54100 $5,502.00BIOPSY OF PROSTATE GLAND 55700 $3,568.00BIOPSY OF RECTUM 45100 $5,301.00BIOPSY OF RECTUM AND LARGE BOWEL USING AN ENDOSCOP 45305 $3,002.00BIOPSY OF ROOF OF MOUTH 42100 $4,553.00BIOPSY OF SALIVARY GLAND 42405 $6,639.00BIOPSY OF SCLERA 68100 $7,246.00BIOPSY OF SMALL BOWEL 44382 $3,462.00BIOPSY OF SMALL BOWEL USING AN ENDOSCOPE 44361 $3,351.00BIOPSY OF SMALL BOWEL USING AN ENDOSCOPE 44377 $205.00BIOPSY OF SMALL BOWEL USING AN ENDOSCOPE 44386 $2,840.00BIOPSY OF SOFT TISSUE OF LEG OR ANKLE 27613 $5,393.00BIOPSY OF SOFT TISSUE OF NECK OR CHEST 21550 $4,139.00BIOPSY OF SOFT TISSUE OF UPPER ARM OR ELBOW 24065 $4,139.00BIOPSY OF THE BLADDER USING AN ENDOSCOPE 52204 $7,042.00BIOPSY OF THE WALL DIVIDING THE LEFT AND RIGHT HEA 93505 $4,753.00BIOPSY OF THIGH OR KNEE REGION TISSUE 27323 $5,393.00BIOPSY OF THROAT LESION BEHIND NOSE 42804 $8,797.00BIOPSY OF TISSUE OF BACK OR FLANK 21920 $5,393.00BIOPSY OF TISSUE OF FOREARM AND/OR WRIST 25065 $5,393.00BIOPSY OF TISSUE OF PELVIS AND HIP 27040 $5,393.00BIOPSY OF TISSUE OF SHOULDER AREA 23065 $5,393.00BIOPSY OF TISSUE OR MUSCLE OF LOWER LEG OR ANKLE 27614 $187.00BIOPSY OF TONGUE 41100 $1,840.00BIOPSY OF TONGUE 41105 $8,797.00BIOPSY OF URINARY DUCT USING IMAGING GUIDANCE 50606 $750.00BIOPSY OF UTERINE LINING 58100 $438.00BIOPSY OF VAGINA AND CERVIX USING AN ENDOSCOPE 57421 $863.00

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 ChargeBIOPSY OF VAGINAL MUCOUS MEMBRANE 57100 $1,838.00BIOPSY OF VOICE BOX USING A FLEXIBLE ENDOSCOPE 31576 $4,988.00BIOPSY OF VOICE BOX USING AN ENDOSCOPE 31535 $9,250.00BIOPSY OR REMOVAL OF LYMPH NODES OF NECK, OPEN PRO 38510 $6,540.00BIOPSY OR REMOVAL OF LYMPH NODES OF UNDER THE ARM, 38525 $8,125.00BIOPSY OR REMOVAL OF LYMPH NODES, OPEN PROCEDURE 38500 $6,714.00BIOPSY OR REMOVAL OF NASAL POLYP OR TISSUE USING A 31237 $4,988.00BIOPSY ORAL TISSUE D7285 $745.00BIOPSY ORAL TISSUE D7286 $653.00BIOPSY THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL 43239 $2,839.00BIOPSY VOICE BOX USING AN ENDOSCOPE WITH OPERATING 31536 $6,036.00BIT DRILL 100 MM 3 FLUTE L330 MM OD3.2 MM CALIBRAT $1,333.80BIT DRILL 100 MM 3 FLUTE L330 MM OD4.2 MM CALIBRAT $1,333.80BIT DRILL 100 MM 3 FLUTE L330 MM OD5 MM CALIBRATE $1,333.80BIT DRILL 12 MM L44.5 MM OD.76 MM J LATCH COUPLING $1,107.41BIT DRILL 126 MM 3 FLUTE L356 MM OD5 MM CALIBRATE $1,363.44BIT DRILL 126 MM CALIBRATION L356 MM OD5 MM QUICK $1,637.61BIT DRILL 135 MM L165 MM OD4.5 MM CANNULATED JACOB $1,997.00BIT DRILL 14 MM STOP L44.5 MM OD.76 MM J LATCH COU $1,107.41BIT DRILL 140 MM L400 MM OD2.5 MM JACOBS CHUCK CAL $3,601.76BIT DRILL 2 FLUTE L165 MM OD2.8 MM QUICK COUPLING $512.01BIT DRILL 2 FLUTE L180 MM L154 MM OD2.5 MM QUICK C $463.06BIT DRILL 3 FLUTE L100 MM OD2 MM QUICK COUPLING NO $722.16BIT DRILL 3 FLUTE L110 MM OD2.5 MM QUICK COUPLING $782.00BIT DRILL 3 FLUTE L110 MM OD2.7 MM QUICK COUPLING $804.96BIT DRILL 3 FLUTE L110 MM OD3.5 MM QUICK COUPLING $679.44BIT DRILL 3 FLUTE L125 MM OD2.7 MM QUICK COUPLING $429.51BIT DRILL 3 FLUTE L145 MM OD3.2 MM QUICK COUPLING $648.56BIT DRILL 3 FLUTE L145 MM OD4.2 MM QUICK COUPLING $952.19BIT DRILL 3 FLUTE L145 MM OD4.5 MM QUICK COUPLING $648.56BIT DRILL 3 FLUTE L150 MM OD2 MM QUICK COUPLING BR $1,782.96BIT DRILL 3 FLUTE L150 MM OD2.7 MM QUICK COUPLING $1,782.96BIT DRILL 3 FLUTE L150 MM OD3.2 MM ODSEC2.9 MM QUI $1,037.40BIT DRILL 3 FLUTE L150 MM OD3.5 MM QUICK COUPLING $1,782.96BIT DRILL 3 FLUTE L150 MM OD3.9 MM ODSEC4.2 MM QUI $1,037.40BIT DRILL 3 FLUTE L180 MM OD2.5 MM QUICK COUPLING $782.00BIT DRILL 3 FLUTE L195 MM OD3.2 MM QUICK COUPLING $961.36BIT DRILL 3 FLUTE L195 MM OD3.5 MM QUICK COUPLING $1,016.88BIT DRILL 3 FLUTE L195 MM OD4 MM QUICK COUPLING NO $1,016.88

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 ChargeBIT DRILL 3 FLUTE L195 MM OD4 MM QUICK COUPLING ST $1,100.39BIT DRILL 3 FLUTE L195 MM OD4.5 MM QUICK COUPLING $961.36BIT DRILL 3 FLUTE L195 MM OD6 MM QUICK COUPLING NO $1,246.56BIT DRILL 3 FLUTE L210 MM L68 MM OD3.2 MM QUICK CO $1,159.20BIT DRILL 3 FLUTE L215 MM L80 MM OD4 MM CALIBRATE $1,641.60BIT DRILL 3 FLUTE L215 MM L82 MM OD3.2 MM CALIBRAT $1,436.40BIT DRILL 3 FLUTE L225 MM L100 MM OD4 MM ODSEC4.5 $1,691.76BIT DRILL 3 FLUTE L225 MM OD3.5 MM QUICK COUPLING $837.20BIT DRILL 3 FLUTE L230 MM L200 MM OD2.5 MM QUICK C $1,334.26BIT DRILL 3 FLUTE L230 MM L200 MM OD3.2 MM QUICK C $1,610.00BIT DRILL 3 FLUTE L270 MM OD3.8 MM QUICK COUPLING $1,178.19BIT DRILL 3 FLUTE L330 MM L100 MM OD4.2 MM TIBIAL $1,607.97BIT DRILL 3 FLUTE L330 MM L100 MM OD5 MM CALIBRATE $2,079.36BIT DRILL 3 FLUTE L331 MM OD3.2 MM ODSEC2.9 MM QUI $1,274.52BIT DRILL 35 MM STOP L60 MM OD1 MM J LATCH NONSTER $791.83BIT DRILL 4 FLUTE L225 MM OD3.2 MM CANNULATED NONS $2,276.11BIT DRILL 4 MM STOP L48 MM OD1.2 MM TWIST STERILE $1,262.69BIT DRILL 5/64 OD2 MM $476.00BIT DRILL 6 MM L44.5 MM OD.76 MM J LATCH COUPLING $1,107.41BIT DRILL 65 MM 3 FLUTE L260 MM OD4 MM QUICK COUPL $1,133.73BIT DRILL 65 MM OD2.4 MM STOP QUICK COUPLING NONST $400.00BIT DRILL 95 MM L248 MM OD2.8 MM QUICK COUPLING CA $1,104.00BIT DRILL 95 MM L250 MM OD2.5 MM QUICK COUPLING ST $687.70BIT DRILL 95 MM L250 MM OD2.8 MM QUICK COUPLING ST $687.70BIT DRILL ACUTRAK 2 LONG $1,287.00BIT DRILL ACUTRAK 2 MICRO $1,150.50BIT DRILL ACUTRAK 2 MINI LONG $1,287.00BIT DRILL ACUTRAK 2 STANDARD $1,150.50BIT DRILL ACUTRAK OD4/5 MM CANNULATED DENSE BONE $1,520.00BIT DRILL ACUTRAK STANDARD OD3 MM ODSEC4.4 MM CANN $1,520.00BIT DRILL ALPS OD2.7 MM CALIBRATE NONSTERILE DISPO $554.32BIT DRILL ASNIS 2 MM OD1.7 MM AO COUPLING CANNULAT $1,010.10BIT DRILL ASNIS MICRO OD1.7 MM AO COUPLING CANNULA $1,274.00BIT DRILL ASNIS OD1.7 MM SOLID AO COUPLING STERILE $403.00BIT DRILL AXSOS 3 TITANIUM SHORT L216 MM OD2.5 MM $1,563.38BIT DRILL AXSOS L289 MM OD4.3 MM CALIBRATE $754.00BIT DRILL AXSOS SHORT L216 MM OD2.5 MM NONLOCK NON $1,371.37BIT DRILL AXSOS SHORT L216 MM OD3.1 MM LOCK NONSTE $1,351.35BIT DRILL BADGER D15-120 MM L9 IN OD5 MM ACL PCL T $923.00

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 ChargeBIT DRILL BADGER L229 MM OD10 MM KNEE ACORN STYLE $884.00BIT DRILL BADGER L229 MM OD11 MM KNEE ACORN STYLE $884.00BIT DRILL BADGER L229 MM OD8 MM ACORN STYLE SMOOTH $884.00BIT DRILL BADGER L229 MM OD9 MM ACORN STYLE SMOOTH $884.00BIT DRILL BADGER L9 IN OD10.5 MM TAPERED HEAD STER $923.00BIT DRILL BADGER L9 IN OD7.5 MM TAPERED HEAD STERI $923.00BIT DRILL BADGER L9 IN OD8.5 MM TAPERED HEAD STERI $923.00BIT DRILL BADGER L9 IN OD9.5 MM ACL TAPERED HEAD T $884.00BIT DRILL BUD OD10 MM NONSTERILE $1,690.00BIT DRILL CARBIDE OD4 MM STERILE $1,950.40BIT DRILL CHARLOTTE OD2 MM CANNULATED NONSTERILE 3 $348.00BIT DRILL CONSTRUX L240 MM OD4.8 MM CANNULATED STE $2,666.80BIT DRILL DART-FIRE OD2 MM CANNULATED NONSTERILE R $572.00BIT DRILL DART-FIRE OD3 MM CANNULATED NONSTERILE R $572.00BIT DRILL DFS MINI OD1.6 MM $830.40BIT DRILL DIAMOND L13 CM OD3 MM MATCH HEAD $1,166.88BIT DRILL DIAMOND OD1.5 MM RAIL CUTTER STERILE DIS $325.00BIT DRILL DVR OD2.2 MM CROSSLOCK TRAY $476.58BIT DRILL DVR STAINLESS STEEL OD2 MM STERILE DISPO $358.28BIT DRILL EASYCLIP OD3 MM ANKLE FOOT AO REAMER DIS $962.00BIT DRILL EXPERT 3 FLUTE L145 MM OD3.2 MM QUICK CO $1,226.36BIT DRILL EXPERT 3 FLUTE L330 MM L100 MM OD3.2 MM $1,607.97BIT DRILL EXPERT L190 MM OD12 MM CANNULATED LARGE $3,638.88BIT DRILL EXPERT LARGE L310 MM OD15 MM LARGE QUICK $3,849.50BIT DRILL FAST OD2 MM $503.62BIT DRILL FIXOS OD2.7 MM CANNULATED $1,590.36BIT DRILL HELIX-R L10 MM OD2.5 MM POWER NONSTERILE $325.00BIT DRILL HOFFMANN II OD4 MM 5 MM PIN $564.98BIT DRILL ILIZAROV OD4.8 MM SHANK COMPONENT SET ST $2,267.44BIT DRILL L100 MM OD1.7 MM ODSEC.9 MM QUICK COUPLI $2,567.63BIT DRILL L100 MM OD1.8 MM J LATCH COUPLING NONSTE $811.20BIT DRILL L100 MM OD2 MM QUICK COUPLING STERILE $713.83BIT DRILL L100 MM OD2.2 MM 3 MM APEX PIN $559.52BIT DRILL L100 MM OD2.4 MM QUICK COUPLING DEPTH MA $998.40BIT DRILL L100 MM OD2.7 MM QUICK COUPLING NONSTERI $411.13BIT DRILL L110 MM OD1.1 MM CRANIOFACIAL MINI QUICK $811.20BIT DRILL L110 MM OD1.5 MM J LATCH DEPTH MARK NONS $1,039.60BIT DRILL L110 MM OD1.5 MM QUICK COUPLING NONSTERI $506.00BIT DRILL L110 MM OD1.8 MM J LATCH COUPLING DEPTH $1,039.60

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 ChargeBIT DRILL L110 MM OD1.8 MM QUICK COUPLING DEPTH MA $1,039.60BIT DRILL L110 MM OD2 MM NONSTERILE JACOBS CHUCK $506.00BIT DRILL L110 MM OD2.5 MM QUICK COUPLING NONSTERI $411.13BIT DRILL L110 MM OD2.5 MM QUICK COUPLING STERILE $317.40BIT DRILL L110 MM OD2.7 MM NONSTERILE JACOBS CHUCK $538.16BIT DRILL L110 MM OD3.5 MM QUICK COUPLING NONSTERI $201.81BIT DRILL L115 MM L20 MM OD1.6 MM DENTAL SHAFT END $1,079.52BIT DRILL L120 MM OD2.3 MM NONSTERILE LATEX FREE R $669.50BIT DRILL L120 MM OD4 MM CANNULATED 6.7 MM SCREW $1,267.50BIT DRILL L122 MM OD3.5 MM AO FIT OVER NONSTERILE $836.81BIT DRILL L125 MM OD1.5 MM J LATCH NONSTERILE $966.88BIT DRILL L125 MM OD2.7 MM QUICK COUPLING NONSTERI $570.40BIT DRILL L125 MM OD4.5 MM QUICK RELEASE STERILE D $824.32BIT DRILL L127 MM OD3.2 MM QUICK RELEASE $728.00BIT DRILL L130 MM OD3.2 MM NONSTERILE JACOBS CHUCK $399.88BIT DRILL L130 MM OD3.5 MM AO COUPLING STERILE $963.60BIT DRILL L135 MM OD2 MM AO FIT SCALE NONSTERILE F $836.81BIT DRILL L135 MM OD2.6 MM AO FIT SCALE NONSTERILE $836.81BIT DRILL L14 MM STERILE REUSABLE $325.00BIT DRILL L140 MM OD2 MM QUICK COUPLING DEPTH MARK $389.85BIT DRILL L140 MM OD2.9 MM STERILE $701.81BIT DRILL L145 MM OD3.2 MM .1 LB QUICK CONNECT SUB $351.52BIT DRILL L145 MM OD3.2 MM 3 FLUTE QUICK COUPLING $1,632.48BIT DRILL L145 MM OD3.2 MM CALIBRATE AO FIT STERIL $863.98BIT DRILL L145 MM OD3.2 MM QUICK COUPLING STERILE $680.23BIT DRILL L145 MM OD4.5 MM QUICK COUPLING NONSTERI $496.80BIT DRILL L145 MM OD4.5 MM QUICK COUPLING STERILE $680.23BIT DRILL L145 MM OD5 MM 3 FLUTED QUICK COUPLING N $1,600.56BIT DRILL L145 MM OD5 MM 3 FLUTED QUICK COUPLING S $1,226.36BIT DRILL L150 MM OD2 MM CANNULATED QUICK COUPLING $2,377.05BIT DRILL L150 MM OD2 MM QUICK COUPLING STERILE $2,653.63BIT DRILL L150 MM OD2.9 MM QUICK COUPLING NONSTERI $630.16BIT DRILL L155 MM OD4.8 MM TRAPEZIUM QUICK COUPLIN $2,460.96BIT DRILL L160 MM OD2.7 MM CANNULATED QUICK COUPLI $2,515.31BIT DRILL L160 MM OD2.7 MM QUICK COUPLING CANNULAT $2,791.88BIT DRILL L160 MM OD3.5 MM CANNULATED QUICK COUPLI $3,095.76BIT DRILL L160 MM OD4 MM QUICK COUPLING NONSTERILE $598.00BIT DRILL L165 MM L135 MM OD4.5 MM CANNULATED STOP $2,271.17BIT DRILL L165 MM OD2.8 MM QUICK COUPLING NONSTERI $512.01

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 ChargeBIT DRILL L170 MM L1.7 MM OD4.5 MM CANNULATED QUIC $2,743.33BIT DRILL L170 MM OD3.2 MM ID1.7 MM CANNULATED QUI $2,466.75BIT DRILL L170 MM OD3.2 MM ID1.7 MM QUICK COUPLING $2,743.33BIT DRILL L170 MM OD4.5 MM ID1.7 MM CANNULATED QUI $2,466.75BIT DRILL L180 MM OD2.5 MM QUICK COUPLING NONSTERI $463.45BIT DRILL L180 MM OD3.2 MM NONSTERILE JACOBS CHUCK $634.80BIT DRILL L180 MM OD3.5 MM JACOBS CHUCK NONSTERILE $570.40BIT DRILL L180 MM OD4 MM AO COUPLING STERILE $963.63BIT DRILL L180 MM OD4.3 MM QUICK COUPLING NONSTERI $1,531.76BIT DRILL L195 MM OD3.2 MM QUICK COUPLING NONSTERI $828.00BIT DRILL L195 MM OD3.5 MM QUICK COUPLING NONSTERI $463.45BIT DRILL L195 MM OD3.5 MM QUICK COUPLING STERILE $740.03BIT DRILL L195 MM OD4.5 MM QUICK COUPLING NONSTERI $828.00BIT DRILL L195 MM OD6 MM QUICK COUPLING NONSTERILE $1,159.20BIT DRILL L197 MM OD4 MM QUICK COUPLING NONSTERILE $542.80BIT DRILL L20 MM OD3.2 MM DISPOSABLE $487.50BIT DRILL L200 MM OD2.4 MM CANNULATED DEPTH STOP $1,868.06BIT DRILL L200 MM OD2.8 MM QUICK COUPLING CALIBRAT $451.95BIT DRILL L200 MM OD3.2 MM GRAY 4 MM PIN $554.04BIT DRILL L200 MM OD3.2 MM TOP LEVEL MAC SYSTEM $863.76BIT DRILL L204 MM OD3.1 MM CALIBRATED NONSTERILE 4 $594.75BIT DRILL L214 MM OD16 MM CANNULATED HOLLOW LARGE $5,012.15BIT DRILL L225 MM OD3.2 MM QUICK COUPLING NONSTERI $1,071.76BIT DRILL L230 MM OD3.2 MM $786.50BIT DRILL L230 MM OD5 MM AO COUPLING STERILE $970.93BIT DRILL L233 MM OD4.5 MM CANNULATED NONSTERILE J $3,036.00BIT DRILL L25 MM OD3.3 MM NONSTERILE $371.80BIT DRILL L270 MM OD3.8 MM 3 FLUTED CALIBRATED STE $1,452.36BIT DRILL L280 MM OD15 MM CANNULATED LARGE QUICK C $3,442.80BIT DRILL L280 MM OD3.2 MM $701.81BIT DRILL L280 MM OD4.3 MM QUICK COUPLING NONSTERI $2,631.20BIT DRILL L29 MM L18 MM OD1.6 MM DENTAL SHAFT END $794.40BIT DRILL L3.8 MM OD3 MM NEURO LESS AGGRESSIVE STE $813.93BIT DRILL L30 MM MODULAR FLEXIBLE ACETABULAR CUP S $812.50BIT DRILL L30 MM OD3.2 MM DISPOSABLE G7 ACETABULAR $487.50BIT DRILL L30 MM OD3.2 MM QUICK CONNECT STERILE $487.50BIT DRILL L300 MM OD13 MM CANNULATED NONSTERILE $3,958.08BIT DRILL L300 MM OD13 MM CANNULATED STERILE $3,490.11BIT DRILL L300 MM OD17 MM CANNULATED LARGE QUICK C $5,367.12

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 ChargeBIT DRILL L300 MM OD3.2 MM PERCUTANEOUS QUICK COUP $1,061.45BIT DRILL L300 MM OD4.2 MM QUICK COUPLING STERILE $1,012.05BIT DRILL L300 MM OD4.3 MM PERCUTANEOUS QUICK COUP $1,061.45BIT DRILL L300 MM OD5 MM ID2.9 MM CANNULATED LARGE $2,481.70BIT DRILL L300 MM OD7.3 MM CANNULATED LARGE QUICK $2,519.08BIT DRILL L320 MM OD4.3 MM CALIBRATE $792.48BIT DRILL L330 MM OD5 MM 3 FLUTED QUICK COUPLING S $1,607.97BIT DRILL L34 MM OD2 MM STOP PILOT STERILE $915.12BIT DRILL L340 MM OD4.2 MM AO COUPLING STERILE $970.91BIT DRILL L36.5 CM OD4.3 MM CALIBRATE $948.48BIT DRILL L380 MM OD3.5 MM JACOBS CHUCK NONSTERILE $3,776.56BIT DRILL L385 MM OD15.5 MM LARGE QUICK COUPLING F $2,922.96BIT DRILL L40 MM OD3.2 MM DISPOSABLE G7 ACETABULAR $487.50BIT DRILL L435 MM OD6 MM ODSEC10 MM QUICK COUPLING $3,134.43BIT DRILL L44.5 MM L10 MM OD.76 MM J LATCH COUPLIN $1,107.41BIT DRILL L44.5 MM L10 MM OD.76 MM MINI QUICK COUP $840.91BIT DRILL L44.5 MM L12 MM OD.76 MM MINI QUICK COUP $1,034.96BIT DRILL L44.5 MM L14 MM OD.76 MM J LATCH COUPLIN $910.80BIT DRILL L44.5 MM L14 MM OD.76 MM MINI QUICK COUP $1,107.41BIT DRILL L44.5 MM L4 MM OD1.5 MM J LATCH COUPLING $811.20BIT DRILL L44.5 MM L6 MM OD.76 MM MINI QUICK COUPL $1,034.96BIT DRILL L44.5 MM L6 MM OD1 MM J LATCH COUPLING S $811.20BIT DRILL L44.5 MM L8 MM OD.76 MM J LATCH COUPLING $1,107.41BIT DRILL L44.5 MM L8 MM OD.76 MM MINI QUICK COUPL $1,034.96BIT DRILL L45 MM OD1.1 MM NONSTERILE JACOBS CHUCK $478.40BIT DRILL L465 MM OD13 MM CANNULATED LARGE QUICK C $4,842.72BIT DRILL L485 MM OD4.5-6.5 MM LARGE QUICK COUPLIN $2,826.92BIT DRILL L5 IN OD2.8 MM QUICK RELEASE $344.50BIT DRILL L50 MM L7 MM OD1.6 MM DENTAL SHAFT END N $930.16BIT DRILL L50 MM OD1 MM MINI QUICK COUPLING SELF S $422.31BIT DRILL L50 MM OD1.8 MM J LATCH NONSTERILE $811.20BIT DRILL L55 MM OD1.1 MM MINI QUICK COUPLING NONS $519.76BIT DRILL L55 MM OD1.1 MM MINI QUICK COUPLING STER $695.18BIT DRILL L55 MM OD1.3 MM MINI QUICK COUPLING SELF $422.31BIT DRILL L60 MM OD1 MM J LATCH COUPLING NONSTERIL $424.84BIT DRILL L60 MM OD1 MM J LATCH STERILE $657.80BIT DRILL L60 MM OD1.1 MM QUICK COUPLING NONSTERIL $506.00BIT DRILL L62 MM OD1.5 MM K WIRE ATTACHMENT NONSTE $487.05BIT DRILL L65 MM L40 MM OD1.3 MM J LATCH COUPLING $910.80

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 ChargeBIT DRILL L65 MM OD1.1 MM J LATCH COUPLING NONSTER $556.14BIT DRILL L65 MM OD1.1 MM J LATCH THREAD HOLE $487.05BIT DRILL L65 MM OD1.3 MM J LATCH COUPLING NONSTER $519.76BIT DRILL L65 MM OD1.5 MM MINI QUICK COUPLING NONS $422.31BIT DRILL L65 MM OD2 MM MINI QUICK COUPLING NONSTE $422.31BIT DRILL L70 MM OD1.5 MM NONSTERILE JACOBS CHUCK $506.00BIT DRILL L70 MM OD2.5 MM CANNULATED SOLID FLIP TR $624.00BIT DRILL L70 MM OD3.5 MM TWIST STERILE DISPOSABLE $554.32BIT DRILL L71 MM OD2 MM K WIRE ATTACHMENT NONSTERI $487.05BIT DRILL L74 MM OD1.5 MM MINI QUICK COUPLING NONS $487.05BIT DRILL L75 MM OD1.1 MM MINI QUICK COUPLING NONS $497.06BIT DRILL L75 MM OD1.5 MM J LATCH COUPLING NONSTER $519.76BIT DRILL L75 MM OD2 MM J LATCH COUPLING NONSTERIL $519.76BIT DRILL L75 MM OD2.4 MM J LATCH COUPLING NONSTER $811.20BIT DRILL L80 MM OD1.8 MM MINI QUICK COUPLING DEPT $411.13BIT DRILL L80 MM OD2.4 MM MINI QUICK COUPLING NONS $506.00BIT DRILL L85 MM L60 MM OD1.5 MM J LATCH COUPLING $910.80BIT DRILL L85 MM OD1.5 MM QUICK COUPLING NONSTERIL $411.13BIT DRILL L85 MM OD2 MM NONSTERILE JACOBS CHUCK $506.00BIT DRILL L85 MM OD2.7 MM JACOBS CHUCK NONSTERILE $506.00BIT DRILL L90 MM OD1.8 MM J LATCH COUPLING NONSTER $506.00BIT DRILL L90 MM OD2.4 MM J LATCH COUPLING NONSTER $506.00BIT DRILL L95 MM OD2.5 MM NONSTERILE JACOBS CHUCK $506.00BIT DRILL L95 MM OD3.5 MM NONSTERILE JACOBS CHUCK $506.00BIT DRILL L96 MM OD1.5 MM MINI QUICK COUPLING DEPT $844.68BIT DRILL LARGE L190 MM OD10 MM QUICK COUPLING CAN $3,588.00BIT DRILL LARGE L190 MM OD11 MM QUICK COUPLING CAN $4,278.00BIT DRILL LARGE L190 MM OD12 MM QUICK COUPLING CAN $4,278.00BIT DRILL LARGE L465 MM OD13 MM CANNULATED QUICK C $4,208.88BIT DRILL LARGE OD5.5 MM CANNULATED STERILE DISPOS $1,237.08BIT DRILL LCP L180 MM OD2.5 MM QUICK COUPLING STER $740.03BIT DRILL LONG 5 MM HALF PIN $2,119.44BIT DRILL LONG FLUTE L200 MM OD4.3 MM CANNULATED Q $1,984.58BIT DRILL LONG L240 MM OD4.8 MM AO CONNECTOR DISPO $887.36BIT DRILL LONG OD2 MM QUICK COUPLING NONSTERILE $463.45BIT DRILL MATRIXMANDIBLE 8 MM L50 MM OD1.5 MM J LA $838.50BIT DRILL MATRIXMANDIBLE L125 MM OD1.5 MM MINI QUI $889.20BIT DRILL MATRIXMANDIBLE L50 MM L12 MM OD1.5 MM J $838.50BIT DRILL MATRIXMANDIBLE L50 MM L6 MM OD1.5 MM 2 F $838.50

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 ChargeBIT DRILL MATRIXMIDFACE L44.5 MM L4 MM OD1.1 MM CR $834.60BIT DRILL MAXAN L12 MM OD4 MM SPINE ANTERIOR CERVI $325.00BIT DRILL MAXAN L14 MM OD4 MM SPINE ANTERIOR CERVI $325.00BIT DRILL MICROMAX OD6 MM DIAMOND BALL $458.19BIT DRILL MINI L65 MM OD1.5 MM QUICK COUPLING STER $695.18BIT DRILL NCB L195 MM OD4.3 MM $550.94BIT DRILL NCB STANDARD L195 MM OD3.3 MM QUICK COUP $605.02BIT DRILL OD1 MM WIRE PASS STERILE $950.00BIT DRILL OD1.3 MM PILOT J LATCH M3X $826.56BIT DRILL OD1.3 MM WIRE PASS STERILE LATEX FREE DI $950.00BIT DRILL OD1.7 MM $513.50BIT DRILL OD1.7 MM CANNULATED $1,137.50BIT DRILL OD1.7 MM CANNULATED AO CONNECTION $1,137.50BIT DRILL OD1.8 MM PILOT $915.12BIT DRILL OD10 MM HOLLOW STERILE MULTILOC HUMERAL $1,863.62BIT DRILL OD11 MM STERILE DISPOSABLE $325.00BIT DRILL OD2 MM $617.50BIT DRILL OD2 MM 3 MM SCREW $952.25BIT DRILL OD2 MM AO $552.50BIT DRILL OD2 MM CANNULATED AO $1,137.50BIT DRILL OD2 MM COMPLETE 3/2.5 MM TAPER BONE SCRE $1,747.20BIT DRILL OD2 MM PILOT MANUAL $915.12BIT DRILL OD2 MM TWIST $338.00BIT DRILL OD2 MM TWIST PILOT $826.56BIT DRILL OD2.4 MM 3.5 MM SCREW ELLI $325.00BIT DRILL OD2.4 MM BONE FIXATION CORRIDOR $7,384.00BIT DRILL OD2.4 MM PILOT J LATCH STERILE $826.56BIT DRILL OD2.4 MM STERILE DISPOSABLE $325.00BIT DRILL OD2.5 MM 3.5 MM SCREW $952.25BIT DRILL OD2.5 MM CALIBRATE $552.50BIT DRILL OD2.5 MM CALIBRATE NONSTERILE LATEX FREE $552.50BIT DRILL OD2.5 MM CANNULATED $1,304.88BIT DRILL OD2.5 MM NONSTERILE DISPOSABLE $503.62BIT DRILL OD2.5 MM NONSTERILE LATEX FREE DISPOSABL $552.50BIT DRILL OD2.6 MM CANNULATED $1,137.50BIT DRILL OD2.7 MM $1,526.40BIT DRILL OD2.7 MM CANNULATED SYSTEM GC $1,172.86BIT DRILL OD2.7 MM PERIPHERAL SCREW COMPREHENSIVE $650.00BIT DRILL OD3.2 MM CALIBRATED NONSTERILE DISPOSABL $608.40

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 ChargeBIT DRILL OD3.2 MM CENTRAL SCREW COMPREHENSIVE REV $650.00BIT DRILL OD3.2 MM OCCIPITAL $325.00BIT DRILL OD3.5 MM $325.00BIT DRILL OD3.5 MM CANNULATED $1,352.33BIT DRILL OD3.5 MM NONSTERILE $338.00BIT DRILL OD3.5 MM STERILE DISPOSABLE $776.88BIT DRILL OD3.6 MM AO FIT RED YELLOW 3.5 MM VARIAX $627.90BIT DRILL OD4 MM STOP $1,399.78BIT DRILL OD4.8 MM NONSTERILE $888.00BIT DRILL OD5 MM CANNULATED STERILE DISPOSABLE $1,237.08BIT DRILL OD8 MM NONSTERILE TRIPLE REAMER $3,098.36BIT DRILL OPTIROM L280 MM OD4.8 MM NONSTERILE $901.52BIT DRILL ORTHOLOC OD1.3 MM 2/2.4 MM SCREW FOREFOO $572.00BIT DRILL PEDILOC OD2.5 MM CALIBRATE LOCK NONSTERI $1,960.00BIT DRILL PHOENIX SHORT L152 MM OD4.3 MM TWIST CRO $913.92BIT DRILL POLARUS 3 SURGIBIT LONG OD2.8 MM STERILE $702.00BIT DRILL POLARUS 3 SURGIBIT SHORT OD2.8 MM EXTEND $669.50BIT DRILL POLYAX OD2.5 MM TIBIA CALIBRATE STERILE $618.54BIT DRILL POLYAX OD3.2 MM FEMORAL TIBIA CALIBRATED $618.54BIT DRILL PRECISION L3.8 MM OD3 MM NEURO STERILE L $771.88BIT DRILL QUICK RELEASE STERILE DISPOSABLE $955.50BIT DRILL QUICKSET L25 MM 1 PIECE FLEXIBLE $3,331.20BIT DRILL SENTINEL L9 IN OD10 MM ACL PCL HIGH STRE $1,157.00BIT DRILL SENTINEL L9 IN OD7.5 MM ROUNDED ECCENTRI $1,157.00BIT DRILL SENTINEL L9 IN OD8.5 MM ROUNDED ECCENTRI $988.00BIT DRILL SENTINEL ROUND L9 IN OD10 MM ECCENTRIC M $1,157.00BIT DRILL SENTINEL ROUND L9 IN OD9 MM ECCENTRIC MO $1,157.00BIT DRILL SHORT FLUTE L200 MM OD5 MM CANNULATED QU $1,984.58BIT DRILL SHORT L145 MM OD5 MM 3 FLUTE QUICK COUPL $952.19BIT DRILL SHORT L216 MM OD3.1 MM LOCK STERILE $1,387.82BIT DRILL SMALL L180 MM OD4.2 MM AO COUPLING STERI $1,039.48BIT DRILL SNOW CAP L12 MM SPINE STOP $325.00BIT DRILL SOLUTION SYSTEM OD4.5 MM HIP CANAL CEMEN $2,906.80BIT DRILL SPINE $325.00BIT DRILL SPIRAL L100 MM OD3.2 MM CANNULATED AO CO $1,308.97BIT DRILL SPS AXSOS STANDARD L125 MM OD2.5 MM AO L $682.50BIT DRILL SPS AXSOS STANDARD TWIST L180 MM OD3.5 M $1,007.50BIT DRILL SPS L230 MM OD2.5 MM TWIST AO FITTING NO $1,007.50BIT DRILL SPS STANDARD TWIST L125 MM OD3.5 MM AO F $682.50

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 ChargeBIT DRILL SPS STANDARD TWIST L230 MM OD3.2 MM CALI $1,007.50BIT DRILL STAINLESS STEEL L110 MM OD3.5 MM QUICK C $713.83BIT DRILL STRAIGHT OD2 MM CANNULATED DISPOSABLE MI $1,267.50BIT DRILL STRAIGHT OD2.7 MM CALIBRATE CANNULATED S $1,267.50BIT DRILL STRAIGHT OD2.7 MM CANNULATED 3.5 MM MINI $1,267.50BIT DRILL STRYKER L115 MM L35 MM OD1.6 MM NONSTERI $2,037.92BIT DRILL STRYKER L57 MM OD1.5 MM J LATCH GLIDE HO $487.05BIT DRILL T2 L230 MM OD3.5 MM AO STERILE PROXIMAL $963.63BIT DRILL TFN-ADVANCED L266 MM OD16 MM CANNULATED $4,214.47BIT DRILL TFN-ADVANCED L500 MM OD6-9 MM CANNULATED $1,303.62BIT DRILL TFN-ADVANCED TAPER L300 MM OD10 MM LARGE $2,491.65BIT DRILL TRILOGY HGP II MEDIUM L30 MM OD3.2 MM HI $1,556.75BIT DRILL TRIM-IT OD3.5 MM $513.50BIT DRILL TWIST L115 MM OD1.5 MM J NOTCH 2 MM SCRE $870.24BIT DRILL VARIAX L122 MM OD2.7 MM OVER NONSTERILE $836.81BIT DRILL VARIAX L30 MM OD2 MM NONSTERILE $936.00BIT DRILL VARIAX SPEEDGUIDE L30 MM OD2.6 MM AO NON $863.20BIT DRILL VERSANAIL 3 FLUTE L6 IN OD3.8 MM QUICK C $786.24BIT DRILL VERSANAIL 3 FLUTE OD4.4 MM QUICK COUPLIN $879.84BIT DRILL VISION DYNAFIX LONG L240 MM OD3.2 MM AO $902.72BIT DRILL YUKON OD2.3 MM ADJUSTABLE DISPOSABLE $325.00BLADDER INSTILLATION OF CANCER PREVENTIVE, INHIBIT 51720 $874.00BLADDER IRRIGATION AND/OR INSTILLATION 51700 $563.00BLADE ARTHROSCOPIC STERLING 2500-6000 RPM L13 CM O $442.00BLADE ARTHROSCOPIC STERLING 2500-6000 RPM L7.6 CM $364.00BLADE ARTHROSCOPIC STERLING GATOR 2500-6000 RPM L1 $442.00BLADE ARTHROSCOPIC STERLING GATOR 2500-6000 RPM L7 $403.00BLADE ARTHROSCOPIC STERLING GATOR OD3.5 MM $442.00BLADE ARTHROSCOPIC STERLING GREAT WHITE 2500-6000 $357.50BLADE ARTHROSCOPIC STERLING ULTRACUT 2500-6000 RPM $535.60BLADE ENDOSCOPIC GREAT WHITE STERLING L13 CM OD4.2 $357.50BLADE FIXATION TITANIUM L100 MM FEMUR SPIRAL STERI C1713 $4,860.96BLADE FIXATION TITANIUM L105 MM FEMUR SPIRAL STERI C1713 $4,860.96BLADE FIXATION TITANIUM L110 MM FEMUR SPIRAL STERI C1713 $4,860.96BLADE FIXATION TITANIUM L115 MM FEMUR SPIRAL STERI C1713 $4,860.96BLADE FIXATION TITANIUM L120 MM FEMUR SPIRAL STERI C1713 $4,860.96BLADE INTRAMEDULLARY FIXATION ANGLED L100 MM NECK C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION ANGLED L105 MM NECK C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION ANGLED L115 MM NECK C1713 $8,675.10

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 ChargeBLADE INTRAMEDULLARY FIXATION ANGLED L120 MM NECK C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION ANGLED L125 MM NECK C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION ANGLED L75 MM NECK S C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION ANGLED L80 MM NECK S C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION ANGLED L85 MM NECK S C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION ANGLED L90 MM NECK S C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION ANGLED L95 MM NECK S C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION L110 MM FEMORAL NECK C1713 $8,675.10BLADE INTRAMEDULLARY FIXATION TITANIUM 90 D L75 MM C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM 90 D L90 MM C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM ALUMINUM NI C1713 $3,445.65BLADE INTRAMEDULLARY FIXATION TITANIUM HELICAL L10 C1713 $3,221.14BLADE INTRAMEDULLARY FIXATION TITANIUM HELICAL L11 C1713 $3,656.64BLADE INTRAMEDULLARY FIXATION TITANIUM HELICAL L12 C1713 $3,656.64BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L100 C1713 $3,656.64BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L105 C1713 $3,656.64BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L115 C1713 $3,656.64BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L125 C1713 $3,964.48BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L75 M C1713 $3,964.48BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L85 M C1713 $3,656.64BLADE INTRAMEDULLARY FIXATION TITANIUM L120 MM FEM C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM L38 MM HUME C1713 $3,903.36BLADE INTRAMEDULLARY FIXATION TITANIUM L40 MM HUME C1713 $3,903.36BLADE INTRAMEDULLARY FIXATION TITANIUM L46 MM X H3 C1713 $3,445.65BLADE INTRAMEDULLARY FIXATION TITANIUM L75 MM FEMU C1713 $4,860.96BLADE INTRAMEDULLARY FIXATION TITANIUM L80 MM FEMU C1713 $4,860.96BLADE INTRAMEDULLARY FIXATION TITANIUM L85 MM FEMU C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM L95 MM FEMU C1713 $4,860.96BLADE INTRAMEDULLARY FIXATION TITANIUM SPIRAL L100 C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM SPIRAL L105 C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM SPIRAL L110 C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM SPIRAL L115 C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM SPIRAL L80 C1713 $4,523.52BLADE INTRAMEDULLARY FIXATION TITANIUM SPIRAL L85 C1713 $4,860.96BLADE INTRAMEDULLARY FIXATION TITANIUM THK3.9 MM S C1713 $3,903.36BLADE INTRAMEDULLARY NAIL EXPERT TITANIUM SPIRAL F C1713 $3,445.65BLADE INTRAMEDULLARY NAIL EXPERT TITANIUM SPIRAL L C1713 $3,903.36BLADE INTRAMEDULLARY NAIL LCP DHHS STAINLESS STEEL C1713 $2,378.16BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM NI C1713 $3,660.13

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 ChargeBLADE INTRAMEDULLARY NAIL TITANIUM 90 D SPIRAL L70 C1713 $4,523.52BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L100 MM C1713 $3,221.14BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L110 MM C1713 $3,964.48BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L115 MM C1713 $3,221.14BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L120 MM C1713 $3,964.48BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L130 MM C1713 $3,964.48BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L80 MM C1713 $3,964.48BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L85 MM C1713 $3,964.48BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L90 MM C1713 $3,656.64BLADE INTRAMEDULLARY NAIL TITANIUM HELICAL L95 MM C1713 $3,656.64BLADE INTRAMEDULLARY NAIL TITANIUM HELIX L80 MM OD C1713 $3,656.64BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L100 MM C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L45 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L50 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L55 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L60 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L65 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L70 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L75 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L80 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L85 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L90 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L90 MM S C1713 $4,860.96BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L95 MM N C1713 $4,523.52BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L95 MM O C1713 $3,675.36BLADE INTRAMEDULLARY NAIL TITANIUM THK3.9 MM SPIRA C1713 $3,903.36BLADE OSTEOTOME EXPLANT 52 MM HEMISPHERE HIP TRUNC $3,575.00BLADE OSTEOTOME EXPLANT 54 MM HEMISPHERE HIP FULL $3,575.00BLADE OSTEOTOME EXPLANT 54 MM HEMISPHERE HIP TRUNC $3,575.00BLADE OSTEOTOME STAINLESS STEEL RADIAL W10 MM HIP $812.50BLADE OSTEOTOME THIN L3 IN X W10 MM STERILE LATEX $682.50BLADE OSTEOTOME THIN L3 IN X W12 MM STERILE LATEX $611.00BLADE REAMER NEXGEN STAINLESS STEEL OD35 MM KNEE P $780.00BLADE SAW OXFORD CEMENTED $968.50BLADE SAW PRECISION THK.015 IN W22.5 MM RECIPROCAT $552.00BLADE SCREWDRIVER MAXDRIVE L94 MM OD2 MM ODSEC2.3 $923.52BLADE SCREWDRIVER OD2 MM CROSS DRIVE $698.56BLADE SCREWDRIVER T10 AO SELF RETAINING $1,461.20BLADE SHAVER RAD 40 360 D 5000 RPM L11 CM OD4 MM S $1,438.53

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 ChargeBLADE SHAVER RAD 60 360 D 5000 RPM L11 CM OD4 MM F $1,165.26BLADE SHAVER RAD L12 CM OD4 MM M4 ROTATABLE CURVED $1,833.65BLADE SHAVER RADENOID PEDIATRIC 40 D CURVED L11 CM $1,014.73BLADE SHAVER TRICUT L13 CM OD4 MM M4 ROTATABLE AUT $1,773.20BLADE SHAVER XPS 360 D 60-3000 RPM L11 CM OD2 MM I $1,423.18BLADE SURGICAL HARMONIC SYNERGY CURVE $1,512.65BLADE SURGICAL PLASMABLADE PLUS PEAK W3 MM SPATULA $2,340.00BLADE SURGICAL PLASMABLADE PLUS PEAK W4 MM CAUTERY $2,800.00BLADE TONGUE DAVIS-CROWE 2 L6.5 CM X W2.6 CM MOUTH $493.81BLADE URETHROTOME LUDVIK HALF ROUND COLD KNIFE STR $1,185.60BLOCK AUGMENTATION GMK THK10 MM 2 TIBIA SCREWED C1776 $4,550.00BLOCK AUGMENTATION GMK THK10 MM 3 TIBIA SCREWED C1776 $4,550.00BLOCK AUGMENTATION GMK THK10 MM 4 TIBIA SCREWED C1776 $4,550.00BLOCK AUGMENTATION GMK THK5 MM 2 TIBIA SCREWED C1776 $4,550.00BLOCK AUGMENTATION GMK THK5 MM 3 TIBIA SCREWED C1776 $4,550.00BLOCK AUGMENTATION GMK THK5 MM 4 TIBIA SCREWED C1776 $4,550.00BLOCK AUGMENTATION GMK THK5 MM 5 TIBIA SCREWED C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT D H10 MM POSTERI C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT D H5 MM POSTERIO C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT E H10 MM DISTAL C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT E H10 MM KNEE PO C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT E H5 MM DISTAL C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT E H5 MM POSTERIO C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT F H10 MM POSTERI C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT F H5 MM POSTERIO C1776 $4,550.00BLOCK AUGMENTATION NEXGEN PRECOAT G H5 MM POSTERIO C1776 $4,550.00BLOCK AUGMENTATION NEXGEN TRABECULAR METAL 2 H15 M C1776 $11,852.75BLOCK AUGMENTATION NEXGEN TRABECULAR METAL 2 H5 MM C1776 $11,992.50BLOCK AUGMENTATION NEXGEN TRABECULAR METAL 3 H10 M C1776 $11,170.25BLOCK AUGMENTATION NEXGEN TRABECULAR METAL C H10 M C1776 $12,577.50BLOCK AUGMENTATION NEXGEN TRABECULAR METAL D H10 M C1776 $12,577.50BLOCK AUGMENTATION NEXGEN TRABECULAR METAL TIVANIU C1776 $25,252.50BLOCK CUTTING MYKNEE GMK 3 KNEE TIBIA RIGHT MEDIAL $1,625.00BLOCK CUTTING MYKNEE GMK 4 KNEE TIBIA RIGHT MEDIAL $1,625.00BLOCK CUTTING MYKNEE GMK 5 KNEE TIBIA RIGHT MEDIAL $1,625.00BLOCK CUTTING MYKNEE GMK POLYAMIDE 3 TIBIA LEFT ME $1,625.00BLOCK CUTTING MYKNEE GMK POLYAMIDE 5 TIBIA LEFT ME $1,625.00BLOCK CUTTING MYKNEE GMK POLYAMIDE 6 TIBIA RIGHT M $1,625.00BLOCKER SPINAL MANTIS PEDICLE BLOCKER REDUCTION C1713 $325.00

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 ChargeBLOOD BANK PHYSICIAN SERVICES INVESTIGATION TRANSF 86078 $218.00BLOOD CREATININE LEVEL 82565 $39.00BLOOD CULTURE - PEDIATRIC 87040 $80.00BLOOD DRAW VENIPUNCTURE 36415 $11.00BLOOD GLUCOSE (SUGAR) LEVEL 82947 $31.00BLOOD GLUCOSE (SUGAR) MEASUREMENT USING REAGENT ST 82948 $24.00BLOOD GROUP TYPING (ABO) 86900 $21.00BLOOD PRODUCT BLOOD P9010 $758.00BLOOD PRODUCT BLOOD P9011 $609.00BLOOD PRODUCT BLOOD P9016 $862.00BLOOD PRODUCT BLOOD P9021 $677.00BLOOD PRODUCT BLOOD P9022 $1,323.00BLOOD PRODUCT BLOOD P9038 $902.00BLOOD PRODUCT BLOOD P9039 $2,141.00BLOOD PRODUCT BLOOD P9040 $1,219.00BLOOD PRODUCT BLOOD P9050 $7,223.00BLOOD PRODUCT BLOOD P9051 $827.00BLOOD PRODUCT BLOOD P9054 $1,134.00BLOOD PRODUCT BLOOD P9056 $786.00BLOOD PRODUCT BLOOD P9057 $1,646.00BLOOD PRODUCT BLOOD P9058 $1,279.00BLOOD PRODUCT CRYOPRECIPITATE P9012 $351.00BLOOD PRODUCT PLASMA P9017 $351.00BLOOD PRODUCT PLASMA P9023 $323.00BLOOD PRODUCT PLASMA P9044 $303.00BLOOD PRODUCT PLASMA P9059 $338.00BLOOD PRODUCT PLASMA PLATELTE RICH P9020 $784.00BLOOD PRODUCT PLATELETES P9019 $409.00BLOOD PRODUCT PLATELETS P9031 $528.00BLOOD PRODUCT PLATELETS P9032 $599.00BLOOD PRODUCT PLATELETS P9033 $698.00BLOOD PRODUCT PLATELETS P9034 $1,928.00BLOOD PRODUCT PLATELETS P9035 $2,283.00BLOOD PRODUCT PLATELETS P9036 $3,016.00BLOOD PRODUCT PLATELETS P9037 $3,010.00BLOOD PRODUCT PLATELETS P9052 $3,461.00BLOOD PRODUCT PLATELETS P9053 $2,948.00BLOOD PRODUCT PLATELETS P9055 $1,502.00BLOOD SMEAR PERIPHERAL INTERPRETATION BY PHYSICIAN 85060 $111.00

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 ChargeBLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS 80048 $66.00BLOOD TEST, CLOTTING TIME 85610 $28.00BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS 80053 $82.00BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) 80061 $93.00BLOOD TEST, THYROID STIMULATING HORMONE (TSH) 84443 $130.00BLOOD TYPING FOR RED BLOOD CELL ANTIGENS 86905 $28.00BLOOD TYPING FOR RH (D) ANTIGEN 86901 $21.00BLOOD UNIT COMPATIBILITY TEST 86923 $652.00BLOOD UNIT COMPATIBILITY TEST 86920 $652.00BLOOD UNIT COMPATIBILITY TEST 86921 $517.00BLOOD UNIT COMPATIBILITY TEST 86922 $652.00BLOOD VISCOSITY MEASUREMENT 85810 $69.00BODY CALCAR VERSYS TIVANIUM 13/15 L30 MM HIP FEMUR C1776 $2,600.00BODY CALCAR VERSYS TIVANIUM 17/19 L20 MM HIP FEMUR C1776 $2,447.25BODY CONE ARCOS TITANIUM A STANDARD OFFSET H50 MM C1776 $40,625.00BODY CONE ARCOS TITANIUM A STANDARD OFFSET H70 MM $40,625.00BODY CONE ARCOS TITANIUM B HIGH OFFSET H70 MM HIP C1776 $40,625.00BODY CONE ARCOS TITANIUM B STANDARD OFFSET H60 MM C1776 $40,625.00BODY CONE ARCOS TITANIUM C STANDARD OFFSET H70 MM C1776 $40,625.00BODY CONE ARCOS TITANIUM D STANDARD OFFSET H70 MM C1776 $40,625.00BODY CONE ARCOS TITANIUM E HIGH OFFSET H70 MM HIP C1776 $40,625.00BODY CONE RESTORATION +0 MM STANDARD OD21 MM HIP M C1776 $19,710.60BODY CONE RESTORATION +0 MM STANDARD OD23 MM HIP P C1776 $19,710.60BODY CONE RESTORATION +0 MM STANDARD OD25 MM HIP P C1776 $19,710.60BODY CONE RESTORATION +10 MM OD27 MM HIP MODULAR R C1776 $19,710.60BODY CONE RESTORATION PUREFIX TITANIUM +20 MM OD25 C1776 $19,710.60BODY CONE RESTORATION PUREFIX TITANIUM +20 MM OD27 C1713 $19,710.60BODY CONE RESTORATION PUREFIX TITANIUM +30 MM OD19 C1776 $19,710.60BODY CONE RESTORATION PUREFIX TITANIUM +30 MM OD27 C1776 $19,710.60BODY CONE RESTORATION TITANIUM +0 MM STANDARD OD19 C1776 $19,710.60BODY CONE RESTORATION TITANIUM +0 MM STANDARD OD27 C1776 $19,710.60BODY CONE RESTORATION TITANIUM +10 MM OD19 MM HIP C1776 $19,710.60BODY CONE RESTORATION TITANIUM +10 MM OD23 MM HIP C1776 $19,710.60BODY CONE RESTORATION TITANIUM +10 MM OD25 MM HIP C1776 $19,710.60BODY CONE RESTORATION TITANIUM +20 MM OD19 MM HIP C1776 $19,710.60BODY CONE RESTORATION TITANIUM +20 MM OD21 MM HIP C1776 $19,710.60BODY CONE RESTORATION TITANIUM +30 MM OD25 MM HIP C1776 $19,710.60BODY DISTRACTOR TITANIUM L12 MM ALVEOLAR STRAIGHT $8,056.00BODY DISTRACTOR TITANIUM L15 MM MANDIBLE END ACTIV $30,817.60

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 ChargeBODY DISTRACTOR TITANIUM L15 MM MANDIBLE U JOINT B $32,510.80BODY DISTRACTOR TITANIUM L20 MM MANDIBLE END ACTIV $30,817.60BODY DISTRACTOR TITANIUM L25 MM MANDIBLE U JOINT B $32,510.80BODY DISTRACTOR TITANIUM L30 MM MANDIBLE END ACTIV $30,817.60BODY DISTRACTOR TITANIUM L35 MM MANDIBLE BODY END $30,817.60BODY EXTERNAL FIXATION DJD II COMPONENT NONSTERILE $19,695.00BODY EXTERNAL FIXATION JET-X HALF PIN STERILE $36,265.52BODY FEMORAL DJO SURGICAL EXPRT STANDARD OFFSET H6 C1776 $16,900.00BODY FEMORAL EXPRT LATERAL OFFSET H75 MM HIP REVIS C1776 $16,900.00BODY FEMORAL EXPRT STANDARD OFFSET H85 MM HIP REVI C1776 $16,900.00BODY FEMORAL RECLAIM ARTICUL/EZE TITANIUM 40 MM 12 C1776 $22,750.00BODY FEMORAL RECLAIM ARTICUL/EZE TITANIUM 45 MM OF C1776 $22,750.00BODY FLUID CELL COUNT 89050 $30.00BODY FLUID CELL COUNT WITH CELL IDENTIFICATION 89051 $50.00BODY HUMERAL GLOBAL UNITE POROCOAT +5 OD10 MM SHOU C1776 $3,250.00BODY HUMERAL GLOBAL UNITE POROCOAT 0 OD10 MM SHOUL C1776 $3,250.00BODY HUMERAL GLOBAL UNITE POROCOAT 135 D OD10 MM S C1776 $3,250.00BODY HUMERAL GLOBAL UNITE POROCOAT 135 D OD12 MM S C1776 $3,250.00BODY HUMERAL GLOBAL UNITE POROCOAT -5 OD10 MM SHOU C1776 $3,250.00BODY POSITION CURRENT STATUS G8981 $0.01BODY POSITION DISCHARGE STATUS G8983 $0.01BODY POSITION GOAL STATUS G8982 $0.01BODY SPOUT ZMR TIVANIUM POROUS 17.7 MM A L80 MM X C1776 $30,095.00BOLT EXTERNAL FIXATION 151 MM INTERLOCK 4.5 MM LCP $1,821.60BOLT EXTERNAL FIXATION CONNECTION NONSTERILE PERIA $2,019.36BOLT EXTERNAL FIXATION DYNAFIX LOCK NONSTERILE SMA $656.64BOLT EXTERNAL FIXATION EYE MRI CONDITIONAL NONSTER $768.16BOLT EXTERNAL FIXATION ILIZAROV ADULT FEMORAL PIN $3,815.76BOLT EXTERNAL FIXATION LARGE OD8 MM CENTRAL BODY $482.56BOLT EXTERNAL FIXATION OD6 MM LOCK BALL JOINT $482.56BOLT EXTERNAL FIXATION PERCUTANEOUS INTERLOCK NONS $2,668.00BOLT EXTERNAL FIXATION RING LOCK EXTEND $547.20BOLT EXTERNAL FIXATION SCHANZ CANNULATED POST MOUN $1,826.16BOLT EXTERNAL FIXATION SCHANZ CANNULATED RING MOUN $1,559.36BOLT EXTERNAL FIXATION SCHANZ SCREW $1,559.36BOLT EXTERNAL FIXATION SCHANZ SCREW POST MOUNT MRI $1,775.60BOLT EXTERNAL FIXATION XS RING BASE LEVEL MAC SYST $460.80BOLT LOCKING STAINLESS STEEL L100 MM OD4.9 MM FEMO C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L26 MM OD4.9 MM FEMOR C1713 $957.60

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 ChargeBOLT LOCKING STAINLESS STEEL L28 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L30 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L32 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L34 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L36 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L38 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L40 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L42 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L44 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L46 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L48 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L50 MM OD4.9 MM FEMOR C1713 $957.60BOLT LOCKING STAINLESS STEEL L52 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L54 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L56 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L58 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L60 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L64 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L68 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L72 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L76 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L80 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L85 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L90 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING STAINLESS STEEL L95 MM OD4.9 MM FEMOR C1713 $1,135.44BOLT LOCKING TITANIUM 3.5 MM 2.3 MM L40 MM OD3.9 M C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM 2.3 MM L40 MM OD4.9 M C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM 2.3 MM L50 MM OD4.9 M C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM 2.3 MM L52 MM OD3.9 M C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM 2.3 MM L72 MM OD3.9 M C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM 2.3 MM L80 MM OD3.9 M C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM FULL THREAD L100 MM O C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM FULL THREAD L34 MM OD C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM HEXAGON L42 MM OD4.9 C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L18 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L20 MM OD3.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L22 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L24 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L26 MM OD3.9 MM ODSEC C1713 $1,554.96

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 ChargeBOLT LOCKING TITANIUM 3.5 MM L26 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L28 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L30 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L30 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L32 MM OD3.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L32 MM OD4.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L34 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L34 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L36 MM OD3.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L36 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L38 MM OD3.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L38 MM OD4.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L40 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L40 MM OD4.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L42 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L42 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L44 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L44 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L46 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L46 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L48 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L48 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L50 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L50 MM OD4.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L52 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L54 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L54 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L56 MM OD3.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L56 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L58 MM OD3.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L58 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L60 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L60 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L62 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L64 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L64 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L66 MM OD3.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L68 MM OD4.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L72 MM OD4.9 MM ODSEC C1713 $1,217.52

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 ChargeBOLT LOCKING TITANIUM 3.5 MM L74 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L76 MM OD4.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L78 MM OD3.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L80 MM OD4.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L85 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM 3.5 MM L90 MM OD4.9 MM ODSEC C1713 $1,554.96BOLT LOCKING TITANIUM 3.5 MM L95 MM OD4.9 MM ODSEC C1713 $1,217.52BOLT LOCKING TITANIUM FULL THREAD L100 MM OD4.9 MM C1713 $1,217.52BOLT LOCKING TITANIUM FULL THREAD L22 MM OD3.9 MM C1713 $1,217.52BOLT LOCKING TITANIUM FULL THREAD L70 MM OD3.9 MM C1713 $1,217.52BOLT LOCKING TITANIUM FULL THREAD L74 MM OD3.9 MM C1713 $1,217.52BOLT LOCKING TITANIUM FULL THREAD L78 MM OD3.9 MM C1713 $1,217.52BOLT LOCKING TITANIUM HEXAGON L60 MM OD3.9 MM ODSE C1713 $989.24BOLT LOCKING TITANIUM HEXAGON L80 MM OD4.9 MM ODSE C1713 $1,217.52BOLT LOCKING TITANIUM HEXAGON L90 MM OD4.9 MM ODSE C1713 $1,217.52BOLT LOCKING TITANIUM L18 MM OD3.9 MM HUMERUS TIBI C1713 $1,217.52BOLT LOCKING TITANIUM L24 MM OD3.9 MM HUMERUS TIBI C1713 $1,217.52BOLT LOCKING TITANIUM L26 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L28 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L30 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L32 MM OD3.9 MM ODSEC8 MM PR C1713 $1,554.96BOLT LOCKING TITANIUM L34 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L36 MM OD3.9 MM ODSEC8 MM PR C1713 $1,554.96BOLT LOCKING TITANIUM L42 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L44 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L46 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L48 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L50 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L52 MM OD3.9 MM ODSEC8 MM PR C1713 $1,554.96BOLT LOCKING TITANIUM L54 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L58 MM OD3.9 MM ODSEC8 MM PR C1713 $1,554.96BOLT LOCKING TITANIUM L62 MM OD3.9 MM NONSTERILE C1713 $1,217.52BOLT LOCKING TITANIUM L64 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L66 MM OD3.9 MM ODSEC8 MM PR C1713 $1,554.96BOLT LOCKING TITANIUM L68 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L72 MM OD3.9 MM ODSEC3.5 MM C1713 $1,554.96BOLT LOCKING TITANIUM L76 MM OD3.9 MM ODSEC3.5 MM C1713 $1,554.96BOLT LOCKING TITANIUM L76 MM OD3.9 MM ODSEC8 MM PR C1713 $1,217.52BOLT LOCKING TITANIUM L76 MM OD4.9 MM ODSEC3.5 MM C1713 $1,217.52

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 ChargeBOLT LOCKING TITANIUM L80 MM OD3.9 MM ODSEC3.5 MM C1713 $1,554.96BOLT LOCKING TITANIUM L95 MM OD4.9 MM FEMUR STERIL C1713 $1,554.96BOLT ORTHOPEDIC ARCOS COCRMO L38 MM HIP TROCHANTER C1713 $3,705.00BOLT ORTHOPEDIC ARCOS COCRMO L40 MM TROCHANTERIC S C1713 $3,705.00BOLT ORTHOPEDIC ARCOS COCRMO L44 MM HIP TROCHANTER C1713 $3,705.00BOLT ORTHOPEDIC STAINLESS STEEL L100 MM OD6.5 MM M C1713 $3,781.20BOLT ORTHOPEDIC STAINLESS STEEL L105 MM OD6.5 MM M C1713 $4,045.88BOLT ORTHOPEDIC STAINLESS STEEL L110 MM OD6.5 MM M C1713 $3,781.20BOLT ORTHOPEDIC STAINLESS STEEL L115 MM OD6.5 MM M C1713 $3,781.20BOLT ORTHOPEDIC STAINLESS STEEL L120 MM OD6.5 MM M C1713 $3,781.20BOLT ORTHOPEDIC STAINLESS STEEL L125 MM OD6.5 MM M C1713 $4,129.52BOLT ORTHOPEDIC STAINLESS STEEL L130 MM OD6.5 MM M C1713 $3,859.36BOLT ORTHOPEDIC STAINLESS STEEL L135 MM OD6.5 MM M C1713 $3,859.36BOLT ORTHOPEDIC STAINLESS STEEL L140 MM OD6.5 MM M C1713 $3,859.36BOLT ORTHOPEDIC STAINLESS STEEL L145 MM OD6.5 MM M C1713 $4,129.52BOLT ORTHOPEDIC STAINLESS STEEL L150 MM OD6.5 MM M C1713 $3,859.36BOLT ORTHOPEDIC STAINLESS STEEL L155 MM OD6.5 MM M C1713 $3,859.36BOLT ORTHOPEDIC STAINLESS STEEL L160 MM OD6.5 MM M C1713 $3,859.36BOLT ORTHOPEDIC STAINLESS STEEL L50 MM OD6.5 MM MI C1713 $3,721.36BOLT ORTHOPEDIC STAINLESS STEEL L55 MM OD6.5 MM MI C1713 $3,981.86BOLT ORTHOPEDIC STAINLESS STEEL L60 MM OD6.5 MM MI C1713 $3,981.86BOLT ORTHOPEDIC STAINLESS STEEL L65 MM OD6.5 MM MI C1713 $3,981.86BOLT ORTHOPEDIC STAINLESS STEEL L70 MM OD6.5 MM MI C1713 $3,981.86BOLT ORTHOPEDIC STAINLESS STEEL L75 MM OD6.5 MM MI C1713 $3,721.36BOLT ORTHOPEDIC STAINLESS STEEL L80 MM OD6.5 MM MI C1713 $3,981.86BOLT ORTHOPEDIC STAINLESS STEEL L85 MM OD6.5 MM MI C1713 $3,721.36BOLT ORTHOPEDIC STAINLESS STEEL L90 MM OD6.5 MM MI C1713 $3,781.20BOLT ORTHOPEDIC STAINLESS STEEL L95 MM OD6.5 MM MI C1713 $3,781.20BOLT ORTHOPEDIC TITANIUM 3.5 MM L70 MM OD3.9 MM OD C1713 $1,554.96BOLT ORTHOPEDIC TITANIUM L100 MM OD6.5 MM MIDFOOT C1713 $4,045.88BOLT ORTHOPEDIC TITANIUM L105 MM OD6.5 MM MIDFOOT C1713 $3,781.20BOLT ORTHOPEDIC TITANIUM L110 MM OD6.5 MM MIDFOOT C1713 $4,045.88BOLT ORTHOPEDIC TITANIUM L115 MM OD6.5 MM MIDFOOT C1713 $3,781.20BOLT ORTHOPEDIC TITANIUM L120 MM OD6.5 MM MIDFOOT C1713 $3,781.20BOLT ORTHOPEDIC TITANIUM L125 MM OD6.5 MM MIDFOOT C1713 $3,859.36BOLT ORTHOPEDIC TITANIUM L130 MM OD6.5 MM MIDFOOT C1713 $3,859.36BOLT ORTHOPEDIC TITANIUM L135 MM OD6.5 MM MIDFOOT C1713 $3,859.36BOLT ORTHOPEDIC TITANIUM L140 MM OD6.5 MM MIDFOOT C1713 $3,859.36BOLT ORTHOPEDIC TITANIUM L145 MM OD6.5 MM MIDFOOT C1713 $3,859.36

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 ChargeBOLT ORTHOPEDIC TITANIUM L150 MM OD6.5 MM MIDFOOT C1713 $3,859.36BOLT ORTHOPEDIC TITANIUM L155 MM OD6.5 MM MIDFOOT C1713 $3,859.36BOLT ORTHOPEDIC TITANIUM L160 MM OD6.5 MM MIDFOOT C1713 $3,859.36BOLT ORTHOPEDIC TITANIUM L50 MM OD6.5 MM MIDFOOT F C1713 $3,981.86BOLT ORTHOPEDIC TITANIUM L55 MM OD6.5 MM MIDFOOT F C1713 $3,721.36BOLT ORTHOPEDIC TITANIUM L60 MM OD6.5 MM MIDFOOT F C1713 $3,981.86BOLT ORTHOPEDIC TITANIUM L65 MM OD6.5 MM MIDFOOT F C1713 $3,721.36BOLT ORTHOPEDIC TITANIUM L68 MM OD3.9 MM LOCK STER C1713 $1,554.96BOLT ORTHOPEDIC TITANIUM L70 MM OD6.5 MM MIDFOOT F C1713 $3,721.36BOLT ORTHOPEDIC TITANIUM L75 MM OD6.5 MM MIDFOOT F C1713 $3,721.36BOLT ORTHOPEDIC TITANIUM L80 MM OD6.5 MM MIDFOOT F C1713 $3,721.36BOLT ORTHOPEDIC TITANIUM L85 MM OD6.5 MM MIDFOOT F C1713 $3,721.36BOLT ORTHOPEDIC TITANIUM L90 MM OD6.5 MM MIDFOOT F C1713 $3,781.20BOLT ORTHOPEDIC TITANIUM L95 MM OD6.5 MM MIDFOOT F C1713 $3,781.20BOLT SPINAL DECADE LARGE L40 MM OD5.5 MM PLATE NON C1713 $1,625.00BOLT SPINAL DECADE LARGE L45 MM OD5.5 MM PLATE NON C1713 $1,625.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L25 MM OD4 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L25 MM OD4.35 C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L27.5 MM OD4 C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L27.5 MM OD4. C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L30 MM OD4 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L30 MM OD4.35 C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L30 MM OD5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L35 MM OD4 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L35 MM OD4.35 C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L35 MM OD5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L35 MM OD6 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L40 MM OD4 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L40 MM OD4.35 C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L40 MM OD5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L40 MM OD6 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L45 MM OD5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L45 MM OD6 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM STAINLESS STEEL L50 MM OD6 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L25 MM OD4 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L25 MM OD4.35 MM 4.5 C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L27.5 MM OD4 MM 4.5 C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L27.5 MM OD4.35 MM 4 C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L30 MM OD4 MM 4.5 MM 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 ChargeBOLT SPINAL EXPEDIUM TITANIUM L30 MM OD4.35 MM 4.5 C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L30 MM OD5 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L35 MM OD4 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L35 MM OD5 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L35 MM OD6 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L40 MM OD4 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L40 MM OD4.35 MM 4.5 C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L40 MM OD5 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L40 MM OD6 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L45 MM OD5 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L45 MM OD6 MM 4.5 MM C1713 $2,800.00BOLT SPINAL EXPEDIUM TITANIUM L50 MM OD6 MM 4.5 MM C1713 $2,800.00BOLT SPINAL POLARIS L60 MM OD8.5 MM ILIUM C1713 $4,800.00BOLT SPINAL TITANIUM L50 MM OD8 MM C1713 $1,300.00BOLT SPINAL VANTAGE TITANIUM L35 MM OD8 MM ANTERIO C1713 $1,300.00BONE AND/OR JOINT IMAGING 78300 $1,153.00BONE AND/OR JOINT IMAGING, 3 PHASE STUDY 78315 $1,530.00BONE AND/OR JOINT IMAGING, MULTIPLE AREAS 78305 $1,265.00BONE AND/OR JOINT IMAGING, WHOLE BODY 78306 $1,265.00BONE DENSITY MEASUREMENT USING DEDICATED X-RAY MAC 77080 $467.00BONE DENSITY MEASUREMENT USING DEDICATED X-RAY MAC 77081 $170.00BONE DENSITY MEASUREMENT USING DEDICATED X-RAY MAC 77085 $467.00BONE MARROW ASPIRATION 38220 $5,393.00BONE MARROW BIOPSY AND ASPIRATION 38222 $5,392.00BONE MARROW, SMEAR INTERPRETATION 85097 $177.00BONE REPLACEMENT GRAFT D4263 $1,995.00BONE REPLACEMENT GRAFT D4264 $1,995.00BONE REPLACEMENT GRAFT D7953 $5,626.00BOOT CAST PROCARE CANVAS RUBBER ADULT LARGE L12.5 L3260 $18.20BOOT CAST PROCARE CANVAS RUBBER ADULT MEDIUM L11 I L3260 $18.20BOOT CAST PROCARE CANVAS RUBBER ADULT XL L13.5 IN L3260 $18.20BOOT CAST PROCARE CANVAS RUBBER PEDIATRIC SMALL L9 L3260 $18.20BOOT WALKING ULTRA CTS 12.5+ 11.5+ TALL LARGE ANKL L4386 $351.26BOOT WALKING ULTRA CTS 4.5 3.5 XS TALL ANKLE FOOT L4386 $169.39BOOT WALKING ULTRA CTS 5-8 4-7 TALL SMALL ANKLE FO L4386 $351.26BOOT WALKING ULTRA CTS 5-8.5 4.5-7 SMALL SHORT ANK L4386 $169.39BOOT WALKING ULTRA CTS 9-11 7.5-10 MEDIUM SHORT AN L4386 $169.39BOOT WALKING ULTRA CTS SMALL SHORT ANKLE LOW HEEL L4360 $193.31BOOT WALKING VECTRA 3.5- 2.5- XS LOW PROFILE FOOT L4386 $65.00

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 ChargeBOWL BONE CEMENT ACM 180 GM VACUUM MIX FILTER BASE $485.33BOWL BONE CEMENT QUICK-VAC POLYETHYLENE VACUUM MIX $325.00BOWL BONE CEMENT VORTEX VACUUM MIX $150.00BRA NURSING AMEDA INTIMATES FABRIC 2 L5 IN X W.75 $665.80BRA NURSING AMEDA INTIMATES FABRIC 5 L5 IN X W.75 $665.80BRA POST SURGICAL FABRIC 34-36 DETACHABLE HOOK LOO L8000 $189.50BRA POST SURGICAL FABRIC 38-40 DETACHABLE HOOK LOO L8000 $188.70BRA POST SURGICAL FABRIC 42-44 DETACHABLE HOOK LOO L8000 $188.70BRA POST SURGICAL FABRIC 46-48 DETACHABLE HOOK LOO L8000 $188.70BRA POST SURGICAL NYLON SPANDEX 32 OD28-30 IN ADJU L8000 $88.00BRA POST SURGICAL NYLON SPANDEX 34 OD31-32 IN ADJU L8000 $88.00BRA POST SURGICAL NYLON SPANDEX 36 OD33-34 IN ADJU L8000 $88.00BRA POST SURGICAL NYLON SPANDEX 38 OD35-36 IN ADJU L8000 $88.00BRA POST SURGICAL NYLON SPANDEX 40 OD37-38 IN ADJU L8000 $88.00BRA POST SURGICAL NYLON SPANDEX 44 OD41-42 IN ADJU L8000 $88.00BRA POST SURGICAL NYLON SPANDEX 48 OD45-46 IN ADJU L8000 $88.00BRA POST SURGICAL NYLON SPANDEX 50 OD47-48 IN ADJU L8000 $88.00BRA POST SURGICAL NYLON THK3/8 IN 50 1 IN FRONT HO L8000 $130.00BRACE ORTHOPEDIC BOA AIRMESH XL L8 IN OD40-45 IN C L0637 $21.13BRACE ORTHOPEDIC BOA AIRMESH XL OD42-48 IN BACK 2 L0460 $19.50BRACE ORTHOPEDIC CANVAS LARGE L11 IN LEFT WRIST FO L3908 $40.76BRACE ORTHOPEDIC CANVAS LARGE L11 IN RIGHT WRIST F L3908 $40.76BRACE ORTHOPEDIC CANVAS SMALL L11 IN RIGHT WRIST F L3908 $40.76BRACE ORTHOPEDIC CONFOR POLYURETHANE FOAM UNIVERSA L4350 $114.66BRACE ORTHOPEDIC COOL SPORT ELITE FABRIC SMALL OD1 $586.30BRACE ORTHOPEDIC FUSION 2XL OD27-30 IN ODSEC20-23 L1845 $2,132.85BRACE ORTHOPEDIC FUSION FEMALE KNEE CUSTOM AIRTECH L1846 $3,198.00BRACE ORTHOPEDIC FUSION FEMALE SMALL L12.5 IN OD15 L1845 $2,132.85BRACE ORTHOPEDIC FUSION KNEE CUSTOM COLOR AND PATT L1845 $3,344.25BRACE ORTHOPEDIC FUSION LATERAL KNEE CUSTOM COLOR L1845 $3,514.88BRACE ORTHOPEDIC FUSION LATERAL PLUS KNEE CUSTOM A L1845 $3,477.76BRACE ORTHOPEDIC FUSION MEDIUM OD18-19.5 IN ODSEC1 L1845 $2,379.00BRACE ORTHOPEDIC FUSION MEDIUM+ OD19.5-21 IN ODSEC L1845 $2,379.00BRACE ORTHOPEDIC FUSION PLUS LOW PROFILE KNEE CUST L1845 $3,224.52BRACE ORTHOPEDIC FUSION PLUS SMALL LOW PROFILE CON L1845 $2,321.87BRACE ORTHOPEDIC FUSION WOMENS PLUS LOW PROFILE CO L1845 $3,224.52BRACE ORTHOPEDIC FUSION WOMENS PLUS SMALL LOW PROF L1845 $2,321.87BRACE ORTHOPEDIC FUSION XT ALUMINUM FEMALE MEDIUM L1845 $2,301.00BRACE ORTHOPEDIC FUSION XT ALUMINUM FEMALE SMALL O L1845 $2,301.00

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 ChargeBRACE ORTHOPEDIC LONG KNEE POSTOPERATIVE L1832 $589.68BRACE ORTHOPEDIC LONG MEDIUM L26 IN OD18-22 IN THI L1830 $622.44BRACE ORTHOPEDIC LONG OD22-27 IN KNEE QUICK SET CO L1832 $416.52BRACE ORTHOPEDIC LONG XL OD27-31 IN KNEE QUICK SET L1832 $416.52BRACE ORTHOPEDIC LPR KNEE AIRTECH FRAME PADDING CU L1844 $3,464.24BRACE ORTHOPEDIC LPR MEDIUM OD18-19.5 IN ODSEC14-1 L1845 $2,288.98BRACE ORTHOPEDIC LPR XL OD24-27 IN ODSEC18-19.75 I L1845 $2,288.98BRACE ORTHOPEDIC NEOPRENE 2XL OD27-30 IN LEFT KNEE L1810 $182.85BRACE ORTHOPEDIC NYLON FOAM LARGE MEDIUM OD8.25-9 L3807 $123.24BRACE ORTHOPEDIC NYLON XS OD0-6.5 IN LEFT WRIST TH L3807 $123.24BRACE ORTHOPEDIC POST-OP LITE FOAM LONG KNEE ANODI L1832 $589.68BRACE ORTHOPEDIC POST-OP LITE FOAM LONG XL KNEE AN L1832 $613.08BRACE ORTHOPEDIC PROCARE COMFORTFORM LYCRA ALUMINU L3908 $35.88BRACE ORTHOPEDIC PROCARE SURROUND VELCRO THERMOPLA L4350 $45.95BRACE ORTHOPEDIC PTO AIRMESH LARGE OD15-18 IN RIGH L1810 $429.00BRACE ORTHOPEDIC ROADRUNNER AIRMESH LARGE KNEE OPE L1832 $704.47BRACE ORTHOPEDIC ROADRUNNER NEOPRENE XL L16 IN OD2 L1832 $687.38BRACE ORTHOPEDIC ROLYAN D-RING ALUMINUM COTTON MED L3908 $58.64BRACE ORTHOPEDIC ROLYAN D-RING ALUMINUM COTTON SMA L3908 $54.93BRACE ORTHOPEDIC SHORTRUNNER NEOPRENE MEDIUM L13 I L1820 $419.25BRACE ORTHOPEDIC SLINGSHOT 2 AIRMESH 15 D MEDIUM U L3670 $358.35BRACE ORTHOPEDIC SLINGSHOT 3 LARGE $420.81BRACE ORTHOPEDIC T SCOPE AIRMESH 2XL SHORT OD27-30 L1832 $453.38BRACE ORTHOPEDIC T SCOPE BRIDGETECH FOAM L17-27 IN L1832 $630.11BRACE ORTHOPEDIC T SCOPE KNEE PREMIER BUCKLE POSTO L1832 $16.25BRACE ORTHOPEDIC T SCOPE KNEE PREMIER Y TAP POSTOP L1832 $11.38BRACE ORTHOPEDIC WRIST LACER SUEDE SMALL L10 IN OD L3908 $66.76BRACE ORTHOPEDIC WRIST PRO FOAM MEDIUM L8 IN OD7-8 L3807 $48.82BRACE ORTHOPEDIC X2K 2XL OD27-31 IN ODSEC19.75-22 L1845 $2,070.25BRACE ORTHOPEDIC X2K LARGE OD21-24 IN ODSEC16.25-1 L1845 $2,270.45BRACE ORTHOPEDIC X2K MEDIUM OD37-40 CM KNEE RIGHT L1845 $2,184.00BRACE ORTHOPEDIC X2K MEDIUM+ OD19.5-21 IN ODSEC15. L1845 $2,184.00BRACE ORTHOPEDIC X2K SMALL OD32-37 CM KNEE RIGHT O L1845 $2,184.00BRACE ORTHOPEDIC X2K XL OD24-27 IN ODSEC18-19.75 I L1845 $2,184.00BRACE ORTHOPEDIC XL LONG KNEE POSTOPERATIVE L1832 $613.08BRACE ORTHOPEDIC XL OD9-10 IN LEFT WRIST THUMB SPI L3807 $123.24BRACE ORTHOPEDIC XL OD9-10 IN RIGHT WRIST SPLINT T L3807 $123.24BRACE ORTHOPEDIC XS OD0-6.5 IN RIGHT WRIST SPLINT L3807 $123.24BRACE WALKING NEXTEP CONTOUR PROCARE NYLON FOAM 7- L4386 $313.52

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 ChargeBRACE WALKING PACESETTER II FOAM 11-16 13+ XL L13+ L4386 $222.89BRACE WALKING PACESETTER II FOAM MEDIUM LARGE L8-1 L4386 $222.89BRACE WALKING PACESETTER II FOAM SMALL L4-8 IN L3- L4386 $154.72BRACE WALKING PACESETTER II FOAM XL L13+ IN L11-16 L4386 $222.89BRACE WALKING PACESETTER II VELCRO FOAM 3-6.5 4-7. L4386 $222.89BRACE WALKING PROCARE MAXTRAX NYLON FOAM 10.5-13.5 L4386 $84.00BRACE WALKING PROCARE MAXTRAX NYLON FOAM 5- 4.5-6 L4386 $84.00BRACE WALKING PROCARE MAXTRAX NYLON FOAM 5.5-10 6. L4386 $84.00BRACE WALKING XCELTRAX PROCARE NYLON FOAM 10.5-12. L4361 $128.65BRACE WALKING XCELTRAX PROCARE NYLON FOAM 4.5-7 6- L4361 $128.65BRACE WALKING XCELTRAX PROCARE NYLON FOAM 7.5-10.5 L4361 $128.65BREATH TEST ANALYSIS FOR HELICOBACTER PYLORI 83013 $225.00BRIDGE PORCELAIN BASE METAL D6241 $1,795.00BRIDGE PORCELAIN NOBLE METAL D6242 $2,214.00BRIDGE RESIN NOBLE METAL D6252 $308.00BRONCHOSCOPE FLEXIBLE AMBU ASCOPE 3 L600 MM OD5 MM $2,080.00BRONCHOSCOPE FLEXIBLE AMBU ASCOPE 3 SLIM L600 MM O $2,080.00BRONCHOSCOPY W/FLUORO GUIDANCE WITH BRONCHIAL THER 31660 $13,711.00BUCKLE EXTERNAL FIXATION ILIZAROV CIRCULAR SMALL B $3,842.72BUMETANIDE 0.25 MG/ML SOLN 50 ML BAG $100.00BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 CRTG 1.8 M $20.02BUPRENORPHINE DEFINITIVE ASSY 80348 $244.00BURN TREATMENT 16000 $264.00BURR CATHETER ROTABLATOR ROTALINK DIAMOND L135 CM C1724 $6,080.00BURR SHAVER COOLCUT 8 FLUTE OVAL L13 CM OD4 MM STE $177.00BURR SHAVER CURVE L11 CM OD4 MM SINUS HIGH SPEED I $1,596.73BURR SHAVER DIAMOND 15 D L15 CM OD5 MM $1,762.48BURR SHAVER DIAMOND 15 D ROUND L12.5 CM OD5 MM HIG $1,596.73BURR SHAVER DYONICS OD5.5 MM HIP ABRADER STERILE D $710.82BURR SHAVER FORMULA 6 FLUTE BARREL LEFT HELIX OD5. $423.36BURR SHAVER SIGNATURE SERIES OVAL STRAIGHT L19 CM $845.00BURR SHAVER XPS 12 D CURVE L11 CM OD3.2 MM HIGH SP $1,198.93BURR SHAVER XPS ASB DIAMOND 15 D L15 CM OD3.2 MM B $1,762.48BURR SHAVER XPS RAD 40 D L13 CM OD3 MM FRONTAL SIN $1,552.53BURR SURGICAL 2 FLUTE ROUND OD2 MM LATEX FREE $1,419.93BURR SURGICAL 40 D REVERSE TAPER L13 CM OD4 MM 30K $2,548.00BURR SURGICAL CARBIDE LONG ROUND FLUTE OD4 MM CRAN $669.92BURR SURGICAL CARBIDE ROUND L30 MM OD4 MM 8 FLUTED $408.00BURR SURGICAL DCR DIAMOND CURVE L110 MM OD2.5 MM H $1,298.38

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 ChargeBURR SURGICAL DIAMOND 40 D BULLET L13 CM OD3 MM 30 $2,756.00BURR SURGICAL DIAMOND 70 D BULLET L13 CM OD3 MM 30 $2,756.00BURR SURGICAL DIAMOND 70 D CURVE TAPER L13 CM OD4 $1,624.35BURR SURGICAL DIAMOND BALL EXTEND LENGTH OD1 MM ST $591.50BURR SURGICAL DIAMOND BALL OD3 MM STERILE LATEX FR $551.20BURR SURGICAL DIAMOND COARSE L13 MM OD3 MM MATCH H $1,166.88BURR SURGICAL DIAMOND COARSE L55 MM OD4 MM ROUND D $450.96BURR SURGICAL DIAMOND COARSE ROUND OD3 MM $910.59BURR SURGICAL DIAMOND COARSE ROUND OD4 MM $910.59BURR SURGICAL DIAMOND COARSE ROUND OD5 MM $1,579.50BURR SURGICAL DIAMOND FINE ROUND OD.5 MM EXTEND ST $910.59BURR SURGICAL DIAMOND FINE ROUND OD.7 MM EXTEND $1,133.80BURR SURGICAL DIAMOND FINE ROUND OD1 MM EXTEND $910.59BURR SURGICAL DIAMOND FINE ROUND OD1.5 MM EXTEND $910.59BURR SURGICAL DIAMOND FINE ROUND OD2 MM EXTEND $910.59BURR SURGICAL DIAMOND FINE ROUND OD3 MM EXTEND $910.59BURR SURGICAL DIAMOND L55 MM OD5 MM DIAMOND ROUND $438.96BURR SURGICAL DIAMOND MEDIUM L25.4 MM OD.8 MM DISC $893.20BURR SURGICAL DIAMOND MEDIUM L54 MM OD4.5 MM ROUND $450.96BURR SURGICAL DIAMOND ROUND COARSE OD6 MM $1,133.80BURR SURGICAL DIAMOND ROUND L54 MM OD3 MM COARSE S $450.96BURR SURGICAL DIAMOND ROUND OD1.5 MM COARSE $1,579.50BURR SURGICAL DIAMOND ROUND OD2 MM $910.59BURR SURGICAL DIAMOND ROUND OD2 MM COARSE $1,579.50BURR SURGICAL DIAMOND ROUND OD2 MM EXTEND $925.60BURR SURGICAL DIAMOND ROUND OD2 MM STERILE LATEX F $450.96BURR SURGICAL DIAMOND ROUND OD2.5 MM STERILE LATEX $438.96BURR SURGICAL DIAMOND ROUND OD3 MM EXTEND $925.60BURR SURGICAL DIAMOND ROUND OD3 MM STERILE LATEX F $910.59BURR SURGICAL DIAMOND ROUND OD4 MM $910.59BURR SURGICAL DIAMOND ROUND OD4 MM FLUTE STERILE L $811.72BURR SURGICAL DIAMOND ROUND OD5 MM $910.59BURR SURGICAL DIAMOND ROUND OD6 MM $910.59BURR SURGICAL DIAMOND TAPER OD3 MM FLUTE STERILE L $811.72BURR SURGICAL DYONICS OD5.5 MM BARREL HIGH VISIBIL $747.76BURR SURGICAL E9000 CARBIDE L30 MM OD3 MM ROUND OT $331.50BURR SURGICAL E9000 CARBIDE ROUND 10 FLUTE L30 MM $408.00BURR SURGICAL E9000 CARBIDE ROUND 10 FLUTE L38 MM $331.50BURR SURGICAL E9000 CARBIDE ROUND L38 MM OD5 MM 10 $331.50

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 ChargeBURR SURGICAL E9000 DIAMOND FINE ROUND L38 MM OD4 $370.50BURR SURGICAL E9000 DIAMOND FINE ROUND L38 MM OD5 $370.50BURR SURGICAL E9000 DIAMOND FINE ROUND L48 MM OD1. $456.00BURR SURGICAL E9000 DIAMOND MEDIUM LONG ROUND L48 $370.50BURR SURGICAL E9000 DIAMOND ROUND L38 MM OD6 MM CO $370.50BURR SURGICAL E9000 DIAMOND ROUND L48 MM OD1 MM CO $370.50BURR SURGICAL E9000 DIAMOND ROUND L48 MM OD2 MM CO $456.00BURR SURGICAL E9000 DIAMOND ROUND L48 MM OD3 MM CO $370.50BURR SURGICAL E9000 DIAMOND ROUND L48 MM OD4 MM CO $370.50BURR SURGICAL E9000 L38 MM OD7 MM ROUND DIAMOND CO $468.00BURR SURGICAL E9000 L48 MM OD2.5 MM COARSE DIAMOND $364.00BURR SURGICAL E9000 ROUND L38 MM OD2 MM DIAMOND ST $357.50BURR SURGICAL E9000 ROUND L38 MM OD3 MM DIAMOND ST $357.50BURR SURGICAL E9000 ROUND L48 MM OD5 MM COARSE DIA $370.50BURR SURGICAL E9000 STAINLESS STEEL ROUND L48 MM O $400.00BURR SURGICAL EGG OD4 MM $950.00BURR SURGICAL ELITE DIAMOND OD3 MM NEURO STERILE L $950.00BURR SURGICAL ELITE DIAMOND ROUND OD4 MM STERILE $771.88BURR SURGICAL ELITE DIAMOND ROUND OD6 MM STERILE L $771.88BURR SURGICAL ELITE DIAMOND ROUND TAPER OD.5 MM $980.59BURR SURGICAL ELITE OD3 MM ROUND DIAMOND COARSE TA $811.72BURR SURGICAL ELITE OD3.5 MM ROUND DIAMOND STERILE $950.00BURR SURGICAL ELITE OD6 MM ROUND FLUTED STERILE $950.00BURR SURGICAL ELITE ROUND FLUTE OD6 MM SOFT TOUCH $771.88BURR SURGICAL ELITE ROUND OD.7 MM DIAMOND STERILE $950.00BURR SURGICAL FLUTE BALL SHORT OD1 MM EXTEND NONST $604.18BURR SURGICAL FLUTE ROUND OD3 MM STERILE LATEX FRE $910.59BURR SURGICAL GENDER SOLUTIONS STANDARD KNEE PATEL $812.50BURR SURGICAL HIP PRESERVATION SYSTEM SIGNATURE SE $1,062.36BURR SURGICAL L11 CM OD6 MM COARSE DIAMOND BALL AN $458.19BURR SURGICAL L3 MM OD3.8 MM NEURO STERILE LATEX F $950.00BURR SURGICAL L3.8 MM OD3 MM NEURO SOFT TOUCH STER $950.00BURR SURGICAL LEGEND DIAMOND BALL L7.5 CM OD1 MM $831.48BURR SURGICAL LEGEND DIAMOND LONG L7.5 CM OD3 MM B $831.48BURR SURGICAL MICRO OD.38 MM SALIVARY STONE $1,920.00BURR SURGICAL MICROMAX COARSE DIAMOND BALL L11 CM $458.19BURR SURGICAL MICROMAX COARSE DIAMOND BALL L14 CM $551.20BURR SURGICAL MICROMAX COARSE DIAMOND BALL L8 CM O $458.19BURR SURGICAL MICROMAX DIAMOND BALL L11 CM OD4 MM $458.19

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 ChargeBURR SURGICAL MICROMAX DIAMOND BALL L11 CM OD5 MM $458.19BURR SURGICAL MICROMAX DIAMOND BALL L8 CM OD2 MM Q $458.19BURR SURGICAL MICROMAX DIAMOND BALL L8 CM OD4 MM Q $458.19BURR SURGICAL MICROMAX DIAMOND BALL L8 CM OD5 MM Q $458.19BURR SURGICAL MICROMAX FLUTE BALL L14 CM OD4 MM QD $478.14BURR SURGICAL MICROMAX FLUTE BALL L8 CM OD4 MM QD $471.45BURR SURGICAL MICROMAX FLUTE BALL L8 CM OD5 MM QD $471.45BURR SURGICAL MICROMAX FLUTE BALL L8 CM OD6 MM QD $471.45BURR SURGICAL MICROMAX FLUTE MATCHSTICK L8 CM OD3 $478.14BURR SURGICAL MICROMAX L12.8 MM OD1.4 MM DRILL BIT $478.14BURR SURGICAL MICROMAX L14 CM OD6 MM BALL DIAMOND $551.20BURR SURGICAL MICROMAX OD6 MM DIAMOND FLUTED STERI $478.14BURR SURGICAL MICROMAX SHORT STRAIGHT DIAMOND BALL $546.48BURR SURGICAL MICROMAX SHORT STRAIGHT FLUTE BALL L $562.32BURR SURGICAL MICROMAX STANDARD DIAMOND BALL L8 CM $458.19BURR SURGICAL MICROMAX STANDARD FLUTE BALL L14 CM $478.14BURR SURGICAL MIDAS REX LEGEND BALL CURVED L9 CM O $1,866.15BURR SURGICAL MIDAS REX LEGEND BALL FLUTE L14 CM O $781.63BURR SURGICAL MULTIFLUTE ROUND OD5 MM LATEX FREE $910.59BURR SURGICAL MULTIFLUTE ROUND OD6 MM LATEX FREE $910.59BURR SURGICAL OD1.2 MM CROSS CUT FISSURE $950.00BURR SURGICAL OD1.5 MM ROUND TAPERED EXTENDER $950.00BURR SURGICAL OD2 MM ROUND TAPERED COARSE $811.72BURR SURGICAL OD2.1 MM CROSS CUT FISSURE $1,944.00BURR SURGICAL OD2.5 MM NEURO CURVED STERILE MIS $1,434.96BURR SURGICAL OD4.5 MM TRANSNASAL ROUND DIAMOND CO $2,363.79BURR SURGICAL OD5.5 MM ROUND FLUTE SOFT TOUCH STER $950.00BURR SURGICAL OSTEON TPS ELITE SOFT TOUCH ROUND OD $771.88BURR SURGICAL OTO-FLEX SKEETER DIAMOND OD.8 MM LOW $1,709.50BURR SURGICAL PRECISION ACORN MEDIUM OD7.5 MM $1,233.77BURR SURGICAL PRECISION MATCH HEAD OD3 MM STERILE $1,630.72BURR SURGICAL PRECISION ROUND OD1 MM EXTEND $2,252.90BURR SURGICAL PRECISION ROUND OD2 MM EXTEND $1,747.60BURR SURGICAL PRECISION ROUND OD3 MM $1,267.50BURR SURGICAL PRECISION ROUND OD6 MM $1,267.50BURR SURGICAL ROUND FLUTE OD4 MM STERILE LATEX FRE $910.59BURR SURGICAL ROUND FLUTE OD5 MM STERILE $950.00BURR SURGICAL ROUND L38 MM OD2 MM STERILE $344.50BURR SURGICAL ROUND XCOARSE DIAMOND OD6 MM STERILE $771.88

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 ChargeBURR SURGICAL S2 DRIVE DIAMOND COARSE OD2 MM EXTEN $925.60BURR SURGICAL S2 DRIVE DIAMOND COARSE OD3 MM EXTEN $925.60BURR SURGICAL SABER ELITE DIAMOND ROUND TAPER FLUT $771.88BURR SURGICAL SABER TPS ELITE SOFT TOUCH DIAMOND R $771.88BURR SURGICAL SIGNATURE SERIES PREBENT L19 CM HIP $1,281.35BURR SURGICAL SIGNATURE SERIES SPHERICAL PREBENT L $845.00BURR SURGICAL SIGNATURE SERIES SPHERICAL STRAIGHT $1,062.36BURR SURGICAL SIGNATURE SERIES STRAIGHT OD4 MM ODS $937.37BURR SURGICAL SOFT TOUCH ROUND FLUTE OD7 MM $950.00BURR SURGICAL STEEL L38 MM OD6 MM ROUND STERILE $370.50BURR SURGICAL STRAIGHT L6 MM OD1.1 MM ROUTER STRAI $771.88BURR SURGICAL TAPER L25 MM OD2 MM ROUTER STERILE $1,417.00BURR SURGICAL TAPER OD3 MM ROUTER WHITE $717.60BURR SURGICAL TPS DIAMOND ROUND OD3 MM 5 NOTCH NUM $771.88BURR SURGICAL TPS ELITE DIAMOND OD5 MM 5 STEP NOTC $771.88BURR SURGICAL TPS ELITE DIAMOND ROUND COARSE OD2 M $771.88BURR SURGICAL TPS ELITE DIAMOND ROUND OD1 MM ROUND $771.88BURR SURGICAL TPS ELITE DIAMOND ROUND OD2 MM $771.88BURR SURGICAL TPS ELITE DIAMOND ROUND TAPER OD2 MM $771.88BURR SURGICAL TPS ELITE FLUTE OD4 MM STERILE $950.00BURR SURGICAL TPS ELITE OD1.6 MM 5 STEP NOTCH CROS $950.00BURR SURGICAL TPS ELITE OD3.5 MM ROUND FLUTED AGGR $1,944.00BURR SURGICAL TPS ELITE OD5 MM ROUND COARSE DIAMON $950.00BURR SURGICAL TPS ELITE OSTEON ROUND FLUTE OD2 MM $771.88BURR SURGICAL TPS ELITE ROUND DIAMOND COARSE OD1 M $1,626.89BURR SURGICAL TPS ELITE ROUND DIAMOND COARSE OD3 M $771.88BURR SURGICAL TPS ELITE ROUND DIAMOND COARSE OD5 M $771.88BURR SURGICAL TPS ELITE ROUND DIAMOND COARSE OD6 M $771.88BURR SURGICAL TPS ELITE ROUND DIAMOND TAPER OD1 MM $771.88BURR SURGICAL TPS ELITE ROUND OD1.5 MM STERILE LAT $771.88BURR SURGICAL XMAX MICROMAX EMAX 2 PLUS LONG STRAI $604.18BURR SURGICAL XMAX MICROMAX EMAX 2 PLUS MEDIUM EXT $591.50BURR SURGICAL XMAX MICROMAX EMAX 2 PLUS MEDIUM FLU $705.58BURR SURGICAL XMAX MICROMAX EMAX 2 PLUS MEDIUM STR $591.50BURR SURGICAL XMAX MICROMAX EMAX 2 PLUS PEDIATRIC $654.88BURR SURGICAL XMAX MICROMAX EMAX 2 PLUS SHORT EXTE $591.50BURR SURGICAL ZEPHYR ELITE OD5 MM ROUND FLUTE STER $1,768.56BURR SURGICAL ZEPHYR ELITE ROUND FLUTE OD3 MM $1,768.56BURR SURGICAL ZEPHYR OD6 MM $950.00

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 ChargeBURR SURGICAL ZYPHR ROUND FLUTE OD4 MM $950.00BUSHING EXTERNAL FIXATION STAINLESS STEEL CIRCULAR $643.36BUSHING FEMORAL GMRS SMALL KNEE C1776 $1,891.50BUSHING FEMORAL OSS POLYETHYLENE HIP REDUCE SIZE C1776 $3,432.00BUSHING FEMORAL OSS POLYETHYLENE KNEE AUXILIARY C1776 $3,432.00BUSHING TIBIAL OSS POLYETHYLENE KNEE LOW FRICTION C1776 $2,464.00BUTTON CABLE CABLE-READY STAINLESS STEEL OD5.5 MM $899.08BUTTON CERCLAGE STAINLESS STEEL HEX OD4 MM CANNULA C1713 $1,251.20BUTTON CERCLAGE STAINLESS STEEL T15 HEX OD2.5 MM S $1,242.00BUTTON CERCLAGE STAINLESS STEEL T25 HEX OD3.5 MM S C1713 $1,242.00BUTTON CERCLAGE TITANIUM T25 HEXAGONAL OD3.5 MM ST C1713 $1,237.36BUTTON FIXATION DOG BONE C1713 $2,275.00BUTTON FIXATION ENDOBUTTON CL ULTRA OD15 MM PRELOA C1713 $2,634.51BUTTON FIXATION ENDOBUTTON CL ULTRA OD20 MM PRELOA C1713 $2,632.00BUTTON FIXATION ENDOBUTTON CL ULTRA OD25 MM PRELOA C1713 $2,624.34BUTTON FIXATION GFS MINI PARCUS BRAID 6AL-4V ELI U C1713 $2,152.00BUTTON FIXATION GRAFTMAX L15 MM CORTICAL ADJUSTABL C1713 $1,755.72BUTTON FIXATION PARCUS TITANIUM L12 MM X W3.9 MM L C1713 $2,152.00BUTTON FIXATION PARCUS TITANIUM LARGE L16.5 MM X W C1713 $2,152.00BUTTON FIXATION PARCUS UHMWPE 20 MM LARGE LOOP WOV C1713 $2,152.00BUTTON FIXATION RETROBUTTON TITANIUM UHMWPE L12 MM C1713 $1,880.00BUTTON FIXATION TIGHTROPE ROUND OD14 MM ACL ATTACH C1713 $1,391.00BUTTON FIXATION TITANIUM OD2.5 MM ORTHOPEDIC CERCL C1713 $1,237.36BUTTON FIXATION XOBUTTON OD15 MM ACL PCL CONTINUOU C1713 $1,404.00BUTTON FIXATION XOBUTTON OD20 MM ACL PCL CONTINUOU C1713 $1,404.00BUTTON GASTROSTOMY BARD L1.7 CM OD18 FR 60 ML NONB $2,288.00BUTTON GASTROSTOMY MIC-KEY SECUR-LOK SILICONE L1.2 B4088 $736.32BUTTON GASTROSTOMY MIC-KEY SECUR-LOK SILICONE L1.5 $736.32BUTTON GASTROSTOMY MIC-KEY SECUR-LOK SILICONE L1.7 B4088 $722.00BUTTON GASTROSTOMY MIC-KEY SECUR-LOK SILICONE L2.5 $598.26BUTTON GASTROSTOMY MIC-KEY SECUR-LOK SILICONE L3 C $598.26BUTTON GASTROSTOMY MINI ONE APPLE L1.2 CM OD14 FR $720.00BUTTON GASTROSTOMY MINI ONE APPLE L1.7 CM OD14 FR $720.00BUTTON GASTROSTOMY MINI ONE APPLE L1.7 CM OD16 FR $720.00BUTTON GASTROSTOMY MINI ONE APPLE L1.7 CM OD18 FR $720.00BUTTON GASTROSTOMY MINI ONE APPLE L2 CM OD14 FR BA $720.00BUTTON GASTROSTOMY MINI ONE APPLE L2.3 CM OD16 FR $720.00BUTTON GASTROSTOMY MINI ONE APPLE L2.3 CM OD18 FR $720.00BUTTON GASTROSTOMY MINI ONE APPLE L3 CM OD16 FR BA $720.00

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 ChargeBUTTON GASTROSTOMY MINIONE L3 CM OD18 FR BALLOON $720.00BUTTON SUTURE L12 MM BICEPS STERILE C1713 $1,917.50BUTTON SUTURE OD3.5 MM C1713 $617.50BUTTON SUTURE POLYPROPYLENE OD14 MM TENDOR REPAIR C1713 $83.96BUTTON SUTURE TIGHTROPE LARGE L20 MM X W5 MM EXTEN C1713 $1,462.50C. DIFF AG IA TECH 87449 $93.00CABLE CATHETER INQUIRY L150 CM 10 PIN CONNECT CHAN $1,200.00CABLE CATHETER L122 CM UMBILICAL ELECTRICAL LATEX $1,202.50CABLE NEUROSTIMULATOR 2 ATTACHED ALLIGATOR CLIP SC $333.45CABLE NEUROSTIMULATOR DEEP BRAIN STIMULATOR (DBS) $389.03CABLE NEUROSTIMULATOR INTERSTIM L25 CM TWIST LOCK $507.00CABLE NEUROSTIMULATOR INTERSTIM L64 CM TWIST LOCK $507.00CABLE NEUROSTIMULATOR INTERSTIM SCREENING STYLET K $500.50CABLE NEUROSTIMULATOR MULTILEAD TRIAL $1,300.00CABLE NEUROSTIMULATOR MULTILEAD TRIAL STERILE LATE $1,235.00CABLE NEUROSTIMULATOR PRECISION SPECTRA L2 FT 1 X $1,560.00CABLE NEUROSTIMULATOR PRECISION SPECTRA L213 CM 2 $1,560.00CABLE ORTHOPEDIC BMP COCR L750 MM OD2 MM C1713 $416.00CABLE ORTHOPEDIC BMP STAINLESS STEEL L750 MM OD2 M C1713 $1,443.26CABLE ORTHOPEDIC CABLE-READY COCR L635 CM OD1.8 MM C1713 $1,690.00CABLE ORTHOPEDIC CABLE-READY STAINLESS STEEL L914 C1713 $1,943.50CABLE ORTHOPEDIC CONTROL COCR L24 IN OD1.8 MM HIP C1713 $2,043.60CABLE ORTHOPEDIC LCP STAINLESS STEEL L750 MM OD1 M C1713 $3,321.20CABLE ORTHOPEDIC LCP STAINLESS STEEL L750 MM OD1.7 C1713 $2,698.48CABLE ORTHOPEDIC TITANIUM COCR L750 MM OD1.7 MM CR C1713 $2,702.18CABLE ORTHOPEDIC TITANIUM L750 MM OD1 MM 2 NEEDLE C1713 $3,726.00CABLE ORTHOPEDIC TITANIUM L750 MM OD1 MM CRIMP STE C1713 $3,321.20CABLE ORTHOPEDIC ZIPFIX PEEK STERNAL NEEDLE FLEXIB C1713 $502.32CABLE PACING L6 FT ATRIUM VENTRICLE EXTERNAL TEMPO $1,120.00CABLE PACING TARGET TIP MICRO ELECTRODE $567.45CABLE SPINAL ATLAS SONGER TITANIUM 1 INTEGRAL CRIM $975.00CABLE SPINAL SONGER STAINLESS STEEL 1 LOOP CRIMP S C1713 $975.00CABLE SPINAL SONGER TITANIUM 1 LOOP CRIMP STERILE C1713 $975.00CABLE SPINAL SONGER TITANIUM 2 LOOP CRIMP STERILE C1713 $975.00CABLE SPINAL STAINLESS STEEL OD1.1 MM STERNAL CUT C1713 $552.50CABLE SPINAL TITANIUM L470 MM OD1 MM 1 LEAD CRIMP C1713 $1,200.00CABLE SPINAL TITANIUM L470 MM OD1 MM 2 LEAD CRIMP $1,200.00CABLE/SLEEVE ORTHOPEDIC BMP L750 MM OD2 MM COMBO S $2,247.70CABLE/SLEEVE ORTHOPEDIC DALL-MILES VITALLIUM OD2 M C1713 $1,588.86

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 ChargeCAFFEINE LEVEL 80155 $232.00CAGE SPINAL BRECKENRIDGE PEEK 0 D L25 MM X W9 MM X C1821 $13,650.00CAGE SPINAL BRECKENRIDGE PEEK 0 D L30 MM X W9 MM X C1821 $13,650.00CAGE SPINAL BRECKENRIDGE PEEK 12 D L32 MM X W24 MM C1821 $14,625.00CAGE SPINAL BRECKENRIDGE PEEK L30 MM X W10 MM X H9 C1821 $13,650.00CAGE SPINAL BRECKENRIDGE PEEK L30 MM X W9 MM X H7 C1821 $13,650.00CAGE SPINAL BRECKENRIDGE PEEK L30 MM X W9 MM X H8 C1821 $13,650.00CAGE SPINAL BRIGADE TITANIUM 12 D L34 MM X W24 MM C1821 $29,250.00CAGE SPINAL CASCADIA 8 D L45 MM X W18 MM X H8 MM S C1821 $22,750.00CAGE SPINAL CASCADIA 8 D L50 MM X W18 MM X H10 MM C1821 $22,750.00CAGE SPINAL CASCADIA 8 D L50 MM X W18 MM X H8 MM S C1821 $22,750.00CAGE SPINAL CASCADIA 8 D L55 MM X W18 MM X H10 MM C1821 $22,750.00CAGE SPINAL CASCADIA TITANIUM POROUS 8 D LORDOTIC C1821 $22,750.00CAGE SPINAL CLYDESDALE PTC PEEK TITANIUM 0 D L50 M C1821 $22,750.00CAGE SPINAL CLYDESDALE PTC PEEK TITANIUM 6 D L45 M C1821 $22,750.00CAGE SPINAL CLYDESDALE PTC PEEK TITANIUM 6 D L50 M C1821 $22,750.00CAGE SPINAL CLYDESDALE PTC PEEK TITANIUM 6 D L55 M C1821 $22,750.00CAGE SPINAL COALESCE LORDOTIC CURVE L32 MM X W11 M C1821 $21,450.00CAGE SPINAL CONCORDE CFRP 5 D BULLET NOSE L27 MM X C1821 $14,950.00CAGE SPINAL COROENT 10 D XL L50 MM X W18 MM X H10 C1821 $22,750.00CAGE SPINAL COROENT PEEK 10 D XL L45 MM X W18 MM X C1821 $22,750.00CAGE SPINAL COROENT PEEK 10 D XL L50 MM X W18 MM X C1821 $22,750.00CAGE SPINAL COROENT PEEK XL L30 MM X W16 MM X H6 M C1821 $26,000.00CAGE SPINAL COROENT PEEK XL L35 MM X W16 MM X H8 M C1821 $26,000.00CAGE SPINAL COROENT PEEK-OPTIMA 4 D LARGE IMPACT L C1821 $14,950.00CAGE SPINAL DIVERGENCE PEEK TITANIUM D14 MM LORDOT C1821 $4,225.00CAGE SPINAL ENDOSKELETON TAS TITANIUM 12 D LORDOTI C1821 $30,225.00CAGE SPINAL ENDOSKELETON TAS TITANIUM 7 D LORDOTIC C1821 $30,225.00CAGE SPINAL ENDOSKELETON TT 4 D LORDOTIC LARGE L30 C1821 $15,600.00CAGE SPINAL ENDOSKELETON TT 4 D LORDOTIC XL L35 MM C1821 $15,600.00CAGE SPINAL FOUNDATION PEEK 7 D LORDOTIC LARGE H6 C1821 $4,225.00CAGE SPINAL FOUNDATION PEEK 7 D LORDOTIC LARGE H7 C1821 $4,225.00CAGE SPINAL FOUNDATION PEEK L25 MM X H10 MM NONSTE C1821 $7,475.00CAGE SPINAL FOUNDATION PEEK L25 MM X H11 MM NONSTE C1821 $7,475.00CAGE SPINAL FOUNDATION PEEK L25 MM X H12 MM NONSTE C1821 $7,475.00CAGE SPINAL FOUNDATION PEEK L25 MM X H7 MM NONSTER C1821 $7,475.00CAGE SPINAL FOUNDATION PEEK L25 MM X H8 MM NONSTER C1821 $7,475.00CAGE SPINAL FOUNDATION PEEK L25 MM X H9 MM NONSTER C1821 $7,475.00CAGE SPINAL FOUNDATION PEEK L30 MM X H10 MM NONSTE C1821 $14,950.00

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 ChargeCAGE SPINAL FOUNDATION PEEK L30 MM X H11 MM NONSTE C1821 $14,950.00CAGE SPINAL FOUNDATION PEEK L30 MM X H12 MM NONSTE C1821 $14,950.00CAGE SPINAL FOUNDATION PEEK L30 MM X H13 MM NONSTE C1821 $14,950.00CAGE SPINAL FOUNDATION PEEK L30 MM X H14 MM NONSTE C1821 $14,950.00CAGE SPINAL FOUNDATION PEEK L30 MM X H7 MM NONSTER C1821 $14,950.00CAGE SPINAL FOUNDATION PEEK L30 MM X H8 MM NONSTER C1821 $14,950.00CAGE SPINAL FOUNDATION PEEK L30 MM X H9 MM NONSTER C1821 $14,950.00CAGE SPINAL FOUNDATION PEEK OBLIQUE L22 MM X W10 M C1821 $7,475.00CAGE SPINAL FOUNDATION PEEK OBLIQUE L26 MM X W10 M C1821 $7,475.00CAGE SPINAL IMPIX 6 D L28 MM X W10 MM X H9 MM 3D P C1821 $14,950.00CAGE SPINAL IMPIX 6 D L33 MM X W10 MM X H10 MM 3D C1821 $14,950.00CAGE SPINAL INCORPORATE PEEK 10 D L12 MM X W14 MM C1821 $19,500.00CAGE SPINAL LUCENT PEEK POROUS 5 D L27 MM X W12 MM C1821 $14,950.00CAGE SPINAL LUCENT PEEK-OPTIMA POROUS 5 D D27 MM C C1821 $14,950.00CAGE SPINAL LUCENT PEEK-OPTIMA POROUS 5 D D37 MM C C1821 $14,950.00CAGE SPINAL MAGNUM+ PEEK TI-BOND 12 D D25 MM W30 M C1821 $29,250.00CAGE SPINAL MAGNUM+ PEEK TI-BOND 12 D D27 MM W37 M C1821 $29,250.00CAGE SPINAL MAGNUM+ PEEK TI-BOND 18 D D27 MM W37 M C1821 $29,250.00CAGE SPINAL MAGNUM+ PEEK TI-BOND 18 D D27 MM W41 M C1821 $29,250.00CAGE SPINAL MD-VUE SHURFIT PEEK 7 D L45 MM X W18 M C1821 $22,750.00CAGE SPINAL MD-VUE SHURFIT PEEK 7 D L50 MM X W18 M C1821 $22,750.00CAGE SPINAL MD-VUE SHURFIT PEEK 7 D L55 MM X W22 M C1821 $22,750.00CAGE SPINAL MOJAVE 9-12 MM CONVEX L28 MM X W11 MM C1821 $26,000.00CAGE SPINAL PEEK MEDIUM CURVE L25 MM X H13 MM THRE C1821 $13,650.00CAGE SPINAL PEEK MEDIUM CURVE L25 MM X H9 MM THREA C1821 $13,650.00CAGE SPINAL PEEK MEDIUM CURVE L30 MM X H12 MM THRE C1821 $13,650.00CAGE SPINAL ROI-A VERTEBRIDGE PEEK-OPTIMA LT1 TITA C1821 $14,625.00CAGE SPINAL ROI-C VERTEBRIDGE TITANIUM D12 MM W14 C1821 $6,500.00CAGE SPINAL SAHARA 10 D L24 MM X W30 MM X H14 MM E C1821 $32,500.00CAGE SPINAL SAHARA 10 D LORDOTIC L24 MM X W30 MM X C1821 $32,500.00CAGE SPINAL SANTORINI PEEK 7 D L12 MM X W14 MM X H C1821 $19,500.00CAGE SPINAL SHURFIT PEEK STRAIGHT BULLET NOSE L29 C1821 $14,950.00CAGE SPINAL SMALL VBR ADD TITANIUM 6 D LORDOTIC H1 C1821 $27,950.00CAGE SPINAL T2 ALTITUDE CENTERPIECE TITANIUM COCR C1821 $16,250.00CAGE SPINAL TLX 15 D L31 MM X W11 MM X H12 MM NONS C1821 $32,500.00CAGE SPINAL UCERV PEEK-OPTIMA 0 D NEUTRAL D13 MM M C1821 $4,225.00CAGE SPINAL UCERV PEEK-OPTIMA 6 D LORDOTIC D13 MM C1821 $4,225.00CAGE SPINAL VBOSS TITANIUM H9 MM OD12 MM THORACOLU C1821 $18,674.96CAGE SPINAL VERTA 7 D L12 MM X W14.5 MM X H19 MM N C1821 $19,500.00

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 ChargeCAGE SPINAL VERTA 7 D L12 MM X W14.5 MM X H27 MM N C1821 $19,500.00CAGE SPINAL VERTA 7 D L12 MM X W14.5 MM X H31 MM N C1821 $19,500.00CAGE SPINAL VERTA 7 D L14.5 MM X W12 MM X H17 MM N C1821 $19,500.00CAGE SPINAL VERTA 7 D L14.5 MM X W12 MM X H21 MM N C1821 $19,500.00CAGE SPINAL VERTA 7 D L14.5 MM X W12 MM X H23 MM N C1821 $19,500.00CAGE SPINAL VERTA 7 D L14.5 MM X W12 MM X H25 MM N C1821 $19,500.00CAGE SPINAL VERTA 7 D L14.5 MM X W12 MM X H27 MM N C1821 $19,500.00CAGE SPINAL VUMESH PEEK-OPTIMA LARGE DIAMETER L15 C1821 $9,743.50CAGE SPINAL VUMESH PEEK-OPTIMA LARGE DIAMETER L20 C1821 $11,511.50CAGE SPINAL VUMESH PEEK-OPTIMA LARGE DIAMETER L25 C1821 $12,688.00CAGE SPINAL VUMESH PEEK-OPTIMA LARGE DIAMETER L30 C1821 $13,871.00CAGE SPINAL VUMESH PEEK-OPTIMA LARGE DIAMETER L35 C1821 $14,456.00CAGE SPINAL VUMESH PEEK-OPTIMA LARGE DIAMETER W14 C1821 $1,300.00CAGE SPINAL X-CORE 2 TITANIUM H16-22 MM ID16 MM EX C1821 $27,625.00CAGE SPINAL X-CORE 2 TITANIUM H21-27 MM ID18 MM EX C1821 $27,625.00CAGE SPINAL X-CORE MINI H36-62 MM ID14 MM EXPAND N C1821 $26,000.00CALCITONIN (HORMONE) LEVEL 82308 $168.00CALCIUM LEVEL 82310 $39.00CALCULATION OF RADIATION THERAPY DOSE 77300 $557.00CAMPY AG, STOOL 87449 $93.00CANAL PREP/FITTING OF DOWEL D3950 $277.00CANISTER SUCTION MAX NONSTERILE $2,275.00CANISTER WOUND DRAINAGE INFOVAC C1000 ML GEL TUBE $270.20CANISTER WOUND DRAINAGE INFOVAC SENSATRAC 1000 ML $270.20CANISTER WOUND DRAINAGE INFOVAC SENSATRAC 500 ML T $256.99CANNABINOIDS DEFINITIVE ASSAY, URINE 80349 $244.00CANNULA ARTERIAL SOFT-FLOW 3/8 IN L14 IN OD21 FR S $409.50CANNULA ARTHROSCOPIC ACUTRAK ASSEMBLY $2,080.00CANNULA ARTHROSCOPIC ASSEMBLY GENERIC $1,144.00CANNULA ARTHROSCOPIC STEEL L1.75 IN TRANSBUCCAL 2 $740.00CANNULA ARTHROSCOPIC STEEL L1.75 IN TRANSBUCCAL PI $740.00CANNULA ARTHROSCOPIC STEEL L1.75 IN TRANSBUCCAL SM $740.00CANNULA ARTHROSCOPIC TRIM-IT HIP CUSTOM $422.50CANNULA BONE CEMENT VERTEPORT OD10 GA PRECISE CION $403.36CANNULA ENDOSCOPIC .035 IN L190 CM OD4.5 FR HIGH F $400.00CANNULA ENDOSCOPIC JACOBS SILICONE L44 MM X W16 MM $694.33CANNULA ENDOSCOPIC JACOBS ULTRA-SMOOTH PLUS SILICO $694.33CANNULA ENDOSCOPIC L300 MM OD5 MM CURVED ARM 2 $6,500.00CANNULA ENDOSCOPIC PROFORMA .035 IN CURVE L190 CM $510.40

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 ChargeCANNULA ENDOSCOPIC VERSASTEP PLUS SANTOPRENE FABRI $325.00CANNULA ENDOSCOPIC VERSASTEP PVC OD5 MM BLADELESS $780.00CANNULA ERCP TANDEM RX L195 CM OD7-5.5 FR BILIARY $598.46CANNULA GUIDING CORRIDOR KIRSCHNER SCREW WIRE STER $7,709.00CANNULA INJECTION TRAUMACEM V+ STERILE TFNA SYSTEM $2,433.60CANNULA LAPAROSCOPIC DA VINCI S/SI ID8 MM OUTLET $6,240.00CANNULA OPHTHALMIC .3 MM OD23 GA LACHRYMAL SIDE PO $475.20CANNULA OPHTHALMIC CONSTELLATION TOTAL PLUS PAK 75 $5,084.40CANNULA OPHTHALMIC GREENBAUM L8 MM OD19 GA PERIBUL $668.80CANNULA OPHTHALMIC GRIESHABER ADULT 4 PLUG SET SIL $790.40CANNULA OPHTHALMIC MCINTYRE .3 MM CURVE OD23 GA LA $460.96CANNULA PERFUSION BIO-MEDICUS ADULT 3/8 IN L17 IN $1,526.79CANNULA PERFUSION POLYURETHANE L12.5 IN OD14 FR OD $870.16CANNULA PERFUSION SURE-TOUCH URETHANE PVC L10.5 IN $533.00CANNULA PERFUSION THIN-FLEX STRAIGHT L16 IN OD30 F $2,390.40CANNULA SURGICAL REVOLVE A $825.50CAP END 0 MM C1713 $1,085.44CAP END EXPERT TITANIUM 0 MM T40 EXTEND LOCK STARD C1713 $1,103.52CAP END EXPERT TITANIUM NIOBIUM ALUMINUM 0 MM T40 C1713 $1,108.56CAP END EXPERT TITANIUM NIOBIUM ALUMINUM 10 MM T40 C1713 $1,448.96CAP END EXPERT TITANIUM NIOBIUM ALUMINUM 15 MM T40 C1713 $1,448.96CAP END EXPERT TITANIUM NIOBIUM ALUMINUM 5 MM T40 C1713 $1,108.56CAP END L11 MM X W5 MM OFFSET C1713 $1,085.44CAP END L15 MM OFFSET C1713 $1,085.44CAP END L20 MM OFFSET C1713 $1,085.44CAP END NCB TI6AL4V OD8 MM ODSEC3.5 MM LOCK C1713 $692.90CAP END OD10 MM OFFSET C1713 $1,085.44CAP END OFFSET L12 MM OD0 MM LOW PROFILE C1713 $1,085.44CAP END OFFSET L12 MM OD10 MM LOW PROFILE C1713 $983.04CAP END OFFSET L12 MM OD15 MM LOW PROFILE C1713 $983.04CAP END OFFSET L12 MM OD20 MM LOW PROFILE C1713 $983.04CAP END OFFSET L12 MM OD5 MM LOW PROFILE C1713 $983.04CAP END OFFSET OD10 MM C1713 $983.04CAP END OFFSET OD15 MM C1713 $983.04CAP END OFFSET OD20 MM C1713 $983.04CAP END OFFSET OD5 MM C1713 $983.04CAP END PHOENIX L13.5 MM OD10 MM OFFSET C1713 $983.04CAP END PHOENIX L13.5 MM OD5 MM OFFSET C1713 $983.04CAP END PHOENIX L15 MM OD10 MM OFFSET C1713 $983.04

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 ChargeCAP END PHOENIX L15 MM OD13.5 MM OFFSET C1713 $983.04CAP END PHOENIX L15 MM OD15 MM OFFSET C1713 $983.04CAP END PHOENIX L15 MM OD5 MM OFFSET C1713 $983.04CAP END PHOENIX L20 MM OD13.5 MM OFFSET C1713 $983.04CAP END PHOENIX L20 MM OD15 MM OFFSET C1713 $983.04CAP END REMOVABLE CMF DISTRACTOR C1713 $3,320.00CAP END STAINLESS STEEL L40 MM OD6 MM ODSEC11 MM O C1713 $1,454.64CAP END STAINLESS STEEL OD3-4 MM NONSTERILE ELASTI C1713 $584.16CAP END STAINLESS STEEL OLECRANON STERILE OSTEOTOM C1713 $1,848.00CAP END T2 FULL THREAD SUPRACONDYLAR C1713 $958.23CAP END TITANIUM 0 MM CANNULATED STERILE GREEN TRO C1713 $1,409.04CAP END TITANIUM 0 MM EXTENSION NONSTERILE GREEN 1 C1713 $1,308.72CAP END TITANIUM 0 MM OD12 MM FEMORAL STANDARD LOC C1713 $1,263.12CAP END TITANIUM 0 MM OD12 MM FEMUR EXTEND STANDAR C1713 $1,674.40CAP END TITANIUM 0 MM OD15 MM FEMUR EXTEND STERILE C1713 $1,724.80CAP END TITANIUM 0 MM OD15 MM FEMUR EXTENSION NONS C1713 $1,308.72CAP END TITANIUM 0 MM OD15 MM FEMUR EXTENSION STER C1713 $1,724.80CAP END TITANIUM 0 MM OD15 MM NONSTERILE LIGHT BLU C1713 $1,399.92CAP END TITANIUM 0 MM T15 EXTEND STARDRIVE NONSTER C1713 $1,263.12CAP END TITANIUM 0 MM T15 HUMERUS STARDRIVE STERIL C1713 $1,600.56CAP END TITANIUM 0 MM T25 HUMERAL STARDRIVE NONSTE C1713 $1,021.44CAP END TITANIUM 0 MM T25 HUMERAL STARDRIVE STERIL C1713 $1,104.09CAP END TITANIUM 0 MM T40 FEMORAL EXTENSION SELF R C1713 $1,103.52CAP END TITANIUM 0 MM T40 TIBIAL EXTENSION CANNULA C1713 $1,103.52CAP END TITANIUM 0 MM TROCHANTER EXTEND CANNULATED C1713 $1,071.60CAP END TITANIUM 10 MM 3.5 MM HUMERUS HEXAGONAL NO C1713 $1,263.12CAP END TITANIUM 10 MM 3.5 MM HUMERUS HEXAGONAL ST C1713 $1,600.56CAP END TITANIUM 10 MM EXTEND NONSTERILE BLUE SOLI C1713 $1,445.52CAP END TITANIUM 10 MM L15 MM OD15 MM FEMUR EXTEND C1713 $1,399.92CAP END TITANIUM 10 MM OD12 MM FEMUR EXTEND STANDA C1713 $1,600.56CAP END TITANIUM 10 MM OD12 MM FEMUR EXTENSION NON C1713 $1,263.12CAP END TITANIUM 10 MM OD15 MM FEMUR EXTEND STERIL C1713 $1,646.16CAP END TITANIUM 10 MM OD15 MM FEMUR EXTENSION NON C1713 $1,308.72CAP END TITANIUM 10 MM STANDARD L15 MM FEMUR NONST C1713 $1,308.72CAP END TITANIUM 10 MM T25 HUMERAL STARDRIVE NONST C1713 $1,021.44CAP END TITANIUM 10 MM T25 HUMERAL STARDRIVE STERI C1713 $1,358.88CAP END TITANIUM 10 MM T40 OD12 MM FEMORAL EXTENSI C1713 $896.61CAP END TITANIUM 10 MM T40 OD16 MM FEMORAL EXTENSI C1713 $1,103.52CAP END TITANIUM 10 MM T40 TIBIAL EXTENSION CANNUL C1713 $1,418.16

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 ChargeCAP END TITANIUM 10 MM TROCHANTER EXTEND CANNULATE C1713 $870.68CAP END TITANIUM 10 MM TROCHANTERIC EXTEND STERILE C1713 $1,144.85CAP END TITANIUM 130 D 10 MM L15 MM FEMUR LOCK STE C1713 $1,646.16CAP END TITANIUM 15 MM 3.5 MM HEX NONSTERILE BLUE C1713 $1,445.52CAP END TITANIUM 15 MM 3.5 MM HUMERUS HEXAGONAL NO C1713 $1,263.12CAP END TITANIUM 15 MM 3.5 MM HUMERUS HEXAGONAL RE C1713 $1,782.96CAP END TITANIUM 15 MM 3.5 MM HUMERUS HEXAGONAL ST C1713 $1,674.40CAP END TITANIUM 15 MM T25 HUMERAL STARDRIVE NONST C1713 $1,021.44CAP END TITANIUM 15 MM T25 HUMERAL STARDRIVE STERI C1713 $1,358.88CAP END TITANIUM 15 MM T40 OD12 MM FEMORAL EXTENSI C1713 $896.61CAP END TITANIUM 15 MM T40 OD16 MM FEMORAL EXTENSI C1713 $1,103.52CAP END TITANIUM 15 MM T40 TIBIAL EXTENSION CANNUL C1713 $1,418.16CAP END TITANIUM 20 MM L15 MM FEMUR EXTEND STERILE C1713 $1,737.36CAP END TITANIUM 20 MM NONSTERILE GREEN 13-15 MM C C1713 $1,308.72CAP END TITANIUM 20 MM OD12 MM FEMORAL STANDARD LO C1713 $1,600.56CAP END TITANIUM 20 MM OD12 MM FEMUR EXTENSION NON C1713 $1,263.12CAP END TITANIUM 20 MM OD15 MM FEMUR EXTENSION NON C1713 $1,308.72CAP END TITANIUM 20 MM OD15 MM FEMUR EXTENSION STE C1713 $1,646.16CAP END TITANIUM 20 MM T40 OD12 MM FEMORAL EXTENSI C1713 $896.61CAP END TITANIUM 20 MM T40 OD16 MM FEMORAL EXTENSI C1713 $1,103.52CAP END TITANIUM 5 MM 2.5 MM HUMERUS HEXAGONAL REC C1713 $1,870.40CAP END TITANIUM 5 MM 3.5 MM HEX NONSTERILE BLUE H C1713 $1,445.52CAP END TITANIUM 5 MM 3.5 MM HUMERUS HEXAGONAL NON C1713 $1,263.12CAP END TITANIUM 5 MM 3.5 MM HUMERUS HEXAGONAL STE C1713 $1,674.40CAP END TITANIUM 5 MM T25 HUMERAL STARDRIVE NONSTE C1713 $1,021.44CAP END TITANIUM 5 MM T25 HUMERAL STARDRIVE STERIL C1713 $1,358.88CAP END TITANIUM 5 MM T40 OD12 MM FEMORAL EXTENSIO C1713 $896.61CAP END TITANIUM 5 MM T40 OD16 MM FEMORAL EXTENSIO C1713 $1,103.52CAP END TITANIUM 5 MM T40 TIBIAL EXTENSION CANNULA C1713 $1,418.16CAP END TITANIUM 5 MM TROCHANTER EXTENDED CANNULAT C1713 $1,071.60CAP END TITANIUM 5 MM TROCHANTERIC EXTEND CANNULAT C1713 $1,409.04CAP END TITANIUM 6 MM FEMORAL DISTAL NONSTERILE AQ C1713 $1,322.40CAP END TITANIUM 6 MM OD15 MM TIBIA EXTEND STERILE C1713 $1,276.80CAP END TITANIUM L15 MM OD15 MM TIBIA EXTENSION NO C1713 $1,655.28CAP END TITANIUM L15 MM OD15 MM TIBIA EXTENSION ST C1713 $1,992.72CAP END TITANIUM L20 MM OD15 MM NONSTERILE LIGHT B C1713 $1,399.92CAP END TITANIUM NONSTERILE BLUE SOLID TIBIAL NAIL C1713 $940.80CAP END TITANIUM NONSTERILE GREEN 3-4 MM ELASTIC I C1713 $584.16CAP END TITANIUM OD10 MM FEMUR EXTEND STERILE LIGH C1713 $1,737.36

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 ChargeCAP END TITANIUM OD8 MM TIBIA EXTENDED HEXAGONAL D C1713 $953.04CAP END TITANIUM PEDIATRIC 10 MM T40 EXTENSION STA C1713 $1,108.56CAP END TITANIUM PEDIATRIC 15 MM T40 EXTENSION STA C1713 $1,108.56CAP END TITANIUM PEDIATRIC LOCK NAIL C1713 $1,520.64CAP END TITANIUM STERILE GREEN 3-4 MM ELASTIC INTR C1713 $924.56CAP END TITANIUM STERILE GREEN CANNULATED TIBIAL N C1713 $1,344.00CAP END TITANIUM T25 NONSTERILE AQUA EXPERT HINDFO C1713 $1,153.68CAP END TITANIUM T25 NONSTERILE GOLD EXPERT HINDFO C1713 $1,153.68CAP END TITANIUM T25 STERILE AQUA EXPERT HINDFOOT C1713 $1,491.12CAP END TITANIUM T25 STERILE GOLD EXPERT HINDFOOT C1713 $1,296.34CAP INTRAMEDULLARY NAIL PEDIFLEX OD2 MM C1713 $1,424.00CAP INTRAMEDULLARY NAIL PEDIFLEX OD2.5 MM C1713 $1,080.00CAP INTRAMEDULLARY NAIL PEDIFLEX OD3 MM C1713 $1,424.00CAP INTRAMEDULLARY NAIL PEDIFLEX OD3.5 MM C1713 $1,424.00CAP INTRAMEDULLARY NAIL PEDIFLEX TITANIUM PEDIATRI C1713 $1,080.00CAP LOCKING ALTA TITANIUM STANDARD STANDALONE NONS C1713 $162.50CAP LOCKING CREO OD5.5 MM SPINAL NONSTERILE C1713 $325.00CAP LOCKING CREO SPINAL THREAD NONSTERILE C1713 $325.00CAP LOCKING ELLIPSE SPINAL NONSTERILE C1713 $325.00CAP LOCKING MALIBU NONSTERILE LATEX FREE C1713 $325.00CAP LOCKING NONSTERILE REFORM PEDICLE SCREW SYSTEM C1713 $325.00CAP LOCKING PANGEA TITANIUM SPINE ROD GRIP RIDGE S C1713 $400.00CAP LOCKING REVOLVE SPINAL NONSTERILE C1713 $325.00CAP LOCKING SIERRA TITANIUM SPINE OCCIPITOCERVICOT C1713 $325.00CAP LOCKING SNOWCAP TITANIUM ANGLE HIGH OD1.5 MM S C1713 $162.50CAP LOCKING SNOWCAP TITANIUM ANGLE HIGH OD2 MM SPI C1713 $162.50CAP LOCKING SPINE SURELOK PEDICLE SCREW SYSTEM C1713 $325.00CAP PROTECTIVE .035 IN OD.9 MM PIN STERILE BLUE C1713 $8.61CAP PROTECTIVE HEAD STERILE YELLOW .028 IN PIN C1713 $8.61CAP PROTECTIVE HOFFMANN XPRESS STAINLESS STEEL L50 C1713 $240.50CAP PROTECTIVE HOFFMANN XPRESS STAINLESS STEEL OD4 C1713 $288.00CAP PROTECTIVE L1.1 MM OD.045 IN ORTHOPEDIC HEAD S C1713 $8.61CAP PROTECTIVE NONSTERILE WHITE 4.5 MM FIXATION PI C1713 $22.98CAP PROTECTIVE NONSTERILE YELLOW 4 MM FIXATION PIN C1713 $23.01CAP PROTECTIVE PINCAP RADIOPAQUE STERILE LATEX FRE C1713 $18.81CAP SOCKET UNILATERAL $663.00CAPSULE PH BRAVO DELIVERY SYSTEM $1,995.50CAPSULE VIDEO PILLCAM SB 3 PLASTIC 156 D 434.1MHZ $3,445.00CAPSULE VIDEO PILLCAM SB3-EX $3,445.00

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 ChargeCARBAMAZEPINE LEVEL 80156 $90.00CARBIDOPA-LEVODOPA 10-100 MG TAB 100 EACH BOTTLE $4.39CARBIDOPA-LEVODOPA 25-100 MG TBSR 100 EACH BOTTLE $5.54CARBOHYDRATE ANALYSIS 84376 $43.00CARBOHYDRATE ANALYSIS 84378 $52.00CARBON DIOXIDE (BICARBONATE) LEVEL 82374 $38.00CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL 82378 $147.00CARDIAC OUTPUT MEASUREMENTS 93561 $80.00CARDIAC OUTPUT MEASUREMENTS 93562 $76.00CARDIAC REHAB PHASE II W/O MONITORING 93797 $386.00CARDIAC SHUNT DETECTION 78428 $1,494.00CARDIOLIPIN ANTIBODY, IGA 86147 $90.00CARDIOLIPIN ANTIBODY, IGM 86147 $90.00CARDIOPLEGIA - COLD INDUCTION 810 ML BAG $1,069.27CARDIOPLEGIA - DEL NIDO 1,052.8 ML BAG $343.75CARDIOPLEGIA - MULTIDOSE 810 ML BAG $175.00CARDIOPLEGIA - WARM INDUCTION 1,000 ML BAG $1,337.25CARDIOPLEGIC - CARDIAC REPERFUSATE 955 ML BAG $902.50CARNITINE LEVEL 82379 $131.00CAROTENE LEVEL 82380 $59.00CARRYING CURRENT STATUS G8984 $0.01CARRYING DISCHARGE STATUS G8986 $0.01CARRYING GOAL STATUS G8985 $0.01CARTRIDGE BONE CEMENT HIVAC 7 $611.00CARTRIDGE BONE CEMENT PRISM II BREAKOFF NOZZLE LAT $650.00CASTOR OIL 100 % OIL 118 ML BOTTLE $3.00CASTOR OIL 100 % OIL 59 ML BOTTLE $8.70CATHETER ABLATION BARRX 360 360 D L85 CM L4 CM ODS C1886 $16,055.00CATHETER ABLATION BARRX 360 L3 CM L85 CM L4 CM OD2 C1733 $11,232.00CATHETER ABLATION BARRX 360 L3 CM L85 CM L4 CM OD7 C1733 $11,232.00CATHETER ABLATION BARRX 360+ L4 CM L3 CM OD18 MM E C1733 $11,232.00CATHETER ABLATION BLAZER II XP 2.5 MM SPACE LARGE C1733 $8,800.00CATHETER ABLATION BLAZER PRIME HTD 4 MM 2.5 MM SPA C1733 $5,200.00CATHETER ABLATION BLAZER PRIME XP 8 MM 2.5 MM SPAC C1733 $9,425.00CATHETER ABLATION C2 CRYOBALLOON STANDARD BALLOON C1733 $5,362.50CATHETER ABLATION CELSIUS 2-5-2 MM SPACING D CURVE C1733 $5,252.00CATHETER ABLATION CELSIUS RMT 2-5-2 MM SPACING L12 C2630 $11,400.00CATHETER ABLATION CELSIUS RMT 2-5-2 MM SPACING L12 C1733 $6,175.00CATHETER ABLATION FLEXABILITY 1-4-1 MM SPACE D-D C C1733 $8,460.00

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 ChargeCATHETER ABLATION FLEXABILITY 1-4-1 MM SPACE D-F C C2630 $8,460.00CATHETER ABLATION FLEXABILITY 1-4-1 MM SPACE F-F C C2630 $8,460.00CATHETER ABLATION FLEXABILITY 1-4-1 MM SPACE F-J C C1733 $8,460.00CATHETER ABLATION HALO360+ 360 D L4 CM L3 CM OD25 C1733 $11,232.00CATHETER ABLATION HALO60 BARRX 90 D L160 CM L15 MM C1886 $8,229.00CATHETER ABLATION HALO90 BARRX 90 D L160 CM L20 MM C1886 $9,431.50CATHETER ABLATION HALO90 BARRX ULTRA LONG L160 CM C1886 $11,492.00CATHETER ABLATION RF CONTACTR 2-15-2 MM SPACING DU C1733 $4,550.00CATHETER ABLATION SAFIRE BLU COMFORTGRIP 2-5-2 MM C2630 $6,965.00CATHETER ABLATION SAFIRE BLU DUO COMFORTGRIP 2-5-2 C2630 $7,465.00CATHETER ABLATION TACTICATH 65 MM CURVE 2-5-2 MM S C1733 $13,435.00CATHETER ABLATION TACTICATH 75 MM CURVE 2-5-2 MM S C1733 $13,435.00CATHETER ABLATION THERAPY COOL PATH 2-5-2 MM SPACE C2630 $5,225.00CATHETER AIRWAY EXCHANGE COOK RAPI-FIT L100 CM OD1 C1889 $431.44CATHETER AIRWAY EXCHANGE RAPI-FIT L83 CM OD14 FR I C1889 $241.55CATHETER ANGIOGRAPHIC ACCU-VU OMNI CURVE L70 CM L2 $552.50CATHETER ANGIOGRAPHIC ACCU-VU PIGTAIL CURVE L100 C $2,762.50CATHETER ANGIOGRAPHIC ARROW-BERMAN PVC L50 CM OD4 $337.55CATHETER ANGIOGRAPHIC ARROW-BERMAN PVC L80 CM OD5 $339.63CATHETER ANGIOGRAPHIC ARROW-BERMAN PVC L90 CM OD6 $335.27CATHETER ANGIOGRAPHIC ARROW-BERMAN PVC L90 CM OD7 $327.47CATHETER ANGIOGRAPHIC CORDIS NYLEX NYLON .035 IN P $422.50CATHETER ANGIOGRAPHIC CORDIS NYLEX NYLON PIGTAIL C $406.25CATHETER ANGIOGRAPHIC CORDIS NYLEX NYLON PIGTAIL M $406.25CATHETER ANGIOGRAPHIC CORDIS NYLEX NYLON STRAIGHT $406.25CATHETER ANGIOGRAPHIC CORDIS NYLEX NYLON UNIV CURV $406.25CATHETER ANGIOGRAPHIC CORDIS SUPER TORQUE POLYURET $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO AQUA NYLON HYDR $861.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON BERN $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON BERN2 $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON C1 CU $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON C2 CU $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON C3 CU $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON H1 CU $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON H3 CU $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON HN3 C $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON HN4 C $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON JB1 C $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON JB2 C $406.25

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 ChargeCATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON JI CU $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON JIII $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON MAN C $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON MPA2 $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON PIGTA $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON RDCA $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON SHK1 $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON SHK2 $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON SIM1 $861.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON SIM2 $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON SIM3 $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON SMALL $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON STRAI $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON UNIV $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON USL2 $861.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX NYLON VERT $406.25CATHETER ANGIOGRAPHIC CORDIS TEMPO SLX TUNGSTEN NY $406.25CATHETER ANGIOGRAPHIC GLIDECATH RADIFOCUS STAINLES $1,990.00CATHETER ANGIOGRAPHIC GLIDECATH STAINLESS STEEL HY $1,616.88CATHETER ANGIOGRAPHIC IMPRESS POLYURETHANE MHK CUR $535.00CATHETER ANGIOGRAPHIC IMPRESS POLYURETHANE STRAIGH $695.50CATHETER ANGIOGRAPHIC IMPRESS STAINLESS STEEL POLY $267.50CATHETER ANGIOGRAPHIC J CURVE L80 CM OD6 FR CORONA $550.00CATHETER ANGIOGRAPHIC LANGSTON 145 D PIGTAIL CURVE $625.00CATHETER ANGIOGRAPHIC PERFORMA PEBAX POLYCARBONATE $561.28CATHETER ANGIOGRAPHIC POSITROL NYLON STANDARD SONA $455.00CATHETER ANGIOGRAPHIC PRO-FLO ANGIOKIT HEMA II STA $411.13CATHETER ANGIOGRAPHIC PRO-FLO ANGIOKIT STAINLESS S $411.13CATHETER ANGIOGRAPHIC PRO-FLO CHOICE-PAK STAINLESS $411.13CATHETER ANGIOGRAPHIC PRO-FLO EZ-PAK STAINLESS STE $411.13CATHETER ANGIOGRAPHIC PRO-FLO STAINLESS STEEL POLY $411.13CATHETER ANGIOGRAPHIC PRO-FLO XT ANGIOKIT STAINLES $411.13CATHETER ANGIOGRAPHIC PRO-FLO XT CHOICE-PAK STAINL $411.13CATHETER ANGIOGRAPHIC SLIP-CATH BEACON STAINLESS S $437.50CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP SHUTTLE $700.00CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP STAINLE $276.88CATHETER ANGIOGRAPHIC SLIP-CATH SHUTTLE BEACON TIP $700.00CATHETER ANGIOGRAPHIC SOFT-VU ANGLE BERENSTEIN CUR $157.50CATHETER ANGIOGRAPHIC SOFT-VU MIKAELSSON CURVE L80 $425.00

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 ChargeCATHETER ANGIOGRAPHIC SOFT-VU OMNI CURVE L65 CM OD $315.00CATHETER ANGIOGRAPHIC SOFT-VU PIGTAIL CURVE L65 CM $825.00CATHETER ANGIOGRAPHIC SOFT-VU SOS OMNI 1 CURVE L80 $341.25CATHETER ANGIOGRAPHIC SONB CURVE L100 CM OD7 FR CO $560.00CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON T $320.00CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE STAINLES $648.25CATHETER ARTERIAL LINE SWAN-GANZ L100 CM L24 CM OD C1751 $500.00CATHETER ATHERECTOMY CORDIS FRONTRUNNER XP CTO L14 $6,435.00CATHETER ATHERECTOMY CORDIS FRONTRUNNER XP CTO L90 $6,435.00CATHETER ATHERECTOMY CORDIS FRONTRUNNER XP CTO MIC $750.00CATHETER ATHERECTOMY CROSSER HYDROPHILIC L146 CM L C1714 $7,975.00CATHETER ATHERECTOMY CROSSER L154 CM OD5 FR ODSEC1 C1714 $7,975.00CATHETER ATHERECTOMY DIAMONDBACK 1.25 MM 30 UM SOL C1724 $16,975.00CATHETER ATHERECTOMY DIAMONDBACK 360 1.25 MM L135 C1724 $18,975.00CATHETER ATHERECTOMY DIAMONDBACK 360 1.5 MM L145 C C1724 $22,067.50CATHETER ATHERECTOMY DIAMONDBACK 360 2 MM L145 CM C1724 $16,975.00CATHETER ATHERECTOMY DIAMONDBACK 360 DIAMOND L145 C1724 $16,975.00CATHETER ATHERECTOMY DIAMONDBACK 360 L60 CM L10 MM C1724 $16,975.00CATHETER ATHERECTOMY DIAMONDBACK 360 L60 CM L7 MM C1724 $16,975.00CATHETER ATHERECTOMY DIAMONDBACK STEALTH 360 .014 C1724 $16,975.00CATHETER ATHERECTOMY ROTABLATOR ROTALINK DIAMOND L C1724 $6,080.00CATHETER ATHERECTOMY SILVERHAWK .075 IN L135 CM L2 C1714 $12,500.00CATHETER ATHERECTOMY SILVERHAWK LS-M MEC .105 IN L C1714 $14,000.00CATHETER ATHERECTOMY SILVERHAWK MEC L110 CM L6 CM C1714 $13,725.00CATHETER ATHERECTOMY SILVERHAWK MEC L113 CM L9 CM C1714 $13,725.00CATHETER ATHERECTOMY SILVERHAWK SS+ .09 IN L135 CM C1714 $12,500.00CATHETER ATHERECTOMY TURBOHAWK MEC CALCIUM L113 CM C1714 $15,975.00CATHETER ATHERECTOMY TURBOHAWK MEC CALCIUM L135 CM C1714 $15,975.00CATHETER ATHERECTOMY TURBOHAWK MEC L110 CM L6 CM O C1714 $16,000.00CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL L1 C1725 $3,875.00CATHETER BALLOON DILATATION ANGIOSCULPT XL NITINOL C1725 $3,750.00CATHETER BALLOON DILATATION APEX MONORAIL OPTILEAP C1725 $696.00CATHETER BALLOON DILATATION APEX OPTILEAP L142 CM C1725 $696.00CATHETER BALLOON DILATATION ATLAS GOLD LARGE DIAME C1725 $870.00CATHETER BALLOON DILATATION ATLAS L120 CM L4 CM OD C1725 $1,560.65CATHETER BALLOON DILATATION ATLAS LARGE DIAMETER L C1725 $1,560.65CATHETER BALLOON DILATATION AVIATOR DURALYN L135 C C1725 $3,315.00CATHETER BALLOON DILATATION AVIATOR PLUS DURALYN L C1725 $1,365.00CATHETER BALLOON DILATATION CHARGER L135 CM L100 M C1725 $337.50

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 ChargeCATHETER BALLOON DILATATION CHARGER L135 CM L150 M C1725 $337.50CATHETER BALLOON DILATATION CHARGER L135 CM L40 MM C1725 $337.50CATHETER BALLOON DILATATION CHARGER L135 CM L60 MM C1725 $337.50CATHETER BALLOON DILATATION CHARGER L135 CM L80 MM C1725 $337.50CATHETER BALLOON DILATATION CHARGER L75 CM L100 MM C1725 $337.50CATHETER BALLOON DILATATION CHARGER L75 CM L20 MM C1725 $337.50CATHETER BALLOON DILATATION CHARGER L75 CM L40 MM C1725 $337.50CATHETER BALLOON DILATATION CHARGER L75 CM L60 MM C1725 $337.50CATHETER BALLOON DILATATION CHOCOLATE NITINOL .014 C1725 $3,875.00CATHETER BALLOON DILATATION CHOCOLATE NITINOL .018 C1725 $3,875.00CATHETER BALLOON DILATATION CODA POLYURETHANE L120 C2628 $2,580.50CATHETER BALLOON DILATATION CONQUEST 40 L50 CM L4 C1725 $480.00CATHETER BALLOON DILATATION CONQUEST 40 L75 CM L4 C1725 $480.00CATHETER BALLOON DILATATION CONQUEST L75 CM L4 CM C1725 $800.00CATHETER BALLOON DILATATION CORDIS AVIATOR DURALYN C1725 $1,365.00CATHETER BALLOON DILATATION CORDIS AVIATOR PLUS DU C1725 $900.00CATHETER BALLOON DILATATION CORDIS MAXI LD DURALYN C1725 $1,000.00CATHETER BALLOON DILATATION CORDIS OPTA PRO DURALY C1725 $390.00CATHETER BALLOON DILATATION CORDIS POWERFLEX EXTRE C1725 $475.00CATHETER BALLOON DILATATION CORDIS POWERFLEX P3 DU C1725 $300.00CATHETER BALLOON DILATATION CORDIS POWERFLEX PRO D C1725 $425.00CATHETER BALLOON DILATATION CORDIS SABER DURALYN H C1725 $875.00CATHETER BALLOON DILATATION CORDIS SAVVY DURALYN S C1725 $1,040.00CATHETER BALLOON DILATATION CORDIS SAVVY LONG QUAD C1725 $875.00CATHETER BALLOON DILATATION CORDIS SAVVY QUADFLEX C1725 $1,137.50CATHETER BALLOON DILATATION CORDIS SLALOM DURALYN C1725 $1,365.00CATHETER BALLOON DILATATION CORDIS SLEEK QUADFLEX C1725 $1,000.00CATHETER BALLOON DILATATION CORDIS SLEEK RX QUADFL C1725 $1,000.00CATHETER BALLOON DILATATION COTTON L200 CM L4 CM O C1726 $325.00CATHETER BALLOON DILATATION COYOTE ES MONORAIL NYB C1725 $810.00CATHETER BALLOON DILATATION COYOTE ES NYBAX BIOSLI C1725 $810.00CATHETER BALLOON DILATATION COYOTE MONORAIL NYBAX C1725 $1,170.00CATHETER BALLOON DILATATION COYOTE NYBAX BIOSLIDE C1725 $1,164.15CATHETER BALLOON DILATATION CROSSTELLA L150 CM L40 C1725 $925.00CATHETER BALLOON DILATATION DORADO CHECKER L120 CM C1725 $674.25CATHETER BALLOON DILATATION DORADO CHECKER L135 CM C1725 $728.00CATHETER BALLOON DILATATION DORADO CHECKER L80 CM C1725 $674.25CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILE C1725 $725.00CATHETER BALLOON DILATATION EMERGE MONORAIL WORKHO C1725 $942.50

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 ChargeCATHETER BALLOON DILATATION EMERGE OPTILEAP XTRA Z C1725 $942.50CATHETER BALLOON DILATATION EMERGE WORKHORSE OPTIL C1725 $942.50CATHETER BALLOON DILATATION EUPHORA ULTRA-SLIM DUR C1725 $720.00CATHETER BALLOON DILATATION EVERCROSS BEVEL 360 CR C1725 $210.00CATHETER BALLOON DILATATION FLEXTOME CUTTING BALLO C1725 $5,600.00CATHETER BALLOON DILATATION FUSION L200 CM L2 CM O C1726 $450.00CATHETER BALLOON DILATATION FUSION TAPER L200 CM L $450.00CATHETER BALLOON DILATATION FUSION TITAN .035 IN L C1726 $975.00CATHETER BALLOON DILATATION GATEWAY HYDROPHILIC L1 C1725 $5,850.00CATHETER BALLOON DILATATION GEENEN OD.025 IN L2 CM C1726 $299.00CATHETER BALLOON DILATATION HURRICANE 11 ATM L180 C1726 $2,511.15CATHETER BALLOON DILATATION HURRICANE 12 ATM L180 C1726 $2,511.15CATHETER BALLOON DILATATION HURRICANE 8 ATM L180 C C1726 $1,586.00CATHETER BALLOON DILATATION INPACT ADMIRAL PACLITA C2623 $9,035.00CATHETER BALLOON DILATATION LUTONIX 035 GEOALIGN P C2623 $11,154.00CATHETER BALLOON DILATATION LUTONIX 035 PACLITAXEL C2623 $6,000.00CATHETER BALLOON DILATATION LUTONIX PACLITAXEL L13 C1725 $7,250.00CATHETER BALLOON DILATATION MAXI LD DURALYN L80 CM C1725 $1,300.00CATHETER BALLOON DILATATION MAXI LD DURALYN LARGE C1725 $3,484.00CATHETER BALLOON DILATATION METACROSS L135 CM L100 C1725 $570.00CATHETER BALLOON DILATATION METACROSS L135 CM L150 C1725 $570.00CATHETER BALLOON DILATATION METACROSS L135 CM L200 C1725 $570.00CATHETER BALLOON DILATATION METACROSS L135 CM L40 C1725 $570.00CATHETER BALLOON DILATATION MINI TREK II PEBAX HYD C1725 $400.00CATHETER BALLOON DILATATION MINI TREK SLIM SEAL TU C1725 $400.00CATHETER BALLOON DILATATION MINI TREK TUNGSTEN L12 C1725 $400.00CATHETER BALLOON DILATATION MINI TREK TUNGSTEN L15 C1725 $400.00CATHETER BALLOON DILATATION MINI TREK TUNGSTEN L20 C1725 $400.00CATHETER BALLOON DILATATION MINI TREK TUNGSTEN L8 C1725 $400.00CATHETER BALLOON DILATATION MUSTANG NYBAX L135 CM C1725 $787.50CATHETER BALLOON DILATATION MUSTANG NYBAX L40 CM L C1725 $848.25CATHETER BALLOON DILATATION MUSTANG NYBAX L75 CM L C1725 $652.50CATHETER BALLOON DILATATION MUSTANG NYBAX L75 CM L C1726 $848.25CATHETER BALLOON DILATATION NC EMERGE MONORAIL XTR C1725 $942.50CATHETER BALLOON DILATATION NC EMERGE MONORAIL ZGL C1725 $942.50CATHETER BALLOON DILATATION NC EMERGE XTRA STAINLE C1725 $942.50CATHETER BALLOON DILATATION NC EUPHORA DURA-TRAC N C1725 $450.00CATHETER BALLOON DILATATION NC QUANTUM APEX MONORA C1725 $696.00CATHETER BALLOON DILATATION NC SPRINTER FULCRUM PL C1725 $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 ChargeCATHETER BALLOON DILATATION NC TREK CROSSFLEX2 TUN C1725 $400.00CATHETER BALLOON DILATATION NC TREK TUNGSTEN L12 M C1725 $400.00CATHETER BALLOON DILATATION NC TREK TUNGSTEN L15 M C1725 $400.00CATHETER BALLOON DILATATION NC TREK TUNGSTEN L20 M C1725 $400.00CATHETER BALLOON DILATATION NC TREK TUNGSTEN L25 M C1725 $400.00CATHETER BALLOON DILATATION NC TREK TUNGSTEN L8 MM C1725 $400.00CATHETER BALLOON DILATATION NEPHROMAX AMPLATZ SILI C1726 $1,458.73CATHETER BALLOON DILATATION NEURO LATEX FREE C1725 $1,969.50CATHETER BALLOON DILATATION ODSEC.7 MM TELESCOPE 1 C1726 $1,988.00CATHETER BALLOON DILATATION OPTA PRO DURALYN .035 C1725 $1,989.00CATHETER BALLOON DILATATION OPTA PRO DURALYN L110 C1725 $390.00CATHETER BALLOON DILATATION OPTA PRO DURALYN L80 C C1725 $390.00CATHETER BALLOON DILATATION OPTA PRO DURALYN LOW P C1725 $1,989.00CATHETER BALLOON DILATATION OPTA PRO DURALYN MDX L C1725 $390.00CATHETER BALLOON DILATATION PERIPHERAL CUTTING BAL C1725 $4,594.27CATHETER BALLOON DILATATION POWERFLEX EXTREME DURA C1725 $1,989.00CATHETER BALLOON DILATATION POWERFLEX P3 DURALYN . C1725 $390.00CATHETER BALLOON DILATATION POWERFLEX P3 DURALYN M C1725 $300.00CATHETER BALLOON DILATATION POWERFLEX PRO DURALYN C1725 $425.00CATHETER BALLOON DILATATION PURSUIT .035 IN L80 CM C1769 $1,200.00CATHETER BALLOON DILATATION SAVVY DURALYN LONG L15 C1725 $875.00CATHETER BALLOON DILATATION SAVVY DURALYN SLX L120 C1725 $1,040.00CATHETER BALLOON DILATATION SAVVY DURALYN SLX LONG C1725 $3,315.00CATHETER BALLOON DILATATION SAVVY NYLON LONG L120 C1725 $3,315.00CATHETER BALLOON DILATATION SAVVY NYLON LONG L150 C1725 $3,315.00CATHETER BALLOON DILATATION SAVVY NYLON LONG L80 C C1725 $3,315.00CATHETER BALLOON DILATATION SAVVY QUADFLEX SILX LO C1725 $3,315.00CATHETER BALLOON DILATATION SLALOM DURALYN .018 IN C1725 $1,365.00CATHETER BALLOON DILATATION SLALOM DURALYN SLX L13 C1725 $1,365.00CATHETER BALLOON DILATATION SPRINTER FASTRAC MINIW C1725 $400.00CATHETER BALLOON DILATATION SPRINTER FULCRUM DURA- C1725 $400.00CATHETER BALLOON DILATATION SPRINTER LEGEND L6 MM C1725 $400.00CATHETER BALLOON DILATATION SPRINTER LEGEND MICRO- C1725 $400.00CATHETER BALLOON DILATATION STERLING MONORAIL PEBA C1725 $1,690.00CATHETER BALLOON DILATATION STERLING PEBAX BIOSLID C1725 $877.50CATHETER BALLOON DILATATION STERLING SL MONORAIL P C1725 $1,072.50CATHETER BALLOON DILATATION STERLING SL PEBAX BIOS C1725 $742.50CATHETER BALLOON DILATATION SYMMETRY HYDROPHILIC 4 C1725 $975.00CATHETER BALLOON DILATATION THREADER MONORAIL HYDR C1725 $2,600.00

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 ChargeCATHETER BALLOON DILATATION TREK PEBAX HYDROCOAT L C1725 $400.00CATHETER BALLOON DILATATION TREK SLIM SEAL CROSSFL C1725 $400.00CATHETER BALLOON DILATATION ULTRASCORE GEOALIGN HY C1725 $4,036.50CATHETER BALLOON DILATATION ULTRA-THIN DIAMOND POL C1725 $630.50CATHETER BALLOON DILATATION ULTRAVERSE 014 ULTRA-C C1725 $713.00CATHETER BALLOON DILATATION ULTRAVERSE 018 ULTRA-C C1725 $713.00CATHETER BALLOON DILATATION UROMAX ULTRA HYDROPLUS C1726 $1,483.04CATHETER BALLOON DILATATION UROMAX ULTRA QUADRA-FO C1726 $1,385.80CATHETER BALLOON DILATATION VAN ANDEL L80 CM L2 CM C1725 $98.00CATHETER BALLOON DILATATION VASCUTRAK HYDROPHILIC C1725 $2,850.00CATHETER BALLOON DILATATION VIATRAC 14 PLUS XCELON C1725 $1,192.00CATHETER BALLOON DILATATION VIDA L100 CM L4 CM ODS C1725 $2,275.00CATHETER BALLOON DILATATION XXL L75 CM L40 MM ODSE C1725 $1,404.00CATHETER BALLOON DILATATION XXL QUADRA-FOLD L120 C C1725 $1,140.75CATHETER BALLOON DILATATION Z-MED II-X L100 CM L4 C1725 $2,975.00CATHETER BALLOON IVAS ELITE L15 MM OD8 GA KIT STER $21,200.00CATHETER BALLOON OCCLUSION ATTAIN POLYURETHANE L80 C2628 $500.00CATHETER BALLOON OCCLUSION CODA POLYURETHANE L100 C2628 $1,985.00CATHETER BALLOON OCCLUSION CODA POLYURETHANE L120 C2628 $1,985.00CATHETER BALLOON OCCLUSION EQUALIZER NYLON STANDAR C2628 $1,576.25CATHETER BALLOON OCCLUSION ER-REBOA P-TIP OD32 MM C2628 $10,875.00CATHETER BALLOON OCCLUSION FOGARTY L40 CM OD4 FR V C2628 $281.84CATHETER BALLOON OCCLUSION FOGARTY L80 CM OD8 FR V C2628 $454.00CATHETER BALLOON OCCLUSION GORE 10-37 MM L90 CM L4 C2628 $2,827.50CATHETER BALLOON OCCLUSION HYPERFORM L2 MM L150 CM C2628 $9,100.00CATHETER BALLOON OCCLUSION HYPERFORM PLATINUM .01 C2628 $9,100.00CATHETER BALLOON OCCLUSION HYPERFORM X-PEDION HYDR C2628 $9,100.00CATHETER BALLOON OCCLUSION HYPERGLIDE PLATINUM HYD C2628 $7,800.00CATHETER BALLOON OCCLUSION HYPERGLIDE X-PEDION PLA C2628 $7,800.00CATHETER BALLOON OCCLUSION OCCLUDER L65 CM OD5 FR C2628 $901.55CATHETER BALLOON OCCLUSION OUTBACK LTD .014 IN L12 C1725 $9,000.00CATHETER BALLOON OCCLUSION SCEPTER C HYDROPHILIC L C2628 $7,280.00CATHETER BALLOON OCCLUSION SCEPTER XC HYDROPHILIC C2628 $8,840.00CATHETER BALLOON OCCLUSION SILICONE L75 CM OD5.3 F C2628 $986.00CATHETER BALLOON OCCLUSION SILICONE L75 CM OD6 FR C2628 $986.00CATHETER BALLOON OCCLUSION TAG LARGE OD26-42 MM TH C1725 $2,925.00CATHETER BASED CLOSURE OF CONGENITAL HEART DEFECT 93580 $64,082.00CATHETER BASED CLOSURE OF CONGENITAL HEART DEFECT 93581 $1,559.00CATHETER BASED ENLARGEMENT OF OPENING BETWEEN TWO 92993 $2,534.00

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 ChargeCATHETER BASED REPAIR OF HEART VALVE (MITRAL) BETW 92987 $42,042.00CATHETER BASED REPAIR OF HEART VALVE (PULMONARY) T 92990 $490.00CATHETER BASED REPAIR OF LEFT LOWER HEART (AORTIC) 92986 $19,443.00CATHETER CECOSTOMY CHAIT L20 CM L6- CM OD10.2 FR P C1729 $1,568.00CATHETER CENTRAL VENOUS BLUE FLEXTIP POLYURETHANE C1751 $141.92CATHETER CENTRAL VENOUS BROVIAC SURECUFF SILICONE C1751 $2,698.00CATHETER CENTRAL VENOUS BROVIAC SURECUFF VITACUFF C1751 $880.00CATHETER CENTRAL VENOUS GROSHONG SURECUFF VITACUFF C1751 $1,556.80CATHETER CENTRAL VENOUS HICKMAN SILICONE PEDIATRIC $2,903.20CATHETER CENTRAL VENOUS HOHN OD7 FR 2 LUMEN BASIC C1751 $920.00CATHETER CENTRAL VENOUS POWERPICC OD5 FR 2 LUMEN T C1751 $975.00CATHETER CENTRAL VENOUS POWERPICC OD5 FR 3 LUMEN H C1751 $1,345.50CATHETER CENTRAL VENOUS POWERPICC PROVENA OD5 FR T C1751 $1,285.00CATHETER CENTRAL VENOUS POWERPICC SHERLOCK 3CG POL C1751 $1,355.25CATHETER CENTRAL VENOUS POWERPICC SOLO SHERLOCK L5 C1751 $1,360.00CATHETER CENTRAL VENOUS RADPICC RADSTIC TUNGSTEN S C1751 $436.80CATHETER CENTRAL VENOUS TPN OD3 FR 1 LUMEN REPAIR C1751 $816.00CATHETER CHOLANGIOGRAM MIXTER L50 CM OD4 FR SET ST C1894 $308.75CATHETER CRICOTHYROTOMY MELKER L9 CM OD7.2 MM ID5 C1769 $1,441.25CATHETER CRYOABLATION ARCTIC FRONT ADVANCE L95 CM C1733 $27,300.00CATHETER DELIVERY SYSTEM AMPLATZER TORQVUE STAINLE C1773 $3,016.00CATHETER DELIVERY SYSTEM BENCHMARK BERENSTEIN CURV C1757 $6,175.00CATHETER DELIVERY SYSTEM NEURON STAINLESS STEEL .0 C1757 $3,737.50CATHETER DELIVERY SYSTEM NEURON STAINLESS STEEL HY $3,737.50CATHETER DELIVERY SYSTEM NEURON STAINLESS STEEL HY C1757 $3,737.50CATHETER DELIVERY SYSTEM NEURON STAINLESS STEEL PL $3,737.50CATHETER DELIVERY SYSTEM PX 400 VELOCITY MICRO 3D C1757 $6,045.00CATHETER DELIVERY SYSTEM PX SLIM 45 D MICRO L150 C $5,440.50CATHETER DIALYSIS ARGYLE CURL CATH BETA-CAP QUINTO $572.80CATHETER DIALYSIS ARGYLE CURL CATH TENCKHOFF QUINT C1750 $554.88CATHETER DIALYSIS ARGYLE TENCKHOFF BETA-CAP QUINTO C1750 $269.92CATHETER DIALYSIS ARGYLE TENCKHOFF SILICONE PEDIAT C1750 $264.48CATHETER DIALYSIS ARGYLE TENCKHOFF SILICONE UNIVER C1750 $264.48CATHETER DIALYSIS QUINTON CURL CATH L57 CM PERITON C1750 $414.16CATHETER DIALYSIS QUINTON CURL CATH L62 CM PERITON C1750 $794.37CATHETER DIALYSIS QUINTON SWAN NECK CURL CATH SILI C1750 $856.80CATHETER DIALYSIS SWAN NECK CURL CATH SILICONE PED C1750 $1,544.80CATHETER DIALYSIS TENCKHOFF BETA-CAP ARGYLE SILICO C1750 $264.48CATHETER DRAINAGE .038 IN L50 CM OD8.3 FR BILIARY C1729 $741.00

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 ChargeCATHETER DRAINAGE ACCU-FLO SILICONE L15 CM VENTRIC C1729 $2,272.48CATHETER DRAINAGE APD FLEXIMA POLYURETHANE LOOP L2 C1729 $627.76CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EY C1729 $30.85CATHETER DRAINAGE BACTISEAL EVD L33 CM OD9 FR VENT C1729 $1,908.27CATHETER DRAINAGE BIOGLIDE L90 CM PERITONEAL CSF C1729 $1,983.60CATHETER DRAINAGE CODMAN BACTISEAL BARIUM SILICONE C1729 $2,816.00CATHETER DRAINAGE CODMAN MEDOS L120 CM OD2.2 MM ID C1729 $1,239.04CATHETER DRAINAGE DAWSON-MUELLER MAC-LOC INTRO-TIP C1729 $358.45CATHETER DRAINAGE EDM BARIUM SILICONE L80 CM LUMBA C1729 $1,222.00CATHETER DRAINAGE EDM SILICONE L24 CM LUMBAR OPEN C1729 $900.90CATHETER DRAINAGE FLEXIMA POLYURETHANE HYDROPHILIC C1729 $1,150.00CATHETER DRAINAGE HYDRAGLIDE XL PVC HYDROPHILIC PE C1729 $113.70CATHETER DRAINAGE INNERVISION L15 CM STERILE LATEX C1729 $1,352.00CATHETER DRAINAGE INPUT TS BARIUM SILICONE STANDAR C1729 $721.50CATHETER DRAINAGE INTRO-TIP ULTRATHANE UNIVERSAL C C1729 $311.22CATHETER DRAINAGE MAC-LOC HYDROPHILIC ULTRATHANE P C1729 $463.10CATHETER DRAINAGE MAC-LOC ULTRATHANE HYDROPHILIC L C1729 $473.10CATHETER DRAINAGE SKATER CHOICE LOCK SLIP-COAT POL C1729 $512.00CATHETER DRAINAGE SKATER CHOICE LOCK SLIP-COAT POL $512.00CATHETER DRAINAGE SKATER SLIP-COAT POLYURETHANE PI C1729 $512.00CATHETER DRAINAGE STANDARD L120 CM CARDIAC PERITON C1729 $455.00CATHETER DRAINAGE ULTRATHANE .038 IN L25 CM OD12 F C1729 $491.85CATHETER DRAINAGE ULTRATHANE HYDROPHILIC .038 IN L C1729 $495.20CATHETER DRAINAGE ULTRATHANE L25 CM OD16 FR RADIOP C1729 $364.45CATHETER DRAINAGE VENTRICLEAR 0.5-1.1 MM L33 CM OD C1729 $2,014.29CATHETER DRAINAGE WORD L5 CM OD10 FR 5 CC BARTHOLI C1729 $154.17CATHETER ELECTROHEMOSTASIS INJECTION GOLD PROBE HE $2,082.75CATHETER ELECTROHEMOSTASIS INJECTION GOLD PROBE L2 $2,082.75CATHETER ELECTROPHYSIOLOGY 5 MM SPACING G CURVE L6 C1730 $3,424.00CATHETER ELECTROPHYSIOLOGY BARD 1 CM SPACING L110 C1730 $905.00CATHETER ELECTROPHYSIOLOGY DYNAMIC TIP 2-5-2 MM SP C1730 $2,028.00CATHETER ELECTROPHYSIOLOGY EXPLORER ST 5 MM SPACE C1730 $14,080.00CATHETER ELECTROPHYSIOLOGY INQUIRY 2-5-2 MM SPACE C1730 $900.00CATHETER ELECTROPHYSIOLOGY INQUIRY 5 MM SPACE LARG C1730 $3,584.00CATHETER ELECTROPHYSIOLOGY INQUIRY LUMA-CATH L110 C1730 $2,400.00CATHETER ELECTROPHYSIOLOGY INQUIRY OD6 FR STEERABL C1730 $1,470.00CATHETER ELECTROPHYSIOLOGY LIVEWIRE 1 MM 2-5-2 MM C1730 $1,965.00CATHETER ELECTROPHYSIOLOGY LIVEWIRE 2 MM SPACE XL C1730 $1,965.00CATHETER ELECTROPHYSIOLOGY LIVEWIRE 2-10-2 MM SPAC C1730 $1,440.00

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 ChargeCATHETER ELECTROPHYSIOLOGY LIVEWIRE 2-5-2 MM SPACE C1731 $4,355.00CATHETER ELECTROPHYSIOLOGY LIVEWIRE 5 MM SPACE SUP C1731 $6,968.00CATHETER ELECTROPHYSIOLOGY LIVEWIRE BDB 1 MM 2 MM C1731 $8,312.00CATHETER ELECTROPHYSIOLOGY NBIH PLATINUM 1 CM SPAC C1733 $1,384.00CATHETER ELECTROPHYSIOLOGY ORBITER ST 2-20-2 MM SP C1731 $6,175.00CATHETER ELECTROPHYSIOLOGY REFLEXION 1-4-1 MM SPAC C1731 $6,220.00CATHETER ELECTROPHYSIOLOGY RESPONSE 2-8-2 MM SPACE C1730 $1,565.00CATHETER ELECTROPHYSIOLOGY SAFIRE COMFORTGRIP 2-5- C1733 $2,985.00CATHETER ELECTROPHYSIOLOGY SAFIRE TX 2-5-2 MM SPAC C1733 $4,330.00CATHETER ELECTROPHYSIOLOGY SUPREME 5 MM SPACE COUR C1730 $178.20CATHETER ELECTROPHYSIOLOGY SUPREME 5 MM SPACE JOSE C1730 $178.20CATHETER ELECTROPHYSIOLOGY WOVEN 5 MM SPACE JOSEPH C1730 $231.66CATHETER ELECTROPHYSIOLOGY WOVEN EASY-MATE 5 MM SP C1730 $231.66CATHETER EMBOLECTOMY FOGARTY L80 CM OD5 FR ODSEC8 C1757 $1,202.50CATHETER EMBOLECTOMY FOGARTY L80 CM OD6 FR ODSEC10 C1757 $1,202.50CATHETER EMBOLECTOMY FOGARTY STAINLESS STEEL SILIC C1757 $188.50CATHETER EMBOLECTOMY FOGARTY THRULUMEN STAINLESS S C1757 $358.55CATHETER ENDOSCOPIC CLASSIC METAL L200 CM OD5.5 FR $255.00CATHETER ENDOSCOPIC FUSION OMNI DOMETIP L200 CM OD $335.00CATHETER EPIDURAL PERIFIX POLYAMIDE L36 IN OD19 GA C1755 $75.14CATHETER EPIDURAL PERIFIX POLYAMIDE L40 IN OD20 GA C1755 $48.30CATHETER EXTERNAL DRAINAGE BARIUM LARGE L35 CM ID1 C1729 $527.00CATHETER EXTERNAL DRAINAGE EDM SILICONE BARIUM L80 C1729 $1,257.88CATHETER EXTERNAL DRAINAGE EDM SILICONE L80 CM LUM C1729 $1,257.88CATHETER EXTERNAL DRAINAGE EDM STAINLESS STEEL L35 C1729 $812.50CATHETER EXTERNAL DRAINAGE EDS3 C1729 $1,107.76CATHETER EXTERNAL DRAINAGE EVD L33 CM OD1.5 FR CSF $1,848.60CATHETER EXTERNAL WIDEBAND SILICONE MALE LARGE OD3 C1758 $8.40CATHETER GUIDING C1887 $352.00CATHETER GUIDING CELLO SILICONE L10 MM L103 CM OD8 C1887 $6,012.50CATHETER GUIDING CELLO SILICONE L7 MM L103 CM OD7+ C1887 $6,012.50CATHETER GUIDING CORDIS ADROIT STAINLESS STEEL PTF C1887 $107.80CATHETER GUIDING CORDIS VISTA BRITE TIP IG STAINLE C1887 $350.00CATHETER GUIDING CORDIS VISTA BRITE TIP PTFE RCB C C1887 $352.00CATHETER GUIDING CORDIS VISTA BRITE TIP STAINLESS C1887 $175.00CATHETER GUIDING CPS DIRECT PL PEBAX 115 D L47 CM C1887 $3,600.00CATHETER GUIDING CPS DIRECT SL II DIRECT-TO-TARGET C1887 $2,250.00CATHETER GUIDING CPS LUMINARY .035 IN LARGE CURL L C1887 $7,164.00CATHETER GUIDING ENVOY STAINLESS STEEL NYLON POLYU C1887 $1,757.20

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 ChargeCATHETER GUIDING FINECROSS MG STAINLESS STEEL HYDR C1887 $2,000.00CATHETER GUIDING GUIDER SOFTIP XF DURAFORM PTFE 40 C1887 $1,722.50CATHETER GUIDING GUIDER SOFTIP XF DURAFORM PTFE MP C1887 $1,722.50CATHETER GUIDING GUIDER SOFTIP XF DURAFORM PTFE ST C1887 $1,722.50CATHETER GUIDING GUIDEZILLA II STAINLESS STEEL POL C1769 $2,424.50CATHETER GUIDING HEARTRAIL III PTFE IL3.5 CURVE L1 C1887 $350.00CATHETER GUIDING HEARTRAIL III PTFE IL3.75 CURVE L C1887 $350.00CATHETER GUIDING HEARTRAIL III PTFE IL4 CURVE L100 C1887 $350.00CATHETER GUIDING LAUNCHER NYLON 3DRC CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON AL.75 CURVE L100 C C1887 $200.00CATHETER GUIDING LAUNCHER NYLON AL1 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON AL1.5 CURVE L100 C C1887 $200.00CATHETER GUIDING LAUNCHER NYLON AL2 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON AL3 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON AL4 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON AR1 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON AR2 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON CHAMP1.5 CURVE L10 C1887 $200.00CATHETER GUIDING LAUNCHER NYLON CHAMP3.5 CURVE L10 C1887 $200.00CATHETER GUIDING LAUNCHER NYLON DC3 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON EBU3 CURVE L100 CM C1887 $320.00CATHETER GUIDING LAUNCHER NYLON EBU3.5 CURVE L100 C1887 $200.00CATHETER GUIDING LAUNCHER NYLON EBU3.5 CURVE L90 C C1887 $200.00CATHETER GUIDING LAUNCHER NYLON EBU3.75 CURVE L100 C1887 $200.00CATHETER GUIDING LAUNCHER NYLON EBU3.75 CURVE L90 C1887 $200.00CATHETER GUIDING LAUNCHER NYLON EBU4 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON EBU4.5 CURVE L100 C1887 $200.00CATHETER GUIDING LAUNCHER NYLON EBU5 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON HSI CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON HSII CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON IMA CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON IMA CURVE L90 CM O C1887 $200.00CATHETER GUIDING LAUNCHER NYLON LCB CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON MB1 CURVE L100 CM C1887 $320.00CATHETER GUIDING LAUNCHER NYLON MB2 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON MP1 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON NOTO CURVE L100 CM C1887 $260.00CATHETER GUIDING LAUNCHER NYLON PK1 CURVE L47 CM O C1887 $260.00CATHETER GUIDING LAUNCHER NYLON RBU3.5 CURVE L100 C1887 $200.00

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 ChargeCATHETER GUIDING LAUNCHER NYLON RBU4 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON RCB CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON SCR3.5 CURVE L100 C1887 $200.00CATHETER GUIDING LAUNCHER NYLON SCR4 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON SL3 CURVE L100 CM C1887 $200.00CATHETER GUIDING LAUNCHER NYLON SL4 CURVE L100 CM C1887 $320.00CATHETER GUIDING LAUNCHER NYLON SL4.5 CURVE L100 C C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD AL1 CURVE C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD EBU4 CURV C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD IMA CURVE C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD JL3 CURVE C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD JL3.5 CUR C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD JL4 CURVE C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD JL4.5 CUR C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD JL5 CURVE C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD JL6 CURVE C1887 $320.00CATHETER GUIDING LAUNCHER NYLON STANDARD JR3.5 CUR C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD JR4 CURVE C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD JR5 CURVE C1887 $200.00CATHETER GUIDING LAUNCHER NYLON STANDARD RBU4 CURV C1887 $200.00CATHETER GUIDING MACH1 PTFE AL1 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE AL1 CURVE L100 CM OD8 C1887 $280.00CATHETER GUIDING MACH1 PTFE AL1 CURVE L90 CM OD8 F C1887 $227.50CATHETER GUIDING MACH1 PTFE AL2 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE AL2 CURVE L100 CM OD8 C1887 $280.00CATHETER GUIDING MACH1 PTFE AR1 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE AR2 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE ART3.5 CURVE L100 CM O C1887 $227.50CATHETER GUIDING MACH1 PTFE ART4 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE C2 CURVE L55 CM OD6 FR C1887 $487.50CATHETER GUIDING MACH1 PTFE CLS3 CURVE L100 CM OD8 C1887 $280.00CATHETER GUIDING MACH1 PTFE CLS3.5 CURVE L100 CM O C1887 $280.00CATHETER GUIDING MACH1 PTFE CLS4 CURVE L100 CM OD8 C1887 $280.00CATHETER GUIDING MACH1 PTFE FL3.5 CURVE L100 CM OD C1887 $227.50CATHETER GUIDING MACH1 PTFE FL4 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE FL5 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE FR4 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE FR4 ST CURVE L100 CM O C1887 $227.50CATHETER GUIDING MACH1 PTFE FR5 CURVE L100 CM OD6 C1887 $227.50

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 ChargeCATHETER GUIDING MACH1 PTFE HS CURVE L100 CM OD6 F C1887 $227.50CATHETER GUIDING MACH1 PTFE IM CURVE L100 CM OD8 F C1887 $280.00CATHETER GUIDING MACH1 PTFE IM CURVE L85 CM OD6 FR C1887 $227.50CATHETER GUIDING MACH1 PTFE IM CURVE L90 CM OD6 FR C1887 $227.50CATHETER GUIDING MACH1 PTFE JL3.5 CURVE L100 CM OD C1887 $280.00CATHETER GUIDING MACH1 PTFE JL4 CURVE L100 CM OD8 C1887 $280.00CATHETER GUIDING MACH1 PTFE JR3.5 CURVE L100 CM OD C1887 $227.50CATHETER GUIDING MACH1 PTFE JR4 CURVE L100 CM OD8 C1887 $280.00CATHETER GUIDING MACH1 PTFE KIMNY CURVE L100 CM OD C1887 $227.50CATHETER GUIDING MACH1 PTFE LCB CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE LEFTBU3.5 CURVE L90 CM C1887 $227.50CATHETER GUIDING MACH1 PTFE LEFTBU3.75 CURVE L100 C1887 $227.50CATHETER GUIDING MACH1 PTFE LIMA CURVE L55 CM OD6 C1887 $581.04CATHETER GUIDING MACH1 PTFE MP1 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE MP1 CURVE L100 CM OD8 C1887 $280.00CATHETER GUIDING MACH1 PTFE RCB CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING MACH1 PTFE VL3.5 CURVE L100 CM OD C1887 $227.50CATHETER GUIDING MACH1 PTFE VL4 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RELIEVA SPIN M-110 MAXILLARY SINU C1887 $1,872.00CATHETER GUIDING RELIEVA SPIN M-110C MAXILLARY SIN C1887 $1,872.00CATHETER GUIDING RUNWAY PTFE AL.75 CURVE L100 CM O C1887 $227.50CATHETER GUIDING RUNWAY PTFE AL1 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE AL1 CURVE L125 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE AL1.5 CURVE L100 CM O C1887 $227.50CATHETER GUIDING RUNWAY PTFE AL2 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE AL2 CURVE L90 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE AL3 CURVE L100 CM OD6 C1887 $491.04CATHETER GUIDING RUNWAY PTFE AR1 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE AR1 CURVE L90 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE AR2 CURVE L100 CM OD6 C1887 $387.20CATHETER GUIDING RUNWAY PTFE AR2 CURVE L90 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE ART3 CURVE L100 CM OD C1887 $280.00CATHETER GUIDING RUNWAY PTFE ART3.5 CURVE L100 CM C1887 $280.00CATHETER GUIDING RUNWAY PTFE ART4 CURVE L100 CM OD C1887 $227.50CATHETER GUIDING RUNWAY PTFE CLS3 CURVE L100 CM OD C1887 $491.04CATHETER GUIDING RUNWAY PTFE CLS3.5 CURVE L100 CM C1887 $491.04CATHETER GUIDING RUNWAY PTFE CLS3.5 CURVE L110 CM C1887 $280.00CATHETER GUIDING RUNWAY PTFE CLS4 CURVE L100 CM OD C1887 $491.04CATHETER GUIDING RUNWAY PTFE CLS4 CURVE L85 CM OD6 C1887 $227.50

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 ChargeCATHETER GUIDING RUNWAY PTFE CLS4.5 CURVE L125 CM C1887 $491.04CATHETER GUIDING RUNWAY PTFE FL3.5 CURVE L100 CM O C1887 $227.50CATHETER GUIDING RUNWAY PTFE FL3.5 CURVE L110 CM O C1887 $227.50CATHETER GUIDING RUNWAY PTFE FL4 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE FL5 CURVE L125 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE FL6 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE FR3.5 CURVE L100 CM O C1887 $227.50CATHETER GUIDING RUNWAY PTFE FR4 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE FR4 CURVE L125 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE HS CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE IM CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE IM CURVE L85 CM OD6 F C1887 $227.50CATHETER GUIDING RUNWAY PTFE JL3 CURVE L100 CM OD6 C1887 $491.04CATHETER GUIDING RUNWAY PTFE JL3.5 CURVE L100 CM O C1887 $387.20CATHETER GUIDING RUNWAY PTFE JL4 CURVE L100 CM OD6 C1887 $491.04CATHETER GUIDING RUNWAY PTFE JL4 CURVE L125 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE JL4 ST CURVE L100 CM C1887 $491.04CATHETER GUIDING RUNWAY PTFE JL4.5 CURVE L100 CM O C1887 $227.50CATHETER GUIDING RUNWAY PTFE JL5 CURVE L125 CM OD6 C1887 $491.04CATHETER GUIDING RUNWAY PTFE JL6 CURVE L100 CM OD6 C1887 $491.04CATHETER GUIDING RUNWAY PTFE JR3.5 CURVE L100 CM O C1887 $227.50CATHETER GUIDING RUNWAY PTFE JR4 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE KR4H CURVE L100 CM OD C1887 $227.50CATHETER GUIDING RUNWAY PTFE LCB CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE LCB CURVE L90 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE LEFTBU3.5 CURVE L100 C1887 $280.00CATHETER GUIDING RUNWAY PTFE LEFTBU4 CURVE L100 CM C1887 $227.50CATHETER GUIDING RUNWAY PTFE MP1 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE MP1 CURVE L125 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE MP2 CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE RC4 SC CURVE L100 CM C1887 $387.20CATHETER GUIDING RUNWAY PTFE RCB CURVE L90 CM OD6 C1887 $227.50CATHETER GUIDING RUNWAY PTFE VL3.5 CURVE L100 CM O C1887 $280.00CATHETER GUIDING RUNWAY PTFE VL4 CURVE L100 CM OD6 C1887 $488.00CATHETER GUIDING RUNWAY PTFE WRP CURVE L100 CM OD6 C1887 $227.50CATHETER GUIDING SOFIA STRAIGHT L125 CM OD5 FR DIS C1887 $7,904.00CATHETER GUIDING STINGRAY LP HYDROPHILIC L135 CM O C1887 $7,475.00CATHETER GUIDING VISTA BRITE TIP PTFE JL4.5 CURVE C1887 $352.00CATHETER GUIDING Z2 AL1 CURVE L100 CM OD6 FR PERIP C1887 $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 ChargeCATHETER GUIDING Z2 AL2 CURVE L100 CM OD6 FR CORON C1887 $320.00CATHETER GUIDING Z2 HSI CURVE L100 CM OD6 FR CORON C1887 $320.00CATHETER GUIDING Z2 IMA CURVE L100 CM OD6 FR CORON C1887 $320.00CATHETER GUIDING Z2 IMA CURVE L100 CM OD6 FR PERIP C1887 $320.00CATHETER GUIDING Z2 JL4 CURVE L100 CM OD6 FR CORON C1887 $320.00CATHETER GUIDING Z2 JL5 CURVE L100 CM OD6 FR CORON C1887 $320.00CATHETER GUIDING Z2 JR4 CURVE L100 CM OD6 FR CORON C1887 $320.00CATHETER GUIDING ZUMA EBU3 CURVE L100 CM OD8 FR CO C1887 $320.00CATHETER HEMODIALYSIS EQUISTREAM AIRGUARD POLYURET C1750 $1,300.00CATHETER HEMODIALYSIS EQUISTREAM XK AIRGUARD POLYU C1750 $2,080.00CATHETER HEMODIALYSIS HEMOSPLIT XK CARBOTHANE ALPH C1750 $1,250.00CATHETER HEMODIALYSIS HEMOSTAR BIOBLOC L19 CM OD14 C1750 $1,200.00CATHETER HEMODIALYSIS HICKMAN L36 CM L19 CM OD13.5 C1750 $1,032.00CATHETER HEMODIALYSIS VITACUFF HICKMAN SILICONE L2 C1750 $1,064.00CATHETER IAB LINEAR DURATHANE .025 IN L221 MM L6 I C1725 $3,530.00CATHETER IAB LINEAR DURATHANE .025 IN L258 MM L6 I C1725 $4,589.00CATHETER IAB MEGA L229 MM L6 IN OD7.5 FR ODSEC16 M C1725 $4,085.00CATHETER IAB MEGA STATLOCK L6 IN L229 MM OD8 FR OD $4,085.00CATHETER IAB OD8 FR 40 ML C1725 $5,525.00CATHETER IAB SENSATION .018 IN L221 MM L6 IN OD7 F C1725 $6,728.00CATHETER INFUSION CRAGG-MCNAMARA CRAGG-MICROVALVE C1751 $235.71CATHETER INFUSION ECHELON 10 NITINOL MICRO L155 CM C1887 $4,322.50CATHETER INFUSION HEADWAY DUO HYDROPHILIC STRAIGHT $6,240.00CATHETER INFUSION MARATHON STAINLESS STEEL NITINOL C1887 $4,413.50CATHETER INFUSION MARKSMAN STAINLESS STEEL HYDROPH C1887 $4,750.00CATHETER INFUSION REBAR 18 STAINLESS STEEL HYDROPH C1887 $2,691.00CATHETER INFUSION TWIN-PASS STAINLESS STEEL HYDROP C1887 $855.00CATHETER INFUSION ULTRAFLOW ONYX STAINLESS STEEL H C1887 $4,017.00CATHETER INSERT STENTS IN MAJOR CORONARY ARTERY OR 92928 $29,125.00CATHETER INSTILLATION OF AGENT ONTO LUNG SURFACE 32560 $1,993.00CATHETER INTERVENTIONAL GUIDELINER L150 CM L25 CM C1887 $1,865.00CATHETER INTERVENTIONAL GUIDELINER V3 L150 CM L25 C1887 $1,865.00CATHETER INTERVENTIONAL GUIDELINER V3 L150 CM L25 $1,865.00CATHETER INTERVENTIONAL GUIDELINER V3 OD.012 IN L1 C1887 $1,119.00CATHETER INTERVENTIONAL PROGREAT HYDROPHILIC L130 C1887 $2,650.00CATHETER INTERVENTIONAL PROGREAT HYDROPHILIC MICRO C1887 $2,650.00CATHETER INTERVENTIONAL PROGREAT HYDROPHILIC PTFE C1887 $1,550.00CATHETER INTERVENTIONAL PROGREAT MICRO L110 CM OD2 C1887 $1,550.00CATHETER INTERVENTIONAL PROGREAT TERUMO GLIDE TECH $1,550.00

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 ChargeCATHETER INTERVENTIONAL PROGREAT TUNGSTEN HYDROPHI C1887 $1,550.00CATHETER INTERVENTIONAL TURNPIKE LP L135 CM OD2.2- C1887 $3,893.50CATHETER INTRATHECAL ASCENDA SILICONE POLYMER L114 C1755 $6,467.50CATHETER INTRATHECAL KIT REVISION SEGMENT C1755 $1,820.00CATHETER INTRAUTERINE BAKRI SILICONE L54 CM L180 C $1,736.00CATHETER INTRAUTERINE CHECK-FLO PERFORMER SILICONE $372.84CATHETER INTRAUTERINE COOK SILICONE L30 CM OD7 FR C2628 $187.40CATHETER INTRAUTERINE SHOLKOFF SILICONE L30 CM OD6 $345.80CATHETER INTRAUTERINE THERMACHOICE UTERUS BALLOON $7,850.88CATHETER IRRIGATION RELIEVA VORTEX 2 SINUS 1 HAND $906.75CATHETER IV ACCUCATH 6 ML/SEC L2.25 IN OD18 GA INT C1751 $210.00CATHETER IV ACCUCATH STATLOCK NITINOL L1.25 IN OD2 C1751 $143.00CATHETER IV ACCUCATH STATLOCK NITINOL L2.25 IN OD2 C1751 $210.00CATHETER IV CATHLON TEFLON METAL L1 1/4 IN OD18 GA C1751 $12.75CATHETER IV JELCO FEP POLYMER STANDARD THIN WALL L C1751 $6.83CATHETER IV JELCO L1 IN OD22 GA STERILE LATEX FREE C1751 $1,365.00CATHETER IV PROTECTIV PLUS POLYURETHANE STRAIGHT L C1751 $4.68CATHETER JEJUNOSTOMY BAKER PLASTIC ADULT L108 IN O B4087 $362.49CATHETER LACRIMAL LACRICATH PEDIATRIC L13 MM OD2 M C1726 $4,440.00CATHETER NEPHROSTOMY BARDEX LUBRICATH OD16 FR 5 CC C1729 $60.78CATHETER NEPHROSTOMY FLEXIMA POLYURETHANE PIGTAIL C1729 $645.84CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD10 F C1729 $70.57CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD12 F C1729 $47.71CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD14 F C1729 $29.43CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD16 F C1729 $34.17CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD18 F C1729 $22.00CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD20 F C1729 $34.32CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD22 F C1729 $158.86CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD24 F C1729 $74.36CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD28 F C1729 $91.52CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD32 F C1729 $195.52CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD36 F C1729 $85.25CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD38 F C1729 $454.09CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD40 F C1729 $195.52CATHETER NEPHROSTOMY PEZZER NATURAL RUBBER OD16 FR C1729 $55.11CATHETER NEUROSURGICAL ARES VENTRICLE ANTIBIOTIC I $2,301.00CATHETER NEUROSURGICAL SMALL L90 CM OD2.1 MM ID1.2 $1,221.76CATHETER OCCLUSION RELIANT POLYURETHANE L100 CM OD C2628 $1,960.20CATHETER PACING ARROW ADVANCER CHLORAPREP HI-LITE $880.62

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 ChargeCATHETER PACING BARD NATURAL RUBBER 1 CM PROXIMAL $1,248.00CATHETER PERFUSION CONNECTOR CABLE PUSH LOCK $877.50CATHETER PERITONEAL BARIUM STANDARD L90 CM CARDIAC C1750 $1,223.30CATHETER PERITONEAL DIALYSIS ARGYLE SILICONE CURL C1750 $346.91CATHETER PLACEMENT STENTS IN MAJOR CORONARY ARTERY 92929 $29,531.00CATHETER PULMONARY ARTERY ARROW L110 CM OD5 FR ODS C1751 $297.64CATHETER PULMONARY ARTERY ARROW L110 CM OD6 FR ODS C1751 $297.64CATHETER PULMONARY ARTERY ARROW L110 CM OD7 FR ODS C1751 $297.64CATHETER PULMONARY ARTERY ARROW L60 CM OD5 FR ODSE C1751 $297.64CATHETER PULMONARY ARTERY SWAN-GANZ CCOMBO STANDAR $1,235.00CATHETER PULMONARY ARTERY SWAN-GANZ CCOMBO VIP STA $950.00CATHETER PULMONARY ARTERY SWAN-GANZ L110 CM L23 CM $439.75CATHETER PULMONARY ARTERY SWAN-GANZ STANDARD L110 $250.00CATHETER PULMONARY ARTERY SWAN-GANZ STANDARD L110 C1751 $304.48CATHETER PULMONARY ARTERY SWAN-GANZ VIP .032 IN ST $400.00CATHETER PULMONARY ARTERY SWAN-GANZ VIP L110 CM OD C1751 $960.00CATHETER REMOVAL OF PLAQUE FROM GROIN ARTERY ACCES 0238T $34,244.00CATHETER REMOVAL OF PLAQUE FROM KIDNEY ARTERY ACCE 0234T $37,074.00CATHETER REMOVAL OF PLAQUE FROM ORGAN ARTERY ACCES 0235T $30,866.00CATHETER REPERFUSION 3MAX L164 CM OD4.7-3.8 FR ID. $6,750.00CATHETER REPERFUSION 4MAX L143 CM OD6-4.3 FR ID.04 $6,750.00CATHETER REPLACEMENT OF CENTRAL VENOUS ACCESS DEVI 36578 $7,066.00CATHETER SHUNT PUDENZ BARIUM STANDARD L60 CM OD2.2 C1729 $3,235.84CATHETER SIZING AUROUS NYLON PIGTAIL CURVE L100 CM $2,850.00CATHETER SUCTION BALLARD OD3.5 MM OD4 MM L12 IN OD $1,881.60CATHETER SUPPORT CXI TUNGSTEN L135 CM OD4 FR MARKE C1887 $775.00CATHETER SUPPORT NAVICROSS STAINLESS STEEL HYDROPH C1887 $925.00CATHETER SUPPORT NAVICROSS STAINLESS STEEL HYDROPH $925.00CATHETER SUPPORT NAVIEN NITINOL STRAIGHT L115 CM L C1887 $5,200.00CATHETER SUPPORT NAVIEN NITINOL STRAIGHT L115 CM L $8,417.50CATHETER SUPPORT NAVIEN NITINOL STRAIGHT L125 CM L $8,417.50CATHETER SUPPORT QUICK-CROSS .018 IN STRAIGHT L150 C1887 $850.00CATHETER SUPPORT QUICK-CROSS 50 MM SPACE L135 CM O C1887 $800.00CATHETER SUPPORT QUICK-CROSS HYDROPHILIC 15 MM SPA C1887 $800.00CATHETER SUPPORT QUICK-CROSS HYDROPHILIC 50 MM SPA C1887 $800.00CATHETER SUPPORT QUICK-CROSS SELECT STAINLESS STEE C1887 $850.00CATHETER SUPPORT QUICK-CROSS STAINLESS STEEL HYDRO C1887 $850.00CATHETER SUPPORT SEEKER HYDROPHILIC L135 CM PERIPH C1887 $550.00CATHETER SUPPORT SEEKER HYDROPHILIC L150 CM PERIPH C1887 $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 ChargeCATHETER SUPPORT SEEKER HYDROPHILIC L90 CM PERIPHE C1887 $550.00CATHETER SUPPORT SEEKER L150 CM ACCEPTS .014 IN GU C1887 $715.00CATHETER SUPPORT SOFIA PLUS L125 CM L19 CM OD6 FR C1887 $12,163.13CATHETER SUPPORT SOFIA PLUS L131 CM L19 CM OD6 FR C1887 $12,163.13CATHETER SUPPORT TRAILBLAZER PUSHPLUS CROSSCOAT 15 C1887 $330.00CATHETER SUPPORT TRAILBLAZER PUSHPLUS CROSSCOAT 50 C1887 $330.00CATHETER SUPRAPUBIC MALECOT SILICONE L20 CM OD10 F C2627 $251.60CATHETER SUPRAPUBIC MALECOT SILICONE L20 CM OD12 F C2627 $251.60CATHETER SUPRAPUBIC MALECOT SILICONE L20 CM OD8 FR C2627 $251.60CATHETER SUPRAPUBIC MALECOT SILICONE L25 CM OD14 F C2627 $251.60CATHETER SUPRAPUBIC MALECOT SILICONE L25 CM OD16 F C2627 $251.60CATHETER SUPRAPUBIC MALECOT SILICONE L25 CM OD18 F C2627 $251.60CATHETER SUPRAPUBIC OBRIEN PEEL-AWAY L12 CM OD16 F C2627 $469.63CATHETER SUPRAPUBIC SIMPLASTIC PVC OD16 FR 5 ML 3 C2627 $273.39CATHETER SURGICAL COLPO-PNEUMO OCCLUDER SILICONE O $410.74CATHETER THROMBECTOMY CLEANERXT L65 CM OD6 FR ROTA C1757 $4,200.00CATHETER THROMBECTOMY CLEANERXT L65 CM OD7 FR ODSE C1757 $4,840.00CATHETER THROMBECTOMY DAC HYDROPHILIC L130 CM OD4. C1887 $6,948.50CATHETER THROMBECTOMY EXPORT AP L140 CM OD6 FR ID. C1757 $1,925.00CATHETER THROMBECTOMY FOGARTY COIL L50 CM OD5 FR V C1757 $2,047.50CATHETER THROMBECTOMY FOGARTY COIL L50 CM OD6 FR V C1757 $2,047.50CATHETER THROMBECTOMY L154 CM L150 CM OD3.9-2.8 FR C1757 $5,950.00CATHETER THROMBECTOMY NEURON 035 IN .038 IN H1 CUR C1757 $620.00CATHETER THROMBECTOMY PENUMBRA SYSTEM 5MAX ACE L13 C1757 $12,935.00CATHETER THROMBECTOMY PRONTO LP SILVA HYDROPHILIC C1757 $1,750.00CATHETER THROMBECTOMY PRONTO V3 HYDROPHILIC TAPER C1757 $2,312.00CATHETER THROMBECTOMY PRONTO V4 HYDROPHILIC L138 C C1757 $867.00CATHETER THROMBECTOMY PRONTO-SHORT BARE METAL TAPE C1757 $2,080.00CATHETER THROMBECTOMY UNI-FUSE FLOW-THRU HUB L135 C1757 $509.25CATHETER THROMBECTOMY UNI-FUSE FLOW-THRU HUB L90 C C1757 $662.03CATHETER ULTRASOUND ACUNAV L90 CM OD10 FR INTRACAR C1759 $6,400.00CATHETER ULTRASOUND ACUNAV L90 CM OD8 FR 4 WAY STE C1753 $4,000.00CATHETER ULTRASOUND ACUNAV L90 CM OD8 FR INTRACARD C1759 $6,400.00CATHETER ULTRASOUND EAGLE EYE GLYDX PLATINUM ST 20 C1753 $3,750.00CATHETER ULTRASOUND EAGLE EYE PLATINUM GLYDX 20MHZ C1753 $3,625.00CATHETER ULTRASOUND OPTICROSS OD5 FR INTRAVASCULAR $3,500.00CATHETER ULTRASOUND REVOLUTION 45MHZ L135 CM L26 M C1753 $3,375.00CATHETER ULTRASOUND VISIONS PV .018 IN L135 CM OD3 C1753 $4,387.50CATHETER ULTRASOUND VISIONS PV 20MHZ L135 CM OD3.4 C1753 $4,387.50

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 ChargeCATHETER ULTRASOUND VISIONS PV GLYDX .035 IN L90 C C1753 $4,750.00CATHETER ULTRASOUND VISIONS PV GLYDX TAPER L150 CM C1753 $4,875.00CATHETER UMBILICAL L72 IN COAXIAL $617.50CATHETER URETERAL .05 IN L54 CM OD10 FR 2 INJECTIO C1758 $413.31CATHETER URETERAL BARD HEYMAN POLYURETHANE L70 CM C1758 $81.90CATHETER URETERAL BARD POLYURETHANE L70 CM OD4 FR C1758 $104.48CATHETER URETERAL BARD POLYURETHANE L70 CM OD5 FR C1758 $81.68CATHETER URETERAL BARD POLYURETHANE L70 CM OD6 FR C1758 $98.08CATHETER URETERAL BARD POLYURETHANE LARGE L70 CM O C1758 $21.31CATHETER URETERAL FLEXIMA L70 CM OD5 FR ODSEC8 FR C1758 $59.74CATHETER URETERAL FLEXI-TIP .05 IN STANDARD L50 CM C1758 $153.00CATHETER URETERAL FLEXI-TIP AQ L50 CM OD6/10 FR OD C1758 $245.90CATHETER URETERAL FLEXI-TIP STANDARD L50 CM OD6/10 C1758 $215.48CATHETER URETERAL L70 CM OD3 FR OPEN END ACCEPTS . C1758 $74.80CATHETER URETERAL L70 CM OD4 FR OPEN END STERILE D C1758 $60.78CATHETER URETERAL L70 CM OD4 FR SPIRAL TIP ACCESS C1758 $82.62CATHETER URETERAL L70 CM OD4.8 FR ODSEC8 FR CONE T C1758 $850.24CATHETER URETERAL L70 CM OD5 FR LEFT WHISTLE TIP C1758 $693.55CATHETER URETERAL L70 CM OD5 FR OPEN END STERILE D C1758 $46.75CATHETER URETERAL L70 CM OD5 FR SPIRAL TIP SIDEPOR C1758 $725.27CATHETER URETERAL L70 CM OD6 FR ODSEC10 FR CONE TI C1758 $53.14CATHETER URETERAL L70 CM OD6 FR OPEN END STERILE D C1758 $74.80CATHETER URETERAL POLYURETHANE L70 CM OD4 FR ADAPT C1758 $98.08CATHETER URETERAL ROYAL FLUSH PLUS NYLON BEACON TI C1758 $90.00CATHETER URETERAL RUTNER ADULT UNIVERSAL L70 CM OD C1758 $841.26CATHETER URETERAL SOF-FLEX L70 CM OD5 FR OPEN END C1758 $74.80CATHETER URETERAL SOF-FLEX L70 CM OD6 FR OPEN END C1758 $74.80CATHETER URETHRAL BARD SILICONE OD14 FR 5 CC FOLEY $506.05CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER A4338 $31.35CATHETER URETHRAL BARDEX LUBRICATH RUBBER HYDROGEL $546.00CATHETER URETHRAL DOVER SILICONE OD20 FR 10 ML FOL $771.68CATHETER URETHRAL LUBRI-SIL IC BACTI-GUARD SILICON $988.26CATHETER URETHRAL PUREWICK NATURAL RUBBER FEMALE L $975.00CATHETER URETHRAL PVC STRAIGHT OD5 FR INTERMITTENT $325.00CATHETER URETHRAL SILICONE PEDIATRIC OD10 FR 3 ML A4344 $403.20CATHETER URETHRAL UNIVERSA SILICONE L25 CM OD10 FR $432.00CATHETER URETHRAL UNIVERSA SILICONE L25 CM OD6 FR $432.00CATHETER URETHRAL UNIVERSA SILICONE L25 CM OD8 FR $1,664.00CATHETER URETHRAL UNIVERSA SILICONE L34 CM OD12 FR $432.00

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 ChargeCATHETER URODYNAMIC PVC L47 CM OD7 FR 2 LUMEN STRA C1726 $89.70CATHETER URODYNAMIC PVC POLYISOPRENE ADULT L47 CM C1726 $133.25CATHETER UROLOGY COOK L88 CM L30 CM OD8 FR ID8.5 F C1892 $256.04CD4 COUNT LYMPHOCYTE SUBSET PANEL 2 86361 $157.00CEFAZOLIN IN D5W 2 GRAM/50 ML PGBK 1 EACH BAG J0690 $50.00CEFOTAXIME 1 GRAM SOLR 1 EACH VIAL J0698 $24.05CEFTRIAXONE 1 GRAM SOLR 1 EACH VIAL J0696 $20.00CELL EXAMINATION 88366 $1,062.00CELL EXAMINATION OF SPECIMEN 88108 $132.00CELL EXAMINATION OF SPECIMEN 88112 $132.00CELLULOSE OXIDIZED ARISTA AH MPH PLANT STARCH 5 GM $1,126.50CEMENT BONE 3 MIX C1713 $611.00CEMENT BONE BETA-TRICALCIUM PHOSPHATE .7-1.4 MM/1 C1713 $1,240.00CEMENT BONE BIOMET 40 GM C1713 $400.00CEMENT BONE COBALT HV GENTAMICIN 40 GM STERILE C1713 $1,430.00CEMENT BONE ENDURANCE SMARTSET 40 GM MEDIUM VISCOS C1713 $756.00CEMENT BONE HV-R KYPHX MIXER GRADUATE MARK DISPENS C1713 $800.00CEMENT BONE HYDROSET CALCIUM PHOSPHATE 10 CC INJEC C1713 $16,741.73CEMENT BONE HYDROSET CALCIUM PHOSPHATE 15 CC INJEC C1713 $24,906.77CEMENT BONE HYDROSET CALCIUM PHOSPHATE 15 ML INJEC C1713 $24,906.77CEMENT BONE KYPHX HV-R 30% BARIUM SULFATE PMMA CAN $680.00CEMENT BONE OD10 MM SHOULDER NONSTERILE C1713 $260.00CEMENT BONE OTOMIMIX CALCIUM PHOSPHATE HA 2 GM EAR C1713 $2,472.21CEMENT BONE PALACOS LV 40 GM BROAD SPECTRUM C1713 $357.50CEMENT BONE PALACOS LV+G GENTAMICIN 40 GM GREEN $1,235.00CEMENT BONE PALACOS R 40 GM GREEN C1713 $357.50CEMENT BONE PALACOS R 40 GM HIGH VISCOSITY GREEN C1713 $357.50CEMENT BONE PALACOS R+G 40 GM C1713 $2,320.00CEMENT BONE PALACOS R+G GENTAMICIN 40 GM LATEX FRE C1713 $1,235.00CEMENT BONE PALACOS R+G GENTAMICIN HIGH VISCOSITY C1713 $1,235.00CEMENT BONE RALLY 40 GM MEDIUM VISCOSITY SPEARMINT C1713 $1,235.00CEMENT BONE REFOBACIN STERILE LATEX FREE DISPOSABL C1713 $1,360.00CEMENT BONE SIMPLEX 20 ML 40 GM HIGH VISCOSITY STE C1713 $165.00CEMENT BONE SIMPLEX GENTAMICIN 20 ML 40 GM HIGH VI C1713 $1,235.00CEMENT BONE SIMPLEX P RADIOPAQUE FULL DOSE STERILE C1713 $357.50CEMENT BONE SIMPLEX P SPEEDSET FULL DOSE C1713 $357.50CEMENT BONE SIMPLEX P TOBRAMYCIN FULL DOSE ANTIBIO C1713 $1,510.00CEMENT BONE SMARTSET 40 GM HIGH VISCOSITY STERILE C1713 $357.50CEMENT BONE SMARTSET GENTAMICIN 40 GM HIGH VISCOSI C1713 $1,235.00

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 ChargeCEMENT BONE TRAUMACEM V+ POLYMETHYLMETHACRYLATE GL C1713 $2,695.68CEMENT DENTAL KETAC CEM APLICAP GLASS IONOMER PEDI $3,395.12CENTRALIZER STEM ACUMATCH PMMA OD12 MM HIP FEMUR D C1776 $260.00CENTRALIZER STEM ACUMATCH PMMA OD13 MM HIP FEMUR D C1776 $260.00CENTRALIZER STEM ACUMATCH PMMA OD15 MM HIP FEMUR D C1776 $260.00CENTRALIZER STEM CEMENTRALIZER PMMA OD10 MM HIP FE C1776 $260.00CENTRALIZER STEM CEMENTRALIZER PMMA OD12 MM HIP FE C1776 $260.00CENTRALIZER STEM CEMENTRALIZER PMMA OD14 MM HIP FE C1776 $260.00CENTRALIZER STEM CEMENTRALIZER PMMA OD16 MM HIP FE C1776 $260.00CENTRALIZER STEM PMMA OD15 MM HIP DISTAL POSITIONE C1776 $260.00CENTRALIZER STEM VERSYS PMMA OD12 MM HIP DISTAL CE C1776 $260.00CENTRALIZER STEM VERSYS PMMA OD13 MM HIP DISTAL CE C1776 $260.00CENTRALIZER STEM VERSYS PMMA OD15 MM HIP DISTAL CE C1776 $260.00CERULOPLASMIN (PROTEIN) LEVEL 82390 $83.00CHANGE OF BREATHING TUBE OF WINDPIPE IN NECK 31502 $373.00CHANGE OF TUBE OR STENT IN URINARY DUCT (URETER) 50688 $4,433.00CHANNEL WORKING L17.2 CM L13 CM OD4.2 MM NEUROENDO $11,846.25CHARGER NEUROSTIMULATOR ACTIVA RC $15,067.00CHARGER NEUROSTIMULATOR PRODIGY 25.5- MA 2-1200HZ C1820 $4,875.00CHECK OF HEARING AID OF BOTH EARS 92593 $195.00CHECK OF HEARING AID OF ONE EAR 92592 $686.00CHEMICAL ANALYSIS OF STONE 82360 $81.00CHEMICAL ANALYSIS USING CHROMATOGRAPHY TECHNIQUE 82542 $144.00CHEMICAL DESTRUCTION OF ANAL GROWTHS 46900 $773.00CHEMICAL PEEL OF SKIN OF FACE 15788 $676.00CHEMICAL PEEL OF SKIN OF FACE 15789 $1,953.00CHEMICAL RECEPTOR ANALYSIS 84238 $283.00CHEMICAL TREATMENT OF ACNE 17340 $264.00CHEMOTHERAPY ADMIN INTO CHEST CAVITY REQUIRING INS 96440 $707.00CHEMOTHERAPY ADMINISTRATION INTO SPINAL CANAL REQU 96450 $1,114.00CHEMOTHERAPY INFUSION INTO ABDOMINAL CAVITY 96446 $707.00CHEMOTHERAPY INJECTION INTO BRAIN THROUGH RESERVOI 96542 $749.00CHERRY SYRUP SYRP 473 ML BOTTLE $50.12CHEST ULTRASOUND EXAMINATION OF HEART W/O CONTRAST 93307 $1,947.00CHIMERISM ANALYSIS POST TRANSPLANTATION 81267 $27.00CHLORHEXIDINE 0.12 % MWSH 473 ML BOTTLE A4248 $3.00CHLORIDE BODY FLUID 82438 $31.00CHLORIDE URINE 82436 $39.00CHOLESTEROL LDL DIRECT 83721 $66.00

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 ChargeCHOLESTEROL LEVEL 82465 $43.00CHOLESTYRAMINE 4 GRAM PWPK 60 EACH PACKET $9.37CHROMOENDOSCOPY 45399 $3,746.00CHROMOSOME ANALYSIS FOR GENETIC DEFECTS 88262 $904.00CHROMOSOME ANALYSIS OF AMNIOTIC FLUID FOR GENETIC 88269 $1,289.00CHRONIC CARE MANAGEMENT SERVICES AT LEAST 20 MINUT 99490 $264.00CILOSTAZOL 100 MG TAB 60 EACH BOTTLE $3.00CILOSTAZOL 50 MG TAB 60 EACH BOTTLE $3.00CIRCUIT BREATHING IVENT ADULT Y L1.8 MR OD22 MM VE $1,606.80CIRCUIT BREATHING L38 IN SHORT HEAT WIRE HUMIDIFIE $732.68CIRCUIT BREATHING L48 IN O2 TUBE ADAPTER LATEX FRE $352.33CIRCUIT BREATHING METANEB NEBULIZER MOUTHPIECE INL $385.00CIRCUIT BREATHING POLYPROPYLENE ADULT Y ANGLED L72 $855.36CIRCUIT BREATHING PRECISION FLOW 1-8 LPM LOW FLOW $611.00CIRCUIT BREATHING PRECISION FLOW 5-40 LPM DELIVERY $611.00CIRCUIT BREATHING Y L4 MR LATEX FREE DISPOSABLE $2,289.30CITALOPRAM 10 MG TAB 100 EACH BOTTLE $12.29CITALOPRAM 40 MG TAB 100 EACH BOTTLE $13.24CITRATE LEVEL 82507 $215.00CLAMP CIRCUMCISION CIRCLAMP OD1.1 CM BELL STERILE $1,855.62CLAMP CIRCUMCISION CIRCLAMP OD1.3 CM BELL STERILE $1,855.62CLAMP ELECTROSURGICAL ISOLATOR SYNERGY LONG JAW LE $16,900.00CLAMP ELECTROSURGICAL ISOLATOR SYNERGY RIGHT CURVE $22,400.00CLAMP EXTERNAL FIXATION .2 CM STRAIGHT XS FIXATOR $5,956.64CLAMP EXTERNAL FIXATION 10.5 MM X 4 MM QUICK CONNE $4,100.64CLAMP EXTERNAL FIXATION 15 D SHIM ADULT CARBON RAI $12,952.32CLAMP EXTERNAL FIXATION 2 PIN $6,018.00CLAMP EXTERNAL FIXATION 20 D SHIM ADULT CARBON RAI $13,751.04CLAMP EXTERNAL FIXATION 4-6 MM QUICK $3,278.00CLAMP EXTERNAL FIXATION 5 D SHIM ADULT CARBON RAIL $11,635.20CLAMP EXTERNAL FIXATION 5-6 MM QUICK $3,849.92CLAMP EXTERNAL FIXATION 6 MM QUICK $3,278.00CLAMP EXTERNAL FIXATION 8 MM PIN LOCKING BOLT CAP $603.44CLAMP EXTERNAL FIXATION ADJUSTABLE NONSTERILE 4/6 $2,966.96CLAMP EXTERNAL FIXATION ADJUSTABLE NONSTERILE MAND $3,091.20CLAMP EXTERNAL FIXATION ADJUSTABLE PARALLEL PIN NO $8,752.00CLAMP EXTERNAL FIXATION ADJUSTABLE WIRE PIN NONSTE $5,874.16CLAMP EXTERNAL FIXATION BIFOCAL LENGTHEN NONSTERIL $7,998.72CLAMP EXTERNAL FIXATION CALANDRUCCIO II COMPRESSIO $36,108.00

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 ChargeCLAMP EXTERNAL FIXATION COMPACT HOFFMANN II STRAIG $2,741.76CLAMP EXTERNAL FIXATION CONSTRUX ALUMINUM 5- CM ST $3,469.20CLAMP EXTERNAL FIXATION CONVERGENT T PARALLEL $374.40CLAMP EXTERNAL FIXATION DFS MINI STRAIGHT LENGTHEN $2,012.40CLAMP EXTERNAL FIXATION DISTRACTION PIN $12,852.00CLAMP EXTERNAL FIXATION DYNAFIX BIFOCAL NONSTERILE $12,687.36CLAMP EXTERNAL FIXATION DYNAFIX END ADAPTER NONSTE $7,946.64CLAMP EXTERNAL FIXATION DYNAFIX GRADUAL SWIVEL NON $16,032.00CLAMP EXTERNAL FIXATION DYNAFIX STRAIGHT NONSTERIL $10,479.36CLAMP EXTERNAL FIXATION DYNAFIX TRANSLATIONAL NONS $16,032.00CLAMP EXTERNAL FIXATION DYNAFIX UNIPLANER ADJUSTME $11,205.12CLAMP EXTERNAL FIXATION DYNAFIX VISION 3 HOLE $3,367.68CLAMP EXTERNAL FIXATION DYNAFIX VISION LOCK RAPID $3,317.76CLAMP EXTERNAL FIXATION HEIDELBERG STRAIGHT $10,118.40CLAMP EXTERNAL FIXATION HEIDELBERG T SHAPE $9,792.00CLAMP EXTERNAL FIXATION HEX-FIX 1 PIN $6,201.60CLAMP EXTERNAL FIXATION HEX-FIX 1 SWIVEL $7,038.00CLAMP EXTERNAL FIXATION HEX-FIX 2 PIN $7,038.00CLAMP EXTERNAL FIXATION HEX-FIX ADD A CLAMP $9,302.40CLAMP EXTERNAL FIXATION HEX-FIX BALL UNILATERAL $14,749.20CLAMP EXTERNAL FIXATION HEX-FIX METATARSAL UNILATE $7,078.80CLAMP EXTERNAL FIXATION HEX-FIX UNIVERSAL SWIVEL $7,038.00CLAMP EXTERNAL FIXATION HOFFMANN 3 30 D OD11 MM 5 $3,814.14CLAMP EXTERNAL FIXATION HOFFMANN 3 5 HOLE PIN $3,452.41CLAMP EXTERNAL FIXATION HOFFMANN II 10 HOLE MRI CO $5,049.60CLAMP EXTERNAL FIXATION HOFFMANN II 5 HOLE MRI COL $3,790.08CLAMP EXTERNAL FIXATION HOFFMANN II CARBON FIBER 8 $3,966.72CLAMP EXTERNAL FIXATION HOFFMANN II CARBON FIBER S $6,155.52CLAMP EXTERNAL FIXATION HOFFMANN II COMPACT PERIAR $2,612.34CLAMP EXTERNAL FIXATION HOFFMANN II COMPACT STRAIG $2,741.76CLAMP EXTERNAL FIXATION HOFFMANN II MRI PELVIC $4,604.16CLAMP EXTERNAL FIXATION HOFFMANN II RING HYBRID $2,929.92CLAMP EXTERNAL FIXATION HOFFMANN II STRAIGHT 4 HOL $2,612.34CLAMP EXTERNAL FIXATION HOFFMANN II TRIAX OD20 MM $6,351.36CLAMP EXTERNAL FIXATION HOFFMANN II TRIAX OD25 MM $6,351.36CLAMP EXTERNAL FIXATION ILIZAROV 1 HOLE PIN $1,468.88CLAMP EXTERNAL FIXATION ILIZAROV 2 HOLE PIN $1,468.88CLAMP EXTERNAL FIXATION ILIZAROV 3 HOLE PIN $1,971.68CLAMP EXTERNAL FIXATION ILIZAROV 4 HOLE PIN $2,490.64

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 ChargeCLAMP EXTERNAL FIXATION ILIZAROV 5 HOLE PIN $2,714.08CLAMP EXTERNAL FIXATION ILIZAROV AD-A-SWIVEL $6,874.80CLAMP EXTERNAL FIXATION ILIZAROV ADJUSTABLE PIN $5,564.00CLAMP EXTERNAL FIXATION ILIZAROV ADJUSTABLE PIN LO $1,828.08CLAMP EXTERNAL FIXATION JET-X 10.5 MM BAR TO BAR M $4,051.36CLAMP EXTERNAL FIXATION JET-X 10.5 MM QUICK CONNEC $4,100.64CLAMP EXTERNAL FIXATION JET-X 10.5-4 MM MINI MR SA $4,051.36CLAMP EXTERNAL FIXATION JET-X 10.5-6 MM QUICK CONN $4,261.28CLAMP EXTERNAL FIXATION JET-X 4 HOLE PIN $3,933.60CLAMP EXTERNAL FIXATION JET-X 6 HOLE PIN $4,261.28CLAMP EXTERNAL FIXATION JET-X 6 MM 4 MM MINI MRI S $2,827.28CLAMP EXTERNAL FIXATION JET-X 6 MM 6 MM MINI $2,128.00CLAMP EXTERNAL FIXATION JET-X 6 MM STANDARD BAR TO $2,952.00CLAMP EXTERNAL FIXATION JET-X 6 MM STANDARD OD6/10 $3,858.40CLAMP EXTERNAL FIXATION JET-X 6-4 MM MINI $2,128.00CLAMP EXTERNAL FIXATION JET-X ALUMINUM STAINLESS S $4,100.64CLAMP EXTERNAL FIXATION JET-X ANKLE $9,880.00CLAMP EXTERNAL FIXATION JET-X ANKLE BAR $6,190.16CLAMP EXTERNAL FIXATION JET-X ANKLE TRANSLATING $14,468.72CLAMP EXTERNAL FIXATION JET-X BAR TO BAR UNILATERA $2,788.00CLAMP EXTERNAL FIXATION JET-X BAR TO MULTI PIN MRI $748.80CLAMP EXTERNAL FIXATION JET-X BAR TO PIN $2,788.00CLAMP EXTERNAL FIXATION JET-X BAR TO RING UNILATER $3,236.00CLAMP EXTERNAL FIXATION JET-X CENTRAL OFFSET UNILA $6,026.96CLAMP EXTERNAL FIXATION JET-X FREEDOM 10.5-5 MM BA $4,051.36CLAMP EXTERNAL FIXATION JET-X FREEDOM 5-6 MM MINI $2,973.52CLAMP EXTERNAL FIXATION JET-X FREEDOM BAR TO RING $3,524.00CLAMP EXTERNAL FIXATION JET-X FREEDOM MINI MULTIPI $3,099.92CLAMP EXTERNAL FIXATION JET-X L3.3 IN X W.85 IN X $2,336.00CLAMP EXTERNAL FIXATION JET-X MINI 10.5-4 MM BAR U $2,952.00CLAMP EXTERNAL FIXATION JET-X MINI 2 PIN BALL JOIN $3,838.48CLAMP EXTERNAL FIXATION JET-X MINI MULTIPLE PIN $2,360.00CLAMP EXTERNAL FIXATION JET-X MINI OD6/6 MM BAR TO $2,827.28CLAMP EXTERNAL FIXATION JET-X MR SAFE ADD BAR $1,253.36CLAMP EXTERNAL FIXATION JET-X STRAIGHT $4,343.92CLAMP EXTERNAL FIXATION JET-X T SHAPE $5,062.48CLAMP EXTERNAL FIXATION JET-X TITANIUM NITRIDE HAL $20,036.00CLAMP EXTERNAL FIXATION JET-X TITANIUM NITRIDEHALF $19,522.08CLAMP EXTERNAL FIXATION JET-X UNIVERSAL BAR TO PIN $3,558.16

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 ChargeCLAMP EXTERNAL FIXATION L4 CM TELESCOPE XS MAC $6,230.40CLAMP EXTERNAL FIXATION LARGE 4 POSITION MULTIPIN $4,178.53CLAMP EXTERNAL FIXATION LARGE 4 POSITION PIN MR CO $2,702.18CLAMP EXTERNAL FIXATION LARGE 5 POSITION MULTIPLE $5,141.50CLAMP EXTERNAL FIXATION LARGE 6 POSITION MULTIPIN $4,462.58CLAMP EXTERNAL FIXATION LARGE 6 POSITION PIN MR CO $2,776.93CLAMP EXTERNAL FIXATION LARGE BALL JOINT T SHAPE $8,670.00CLAMP EXTERNAL FIXATION LARGE CLOSED ROD $4,647.50CLAMP EXTERNAL FIXATION LARGE COMBINATION MR CONDI $3,901.95CLAMP EXTERNAL FIXATION LARGE FIXED T SHAPE $6,630.00CLAMP EXTERNAL FIXATION LARGE OD6 MM EXTRA SMALL R $5,635.20CLAMP EXTERNAL FIXATION LARGE OPEN ADJUSTABLE MR C $3,978.96CLAMP EXTERNAL FIXATION LARGE OPEN ROD $4,524.00CLAMP EXTERNAL FIXATION LARGE ROD TO PIN ADJUSTABL $4,647.50CLAMP EXTERNAL FIXATION LARGE ROD TO PIN OPEN $4,524.00CLAMP EXTERNAL FIXATION LARGE STRAIGHT BALL JOINT $3,717.90CLAMP EXTERNAL FIXATION LARGE STRAIGHT FIXED $3,964.80CLAMP EXTERNAL FIXATION LARGE TUBE TO TUBE MR COND $4,958.80CLAMP EXTERNAL FIXATION LARGE UNIVERSAL ADJUSTABLE $4,848.40CLAMP EXTERNAL FIXATION MEDIUM 4 POSITION MULTIPIN C1713 $4,728.80CLAMP EXTERNAL FIXATION MEDIUM 4 POSITION PIN MR C $2,552.68CLAMP EXTERNAL FIXATION MEDIUM 6 POSITION MULTIPIN C1713 $5,147.36CLAMP EXTERNAL FIXATION MEDIUM COMBINATION MR SAFE C1713 $3,176.88CLAMP EXTERNAL FIXATION MEDIUM OPEN ADJUSTABLE MR $3,224.56CLAMP EXTERNAL FIXATION METAPHYSEAL T CORRECTION S $3,959.04CLAMP EXTERNAL FIXATION MINI STRAIGHT FIXATOR $1,868.10CLAMP EXTERNAL FIXATION MONOTUBE TRIAX OD20 MM T A $2,720.00CLAMP EXTERNAL FIXATION MONOTUBE TRIAX OD25 MM T A $2,780.80CLAMP EXTERNAL FIXATION MONOTUBE TRIAX STANDARD OD $3,912.96CLAMP EXTERNAL FIXATION MULTIPLE PIN UNILATERAL DI $5,467.20CLAMP EXTERNAL FIXATION OD1.25 MM HOLD NONSTERILE $5,202.56CLAMP EXTERNAL FIXATION OD1.6 MM HOLD NONSTERILE 1 $5,202.56CLAMP EXTERNAL FIXATION OD11 MM ODSEC8 MM COMBINAT $4,494.16CLAMP EXTERNAL FIXATION OD3 MM CONNECT NONSTERILE $4,839.20CLAMP EXTERNAL FIXATION OD4 MM ADJUSTABLE MR CONDI $5,676.40CLAMP EXTERNAL FIXATION OD4 MM CONNECT NONSTERILE $4,839.20CLAMP EXTERNAL FIXATION OD4 MM NONSTERILE SMALL EX $2,221.76CLAMP EXTERNAL FIXATION OD4 MM ODSEC2.5 MM NONSTER $2,221.76CLAMP EXTERNAL FIXATION OD4 MM ODSEC2.5 MM OPEN NO $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 ChargeCLAMP EXTERNAL FIXATION OD4 MM OPEN NONSTERILE SMA $2,378.16CLAMP EXTERNAL FIXATION OD6 MM HIP DISTRACTOR $1,082.88CLAMP EXTERNAL FIXATION OPEN NONSTERILE PIN INSERT $1,770.96CLAMP EXTERNAL FIXATION RAPID ROD SCREW $3,463.68CLAMP EXTERNAL FIXATION RING TO ROD NONSTERILE $6,578.00CLAMP EXTERNAL FIXATION SCHANZ SCREW MR SAFE PIVOT $3,104.96CLAMP EXTERNAL FIXATION SCREW ANGULATE $3,456.00CLAMP EXTERNAL FIXATION SMALL ADJUSTABLE NONSTERIL $4,705.92CLAMP EXTERNAL FIXATION SMALL COMBINATION MR CONDI $2,520.80CLAMP EXTERNAL FIXATION SMALL OD4 MM EXTRA SMALL R $4,776.00CLAMP EXTERNAL FIXATION SMALL OD6 MM EXTRA SMALL R $4,118.40CLAMP EXTERNAL FIXATION SMALL RAIL GRADUAL ANGULAT $4,000.00CLAMP EXTERNAL FIXATION STANDARD OD2 MM OD1.6 MM W $1,444.80CLAMP EXTERNAL FIXATION STANDARD OD4 MM BONE SCREW $1,286.40CLAMP EXTERNAL FIXATION STANDARD OD6 MM BONE SCREW $1,286.40CLAMP EXTERNAL FIXATION STRAIGHT NONSTERILE SMALL $7,276.80CLAMP EXTERNAL FIXATION SUPPLEMENTAL SCREW $2,393.04CLAMP EXTERNAL FIXATION T L6 MM VARIABLE EXTRA SMA $7,152.00CLAMP EXTERNAL FIXATION T VARIABLE XS MAC $7,566.16CLAMP EXTERNAL FIXATION TITANIUM BODY PIN HOLDING $8,144.00CLAMP EXTERNAL FIXATION TITANIUM MULTIVECTOR CARBO $4,704.00CLAMP EXTERNAL FIXATION TITANIUM RAMUS PIN HOLDING $8,144.00CLAMP EXTERNAL FIXATION TITANIUM UNIVERSAL PIN HOL $8,144.00CLAMP EXTERNAL FIXATION TRANSVERSE NONSTERILE $4,958.80CLAMP EXTERNAL FIXATION TRIAX MONOTUBE ALUMINUM OD $5,536.00CLAMP EXTERNAL FIXATION TRIAX MONOTUBE OD15 MM ODS $4,258.56CLAMP EXTERNAL FIXATION TRIAX MONOTUBE OD20 MM ODS $4,185.60CLAMP EXTERNAL FIXATION TRIAX MONOTUBE OD25 MM ODS $4,310.40CLAMP EXTERNAL FIXATION TRIAX MONOTUBE STANDARD OD $7,795.20CLAMP EXTERNAL FIXATION UNIPLANAR ADJUSTABLE SMALL $8,563.20CLAMP EXTERNAL FIXATION UNIVERSAL LARGE JOINT NONS $5,386.56CLAMP EXTERNAL FIXATION UNIVERSAL OD2.7-6 MM COMPR $4,124.16CLAMP EXTERNAL FIXATION UNIVERSAL PIN $3,490.56CLAMP EXTERNAL FIXATION VISION 5 HOLE LOWER TIER $3,677.44CLAMP EXTERNAL FIXATION VISION OD4-6 MM PIN TO ROD $4,865.28CLAMP EXTERNAL FIXATION VISION STRAIGHT ROD TO ROD $3,843.84CLAMP EXTERNAL FIXATION WIRE FIXATION EXTERNAL MID $1,960.00CLAMP SPINAL ELLIPSE L8 MM 2 ROD TO ROD CERVICOTHO C1713 $1,625.00CLAMP SPINAL NILE OD5.5 MM NONSTERILE DISPOSABLE A C1713 $8,190.00

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 ChargeCLAMP SPINAL NILE OD5.5 MM NONSTERILE LATEX FREE A C1713 $8,190.00CLAMP SPINAL REVERE ADDITION L200 MM OD5.5-6 MM RI C1713 $5,200.00CLAMP SPINAL REVERE L160 MM OD5.5-6 MM RIGHT EXTEN C1713 $5,200.00CLAMP SPINAL REVERE L200 MM OD5.5-6 MM LEFT INLINE C1713 $5,200.00CLAMP SURGICAL BEAR LARGE 60 GM CLOSED PRESSURE VE $5,362.50CLAMP SURGICAL BEAR SMALL MICRO 20 GM CLOSED PRESS $536.25CLAMP SURGICAL BIOVER POLYCARBONATE 30 GM/SQ MM ME $520.00CLAMP SURGICAL STAINLESS STEEL UNIVERSAL L5.5 MM L $6,400.00CLAMP SURGICAL STAINLESS STEEL UNIVERSAL L6.35 MM $6,400.00CLAMP TUBE CRANIOFIX TITANIUM LOW PROFILE OD20 MM C1713 $816.00CLAMP TUBE CRANIOFIX2 TITANIUM OD11 MM CRANIAL FLA C1713 $549.09CLAMP TUBE CRANIOFIX2 TITANIUM OD16 MM CRANIAL FLA C1713 $679.59CLAMP TUBE TITANIUM CLOVER LEAF OD11 MM CRANIAL FL C1713 $2,364.00CLAMP TUBE TITANIUM CLOVER LEAF OD13 MM CRANIAL FL C1713 $2,496.00CLAMP TUBE TITANIUM CLOVER LEAF OD18 MM CRANIAL FL C1713 $2,496.00CLAMP TUBE TITANIUM OD13 MM CRANIAL FLAP NONSTERIL C1713 $2,388.00CLAMP TUBE TITANIUM OD13 MM CRANIAL FLAP STERILE C1713 $2,616.00CLAMP TUBE TITANIUM OD13 MM CRANIAL FLAP TEXTURE N C1713 $2,706.00CLAMP TUBE TITANIUM OD18 MM CRANIAL FLAP STERILE C1713 $1,587.52CLAMP TUBE TITANIUM OD18 MM CRANIAL FLAP TEXTURE S C1713 $2,808.00CLAMP TUBE TITANIUM OD22 MM CRANIAL FLAP STERILE C1713 $2,808.00CLAMP TUBE TITANIUM OD22 MM CRANIAL FLAP TEXTURE S C1713 $2,922.00CLAMP TUBE TITANIUM OD22 MM CRANIAL NONSTERILE C1713 $2,616.00CLAW FEMORAL ARCOS COCRMO LARGE L100 MM HIP TROCHA C1776 $5,947.50CLAW FEMORAL ARCOS COCRMO SMALL L100 MM HIP TROCHA C1776 $5,947.50CLIP ANEURYSM SUGITA TITANIUM 2 11 MM STANDARD SLI $2,470.00CLIP ANEURYSM SUGITA TITANIUM 2 14.5 MM OPEN STAND $2,470.00CLIP ANEURYSM SUGITA TITANIUM 2 8 MM STANDARD L L7 $2,470.00CLIP ANEURYSM SUGITA TITANIUM STANDARD BENT L7.5 M $2,470.00CLIP ANEURYSM SUGITA TITANIUM STANDARD STRAIGHT L1 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM 65 STANDARD SLIGH $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM 66 STANDARD SLIGH $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM 68 STANDARD SLIGH $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM 69 STANDARD CURVE $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM 8 STANDARD CURVE $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM 9 STANDARD SLIGHT $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI BAYONET L5 M $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI BAYONET L7 M $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI BENT L5 MM W $2,470.00

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 ChargeCLIP ANEURYSM T2 SUGITA TITANIUM MINI CURVE L4 MM $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI CURVE L5 MM $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI CURVE L5.2 M $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI CURVE L5.5 M $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI CURVE L6.5 M $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI CURVE L6.7 M $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI CURVE L7 MM $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI CURVE L8.2 M $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI SIDEWARD BEN $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI SLIGHT CURVE $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI SLIM STRAIGH $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI STRAIGHT L4 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI STRAIGHT L6 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM MINI STRAIGHT L8 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM SIDEWARD CURVE BA $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD 1/4 CURV $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD 45 D L10 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD 45 D L5 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD 45 D L7. $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD BAYONET $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD BENT L10 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD BENT L12 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD BENT L5 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD BENT L7. $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD BENT L8 $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD J SHAPE $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD L SHAPE $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD SIDEWARD $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD SLIGHT B $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD SLIGHT C $2,470.00CLIP ANEURYSM T2 SUGITA TITANIUM STANDARD STRAIGHT $2,470.00CLIP ANEURYSM TITANIUM 15.5 MM SLIGHTLY CURVE L18 $2,470.00CLIP ANEURYSM TITANIUM 15.5 MM STRAIGHT L18 MM $2,470.00CLIP ANEURYSM YASARGIL PHYNOX 1.77 NW 10 MM OPENIN $2,450.96CLIP ANEURYSM YASARGIL PHYNOX 1.77 NW 9.6 MM OPENI $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 11 MM OPEN STANDARD $2,450.96CLIP ANEURYSM YASARGIL PHYNOX 3.2 MM OPEN MINI L2. $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 3.3 MM OPEN MINI L3 $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 3.3 MM OPEN MINI NAR $1,991.41

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 ChargeCLIP ANEURYSM YASARGIL PHYNOX 3.8 MM OPEN MINI L4. $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 4 MM OPEN MINI L5 MM $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 4 MM OPENING MINI ST $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 4.4 MM OPEN MINI L6. $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 4.6 MM OPEN MINI L7 $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 4.9 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 5.5 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 5.7 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 6.1 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 6.2 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 6.5 MM OPENING STAND $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 6.8 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 7 MM OPENING STANDAR $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 7.2 MM OPENING STAND $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 7.4 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 7.5 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 7.9 MM L12.7 MM L6 M $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 7.9 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 8.4 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 8.7 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 9.1 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX 9.9 MM OPEN STANDARD $1,991.41CLIP ANEURYSM YASARGIL PHYNOX STANDARD 11.4 MM OPE $1,991.41CLIP ANEURYSM YASARGIL PHYNOX STANDARD 7 MM OPENIN $1,991.41CLIP ANEURYSM YASARGIL PHYNOX STANDARD 7.5 MM OPEN $2,450.96CLIP ANEURYSM YASARGIL PHYNOX STANDARD MINI L7 MM $1,991.41CLIP ANEURYSM YASARGIL PHYNOX TITANIUM 5.5 MM OPEN $1,991.41CLIP ANEURYSM YASARGIL PHYNOX TITANIUM 6 MM OPEN S $1,991.41CLIP ANEURYSM YASARGIL PHYNOX TITANIUM 6.5 MM OPEN $1,991.41CLIP ANEURYSM YASARGIL PHYNOX TITANIUM 9.2 MM OPEN $1,991.41CLIP ANEURYSM YASARGIL TITANIUM 5.5 MM OPEN STANDA $1,991.41CLIP ANEURYSM YASARGIL TITANIUM 7.8 MM L11 MM CERE $1,991.41CLIP ANEURYSM YASARGIL TITANIUM MINI 3.5 MM OPENIN $1,991.41CLIP ANEURYSM YASARGIL TITANIUM MINI 3.6 MM OPENIN $2,450.96CLIP ANEURYSM YASARGIL TITANIUM MINI 3.8 MM OPENIN $1,991.41CLIP ANEURYSM YASARGIL TITANIUM MINI 4 MM OPENING $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 10.3 MM O $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 11.4 MM O $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 13.3 MM O $1,991.41

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 ChargeCLIP ANEURYSM YASARGIL TITANIUM STANDARD 5 MM OPEN $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 5.5 MM OP $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 6.5 MM OP $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 6.8 MM OP $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 7 MM OPEN $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 7.1 MM OP $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 7.4 MM OP $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 7.8 MM OP $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 8.8 MM OP $1,991.41CLIP ANEURYSM YASARGIL TITANIUM STANDARD 9.2 MM OP $1,991.41CLIP EXTERNAL FIXATION DYNAMIZATION MR CONDITIONAL $763.60CLIP FIXATION AMBI HIP SCREW C1713 $595.28CLIP HEMOSTATIC RESOLUTION 2.8 MM 11 MM OPEN L235 $1,240.00CLIP INTERNAL BEAR LARGE 60 GM CLOSED PRESSURE ART $536.25CLIP INTERNAL DEBAKEY 350 G L25 MM VESSEL CURVE JA $4,098.34CLIP INTERNAL DEBAKEY 350 G L25 MM VESSEL STRAIGHT $4,098.34CLIP INTERNAL DEBAKEY 450 G L45 MM VESSEL STRAIGHT $4,098.34CLIP INTERNAL FILSHIE SILASTIC TITANIUM SMALL FALL $512.76CLIP INTERNAL GEM TITANIUM MICRO FINE CARTRIDGE BL $2,275.00CLIP INTERNAL INSTINCT HEMOCLIP 16 MM L230 CM OD7 $600.00CLIP INTERNAL LAPRO-CLIP TITANIUM L8 MM LIGATURE A $374.34CLIP INTERNAL LAPRO-CLIP TITANIUM LARGE L12 MM LIG $374.34CLIP INTERNAL LAPRO-CLIP TITANIUM MEDIUM LARGE L8 $455.00CLIP INTERNAL SLS-CLIP TITANIUM LARGE CHEVRON LIGA $1,616.00CLIP INTERNAL WECK HORIZON TITANIUM SMALL WIDE CHE $380.25CLIP POSITIONING CLOSED TUBE $1,436.50CLIP PROBE ELECTRODE PLUNGER $1,183.00CLIP SPINAL SPHERX GUIDANCE GUIDEWIRE MULTIPLE SCL $3,070.54CLIP SUTURE LAPRA-TY VICRYL POLYDIOXANONE ABSORBAB $316.61CLOSED TREATMENT BROKEN & DISLOCATED FOREARM BONES 24620 $6,159.00CLOSED TREATMENT BROKEN JAW BONE WITH INSERTION OF 21453 $13,593.00CLOSED TREATMENT BROKEN UPPER ARM BONE AT SHOULDER 23625 $3,082.00CLOSED TREATMENT BROKEN/GROWTH PLATE SEPARATE FORE 25605 $1,653.00CLOSED TREATMENT COLLAR BONE AND SHOULDER JOINT DI 23545 $493.00CLOSED TREATMENT DISLOCATION JOINT BETWEEN COLLAR 23525 $860.00CLOSED TREATMENT OF ANKLE DISLOCATION 27840 $616.00CLOSED TREATMENT OF ANKLE DISLOCATION UNDER ANESTH 27842 $5,400.00CLOSED TREATMENT OF ANKLE JOINT BONE DISLOCATION 28540 $616.00CLOSED TREATMENT OF BROKE FOREARM BONE AT ELBOW 24670 $493.00

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 ChargeCLOSED TREATMENT OF BROKEN ANKLE 27780 $771.00CLOSED TREATMENT OF BROKEN ANKLE 27786 $1,063.00CLOSED TREATMENT OF BROKEN ANKLE 27760 $771.00CLOSED TREATMENT OF BROKEN ANKLE 27767 $1,063.00CLOSED TREATMENT OF BROKEN ANKLE 27808 $771.00CLOSED TREATMENT OF BROKEN ANKLE 27816 $1,063.00CLOSED TREATMENT OF BROKEN ANKLE JOINT BONE 28430 $493.00CLOSED TREATMENT OF BROKEN ANKLE JOINT BONE WITH M 28435 $1,414.00CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27818 $4,903.00CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27762 $4,903.00CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27768 $4,903.00CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27781 $4,903.00CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27788 $1,063.00CLOSED TREATMENT OF BROKEN ANKLE WITH MANIPULATION 27810 $4,903.00CLOSED TREATMENT OF BROKEN CHEST BONE 21820 $616.00CLOSED TREATMENT OF BROKEN EYE SOCKET BONE 21400 $4,233.00CLOSED TREATMENT OF BROKEN FINGER OR THUMB WITH MA 26755 $493.00CLOSED TREATMENT OF BROKEN FINGER OR THUMB WITH MA 26725 $493.00CLOSED TREATMENT OF BROKEN FOOT BONE 28470 $555.00CLOSED TREATMENT OF BROKEN FOOT BONE 28530 $106.00CLOSED TREATMENT OF BROKEN FOREARM AND DISLOCATED 25520 $784.00CLOSED TREATMENT OF BROKEN FOREARM AT WRIST BONE 25650 $493.00CLOSED TREATMENT OF BROKEN FOREARM BONE 25500 $493.00CLOSED TREATMENT OF BROKEN FOREARM BONE 25530 $616.00CLOSED TREATMENT OF BROKEN FOREARM BONE AT ELBOW 24650 $493.00CLOSED TREATMENT OF BROKEN FOREARM BONE AT ELBOW W 24675 $493.00CLOSED TREATMENT OF BROKEN FOREARM BONE WITH MANIP 25535 $493.00CLOSED TREATMENT OF BROKEN FOREARM BONE WITH MANIP 25505 $1,471.00CLOSED TREATMENT OF BROKEN FOREARM BONES 25600 $493.00CLOSED TREATMENT OF BROKEN FOREARM BONES 25560 $493.00CLOSED TREATMENT OF BROKEN FOREARM BONES WITH MANI 25565 $2,046.00CLOSED TREATMENT OF BROKEN GREAT TOE 28490 $493.00CLOSED TREATMENT OF BROKEN GREAT TOE WITH MANIPULA 28495 $493.00CLOSED TREATMENT OF BROKEN HAND OR FINGER 26740 $616.00CLOSED TREATMENT OF BROKEN HAND OR FINGER WITH MAN 26742 $5,400.00CLOSED TREATMENT OF BROKEN HEEL BONE 28400 $493.00CLOSED TREATMENT OF BROKEN HEEL BONE WITH MANIPULA 28405 $860.00CLOSED TREATMENT OF BROKEN JAW BONE 21450 $953.00CLOSED TREATMENT OF BROKEN JAW BONE WITH MANIPULAT 21451 $4,757.00

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 ChargeCLOSED TREATMENT OF BROKEN JAW OR CHEEK BONE 21440 $7,460.00CLOSED TREATMENT OF BROKEN NASAL AND CHEEK BONES W 21345 $4,233.00CLOSED TREATMENT OF BROKEN NASAL BONE 21310 $360.00CLOSED TREATMENT OF BROKEN NASAL BONE 21315 $4,233.00CLOSED TREATMENT OF BROKEN NASAL BONE WITH STABILI 21320 $4,233.00CLOSED TREATMENT OF BROKEN OF UPPER ARM BONE AT SH 24577 $493.00CLOSED TREATMENT OF BROKEN SHIN BONE 27750 $1,063.00CLOSED TREATMENT OF BROKEN SHIN BONE WITH MANIPULA 27752 $4,903.00CLOSED TREATMENT OF BROKEN SHIN BONES 27538 $3,885.00CLOSED TREATMENT OF BROKEN SHOULDER BLADE WITH MAN 23575 $5,400.00CLOSED TREATMENT OF BROKEN TAILBONE 27200 $616.00CLOSED TREATMENT OF BROKEN THIGH BONE 27246 $285.00CLOSED TREATMENT OF BROKEN THIGH BONE 27501 $169.00CLOSED TREATMENT OF BROKEN THIGH BONE 27508 $263.00CLOSED TREATMENT OF BROKEN THIGH BONE WITH MANIPUL 27502 $3,730.00CLOSED TREATMENT OF BROKEN THIGH BONE WITH MANIPUL 27503 $7,801.00CLOSED TREATMENT OF BROKEN THIGH BONE WITH MANIPUL 27510 $5,185.00CLOSED TREATMENT OF BROKEN THUMB WITH MANIPULATION 26645 $5,400.00CLOSED TREATMENT OF BROKEN TOE 28510 $493.00CLOSED TREATMENT OF BROKEN TOE WITH MANIPULATION 28515 $493.00CLOSED TREATMENT OF BROKEN UPPER ARM BONE AT SHOUL 24560 $455.00CLOSED TREATMENT OF BROKEN UPPER ARM BONE AT SHOUL 24565 $5,400.00CLOSED TREATMENT OF BROKEN UPPER ARM BONE AT SHOUL 24576 $860.00CLOSED TREATMENT OF BROKEN UPPER ARM BONE WITH MAN 23605 $3,082.00CLOSED TREATMENT OF BROKEN UPPER ARM BONE WITH MAN 24505 $555.00CLOSED TREATMENT OF BROKEN WRIST BONE 25622 $493.00CLOSED TREATMENT OF BROKEN WRIST BONE 25630 $493.00CLOSED TREATMENT OF BROKEN WRIST BONE WITH MANIPUL 25624 $5,400.00CLOSED TREATMENT OF BROKEN WRIST BONE WITH MANIPUL 25635 $5,400.00CLOSED TREATMENT OF COLLAR BONE AND SHOULDER JOINT 23540 $493.00CLOSED TREATMENT OF COLLAR BONE BROKEN WITH MANIPU 23505 $3,082.00CLOSED TREATMENT OF DISLOCATED FINGER JOINT WITH M 26770 $493.00CLOSED TREATMENT OF DISLOCATED FOOT BONE 28630 $616.00CLOSED TREATMENT OF DISLOCATED FOOT BONE UNDER ANE 28635 $4,791.00CLOSED TREATMENT OF DISLOCATED FOOT JOINT 28570 $860.00CLOSED TREATMENT OF DISLOCATED FOOT JOINT 28600 $493.00CLOSED TREATMENT OF DISLOCATED HAND BONE UNDER ANE 26675 $493.00CLOSED TREATMENT OF DISLOCATED HAND BONE WITH MANI 26670 $493.00CLOSED TREATMENT OF DISLOCATED HAND JOINT WITH MAN 26700 $616.00

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 ChargeCLOSED TREATMENT OF DISLOCATED HIP PROSTHESIS 27265 $493.00CLOSED TREATMENT OF DISLOCATED HIP PROSTHESIS UNDE 27266 $4,791.00CLOSED TREATMENT OF DISLOCATED WRIST BONE WITH MAN 25690 $3,082.00CLOSED TREATMENT OF DISLOCATED WRIST WITH MANIPULA 25675 $616.00CLOSED TREATMENT OF DISLOCATED WRIST WITH MANIPULA 25680 $860.00CLOSED TREATMENT OF DISLOCATED WRIST WITH MANIPULA 25660 $493.00CLOSED TREATMENT OF DISLOCATION JOINT BETWEEN COLL 23520 $5,400.00CLOSED TREATMENT OF DISLOCATION OF KNEE CAP 27560 $616.00CLOSED TREATMENT OF DISLOCATION OF TOE JOINT 28660 $616.00CLOSED TREATMENT OF FINGER TENDON 26432 $4,955.00CLOSED TREATMENT OF FRACTURE AND/OR DISLOCATION OF 27197 $851.00CLOSED TREATMENT OF FRACTURE AND/OR DISLOCATION OF 27198 $851.00CLOSED TREATMENT OF FRACTURE BELOW NECK OF UPPER T 27238 $5,400.00CLOSED TREATMENT OF FRACTURE HAND BONE 26600 $555.00CLOSED TREATMENT OF FRACTURE OF BONE OF HAND WITH 26605 $493.00CLOSED TREATMENT OF FRACTURE OF FOOT WITH MANIPULA 28475 $493.00CLOSED TREATMENT OF FRACTURE OF LOWER WEIGHT BEARI 27825 $4,903.00CLOSED TREATMENT OF FRACTURE OF LOWER WEIGHT BEARI 27824 $1,063.00CLOSED TREATMENT OF FRACTURE OF SHIN BONE 27530 $493.00CLOSED TREATMENT OF FRACTURE OF SHIN BONE WITH TRA 27532 $3,730.00CLOSED TREATMENT OF FRACTURE OF UPPER ARM BONE AT 23620 $493.00CLOSED TREATMENT OF GROWTH PLATE OR BROKEN UPPER A 24530 $493.00CLOSED TREATMENT OF GROWTH PLATE OR BROKEN UPPER A 24535 $1,471.00CLOSED TREATMENT OF GROWTH PLATE SEPARATION AT END 27516 $278.00CLOSED TREATMENT OF GROWTH PLATE SEPARATION AT END 27517 $5,400.00CLOSED TREATMENT OF HIP DISLOCATION UNDER ANESTHES 27252 $4,791.00CLOSED TREATMENT OF HIP SOCKET FRACTURES 27220 $860.00CLOSED TREATMENT OF JAW TEMPOROMANDIBULAR JOINT (T 21480 $332.00CLOSED TREATMENT OF JAW TEMPOROMANDIBULAR JOINT (T 21485 $6,639.00CLOSED TREATMENT OF KNEE CAP DISLOCATION UNDER ANE 27562 $860.00CLOSED TREATMENT OF KNEE CAP FRACTURE 27520 $493.00CLOSED TREATMENT OF KNEE DISLOCATION 27550 $616.00CLOSED TREATMENT OF KNEE DISLOCATION UNDER ANESTHE 27552 $4,791.00CLOSED TREATMENT OF KNEE JOINT DISLOCATION 27830 $860.00CLOSED TREATMENT OF NASAL CARTILAGE DIVIDING NASAL 21337 $4,233.00CLOSED TREATMENT OF SHOULDER BLADE FRACTURE 23570 $1,434.00CLOSED TREATMENT OF SHOULDER DISLOCATION AND BROKE 23675 $555.00CLOSED TREATMENT OF SHOULDER DISLOCATION WITH MANI 23655 $3,833.00CLOSED TREATMENT OF SHOULDER DISLOCATION WITH MANI 23650 $555.00

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 ChargeCLOSED TREATMENT OF THIGH BONE FRACTURE 27500 $860.00CLOSED TREATMENT OF THUMB DISLOCATION WITH MANIPUL 26641 $616.00CLOSED TREATMENT OF UPPER ARM FRACTURE 23600 $493.00CLOSED TREATMENT OF UPPER ARM FRACTURE 24500 $555.00CLOSED TREATMENT OF UPPER THIGH BONE FRACTURE 27230 $493.00CLOSED TREATMENT SHOULDER DISLOCATION AND BROKEN O 23665 $1,840.00CLOSED VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING 22310 $901.00CLOSURE CONGENITAL HEART DEFECT FROM PULMONARY ART 93582 $2,093.00CLOSURE FISTULA OROLANTRAL D7260 $1,995.00CLOSURE OF PERMANENT WINDPIPE OPENING OR ABNORMAL 31820 $8,034.00CLOSURE OF SKIN OPENING TO STOMACH 43870 $8,336.00CLOSURE OF TEAR DUCT OPENING USING PLUG 68761 $855.00CLOTTING FACTOR IX (PTC OR CHRISTMAS) MEASUREMENT 85250 $111.00CLOTTING FACTOR VII (PROCONVERTIN, STABLE FACTOR) 85230 $85.00CLOTTING FACTOR VIII (AHG) MEASUREMENT 85240 $110.00CLOTTING FACTOR VIII (VW FACTOR) ANTIGEN 85246 $141.00CLOTTING FACTOR VIII (VW FACTOR) MEASUREMENT 85245 $141.00CLOTTING FACTOR X ASSESSMENT TEST 85613 $68.00CLOTTING FACTOR XI (PTA) MEASUREMENT 85270 $82.00CLOTTING FACTOR XII (HAGEMAN) MEASUREMENT 85280 $101.00CLOVE OIL (BULK) OIL 3.5 ML BOTTLE $10.87CLOVE OIL (BULK) OIL 30 ML BOTTLE $64.10CLOZAPINE LEVEL 80159 $139.00COAGULATION ASSESSMENT BLOOD TEST 85732 $47.00COAGULATION FACTOR IX 500 (+/-) UNIT SOLR 1 EACH V J7193 $20.00COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) SO J7189 $8,004.45COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) SO J7189 $14,943.70COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) SO J7189 $39,974.20COAGULATION FUNCTION MEASUREMENT 85379 $72.00COAGULATION OR FIBRINOLYSIS FUNCTION MEASUREMENT W 85396 $102.00COCAINE DEFINITIVE ASSAY, URINE 80353 $101.00COENZYME Q10 100 MG CAP 45 EACH BOTTLE $3.41COIL EMBOLIZATION AXIUM MICROFX LATTICEFX PLATINUM $5,167.50COIL EMBOLIZATION AXIUM PLATINUM HELIX L40 CM OD16 $5,167.50COIL EMBOLIZATION AZUR .018 IN L20 CM OD6 MM $6,000.00COIL EMBOLIZATION AZUR .018 IN L5 CM OD3 MM $3,750.00COIL EMBOLIZATION AZUR CX HYDROCOIL HYDROGEL .018 $3,750.00COIL EMBOLIZATION AZUR CX HYDROGEL .018 IN L16 CM $6,000.00COIL EMBOLIZATION AZUR CX HYDROGEL .018 IN L20 CM $6,000.00

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 ChargeCOIL EMBOLIZATION AZUR CX HYDROGEL .018 IN L24 CM $3,750.00COIL EMBOLIZATION AZUR CX HYDROGEL POROUS .035 IN $8,000.00COIL EMBOLIZATION AZUR CX PLATINUM HYDROGEL HYDROP $6,000.00COIL EMBOLIZATION AZUR HYDROCOIL .018 IN L10 CM OD $1,125.00COIL EMBOLIZATION AZUR HYDROCOIL .018 IN L2 CM OD4 $675.00COIL EMBOLIZATION AZUR HYDROCOIL .018 IN L20 CM OD $6,000.00COIL EMBOLIZATION AZUR HYDROCOIL .018 IN L4 CM OD4 $900.00COIL EMBOLIZATION AZUR HYDROCOIL HYDROGEL .018 IN $675.00COIL EMBOLIZATION AZUR HYDROCOIL HYDROGEL PLATINUM $3,750.00COIL EMBOLIZATION AZUR HYDROCOIL PLATINUM HYDROGEL $675.00COIL EMBOLIZATION AZUR PLATINUM HYDROGEL .018 IN L $2,000.00COIL EMBOLIZATION AZUR PLATINUM HYDROGEL .035 IN L $5,000.00COIL EMBOLIZATION COMPLEX PLATINUM FIBER .018 IN H $396.45COIL EMBOLIZATION CONCERTO L30 CM OD.34 MM ODSEC10 $5,167.50COIL EMBOLIZATION CONCERTO L30 CM OD.34 MM ODSEC8 $5,167.50COIL EMBOLIZATION CONCERTO L30 CM OD12 MM DETACHAB $5,167.50COIL EMBOLIZATION CONCERTO L40 CM OD18 MM DETACHAB $5,167.50COIL EMBOLIZATION CONCERTO L50 CM OD20 MM DETACHAB $5,167.50COIL EMBOLIZATION COSMOS V-TRAK L12 CM OD4 MM 10 C $6,422.00COIL EMBOLIZATION COSMOS V-TRAK L15 CM OD5 MM 10 C $7,020.00COIL EMBOLIZATION COSMOS V-TRAK L22 CM OD5 MM 10 C $6,422.00COIL EMBOLIZATION COSMOS V-TRAK L31 CM OD7 MM 10 C $6,844.50COIL EMBOLIZATION COSMOS V-TRAK L36 CM OD10 MM 10 $7,410.00COIL EMBOLIZATION COSMOS V-TRAK L8 CM OD4 MM 10 CO $6,422.00COIL EMBOLIZATION GDC .015 IN HELICAL L4 CM OD2 MM $3,900.00COIL EMBOLIZATION GDC .015 IN L8 CM OD4 MM NEUROVA $3,900.00COIL EMBOLIZATION GDC 10 .015 IN 2D HELICAL L8 CM $3,900.00COIL EMBOLIZATION GDC 10 2D HELICAL L30 CM OD10 MM $3,347.50COIL EMBOLIZATION GDC 10 2D HELICAL L30 CM OD9 MM $3,347.50COIL EMBOLIZATION GDC 10 2D HELICAL L4 CM OD3 MM D $3,900.00COIL EMBOLIZATION GDC 10 2D HELICAL L4 CM OD4 MM D $3,900.00COIL EMBOLIZATION GDC 10 3D L10 CM OD6 MM DETACHAB $3,900.00COIL EMBOLIZATION GDC 10 3D L6 CM OD4 MM 10 COIL D $3,900.00COIL EMBOLIZATION GDC 10 HELICAL L4 CM OD2 MM 10 C $3,900.00COIL EMBOLIZATION GDC 10 HELICAL L6 CM OD2 MM 10 C $3,900.00COIL EMBOLIZATION GDC 10 L15 CM OD6 MM NEUROVASCUL $3,900.00COIL EMBOLIZATION GDC 10 L2 CM OD2 MM DETACHABLE S $3,900.00COIL EMBOLIZATION GDC 10 L30 CM OD8 MM NEUROVASCUL $3,347.50COIL EMBOLIZATION GDC HELICAL L3 CM OD2 MM NEUROVA $3,900.00

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 ChargeCOIL EMBOLIZATION GDC HELICAL L3 CM OD3 MM NEUROVA $3,900.00COIL EMBOLIZATION GDC HELIX L4 CM OD4 MM 10 COIL D $3,900.00COIL EMBOLIZATION GDC SYNTHETIC FIBER VORTX L3 CM $3,900.00COIL EMBOLIZATION GDC SYNTHETIC FIBER VORTX L4 MM $3,900.00COIL EMBOLIZATION GDC SYNTHETIC FIBER VORTX L6 MM $3,900.00COIL EMBOLIZATION GDC ULTRASOFT HELIX L2 CM OD2 MM $3,900.00COIL EMBOLIZATION GDC ULTRASOFT HELIX L3 CM OD2 MM $3,900.00COIL EMBOLIZATION GDC ULTRASOFT HELIX L4 CM OD3 MM $3,900.00COIL EMBOLIZATION HYDROFILL HYDROCOIL V-TRAK HYDRO $7,436.00COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK HYDR $9,750.00COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK L15 $9,750.00COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK L19 $11,661.00COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK L23 $11,661.00COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK L33 $9,750.00COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK L6 C $9,750.00COIL EMBOLIZATION HYDROFRAME HYDROCOIL V-TRAK L8 C $9,750.00COIL EMBOLIZATION HYDROSOFT HYDROCOIL V-TRAK HELIC $7,410.00COIL EMBOLIZATION HYDROSOFT HYDROCOIL V-TRAK PLATI $6,675.50COIL EMBOLIZATION HYDROSOFT V-TRAK PLATINUM L2 CM $9,230.00COIL EMBOLIZATION HYPERSOFT V-TRAK 3D L6 CM OD2.5 $7,605.00COIL EMBOLIZATION HYPERSOFT V-TRAK 3D L6 CM OD3 MM $7,605.00COIL EMBOLIZATION HYPERSOFT V-TRAK 3D L6 CM OD4 MM $7,605.00COIL EMBOLIZATION HYPERSOFT V-TRAK 3D L8 CM OD3.5 $7,605.00COIL EMBOLIZATION HYPERSOFT V-TRAK 3D L8 CM OD4 MM $7,605.00COIL EMBOLIZATION HYPERSOFT V-TRAK COMPLEX L15 CM $7,605.00COIL EMBOLIZATION HYPERSOFT V-TRAK PLATINUM L4 CM $6,337.50COIL EMBOLIZATION INTERLOCK FIBERED IDC DACRON PLA $3,018.15COIL EMBOLIZATION MREYE PLATINUM L2 CM OD3 MM ARTE $521.24COIL EMBOLIZATION MREYE PLATINUM L5 CM OD10 MM ART $510.71COIL EMBOLIZATION MREYE PLATINUM L5 CM OD3 MM ARTE $373.20COIL EMBOLIZATION MREYE PLATINUM L8 CM OD10 MM ART $475.48COIL EMBOLIZATION NESTER MICROCOIL PLATINUM SYNTHE $348.35COIL EMBOLIZATION NESTER PLATINUM .035 IN L14 CM O $665.36COIL EMBOLIZATION NESTER PLATINUM FIBER .018 IN L3 $378.00COIL EMBOLIZATION NESTER PLATINUM L7 IN OD3 MM ACC $433.50COIL EMBOLIZATION NESTER PLATINUM SYNTHETIC FIBER $348.35COIL EMBOLIZATION ORBIT GALAXY G2 PLATINUM HELICAL $9,414.08COIL EMBOLIZATION ORBIT GALAXY G2 PLATINUM L10 CM $9,414.08COIL EMBOLIZATION ORBIT GALAXY G2 PLATINUM L15 CM $9,414.08

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 ChargeCOIL EMBOLIZATION ORBIT GALAXY G2 PLATINUM L20 CM $9,414.08COIL EMBOLIZATION ORBIT GALAXY G2 PLATINUM L21 CM $9,414.08COIL EMBOLIZATION ORBIT GALAXY G2 PLATINUM L24 CM $9,414.08COIL EMBOLIZATION ORBIT GALAXY G2 PLATINUM L6 CM O $9,414.08COIL EMBOLIZATION ORBIT GALAXY G2 XTRASOFT PLATINU $9,414.08COIL EMBOLIZATION ORBIT GALAXY L10 CM OD4 MM G2 CO $11,735.36COIL EMBOLIZATION ORBIT GALAXY L12 CM OD4 CM G2 CO $11,735.36COIL EMBOLIZATION ORBIT GALAXY XTRASOFT PLATINUM L $9,414.08COIL EMBOLIZATION PENUMBRA COIL 400 NITINOL PLATIN $13,949.00COIL EMBOLIZATION PLATINUM FIBER .018 IN MULTILOOP $408.85COIL EMBOLIZATION PLATINUM L10 CM OD2 MM FIBERED C $396.50COIL EMBOLIZATION SMART COIL HELIX L2 CM OD2 MM EX $6,955.00COIL EMBOLIZATION SMART COIL HELIX L3 CM OD1 MM EX $6,955.00COIL EMBOLIZATION SMART COIL HELIX L3 CM OD2 MM EX $6,955.00COIL EMBOLIZATION SMART COIL HELIX L4 CM OD2 MM EX $6,955.00COIL EMBOLIZATION SMART COIL HELIX L4 CM OD2.5 MM $6,955.00COIL EMBOLIZATION SMART COIL HELIX L4 CM OD3 MM EX $6,955.00COIL EMBOLIZATION SMART COIL HELIX L6 CM OD3 MM EX $6,955.00COIL EMBOLIZATION SMART COIL HELIX L6 CM OD4 MM EX $6,955.00COIL EMBOLIZATION SMART COIL HELIX L8 CM OD4 MM EX $6,955.00COIL EMBOLIZATION SMART COIL L10 CM OD4 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L10 CM OD5 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L10 CM OD6 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L15 CM OD5 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L15 CM OD6 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L15 CM OD7 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L2 CM OD1 MM EXTRA SO $10,465.00COIL EMBOLIZATION SMART COIL L2 CM OD1.5 MM EXTRA $10,465.00COIL EMBOLIZATION SMART COIL L2 CM OD2 MM EXTRA SO $10,465.00COIL EMBOLIZATION SMART COIL L20 CM OD8 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L3 CM OD2 MM EXTRA SO $10,465.00COIL EMBOLIZATION SMART COIL L3 CM OD2.5 MM EXTRA $10,465.00COIL EMBOLIZATION SMART COIL L4 CM OD2 MM EXTRA SO $10,465.00COIL EMBOLIZATION SMART COIL L4 CM OD3 MM EXTRA SO $10,465.00COIL EMBOLIZATION SMART COIL L4 CM OD3 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L6 CM OD2 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L6 CM OD3 MM EXTRA SO $10,465.00COIL EMBOLIZATION SMART COIL L6 CM OD3 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L6 CM OD4 MM EXTRA SO $10,465.00

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 ChargeCOIL EMBOLIZATION SMART COIL L6 CM OD4 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L6 CM OD5 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L8 CM OD3 MM EXTRA SO $10,465.00COIL EMBOLIZATION SMART COIL L8 CM OD3 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL L8 CM OD4 MM EXTRA SO $10,465.00COIL EMBOLIZATION SMART COIL L8 CM OD4 MM SOFT $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L10 CM OD5 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L15 CM OD5 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L15 CM OD6 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L15 CM OD7 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L20 CM OD6 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L20 CM OD8 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L20 CM OD9 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L25 CM OD7 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L30 CM OD10 $11,277.50COIL EMBOLIZATION SMART COIL STANDARD L30 CM OD8 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L30 CM OD9 M $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L60 CM OD11 $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L60 CM OD12 $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L60 CM OD14 $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L60 CM OD16 $10,465.00COIL EMBOLIZATION SMART COIL STANDARD L8 CM OD4 MM $10,465.00COIL EMBOLIZATION STAINLESS STEEL .038 IN L5 CM OD $511.88COIL EMBOLIZATION STAINLESS STEEL LOOP L2 CM OD3 M $455.00COIL EMBOLIZATION TARGET 360 D L10 CM OD3 MM DETAC $9,425.00COIL EMBOLIZATION TARGET 360 D L10 CM OD6 MM DETAC $9,100.00COIL EMBOLIZATION TARGET 360 D L20 CM OD7 MM DETAC $9,100.00COIL EMBOLIZATION TARGET 360 D L6 CM OD2 MM DETACH $9,425.00COIL EMBOLIZATION TARGET 360 D L6 CM OD3 MM DETACH $9,100.00COIL EMBOLIZATION TARGET 360 D L6 CM OD4 MM DETACH $9,100.00COIL EMBOLIZATION TARGET 360 D L8 CM OD3 MM DETACH $9,100.00COIL EMBOLIZATION TARGET 360 D L8 CM OD4 MM DETACH $9,425.00COIL EMBOLIZATION TARGET 360 D STANDARD L15 CM OD5 $9,100.00COIL EMBOLIZATION TARGET 360 D STANDARD L15 CM OD6 $9,100.00COIL EMBOLIZATION TARGET 360 D STANDARD L30 CM OD1 $9,100.00COIL EMBOLIZATION TARGET HELICAL L2 CM OD1.5 MM DE $8,125.00COIL EMBOLIZATION TARGET HELICAL L3 CM OD1.5 MM DE $8,125.00COIL EMBOLIZATION TARGET HELICAL L4 CM OD1.5 MM DE $8,125.00COIL EMBOLIZATION TARGET HELIX L1 CM OD2 MM DETACH $6,240.00

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 ChargeCOIL EMBOLIZATION TARGET HELIX L2 CM OD2 MM DETACH $6,240.00COIL EMBOLIZATION TARGET HELIX L3 CM OD2 MM DETACH $6,240.00COIL EMBOLIZATION TARGET HELIX L4 CM OD2 MM DETACH $6,240.00COIL EMBOLIZATION TARGET HELIX L4 CM OD3 MM DETACH $6,240.00COIL EMBOLIZATION TARGET HELIX L6 CM OD2 MM DETACH $6,240.00COIL EMBOLIZATION TARGET HELIX L6 CM OD3 MM DETACH $6,240.00COIL EMBOLIZATION TARGET HELIX L6 CM OD4 MM DETACH $6,240.00COIL EMBOLIZATION TARGET HELIX L8 CM OD3 MM DETACH $6,240.00COIL EMBOLIZATION TARGET HELIX L8 CM OD4 MM DETACH $6,240.00COIL EMBOLIZATION TARGET PLATINUM 360 D L10 CM OD4 $9,425.00COIL EMBOLIZATION TARGET PLATINUM 360 D L10 CM OD5 $9,425.00COIL EMBOLIZATION TARGET PLATINUM 360 D L15 CM OD4 $9,425.00COIL EMBOLIZATION TARGET PLATINUM 360 D L15 CM OD5 $9,100.00COIL EMBOLIZATION TARGET PLATINUM 360 D L15 CM OD6 $9,100.00COIL EMBOLIZATION TARGET PLATINUM 360 D L30 CM OD8 $9,100.00COIL EMBOLIZATION TARGET PLATINUM 360 D L4 CM OD2 $9,100.00COIL EMBOLIZATION TARGET PLATINUM 360 D L4 CM OD2. $9,425.00COIL EMBOLIZATION TARGET PLATINUM 360 D L6 CM OD3 $9,425.00COIL EMBOLIZATION TARGET PLATINUM 360 D L6 CM OD4 $9,425.00COIL EMBOLIZATION TARGET PLATINUM 360 D L8 CM OD3 $9,425.00COIL EMBOLIZATION TARGET PLATINUM 360 D L8 CM OD4 $9,100.00COIL EMBOLIZATION TARGET PLATINUM 360 D STANDARD L $9,100.00COIL EMBOLIZATION TARGET PLATINUM HELIX L10 CM OD3 $6,240.00COIL EMBOLIZATION TARGET PLATINUM HELIX L15 CM OD4 $7,800.00COIL EMBOLIZATION TARGET PLATINUM HELIX L8 CM OD2 $6,240.00COIL EMBOLIZATION TARGET PLATINUM L15 CM OD5 MM DE $9,425.00COIL EMBOLIZATION TARGET PLATINUM L20 CM OD5 MM DE $9,100.00COIL EMBOLIZATION TARGET PLATINUM L20 CM OD6 MM DE $9,100.00COIL EMBOLIZATION TARGET PLATINUM L30 CM OD6 MM DE $9,100.00COIL EMBOLIZATION TARGET PLATINUM STANDARD L10 CM $9,100.00COIL EMBOLIZATION TARGET PLATINUM STANDARD L15 CM $9,100.00COIL EMBOLIZATION TARGET PLATINUM STANDARD L20 CM $9,100.00COIL EMBOLIZATION TARGET PLATINUM STANDARD L30 CM $9,100.00COIL EMBOLIZATION TARGET XL 360 D LARGE L40 CM OD1 $14,267.50COIL EMBOLIZATION TARGET XL 360 D LARGE L45 CM OD1 $14,267.50COIL EMBOLIZATION TARGET XL 360 D LARGE L50 CM OD1 $14,267.50COIL EMBOLIZATION TARGET XL 360 D STANDARD LARGE L $14,267.50COIL EMBOLIZATION THE PENUMBRA COIL 400 .02 IN COM $13,643.50COIL EMBOLIZATION THE PENUMBRA COIL 400 .02 IN STA $14,092.00

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 ChargeCOIL EMBOLIZATION THE PENUMBRA COIL 400 NITINOL PL $13,539.50COIL EMBOLIZATION TORNADO MICROCOILS PLATINUM L9 C $446.60COIL EMBOLIZATION TORNADO MICROCOILS PLATINUM L9.5 $446.60COIL EMBOLIZATION TORNADO MICROCOILS PLATINUM SYNT $411.55COIL EMBOLIZATION TORNADO PLATINUM L12.5 CM OD10-4 $475.00COIL EMBOLIZATION TORNADO PLATINUM L2.6 CM OD4-3 M $411.55COIL EMBOLIZATION TORNADO PLATINUM L4 CM OD4-2 MM $411.55COIL EMBOLIZATION TORNADO PLATINUM L4.1 CM OD5-3 M $411.55COIL EMBOLIZATION TORNADO PLATINUM L5 CM OD5-2 MM $411.55COIL EMBOLIZATION TORNADO PLATINUM L5.8 CM OD6-3 M $411.55COIL EMBOLIZATION TORNADO PLATINUM L7 CM OD6-2 MM $411.55COIL EMBOLIZATION TORNADO PLATINUM L8 CM OD7-3 MM $411.55COIL EMBOLIZATION TORNADO PLATINUM L8 CM OD8-4 MM $411.55COIL EMBOLIZATION TORNADO PLATINUM L8.2 CM OD8-5 M $475.00COIL EMBOLIZATION TORNADO PLATINUM MICRO L2 CM OD3 $411.55COIL EMBOLIZATION TORNADO PLATINUM OD5-3 MM .035 I $411.55COIL EMBOLIZATION TORNADO PLATINUM SYNTHETIC FIBER $411.55COIL EMBOLIZATION XL TARGET LARGE L50 CM OD16 MM D $14,267.50COIL EMBOLIZATION XL TARGET STANDARD LARGE L40 CM $14,267.50COIL EMBOLIZATION XL TARGET STANDARD LARGE L50 CM $14,267.50COIL LEAD RETRIEVAL ONE-TIE COMPRESSION $978.50COLLAGEN CROSS LINKS TEST, (URINE TEST TO EVALUATE 82523 $118.00COLLAR CERVICAL ADULT SHORT LATEX FREE L0172 $143.07COLLAR CERVICAL ASPEN PLASTIC FOAM ADULT REGULAR C L0172 $143.07COLLAR CERVICAL ASPEN PLASTIC FOAM ADULT TALL CHIN L0172 $133.64COLLAR CERVICAL ASPEN PLASTIC FOAM ADULT XTALL CHI L0172 $143.07COLLAR CERVICAL ATLAS PROCARE POLYETHYLENE FOAM PE L0120 $128.35COLLAR CERVICAL COTTON FOAM MEDIUM L20 IN X H3.5 I L0120 $29.77COLLAR CERVICAL FOAM SMALL L18 IN X H3.5 IN MEDIUM L0120 $29.77COLLAR CERVICAL MIAMI J SORBATEX II 1 ADVANCE PAD L0174 $268.97COLLAR CERVICAL MIAMI J SORBATEX II STOUT PAD L0174 $478.41COLLAR CERVICAL PATRIOT PROCARE POLYETHYLENE FOAM L0120 $17.25COLLAR CERVICAL PROCARE XTEND 174 FOAM ADULT REGUL L0174 $196.53COLLAR CERVICAL PROCARE XTEND 174 FOAM ADULT SHORT L0174 $196.53COLLAR CERVICAL PROCARE XTEND 174 FOAM ADULT STOUT L0174 $168.25COLLAR CERVICAL PROCARE XTEND 174 FOAM ADULT SUPER L0174 $168.25COLLAR CERVICAL PROCARE XTEND 174 FOAM ADULT TALL L0174 $196.53COLLAR CERVICAL PROCARE XTEND 174 FOAM PEDIATRIC 1 L0174 $127.05COLLAR CERVICAL PROCARE XTEND 174 FOAM PEDIATRIC 2 L0174 $127.05

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 ChargeCOLLAR CERVICAL PROCARE XTEND 174 FOAM PEDIATRIC 3 L0174 $173.25COLLAR EXTRICATION CALIFORNIA PROCARE POLYETHYLENE L0172 $40.95COLLAR EXTRICATION PROCARE PHILADELPHIA CALIFORNIA L0172 $40.95COLLAR LOCKING TRABECULAR METAL OD35 MM KNEE SEGME C1776 $18,096.00COLLAR SUTURE GLOBAL UNITE OD44 MM SHOULDER HUMERA C1776 $1,950.00COLLAR SUTURE GLOBAL UNITE OD48 MM SHOULDER HUMERA C1776 $1,950.00COLLAR SUTURE GLOBAL UNITE OD52 MM SHOULDER HUMERA C1776 $1,950.00COLLECTION & ANALYSIS EXHALED AIR & CARBON DIOXIDE 94681 $869.00COLLECTION & ANALYSIS EXHALED AIR FOR EVALUATION O 94690 $231.00COLLECTION BLOOD SPECIMEN FROM COMPLETELY IMPLANTA 36591 $181.00COLLECTION OF DONOR STEM CELLS FOR TRANSPLANTATION 38205 $462.00COLLECTION OF STEM CELLS FOR TRANSPLANTATION 38206 $3,507.00COLONOSCOPY CANCER SCREENING HIGH RISK G0105 $1,947.00COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION 44404 $3,920.00COLORECTAL CANCER SCREENING HIGH RISK 45378 $2,731.00COMMUNITY OR WORK REINTEGRATION TRAINING, EACH 15 97537 $104.00COMP PERIODONTAL EVALUATION D0180 $100.00COMPARATIVE ANALYSIS SHORT TANDEM REPEAT (STR) MAR 81265 $78.00COMPLEMENT C3 86160 $93.00COMPLEMENT C-3 86160 $93.00COMPLETE BLOOD CELL COUNT AUTOMATED TEST 85025 $55.00COMPLETE BLOOD CELL COUNT AUTOMATED TEST 85027 $47.00COMPLEX CONTROL OF NOSE BLEED 30903 $332.00COMPLEX EYE MOVEMENT TEST WHILE VIEWING OBJECTS IN 92544 $315.00COMPLICATED REMOVAL FOREIGN BODY STONE/STENT FROM 52315 $7,042.00COMPONENT ACETABULAR REGENEREX RINGLOC+ 24 OD56 MM C1776 $13,000.00COMPONENT ARTICULAR SURFACE HEMICAP DF COCR TITANI C1776 $12,675.00COMPONENT CARPAL COCR MOLYBDENUM TITANIUM SMALL L2 C1776 $5,729.43COMPONENT CARPAL FREEDOM POLY 1 STANDARD WRIST C1776 $5,408.00COMPONENT EXTERNAL FIXATION STAINLESS STEEL L200 M $1,170.00COMPONENT FEMORAL 38 MM OFFSET KNEE PROXIMAL BASIC C1776 $25,782.90COMPONENT FEMORAL 5+ SPHERE SET C1776 $650.00COMPONENT FEMORAL ACUMATCH W52 MM KNEE UNIPOLAR L C1776 $1,950.00COMPONENT FEMORAL ACUMATCH W55 MM KNEE UNIPOLAR L C1776 $1,950.00COMPONENT FEMORAL ATTUNE 3 KNEE RIGHT CEMENTED CRU C1776 $9,750.00COMPONENT FEMORAL ATTUNE 3 NARROW KNEE LEFT CEMENT C1776 $9,750.00COMPONENT FEMORAL ATTUNE 4 KNEE LEFT CEMENT CRUCIA C1776 $9,750.00COMPONENT FEMORAL ATTUNE 4 KNEE RIGHT CEMENTED CRU C1776 $9,750.00COMPONENT FEMORAL ATTUNE 4 NARROW KNEE LEFT CEMENT C1776 $12,000.00

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 ChargeCOMPONENT FEMORAL ATTUNE 4 NARROW KNEE RIGHT CEMEN C1776 $12,000.00COMPONENT FEMORAL ATTUNE 5 KNEE LEFT CEMENTED CRUC C1776 $9,750.00COMPONENT FEMORAL ATTUNE 5 KNEE RIGHT CEMENT CRUCI C1776 $12,000.00COMPONENT FEMORAL ATTUNE 5 NARROW KNEE LEFT CEMENT C1776 $12,000.00COMPONENT FEMORAL ATTUNE 5 NARROW KNEE RIGHT CEMEN C1776 $9,750.00COMPONENT FEMORAL ATTUNE 6 KNEE LEFT CEMENT CRUCIA C1776 $9,750.00COMPONENT FEMORAL ATTUNE 6 KNEE RIGHT CEMENTED CRU C1776 $9,750.00COMPONENT FEMORAL ATTUNE 6 NARROW KNEE LEFT CEMENT C1776 $9,750.00COMPONENT FEMORAL ATTUNE 6 NARROW KNEE RIGHT CEMEN C1776 $12,000.00COMPONENT FEMORAL ATTUNE 7 KNEE LEFT CEMENT CRUCIA C1776 $9,750.00COMPONENT FEMORAL ATTUNE 7 KNEE RIGHT CEMENTED CRU C1776 $9,750.00COMPONENT FEMORAL ATTUNE 8 KNEE LEFT CEMENTED CRUC C1776 $9,750.00COMPONENT FEMORAL ATTUNE 8 KNEE RIGHT CEMENT CRUCI C1776 $12,000.00COMPONENT FEMORAL COLUMBUS AS 2 OFFSET KNEE TIBIA C1776 $14,950.00COMPONENT FEMORAL COLUMBUS AS 4 KNEE RIGHT CEMENTE C1776 $26,000.00COMPONENT FEMORAL COLUMBUS F3 KNEE RIGHT CEMENTED C1776 $26,000.00COMPONENT FEMORAL COLUMBUS PLASMAPORE F4N NARROW K C1776 $11,050.00COMPONENT FEMORAL COLUMBUS PLASMAPORE F5N NARROW K C1776 $11,050.00COMPONENT FEMORAL GENDER SOLUTIONS NEXGEN PRECOAT C1776 $19,500.00COMPONENT FEMORAL GMK 2 KNEE RIGHT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 2+ SPHERE KNEE LEFT CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 23 KNEE RIGHT SPHERE CEMENTE C1776 $9,750.00COMPONENT FEMORAL GMK 3 KNEE LEFT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 3 KNEE RIGHT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 3+ KNEE LEFT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 4 KNEE LEFT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 4 KNEE RIGHT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 4+ SPHERE KNEE LEFT CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 4+ SPHERE KNEE RIGHT CEMENTE C1776 $9,750.00COMPONENT FEMORAL GMK 5 KNEE LEFT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 5 KNEE RIGHT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 5+ KNEE RIGHT SPHERE CEMENTE C1776 $9,750.00COMPONENT FEMORAL GMK 5+ SPHERE KNEE LEFT CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 5+ SPHERE KNEE RIGHT CEMENTE C1776 $9,750.00COMPONENT FEMORAL GMK 6 KNEE LEFT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 6 KNEE RIGHT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 6+ KNEE LEFT SPHERE CEMENTED C1776 $9,750.00COMPONENT FEMORAL GMK 6+ SPHERE KNEE RIGHT CEMENTE C1776 $9,750.00COMPONENT FEMORAL GMK 7 KNEE LEFT SPHERE CEMENTED C1776 $9,750.00

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 ChargeCOMPONENT FEMORAL GMK COCR 2 KNEE LEFT CEMENTED PO C1776 $22,750.00COMPONENT FEMORAL GMK COCR 2 KNEE RIGHT CEMENTED P C1776 $22,750.00COMPONENT FEMORAL GMK COCR 3 KNEE LEFT CEMENTED HI C1776 $36,625.62COMPONENT FEMORAL GMK COCR 3 KNEE LEFT CEMENTED PO C1776 $7,800.00COMPONENT FEMORAL GMK COCR 3 KNEE RIGHT CEMENTED H C1776 $36,625.59COMPONENT FEMORAL GMK COCR 3 KNEE RIGHT CEMENTED P C1776 $22,750.00COMPONENT FEMORAL GMK COCR 4 KNEE LEFT CEMENTED HI C1776 $36,625.62COMPONENT FEMORAL GMK COCR 4 KNEE LEFT CEMENTED PO C1776 $22,750.00COMPONENT FEMORAL GMK COCR 4 KNEE RIGHT CEMENTED H C1776 $36,625.62COMPONENT FEMORAL GMK COCR 4 KNEE RIGHT CEMENTED P C1776 $22,750.00COMPONENT FEMORAL GMK COCR 5 KNEE LEFT CEMENTED HI C1776 $36,625.62COMPONENT FEMORAL GMK COCR 5 KNEE LEFT CEMENTED PO C1776 $22,750.00COMPONENT FEMORAL GMK COCR 5 KNEE RIGHT CEMENTED H C1776 $36,625.59COMPONENT FEMORAL GMK COCR 6 KNEE LEFT CEMENTED PO C1776 $22,750.00COMPONENT FEMORAL GMK COCR 6 KNEE RIGHT CEMENTED H C1776 $36,625.62COMPONENT FEMORAL GMK COCR 6 KNEE RIGHT CEMENTED P C1776 $22,750.00COMPONENT FEMORAL GMRS COCR STANDARD NEUTRAL HIP C1776 $30,630.60COMPONENT FEMORAL GMRS SMALL L65 MM DISTAL RIGHT C1776 $44,140.20COMPONENT FEMORAL JOURNEY II OXINIUM 3 L61.5 MM X C1776 $11,862.50COMPONENT FEMORAL JOURNEY II OXINIUM 5 L67.5 MM X C1776 $11,862.50COMPONENT FEMORAL JOURNEY II OXINIUM 7 L73.5 MM X C1776 $11,862.50COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY E L68 C1776 $29,250.00COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY F L72 C1776 $29,250.00COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY G L76 C1776 $29,250.00COMPONENT FEMORAL LEGION OXINIUM 5N NARROW KNEE RI C1776 $11,050.00COMPONENT FEMORAL LOGIC HI-FLEX 1 KNEE RIGHT CEMEN C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 2 KNEE LEFT CEMENT C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 2 KNEE RIGHT CEMEN C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 2.5 KNEE LEFT CEME C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 2.5 KNEE RIGHT CEM C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 3 KNEE LEFT CEMENT C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 3 KNEE RIGHT CEMEN C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 3.5 KNEE LEFT CEME C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 4 KNEE LEFT CEMENT C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 4 KNEE RIGHT CEMEN C1776 $9,750.00COMPONENT FEMORAL LOGIC HI-FLEX 5 KNEE LEFT CEMENT C1776 $9,750.00COMPONENT FEMORAL MAXIM INTERLOK L75 MM X W72 MM K C1776 $7,800.00COMPONENT FEMORAL MOTO 1 KNEE RIGHT MEDIAL CEMENTE C1776 $7,800.00COMPONENT FEMORAL MOTO 2 KNEE LEFT MEDIAL CEMENTED 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 ChargeCOMPONENT FEMORAL MOTO 4 KNEE RIGHT MEDIAL CEMENTE C1776 $7,800.00COMPONENT FEMORAL NATURAL-KNEE FLEX GENDER SOLUTIO C1776 $11,050.00COMPONENT FEMORAL NCB OD2.5 MM FEMUR C1776 $676.00COMPONENT FEMORAL NEXGEN LCCK OPTION ZIMALOY C L60 C1776 $29,250.00COMPONENT FEMORAL NEXGEN LCCK OPTION ZIMALOY D L64 C1776 $29,250.00COMPONENT FEMORAL NEXGEN LCCK OPTION ZIMALOY F L72 C1776 $29,250.00COMPONENT FEMORAL NEXGEN LPS-FLEX GENDER SOLUTIONS C1776 $9,750.00COMPONENT FEMORAL NEXGEN ZIMALOY B KNEE LEFT RECON C1776 $52,066.30COMPONENT FEMORAL NEXGEN ZIMALOY B L58 MM X W50 MM C1776 $48,087.00COMPONENT FEMORAL NEXGEN ZIMALOY C L64 MM X W54 MM C1776 $52,520.00COMPONENT FEMORAL NEXGEN ZIMALOY D L68 MM X W58 MM C1776 $52,520.00COMPONENT FEMORAL NEXGEN ZIMALOY E L72 MM X W62 MM C1776 $52,520.00COMPONENT FEMORAL NEXGEN ZIMALOY F L76 MM X W66 MM C1776 $52,520.00COMPONENT FEMORAL NEXGEN ZIMALOY F STANDARD L77 MM C1776 $7,800.00COMPONENT FEMORAL NEXGEN ZIMALOY G STANDARD L81 MM C1776 $7,800.00COMPONENT FEMORAL OPTETRAK 1 KNEE RIGHT CRUCIATE R C1776 $7,800.00COMPONENT FEMORAL OPTETRAK 4 KNEE LEFT CEMENTED PO C1776 $7,800.00COMPONENT FEMORAL OPTETRAK 4 KNEE RIGHT CRUCIATE R C1776 $7,800.00COMPONENT FEMORAL OPTETRAK LOGIC 0 KNEE RIGHT CEME C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 1 KNEE LEFT CEMEN C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 1 KNEE RIGHT CEME C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 1.5 KNEE LEFT CEM C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 1.5 KNEE RIGHT CE C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 2 KNEE LEFT CEMEN C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 2 KNEE RIGHT CEME C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 2.5 KNEE LEFT CEM C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 2.5 KNEE RIGHT CE C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 3 KNEE LEFT CEMEN C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 3 KNEE RIGHT CEME C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 3.5 KNEE LEFT CEM C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 3.5 KNEE RIGHT CE C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 4 KNEE LEFT CEMEN C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 4 KNEE RIGHT CEME C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 5 KNEE LEFT CEMEN C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 5 KNEE RIGHT CEME C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 6 KNEE LEFT CEMEN C1776 $9,750.00COMPONENT FEMORAL OPTETRAK LOGIC 6 KNEE RIGHT CEME C1776 $9,750.00COMPONENT FEMORAL OPTION NEXGEN ZIMALOY C STANDARD C1776 $7,800.00COMPONENT FEMORAL OSS H7 CM KNEE LEFT MODULAR SEGM C1776 $60,544.00

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 ChargeCOMPONENT FEMORAL OSS L9 CM KNEE DIAPHYSEAL SEGMEN C1776 $50,028.00COMPONENT FEMORAL OSS POROUS L7 CM KNEE RIGHT SEGM C1776 $63,096.00COMPONENT FEMORAL OXFORD COCRMO LARGE PARTIAL KNEE C1776 $11,050.00COMPONENT FEMORAL OXFORD COCRMO MEDIUM PARTIAL KNE C1776 $11,050.00COMPONENT FEMORAL OXFORD COCRMO SMALL KNEE UNICOMP C1776 $11,050.00COMPONENT FEMORAL OXFORD COCRMO XS PARTIAL KNEE PH C1776 $11,050.00COMPONENT FEMORAL PERSONA COCR 10 NARROW KNEE RIGH C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 10 STANDARD KNEE LE C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 10 STANDARD KNEE RI C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 11 STANDARD KNEE RI C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 12 STANDARD KNEE LE C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 12 STANDARD KNEE RI C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 3 NARROW KNEE LEFT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 3 STANDARD KNEE LEF C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 4 NARROW KNEE LEFT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 4 NARROW KNEE RIGHT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 4 STANDARD KNEE LEF C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 4 STANDARD KNEE RIG C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 5 NARROW KNEE LEFT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 5 NARROW KNEE RIGHT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 5 STANDARD KNEE LEF C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 5 STANDARD KNEE RIG C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 6 NARROW KNEE LEFT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 6 NARROW KNEE RIGHT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 6 STANDARD KNEE LEF C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 6 STANDARD KNEE RIG C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 7 NARROW KNEE LEFT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 7 NARROW KNEE RIGHT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 7 STANDARD KNEE LEF C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 7 STANDARD KNEE RIG C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 8 NARROW KNEE LEFT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 8 NARROW KNEE RIGHT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 8 STANDARD KNEE LEF C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 8 STANDARD KNEE RIG C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 9 NARROW KNEE LEFT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 9 NARROW KNEE RIGHT C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 9 STANDARD KNEE LEF C1776 $9,750.00COMPONENT FEMORAL PERSONA COCR 9 STANDARD KNEE RIG C1776 $9,750.00COMPONENT FEMORAL PFC SIGMA NONPOROUS 2 L60 MM X W 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 ChargeCOMPONENT FEMORAL PFC SIGMA NONPOROUS 2.5 L63 MM X C1776 $7,800.00COMPONENT FEMORAL PFC SIGMA NONPOROUS 3 L66 MM X W C1776 $7,800.00COMPONENT FEMORAL PFC SIGMA NONPOROUS 4 L71 MM X W C1776 $7,800.00COMPONENT FEMORAL PFC SIGMA NONPOROUS 5 L73 MM X W C1776 $7,800.00COMPONENT FEMORAL PFC SIGMA NONPOROUS 6 L78 MM X W C1776 $7,800.00COMPONENT FEMORAL PFC SIGMA TC3 2 L60 MM X W56 MM C1776 $26,000.00COMPONENT FEMORAL PFC SIGMA TC3 2.5 L63 MM X W59 M C1776 $26,000.00COMPONENT FEMORAL PFC SIGMA TC3 3 L65 MM X W61 MM C1776 $26,000.00COMPONENT FEMORAL PFC SIGMA TC3 4 L71 MM X W65 MM C1776 $26,000.00COMPONENT FEMORAL SIGMA COCR 1.5 KNEE RIGHT CEMENT C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR 2.5 KNEE LEFT CEMENTE C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR 2.5 KNEE RIGHT CEMENT C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR 3 KNEE LEFT CEMENT PO C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR 3 KNEE RIGHT CEMENTED C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR 4 KNEE LEFT CEMENT PO C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR 4 KNEE RIGHT CEMENT P C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR 5 KNEE RIGHT CEMENT P C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR NONPOROUS 4N KNEE LEF C1776 $7,800.00COMPONENT FEMORAL SIGMA COCR NONPOROUS 4N KNEE RIG C1776 $7,800.00COMPONENT FEMORAL TRIATHLON 2 KNEE LEFT CEMENTED P C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 2 KNEE LEFT CRUCIATE R C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 2 KNEE RIGHT CRUCIATE C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 3 KNEE LEFT CEMENTED P C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 3 KNEE LEFT CRUCIATE R C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 3 KNEE RIGHT CEMENT CR C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 4 KNEE LEFT CEMENTED P C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 4 KNEE LEFT CRUCIATE R C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 4 KNEE RIGHT CEMENTED C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 4 KNEE RIGHT CRUCIATE C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 5 KNEE LEFT CEMENTED P C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 5 KNEE LEFT CRUCIATE R C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 5 KNEE RIGHT CRUCIATE C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 6 KNEE LEFT CRUCIATE R C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 6 KNEE RIGHT CEMENTED C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 6 KNEE RIGHT CRUCIATE C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 7 KNEE LEFT CRUCIATE R C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 7 KNEE RIGHT CEMENTED C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 7 KNEE RIGHT CRUCIATE C1776 $9,750.00COMPONENT FEMORAL TRIATHLON 8 KNEE LEFT CRUCIATE R C1776 $9,750.00

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 ChargeCOMPONENT FEMORAL TRIATHLON 8 KNEE RIGHT CRUCIATE C1776 $9,750.00COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTA C1776 $29,997.24COMPONENT FEMORAL TRIATHLON PA 1 KNEE LEFT CRUCIAT C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 1 KNEE RIGHT CRUCIA C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 2 KNEE LEFT CRUCIAT C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 2 KNEE RIGHT CRUCIA C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 3 KNEE LEFT CRUCIAT C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 3 KNEE LEFT POSTERI C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 3 KNEE RIGHT CRUCIA C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 4 KNEE LEFT CRUCIAT C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 4 KNEE RIGHT CRUCIA C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 5 KNEE LEFT CRUCIAT C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 5 KNEE RIGHT CRUCIA C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 6 KNEE LEFT CRUCIAT C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 6 KNEE RIGHT CRUCIA C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 6 KNEE RIGHT POSTER C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 7 KNEE LEFT CRUCIAT C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 7 KNEE RIGHT CRUCIA C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 8 KNEE LEFT CRUCIAT C1776 $11,050.00COMPONENT FEMORAL TRIATHLON PA 8 KNEE RIGHT CRUCIA C1776 $11,050.00COMPONENT FEMORAL VANGUARD INTERLOK COCR L55 MM KN C1776 $9,750.00COMPONENT FEMORAL VANGUARD INTERLOK COCR L62.5 MM C1776 $9,750.00COMPONENT FEMORAL VANGUARD INTERLOK COCR L65 MM KN C1776 $9,750.00COMPONENT FEMORAL VANGUARD INTERLOK COCR L67.5 MM C1776 $9,750.00COMPONENT FEMORAL VANGUARD INTERLOK COCR L70 MM KN C1776 $9,750.00COMPONENT FEMORAL VANGUARD INTERLOK COCR L72.5 MM C1776 $9,750.00COMPONENT GLENOID AEQUALIS PERFORM CORTILOC SMALL C1776 $6,500.00COMPONENT GLENOID COMPREHENSIVE HYBRID MEDIUM H4 M C1776 $3,900.00COMPONENT GLENOID COMPREHENSIVE HYBRID POLYETHYLEN C1776 $1,600.00COMPONENT GLENOID COMPREHENSIVE HYBRID SMALL H4 MM C1776 $3,900.00COMPONENT GLENOID COMPREHENSIVE REGENEREX TITANIUM C1776 $2,600.00COMPONENT GLENOID COMPREHENSIVE VERSA-DIAL HA PORO C1776 $6,500.00COMPONENT GLENOID DELTA XTEND METAGLENE STANDARD O C1776 $6,500.00COMPONENT GLENOID DELTA XTEND STANDARD OD38 MM SHO C1776 $6,500.00COMPONENT GLENOID EQUINOXE +4 MM OD38 MM EXPAND GL C1776 $7,800.00COMPONENT GLENOID EQUINOXE 8 D SMALL W6.8 MM LEFT C1776 $8,450.00COMPONENT GLENOID EQUINOXE LARGE SHOULDER CAGE BET C1776 $8,450.00COMPONENT GLENOID EQUINOXE MEDIUM SHOULDER CAGE AL C1776 $8,450.00COMPONENT GLENOID EQUINOXE MEDIUM SHOULDER PEGGED C1776 $5,200.00

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 ChargeCOMPONENT GLENOID EQUINOXE OD42 MM SHOULDER GLENOS C1776 $7,800.00COMPONENT GLENOID EQUINOXE SMALL SHOULDER CAGE ALP C1776 $8,450.00COMPONENT GLENOID OD38 MM SHOULDER GLENOSPHERE REV C1776 $7,800.00COMPONENT GLENOID REUNION X3 OD48 MM PEG STERILE L C1776 $5,200.00COMPONENT HUMERAL COONRAD MORREY ZIMALOY TIVANIUM C1776 $21,125.00COMPONENT HUMERAL DISCOVERY CONDYLE 2 SCREW C1776 $4,875.00COMPONENT HUMERAL DISCOVERY L100 MM OD4 MM ELBOW R C1776 $23,764.00COMPONENT HUMERAL DISCOVERY L150 MM OD4 MM ELBOW R C1776 $23,764.00COMPONENT HUMERAL EQUINOXE TITANIUM 1.5 MM OFFSET C1776 $4,550.00COMPONENT PATELLAR CONSTRUCT OD31 MM KNEE BUTTON S C1776 $7,560.00COMPONENT PATELLAR E-PLUS DOME H8 MM OD32 MM KNEE C1776 $1,950.00COMPONENT PATELLAR GENESIS II H7.5 MM OD26 MM KNEE C1776 $1,625.00COMPONENT PATELLAR GENESIS II H7.5 MM OD29 MM KNEE C1776 $1,625.00COMPONENT PATELLAR GENESIS II H7.5 MM OD32 MM C1776 $1,625.00COMPONENT PATELLAR GENESIS II OXINIUM L29 MM KNEE C1776 $1,625.00COMPONENT PATELLAR GENESIS II OXINIUM L32 MM KNEE C1776 $1,625.00COMPONENT PATELLAR GMK 1 RESURFACING C1776 $1,950.00COMPONENT PATELLAR GMK 2 RESURFACING C1776 $1,950.00COMPONENT PATELLAR GMK 3 RESURFACING C1776 $1,950.00COMPONENT PATELLAR GMK 4 RESURFACING C1776 $1,950.00COMPONENT PATELLAR L37 MM X W32 MM X H8.2 MM 1 LOG C1776 $1,625.00COMPONENT PATELLAR NEXGEN PROLONG ALL POLY OD26 MM C1776 $1,950.00COMPONENT PATELLAR NEXGEN PROLONG OD35 MM KNEE C1776 $1,950.00COMPONENT PATELLAR NEXGEN TRABECULAR METAL POLYETH C1776 $1,950.00COMPONENT PATELLAR NEXGEN UHMWPE STANDARD H8 MM OD C1776 $1,625.00COMPONENT PATELLAR NEXGEN UHMWPE STANDARD H8.5 MM C1776 $1,625.00COMPONENT PATELLAR OPTETRAK OD32 MM KNEE 3 PEG C1776 $1,625.00COMPONENT PATELLAR OPTETRAK POLYETHYLENE ASYMMETRI C1776 $1,625.00COMPONENT PATELLAR OPTETRAK POLYETHYLENE OD26 MM 3 C1776 $1,625.00COMPONENT PATELLAR OPTETRAK POLYETHYLENE OD29 MM 3 C1776 $1,625.00COMPONENT PATELLAR P2 H8 MM OD29 MM KNEE 3 PEG C1776 $1,950.00COMPONENT PATELLAR P3 H9 MM OD32 MM KNEE 3 PEG C1776 $1,950.00COMPONENT PATELLAR PERSONA ALL POLY OD29 MM KNEE L C1776 $1,625.00COMPONENT PATELLAR PERSONA ALL POLY OD32 MM KNEE C1776 $1,625.00COMPONENT PATELLAR PERSONA ALL POLY OD35 MM KNEE L C1776 $1,625.00COMPONENT PATELLAR PERSONA ALL POLY OD38 MM KNEE L C1776 $1,625.00COMPONENT PATELLAR PERSONA VIVACIT-E ALL POLY OD38 C1776 $2,925.00COMPONENT PATELLAR STANDARD OD31 MM KNEE 1 PEG WIR C1776 $1,625.00COMPONENT PATELLAR STANDARD OD31 MM KNEE 3 PEG STE C1776 $1,625.00

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 ChargeCOMPONENT PATELLAR STANDARD OD34 MM KNEE 1 PEG WIR C1776 $2,000.00COMPONENT PATELLAR STANDARD OD34 MM KNEE 3 PEG SER C1776 $1,625.00COMPONENT PATELLAR STANDARD OD37 MM KNEE 1 PEG WIR C1776 $2,000.00COMPONENT PATELLAR STANDARD OD37 MM KNEE 3 PEG SER C1776 $1,625.00COMPONENT PATELLAR THIN H8.5 MM OD37 MM KNEE 1 PEG C1776 $2,000.00COMPONENT PATELLAR TRIATHLON POLYETHYLENE H8 MM OD C1776 $1,300.00COMPONENT PATELLAR TRIATHLON POLYETHYLENE H9 MM OD C1776 $1,300.00COMPONENT PATELLAR TRIATHLON TRITANIUM H9 MM OD33 C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H10 MM OD32 MM KNE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H10 MM OD35 MM KNE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H10 MM OD36 MM KNE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H11 MM OD38 MM KNE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H11 MM OD40 MM KNE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H8 MM OD27 MM KNEE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H8 MM OD29 MM KNEE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H9 MM OD29 MM KNEE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H9 MM OD31 MM KNEE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 H9 MM OD33 MM KNEE C1776 $1,950.00COMPONENT PATELLAR TRIATHLON X3 KNEE SYMMETRIC TOT C1776 $1,950.00COMPONENT PATELLAR TRITANIUM S L31 MM X W9 MM STER C1776 $1,950.00COMPONENT PATELLAR VIVACIT-E ALL POLY H7.5 MM OD26 C1776 $2,925.00COMPONENT PATELLAR VIVACIT-E ALL POLY OD29 MM KNEE C1776 $1,950.00COMPONENT PATELLAR VIVACIT-E ALL POLY OD32 MM KNEE C1776 $1,950.00COMPONENT PATELLAR VIVACIT-E ALL POLY OD35 MM KNEE C1776 $1,950.00COMPONENT RADIAL XS LEFT DISTAL C1776 $24,431.55COMPONENT SEGMENTAL NEXGEN TIVANIUM L60 MM KNEE TI C1776 $22,561.83COMPONENT SEGMENTAL TRABECULAR METAL OD25 MM KNEE C1776 $15,158.00COMPONENT SEGMENTAL TRABECULAR METAL OD35 MM KNEE C1776 $15,158.00COMPONENT SUBTALAR PROSTOP TITANIUM POLY L LACTIC C1776 $7,117.50COMPONENT TIBIAL MONOGRAM XS-XL KNEE MODULAR ROTAT C1776 $18,131.10COMPONENT TIBIAL TRIATHLON 2 KNEE STERILE LATEX FR C1776 $7,150.00COMPONENT ULNAR COONRAD MORREY ZIMALOY TIVANIUM UH C1776 $20,800.00COMPONENT ULNAR COONRAD/MORREY TIVANIUM UHMWPE PLA C1776 $20,800.00COMPONENT ULNAR DISCOVERY L75 MM OD3 MM ELBOW RIGH C1776 $16,900.00COMPONENT ULNAR DISCOVERY OD75/115 MM ELBOW BEARIN C1776 $4,875.00COMPREHENSVE ORAL EVALUATION D0150 $3,090.00COMPUTED TOMOGRAPHY OF BRAIN BLOOD FLOW VOLUME & T 0042T $1,951.00COMPUTERIZED MAPPING OF CORNEAL CURVATURE 92025 $234.00CONCENTRATION OF SPECIMEN FOR INFECTIOUS AGENTS 87015 $52.00

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 ChargeCONDUIT CARDIOVASCULAR CARDIOGRAFT D17-21 MM SMALL $36,989.88CONDUIT MITRAL VALVE HANCOCK II CINCH PORCINE 20.5 $22,750.00CONE BIOPSY OF THE CERVIX AND VAGINA USING AN ENDO 57461 $5,366.00CONFIRMATION TEST FOR ANTIBODY TO HUMAN T-CELL LYM 86689 $121.00CONJUGATED ESTROGENS 0.625 MG/GRAM CREA 30 G TUBE/ $971.45CONNECTIVE TISSUE GRAFT D4273 $1,995.00CONNECTOR EXTERNAL FIXATION BAR $7,242.00CONNECTOR EXTERNAL FIXATION CONSTRUX LEFT LOCK $5,154.24CONNECTOR EXTERNAL FIXATION DYNAFIX RING $1,638.00CONNECTOR EXTERNAL FIXATION DYNAFIX VISION BOLT RO $4,819.20CONNECTOR EXTERNAL FIXATION DYNAFIX VISION TIBIAL $3,532.80CONNECTOR EXTERNAL FIXATION ILIZAROV OBLIQUE SUPPO $4,095.20CONNECTOR EXTERNAL FIXATION JET-X HINGE $2,108.72CONNECTOR EXTERNAL FIXATION JET-X STRAIGHT $1,456.88CONNECTOR EXTERNAL FIXATION UNIVERSAL ROD $6,364.80CONNECTOR NERVE AXOGUARD PORCINE EXTRACELLULAR MAT C1763 $8,970.00CONNECTOR PERFUSION OD1/4 IN X 3/8 IN STERILE $1,560.00CONNECTOR ROD +15 D LATERAL OFFSET L25 MM SPINE PO C1713 $2,000.00CONNECTOR ROD +15 D UP OFFSET L50 MM SPINE LATERAL C1713 $2,000.00CONNECTOR ROD 1 X 2 SPINE PARALLEL EXTENDED BODY C1713 $1,625.00CONNECTOR ROD -15 D DOWN OFFSET L50 MM SPINE LATER C1713 $2,000.00CONNECTOR ROD 15 D DOWN OFFSET OD25 MM SPINE LATER C1713 $2,000.00CONNECTOR ROD 15 D DOWN OFFSET OD50 MM SPINE LATER C1713 $2,000.00CONNECTOR ROD -15 D LATERAL OFFSET L25 MM SPINE PO C1713 $2,000.00CONNECTOR ROD 15 D UP OFFSET OD25 MM SPINE LATERAL C1713 $2,000.00CONNECTOR ROD 15 D UP OFFSET OD50 MM SPINE LATERAL C1713 $2,000.00CONNECTOR ROD ARMADA 15T L50 MM SPINE CROSS LOW PR C1713 $3,250.00CONNECTOR ROD ARMADA L35 MM SPINE CROSS ADJUSTABLE C1713 $3,250.00CONNECTOR ROD ARMADA L45-50 MM SPINE CROSS NONSTER C1713 $3,250.00CONNECTOR ROD ARMADA L55 MM SPINE CROSS ADJUSTABLE C1713 $3,250.00CONNECTOR ROD ARMADA TITANIUM L37.5 MM OD5.5 MM SP C1713 $3,250.00CONNECTOR ROD ARRAY STAINLESS STEEL 2XS CROSS C1713 $4,000.00CONNECTOR ROD ARRAY STAINLESS STEEL L16 MM CROSS F C1713 $4,000.00CONNECTOR ROD ARRAY STAINLESS STEEL L18 MM CROSS F C1713 $4,000.00CONNECTOR ROD ARRAY STAINLESS STEEL L20 MM CROSS F C1713 $4,000.00CONNECTOR ROD ARRAY STAINLESS STEEL L22 MM CROSS F C1713 $4,000.00CONNECTOR ROD ARRAY STAINLESS STEEL L24 MM CROSS F C1713 $4,000.00CONNECTOR ROD ARRAY STAINLESS STEEL LARGE CROSS C1713 $4,000.00CONNECTOR ROD ARRAY STAINLESS STEEL MEDIUM CROSS C1713 $4,000.00

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 ChargeCONNECTOR ROD ARRAY STAINLESS STEEL SMALL CROSS C1713 $4,000.00CONNECTOR ROD ARRAY STAINLESS STEEL XS CROSS C1713 $4,000.00CONNECTOR ROD ARRAY TITANIUM L18 MM THORACOLUMBAR C1713 $4,000.00CONNECTOR ROD ARRAY TITANIUM L20 MM THORACOLUMBAR C1713 $4,000.00CONNECTOR ROD ARRAY TITANIUM L22 MM THORACOLUMBAR C1713 $4,000.00CONNECTOR ROD ARRAY TITANIUM L24 MM THORACOLUMBAR C1713 $4,000.00CONNECTOR ROD AXIAL SPINE RAIL POSTERIOR FUSION C1713 $2,000.00CONNECTOR ROD AXIAL TITANIUM OD5.5/5.5 MM SPINE C1713 $4,800.00CONNECTOR ROD CD HORIZON L25 MM OD5/6-6 MM SPINE L C1713 $1,625.00CONNECTOR ROD CD HORIZON LEGACY STAINLESS STEEL L1 C1713 $2,400.00CONNECTOR ROD CD HORIZON LEGACY STAINLESS STEEL L2 C1713 $2,400.00CONNECTOR ROD CD HORIZON LEGACY STAINLESS STEEL L3 C1713 $2,400.00CONNECTOR ROD CD HORIZON LEGACY STAINLESS STEEL OF C1713 $2,000.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM L10 MM SP C1713 $2,000.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM L20 MM OD C1713 $1,625.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM L20 MM SP C1713 $2,000.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM L30 MM OD C1713 $2,400.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM L30 MM SP C1713 $2,400.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM OFFSET L1 C1713 $1,625.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM OFFSET L2 C1713 $1,625.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM OFFSET L3 C1713 $2,400.00CONNECTOR ROD CD HORIZON LEGACY TITANIUM OFFSET L6 C1713 $2,400.00CONNECTOR ROD CD HORIZON SOLERA L20 MM OD5/8-6 MM C1713 $1,625.00CONNECTOR ROD CD HORIZON STAINLESS STEEL L12 MM OD C1713 $2,400.00CONNECTOR ROD CL4.75 SD4.75 CURVE L35 MM SPINE LAT C1713 $1,625.00CONNECTOR ROD CORAL OD5.5 MM SPINE CLAMSHELL C1713 $1,625.00CONNECTOR ROD CREO L15 MM SPINE THREAD HEAD OFFSET C1713 $1,625.00CONNECTOR ROD CREO L20 MM SPINE THREAD HEAD OFFSET C1713 $1,625.00CONNECTOR ROD CREO L25 MM SPINE THREAD HEAD OFFSET C1713 $1,625.00CONNECTOR ROD CREO L30 MM SPINE THREAD HEAD OFFSET C1713 $1,625.00CONNECTOR ROD CREO L38-50 MM OD5.5 MM SPINE CROSS C1713 $3,250.00CONNECTOR ROD CREO L48-60 MM OD5.5 MM SPINE CROSS C1713 $3,250.00CONNECTOR ROD CREO L58-70 MM OD5.5 MM SPINE CROSS C1713 $3,250.00CONNECTOR ROD CROSSLINK LARGE SPINAL C1713 $3,250.00CONNECTOR ROD CROSSLINK OD6.35 MM SPINE REVISION C1713 $3,250.00CONNECTOR ROD CROSSLINK VERTEX MAX TITANIUM MEDIUM C1713 $4,800.00CONNECTOR ROD DENALI L22 MM SPINE TRANSVERSE FIXED C1713 $4,000.00CONNECTOR ROD DOMINO OD4.5/4.5 MM SPINE C1713 $4,800.00CONNECTOR ROD DOMINO TITANIUM CL5.5 SD6.35 CURVE S C1713 $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 ChargeCONNECTOR ROD DOMINO TITANIUM L12 MM OD5.5 MM LATE C1713 $2,400.00CONNECTOR ROD DOMINO TITANIUM L32 MM OD5.5 MM LATE C1713 $2,400.00CONNECTOR ROD DOMINO TITANIUM OD6.35 MM SPINE SOLI C1713 $1,625.00CONNECTOR ROD DOMINO TITANIUM SD5.5 CURVE SPINE C1713 $3,250.00CONNECTOR ROD ELLIPSE L10 MM OD3.5-5.5 MM SPINE PA C1713 $1,625.00CONNECTOR ROD ELLIPSE OD10 MM 2 PARALLEL CERVICOTH C1713 $1,625.00CONNECTOR ROD ELLIPSE TITANIUM L33-39 MM OD3.5 MM C1713 $3,250.00CONNECTOR ROD ELLIPSE TITANIUM OD3.5-5.5 MM SPINE C1713 $1,625.00CONNECTOR ROD EVEREST LARGE OD6 MM ODSEC5.5 MM SPI C1713 $3,250.00CONNECTOR ROD EVEREST MEDIUM OD6 MM ODSEC5.5 MM SP C1713 $3,250.00CONNECTOR ROD EVEREST OFFSET L25 MM SPINE LATERAL C1713 $1,625.00CONNECTOR ROD EVEREST OFFSET L35 MM SPINE LATERAL C1713 $1,625.00CONNECTOR ROD EVEREST OFFSET L50 MM SPINE LATERAL C1713 $1,625.00CONNECTOR ROD EXPEDIUM L20 MM OD5.5 MM SPINE NONST C1713 $2,000.00CONNECTOR ROD EXPEDIUM L40 MM OD5.5 MM SPINE NONST C1713 $2,000.00CONNECTOR ROD EXPEDIUM L5.5 MM OD5.5 MM SPINE 2 SI C1713 $2,000.00CONNECTOR ROD EXPEDIUM SFX TITANIUM A1 L26-28 MM O C1713 $4,000.00CONNECTOR ROD EXPEDIUM SFX TITANIUM A3 L32-37 MM O C1713 $3,250.00CONNECTOR ROD EXPEDIUM SFX TITANIUM A4 L37-41 MM O C1713 $4,000.00CONNECTOR ROD EXPEDIUM SFX TITANIUM A6 L49-66 MM O C1713 $4,000.00CONNECTOR ROD EXPEDIUM SFX TITANIUM A7 L65-98 MM O C1713 $4,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL L125 MM OD5 C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL L20 MM OD4. C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL L40 MM OD4. C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL L40 MM OD5. C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL L60 MM OD4. C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL L60 MM OD5. C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL LEFT OFFSET C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL MINI LEFT O C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL MINI RIGHT C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4.5 MM SP C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4.5-4.75 C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4.5-5 MM C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4.5-5.5 M C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4.75 MM O C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4.75-5 MM C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4.75-5.5 C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD4-4.5 MM C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD5 MM ODSE C1713 $2,000.00

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 ChargeCONNECTOR ROD EXPEDIUM STAINLESS STEEL OD5.5 MM OD C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD5.5 MM SP C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD5.5-6.35 C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL OD5-5.5 MM C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL RIGHT OFFSE C1713 $2,000.00CONNECTOR ROD EXPEDIUM STAINLESS STEEL STRAIGHT OD C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L150 MM OD5.5 MM S C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L20 MM OD4.5 MM SP C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L20 MM OD5.5 MM SP C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L200 MM OD5.5 MM S C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L40 MM OD4.5 MM SP C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L40 MM OD5.5 MM SP C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L60 MM OD4.5 MM SP C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L60 MM OD5.5 MM IL C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM L60 MM OD5.5 MM SP C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM LEFT OFFSET OD4.5 C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM MINI LEFT OFFSET O C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM MINI RIGHT OFFSET C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD4.5 MM SPINE END C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD4.5 MM SPINE EXT C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD4.5 MM SPINE OPE C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD4.5 MM SPINE SID C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD4.5-4.75 MM SPIN C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD4.5-5.5 MM SPINE C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD4.75-5.5 MM SPIN C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD5.5 MM ODSEC4.75 C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD5.5 MM ODSEC6.35 C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD5.5 MM SPINE END C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD5.5 MM SPINE LAT C1713 $4,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD5.5 MM SPINE OPE C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM OD5.5-6.35 MM SPIN C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM RIGHT OFFSET OD4.5 C1713 $2,000.00CONNECTOR ROD EXPEDIUM TITANIUM STRAIGHT OD4.5 MM C1713 $2,000.00CONNECTOR ROD L100 MM SPINE LATERAL CLOSED OFFSET C1713 $2,000.00CONNECTOR ROD L100 MM SPINE LATERAL OFFSET GRAY C1713 $2,000.00CONNECTOR ROD L14 MM CROSS C1713 $4,000.00CONNECTOR ROD L15 MM SPINE OPEN OFFSET C1713 $1,625.00CONNECTOR ROD L20 MM OD5.5/5.5 MM SPINE OFFSET C1713 $1,625.00CONNECTOR ROD L20 MM SPINE POSTERIOR FUSION C1713 $2,000.00

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 ChargeCONNECTOR ROD L20 MM SPINE SEMIADJUSTABLE TRANSVER C1713 $4,000.00CONNECTOR ROD L23 MM SPINE SEMIADJUSTABLE TRANSVER C1713 $4,000.00CONNECTOR ROD L25 MM LATERAL C1713 $2,000.00CONNECTOR ROD L25 MM OD5.5 MM SPINE OFFSET C1713 $1,625.00CONNECTOR ROD L25 MM SPINE LATERAL CLOSED OFFSET C1713 $2,000.00CONNECTOR ROD L25 MM SPINE LATERAL OFFSET RAIL POS C1713 $2,000.00CONNECTOR ROD L25 MM SPINE OPEN OFFSET C1713 $1,625.00CONNECTOR ROD L26 MM SPINE SEMIADJUSTABLE TRANSVER C1713 $4,000.00CONNECTOR ROD L29 MM SPINE SEMIADJUSTABLE TRANSVER C1713 $4,000.00CONNECTOR ROD L32 MM SPINE SEMIADJUSTABLE TRANSVER C1713 $4,000.00CONNECTOR ROD L35 MM CROSS NONSTERILE REFORM PEDIC C1713 $3,250.00CONNECTOR ROD L35 MM OD5/6-6 MM LATERAL CLOSED C1713 $1,625.00CONNECTOR ROD L35 MM SPINE SEMIADJUSTABLE TRANSVER C1713 $4,000.00CONNECTOR ROD L40 MM CROSS NONSTERILE REFORM PEDIC C1713 $3,250.00CONNECTOR ROD L40 MM OD4.5 MM SPINE AXIAL POSTERIO C1713 $2,000.00CONNECTOR ROD L40 MM SPINE AXIAL POSTERIOR FUSION C1713 $2,000.00CONNECTOR ROD L40 MM SPINE POSTERIOR FUSION C1713 $2,000.00CONNECTOR ROD L40-46 MM SPINE HEAD TO HEAD TRANSVE C1713 $3,250.00CONNECTOR ROD L48 MM CROSS NONSTERILE REFORM PEDIC C1713 $3,250.00CONNECTOR ROD L50 MM SPINE LATERAL CLOSED OFFSET C1713 $2,000.00CONNECTOR ROD L50 MM SPINE LATERAL OFFSET C1713 $2,000.00CONNECTOR ROD L60 MM OD4.5 MM SPINE AXIAL POSTERIO C1713 $2,000.00CONNECTOR ROD L60 MM SPINE AXIAL POSTERIOR FUSION C1713 $2,000.00CONNECTOR ROD L80 MM OD4.5 MM SPINE AXIAL POSTERIO C1713 $2,000.00CONNECTOR ROD L80 MM SPINE AXIAL POSTERIOR FUSION C1713 $2,000.00CONNECTOR ROD L85 MM OD5.5 MM SPINE CONTOUR C1713 $1,000.00CONNECTOR ROD LARGE L100 MM OD5.5 MM SPINE OFFSET C1713 $1,625.00CONNECTOR ROD LARGE L30 MM OD5.5 MM SPINE OFFSET C1713 $1,625.00CONNECTOR ROD LARGE SPINE ADJUSTABLE TRANSVERSE PO C1713 $4,000.00CONNECTOR ROD LATERAL OFFSET L30 MM CLOSED NONSTER C1713 $1,625.00CONNECTOR ROD LEGACY CD HORIZON DOMINO STAINLESS S C1713 $4,000.00CONNECTOR ROD LEGACY CD HORIZON STAINLESS STEEL OD C1713 $4,800.00CONNECTOR ROD LEGACY CD HORIZON TITANIUM OFFSET L6 C1713 $2,000.00CONNECTOR ROD LOTUS OFFSET L11 MM NONSTERILE LATEX C1713 $1,625.00CONNECTOR ROD LOW PROFILE OD31 MM SPINE TRANSVERSE C1713 $4,000.00CONNECTOR ROD LOW PROFILE OD33 MM SPINE TRANSVERSE C1713 $4,000.00CONNECTOR ROD MEDIUM SPINE ADJUSTABLE TRANSVERSE P C1713 $4,000.00CONNECTOR ROD MEDIUM TELESCOPING ARCHED CROSS C1713 $3,250.00CONNECTOR ROD MESA 15- D SMALL STATURE LATERAL OFF C1713 $2,000.00

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 ChargeCONNECTOR ROD MESA 15 D SMALL STATURE LATERAL OFFS C1713 $2,000.00CONNECTOR ROD MESA 30- D SMALL STATURE LATERAL OFF C1713 $2,000.00CONNECTOR ROD MESA 30 D SMALL STATURE LATERAL OFFS C1713 $2,000.00CONNECTOR ROD MESA L31 MM SPINE TRANSVERSE SEMIADJ C1713 $4,000.00CONNECTOR ROD MESA L33 MM SPINE TRANSVERSE SEMIADJ C1713 $4,000.00CONNECTOR ROD MESA NATURAL BRIDGE MEDIUM SPINE TRA C1713 $3,250.00CONNECTOR ROD MESA RAIL LARGE SPINE ADJUSTABLE TRA C1713 $4,000.00CONNECTOR ROD MESA RAIL MEDIUM SPINE ADJUSTABLE TR C1713 $4,000.00CONNECTOR ROD MESA RAIL SMALL SPINE ADJUSTABLE TRA C1713 $4,000.00CONNECTOR ROD MESA RAIL SMALL STATURE L80 MM OD4.5 C1713 $2,000.00CONNECTOR ROD MESA RAIL XS SPINE ADJUSTABLE TRANSV C1713 $4,000.00CONNECTOR ROD MESA SMALL STATURE L20 MM OD4.5 MM S C1713 $2,000.00CONNECTOR ROD MESA SMALL STATURE L38 MM OD4.5 MM S C1713 $4,000.00CONNECTOR ROD MESA SMALL STATURE L40 MM OD4.5 MM S C1713 $2,000.00CONNECTOR ROD MESA SMALL STATURE L60 MM OD4.5 MM S C1713 $2,000.00CONNECTOR ROD MESA SMALL STATURE L80 MM OD4.5 MM S C1713 $2,000.00CONNECTOR ROD MESA SMALL STATURE LATERAL OFFSET L5 C1713 $2,000.00CONNECTOR ROD MONARCH OD5.5 MM SPINE 2 SIDE BY SID C1713 $2,000.00CONNECTOR ROD MONARCH TITANIUM OD5.5 MM ODSEC4.75 C1713 $2,000.00CONNECTOR ROD MONARCH TITANIUM OD5.5 MM SPINE 2 SI C1713 $2,000.00CONNECTOR ROD MONARCH TITANIUM WIDE OD5.5 MM ODSEC C1713 $2,400.00CONNECTOR ROD NARROW PARALLEL OD3.5 MM ODSEC4.5 MM C1713 $2,000.00CONNECTOR ROD NARROW PARALLEL OD4.5 MM ODSEC5.5 MM C1713 $2,000.00CONNECTOR ROD NARROW PARALLEL OD4.5 MM SPINE CLOSE C1713 $2,000.00CONNECTOR ROD NATURAL BRIDGE L16 MM SPINE TRANSVER C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L18 MM SPINE TRANSVER C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L26 MM SPINE TRANSVER C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L27 MM SPINE LOW PROF C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L29 MM SPINE TRANSVER C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L30 MM SPINE LOW PROF C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L32 MM SPINE TRANSVER C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L33 MM SPINE LOW PROF C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L35 MM SPINE TRANSVER C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L36 MM SPINE LOW PROF C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE L39 MM SPINE LOW PROF C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE LARGE SPINE ADJUSTABL C1713 $3,250.00CONNECTOR ROD NATURAL BRIDGE MEDIUM SPINE ADJUSTAB C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE MEDIUM SPINE TRANSVER C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE SMALL SPINE ADJUSTABL C1713 $4,000.00

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 ChargeCONNECTOR ROD NATURAL BRIDGE SMALL SPINE TRANSVERS C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE SPINE LOW PROFILE SEM C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE XL SPINE ADJUSTABLE C1713 $4,000.00CONNECTOR ROD NATURAL BRIDGE XL SPINE ADJUSTABLE L C1713 $4,000.00CONNECTOR ROD NEUTRAL BRIDGE TITANIUM L60 MM THORA C1713 $4,000.00CONNECTOR ROD OD4.5 MM SPINE PARALLEL CLOSED WIDE C1713 $2,000.00CONNECTOR ROD OD4.5 MM SPINE PARALLEL OPEN WIDE PO C1713 $2,000.00CONNECTOR ROD OD5.5 MM SPINE 2 PIECE PARALLEL C1713 $2,000.00CONNECTOR ROD OD5.5 MM SPINE CLAMP C1713 $1,625.00CONNECTOR ROD OD5.5 MM SPINE LEFT INLINE C1713 $5,200.00CONNECTOR ROD OD5.5 MM SPINE OPENED CLOSED C1713 $2,000.00CONNECTOR ROD OD5.5 MM SPINE PARALLEL LINK OPENED C1713 $2,000.00CONNECTOR ROD OD5.5/6.35 MM LATERAL C1713 $13,756.80CONNECTOR ROD OD8.5 MM SPINE END TO END C1713 $2,000.00CONNECTOR ROD OFFSET L25 MM SPINE LATERAL C1713 $1,625.00CONNECTOR ROD OFFSET L50 MM SPINE LATERAL C1713 $1,625.00CONNECTOR ROD PARALLEL SPINE RAIL CLOSE POSTERIOR C1713 $2,000.00CONNECTOR ROD PARALLEL SPINE RAIL OPEN CLOSE POSTE C1713 $2,000.00CONNECTOR ROD PASS LP 20 MM SPINE CLOSED OPEN 1 DO C1713 $1,625.00CONNECTOR ROD PASS LP ANGULATE SPINE NONSTERILE 6 C1713 $1,625.00CONNECTOR ROD PASS LP CLOSED DOMINO NONSTERILE LAT C1713 $1,625.00CONNECTOR ROD PASS LP INLINE DOMINO NONSTERILE C1713 $1,625.00CONNECTOR ROD PASS LP OD6 MM SPINE OPEN NONSTERILE C1713 $1,625.00CONNECTOR ROD PASS LP OFFSET L11.5 MM SPINE NONSTE C1713 $1,625.00CONNECTOR ROD PASS LP OFFSET SPINE NONSTERILE LATE C1713 $1,625.00CONNECTOR ROD PASS LP PARALLEL SPINE CLOSED OPEN D C1713 $2,000.00CONNECTOR ROD PASS LP SHORT ANGLE LEFT SPINE ILIAC C1713 $1,625.00CONNECTOR ROD PASS LP SHORT ANGLE RIGHT SPINE ILIA C1713 $1,625.00CONNECTOR ROD PASS LP SHORT SPINE ILIAC NONSTERILE C1713 $1,625.00CONNECTOR ROD PASS LP SPINE CLEMENT DEROTATION NON C1713 $2,600.00CONNECTOR ROD PASS LP SPINE CLOSED 1 DOMINO NONSTE C1713 $1,625.00CONNECTOR ROD PASS LP SPINE CLOSED OPEN 1 DOMINO N C1713 $1,625.00CONNECTOR ROD PASS LP SPINE REALIGNMENT NONSTERILE C1713 $1,625.00CONNECTOR ROD PASS LP STANDARD SPINE NONSTERILE 5. C1713 $1,625.00CONNECTOR ROD PASS LP STANDARD SPINE NONSTERILE 6 C1713 $1,625.00CONNECTOR ROD PASS LP STRAIGHT SPINE ILIAC NONSTER C1713 $1,625.00CONNECTOR ROD PASS MIS SHORT OD5.5 MM INITIAL NONS C1713 $1,625.00CONNECTOR ROD PASS MIS SHORT STANDARD NONSTERILE L C1713 $1,625.00CONNECTOR ROD PASS OCT 6-10 MM OFFSET SPINE NONSTE C1713 $1,625.00

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 ChargeCONNECTOR ROD PASS TULIP L30 MM SPINE ILIAC CLOSED C1713 $2,860.00CONNECTOR ROD PASS TULIP L30 MM SPINE ILIAC OPEN N C1713 $2,860.00CONNECTOR ROD POLARIS L25 MM OD5.5 MM SPINE HELICA C1713 $2,000.00CONNECTOR ROD POLARIS STAINLESS STEEL L12 MM OD5.5 C1713 $4,000.00CONNECTOR ROD POLARIS STAINLESS STEEL L35 MM OD5.5 C1713 $2,000.00CONNECTOR ROD POLARIS STAINLESS STEEL L50 MM OD5.5 C1713 $2,000.00CONNECTOR ROD POLARIS STAINLESS STEEL L75 MM OD5.5 C1713 $2,000.00CONNECTOR ROD POLARIS TITANIUM 2XS OD5.5 MM SPINE C1713 $4,000.00CONNECTOR ROD POLARIS TITANIUM L12 MM OD5.5 MM SPI C1713 $4,000.00CONNECTOR ROD POLARIS TITANIUM L14 MM OD5.5 MM SPI C1713 $4,000.00CONNECTOR ROD POLARIS TITANIUM L16 MM THORACOLUMBA C1713 $4,000.00CONNECTOR ROD POLARIS TITANIUM L35 MM SPINE LATERA C1713 $2,000.00CONNECTOR ROD POLARIS TITANIUM L50 MM OD5.5 MM SPI C1713 $2,000.00CONNECTOR ROD POLARIS TITANIUM L50 MM OD6.35 MM SP C1713 $1,625.00CONNECTOR ROD POLARIS TITANIUM L75 MM OD5.5 MM SPI C1713 $1,625.00CONNECTOR ROD POLARIS TITANIUM LARGE OD5.5 MM SPIN C1713 $4,000.00CONNECTOR ROD POLARIS TITANIUM MEDIUM OD5.5 MM SPI C1713 $4,000.00CONNECTOR ROD POLARIS TITANIUM SMALL OD5.5 MM SPIN C1713 $4,000.00CONNECTOR ROD POLARIS TITANIUM XS OD5.5 MM SPINE T C1713 $4,000.00CONNECTOR ROD RAIL +15 D LATERAL OFFSET L25 MM SPI C1713 $2,000.00CONNECTOR ROD RAIL 15 D DOWN OFFSET OD25 MM SPINE C1713 $2,000.00CONNECTOR ROD RAIL 15 D DOWN OFFSET OD50 MM SPINE C1713 $2,000.00CONNECTOR ROD RAIL -15 D LATERAL OFFSET L25 MM SPI C1713 $2,000.00CONNECTOR ROD RAIL 15 D UP OFFSET OD25 MM SPINE LA C1713 $2,000.00CONNECTOR ROD RAIL 15 D UP OFFSET OD50 MM SPINE LA C1713 $2,000.00CONNECTOR ROD RAIL LATERAL OFFSET L25 MM SPINE CLO C1713 $2,000.00CONNECTOR ROD RAIL LATERAL OFFSET L25 MM SPINE POS C1713 $2,000.00CONNECTOR ROD RAIL LATERAL OFFSET L50 MM SPINE POS C1713 $2,000.00CONNECTOR ROD RAIL OFFSET L50 MM SPINE LATERAL CLO C1713 $2,000.00CONNECTOR ROD RAIL OFFSET OD25 MM SPINE LATERAL CL C1713 $2,000.00CONNECTOR ROD RAIL OFFSET OD50 MM SPINE LATERAL CL C1713 $2,000.00CONNECTOR ROD RAIL OFFSET OD50 MM SPINE LATERAL PO C1713 $2,000.00CONNECTOR ROD REFORM NARROW PARALLEL DOMINO SPINE C1713 $1,625.00CONNECTOR ROD REFORM WIDE PARALLEL DOMINO SPINE CL C1713 $1,625.00CONNECTOR ROD REVERE ADDITION L15 MM SPINE HEAD OF C1713 $1,625.00CONNECTOR ROD REVERE CLOSED OFFSET L120 MM OD5.5 M C1713 $1,625.00CONNECTOR ROD REVERE CLOSED OFFSET L15 MM OD5.5 MM C1713 $1,625.00CONNECTOR ROD REVERE CLOSED OFFSET L150 MM OD5.5 M C1713 $1,625.00CONNECTOR ROD REVERE CLOSED OFFSET L35 MM OD5.5 MM C1713 $1,625.00

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 ChargeCONNECTOR ROD REVERE OFFSET W30 MM SPINE NONSTERIL C1713 $1,625.00CONNECTOR ROD REVERE WIDE W12 MM OD5.5 MM SPINE 2 C1713 $1,625.00CONNECTOR ROD SFX STAINLESS STEEL F13 OD6.35 MM SP C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL F14 OD6.35 MM SP C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P1 L13 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P10 L24 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P11 L26 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P12 L28 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P13 L30 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P14 L32 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P15 L34 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P16 L36 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P17 L39 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P18 L42 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P19 L45 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P2 L14 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P3 L15 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P4 L16 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P5 L17 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P6 L18 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P7 L19 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P8 L20 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX STAINLESS STEEL P9 L22 MM OD4.5 C1713 $4,000.00CONNECTOR ROD SFX TITANIUM A1 OD6.35 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM A2 OD5.5 MM SPINE MEDIA C1713 $4,000.00CONNECTOR ROD SFX TITANIUM A2 OD6.35 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM A3 OD6.35 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM A4 OD6.35 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM A6 OD6.35 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM A7 OD5.5 MM SPINE MEDIA C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F1 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F1 OD6.35 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F10 OD5.5 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F10 OD5.5 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F10 OD6.35 MM SPINE MED C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F11 OD5.5 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F11 OD5.5 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F11 OD6.35 MM SPINE MED C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F12 OD5.5 MM SPINE LATE C1713 $4,000.00

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 ChargeCONNECTOR ROD SFX TITANIUM F12 OD5.5 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F12 OD6.35 MM SPINE MED C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F2 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F2 OD6.35 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F3 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F3 OD6.35 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F4 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F4 OD6.35 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F5 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F5 OD6.35 MM SPINE LATE C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F6 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F6 OD5.5 MM SPINE MEDIA C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F6 OD6.35 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F7 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F7 OD6.35 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F8 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F8 OD5.5 MM SPINE MEDIA C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F8 OD6.35 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F9 OD5.5 MM SPINE LATER C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F9 OD5.5 MM SPINE MEDIA C1713 $4,000.00CONNECTOR ROD SFX TITANIUM F9 OD6.35 MM SPINE MEDI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P1 L13 MM OD4.5 MM SPIN C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P10 L24 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P11 L26 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P12 L28 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P13 L30 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P14 L32 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P15 L34 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P16 L36 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P17 L39 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P18 L42 MM OD5.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P19 L45 MM OD4.5 MM SPI C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P2 L14 MM OD4.5 MM SPIN C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P3 L15 MM OD4.5 MM SPIN C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P4 L16 MM OD4.5 MM SPIN C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P5 L17 MM OD4.5 MM SPIN C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P6 L18 MM OD4.5 MM SPIN C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P7 L19 MM OD4.5 MM SPIN C1713 $4,000.00CONNECTOR ROD SFX TITANIUM P8 L20 MM OD4.5 MM SPIN C1713 $4,000.00

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 ChargeCONNECTOR ROD SFX TITANIUM P9 L22 MM OD4.5 MM SPIN C1713 $4,000.00CONNECTOR ROD SILVERTON TITANIUM L48-60 MM SPINE C C1713 $3,250.00CONNECTOR ROD SILVERTON TITANIUM L58-80 MM SPINE V C1713 $3,250.00CONNECTOR ROD SMALL OD3.5 MM SPINE 2 C1713 $1,625.00CONNECTOR ROD SMALL OD3.5/5.5 MM SPINE 2 C1713 $1,625.00CONNECTOR ROD SMALL SPINE ADJUSTABLE TRANSVERSE PO C1713 $4,000.00CONNECTOR ROD SOLERA L20 MM OD5/6-6 MM SPINE ILIUM C1713 $1,625.00CONNECTOR ROD SOLERA L25 MM OD4.75 MM ILIAC SPINE C1713 $1,625.00CONNECTOR ROD SPINE LINK OPENED CLOSED C1713 $2,000.00CONNECTOR ROD STAINLESS STEEL L12 MM OD5.5 MM LATE C1713 $2,400.00CONNECTOR ROD STAINLESS STEEL L150 MM OD5.5 MM SPI C1713 $2,000.00CONNECTOR ROD STAINLESS STEEL L20 MM OD5.5 MM SPIN C1713 $2,000.00CONNECTOR ROD STAINLESS STEEL L200 MM OD5.5 MM SPI C1713 $2,000.00CONNECTOR ROD STAINLESS STEEL L32 MM OD4.5 MM LATE C1713 $2,000.00CONNECTOR ROD STAINLESS STEEL L32 MM OD5.5 MM LATE C1713 $2,400.00CONNECTOR ROD STAINLESS STEEL L32 MM OD6.35 MM LAT C1713 $2,400.00CONNECTOR ROD STAINLESS STEEL L40 MM OD5.5 MM SPIN C1713 $2,000.00CONNECTOR ROD STAINLESS STEEL L60 MM OD5.5 MM SPIN C1713 $2,000.00CONNECTOR ROD STAINLESS STEEL L60 MM OD6.35 MM SPI C1713 $2,400.00CONNECTOR ROD STAINLESS STEEL SMALL OD5 MM ODSEC6 C1713 $2,000.00CONNECTOR ROD STAINLESS STEEL SMALL OD5 MM SPINE P C1713 $2,000.00CONNECTOR ROD SYNERGY STAINLESS STEEL L15.5 MM THO C1713 $3,350.88CONNECTOR ROD SYNERGY STAINLESS STEEL OD4.75/6.35 C1713 $4,867.20CONNECTOR ROD TIGER L16 MM SPINE LATERAL CLOSED NO C1713 $1,625.00CONNECTOR ROD TIGER L16 MM SPINE LATERAL TOP LOAD C1713 $1,625.00CONNECTOR ROD TIGER L17-28 MM SPINE CROSS NONSTERI C1713 $3,250.00CONNECTOR ROD TIGER L30-37 MM SPINE CROSS NONSTERI C1713 $3,250.00CONNECTOR ROD TIGER L35-41 MM SPINE TRANSVERSE HEA C1713 $3,250.00CONNECTOR ROD TIGER L37-50 MM SPINE CROSS NONSTERI C1713 $3,250.00CONNECTOR ROD TIGER L8.5 MM SPINE LATERAL TOP LOAD C1713 $1,625.00CONNECTOR ROD TIGER OD3.5 MM ODSEC5.5 MM SPINE CLO C1713 $487.50CONNECTOR ROD TIGER OD3.5 MM SPINE ROD TO ROD END C1713 $487.50CONNECTOR ROD TIGER OD8.5 MM SPINE LATERAL CLOSED C1713 $1,625.00CONNECTOR ROD TITANIUM ANGLE OD5.5-6.35 MM SPINE O C1713 $1,625.00CONNECTOR ROD TITANIUM L12 MM OD4.5 MM LATERAL SPI C1713 $2,400.00CONNECTOR ROD TITANIUM L12 MM OD6.35 MM LATERAL C1713 $2,400.00CONNECTOR ROD TITANIUM L13.5 MM SPINE TRANSVERSE C1713 $948.48CONNECTOR ROD TITANIUM L22 MM OD5.5 MM LATERAL SPI C1713 $2,000.00CONNECTOR ROD TITANIUM L32 MM OD4.5 MM LATERAL SPI 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 ChargeCONNECTOR ROD TITANIUM L32 MM OD6.35 MM LATERAL SP C1713 $2,400.00CONNECTOR ROD TITANIUM L40-45 MM SPINE CROSS FIX C1713 $3,250.00CONNECTOR ROD TITANIUM L45 MM SPINE CROSS VARIABLE C1713 $3,250.00CONNECTOR ROD TITANIUM OD5.5 MM SPINE SLOTTED C1713 $4,800.00CONNECTOR ROD TITANIUM WIDE T20 HEXALOBE L21 MM X C1713 $1,625.00CONNECTOR ROD TSRH SMALL SPINE 3DX C1713 $400.00CONNECTOR ROD TSRH TITANIUM LARGE SPINE 3DX C1713 $4,800.00CONNECTOR ROD TSRH TITANIUM MEDIUM SPINE 3DX C1713 $4,800.00CONNECTOR ROD TSRH TITANIUM SMALL SPINE 3DX C1713 $4,800.00CONNECTOR ROD UNIVERSAL SPINE C1713 $2,083.20CONNECTOR ROD VEPTR II TITANIUM L6 MM OD5 MM SPINE C1713 $4,000.00CONNECTOR ROD VEPTR II TITANIUM L6 MM OD6 MM SPINE C1713 $4,000.00CONNECTOR ROD VEPTR II TITANIUM OD6 MM SPINE EXTEN C1713 $4,000.00CONNECTOR ROD VEPTR TITANIUM OD5 MM ODSEC6 MM SPIN C1713 $4,000.00CONNECTOR ROD VERTEX L10 MM LATERAL CLOSED C1713 $1,625.00CONNECTOR ROD VERTEX MAX TITANIUM L10 MM LATERAL S C1713 $2,400.00CONNECTOR ROD VERTEX MAX TITANIUM L13 MM LATERAL S C1713 $2,400.00CONNECTOR ROD VERTEX SPINE TRANSVERSE C1713 $1,625.00CONNECTOR ROD VIRAGE TITANIUM ALUMINUM VANADIUM OF C1713 $1,625.00CONNECTOR ROD VITALITY TITANIUM W41-51 MM OD5.5 MM C1713 $3,250.00CONNECTOR ROD VITALITY TITANIUM W51-70 MM OD5.5 MM C1713 $3,250.00CONNECTOR ROD VUEPOINT L120 MM OD3.5 MM POSTERIOR C1713 $812.50CONNECTOR ROD WIDE OD5.5/5.5 MM SPINE PARALLEL CLA C1713 $1,625.00CONNECTOR ROD WIDE PARALLEL OD3.5 MM ODSEC4.5 MM S C1713 $2,000.00CONNECTOR ROD WIDE PARALLEL OD4.5 MM ODSEC5.5 MM S C1713 $2,000.00CONNECTOR ROD XIA 15 D OD4.5 MM SPINE ILIAC STRAIG C1713 $2,000.00CONNECTOR ROD XIA 25 D OD4.5 MM SPINE ILIAC STRAIG C1713 $2,000.00CONNECTOR ROD XIA 3 TITANIUM MEDIUM L30-36 MM THOR C1713 $4,000.00CONNECTOR ROD XIA 3 TITANIUM SMALL L24-30 MM THORA C1713 $4,000.00CONNECTOR ROD XIA 35 D OD4.5 MM SPINE ILIAC STRAIG C1713 $2,000.00CONNECTOR ROD XIA 45 D OD4.5 MM SPINE ILIAC STRAIG C1713 $2,000.00CONNECTOR ROD XIA L19 MM OD4.5 MM SPINE MONOBLOCK C1713 $2,000.00CONNECTOR ROD XIA L60 MM OD4.5 MM SPINE C1713 $2,000.00CONNECTOR ROD XIA L70 MM OD4.5 MM SPINE OFFSET C1713 $2,000.00CONNECTOR ROD XIA LONG OD4.5 MM SPINE EXTEND C1713 $2,000.00CONNECTOR ROD XIA MAC STAINLESS STEEL L42-51 MM TH C1713 $4,000.00CONNECTOR ROD XIA MAC TITANIUM L18 MM ANTERIOR THO C1713 $4,000.00CONNECTOR ROD XIA STAINLESS STEEL SMALL L35-37 MM C1713 $4,000.00CONNECTOR ROD XIA TITANIUM ILIAC SPINE STRAIGHT C1713 $2,000.00

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 ChargeCONNECTOR ROD XIA TITANIUM L30 MM OD4.5 MM SPINE O C1713 $2,000.00CONNECTOR ROD XIA TITANIUM L30 MM OD4.5 MM SPINE R C1713 $2,000.00CONNECTOR ROD XIA TITANIUM LARGE L36-45 MM THORACO C1713 $4,000.00CONNECTOR ROD XIA TITANIUM LARGE L45-60 MM SPINE T C1713 $4,000.00CONNECTOR ROD XIA TITANIUM SMALL THORACOLUMBAR SPI C1713 $2,000.00CONNECTOR ROD XL SPINE TRANSVERSE ADJUSTABLE POSTE C1713 $4,000.00CONNECTOR SHUNT ACCU-FLO PLASTIC 3 WAY $1,712.00CONNECTOR SHUNT ACCU-FLO PLASTIC CSF CATHETER 3 WA $1,864.00CONNECTOR SHUNT ACCU-FLO PLASTIC STRAIGHT $752.00CONNECTOR SHUNT STAINLESS STEEL STRAIGHT OD1.8 MM $2,356.00CONNECTOR SHUNT STANDARD STEPDOWN TUBE $461.50CONSCIOUS SEDATION NON-INTRAVENOUS D9248 $515.00CONSULTATION ON X-RAY IMAGING 76140 $1,562.00CONTRAST INJECTION FOR X-RAY IMAGING PROCEDURE TO 36598 $621.00CONTRAST INJECTS X-RAY IMAGING THRU EXIST TUBE STO 49465 $548.00CONTROL OF ANAL BLEEDING USING AN ENDOSCOPE 46614 $3,525.00CONTROL OF BLEEDING IN LARGE BOWEL USING AN ENDOSC 45334 $40.00CONTROL OF BLEEDING IN LARGE BOWEL USING AN ENDOSC 45382 $3,086.00CONTROL OF BLEEDING IN RECTUM AND LARGE BOWEL USIN 45317 $20.00CONTROL OF BLEEDING OF ESOPHAGUS STOMACH AND/OR UP 43255 $4,137.00CONTROL OF BLEEDING OF THROAT 42960 $1,840.00CONTROL OF BLEEDING OF THROAT WITH INSERTION OF PA 42972 $6,063.00CONTROL OF NASAL BLEEDING USING AN ENDOSCOPE 31238 $6,036.00CONTROL OF NOSE BLEED AND INSERTION OF PACKING 30905 $332.00CONVERSION OF STOMACH TUBE TO SMALL BOWEL TUBE 49446 $3,331.00CONVERSION TO TWO CHAMBER PACEMAKER SYSTEM 33214 $38,991.00CONVERT EXTERNAL BILIARY DRAIN CATH TO INTERNAL-EX 47535 $9,736.00CONVERT NEPHROSTOMY CATH TO NEPHROURETERAL CATHETE 50434 $2,346.00CONVERT STOMACH TUBE TO SMALL BOWEL TUBE (ACCESSED 44373 $4,947.00COPPER LEVEL 82525 $96.00CORD ELECTROSURGICAL AUTOCON L300 CM OD8 MM UNIPOL $1,192.10CORE BUILD-UP INCLUDING ANY PINS D2950 $474.00CORNEAL HYSTERESIS DETERMINATION 92145 $129.00CORTISOL (HORMONE) MEASUREMENT 82533 $127.00CORTISOL (HORMONE) MEASUREMENT 82530 $105.00CORTISOL 30 MINUTE 80400 $252.00CORTISOL 60 MINUTE 80400 $252.00CORTISOL BASELINE 80400 $252.00CORTISOL TOTAL 82533 $127.00

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 ChargeCOSMETIC SELF-PAY BOTOX PER UNIT $9.00COSMETIC SELF-PAY CHEMICAL PEEL GLYCOLIC $75.00COSMETIC SELF-PAY CHEMICAL PEEL JESSNER $75.00COSMETIC SELF-PAY CHEMICAL PEEL SAL ACID $75.00COSMETIC SELF-PAY CHEMICAL PEEL TCA $50.00COSMETIC SELF-PAY COSMETIC FACILITY FEE $25.00COSMETIC SELF-PAY JUVEDERM ULTRA PLUS XC $375.00COSMETIC SELF-PAY JUVEDERM ULTRA XC $350.00COSMETIC SELF-PAY PERLANE L $350.00COSMETIC SELF-PAY PUNCH EXCISION $100.00COSMETIC SELF-PAY RADIESSE 0.8ML $200.00COSMETIC SELF-PAY RADIESSE 1.5ML $400.00COSMETIC SELF-PAY REMOVAL OF BENIGN SKIN LESIONS $82.50COSMETIC SELF-PAY RESTYLANE L 0.4CC $200.00COSMETIC SELF-PAY RESTYLANE L 1CC $300.00COSMETIC SELF-PAY SCAR REVISION $100.00COSMETIC SELF-PAY SCLER BOTH LEGS $150.00COSMETIC SELF-PAY SCLERO SPOT $25.00COSMETIC SELF-PAY SLER ONE LEG $75.00COUNTER EXTERNAL FIXATION ILIZAROV STAINLESS STEEL $578.72COUNTERSINK DRILL AO FIT 2.7/3.5 MM SCREW $666.90COUNTERSINK DRILL ASNIS MICRO 3 MM OD3.8 MM AO COU $1,293.50COUNTERSINK DRILL CANNULATED CENTERING PIN NONSTER $2,423.47COUNTERSINK DRILL CANNULATED QUICK COUPLING NONSTE $2,021.96COUNTERSINK DRILL OD2 MM 3.5 MM CORTEX 4 MM CANCEL C1713 $1,025.76COUNTERSINK DRILL PONTO 4 MM L26-30 MM OD4.5 MM GU $1,337.70COUNTERSINK DRILL WIDE OD3 MM STERILE DISPOSABLE $1,337.70COUPLER ANASTOMOSIS GEM MICROVASCULAR ANASTOMOSES $1,760.42COUPLER ANASTOMOSIS GEM MICROVASCULAR STAINLESS ST $1,495.83COUPLER ANASTOMOSIS GEM STAINLESS STEEL POLYETHYLE $1,495.83COUPLER EXTERNAL FIXATION JET-X ADD A BAR $1,210.72COUPLER EXTERNAL FIXATION OPTIROM $2,860.80COUPLING EXTERNAL FIXATION COMPACT HOFFMANN II OD5 $6,240.00COUPLING EXTERNAL FIXATION HOFFMANN 3 INVERT PIN T $3,322.80COUPLING EXTERNAL FIXATION HOFFMANN 3 PIN TO ROD M $1,847.04COUPLING EXTERNAL FIXATION HOFFMANN 3 ROD TO ROD D $3,322.80COUPLING EXTERNAL FIXATION HOFFMANN II 4-5 MM 8 MM $3,605.76COUPLING EXTERNAL FIXATION HOFFMANN II COMPACT MR $3,290.88COUPLING EXTERNAL FIXATION HOFFMANN II COMPACT OD1 $2,215.68

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 ChargeCOUPLING EXTERNAL FIXATION HOFFMANN II COMPACT OD8 $3,417.07COUPLING EXTERNAL FIXATION HOFFMANN II COMPACT ROD $5,208.00COUPLING EXTERNAL FIXATION HOFFMANN II INVERT PIN $3,571.20COUPLING EXTERNAL FIXATION HOFFMANN II MRI ROD TO $3,571.20COUPLING EXTERNAL FIXATION HOFFMANN II OD8 MM ROD $3,571.20COUPLING EXTERNAL FIXATION HOFFMANN II STANDARD OD $3,851.52COVER ABUTMENT PONTO ACCESSORY BEIGE AUDITORY OSSE $338.00COVER BURR HOLE CRANIOMAXILLOFACIAL 10 HOLE RAPID C1713 $2,400.00COVER BURR HOLE CRANIOMAXILLOFACIAL 8 HOLE RAPID R C1713 $2,400.00COVER BURR HOLE LEIBINGER UNIVERSAL 2 TITANIUM STA C1713 $1,466.56COVER BURR HOLE MATRIXNEURO TITANIUM H.4 MM OD12 M C1713 $1,171.68COVER BURR HOLE MATRIXNEURO TITANIUM H.4 MM OD15 M C1713 $1,808.80COVER BURR HOLE MATRIXNEURO TITANIUM H.4 MM OD17 M C1713 $1,808.80COVER BURR HOLE MATRIXNEURO TITANIUM H.4 MM OD24 M C1713 $1,808.80COVER BURR HOLE OD10 MM CRANIUM LOW PROFILE 3 MM S C1713 $1,758.51COVER BURR HOLE TIMESH TITANIUM OD18 MM CRANIAL FA C1713 $1,391.00COVER BURR HOLE TIMESH TITANIUM TRISTAR STANDARD O C1713 $1,423.50COVER BURR HOLE TITANIUM H.5 MM OD12 MM CRANIOMAXI C1713 $1,719.20COVER BURR HOLE TITANIUM H.5 MM OD15 MM 6 HOLE LOW C1713 $1,719.20COVER BURR HOLE TITANIUM H.5 MM OD15 MM CRANIOFACI C1713 $882.00COVER BURR HOLE TITANIUM H.5 MM OD17 MM 6 HOLE LOW C1713 $1,719.20COVER BURR HOLE TITANIUM H.5 MM OD17 MM CRANIOMAXI C1713 $1,719.20COVER BURR HOLE TITANIUM H.5 MM OD24 MM CRANIOFACI C1713 $1,719.20COVER BURR HOLE TITANIUM OD12 MM CRANIOFACIAL 6 HO C1713 $1,758.00COVER BURR HOLE TITANIUM OD17 MM CRANIOFACIAL 6 HO C1713 $1,758.00COVER BURR HOLE TITANIUM OD20 MM CRANIOMAXILLOFACI C1713 $1,461.92COVER BURR HOLE TITANIUM OD7 MM CRANIOMAXILLOFACIA C1713 $1,323.92COVER BURR HOLE UNIVERSAL NEURO 2 TITANIUM MEDIUM C1713 $1,323.92COVER BURR HOLE UNIVERSAL NEURO II THK.05 MM OD14 C1713 $1,323.92COVER BURR HOLE UNIVERSAL NEURO III H.4 MM OD14 MM C1713 $1,718.40COVER BURR HOLE UNIVERSAL NEURO III LOW PROFILE OD $1,718.40COVER BURR HOLE UNIVERSAL NEURO III OD20 MM LOW PR C1713 $1,893.92COVER BURR HOLE UNIVERSAL NEURO III OD24 MM CRANIO C1713 $2,085.44COVER BURR HOLE UNIVERSAL NEURO III TITANIUM L14 M C1713 $1,893.92COVER BURR HOLE UNIVERSAL NEURO III TITANIUM L20 M C1713 $2,085.44COVER BURR HOLE WURZBURG MICROPLUS TITANIUM OD14 M C1713 $1,758.51COVER LOCKING DURANGO TITANIUM ZERO H16 MM SPINE N C1713 $1,625.00C-PEPTIDE (PROTEIN) LEVEL 84681 $162.00CRADLE RIB VEPTR II TITANIUM 10 220 MM RADIUS SPIN C1713 $11,043.20

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 ChargeCRADLE RIB VEPTR II TITANIUM 10 500 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 11 220 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 11 500 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 12 220 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 12 500 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 13 220 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 13 500 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 14 500 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 15 500 MM RADIUS SPIN C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 3 220 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 4 220 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 4 500 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 5 220 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 5 500 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 6 220 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 6 500 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 7 220 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 7 500 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 7 500 MM RADIUS SPINE C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 8 220 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 8 500 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 9 220 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR II TITANIUM 9 500 MM RADIUS SPINA C1713 $11,043.20CRADLE RIB VEPTR TITANIUM 10 220 MM RADIUS INFERIO C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 10 220 MM RADIUS NEUTRAL C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 10 70 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 10 70 MM RADIUS NEUTRAL C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 11 220 MM RADIUS LEFT AN C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 11 220 MM RADIUS NEUTRAL C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 11 220 MM RADIUS RIGHT A C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 11 70 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 11 70 MM RADIUS NEUTRAL C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 12 220 MM RADIUS INFERIO C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 12 220 MM RADIUS NEUTRAL C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 12 220 MM RADIUS SPINE E C1713 $3,958.40CRADLE RIB VEPTR TITANIUM 13 220 MM RADIUS INFERIO C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 13 220 MM RADIUS NEUTRAL C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 220 MM RADIUS NEUTRAL SP C1713 $7,116.80CRADLE RIB VEPTR TITANIUM 220 MM RADIUS SUPERIOR T C1713 $7,116.80

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 ChargeCRADLE RIB VEPTR TITANIUM 4 220 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 4 70 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 5 220 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 5 70 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 6 220 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 6 220 MM RADIUS LEFT ANG C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 6 70 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 7 220 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 7 70 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 70 MM RADIUS SUPERIOR TH C1713 $7,116.80CRADLE RIB VEPTR TITANIUM 8 220 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 8 220 MM RADIUS LEFT ANG C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 8 70 MM LEFT ANGLE INFER C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 8 70 MM RADIUS INFERIOR C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 9 220 MM RADIUS LEFT ANG C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 9 220 MM RADIUS NEUTRAL C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 9 220 MM RADIUS RIGHT AN C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 9 70 MM RADIUS LEFT ANGL C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 9 70 MM RADIUS NEUTRAL S C1713 $8,688.00CRADLE RIB VEPTR TITANIUM 9 70 MM RADIUS RIGHT ANG C1713 $8,688.00CRADLE RIB VEPTR TITANIUM SPINE END HALF NONSTERIL C1713 $3,958.40CREATE OPENINGS IN IRIS FOR EYE FLUID DRAIN USING 66762 $1,833.00CREATINE KINASE (CARDIAC ENZYME) LEVEL 82550 $64.00CREATINE KINASE (CARDIAC ENZYME) LEVEL 82553 $112.00CREATINE KINASE (CARDIAC ENZYME) LEVEL 82552 $104.00CREATININE CLEARANCE MEASUREMENT TO TEST FOR KIDNE 82575 $73.00CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MU 82570 $40.00CREATININE URINE 82570 $40.00CREATION OF ABDOMINAL CAVITY CATHETER EXIT SITE 49436 $4,433.00CREATION OF BLOOD FLOW TRACT FROM PENIS TO GROIN V 54420 $6,736.00CREATION OF DRAINAGE TRACT FOR FEMALE GENITAL GLAN 56440 $5,366.00CREATION OF DRAINAGE TRACT FOR SPINAL FLUID 62180 $490.00CREATION OF MULTIPLE TISSUE SKIN GRAFT 15760 $5,755.00CREATION OF OPENING OF WINDPIPE AND WITH INSERTION 31611 $5,111.00CREATION OF PERMANENT EYELID MARGIN SCARRING 67880 $5,041.00CREATION OF SKIN AND TISSUE GRAFT 15740 $4,047.00CREATION OF TRACT TO DRAIN SALIVARY GLAND CYST 42409 $6,639.00CRITICAL CARE EACH ADDL 30 MINUTES 99292 $532.00CRITICAL CARE FIRST 30-74 MINUTE 99291 $3,194.00

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 ChargeCROSSLINK SPINAL L15 MM C1713 $2,000.00CROSSLINK SPINAL OVERWATCH L34-42 MM ADJUSTABLE NO C1713 $3,250.00CROSSLINK SPINAL OVERWATCH L42-58 MM ADJUSTABLE NO C1713 $3,250.00CROSSLINK SPINAL OVERWATCH L54-80 MM ADJUSTABLE NO C1713 $3,250.00CROSSLINK SPINAL PASS LP L22-34 MM NONSTERILE 6 MM C1713 $4,000.00CROSSLINK SPINAL PASS LP L22-34 MM POLYAXIAL LOW P C1713 $3,250.00CROSSLINK SPINAL PASS LP MEDIUM DISTANCE NONSTERIL C1713 $3,250.00CROSSLINK SPINAL PASS LP SMALL DISTANCE NONSTERILE C1713 $3,250.00CROSSLINK SPINAL XIA STAINLESS STEEL L31-34 MM THO C1713 $4,000.00CROSSLINK SPINAL XIA STAINLESS STEEL L38-43 MM THO C1713 $4,000.00CROWN FULL CAST NOBLE METAL D2792 $2,214.00CROWN LENGTHENING D4249 $977.00CROWN PORCELAIN/CERAMIC D2740 $2,767.00CROWN PREFABRICATED STAINLESS STEEL D2930 $471.00CROWN REPAIR D2980 $152.00CROWN RESIN BASED D2710 $299.00CROWN RESIN NOBLE METAL D2722 $422.00CROWN RESIN WITH HIGH NOBLE METAL D2720 $495.00CRRT DIALYSIS 90945 $1,423.00CRYOFIBRINOGEN (PROTEIN) LEVEL 82585 $66.00CRYOGLOBULIN (PROTEIN) MEASUREMENT 82595 $50.00CRYPTOCOCCUS AG 87899 $73.00CRYPTOCOCCUS ANTIGEN TITER CSF 86406 $82.00CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID 89060 $57.00C-SECTION / L&D OR LEVEL 1 EACH ADDITIONAL 15 MINU $1,941.00C-SECTION / L&D OR LEVEL 1 FIRST 15 MINUTES $2,787.00C-SECTION / L&D OR LEVEL 2 EACH ADDITIONAL 15 MINU $9,555.00C-SECTION / L&D OR LEVEL 2 FIRST 15 MINUTES $9,555.00C-SECTION / L&D OR LEVEL 3 EACH ADDITIONAL 15 MINU $361.00C-SECTION / L&D OR LEVEL 3 FIRST 15 MINUTES $9,555.00CT ANGIOGRAPHY AORTA FOR PLANNING G0288 $2,234.00CT CONE BEAM INTERPRETATION JAWS D0367 $2,949.00CT CONE BEAM INTERPRETATION TMJ D0368 $2,594.00CT LUNG LOW DOSE CANCER SCREENING G0297 $249.00CT SCAN ABDOMEN 74150 $839.00CT SCAN ABDOMEN BEFORE AND AFTER CONTRAST 74170 $1,592.00CT SCAN ABDOMEN WITH CONTRAST 74160 $1,436.00CT SCAN BONE MINERAL DENSITY STUDY 1 OR MORE SITES 77078 $357.00CT SCAN CHEST 71250 $839.00

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 ChargeCT SCAN CHEST BEFORE AND AFTER CONTRAST 71270 $1,592.00CT SCAN CHEST WITH CONTRAST 71260 $1,436.00CT SCAN GUIDANCE FOR AND MONITORING OF TISSUE DEST 77013 $680.00CT SCAN GUIDANCE FOR INSERTION OF RADIATION THERAP 77014 $357.00CT SCAN GUIDANCE FOR STEREOTACTIC LOCALIZATION 77011 $579.00CT SCAN HEAD OR BRAIN 70450 $1,049.00CT SCAN HEAD OR BRAIN BEFORE AND AFTER CONTRAST 70470 $1,914.00CT SCAN HEAD OR BRAIN WITH CONTRAST 70460 $1,795.00CT SCAN LEG 73700 $1,049.00CT SCAN LEG WITH CONTRAST INJECTION 73701 $1,795.00CT SCAN LIMITED OR FOLLOW-UP STUDY 76380 $478.00CT SCAN OF ABDOMEN AND PELVIS 74176 $1,479.00CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CON 74178 $2,333.00CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST 74177 $2,333.00CT SCAN OF ABDOMINAL AND PELVIC BLOOD VESSELS WITH 74174 $2,333.00CT SCAN OF ABDOMINAL AORTA AND BOTH LEG ARTERIES W 75635 $1,640.00CT SCAN OF ABDOMINAL BLOOD VESSELS WITH CONTRAST 74175 $1,640.00CT SCAN OF ARM 73200 $1,049.00CT SCAN OF ARM BEFORE AND AFTER CONTRAST 73202 $1,990.00CT SCAN OF ARM BLOOD VESSELS WITH CONTRAST 73206 $2,050.00CT SCAN OF ARM WITH CONTRAST 73201 $1,795.00CT SCAN OF BLOOD VESSEL OF HEAD WITH CONTRAST 70496 $1,683.00CT SCAN OF BLOOD VESSELS IN CHEST WITH CONTRAST 71275 $1,640.00CT SCAN OF CONGENITAL HEART STRUCTURE DEFECT WITH 75573 $1,291.00CT SCAN OF CRANIAL CAVITY 70480 $839.00CT SCAN OF CRANIAL CAVITY BEFORE AND AFTER CONTRAS 70482 $1,592.00CT SCAN OF CRANIAL CAVITY WITH CONTRAST 70481 $1,436.00CT SCAN OF FACE 70486 $839.00CT SCAN OF FACE BEFORE AND AFTER CONTRAST 70488 $1,592.00CT SCAN OF FACE WITH CONTRAST 70487 $1,436.00CT SCAN OF HEART BLOOD VESSELS AND GRAFTS WITH CON 75574 $1,098.00CT SCAN OF HEART STRUCTURE WITH CONTRAST 75572 $1,291.00CT SCAN OF HEART WITH EVALUATION OF BLOOD VESSEL C 75571 $240.00CT SCAN OF LEG BEFORE AND AFTER CONTRAST INJECTION 73702 $1,990.00CT SCAN OF LOWER LEG BLOOD VESSELS WITH CONTRAST 73706 $2,050.00CT SCAN OF LOWER SPINE 72131 $1,049.00CT SCAN OF LOWER SPINE BEFORE AND AFTER CONTRAST 72133 $1,990.00CT SCAN OF LOWER SPINE WITH CONTRAST 72132 $1,643.00CT SCAN OF MIDDLE SPINE 72128 $1,049.00

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 ChargeCT SCAN OF MIDDLE SPINE BEFORE AND AFTER CONTRAST 72130 $1,990.00CT SCAN OF MIDDLE SPINE WITH CONTRAST 72129 $1,795.00CT SCAN OF NECK 70490 $839.00CT SCAN OF NECK BEFORE AND AFTER CONTRAST 70492 $1,592.00CT SCAN OF NECK BLOOD VESSELS WITH CONTRAST 70498 $2,050.00CT SCAN OF NECK WITH CONTRAST 70491 $1,436.00CT SCAN OF PELVIC BLOOD VESSELS WITH CONTRAST 72191 $1,640.00CT SCAN OF PELVIS BEFORE AND AFTER CONTRAST 72194 $1,592.00CT SCAN OF UPPER SPINE 72125 $1,049.00CT SCAN OF UPPER SPINE BEFORE AND AFTER CONTRAST 72127 $1,592.00CT SCAN OF UPPER SPINE WITH CONTRAST 72126 $1,795.00CT SCAN PELVIS 72192 $839.00CT SCAN PELVIS WITH CONTRAST 72193 $1,436.00CUBE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 1 $1,124.80CUBE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 2 $1,290.64CUBE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 3 $1,444.56CUBE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 4 $1,527.44CUBE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 5 $1,693.20CUFF URETHRAL AMS 800 INHIBIZONE L3.5 CM SPHINCTER C1815 $33,087.60CUFF URETHRAL AMS 800 INHIBIZONE L4 CM SPHINCTER O C1815 $33,087.60CUFF URETHRAL AMS 800 INHIBIZONE L4.5 CM SPHINCTER C1815 $24,347.31CUFF URETHRAL AMS 800 INHIBIZONE L5.5 CM SPHINCTER C1815 $33,087.60CULTURE FOR ACID-FAST BACILLI 87116 $84.00CULTURE FOR CHLAMYDIA 87110 $125.00CULTURE FUNGUS DEFINITIVE ID MOLD 87107 $69.00CULTURE STOOL AEROBIC ADDL PATHOGENS AND ID EACH 87046 $63.00CULTURE, URINE EACH ISOLATE 87088 $63.00CUP ACETABULAR PINNACLE GRIPTION OD46 MM HIP 6 DOM C1776 $5,850.00CUP ACETABULAR PINNACLE GRIPTION OD52 MM HIP 10 DO C1776 $14,400.00CUP HUMERAL DELTA XTEND POLYETHYLENE +9 MM STANDAR C1776 $6,500.00CUP HUMERAL REUNION H4 MM OD36 MM SHOULDER STERILE C1776 $6,500.00CUP HUMERAL THK4 MM OD32 MM SHOULDER C1776 $6,500.00CUP HUMERAL UNIVERS REVERS NEUTRAL OD39 MM SHOULDE C1776 $11,602.50CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW P $2,112.50CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE OD7.5 $2,600.00CUTTER STITCH SEQUENT SUTURE STERILE DISPOSABLE $598.00CUTTER SUTURE REMOVAL MENISCAL CINCH KNOT PUSHER S $812.50CYANOCOBALAMIN (VITAMIN B-12) LEVEL 82607 $117.00CYANOCOBALAMIN (VITAMIN B-12) LEVEL 82608 $111.00

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 ChargeCYCLOPHOSPHAMIDE 50 MG CAP 100 EACH BOTTLE J8530 $37.23CYCLOSPORINE LEVEL 80158 $139.00CYCLOSPORINE MODIFIED 100 MG CAP 1 EACH BLIST PACK J7502 $15.27CYP3A4 GENE ANALYSIS COMMON VARIANTS 81230 $774.00CYP3A5 GENE ANALYSIS COMMON VARIANTS 81231 $774.00CYSTOURETHROSCOPY W/MECH DILATION & URETHRAL THERA 0499T $6,783.00CYTOTOXIC PRA ANTIBODY SCREENING STANDARD METHOD S 86807 $275.00D&C FOR DIAGNOSIS AND/OR THERAPY (NON-OBSTETRICAL) 58120 $5,366.00DAILY MANAGEMENT EXTERNAL VEIN TO VEIN BLOOD CIRCU 33948 $1,019.00DAILY MANAGEMENT OF EXTERNAL VEIN TO ARTERY BLOOD 33949 $993.00DEBRIDEMENT FULL MOUTH D4355 $1,995.00DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS AC 36593 $637.00DECOMPRESSIVE FASCIOTOMY HAND 26037 $10,494.00DEEP BIOPSY OF BONE USING NEEDLE OR TROCAR 20225 $4,031.00DEEP BIOPSY OF MUSCLE 20205 $4,139.00DEFIBRILLATOR CARDIAC AMPLIA MRI 35 CC 80 GM DF-4 C1882 $114,725.00DEFIBRILLATOR CARDIAC AMPLIA MRI 35 CC BIPHASIC WA C1882 $114,725.00DEFIBRILLATOR CARDIAC AMPLIA MRI CRT-D LEFT VENTRI C1882 $114,725.00DEFIBRILLATOR CARDIAC AMPLIA MRI CRT-D SURESCAN PH C1882 $114,725.00DEFIBRILLATOR CARDIAC AMPLIA MRI QUADRIPOLAR C1882 $144,774.50DEFIBRILLATOR CARDIAC COMPIA MRI CRT-D SURESCAN PH C1882 $94,575.00DEFIBRILLATOR CARDIAC COMPIA MRI SURESCAN QUAD CRT C1882 $94,575.00DEFIBRILLATOR CARDIAC ELLIPSE THK12 MM 36 J ANGLE C1722 $82,875.00DEFIBRILLATOR CARDIAC ELLIPSE THK12 MM 36 J W51 MM C1721 $67,925.00DEFIBRILLATOR CARDIAC EVERA MRI S DR SURESCAN 2 CH C1721 $67,925.00DEFIBRILLATOR CARDIAC EVERA MRI S PHYSIOCURVE SMAR C1721 $67,925.00DEFIBRILLATOR CARDIAC EVERA MRI SURESCAN DF-1 PIN C1721 $89,817.00DEFIBRILLATOR CARDIAC EVERA MRI XT DR SURESCAN TIT C1721 $89,817.00DEFIBRILLATOR CARDIAC EVERA S DR 2 CHAMBER ICD DF- C1721 $67,925.00DEFIBRILLATOR CARDIAC EVERA S DR PHYSIOCURVE SMART C1721 $65,000.00DEFIBRILLATOR CARDIAC EVERA S VR 1 CHAMBER ICD DF4 C1722 $40,000.00DEFIBRILLATOR CARDIAC EVERA S VR 2 CHAMBER ICD DF- C1722 $52,000.00DEFIBRILLATOR CARDIAC EVERA XT 1 CHAMBER C1882 $105,300.00DEFIBRILLATOR CARDIAC EVERA XT GOLD DF1 RESYNCHRON C1721 $91,390.00DEFIBRILLATOR CARDIAC EVERA XT SMARTSHOCK 1 CHAMBE C1722 $68,250.00DEFIBRILLATOR CARDIAC EVERA XT SMARTSHOCK PHYSIOCU C1721 $74,750.00DEFIBRILLATOR CARDIAC FORTIFY ASSURA THK14 MM 40 J C1721 $52,250.00DEFIBRILLATOR CARDIAC FORTIFY ASSURA VR PARYLENE T C1722 $63,375.00DEFIBRILLATOR CARDIAC FORTIFY ASSURA VR THK14 MM 4 C1722 $48,750.00

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 ChargeDEFIBRILLATOR CARDIAC FORTIFY DR TITANIUM THK14 MM C1721 $43,000.00DEFIBRILLATOR CARDIAC FORTIFY VR TITANIUM THK14 MM C1722 $40,000.00DEFIBRILLATOR CARDIAC ILESTO DX C1722 $55,250.00DEFIBRILLATOR CARDIAC ILESTO VR-T DX C1722 $55,250.00DEFIBRILLATOR CARDIAC ILESTO VR-T TITANIUM THK13 M C1721 $50,000.00DEFIBRILLATOR CARDIAC INOGEN ENDURALIFE EASYVIEW D C1722 $61,100.00DEFIBRILLATOR CARDIAC IPERIA 7 PROMRI DF-4 IS-1 CO C1721 $67,925.00DEFIBRILLATOR CARDIAC IPERIA 7 VR-T DX IMPLANTABLE C1722 $63,375.00DEFIBRILLATOR CARDIAC IPERIA DR-T PROMRI HOME MONI C1721 $105,920.43DEFIBRILLATOR CARDIAC IPERIA DX PROMRI HOME MONITO C1722 $98,260.83DEFIBRILLATOR CARDIAC PARADYM RF CRT-D 9750 $128,700.00DEFIBRILLATOR CARDIAC PHYSIOCURVE EVERA XT VR SMAR C1721 $68,250.00DEFIBRILLATOR CARDIAC PROTECTA XT DR THK15 MM W51 C1721 $65,000.00DEFIBRILLATOR CARDIAC QUADRA ASSURA CRT PARYLENE 4 C1882 $95,850.00DEFIBRILLATOR CARDIAC QUADRA ASSURA MP THK14 MM 40 C1882 $136,000.00DEFIBRILLATOR CARDIAC UNIFY ASSURA PARYLENE 40 J R C1882 $114,725.00DEFIBRILLATOR CARDIAC UNIFY TITANIUM THK14 MM 2.5V C1882 $85,000.00DEFIBRILLATOR CARDIAC VISIA AF 33 CC 77 GM CX CONN C1722 $68,250.00DEFIBRILLATOR CARDIAC VISIA AF DF-4 CONNECTOR VR C1722 $68,250.00DEFIBRILLATOR CARDIAC VISIA AF MRI 33 CC 77 GM DF- C1722 $82,725.50DEFIBRILLATOR CARDIAC VISIA AF MRI S MRI SURESCAN C1722 $63,375.00DEFIBRILLATOR CARDIAC VISIA AF MRI SURESCAN L66 MM C1722 $84,500.00DEFIBRILLATOR CARDIAC VIVA CRT D QUAD S IS-4 DF4 U C1882 $94,575.00DEFIBRILLATOR CARDIAC VIVA QUAD XT 35 ML 80 GM BIP C1882 $101,400.00DEFIBRILLATOR CARDIAC VIVA QUAD XT CRT-D 35 ML 80 C1882 $101,400.00DEFIBRILLATOR CARDIAC VIVA S CRT-D ICD DF-1 PHYSIO C1882 $94,575.00DEFIBRILLATOR CARDIAC VIVA XT CRT-D 35 ML 80 GM BI C1882 $101,400.00DEFIBRILLATOR CARDIAC VIVA XT CRT-D SMARTSHOCK TIT C1882 $101,400.00DELAYED INSERTION OF PROSTHESIS FOR REPAIR OF ABDO 34710 $3,420.00DELAYED INSERTION OF PROSTHESIS FOR REPAIR OF ABDO 34711 $1,280.00DEMONSTRATION EVALUATION OF PATIENT USE OF AEROSOL 94664 $134.00DEMONSTRATION/EVALUATION MANUAL MANEUVERS CHEST WA 94667 $160.00DENTAL ANESTHSIA D9210 $106.00DENTAL IMPLANT ABUTMENT D6056 $736.00DENTAL IMPLANT CONNECTING BAR D6055 $8,116.00DENTAL INLAY RESIN BASED COMPOSITE ONE SURFACE D2650 $395.00DENTAL OCCLUSAL ADJUSTMENT D9951 $1,995.00DENTAL OCCLUSAL ADJUSTMENT D9952 $1,995.00DENTAL OCCLUSAL GUARD D9940 $1,995.00

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 ChargeDENTAL ONLAY PORCELIN 3 SURFACES D2643 $738.00DENTAL ONLY RESIN BASED COMPOSITE TWO SURFACES D2662 $443.00DENTAL PAIN PALLIATIVE TREATMENT D9110 $225.00DENTAL PROPHYLAXIS ADULT D1110 $177.00DENTAL PROPHYLAXIS CHILD D1120 $129.00DENTAL RECEMENT CROWN D2920 $184.00DENTAL SEALANT PER TOOTH D1351 $94.00DENTURE CROWN 3/4 CAST NOBLE METAL D6782 $487.00DENTURE CROWN FULL CAST BASE METAL D6791 $473.00DENTURE CROWN FULL CAST HIGH NOBLE METAL D6790 $654.00DENTURE CROWN FULL CAST NOBLE METAL D6792 $561.00DENTURE CROWN NOBLE METAL D6752 $2,214.00DENTURE CROWN PORCELAIN D6750 $730.00DENTURE CROWN PORCELAIN D6751 $597.00DENTURE CROWN RESIN BASE METAL D6721 $394.00DENTURE CROWN RESIN HIGH NOBLE METAL D6720 $572.00DENTURE CROWN RESIN NOBLE METAL D6722 $531.00DENTURE PARTIAL FIXED ATTACHMENT D6950 $1,107.00DENTURE PARTIAL FIXED CONNECTOR BAR D6920 $1,995.00DENTURE PARTIAL FIXED RECEMENT D6930 $184.00DENTURE REPAIR FIXED PARTIAL D6980 $177.00DENTURES ADJUSTMENT COMPLETE MANDIBULAR D5411 $148.00DENTURES ADJUSTMENT COMPLETE MAXILLARY D5410 $148.00DENTURES ADJUSTMENT PARTIAL MANDIBULAR D5422 $30.00DENTURES ADJUSTMENT PARTIAL MAXILLARY D5421 $30.00DENTURES COMPLETE MANDIBLE D5120 $1,826.00DENTURES COMPLETE MAXILLARY D5110 $1,826.00DENTURES IMMEDIATE MANDIBLE D5140 $2,191.00DENTURES IMMEDIATE MAXILLARY D5130 $1,826.00DENTURES INTERIM COMPLETE MANDIBULAR D5811 $413.00DENTURES INTERIM COMPLETE MAXILLARY D5810 $413.00DENTURES INTERIM PARTIAL MANDIBULAR D5821 $413.00DENTURES INTERIM PARTIAL MAXILLARY D5820 $413.00DENTURES INTERIM TISSUE CONDITIONING D5850 $184.00DENTURES INTERIM TISSUE CONDITIONING D5851 $184.00DENTURES MANDIBLE PARTIAL METAL D5214 $2,538.00DENTURES MANDIBLE PARTIAL RESIN D5212 $1,734.00DENTURES MAXILLARY PARTIAL METAL D5213 $2,538.00DENTURES MAXILLARY PARTIAL RESIN D5211 $1,734.00

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 ChargeDENTURES RELINE COMPLETE MANDIBULAR D5731 $196.00DENTURES RELINE COMPLETE MANDIBULAR D5751 $1,514.00DENTURES RELINE COMPLETE MAXILLARY D5730 $196.00DENTURES RELINE COMPLETE MAXILLARY D5750 $618.00DENTURES RELINE PARTIAL MANDIBULAR D5741 $196.00DENTURES RELINE PARTIAL MANDIBULAR D5761 $3,877.00DENTURES RELINE PARTIAL MAXILLARY D5740 $196.00DENTURES RELINE PARTIAL MAXILLARY D5760 $196.00DENTURES REMOVABLE PARTIAL D5281 $558.00DENTURES REPAIR BROKEN CLASP D5630 $2,885.00DENTURES REPLACE BROKEN TEETH D5640 $240.00DENTURES REPLACE MISSING OR BROKEN TEETH D5520 $240.00DEOXYCORTISOL, 11 (HORMONE) LEVEL 82634 $227.00DESIGN AND CONSTRUCTION OF DEVICE FOR RADIATION TH 77338 $1,547.00DESMOPRESSIN 0.1 MG TAB 1 EACH BLIST PACK $3.04DESTRUCTION LOWER OR SACRAL SPINAL FACET JOINT NER 64635 $3,160.00DESTRUCTION LOWER OR SACRAL SPINAL FACET JOINT NER 64636 $2,087.00DESTRUCTION MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETE 17261 $395.00DESTRUCTION MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETE 17262 $395.00DESTRUCTION MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETE 17263 $395.00DESTRUCTION MALIGNANT GROWTH (3.1 TO 4.0 CENTIMETE 17264 $395.00DESTRUCTION MALIGNANT GROWTH (OVER 4.0 CENTIMETERS 17266 $773.00DESTRUCTION MALIGNANT GROWTH OF FACE EAR EYELID NO 17280 $395.00DESTRUCTION MALIGNANT GROWTH OF SCALP NECK HAND FE 17270 $395.00DESTRUCTION MALIGNANT GROWTH OF SCALP NECK HAND FE 17271 $395.00DESTRUCTION MALIGNANT GROWTH OF SCALP NECK HAND FE 17272 $395.00DESTRUCTION MALIGNANT GROWTH OF SCALP NECK HAND FE 17273 $773.00DESTRUCTION MALIGNANT GROWTH OF SCALP NECK HAND FE 17274 $773.00DESTRUCTION MALIGNANT GROWTH OF SCALP NECK HAND FE 17276 $773.00DESTRUCTION MALIGNANT GROWTH OF TRUNK ARM OR LEG 17260 $395.00DESTRUCTION OF 1 OR MORE BONE GROWTHS ACCESSED THR 20982 $16,614.00DESTRUCTION OF 1 OR MORE BONE GROWTHS, ACCESSED TH 20983 $18,510.00DESTRUCTION OF 1 OR MORE GROWTHS IN LIVER, ACCESSE 47382 $14,542.00DESTRUCTION OF 1 OR MORE GROWTHS IN ONE KIDNEY, AC 50592 $14,542.00DESTRUCTION OF 1 OR MORE LIVER GROWTHS, ACCESSED T 47383 $20,147.00DESTRUCTION OF 15 OR MORE SKIN GROWTHS 17004 $773.00DESTRUCTION OF 15 OR MORE SKIN GROWTHS 17111 $395.00DESTRUCTION OF 2-14 SKIN GROWTHS 17003 $104.00DESTRUCTION OF ANAL GROWTHS 46924 $5,231.00

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 ChargeDESTRUCTION OF ANAL GROWTHS USING ELECTRIC CURRENT 46910 $6,334.00DESTRUCTION OF ANAL POLYPS OR GROWTHS USING AN END 46615 $5,649.00DESTRUCTION OF EXTENSIVE GROWTHS OF EXTERNAL FEMAL 56515 $5,231.00DESTRUCTION OF EXTERNAL FEMALE GENITAL GROWTHS 56501 $5,231.00DESTRUCTION OF GROWTH OF DENTAL BONE 41850 $6,639.00DESTRUCTION OF GROWTH OF SCLERA 68135 $2,748.00DESTRUCTION OF GROWTH OR NARROWING OF LUNG AIRWAY 31641 $7,019.00DESTRUCTION OF GROWTH OR SCAR OF MOUTH 40820 $8,797.00DESTRUCTION OF GROWTH OR SOFT TISSUE AT ROOF OF MO 42160 $8,797.00DESTRUCTION OF GROWTHS IN ONE KIDNEY, ACCESSED THR 50593 $18,064.00DESTRUCTION OF GROWTHS IN ONE LUNG, ACCESSED THROU 32998 $14,929.00DESTRUCTION OF GROWTHS IN ONE LUNG, ACCESSED THROU 32994 $17,953.00DESTRUCTION OF GROWTHS OF ESOPHAGUS USING AN ENDOS 43229 $10,974.00DESTRUCTION OF GROWTHS ON ESOPHAGUS STOMACH AND/OR 43270 $5,710.00DESTRUCTION OF INSUFFICIENT VEIN OF ARM OR LEG, AC 36475 $5,045.00DESTRUCTION OF INTERNAL ANAL HEMORRHOIDS 46930 $5,231.00DESTRUCTION OF KIDNEY CYSTS USING AN ENDOSCOPE 50541 $12,187.00DESTRUCTION OF KIDNEY GROWTHS USING AN ENDOSCOPE 50542 $40,535.00DESTRUCTION OF LARGE BOWEL GROWTHS USING AN ENDOSC 45388 $1,063.00DESTRUCTION OF LEAKING RETINAL BLOOD VESSELS, 1 OR 67227 $6,437.00DESTRUCTION OF LENS TISSUE USING LASER 66710 $5,041.00DESTRUCTION OF LINING OF UTERUS USING ULTRASOUND G 58356 $15,202.00DESTRUCTION OF LIVER GROWTHS USING AN ENDOSCOPE 47370 $40,535.00DESTRUCTION OF MALIGNANT GROWTH OF FACE EARS EYELI 17283 $773.00DESTRUCTION OF MALIGNANT GROWTH OF FACE EARS EYELI 17281 $773.00DESTRUCTION OF MALIGNANT GROWTH OF FACE EARS EYELI 17282 $773.00DESTRUCTION OF MASS ON GALLBLADDER PANCREATIC LIVE 43278 $10,974.00DESTRUCTION OF MULTIPLE PENILE GROWTHS 54065 $5,231.00DESTRUCTION OF MULTIPLE VAGINAL GROWTHS 57065 $5,366.00DESTRUCTION OF PERIPHERAL NERVE OR BRANCH 64640 $2,087.00DESTRUCTION OF POLYPS OR GROWTHS OF LARGE BOWEL US 45346 $3,746.00DESTRUCTION OF PROSTATE TISSUE THROUGH BLADDER CAN 53850 $12,031.00DESTRUCTION OF RECTAL GROWTH 45190 $9,263.00DESTRUCTION OF RETINAL GROWTH BY HEAT OR FREEZING, 67208 $1,859.00DESTRUCTION OF SKIN GROWTH 17000 $264.00DESTRUCTION OF SKIN GROWTH (LESS THAN 10 SQ CENTIM 17106 $773.00DESTRUCTION OF SOFT TISSUE IN NASAL PASSAGES 30802 $3,787.00DESTRUCTION OF SOFT TISSUE OF NASAL PASSAGES 30801 $4,233.00DESTRUCTION OF STONE IN BILE OR PANCREATIC DUCT US 43265 $7,711.00

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 ChargeDESTRUCTION OF TISSUE ENCIRCLING LENS 66720 $5,041.00DESTRUCTION OF TISSUE OF EYELID BORDER 66740 $7,484.00DESTRUCTION OF UP TO 14 SKIN GROWTHS 17110 $264.00DESTRUCTION OF VAGINAL GROWTHS 57061 $5,366.00DESTRUCTION OF VASCULAR GROWTH BETWEEN RETINA AND 67220 $1,859.00DESTRUCTION OF VASCULAR GROWTH BETWEEN RETINA AND 67221 $1,859.00DESTRUCTION POLYPS OR GROWTHS OF THE RECTUM AND LA 45320 $9,263.00DESTRUCTION TISSUE RT/LT UPPER HEART CHAMBER VIA C 93657 $1,421.00DESTRUCTION UPPER OR MIDDLE SPINAL FACET JOINT NER 64633 $2,087.00DESTRUCTION UPPER OR MIDDLE SPINAL FACET JOINT NER 64634 $674.00DETECTION OF MIDDLE EAR FLUID WITH ASSESSMENT EARD 92570 $428.00DETECTION TEST FOR ASPERGILLUS (FUNGUS) 87305 $80.00DETECTION TEST FOR BACTERIA TOXIN (SHIGA-LIKE TOXI 87427 $70.00DETECTION TEST FOR CHLAMYDIA 87491 $271.00DETECTION TEST FOR CLOSTRIDIUM DIFFICILE 87493 $271.00DETECTION TEST FOR CLOSTRIDIUM DIFFICILE TOXINS (S 87324 $117.00DETECTION TEST FOR CRYPTOCOCCUS NEOFORMANS (YEAST) 87327 $93.00DETECTION TEST FOR CRYPTOSPORIDIUM (PARASITE) 87328 $117.00DETECTION TEST FOR CYTOMEGALOVIRUS (CMV) 87496 $221.00DETECTION TEST FOR CYTOMEGALOVIRUS, QUANTIFICATION 87497 $332.00DETECTION TEST FOR ENTAMOEBA HISTOLYTICA GROUP (PA 87337 $93.00DETECTION TEST FOR ENTEROVIRUS (INTESTINAL VIRUS) 87498 $204.00DETECTION TEST FOR GIARDIA (INTESTINAL PARASITE) 87329 $86.00DETECTION TEST FOR HEPATITIS B SURFACE ANTIGEN 87340 $80.00DETECTION TEST FOR HEPATITIS B SURFACE ANTIGEN 87341 $65.00DETECTION TEST FOR HEPATITIS B VIRUS 87517 $332.00DETECTION TEST FOR HEPATITIS B VIRUS 87516 $271.00DETECTION TEST FOR HEPATITIS BE SURFACE ANTIGEN 87350 $87.00DETECTION TEST FOR HEPATITIS C VIRUS 87521 $232.00DETECTION TEST FOR HEPATITIS D 87380 $96.00DETECTION TEST FOR HERPES SIMPLEX VIRUS 87529 $232.00DETECTION TEST FOR HERPES VIRUS-6 87531 $155.00DETECTION TEST FOR HISTOPLASMA CAPSULATUM (PARASIT 87385 $80.00DETECTION TEST FOR HIV-1 AND HIV-2 87389 $169.00DETECTION TEST FOR HIV-1 VIRUS 87535 $289.00DETECTION TEST FOR HUMAN PAPILLOMAVIRUS (HPV) 87624 $264.00DETECTION TEST FOR INFLUENZA A VIRUS 87276 $172.00DETECTION TEST FOR INFLUENZA B VIRUS 87275 $172.00DETECTION TEST FOR INFLUENZA VIRUS 87804 $209.00

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 ChargeDETECTION TEST FOR MULTIPLE TYPES INFLUENZA VIRUS 87502 $659.00DETECTION TEST FOR MYCOBACTERIA TUBERCULOSIS (TB B 87556 $221.00DETECTION TEST FOR MYCOPLASMA PNEUMONIAE (BACTERIA 87581 $271.00DETECTION TEST FOR NEISSERIA GONORRHOEAE (GONORRHO 87591 $271.00DETECTION TEST FOR ORGANISM 87299 $213.00DETECTION TEST FOR PARAINFLUENZA VIRUS 87279 $74.00DETECTION TEST FOR PNEUMOCYSTIS CARINII (RESPIRATO 87281 $80.00DETECTION TEST FOR RESPIRATORY SYNCYTIAL VIRUS 87634 $390.00DETECTION TEST FOR RESPIRATORY SYNCYTIAL VIRUS (RS 87280 $172.00DETECTION TEST FOR RESPIRATORY SYNCYTIAL VIRUS (RS 87420 $93.00DETECTION TEST FOR ROTAVIRUS 87425 $77.00DETECTION TEST FOR STREPTOCOCCUS, GROUP B (BACTERI 87802 $93.00DETECTION TEST FOR TRICHOMONAS VAGINALIS (GENITAL 87661 $195.00DETECTION TEST FOR VARICELLA (CHICKEN POX) ZOSTER 87290 $172.00DETECTION TEST FOR ZIKA VIRUS 87662 $286.00DETERMINATION OF LUNG VOLUMES USING GAS DILUTION O 94727 $177.00DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPH 94726 $218.00DEVELOPMENTAL SCREENING 96110 $565.00DEVICE BALLOON DILATATION ACCLARENT HIGH PRESSURE $436.12DEVICE BALLOON DILATATION XPRESS ULTRA 1.5 MM L20 C1726 $10,010.00DEVICE BALLOON DILATATION XPRESSTM LOPROFILE L20 M C1726 $9,555.00DEVICE BALLOON INFLATION XPRESS LOPROFILE L8 MM OD C1726 $9,555.00DEVICE BIOPSY ACQUIRE OD25 GA ENDOSCOPIC ULTRASOUN $3,160.00DEVICE BIOPSY BIOMOL L100 MM OD20 GA MENGHINI TYPE $501.70DEVICE BREAST BIOPSY EVIVA INTEGRATE SITE MARK THU $975.00DEVICE CARDIAC BIOMONITOR IMPLANTABLE STERILE LATE C1764 $21,000.00DEVICE CATHETER FIXATION TRAPPER OD2 FR EXCHANGE O $2,275.00DEVICE CLOSURE ANGIO-SEAL VIP BONDEK-PLUS POLYGLYD C1760 $895.00DEVICE CLOSURE ATRICLIP GILLINOV-COSGROVE NITINOL $6,175.00DEVICE CLOSURE ATRICLIP NITINOL POLYESTER 45 D L40 $6,175.00DEVICE CLOSURE ATRICLIP NITINOL TITANIUM POLYESTER $6,175.00DEVICE CLOSURE CARTER-THOMASON CLOSESURE SYSTEM PI C1760 $643.50DEVICE CLOSURE CARTER-THOMASON CLOSESURE SYSTEM XL $993.05DEVICE CLOSURE CARTER-THOMASON PILOT 10 12 MM SUTU C1760 $227.50DEVICE CLOSURE CARTER-THOMASON XL PILOT GUIDES 5MM $496.52DEVICE CLOSURE CORDIS EXOSEAL OD5 FR FEMORAL ARTER C1760 $9,750.00DEVICE CLOSURE CORDIS EXOSEAL OD6 FR FEMORAL ARTER C1760 $1,200.00DEVICE CLOSURE CORDIS EXOSEAL OD7 FR FEMORAL ARTER C1760 $750.00DEVICE CLOSURE CORDIS MYNXGRIP OD5 FR 10 ML VASCUL C1760 $845.00

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 ChargeDEVICE CLOSURE CORDIS MYNXGRIP OD6-7 FR 10 ML VASC C1760 $845.00DEVICE CLOSURE DUPLOCATH TISSEEL L35 CM OD.17 CM 2 $421.04DEVICE CLOSURE MONODERM 2-0 3/8 CIRCLE L30 CM L18 C1713 $152.96DEVICE CLOSURE PERCLOSE PROGLIDE OD6 FR VASCULAR S C1760 $825.00DEVICE CLOSURE PUNCTURE C1760 $66.63DEVICE CLOSURE QUILL PDO 0 1/2 CIRCLE L30 CM L26 M C1713 $93.00DEVICE CLOSURE V-LOC 0 GS-22 L18 IN TAPER POINT NO $1,919.04DEVICE CLOSURE V-LOC 180 2-0 GS-22 TAPER POINT L9 $1,919.04DEVICE CLOSURE V-LOC 90 2-0 P-14 3/8 CIRCLE L18 IN $1,535.04DEVICE CRYOSURGICAL CLARIFIX STERILE LATEX FREE DI $8,125.00DEVICE ELECTROSURGICAL ENSEAL 5 MM L25 CM OD5 MM S $2,075.32DEVICE ELECTROSURGICAL ENSEAL 5 MM STANDARD L14 CM $2,075.32DEVICE ELECTROSURGICAL ENSEAL 5 MM STANDARD L35 CM $2,447.12DEVICE ELECTROSURGICAL ENSEAL 5 MM STANDARD L45 CM $2,746.51DEVICE ELECTROSURGICAL ENSEAL L45 CM OD5 MM ROUND $16,543.15DEVICE ELECTROSURGICAL ENSEAL ROUND L14 CM OD5 MM $2,144.68DEVICE ELECTROSURGICAL ENSEAL STRAIGHT L25 CM OD5 $12,867.92DEVICE ELECTROSURGICAL HABIB STERILE LATEX FREE DI $24,213.41DEVICE ELECTROSURGICAL VIVAER ARC 5 GM STYLUS AQUA $6,175.00DEVICE EMBOLIZATION AZUR DETACHMENT $805.05DEVICE EMBOLIZATION PIPELINE FLEX 75% COCR 25% PLA $91,000.00DEVICE EMBOLIZATION PIPELINE FLEX L35 MM OD4.25 MM $91,000.00DEVICE EMBOLIZATION PIPELINE FLEX L35 MM OD5 MM NE $91,000.00DEVICE ENDOSCOPIC CAPTIVATOR ACCESS PORT HANDLE BA $3,410.55DEVICE EXTERNAL FIXATION 180 MM ROTATION PLATFORM $17,242.80DEVICE EXTERNAL FIXATION 200 MM ROTATION PLATFORM $21,379.32DEVICE EXTERNAL FIXATION DFS VARIABLE SCREW CARRIA $3,978.24DEVICE EXTERNAL FIXATION DYNAMIZATION ADULT CARBON $3,820.80DEVICE EXTERNAL FIXATION HEIDELBERG ANGULATOR $31,864.80DEVICE EXTERNAL FIXATION HEX-FIX PELVIC BOX $53,863.65DEVICE EXTERNAL FIXATION ILIZAROV TRANSLATION ROTA $6,498.00DEVICE EXTERNAL FIXATION PULL REDUCTION 4.3 MM PER $2,952.63DEVICE FIXATION ABSORBATACK POLYESTER OD5 MM 15 TA $1,976.20DEVICE FIXATION ABSORBATACK POLYESTER OD5 MM 30 TA $3,969.31DEVICE FIXATION ABSORBATACK SHORT OD5 MM 20 TACK A C1713 $2,288.72DEVICE FIXATION BIOCOMPOSITE DISTAL BICEPS REPAIR C1713 $7,150.00DEVICE FIXATION ETHICON SECURESTRAP 20 OPEN ABSORB C1713 $2,830.83DEVICE FIXATION ETHICON SECURESTRAP 5 MM 12 ABSORB C1713 $15,353.72DEVICE FIXATION FAST-FIX 360 D CURVE 2 ANCHOR PRET C1713 $3,560.00

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 ChargeDEVICE FIXATION MAXFIRE MARXMAN CURVE MENISCUS ZIP C1713 $2,167.17DEVICE FIXATION MAXFIRE MARXMAN ZIPLOOP STRAIGHT M C1713 $2,167.17DEVICE FIXATION PROTACK TITANIUM L35.5 MM OD5 MM 3 $832.38DEVICE FIXATION SECURESTRAP 20 OPEN ABSORBABLE STR C1713 $3,902.69DEVICE FIXATION SECURESTRAP L5 MM 25 ABSORBABLE ST C1713 $3,129.10DEVICE FIXATION SECURESTRAP L5 MM ABSORBABLE STRAP C1713 $23,078.25DEVICE FIXATION SEQUENT 7 CURVE NEEDLE MENISCAL RE C1713 $7,254.00DEVICE FIXATION SEQUENT CURVED NEEDLE EASY TO MAST C1713 $2,597.40DEVICE FIXATION TACKER TITANIUM MESH HELIX OD5 MM C1713 $9,324.58DEVICE FIXATION TACKER TITANIUM OD5 MM 30 HELICAL C1713 $1,793.22DEVICE FIXATION TACKER TITANIUM OD5 MM 5 FULL HELI C1713 $1,613.82DEVICE FIXATION TIGHTROPE ACL RIGHT 2 LOAD PASS SU C1713 $2,405.00DEVICE FIXATION TIGHTROPE BONE TENDON BONE SMALL L C1713 $2,762.50DEVICE FIXATION TIGHTROPE DEPLOYING SUTURE C1713 $2,892.50DEVICE FIXATION TIGHTROPE TITANIUM UHMWPE ACL RIGH C1713 $1,050.00DEVICE FIXATION TIGHTROPE UHMWPE ACL ATTACHABLE C1713 $1,196.00DEVICE FIXATION ZIPTIGHT ZIPLOOP TITANIUM ANKLE KN C1713 $4,834.83DEVICE GUIDEWIRE EXCHANGE THE MAGNET ACCEPTS 182 C C1769 $240.00DEVICE INFLATION ACCLARENT SE TUBE PRESSURE GAUGE $436.12DEVICE INFLATION BASIXCOMPAK POLYCARBONATE 30 ATM $612.50DEVICE INFLATION BLUE DIAMOND 30 ATM L13 IN SYRING $279.30DEVICE INFLATION CADENCE PRECISION 1 ML SYRINGE IN $585.00DEVICE INFLATION ENCORE 26 $533.00DEVICE IRRIGATION XPRESS ULTRA 1.5 MM BALL SUPER S C1726 $10,010.00DEVICE MEASURING NONSTERILE 2.4 MM CANNULATED SCRE $879.81DEVICE PESSARY COLPASSIST VAGINAL 2 END POSITION F $1,283.75DEVICE PLACEMENT FOR IMPACTED TOOTH D7283 $907.00DEVICE REMOVAL MYOSURE REACH HYSTEROSCOPIC POLYPS $6,467.50DEVICE REMOVAL TRUCLEAR L357 MM OD2.9 MM TISSUE WI $3,698.83DEVICE REMOVAL TRUCLEAR ULTRA 10 MM MINI CUT WINDO $6,019.26DEVICE REMOVAL TRUCLEAR ULTRA PLUS 10 MM OD4 MM TI $4,933.83DEVICE RETRIEVAL TREVO XP PROVUE 20 MM L32 MM L180 C1773 $42,250.00DEVICE SEALING DUETT PRO VASCULAR C1760 $1,920.00DEVICE SPECIMEN RETRIEVAL INZII MONARCH OD12/15 MM $650.00DEVICE SPECIMEN RETRIEVAL NAKAO SPIDER-NET NYLON S $600.00DEVICE SPECIMEN RETRIEVAL RAPTOR L230 CM OD2.4 MM $858.00DEVICE SPECIMEN RETRIEVAL TWISTER PLUS L230 CM W26 $489.74DEVICE STONE RETRIEVAL STONETOME 20 MM L200 CM L5 $3,199.11DEVICE SUTURE STRATAFIX PDS PLUS 2-0 CT-1 SPIRAL L C1713 $138.97

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 ChargeDEVICE SUTURING CAPIO L25 CM OD12 MM TRANSVAGINAL C2631 $2,431.00DEVICE SUTURING CAPIO SLIM FUNNEL TRANSVAGINAL ERG C2631 $2,545.40DEVICE SUTURING ENDO STITCH L15 IN OD10 MM SOFT TI $811.20DEVICE SUTURING MENISCAL CINCH CURVE STERILE DISPO $1,852.50DEVICE SUTURING SILS L25 IN L17 IN OD10 MM ARTICUL $1,670.50DEVICE SUTURING SPEEDCINCH FIBERWIRE PEEK 2-0 CURV C1713 $2,567.50DEVICE SUTURING TACKER MESH FIXATION MULTIUSE HAND $681.40DEVICE TARGET FREEHAND DISTAL $1,272.96DEVICE TARGET RADIOLUCENT $1,336.78DEVICE THROMBECTOMY SOLITAIRE 2 15 MM MICRO L26 MM C1757 $32,500.00DEVICE THROMBECTOMY SOLITAIRE 2 20 MM MICRO L31 CM C1757 $32,500.00DEVICE THROMBECTOMY SOLITAIRE 2 20 MM MICRO L31 MM C1757 $42,250.00DEVICE THROMBECTOMY SOLITAIRE 2 30 MM MICRO L42 CM C1757 $42,250.00DEVICE THROMBECTOMY SOLITAIRE 2 40 MM MICRO L50 CM C1757 $42,250.00DEVICE THROMBECTOMY SOLITARE L180 CM L20 MM OD4 MM C1757 $42,250.00DEVICE TORQUE ACCEPTS .009-.018 IN GUIDEWIRE C1769 $40.00DEVICE TORQUE GLIDECATH ACCEPTS .01-.038 IN GUIDEW C1769 $27.55DEVICE TORQUE TD2 STERILE WHITE YELLOW ACCEPTS .01 C1769 $585.00DEVICE UTERINE NOVASURE ENDOMETRIUM KIT ABLATION I $8,779.68DEVICE UTERINE RUMI II KOH-EFFICIENT OD4 CM CERVIX $600.60DEVICE VISCOELASTIC VISCOAT 4% CHONDROITIN SULFATE $377.00DEXTROSE 5 % SOLP 50 ML BAG ABCDE $100.00DIABETES TRAINING G0108 $303.00DIABETES TRAINING G0109 $303.00DIAG COLONOSCOPY W/SPEC COLLECTION 45378 $2,415.00DIAGNOSTIC ASPIRATION OF SPINAL DISC OR TISSUE, AC 62267 $1,543.00DIAGNOSTIC CASTS D0470 $204.00DIAGNOSTIC CT SCAN OF LARGE BOWEL 74261 $458.00DIAGNOSTIC CT SCAN OF LARGE BOWEL WITH CONTRAST DY 74262 $1,011.00DIAGNOSTIC EXAM GALLBLADDER PANCREATIC LIVER & BIL 0397T $503.00DIAGNOSTIC EXAM OF ANUS WITH MAGNIFICATION AND CHE 46601 $648.00DIAGNOSTIC EXAM OF BILE DUCTS USING ENDOSCOPE ACCE 47552 $9,052.00DIAGNOSTIC EXAM OF ESOPHAGUS STOMACH/UPPER SMALL B 43235 $2,783.00DIAGNOSTIC EXAM OF GALLBLADDER AND PANCREATIC LIVE 43260 $7,711.00DIAGNOSTIC EXAM OF LARGE BOWEL 44388 $2,550.00DIAGNOSTIC EXAM OF THE BLADDER AND BLADDER CANAL ( 52000 $2,263.00DIAGNOSTIC EXAM OF VOICE BOX USING ENDOSCOPE WITH 31526 $5,111.00DIAGNOSTIC EXAM SMALL BOWEL USING ENDOSCOPE 44380 $1,548.00DIAGNOSTIC EXAMINATION OF DEFECT IN WALL OF SMALL 44385 $3,086.00

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 ChargeDIAGNOSTIC EXAMINATION OF EAR AND NOSE 92504 $110.00DIAGNOSTIC EXAMINATION OF ESOPHAGUS USING AN ENDOS 43200 $2,300.00DIAGNOSTIC EXAMINATION OF ESOPHAGUS USING AN ENDOS 43191 $5,710.00DIAGNOSTIC EXAMINATION OF LARGE BOWEL USING AN END 45330 $1,694.00DIAGNOSTIC EXAMINATION OF LUNG AIRWAYS USING AN EN 31622 $3,166.00DIAGNOSTIC EXAMINATION OF NASAL PASSAGES USING AN 31231 $527.00DIAGNOSTIC EXAMINATION OF RECTUM AND LARGE BOWEL U 45300 $1,601.00DIAGNOSTIC EXAMINATION OF SMALL BOWEL USING AN END 44376 $268.00DIAGNOSTIC EXAMINATION OF THE ANUS USING AN ENDOSC 46600 $343.00DIAGNOSTIC EXAMINATION OF UTERUS USING AN ENDOSCOP 58555 $6,205.00DIAGNOSTIC EXAMINATION OF VOICE BOX USING AN ENDOS 31505 $285.00DIAGNOSTIC EXAMINATION OF VOICE BOX USING AN ENDOS 31525 $4,988.00DIAGNOSTIC EXAMINATION OF VOICE BOX USING FLEXIBLE 31575 $527.00DIAGNOSTIC IMAGING OF EYES 92132 $234.00DIAGNOSTIC IMAGING OF OPTIC NERVE OF EYE 92133 $234.00DIAGNOSTIC IMAGING OF RETINA 92227 $97.00DIAGNOSTIC IMAGING OF RETINA 92134 $234.00DIAGNOSTIC INSERTION OF STOMACH TUBE & MULTIPLE AS 43755 $546.00DIAGNOSTIC INSERTION OF STOMACH TUBE AND ASPIRATIO 43754 $996.00DIAGNOSTIC INSERTION SMALL BOWEL TUBE & MULTIPLE S 43757 $2,974.00DIAGNOSTIC NUCLEAR IMAGING PLATELET PROTEINS FOR B 78456 $4,811.00DIALYSIS PROCEDURE INCLUDING ONE EVALUATION 90945 $131.00DIALYSIS SERVICES PER DAY PATIENT 20 YEARS OF AGE 90970 $26.00DIGESTIVE TRACT PROTEIN LOSS 78282 $1,240.00DIGITAL ANALYSIS OF ELECTRICAL BRAIN WAVE ACTIVITY 95957 $1,162.00DIGITAL TOMOGRAPHY OF BOTH BREASTS 77062 $278.00DIGITAL TOMOGRAPHY OF ONE BREAST 77061 $278.00DIGOXIN LEVEL 80162 $103.00DILATION OF ANUS USING AN ENDOSCOPE 46604 $3,300.00DILATION OF BILE DUCTS USING AN ENDOSCOPE, ACCESSE 47555 $9,052.00DILATION OF BILE DUCTS WITH STENT INSERTION USING 47556 $18,064.00DILATION OF BLADDER CANAL (URETHRA) USING AN ENDOS 52281 $4,180.00DILATION OF BLADDER CANAL (URETHRA), FEMALE 53660 $341.00DILATION OF BLADDER CANAL (URETHRA), FEMALE 53661 $302.00DILATION OF ESOPHAGUS 43450 $1,782.00DILATION OF ESOPHAGUS 43453 $5,710.00DILATION OF ESOPHAGUS USING AN ENDOSCOPE 43213 $5,710.00DILATION OF LARGE BOWEL STRICTURE USING AN ENDOSCO 45340 $3,194.00DILATION OF NARROWING OF BLADDER CANAL (URETHRA), 53620 $2,263.00

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 ChargeDILATION OF NARROWING OF BLADDER CANAL (URETHRA), 53600 $857.00DILATION OF NARROWING OF BLADDER CANAL (URETHRA), 53601 $302.00DILATION OF NARROWING OF BLADDER CANAL (URETHRA), 53621 $563.00DILATION OF RECTUM AND LARGE BOWEL USING AN ENDOSC 45303 $3,746.00DILATION OF STOMACH OUTLET USING AN ENDOSCOPE 43245 $4,137.00DILATION OF TEAR-DRAINAGE OPENING 68801 $1,321.00DILATION OF THE VOICE BOX USING AN ENDOSCOPE 31528 $7,477.00DILATION OF TISSUE AT UTERINE OPENING (CERVIX) 57800 $5,366.00DILATION OF VAGINA UNDER ANESTHESIA 57400 $5,366.00DILATION TO IMPROVE EYE FLUID FLOW 66174 $13,293.00DILATION WITH INSERTION OF DEVICE OR STENT TO IMPR 66175 $13,293.00DILATOR ENDOSCOPIC CRE L180 CM L5.5 CM OD7.5 FR OD C1726 $1,878.50DILATOR ENDOSCOPIC CRE L3 CM L75 CM OD10-11-12 MM C1726 $2,960.00DILATOR ENDOSCOPIC CRE L3 CM L75 CM OD8-9-10 MM PU C1726 $2,471.92DILATOR ENDOSCOPIC CRE L75 CM L3 CM OD12-13.5-15 M C1726 $2,960.00DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM 3.2 MM L180 CM C1726 $1,878.50DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM 3.2 MM L240 CM C1726 $1,878.50DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM L180 CM L8 CM C1726 $1,657.50DILATOR ENDOSCOPIC CRE PEBAX L180 CM L8 CM OD6 FR C1726 $1,657.50DILATOR ENDOSCOPIC HERCULES 2.8 MM L5.5 CM L240 CM C1726 $1,175.00DILATOR ENDOSCOPIC HERCULES NITINOL 2.8 MM L8 CM L C1726 $900.00DILATOR ENDOSCOPIC HERCULES PET FLEX L5.5 CM L240 C1726 $1,175.00DILATOR ENDOSCOPIC QUANTUM TTC 2.8 MM L195 CM L8 C C1726 $600.00DILATOR ENDOSCOPIC QUANTUM TTC L195 CM L8 CM OD18 C1726 $375.00DILATOR ENDOSCOPIC QUANTUM TTC L195 CM L8 CM OD30 C1726 $600.00DILATOR ENDOSCOPIC QUANTUM TTC L195 CM L8 CM OD36 C1726 $680.00DILATOR ENDOSCOPIC QUANTUM TTC L195 CM L8 CM OD42 C1726 $600.00DILATOR ENDOSCOPIC QUANTUM TTC L195 CM L8 CM OD48 C1726 $600.00DILATOR ENDOSCOPIC QUANTUM TTC L195 CM L8 CM OD54 C1726 $600.00DILATOR ENDOSCOPIC QUANTUM TTC L5.5 CM L240 CM OD1 C1726 $600.00DILATOR ENDOSCOPIC QUANTUM TTC L5.5 CM L240 CM OD2 C1726 $600.00DILATOR SHEATH BYRD POLYPROPYLENE A REGULAR L13-15 C1893 $1,900.00DILATOR SHEATH BYRD POLYPROPYLENE B REGULAR L13-15 C1893 $1,900.00DILATOR SURGICAL METRX OD12.8 MM $1,674.40DILATOR SURGICAL METRX OD14.8 MM $1,674.40DILATOR SURGICAL METRX OD16.8 MM $1,674.40DILATOR SURGICAL METRX OD18.8 MM $1,674.40DILATOR SURGICAL METRX OD20.8 MM $1,674.40DILATOR SURGICAL METRX OD5.3 MM $1,674.40

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 ChargeDILATOR SURGICAL METRX OD9.4 MM $1,674.40DISC ARTIFICIAL BRYAN OD17 MM CERVICAL STERILE $29,250.00DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE C1713 $29,250.00DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE $29,250.00DISC INTERVERTEBRAL MOBI-C D17 MM STANDARD W17 MM C1713 $29,250.00DISC INTERVERTEBRAL PRESTIGE LP TITANIUM L16 MM OD $29,250.00DISC INTERVERTEBRAL PRESTIGE LP TITANIUM L18 MM OD $29,250.00DISC SPINAL BRYAN OD14 MM CERVICAL MOTION $29,250.00DISC SPINAL BRYAN OD15 MM CERVICAL MOTION $29,250.00DISC SPINAL BRYAN OD16 MM CERVICAL MOTION $29,250.00DISC SPINAL BRYAN OD18 MM CERVICAL MOTION $29,250.00DISSECTOR LAPAROSCOPIC SONICISION 360 D L39 CM L14 $1,215.00DISSECTOR MONOPOLAR ENDO DISSECT ENDO SHEARS STAIN $415.22DISTRACTOR SURGICAL L7 MM OD1.2 MM CRANIOFACIAL IN C1713 $740.00DNA ANTIBODY NATIVE 86225 $106.00DNA TESTING FOR GENETIC DEFECTS 88271 $166.00DOFETILIDE 125 MCG CAP 14 EACH BOTTLE $3.00DOME PATELLAR ATTUNE AOX H32 MM KNEE CEMENTED MEDI C1776 $1,950.00DOME PATELLAR ATTUNE AOX H35 MM KNEE CEMENTED MEDI C1776 $1,950.00DOME PATELLAR ATTUNE AOX H38 MM KNEE CEMENT MEDIAL C1776 $1,950.00DOME PATELLAR ATTUNE AOX H41 MM KNEE CEMENT MEDIAL C1776 $2,400.00DOME PATELLAR DJO SURGICAL E-PLUS H9 MM OD35 MM 3 C1776 $1,950.00DOME PATELLAR PFC SIGMA UHMWPE OVAL OD38 MM KNEE C C1776 $1,625.00DOME PATELLAR PFC SIGMA UHMWPE SMALL OVAL OD35 MM C1776 $1,625.00DOME PATELLAR PFC SIGMA UHMWPE XS OVAL OD32 MM KNE C1776 $1,625.00DOPPLER ULTRASOUND STUDY OF COLOR-DIRECTED HEART B 93325 $713.00DOPPLER ULTRASOUND STUDY OF HEART BLOOD FLOW, VALV 93320 $961.00DOXORUBICIN 2 MG/ML SOLN 100 ML VIAL J9000 $290.50DOXORUBICIN 2 MG/ML SOLN 75 ML VIAL J9000 $273.50DOXORUBICIN 20 MG/10 ML SOLN 10 ML VIAL J9000 $117.30DOXORUBICIN 50 MG SOLR 1 EACH VIAL J9000 $138.94DRAIN GLAUCOMA AHMED FLEXIBLE PLATE SILICONE THK.9 L8612 $3,867.50DRAIN GLAUCOMA AHMED GLAUCOMA VALVE FLEXIBLE PLATE L8612 $3,867.50DRAIN INCISION BLAKE SILICONE ROUND OD15 FR ODSEC3 $286.67DRAIN INCISION EXPRESS C500 ML MINI CHEST 1 WAY VA $179.40DRAIN INCISION EXPRESS CHEST COLLECTION TUBE PREFI $254.64DRAINAGE 66761 $1,833.00DRAINAGE ABSCESS CYST OR BLOOD ACCUMULATION UNDER 41016 $17,356.00DRAINAGE ABSCESS CYST OR BLOOD ACCUMULATION UNDER 41018 $4,553.00

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 ChargeDRAINAGE ABSCESS, CYST, OR BLOOD ACCUMULATION UNDE 41017 $8,797.00DRAINAGE BSCESS CYST OR BLOOD ACCUMULATION UNDER T 41007 $6,639.00DRAINAGE OF ABSCESS CYST OR BLOOD ACCUMULATION OF 41800 $463.00DRAINAGE OF ABSCESS OF SALIVARY GLAND 42300 $4,553.00DRAINAGE OF ABSCESS OR BLOOD ACCUMULATION AT FOREA 25028 $5,738.00DRAINAGE OF ABSCESS OR BLOOD ACCUMULATION AT UPPER 23930 $9,147.00DRAINAGE OF ABSCESS OR BLOOD ACCUMULATION IN NASAL 30020 $1,840.00DRAINAGE OF ABSCESS OR BLOOD ACCUMULATION IN NOSE 30000 $848.00DRAINAGE OF ABSCESS OR BLOOD ACCUMULATION IN PELVI 26990 $6,943.00DRAINAGE OF ABSCESS OR BLOOD COLLECTION AT THIGH O 27301 $6,083.00DRAINAGE OF ABSCESS OR CYST OF SKENE'S GLANDS, MAL 53060 $5,682.00DRAINAGE OF ABSCESS SIMPLE 10060 $463.00DRAINAGE OF ABSCESS, CYST, OR BLOOD ACCUMULATION O 41000 $1,840.00DRAINAGE OF ABSCESS, CYST, OR BLOOD ACCUMULATION U 41009 $1,840.00DRAINAGE OF ABSCESS, CYST, OR BLOOD ACCUMULATION U 41005 $848.00DRAINAGE OF ABSCESS, CYST, OR BLOOD ACCUMULATION U 41008 $8,797.00DRAINAGE OF BLOOD OR FLUID ACCUMULATION 10140 $5,502.00DRAINAGE OF CYST OF THE ESOPHAGUS STOMACH AND/OR U 43240 $4,137.00DRAINAGE OF FINGER ABSCESS COMPLICATED 26011 $2,677.00DRAINAGE OF FINGER ABSCESS SIMPLE 26010 $521.00DRAINAGE OF FLUID FROM ABDOMINAL CAVITY 49082 $1,483.00DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAG 49083 $2,407.00DRAINAGE OF FLUID-FILLED SAC (BURSA) OF UPPER ARM 23931 $3,347.00DRAINAGE OF LIVER ABSCESS OR CYST, OPEN PROCEDURE 47010 $5,053.00DRAINAGE OF LOWER JAW ABSCESS 42310 $1,840.00DRAINAGE OF LOWER JAW ABSCESS 42320 $1,840.00DRAINAGE OF LYMPH NODE ABSCESS OR INFLAMMATION 38300 $5,393.00DRAINAGE OF MULTIPLE ABSCESS 10061 $463.00DRAINAGE OF PELVIC OR RECTAL ABSCESS 45020 $4,718.00DRAINAGE OF RECTAL ABSCESS 45005 $4,718.00DRAINAGE OF RECTAL ABSCESS 46040 $4,718.00DRAINAGE OF RECTAL ABSCESS 46050 $1,620.00DRAINAGE OF TAILBONE CYST COMPLICATED 10081 $2,677.00DRAINAGE OF TAILBONE CYST SIMPLE 10080 $521.00DRAINAGE OF TEAR-PRODUCING GLAND 68400 $5,047.00DRAINAGE OF TENDON OF FINGER AND/OR PALM 26020 $10,581.00DRAINAGE OF TONSIL ABSCESS 42700 $848.00DRAINAGE OF WOUND INFECTION AFTER SURGERY 10180 $4,867.00DRAPE SURGICAL STERILE LATEX FREE DISPOSABLE ALLY $790.08

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 ChargeDRESSING ADHESIVE MEPORE POLYACRYLATE FABRIC L20 C A6219 $3.74DRESSING ADHESIVE SILK L8 IN X W6 IN HYPOALLERGENI A6255 $3.09DRESSING ALGINATE AQUACEL HYDROFIBER L5 IN X W4 IN A6197 $16.49DRESSING BIOLOGICAL INTEGRA BOVINE COLLAGEN GLYCOS Q4104 $17,946.83DRESSING BIOLOGICAL INTEGRA BOVINE COLLAGEN GLYCOS C9363 $21,541.33DRESSING BIOLOGICAL MICROMATRIX PORCINE EXTRACELLU Q4118 $7,866.24DRESSING BIOLOGICAL OASIS PORCINE SMALL INTESTINE Q4102 $375.16DRESSING BIOLOGICAL OASIS ULTRA PORCINE SMALL INTE Q4124 $11,162.52DRESSING BURN SILVERLON L24 IN X W24 IN CONTACT A6208 $910.95DRESSING CHANGE AND/OR REMOVAL BURN TISSUE (5% TO 16025 $445.00DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE 16030 $445.00DRESSING CHANGE AND/OR REMOVE BURN TISSUE (LESS TH 16020 $394.00DRESSING CHANGE UNDER ANESTHESIA 15852 $1,953.00DRESSING FOAM ALLEVYN L5 CM X W5 CM A6212 $27.63DRESSING FOAM AQUACEL HYDROFIBER SILICONE SQUARE L A6212 $17.55DRESSING FOAM HYDROFERA BLUE L2.5 IN X W2.5 IN WIT A6209 $580.64DRESSING FOAM MEPILEX AG SAFETAC SILVER POLYURETHA A6210 $76.38DRESSING FOAM MEPILEX AG SILVER SILICONE POLYURETH A6209 $20.59DRESSING FOAM MEPILEX AG SILVER SILICONE POLYURETH A6210 $72.53DRESSING FOAM MEPILEX BORDER AG L6 IN X W4 IN STER $12,152.00DRESSING FOAM MEPILEX BORDER L3 IN X W3 IN ALL IN A6212 $6.18DRESSING FOAM MEPILEX BORDER L7.9 IN X W6.3 IN SAC A6213 $40.66DRESSING FOAM MEPILEX BORDER LITE SILICONE THIN L1 A6212 $13.35DRESSING FOAM MEPILEX BORDER LITE SILICONE THIN L5 A6212 $11.08DRESSING FOAM MEPILEX BORDER LITE SILICONE THIN L7 A6212 $14.82DRESSING FOAM MEPILEX BORDER SAFETAC L9.2 IN X W9. A6213 $29.48DRESSING FOAM MEPILEX BORDER SILICONE L23 CM X W23 A6213 $78.61DRESSING FOAM MEPILEX BORDER SILICONE L4 IN X W4 I A6212 $8.41DRESSING FOAM MEPILEX BORDER SILICONE L7.2 IN X W7 A6213 $31.28DRESSING FOAM MEPILEX BORDER SILICONE L8 IN X W6 I A6213 $17.57DRESSING FOAM MEPILEX BORDER SILICONE SQUARE L6 IN A6213 $14.27DRESSING FOAM MEPILEX SILICONE L4 IN X W4 IN ABSOR A6209 $8.84DRESSING FOAM MEPILEX TRANSFER SAFETAC SILVER L20 A6211 $35.00DRESSING FOAM MEPILEX TRANSFER SILICONE L20 IN X W A6211 $46.12DRESSING FOAM MEPILEX XT SAFETAC L4 IN X W4 IN NON A6209 $21.07DRESSING FOAM OPTIFOAM GENTLE SILICONE L3 IN X W3 A6212 $9.45DRESSING FOAM OPTIFOAM POLYURETHANE THIN L4 IN X W A6212 $13.38DRESSING FOAM VAC GRANUFOAM SILVER LARGE $225.19DRESSING FOAM WHITEFOAM VAC POLYVINYL ALCOHOL THK1 $1,098.64

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 ChargeDRESSING GEL SILVASORB IONIC SILVER HYDROGEL 1.5 O A6248 $1,397.20DRESSING GERMICIDAL PROMOGRAN COLLAGEN CELLULOSE 4 A6022 $47.22DRESSING GERMICIDAL PROMOGRAN COLLAGEN CELLULOSE 4 A6021 $47.22DRESSING GERMICIDAL PROMOGRAN PRISMA 55% COLLAGEN A6021 $56.44DRESSING GERMICIDAL PROMOGRAN PRISMA COLLAGEN CELL A6022 $158.56DRESSING GERMICIDAL PROMOGRAN PRISMA COLLAGEN CELL A6021 $56.44DRESSING GERMICIDAL SILVERCEL ALGINATE CARBOXYMETH A6197 $50.30DRESSING GERMICIDAL SILVERCEL ALGINATE CARBOXYMETH A6196 $14.46DRESSING GERMICIDAL SILVERCEL NON-ADHERENT EASYLIF A6196 $14.46DRESSING HYDROCOLLOID DUODERM CGF L4 IN X W4 IN MO A6237 $6.11DRESSING HYDROCOLLOID DUODERM CGF RECTANGLE L12 IN A6239 $79.91DRESSING HYDROCOLLOID DUODERM CGF SQUARE L6 IN X W A6235 $16.19DRESSING HYDROCOLLOID DUODERM SIGNAL HYDROFIBER IO A6238 $22.63DRESSING HYDROCOLLOID DUODERM SIGNAL HYDROFIBER IO A6237 $15.56DRESSING HYDROCOLLOID DUODERM XTHIN SQUARE L4 IN X A6234 $4.36DRESSING HYDROCOLLOID DUODERM XTHIN SQUARE L6 IN X A6235 $413.25DRESSING HYDROCOLLOID RESTORE L4 IN X W4 IN OCCLUS A6234 $25.50DRESSING NASAL RAPID RHINO STAMMBERGER SINU-FOAM C $419.25DRESSING PETROLATUM ADAPTIC CELLULOSE ACETATE FABR A6223 $12.97DRESSING PETROLATUM CURAD COTTON GAUZE L36 IN X W3 A6224 $4.05DRESSING PETROLATUM CURAD COTTON GAUZE L72 IN X W. A6223 $6.45DRESSING PETROLATUM CURAD COTTON GAUZE L8 IN X W1 A6222 $1.98DRESSING PETROLATUM CURAD COTTON GAUZE L9 IN X W3 A6223 $764.25DRESSING PETROLATUM CURAD GAUZE L36 IN X W6 IN NON A6224 $5.94DRESSING PETROLATUM CURAD GAUZE OIL EMULSION L16 I A6223 $8.62DRESSING PETROLATUM CURAD XEROFORM COTTON L9 IN X A6223 $2.50DRESSING PETROLATUM VASELINE CISION GAUZE L8 IN X A6222 $2.24DRESSING PETROLATUM VASELINE GAUZE L18 IN X W3 IN A6224 $2.85DRESSING PETROLATUM VASELINE GAUZE L9 IN X W3 IN N A6223 $1.11DRESSING PETROLATUM XEROFORM 3% BISMUTH TRIBROMOPH A6223 $1.24DRESSING PETROLATUM XEROFORM 3% BISMUTH TRIBROMOPH A6222 $13.37DRESSING PETROLATUM XEROFORM GAUZE L9 IN X W5 IN N A6223 $5.60DRESSING PETROLATUM XEROFORM XEROFLO 3% BISMUTH TR A6223 $6.88DRESSING TRANSPARENT 3M TEGADERM CHLORHEXIDINE GLU $16.53DRESSING TRANSPARENT 3M TEGADERM POLYURETHANE L10 $6.76DRESSING TRANSPARENT 3M TEGADERM POLYURETHANE L12 $11.08DRESSING TRANSPARENT 3M TEGADERM POLYURETHANE L2 3 $0.91DRESSING TRANSPARENT 3M TEGADERM POLYURETHANE L4 1 $4.85DRESSING TRANSPARENT 3M TEGADERM POLYURETHANE L6 I $6.02

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 ChargeDRESSING TRANSPARENT 3M TEGADERM POLYURETHANE STAN $2.97DRESSING TRANSPARENT SURESITE WINDOW MICROPOROUS L $3.68DRESSING WOUND ABTHERA GRANUFOAM VAC FOAM OPEN ABD $1,821.60DRESSING WOUND ABTHERA SENSA TRAC OPEN ABDOMEN NEG $1,821.60DRESSING WOUND ABTHERA SENSAT RAC GRANUFOAM VAC AB $11,720.80DRESSING WOUND AQUACEL AG HYDROFIBER IONIC SILVER A6198 $225.32DRESSING WOUND AQUACEL AG HYDROFIBER IONIC SILVER A6197 $202.22DRESSING WOUND BIATAIN SUPER HYDROCOLLOID L4 IN X A6251 $17.00DRESSING WOUND BOVINE COLLAGEN L2 IN X W2 IN MATRI Q4108 $13,240.40DRESSING WOUND CALCICARE CALCIUM ALGINATE SILVER L A6197 $64.75DRESSING WOUND CALCICARE CALCIUM ALGINATE SILVER L A6199 $64.97DRESSING WOUND CALCICARE CALCIUM ALGINATE SILVER L A6196 $29.51DRESSING WOUND COVADERM PLUS L4 IN X W4 IN ABSORBE A6203 $9.98DRESSING WOUND CURITY FABRIC L3 IN X W3 IN KNIT OI A6222 $0.50DRESSING WOUND CURITY FABRIC L8 IN X W3 IN KNIT OI A6223 $3.47DRESSING WOUND CURITY FABRIC L8 IN X W3 IN NONADHE A6222 $1.25DRESSING WOUND CURITY L30 IN X W10 IN MULTITRAUMA A6240 $451.87DRESSING WOUND EXCILON PHMB L2 IN X W2 IN ABSORBEN A6222 $1.33DRESSING WOUND KALTOSTAT CALCIUM SODIUM ALGINATE L A6196 $21.60DRESSING WOUND KALTOSTAT CALCIUM SODIUM ALGINATE L A6199 $24.62DRESSING WOUND MEPILEX BORDER L9.1 IN X W8.7 IN HE A6214 $60.00DRESSING WOUND MEPITEL L3 IN X W2 IN NONADHERENT S A6206 $25.06DRESSING WOUND MEPITEL SAFETAC L12 IN X W8 IN NONA A6208 $68.49DRESSING WOUND OIL EMULSION L8 IN X W3 IN NONADHER A6223 $5.08DRESSING WOUND PURAPLY 25 SQ CM L5 CM X W5 CM ANTI Q4196 $18,850.00DRESSING WOUND PURAPLY 54 SQ CM L6 CM X W9 CM ANTI Q4196 $40,950.00DRESSING WOUND PURAPLY 8 SQ CM L2 CM X W4 CM ANTIM Q4196 $5,850.00DRESSING WOUND SILVERLON SILVER L4 IN X W4 IN 7 DA A6206 $35.55DRESSING WOUND SILVERLON SILVER L66 IN X W4 IN 7 D A6208 $780.75DRESSING WOUND STRATASORB POLYURETHANE L4 IN X W4 A6203 $18.56DRESSING WOUND STRATASORB POLYURETHANE L6 IN X W6 A6203 $17.94DRESSING WOUND VAC VERAFLO MEDIUM KIT DISPOSABLE $569.25DRILL BIT COUNTERSINK ASNIS III CANNULATED AO FIT $1,217.78DRILL BIT COUNTERSINK ASNIS MICRO OD2 MM CANNULATE $1,391.00DRILL BIT COUNTERSINK OD1.5 MM MULTISCREW $481.00DRILL BIT COUNTERSINK OD2-2.5 MM CANNULATED $1,378.00DRILL BIT COUNTERSINK QUICK RELEASE CANNULATED 2 M $1,794.00DRILL BIT COUNTERSINK QUICKFIX OD2-2.4 MM CANNULAT $1,137.50DRILL HAND L7.75 MM OD10 GA IVAS $362.27

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 ChargeDRILL HAND OD8 GA IVAS $640.04DRILL SURGICAL 41 SHORT OD4.3 MM DISTAL SCREW GRAD $1,092.00DRILL SURGICAL ACUTRAK 2 LONG OD4.7 MM $1,657.50DRILL SURGICAL ACUTRAK 2 MICRO LONG $1,287.00DRILL SURGICAL ACUTRAK 2 MINI PROFILE NONSTERILE 3 $1,150.50DRILL SURGICAL ACUTRAK 2 OD4.7 MM PROFILE $1,657.50DRILL SURGICAL ANTIROTATIONAL SCREW DISPOSABLE AFF $1,338.48DRILL SURGICAL ASNIS III CANNULATED TWIST NONSTERI $2,359.50DRILL SURGICAL BAHA 4 STAINLESS STEEL 3 MM 4 MM L2 $1,162.72DRILL SURGICAL BAHA L4 MM WIDENING COUNTERSINK AUD $1,162.72DRILL SURGICAL BIO-TENODESIS OD4 MM BIT SCREW $747.50DRILL SURGICAL CORRIDOR CANNULATED FLEXIBLE SHAFT $6,487.00DRILL SURGICAL FULL THICK OD10 MM KNEE CANNULATED $1,344.00DRILL SURGICAL FULL THICK OD6 MM KNEE CANNULATED G $1,344.00DRILL SURGICAL FULL THICK OD9 MM KNEE CANNULATED G $1,344.00DRILL SURGICAL ICONIX OD2.3 MM DISPOSABLE $1,342.12DRILL SURGICAL L115 MM L35 MM OD1.6 MM COLOR CODED $1,981.98DRILL SURGICAL L3.5 IN OD1.1 MM QUICK RELEASE STAN $526.50DRILL SURGICAL L340 MM OD5 MM AO FIT NONSTERILE $1,042.28DRILL SURGICAL L495 MM OD10.5 MM LAG SCREW STEP GA $8,533.20DRILL SURGICAL L5 IN OD3.5 MM QUICK RELEASE $344.50DRILL SURGICAL LARGE OD4.9 MM CANNULATED AO FIT $1,595.95DRILL SURGICAL MICRO OD2.1 MM HAND FOOT AO COUPLIN $1,267.50DRILL SURGICAL MINI L2.75 MM OD.066 IN CANNULATED $2,275.00DRILL SURGICAL OD2 MM AO CONNECTOR NONSTERILE 2.7 $776.88DRILL SURGICAL OD2.2 MM PHALANX CANNULATED 12 MM M $375.18DRILL SURGICAL OD2.4 MM CANNULATED ACROMIOCLAVICUL $1,787.50DRILL SURGICAL OD2.7 MM AO CONNECTOR OVER NONSTERI $776.88DRILL SURGICAL OD2.7 MM CANNULATED AO COUPLING TWI $1,573.00DRILL SURGICAL OD2.8 MM QUICK RELEASE 3.5 MM SCREW $539.50DRILL SURGICAL OD3 MM WIDENING COUNTERSINK $1,162.72DRILL SURGICAL OD3.2 MM FLEXIBLE STERILE $1,859.00DRILL SURGICAL OD9 MM STERILE LATEX FREE DISPOSABL $325.00DRILL SURGICAL PHALINX MEDIUM OD2.55 MM CANNULATED $825.50DRILL SURGICAL PHALINX SMALL OD2.45 MM CANNULATED $825.50DRILL SURGICAL POLARUS 3 SURGIBIT LONG BLUNT OD2.8 $1,365.00DRILL SURGICAL PROFILE MICRO COMPRESSION FT SCREW $975.00DRILL SURGICAL PROFILE MINI COMPRESSION FT SCREW $975.00DRILL SURGICAL SHORT OD4.9 MM CALIBRATED BLACK ORA $639.60

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 ChargeDRILL SURGICAL SONICANCHOR D2.8 STERILE LATEX FREE $1,755.00DRILL SURGICAL SPEEDGUIDE L30 MM OD2 MM AO NONSTER $936.00DRILL SURGICAL SPEEDGUIDE L70 MM OD2.6 MM AO CONNE $863.20DRILL SURGICAL STANDARD PROFILE STANDARD COMPRESSI $975.00DRILL SURGICAL SURGIBIT L3.5 IN OD2 MM QUICK RELEA $754.00DRILL SURGICAL SURGIBIT OD2 MM QUICK COUPLER $435.50DRILL SURGICAL SURGIBIT OD2 MM QUICK RELEASE $539.50DRILL SURGICAL SURGIBIT OD2 MM QUICK RELEASE DEPTH $663.00DRILL SURGICAL SURGIBIT OD2.8 MM QUICK RELEASE DEP $663.00DRILL SURGICAL T2 STEP SOLID LAG SCREW SLEEVE STER $1,226.03DRILL SURGICAL UNIVERS REVERS L200 MM OD2.4 MM $1,170.00DRILL SURGICAL VIRAGE L12 MM OD2.3 MM FIX LENGTH O $325.00DRILL SURGICAL VIRAGE L14 MM OD2.3 MM FIX LENGTH O $325.00DRILL TWIST 2.7 MM L105 MM OD2.2 MM J NOTCH GLIDE $870.24DRILL TWIST 2.7 MM L70 MM OD2.2 MM J NOTCH GLIDING $870.24DRILL TWIST 5 MM L50 MM OD1.1 MM J NOTCH STOP DISP $870.24DRILL TWIST APTUS L91 MM L40 MM OD2 MM STOP AO QUI $540.54DRILL TWIST DELTA OD1.8 MM SHAFT END STERILE 3MM 4 $726.48DRILL TWIST HEXAGON OD1.2 MM SHAFT LATEX FREE $677.95DRILL TWIST L122 MM L70 MM OD2.6 MM AO SHAFT END N $666.90DRILL TWIST L50 MM L7 MM OD1.6 MM STOP STERILE REP $889.44DRILL TWIST L50 MM L8 MM OD1.5 MM STOP STERILE DIS $964.16DRILL TWIST L85 MM L26 MM OD1.6 MM NONSTERILE LATE $594.10DRILL TWIST LONG L195 MM OD4.5 MM AO FIT STERILE $1,007.50DRILL TWIST MORRISON L115 MM OD1.5 MM NOTCH DISPOS $1,231.36DRILL TWIST OD2.9 MM BIT CALIBRATED $1,912.56DRILL TWIST OD4.5 MM CROWE POINT TIP RETROGRADE FE $1,189.50DRILL TWIST PROFYLE L105 MM L40 MM OD2 MM HAND AO $585.00DRILL TWIST SPEEDGUIDE L30 MM OD2.6 MM AO $936.00DRILL TWIST STAINLESS STEEL L175 IN OD3.8 IN SOLID $464.88DRILL TWIST STAINLESS STEEL L50 MM L20 MM OD1.5 MM $870.24DRILL TWIST STAINLESS STEEL L50 MM OD1.1 MM NOTCH $870.24DRILL TWIST STAINLESS STEEL L70 MM OD1.9 MM $870.24DRILL TWIST STEEL L115 MM OD1.9 MM J NOTCH 2/2.3 M $870.24DRIVER EXTERNAL FIXATION HEX-FIX $8,812.80DRIVER NEEDLE ENDOWRIST MEGA DA VINCI S/SI 30- D T $1,430.00DRIVER SURGICAL 2 MM HEXAGON OD4.5 MM FEMORAL SET $520.00DRUG ELUTING STENT PLACEMENT C9600 $42,042.00DRUG INFUSION DURING CARDIAC CATHETERIZATION 93463 $279.00

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 ChargeDRUG INFUSION OR EXERCISE FOR HEART STIMULATION DU 93464 $517.00DRUGS OR SUBSTANCES MEASUREMENT 80375 $244.00DRUGS OR SUBSTANCES MEASUREMENT 80377 $560.00DULOXETINE 30 MG CPDR 30 EACH BOTTLE $26.62EARDRUM TESTING USING EAR PROBE 92567 $174.00EARPHONE HEARING AID HYBRID COCHLEAR NUCLEUS 6 2 R L8619 $1,293.50EBV DNA PCR QT 87799 $281.00ED VISIT, LVL 1 99281 $319.00ED VISIT, LVL 2 99282 $532.00ED VISIT, LVL 3 99283 $852.00ED VISIT, LVL 4 99284 $1,171.00ED VISIT, LVL 5 99285 $1,916.00EDUCATION & TRAINING FOR PATIENT SELF-MANAGEMENT 2 98961 $71.00EDUCATION & TRAINING FOR PATIENT SELF-MANAGEMENT 5 98962 $71.00EDUCATION AND TRAINING FOR PATIENT SELF-MANAGEMENT 98960 $264.00EHRLICHIA CHAFFEENSIS AB IGG 86666 $79.00EHRLICHIA CHAFFEENSIS AB IGM 86666 $79.00ELECTRICAL STIMLUATION UNATTENDED TO ONE OR MORE A 97014 $1,066.00ELECTRICAL STIMULATION NOT WOUND G0283 $0.01ELECTRICAL STIMULATION UNATTENDED ONE OR MORE AREA 97014 $586.00ELECTRICAL STIMULATION UNATTENDED TO ONE OR MORE A 97014 $36.00ELECTRO OR THERMAL DESTRUCTION OF CERVIX 57510 $5,366.00ELECTRODE ELECTROSURGICAL BALL L3 MM OD24/26 FR OD $834.60ELECTRODE ELECTROSURGICAL BALL OD22 FR ODSEC3 MM C $730.67ELECTRODE ELECTROSURGICAL BARREL L3 MM OD24-26 FR $834.60ELECTRODE ELECTROSURGICAL COLORADO TUNGSTEN NEEDLE $434.56ELECTRODE ELECTROSURGICAL EPITOME L2 IN FINE WIRE $1,658.00ELECTRODE ELECTROSURGICAL GOLDVAC ULTRACLEAN BLADE $2,265.25ELECTRODE ELECTROSURGICAL HARMONIC SCALPEL HOOK L3 $1,084.94ELECTRODE ELECTROSURGICAL HARMONIC SCALPEL ULTRACI $6,509.62ELECTRODE ELECTROSURGICAL HARMONIC SYNERGY BLADE C $1,512.65ELECTRODE ELECTROSURGICAL HARMONIC SYNERGY TITANIU $1,512.65ELECTRODE ELECTROSURGICAL L32 CM L HOOK LAPAROSCOP $331.50ELECTRODE ELECTROSURGICAL L5 MM OD24 FR UROLOGICAL $834.60ELECTRODE ELECTROSURGICAL L53 CM OD5 FR BALL END U $918.84ELECTRODE ELECTROSURGICAL L53 CM OD7 FR BALL END U $918.84ELECTRODE ELECTROSURGICAL L53 CM OD8 FR BALL END $918.84ELECTRODE ELECTROSURGICAL LIGHTWAVE 90 D 200W 50W $970.78ELECTRODE ELECTROSURGICAL LOOP 12 D .2 IN OD26 FR $653.95

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 ChargeELECTRODE ELECTROSURGICAL LOOP 12 D MEDIUM OD24 FR $2,739.10ELECTRODE ELECTROSURGICAL LOOP 12 D OD22.5 FR HIGH $614.33ELECTRODE ELECTROSURGICAL LOOP 30 D .35 IN OD24 FR $751.29ELECTRODE ELECTROSURGICAL LOOP 30 D .35 IN OD26 FR $12,032.00ELECTRODE ELECTROSURGICAL LOOP 30 D .35 IN OD28 FR $1,203.84ELECTRODE ELECTROSURGICAL LOOP OD24 FR CUT OLYMPUS $448.84ELECTRODE ELECTROSURGICAL LOOP OD24 FR CUT STORZ 1 $448.84ELECTRODE ELECTROSURGICAL LOOP OD26 FR CUT OLYMPUS $492.00ELECTRODE ELECTROSURGICAL LOOP OD27 FR CUT STORZ 1 $448.84ELECTRODE ELECTROSURGICAL MEGADYNE MEGAFINE PTFE 4 $2,802.09ELECTRODE ELECTROSURGICAL OD24/26 FR COAGULATE POI $4,092.40ELECTRODE ELECTROSURGICAL OD27 FR CUT LOOP ENDOSCO $4,092.40ELECTRODE ELECTROSURGICAL OD3 FR BALL END $918.84ELECTRODE ELECTROSURGICAL OLYMPUS PLASMABUTTON 12 $2,717.65ELECTRODE ELECTROSURGICAL PERKASH ANGLE RIGHT OD24 $669.50ELECTRODE ELECTROSURGICAL PKS PLASMASPATULA SPATUL $2,835.20ELECTRODE ELECTROSURGICAL PLUMEPEN ELITE BLADE PEN $1,059.04ELECTRODE ELECTROSURGICAL STARBURST TALON L25 CM O $15,395.51ELECTRODE ELECTROSURGICAL STARBURST XLI L25 CM L4- $19,807.32ELECTRODE ELECTROSURGICAL TROFLEX NEEDLE CURVE LAT $2,230.80ELECTRODE ELECTROSURGICAL USA ELITE SYSTEM ROLLER $644.95ELECTRODE ELECTROSURGICAL USA ELITE SYSTEM VAPORTR $961.85ELECTRODE ELECTROSURGICAL VAPR 90 D L40 MM SUCTION $1,496.00ELECTRODE MONOPOLAR LIGHTWAVE ABLATOR SUCTION DISP $1,283.43ELECTRODE PACING BARD NBIH 1 CM PROXIMAL L125 CM O $1,124.50ELECTRON MICROSCOP 88348 $2,512.00ELECTRONIC ANALYSIS AND REPROGRAMMING OF SPINAL CA 62368 $707.00ELECTRONIC ANALYSIS REPROGRAM & REFILL OF SPINAL C 62369 $926.00ELECTRONIC ANALYSIS REPROGRAM AND REFILL OF SPINAL 62370 $926.00ELECTRONIC ASSESSMENT OF BLADDER EMPTYING 51741 $544.00ELIMINATOR HOLE PINNACLE MARATHON HIP APEX STERILE C1776 $260.00ELOTUZUMAB 300 MG SOLR 1 EACH VIAL J9176 $9,335.65ELOTUZUMAB 400 MG SOLR 1 EACH VIAL J9176 $12,430.80EMERGENCY DIALYSIS ESRD PATIENT 90935 $2,216.00EMERGENT INSERTION BREATHING TUBE INTO WINDPIPE CA 31500 $612.00EMERGENT SURGICAL OPENING OF WINDPIPE FOR INSERTIO 31605 $2,299.00END CAP SPINAL ALTA TITANIUM NONSTERILE STAND ALON C1713 $162.50END CAP SPINAL T2 8 D OD25 MM C1713 $1,625.00END CAP SPINAL VUMESH PEEK-OPTIMA 5 D LARGE DIAMET C1713 $2,223.00

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 ChargeEND CAP SPINAL VUMESH PEEK-OPTIMA 7.5 D LARGE DIAM C1713 $2,223.00END CAP SPINAL X-CORE 2 TITANIUM 0 D H22 MM OD18 M C1713 $6,500.00END CAP SPINAL X-CORE 2 TITANIUM 0 D H22 MM OD22 M C1713 $6,500.00END CAP SPINAL X-CORE 2 TITANIUM 0 D H30 MM H18 MM C1713 $6,500.00END CAP SPINAL X-CORE 2 TITANIUM 0 D H40 MM H18 MM C1713 $6,500.00END CAP SPINAL X-CORE 2 TITANIUM 0 D H50 MM H22 MM C1713 $6,500.00END CAP SPINAL X-CORE 2 TITANIUM 0 D L40 MM X W22 C1713 $6,500.00END CAP SPINAL X-CORE 2 TITANIUM 4 D H22 MM OD18 M C1713 $6,500.00END CAP SPINAL X-CORE 2 TITANIUM 4 D H22 MM OD22 M C1713 $6,500.00END CAP SPINAL X-CORE 2 TITANIUM H20-25 MM OD18 MM C1713 $27,625.00END CAP SPINAL X-CORE 2 TITANIUM H22 MM H18 MM LOC C1713 $325.00END CAP SPINAL X-CORE 2 TITANIUM H24-33 MM OD18 MM C1713 $27,625.00END CAP SPINAL X-CORE 2 TITANIUM H28-41 MM OD18 MM C1713 $27,625.00END CAP SPINAL X-CORE 2 TITANIUM H35-55 MM OD18 MM C1713 $27,625.00END CAP SPINAL X-CORE 2 TITANIUM LOCK SCREW NONSTE C1713 $325.00END CAP SPINAL X-CORE MINI LOCK SCREW NONSTERILE C1713 $325.00END CAP SPINAL X-CORE MINI PARALLEL H16 MM OD14 MM C1713 $3,250.00END CAP SPINAL X-CORE MINI TITANIUM 7 D LORDOTIC H C1713 $3,250.00ENDODONTIC THERAPY D3310 $1,243.00ENDODONTIC THERAPY D3320 $1,459.00ENDODONTIC THERAPY D3330 $1,750.00ENDOVASCULAR REPAIR DEPLOY AORTO-BIL-ILIAC ENDOGRA 34705 $6,531.00ENDOVASCULAR REPAIR DEPLOY AORTO-UNI-ILIAC ENDOGRA 34703 $5,942.00ENDOVASCULAR REPAIR DEPLOYMENT AORTO-BIL-ILIAC END 34706 $9,835.00ENDOVASCULAR REPAIR DEPLOYMENT AORTO-UNI-ILIAC END 34704 $9,879.00ENDOVASCULAR REPAIR DEPLOYMENT ILIO-ILIAC FOR RUPT 34708 $7,896.00ENDOVASCULAR REPAIR DEPLOYMENT ILIO-ILIAC OTHER TH 34707 $4,905.00ENDPLATE SPINAL VUMESH PEEK-OPTIMA 0 D LARGE DIAME C1713 $1,989.00ENDPLATE SPINAL VUMESH PEEK-OPTIMA 2.5 D LARGE DIA C1713 $1,924.00ENDPLATE SPINAL VUMESH PEEK-OPTIMA 5 D LARGE DIAME C1713 $2,138.50ENDPLATE SPINAL VUMESH PEEK-OPTIMA 7.5 D LARGE DIA C1713 $2,138.50ENLARGEMENT OF EYELID MARGIN 67950 $5,047.00ENOXAPARIN 120 MG/0.8 ML SYRG 0.8 ML SYRINGE J1650 $67.90ENVELOPE ABSORBABLE TYRX POLYARYLATE MINOCYCLINE R $5,817.50ENZYME ACTIVITY MEASUREMENT 82657 $114.00EOSINOPHIL URINE 89050 $30.00EPOETIN ALFA 20,000 UNIT/ML SOLN 1 ML VIAL $566.56ERYTHROPOIETIN (PROTEIN) LEVEL 82668 $146.00ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VIS 99211 $210.00

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 ChargeESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VIS 99212 $271.00ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VIS 99213 $308.00ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VI 99214 $358.00ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VI 99215 $474.00ESTRIOL (HORMONE) LEVEL 82677 $152.00ESTROGEN ANALYSIS 82671 $203.00ESTROGEN ANALYSIS 82672 $136.00ETHAMBUTOL 80299 $86.00ETHOSUXIMIDE LEVEL 80168 $127.00ETHYLENE GLYCOL (ANTIFREEZE) MEASUREMENT 82693 $95.00ETONOGESTREL 68 MG IMPL 1 EACH PF APPLI J7307 $3,302.10EVALUATION & INSERT CATHETERS REC PACING & ATTEMPT 93654 $74,065.00EVALUATION & INSERT CATHETERS REC PACING & TREATME 93656 $74,065.00EVALUATION & PRESCRIPTION NON-SPEECH-GENERAT & ALT 92605 $382.00EVALUATION & PRESCRIPTION NON-SPEECH-GENERAT & ALT 92618 $89.00EVALUATION & PRESCRIPTION SPEECH-GENERAT & ALTERN 92608 $146.00EVALUATION & RECORDING SWALLOWING & VOICE BOX SENS 92616 $316.00EVALUATION AND INSERTION OF CATHETERS FOR CREATION 93653 $74,065.00EVALUATION AND PROGRAMMING ADJUSTMENT OF DEFIBRILL 93287 $46.00EVALUATION AND RECORDING OF SWALLOWING USING AN EN 92612 $203.00EVALUATION AND RECORDING OF VOICE BOX SENSORY FUNC 92614 $215.00EVALUATION IMPLANTABLE DEFIBRILLATOR 93644 $1,559.00EVALUATION MD ANALYSIS REV&REP&PROGRAM ADJ SNGL/DU 93286 $42.00EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTI 87181 $36.00EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTI 87184 $68.00EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTI 87186 $85.00EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTI 87188 $563.00EVALUATION OF ATHLETIC TRAINING TYPICALLY 15 MINUT 97169 $2,539.00EVALUATION OF ATHLETIC TRAINING TYPICALLY 20 MINUT 97172 $1,666.00EVALUATION OF ATHLETIC TRAINING TYPICALLY 30 MINUT 97170 $2,340.00EVALUATION OF ATHLETIC TRAINING TYPICALLY 45 MINUT 97171 $3,767.00EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION R 93289 $137.00EVALUATION OF DEFIBRILLATOR WITH ANALYSIS, REVIEW, 93261 $172.00EVALUATION OF FINE NEEDLE ASPIRATE 88172 $113.00EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETA 88173 $230.00EVALUATION OF HEARING FUNCTION BRAIN RESPONSES 92521 $530.00EVALUATION OF HEARING FUNCTION BRAIN RESPONSES 92621 $2,847.00EVALUATION OF HEARING REHABILITATION 92627 $712.00EVALUATION OF HEARING REHABILITATION FIRST HOUR 92626 $565.00

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 ChargeEVALUATION OF HEART FUNCTION USING TILT TABLE 93660 $1,467.00EVALUATION OF IMPLANTABLE HEART RECORDER SYSTEM 93291 $164.00EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLA 97167 $366.00EVALUATION OF OCCUPATIONAL THERAPY TYPICALLY 30 MI 97165 $366.00EVALUATION OF OCCUPATIONAL THERAPY TYPICALLY 45 MI 97166 $366.00EVALUATION OF ORTHOTIC OR PROSTHETIC USE, EACH 15 97763 $128.00EVALUATION OF PHYSICAL THERAPY TYPICALLY 20 MINUTE 97161 $378.00EVALUATION OF PHYSICAL THERAPY TYPICALLY 30 MINUTE 97162 $378.00EVALUATION OF PHYSICAL THERAPY TYPICALLY 45 MINUTE 97163 $378.00EVALUATION OF SPEECH SOUND PRODUCTION 92522 $477.00EVALUATION OF SWALLOWING FUNCTION 92610 $269.00EVALUATION OF THICKNESS OF COMMON CAROTID ARTERY ( 0126T $623.00EVALUATION PARAMETERS SNGL/DUAL/MULT LD CARD-DEFIB 93290 $113.00EVALUATION PARAMETERS SNGL/DUAL/MULT LD PACEMKR W/ 93288 $164.00EVALUATION PATIENT W/PRESCRIPTION SPEECH-GENERAT & 92607 $364.00EVALUATION SNGL/DUAL CHAMBER PACING CARD-DEFIB & G 93641 $541.00EVALUATION SNGL/DUAL CHAMBER PACING CARD-DEFIB AT 93640 $586.00EVALUATION SNGL/DUAL CHAMBER PACING CARD-DEFIB W/P 93642 $2,849.00EVALUATION SPEECH SOUND PRODUCTION W/EVAL LANGUAGE 92523 $990.00EVALUATION TEST & PROGRAM ADJUST IMPLANT PATIENT A 93285 $164.00EVALUATION TEST & PROGRAM ADJUSTMENT PERMANENT MUL 93281 $164.00EVALUATION TESTING & PROGRAM ADJUST PERMANENT SNGL 93279 $164.00EVALUATION TESTING & PROGRAMMING ADJUST PERMANENT 93280 $164.00EVALUATION TESTING AND PROGRAMMING ADJUSTMENT OF D 93282 $164.00EVALUATION TESTING AND PROGRAMMING ADJUSTMENT OF D 93283 $164.00EVALUATION TESTING AND PROGRAMMING ADJUSTMENT OF D 93284 $164.00EVALUATION USE/FITTING OF VOICE PROSTHETIC DEVICE 92597 $221.00EVALUATION WEARABLE DEFIBRILLATOR SYSTEM INCLUDE C 93292 $164.00EVEROLIMUS LEVEL 80169 $90.00EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/> 26111 $5,502.00EXAM OF BLADDER AND BLADDER CANAL FOR TREATMENT OF 52285 $6,783.00EXAM OF LUNG AIRWAYS USING ENDOSCOPE WITH IMAGING 31652 $9,201.00EXAM OF LUNG AIRWAYS USING ENDOSCOPE WITH IMAGING 31653 $8,907.00EXAM OF WINDPIPE & LUNG AIRWAYS THROUGH PERMANENT 31615 $1,840.00EXAM WITH INJECTIONS OF CHEMICAL FOR DESTRUCTION O 52287 $4,174.00EXAMINATION AND BIOPSY OF EXTERNAL FEMALE GENITALS 56821 $438.00EXAMINATION NASAL PASSAGES AND SINUS USING AN ENDO 31235 $4,988.00EXAMINATION OF CERVIX USING AN ENDOSCOPE WITH BIOP 58110 $110.00EXAMINATION OF COMMON BILE AND/OR PANCREATIC DUCTS 43273 $6,372.00

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 ChargeEXAMINATION OF CORNEA AND IRIS USING LENS DEVICE A 92020 $234.00EXAMINATION OF EXTERNAL FEMALE GENITALS USING AN E 56820 $438.00EXAMINATION OF LUNG AIRWAYS USING AN ENDOSCOPE 31623 $2,577.00EXAMINATION OF LUNG AIRWAYS WITH REPAIR OF AIR LEA 31634 $19,457.00EXAMINATION OF NASAL PASSAGE AND SINUS USING AN EN 31233 $1,502.00EXAMINATION OF SMALL BOWEL USING AN ENDOSCOPE 44360 $3,351.00EXAMINATION OF THE NOSE AND THROAT USING AN ENDOSC 92511 $285.00EXAMINATION OF THE VAGINA AND CERVIX USING AN ENDO 57452 $438.00EXAMINATION OF THE VAGINA USING AN ENDOSCOPE 57420 $863.00EXAMINATION OF UTERUS WITH DESTRUCTION OF UTERINE 58563 $11,946.00EXAMINATION TO ASSESS MOVEMENT OF VOCAL CORD FLAPS 31579 $1,150.00EXC MUSCLE GROWTH OF HAND OR FINGER <1.5CM 26116 $5,502.00EXC MUSCLE GROWTH OF HAND OR FINGER >1.5CM 26113 $5,502.00EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM 26115 $5,502.00EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM 21932 $9,514.00EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/> 21933 $9,514.00EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/> 24073 $9,514.00EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/> 27045 $9,514.00EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/> 23073 $9,514.00EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM 27328 $9,514.00EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/> 27339 $9,514.00EXCHANGE BLOOD TRANSFUSION, NEWBORN 36450 $1,163.00EXCHANGE OF ABDOMINAL CAVITY DRAINAGE CATHETER USI 49423 $4,318.00EXCISE TUMOR,SOFT TISS SHLDR, SUBFA LESS THN 5CM 23076 $9,514.00EXCISION BENIGN LESION D7412 $69.00EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY 25111 $5,254.00EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT 25112 $5,254.00EXCISION HYPERPLASTIC TISSUE D7970 $3,951.00EXCISION LESION MENISCUS/CAPSULE KNEE 27347 $9,514.00EXCISION LESION TENDON SHEATH FOREARM&/WRIST 25110 $5,254.00EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK 27630 $10,494.00EXCISION OF BLOOD CLOT AND/OR INFUS TO DISSOLVE BL 36904 $20,541.00EXCISION OF BLOOD CLOT AND/OR INFUS TO DISSOLVE BL 36905 $41,516.00EXCISION OF BLOOD CLOT AND/OR INFUS TO DISSOLVE BL 36906 $64,082.00EXCISION OF VAGINAL CYST OR TUMOR 57135 $5,366.00EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/> 21931 $5,502.00EXCISIONAL DESTRUCTION OF ANAL GROWTHS 46922 $5,231.00EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL ST 93017 $985.00EXERCISE TEST FOR SPASM OF LUNG AIRWAYS 94617 $421.00

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 ChargeEXPANDER TISSUE ARTORA HIGH PROFILE 475 CC INJECTI $14,200.00EXPANDER TISSUE ARTOURA HIGH PROFILE 225 CC INJECT $11,537.50EXPANDER TISSUE ARTOURA HIGH PROFILE 300 CC INJECT $11,537.50EXPANDER TISSUE ARTOURA HIGH PROFILE 375 CC INJECT $11,537.50EXPANDER TISSUE ARTOURA HIGH PROFILE 500 CC INJECT $11,537.50EXPANDER TISSUE ARTOURA HIGH PROFILE 600 CC INJECT $11,537.50EXPANDER TISSUE ARTOURA HIGH PROFILE 750 CC TEXTUR $11,537.50EXPANDER TISSUE ARTOURA HIGH PROFILE 850 CC INJECT $11,537.50EXPANDER TISSUE ARTOURA ULTRA HIGH PROFILE 350 CC $9,400.00EXPANDER TISSUE ARTOURA ULTRA HIGH PROFILE 455 CC $14,200.00EXPANDER TISSUE ARTOURA ULTRA HIGH PROFILE 535 CC $14,200.00EXPANDER TISSUE ARTOURA ULTRA HIGH PROFILE 650 CC $11,537.50EXPANDER TISSUE ARTOURA ULTRA HIGH PROFILE 850 CC $11,537.50EXPANDER TISSUE CPX P6.2 CM W10.7 CM X H9.3 CM 275 $8,287.50EXPANDER TISSUE CPX P6.6 CM W11.7 CM X H10 CM 350 $8,287.50EXPANDER TISSUE CPX P7 CM W12.7 CM X H10.8 CM 450 $8,287.50EXPANDER TISSUE CPX4 SILTEX P6.2 CM CONTOUR PROFIL $9,100.00EXPANDER TISSUE CPX4 SILTEX P6.5 CM CONTOUR PROFIL $9,100.00EXPANDER TISSUE CPX4 SILTEX P6.6 CM CONTOUR PROFIL $9,100.00EXPANDER TISSUE CPX4 SILTEX P7 CM CONTOUR PROFILE $9,100.00EXPANDER TISSUE CPX4 SILTEX P7.1 CM CONTOUR PROFIL $9,100.00EXPANDER TISSUE CPX4 SILTEX P7.4 CM CONTOUR PROFIL $9,100.00EXPANDER TISSUE CPX4 SILTEX P7.6 CM CONTOUR PROFIL $9,100.00EXPANDER TISSUE CPX4 SILTEX P7.9 CM CONTOUR PROFIL $9,100.00EXPANDER TISSUE DACRON P2.5-5.3 CM ELLIPTICAL L8 C $3,640.00EXPANDER TISSUE DACRON P3.2 CM RECTANGLE L6.9 CM X $3,640.00EXPANDER TISSUE DACRON P5.6 CM RECTANGLE L10.4 CM $3,640.00EXPANDER TISSUE DACRON P5.6 CM RECTANGLE L6.6 CM X $3,640.00EXPANDER TISSUE DACRON P5.8 CM ROUND OD13.4 CM 550 $3,640.00EXPANDER TISSUE DACRON P5.9 CM ROUND OD11.3 CM 400 $3,640.00EXPANDER TISSUE DACRON P6.6 CM RECTANGLE L10.6 CM $3,640.00EXPANDER TISSUE DACRON P7.9 CM RECTANGLE L15 CM X $3,640.00EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE MAGNA- $8,281.00EXPLORATION OF PENETRATING WOUND OF ABDOMEN, FLANK 20102 $6,963.00EXPLORATION OF PENETRATING WOUND OF ARM OR LEG 20103 $3,346.00EXPLORATION OF PENETRATING WOUND OF CHEST 20101 $6,963.00EXPLORATION OF PENETRATING WOUND OF NECK 20100 $2,299.00EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY 26080 $5,400.00EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY 28024 $5,400.00

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 ChargeEXPOSURE OF ONE GROIN ARTERY WITH CREATION OF COND 34714 $1,153.00EXPOSURE OF ONE UNDERARM OR UPPER CHEST ARTERY WIT 34716 $1,598.00EXPOSURE OF SKIN SURFACE BY CREATION OF AN OPENING 29730 $349.00EXTENDER GRAFT INQU POLYSACCHARIDHYALURONIC ACID P $9,587.50EXTENSION GUIDEWIRE DOC L145 CM OD.014 IN C1769 $345.00EXTENSION GUIDEWIRE WHOLEY HI-TORQUE STANDARD L155 C1769 $389.33EXTENSION NEUROSTIMULATOR DBS L40 CM $4,855.50EXTENSION NEUROSTIMULATOR L10 CM 8 ELECTRODE 4 DUA C1883 $5,526.63EXTENSION NEUROSTIMULATOR L35 CM SPINAL CORD PHASE C1778 $3,250.00EXTENSION NEUROSTIMULATOR RENEW L30 CM 8 CHANNEL A C1883 $3,250.00EXTENSION NEUROSTIMULATOR RESTORE L20 CM OD4.7-1.3 C1883 $3,250.00EXTENSION NEUROSTIMULATOR SILICONE PLATINUM IRIDIU C1883 $3,250.00EXTENSION NEUROSTIMULATOR STRETCH-COIL 2 BRANCH L2 C1883 $6,500.00EXTENSION NEUROSTIMULATOR STRETCH-COIL L40 CM OD1. C1883 $6,500.00EXTENSION NEUROSTIMULATOR STRETCH-COIL L60 CM OD1. C1883 $6,500.00EXTENSION SPINAL VEPTR II TITANIUM 3 500 MM RADIUS C1713 $11,043.20EXTENSION SPINAL VEPTR II TITANIUM L20 MM RIB HOOK $8,550.40EXTENSION SPINAL VEPTR II TITANIUM L30 MM RIB HOOK $8,550.40EXTENSION SPINAL VEPTR II TITANIUM L40 MM RIB HOOK $8,550.40EXTENSION SPINAL VEPTR TITANIUM 10 220 MM RADIUS L $9,475.20EXTENSION SPINAL VEPTR TITANIUM 11 220 MM RADIUS L $9,475.20EXTENSION SPINAL VEPTR TITANIUM 12 220 MM RADIUS L $9,475.20EXTENSION SPINAL VEPTR TITANIUM 13 220 MM RADIUS L $9,475.20EXTENSION SPINAL VEPTR TITANIUM 6 220 MM RADIUS LU $9,475.20EXTENSION SPINAL VEPTR TITANIUM 7 220 MM RADIUS LU $9,475.20EXTENSION SPINAL VEPTR TITANIUM 8 220 MM RADIUS LU $9,475.20EXTENSION SPINAL VEPTR TITANIUM 9 220 MM RADIUS LU $9,475.20EXTENSION STEM NEXGEN FLUTE L75 MM L120 MM OD15 MM C1776 $4,550.00EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD1 C1776 $4,550.00EXTENSION STEM NEXGEN STRAIGHT L155 MM L200 MM OD1 C1776 $4,550.00EXTENSION STEM NEXGEN STRAIGHT L30 MM L75 MM OD15 C1776 $4,550.00EXTENSION STEM OPTETRAK L25 MM OD14 MM TIBIAL KNEE C1776 $4,550.00EXTENSION STEM PERSONA TAPER L30+ MM OD14 MM KNEE C1776 $4,550.00EXTENSIVE ORAL EVALUATION D0160 $175.00EXTENSIVE REPAIR OF TURNING-OUTWARD EYELID DEFECT 67917 $6,106.00EXTERNAL EKG RECORDING FOR MORE THAN 48 HOURS UP T 0296T $712.00EXTERNAL HYPERTHERMIA TREATMENT DEPTH GREATER THAN 77605 $1,896.00EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT 92960 $2,089.00EXTRACTION ERUPTED TOOTH D7140 $1,995.00

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 ChargeEXTRACTOR STONE NCIRCLE DELTA WIRE NITINOL TRIANGL $1,552.00EXTRACTOR STONE NCIRCLE NITINOL L115 CM OD1.5 FR O $970.00EXTRACTOR STONE NCIRCLE NITINOL L65 CM OD3 FR ODSE $870.00EXTRACTOR STONE NCOMPASS NITINOL L115 CM OD1.7 FR $1,552.00EXTRACTOR STONE NCOMPASS NITINOL L115 CM OD2.4 FR $1,261.00EXTRACTOR STONE NGAGE NITINOL L115 CM OD1.7 FR ODS $1,552.00EXTRACTOR STONE NGAGE NITINOL L115 CM OD2.2 FR ODS $1,261.00EXTRACTOR STONE OD.4 MM 4 WIRE BASKET STERILE DISP $2,139.20EXTRACTOR STONE OD.6 MM 3 WIRE BASKET STERILE DISP $2,139.20EXTRACTOR STONE OD.6 MM 4 WIRE TIPLESS HANDLE STER $2,240.00EXTRACTOR STONE PERC NCIRCLE NITINOL L38 CM OD10 F $550.85EYE & MEDICAL EXAM DIAGNOSIS & TREATMENT ESTAB PAT 92014 $271.00EYE AND MEDICAL EXAM FOR DIAGNOSIS & TREATMENT NEW 92004 $358.00EYE AND MEDICAL EXAMINATION FOR DIAGNOSIS & TREATM 92012 $271.00EYE CHART TESTING OF VISUAL ACUITY OF BOTH EYES 99173 $17.00E-Z-ON MODIFIED MINI PUSH BUTTON VEST EXTRA SMALL $1,160.00E-Z-ON MODIFIED VEST $1,160.00FABRIC CARDIOVASCULAR BARD SAUVAGE POLYESTER PTFE C1768 $570.00FABRIC CARDIOVASCULAR DEBAKEY THK1.5 MM L4 IN X W4 C1768 $488.00FABRIC CARDIOVASCULAR PRECLUDE GORE-TEX THK.1 MM L $5,176.00FACIAL MOULAGE D5911 $1,995.00FACTOR 8 INHIBITOR 85335 $93.00FACTOR 9 INHIBITOR 85335 $93.00FACTOR V ASSAY 85220 $82.00FACTOR VIII ASSAY 85240 $110.00FASCIOTOMY, PALMAR PERCUTANEOUS 26040 $5,254.00FASCIOTOMY, PALMAR; OPEN, PARTIAL 26045 $10,494.00FATTY ACIDS MEASUREMENT 82725 $103.00FELT CARDIOVASCULAR BARD PTFE THK2.87 MM L4 IN X W C1768 $557.31FELT CARDIOVASCULAR BARD PTFE THK2.87 MM L6 IN X W C1768 $835.38FELT CARDIOVASCULAR PTFE THK1.65 MM L1 IN X W1 IN C1768 $89.18FELT CARDIOVASCULAR PTFE THK1.65 MM L2 IN X W.25 I C1768 $105.59FELT CARDIOVASCULAR PTFE THK1.65 MM L2 IN X W2 IN C1768 $129.06FELT CARDIOVASCULAR PTFE THK1.65 MM L4 IN X W1/2 I C1768 $127.86FELT CARDIOVASCULAR PTFE THK1.65 MM L4 IN X W4 IN C1768 $370.50FELT CARDIOVASCULAR PTFE THK1.65 MM L6 IN X W6 IN C1768 $463.13FENTANYL 50 MCG/ML SOLN 2 ML VIAL J3010 $20.12FENTANYL LEVEL 80354 $244.00FERRIC GLUCONATE 62.5 MG/5 ML SOLN 5 ML VIAL J2916 $78.10

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 ChargeFERRIC SUBSULFATE 20 TO 22 GRAM/100 ML SOLN 15 ML $10.98FERRITIN (BLOOD PROTEIN) LEVEL 82728 $105.00FETAL HEMOGLOBIN ANALYSIS 83033 $46.00FETAL HEMOGLOBIN/RED BLOOD CELLS MEASURE ASSESS FE 85461 $18.00FETAL LUNG MATURITY ASSESSMENT 83664 $147.00FETAL NON-STRESS TEST 59025 $573.00FIBER LASER FLEXIVA FLEXSHIELD 1000 UM HIGH POWER $4,162.76FIBER LASER FLEXIVA FLEXSHIELD 200 UM HIGH POWER P $2,262.83FIBER LASER FLEXIVA FLEXSHIELD 365 UM HIGH POWER P $1,878.57FIBER LASER FLEXIVA FLEXSHIELD 550 UM HIGH POWER P $2,476.31FIBER LASER SLIMLINE EZ 200 UM 1 INCISION SLING $3,066.61FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT 85384 $77.00FILIFORM URETHRAL L12.5 IN OD3 FR DILATION CATHETE $465.79FILIFORM URETHRAL L12.5 IN OD4 FR DILATION CATHETE $465.79FILIFORM URETHRAL SPIRAL L12.5 IN OD2 FR WOVEN STE $465.79FILLER BONE VOID 50% CORTICAL 50% CANCELLOUS 1.7-1 C1713 $2,973.60FILLER BONE VOID 80% CORTICAL 20% CANCELLOUS .5-5 C1713 $5,216.40FILLER BONE VOID BIOCARTILAGE 1 CC C1713 $6,370.00FILLER BONE VOID CANCELLOUS 1.7-10 MM 15 CC ALLOGR $1,242.00FILLER BONE VOID CANCELLOUS 1.7-10 MM 30 CC ALLOGR C1713 $2,106.00FILLER BONE VOID CANCELLOUS 1.7-10 MM 60 CC ALLOGR C1713 $4,176.00FILLER BONE VOID CANCELLOUS 1-5 MM 5 ML ALLOGRAFT C1713 $1,138.80FILLER BONE VOID CERAMENT CALCIUM SULPHATE HA 10 M C1713 $13,000.00FILLER BONE VOID DBX .5 ML PUTTY NONSTERILE C1713 $560.17FILLER BONE VOID DBX 1 CC ALLOGRAFT FREEZE DRIED P C1713 $845.00FILLER BONE VOID DBX 10 CC ALLOGRAFT FREEZE DRIED C1713 $6,286.80FILLER BONE VOID DBX 20 CC ALLOGRAFT FREEZE DRIED C1713 $16,000.00FILLER BONE VOID DBX 5 CC ALLOGRAFT PUTTY FREEZE D $4,090.45FILLER BONE VOID DBX L10 CM X W2.5 CM ALLOGRAFT ST C1713 $8,382.40FILLER BONE VOID GRAFTON DEMINERALIZED BONE MATRIX C1713 $8,723.00FILLER BONE VOID KINEX 10 CC BIOACTIVE GEL C1713 $3,087.50FILLER BONE VOID MASTERGRAFT 5 ML MATRIX BLOCK EXT C1713 $2,427.84FILLER BONE VOID NORIAN CALCIUM PHOSPHATE FIBER 10 C1713 $14,976.13FILLER BONE VOID NORIAN CALCIUM PHOSPHATE FIBER 5 C1713 $7,620.73FILLER BONE VOID NORIAN CALCIUM PHOSPHATE FIBER SO C1713 $7,620.73FILLER BONE VOID STIMUBLAST 1 CC PUTTY C1713 $1,300.00FILLER BONE VOID STIMULAN RAPID CURE CALCIUM SULFA C1713 $13,650.00FILM OPHTHALMIC GELFILM GELATIN ABSORBABLE STERILE $1,265.44FILTER EMBOLIZATION CELECT NAVALIGN PLATINUM HYDRO C1880 $5,866.25

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 ChargeFILTER EMBOLIZATION CELECT PLATINUM NAVALIGN DELIV C1880 $4,512.50FILTER EMBOLIZATION DENALI NITINOL VENA CAVA FEMOR C1880 $6,825.00FILTER EMBOLIZATION DENALI NITINOL VENA CAVA JUGUL C1880 $6,825.00FILTER EMBOLIZATION GUNTHER TULIP CONICHROME HOOK C1880 $6,800.00FILTER EMBOLIZATION GUNTHER TULIP NAVALIGN STAINLE C1880 $7,220.00FILTER EMBOLIZATION OPTEASE L55 CM VENA CAVA INTRO C1880 $3,900.00FILTER GRAFT 100 CC PLUNGER GRADUATE STERILE HAZAR $1,778.40FILTER VASCULAR GREENFIELD FEMORAL SYSTEM FLEXCARR C1880 $6,926.73FILTER VASCULAR GREENFIELD JUGULAR SYSTEM .035 IN C1880 $7,600.00FILTER VASCULAR GREENFIELD TITANIUM L47 MM L38 MM C1880 $859.04FILTER VASCULAR GREENFIELD TITANIUM OD12 FR PERIPH C1880 $7,600.00FINE NEEDLE ASPIRATION 10021 $509.00FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION 10007 $2,318.00FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION 10005 $2,318.00FITTING AND INSERTION OF PREGNANCY PREVENTION DEVI 57170 $31.00FITTING AND INSERTION OF VAGINAL SUPPORT DEVICE 57160 $438.00FITTING OF CONTACT LENS FOR MANAGEMENT OF CORNEAL 92072 $380.00FITTING OF CONTACT LENS FOR TREATMENT OF OCULAR SU 92071 $965.00FIXATOR EXTERNAL FIXATION ANKLE RADIOLUCENT $33,296.64FIXATOR EXTERNAL FIXATION CARBON STANDARD COMPLETE $22,575.36FIXATOR EXTERNAL FIXATION COMPONENT DYNAMIZATION $2,580.48FIXATOR EXTERNAL FIXATION CONSTRUX $22,962.80FIXATOR EXTERNAL FIXATION CONSTRUX DYNAMIZATION $16,899.84FIXATOR EXTERNAL FIXATION CONSTRUX MALE TELESCOPE $9,034.08FIXATOR EXTERNAL FIXATION CONSTRUX STANDARD $22,778.72FIXATOR EXTERNAL FIXATION DFS 3 MM RADIAL DISTAL N $8,595.60FIXATOR EXTERNAL FIXATION DFS ANGLE STANDARD ANTER $30,128.64FIXATOR EXTERNAL FIXATION DFS STAINLESS STEEL RADI $5,817.60FIXATOR EXTERNAL FIXATION DFS STAINLESS STEEL WRIS $16,803.84FIXATOR EXTERNAL FIXATION DFS WRIST RADIUS DISTAL $6,347.52FIXATOR EXTERNAL FIXATION DFS XS 2 CONNECTOR CENTR $10,195.20FIXATOR EXTERNAL FIXATION DFS XS BASE LEVEL $21,074.80FIXATOR EXTERNAL FIXATION DFS XS CONNECTOR CENTRAL $4,413.20FIXATOR EXTERNAL FIXATION DFS XS L2- CM MIDDLE LEV $2,649.99FIXATOR EXTERNAL FIXATION DFS XS L4- CM DISTRACTIO $3,379.52FIXATOR EXTERNAL FIXATION ELBOW HINGE UNSTABLE FRA $10,543.20FIXATOR EXTERNAL FIXATION FLEXIBLE GOLD COLLES FRA $34,251.60FIXATOR EXTERNAL FIXATION HEIDELBERG SHORT CENTRAL $41,616.00FIXATOR EXTERNAL FIXATION HEIDELBERG STANDARD CENT $35,210.40

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 ChargeFIXATOR EXTERNAL FIXATION JET-X ALUMINUM STAINLESS $11,974.16FIXATOR EXTERNAL FIXATION JET-X LONG CENTRAL BODY $13,404.32FIXATOR EXTERNAL FIXATION JET-X STANDARD CENTRAL B $12,672.72FIXATOR EXTERNAL FIXATION JET-X XSHORT CENTRAL BOD $7,996.08FIXATOR EXTERNAL FIXATION JET-X XSHORT COMPRESSION $4,929.36FIXATOR EXTERNAL FIXATION LARGE CENTRAL BODY BALL $28,090.80FIXATOR EXTERNAL FIXATION LARGE LONG CENTRAL BODY $18,502.80FIXATOR EXTERNAL FIXATION LARGE RADIAL DISTAL ADJU $22,888.45FIXATOR EXTERNAL FIXATION LARGE SHORT CENTRAL BODY $19,849.20FIXATOR EXTERNAL FIXATION MEDIUM CENTRAL BODY BALL $26,397.60FIXATOR EXTERNAL FIXATION OPTIROM ELBOW LEFT DISTA $15,556.80FIXATOR EXTERNAL FIXATION OPTIROM ELBOW PASSIVE DI $5,986.50FIXATOR EXTERNAL FIXATION OPTIROM ELBOW PROXIMAL $31,617.60FIXATOR EXTERNAL FIXATION OPTIROM ELBOW RIGHT DIST $16,635.84FIXATOR EXTERNAL FIXATION RADIAL DISTAL ADJUSTABLE $13,827.60FIXATOR EXTERNAL FIXATION SCHANZ CARBON FIBER L200 $20,273.68FIXATOR EXTERNAL FIXATION SCHANZ CARBON FIBER L240 $18,947.36FIXATOR EXTERNAL FIXATION SHORT COMPONENT $3,686.40FIXATOR EXTERNAL FIXATION SMALL COMPRESSION DISTRA $3,483.36FIXATOR EXTERNAL FIXATION STANDARD LARGE CENTRAL B $21,481.20FLEX SIGMOIDOSCOPY W/ STENT INSERTION SIG COLON 45347 $17,958.00FLOW CYTOMETRY TECHNIQUE FOR DNA OR CELL ANALYSIS 88184 $1,234.00FLOW CYTOMETRY TECHNIQUE FOR DNA OR CELL ANALYSIS 88185 $71.00FLU VAC TS 2017-18(4 YR,UP)-PF 45 MCG (15 MCG X 3) 90656 $59.75FLUCONAZOLE IN DEXTROSE 200 MG/100 ML PGBK 100 ML J1450 $62.00FLUCONAZOLE IN SODIUM CHLORIDE 200 MG/100 ML PGBK J1450 $50.00FLUCONAZOLE IN SODIUM CHLORIDE 400 MG/200 ML PGBK J1450 $50.00FLUID COLLECTION DRAINAGE BY CATHETER ACCESSED THR 10030 $669.00FLUID COLLECTION DRAINAGE BY CATHETER USING IMAGIN 49405 $4,448.00FLUID COLLECTION DRAINAGE BY CATHETER USING IMAGIN 49406 $5,525.00FLUID COLLECTION DRAINAGE BY CATHETER USING IMAGIN 49407 $3,729.00FLUORIDE APPLICATION D5986 $289.00FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION 92611 $351.00FLUOROSCOPIC GUIDANCE FOR INJECTION INTO SPINE OR 77003 $227.00FLUOROSCOPIC GUIDANCE FOR INSERTION OF NEEDLE 77002 $184.00FLUOROSCOPIC GUIDE INSERTION REPLACE OR REMOVAL OF 77001 $359.00FLUOROURACIL (INTRADERMAL) 1 GRAM/20 ML SOLN 20 ML J9190 $75.00FLUOROURACIL 5 % CREA 40 G TUBE $814.40FLUTEMETAMOL F-18 5 MCI (185 MBQ) SOLN 1 EACH VIAL Q9982 $11,801.79

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 ChargeFOLIC ACID LEVEL 82746 $114.00FOLIC ACID LEVEL 82747 $133.00FOLLOWER URETHRAL HEYMAN PLASTIC L13.35 IN OD22 FR $824.85FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD10 F $699.01FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD12 F $699.01FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD14 F $699.01FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD16 F $699.01FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD18 F $699.01FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD20 F $699.01FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD22 F $699.01FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD24 F $391.82FOLLOWER URETHRAL PHILLIPS PLASTIC L13.5 IN OD8 FR $699.01FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF CON 93304 $1,578.00FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEA 93308 $1,887.00FOLLOW-UP OR REPEAT ULTRASOUND OF FETAL HEART 76828 $312.00FOLLOW-UP OR REPEAT ULTRASOUND OF FETAL HEART BLOO 76826 $1,027.00FOLLOW-UP/LIMITED HEART DOPPLER US STUDY HEART BLO 93321 $57.00FOOTPLATE BONE MANDIBLE CLOVERLEAF B TYPE INTERNAL C1713 $6,616.00FOOTPLATE BONE MANDIBLE MESH C TYPE INTERNAL 1 MM C1713 $4,867.20FOOTPLATE BONE STAINLESS STEEL H10 MM LEFT ANTERIO C1713 $3,240.00FOOTPLATE BONE STAINLESS STEEL H10 MM RIGHT ANTERI C1713 $4,608.00FOOTPLATE BONE STAINLESS STEEL H14 MM LEFT ANTERIO C1713 $4,608.00FOOTPLATE BONE STAINLESS STEEL H14 MM RIGHT ANTERI C1713 $4,608.00FOOTPLATE BONE STAINLESS STEEL H6 MM LEFT ANTERIOR C1713 $4,608.00FOOTPLATE BONE STAINLESS STEEL H6 MM RIGHT ANTERIO C1713 $4,608.00FOOTPLATE BONE STAINLESS STEEL MEDIUM L12 MM POSTE C1713 $9,168.00FOOTPLATE BONE STAINLESS STEEL MEDIUM L7 MM POSTER C1713 $9,168.00FOOTPLATE BONE STAINLESS STEEL SHORT L12 MM POSTER C1713 $9,168.00FOOTPLATE BONE STAINLESS STEEL SHORT L7 MM POSTERI C1713 $9,168.00FOOTPLATE BONE STAINLESS STEEL TALL L12 MM POSTERI C1713 $9,168.00FOOTPLATE BONE STAINLESS STEEL TALL L7 MM POSTERIO C1713 $9,168.00FOOTPLATE BONE TITANIUM 5.5 MM MANDIBLE TYPE B ELE C1713 $6,616.00FOOTPLATE BONE TITANIUM 5.5 MM MANDIBLE TYPE B MES C1713 $6,616.00FOOTPLATE BONE TITANIUM 7.5 MM MANDIBLE TYPE B ELE C1713 $6,616.00FOOTPLATE BONE TITANIUM 7.5 MM MANDIBLE TYPE C MES C1713 $4,867.20FOOTPLATE BONE TITANIUM ANTERIOR MIDFACIAL BUTTRES C1713 $4,792.00FOOTPLATE BONE TITANIUM ANTERIOR MIDFACIAL ELEVATE C1713 $5,342.40FOOTPLATE BONE TITANIUM ANTERIOR MIDFACIAL LOW PRO C1713 $7,616.00FOOTPLATE BONE TITANIUM ANTERIOR MIDFACIAL MESH NO C1713 $4,792.00

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 ChargeFOOTPLATE BONE TITANIUM L20 MM MANDIBLE LEFT 1 VEC C1713 $43,928.00FOOTPLATE BONE TITANIUM L20 MM MANDIBLE RIGHT 1 VE C1713 $51,680.00FOOTPLATE BONE TITANIUM L30 MM MANDIBLE LEFT 1 VEC C1713 $51,680.00FOOTPLATE BONE TITANIUM L30 MM MANDIBLE RIGHT 1 VE C1713 $51,680.00FOOTPLATE BONE TITANIUM L40 MM MAXILLARY NONSTERIL C1713 $3,968.00FOOTPLATE BONE TITANIUM LEFT ANTERIOR MIDFACIAL EL C1713 $7,616.00FOOTPLATE BONE TITANIUM MANDIBLE B TYPE MESH NONST C1713 $6,616.00FOOTPLATE BONE TITANIUM MANDIBLE C TYPE MESH NONST C1713 $6,616.00FOOTPLATE BONE TITANIUM MANDIBLE TYPE A CLOVERLEAF C1713 $6,616.00FOOTPLATE BONE TITANIUM MANDIBLE TYPE A MESH NONST C1713 $4,867.20FOOTPLATE BONE TITANIUM MANDIBLE TYPE B CLOVERLEAF C1713 $6,616.00FOOTPLATE BONE TITANIUM MANDIBLE TYPE B MESH NONST C1713 $6,616.00FOOTPLATE BONE TITANIUM MANDIBLE TYPE C CLOVERLEAF C1713 $6,616.00FOOTPLATE BONE TITANIUM MANDIBLE TYPE C ELEVATED M C1713 $4,867.20FOOTPLATE BONE TITANIUM MANDIBLE TYPE C MESH NONST C1713 $6,616.00FOOTPLATE BONE TITANIUM MANDIBLE TYPE C MESH OFFSE C1713 $6,616.00FOOTPLATE BONE TITANIUM MIDFACE POSTERIOR 1 VECTOR C1713 $7,616.00FOOTPLATE BONE TITANIUM RIGHT ANTERIOR MIDFACIAL E C1713 $7,616.00FOOTPLATE BONE TITANIUM ZYGOMATIC 3 HOLE NONSTERIL C1713 $1,398.00FORCEPS BIOPSY 2 MM L8.25 IN OD2 MM CUP $1,222.00FORCEPS BIPOLAR .7 MM L6.25 IN NONINSULATED $2,098.33FORCEPS BIPOLAR S/SI ENDOWRIST MARYLAND 0-45 D L55 $17,550.00FORCEPS BIPOLAR STRAIGHT HD $3,372.20FORCEPS BIPOLAR V MUELLER ADSON MICRO STRAIGHT L4 $429.98FORCEPS BIPOLAR V MUELLER JEWELER KYNAR 4 L4 1/4 I $513.37FORCEPS ELECTROSURGICAL LONG BAYONET STRAIGHT BIPO $4,803.50FORCEPS ENDOSCOPIC 70 D L12 CM OD4 MM UPTURNED ANG $3,155.49FORCEPS ENDOSCOPIC 70 D L12 CM OD4 MM UPTURNED CUP $3,155.49FORCEPS ENDOSCOPIC BLAKESLEY RHINOFORCE II 00 L13 $3,264.30FORCEPS ENDOSCOPIC BLAKESLEY-WILDE RHINOFORCE II 0 $3,264.30FORCEPS ENDOSCOPIC KUHN RHINOFORCE II 90 D L12 CM $4,594.20FORCEPS ENDOSCOPIC MACKAY-GRUNWALD RHINOFORCE 45 D $3,264.30FORCEPS ENDOSCOPIC MACKAY-GRUNWALD RHINOFORCE II 2 $3,264.30FORCEPS ENDOSCOPIC RHINOFORCE BLAKESLEY 1 L13 CM N $3,264.30FORCEPS ENDOSCOPIC RHINOFORCE II BLAKESLEY-WILDE 1 $3,264.30FORCEPS ENDOSCOPIC STAINLESS STEEL PTFE L120 CM OD C1773 $2,582.05FORCEPS GRASPING JAKO CUP LEFT ANGLE L9.5 IN OD4.5 $1,245.47FORCEPS GRASPING JAKO CUP RIGHT ANGLE L9.5 IN OD4. $1,270.88FORCEPS LAPAROSCOPIC DA VINCI S/SI ENDOWRIST 45- D $13,500.00

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 ChargeFORCEPS LAPAROSCOPIC DA VINCI S/SI ENDOWRIST CADIE $1,300.00FORCEPS LAPAROSCOPIC DA VINCI S/SI ENDOWRIST PK 70 $18,850.00FORCEPS LAPAROSCOPIC DA VINCI SI SINGLE-SITE MARYL $1,551.33FORCEPS LAPAROSCOPIC PROGRASP DA VINCI S/SI ENDOWR $14,300.00FORCEPS LAPAROSCOPIC SINGLE-SITE OD5 MM BIPOLAR FE $1,551.33FORCEPS OPHTHALMIC CASTROVIEJO STAINLESS STEEL .12 $1,840.80FORCEPS OPHTHALMIC LEHNER-UTRATA CAPSULORHEXIS ADU $2,181.60FORCEPS SPECIMEN RETRIEVAL TRICEP POLYAMIDE L120 C $1,060.02FORCEPS SPECIMEN RETRIEVAL TRICEP POLYIMIDE L120 C $1,060.02FORCEPS STONE RETRIEVAL GRASPIT NITINOL POLYIMIDE $1,337.18FORCEPS SURGICAL .8 MM STRAIGHT L2.8 IN L4.5 MM SE $2,300.48FORCEPS SURGICAL 3 MM L4 IN CUP $1,223.89FORCEPS SURGICAL BABCOCK L12 IN TISSUE HOLD $794.72FORCEPS SURGICAL BISHOP-HARMON L3 3/8 IN TISSUE 1 $498.62FORCEPS SURGICAL BLAKESLEY-WEIL 0 STRAIGHT L4.5 IN $1,907.36FORCEPS SURGICAL BROAD L132 MM RATCHET REDUCTION P $2,421.90FORCEPS SURGICAL COLVER L7 5/8 IN TONSIL PILLAR 5 $623.22FORCEPS SURGICAL DISC-FX STERILE DISPOSABLE $10,341.50FORCEPS SURGICAL DOYEN CURVE L8.75 IN INTESTINAL D $453.18FORCEPS SURGICAL DOYEN STRAIGHT L8.75 IN INTESTINA $413.14FORCEPS SURGICAL FRIEDMAN STAINLESS STEEL HALF CUR $567.52FORCEPS SURGICAL HARTMANN L6 CM EAR SLENDER $737.49FORCEPS SURGICAL HARTMANN-CITELLI 2 MM L3 1/8 IN E $1,051.57FORCEPS SURGICAL HEERMANN L6 CM EAR DRESSING SLEND $737.49FORCEPS SURGICAL HEUWIESER NASAL $3,175.64FORCEPS SURGICAL HOUSE .5 CM L4.75 IN L3 1/8 IN SE $1,058.59FORCEPS SURGICAL HOUSE GELFOAM L6.25 IN X W.5 IN L $571.94FORCEPS SURGICAL HOUSE L3 1/8 IN FINE SMOOTH JAW S $1,318.66FORCEPS SURGICAL MACKAY-GRUNWALD RHINOFORCE II 1 L $3,264.30FORCEPS SURGICAL MIXTER RIGHT ANGLE L8 IN CARDIOVA $327.28FORCEPS SURGICAL NOYES L5.5 IN EAR ENDURAL DELICAT $602.10FORCEPS SURGICAL PATTERSON 8 MM 3 MM XS L8 IN TISS $1,767.81FORCEPS SURGICAL RUSSIAN L12 IN TISSUE $770.25FORCEPS SURGICAL SEMB L9.5 IN CURVED FULLY JAW PER $977.67FORCEPS SURGICAL TAKAHASHI L7 IN L10 MM X W4 MM NA $1,678.95FORCEPS SURGICAL V MUELLER BLAKESLEY STAINLESS STE $2,251.73FORCEPS SURGICAL V MUELLER JACOBSON SLIGHT CURVE L $698.15FORCEPS SURGICAL V MUELLER STAINLESS STEEL L4 IN W $1,223.89FORCEPS SURGICAL V MUELLER WULLSTEIN L3 1/8 IN L.9 $1,536.28

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 ChargeFORCEPS SURGICAL WEIL-BLAKESLEY UPTURN $2,829.39FOREIGN BODY REMOVAL IN RECTUM AND LARGE BOWEL USI 45307 $7,061.00FOSAPREPITANT 150 MG SOLR 1 EACH VIAL J1453 $1,246.09FOSPHENYTOIN 100 MG PE/2 ML SOLN 2 ML VIAL Q2009 $127.28FRACTURE ASSESS SPINE BONES USING X-RAY MACHINE FO 77086 $292.00FRAME EXTERNAL FIXATION ACCESSORY BLOCK TAYLOR SPA $1,476.48FRAME EXTERNAL FIXATION L75 MM LOBE TAYLOR SPATIAL $8,291.44FRAME EXTERNAL FIXATION MEDIUM ID155 MM TAYLOR SPA $71,240.96FRAME EXTERNAL FIXATION MEDIUM ID180 MM OPEN TAYLO $71,240.96FRAME EXTERNAL FIXATION MEDIUM ID205 MM OPEN TAYLO $71,240.96FRAME EXTERNAL FIXATION STANDARD MEDIUM ID155 MM T $60,694.72FRAME EXTERNAL FIXATION STANDARD MEDIUM ID180 MM T $60,694.72FRAME EXTERNAL FIXATION STANDARD SHORT ID180 MM TA $60,694.72FRAME EXTERNAL FIXATION TEMPORARY $33,713.55FREE LIGHT CHAIN, SERUM 83883 $36.00FREEZING AND THAWING OF BLOOD UNIT 86932 $179.00FREEZING DESTRUCTION OF ANAL GROWTHS 46916 $444.00FREEZING DESTRUCTION OF CERVIX 57511 $438.00FREEZING DESTRUCTION OF PENILE GROWTHS 54056 $264.00FREEZING, PRESERVATION, AND STORAGE OF STEM CELLS 38207 $1,163.00FUNCTIONAL ASSESSMENT OF THE VOICE BOX 92520 $590.00FUNCTIONAL MRI SCAN OF BRAIN 70554 $1,635.00FUNCTIONAL MRI SCAN OF BRAIN W/ADMINISTRATION OF N 70555 $1,635.00FUNGAL BLOOD CULTURE (MOLD OR YEAST) 87103 $66.00FUNGAL CULTURE (MOLD OR YEAST) 87102 $82.00FUNGAL CULTURE (MOLD OR YEAST) OF SKIN, HAIR, OR N 87101 $54.00G6PD (ENZYME) LEVEL 82955 $76.00G6-PD QUANT 82955 $76.00GABAPENTIN 300 MG CAP 100 EACH BLIST PACK $3.00GABAPENTIN LEVEL NON-BLOOD 80355 $56.00GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE (ENZYME) 82775 $163.00GARMENT COMPRESSION TORSO POWERNET COTTON 3XL BRIE $527.76GARMENT COMPRESSION VASOPRESS TRICOT NYLON 13- FOO $1,885.00GAS CALIBRATION CDI A 540 $487.50GAS CALIBRATION CDI B 540 $487.50GAS INTRAOCULAR ISPAN CONSTELLATION 125 GM VISION $8,040.00GAS INTRAOCULAR ISPAN PERFLUOROPROPANE 20 GM CYLIN $459.20GAS INTRAOCULAR ISPAN SULFUR HEXAFLUORIDE CYLINDER $3,616.00GASTRIN (GI TRACT HORMONE) LEVEL 82941 $113.00

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 ChargeGBM AB IGG 86255 $88.00GENE ANALYSIS (5, 10-METHYLENETETRAHYDROFOLATE RED 81291 $427.00GENE ANALYSIS (ABL PROTO-ONCOGENE 1, NON-RECEPTOR 81170 $1,590.00GENE ANALYSIS (ALPHA GLOBIN 1 AND ALPHA GLOBIN 2) 81258 $1,689.00GENE ANALYSIS (ALPHA GLOBIN 1 AND ALPHA GLOBIN 2) 81259 $2,700.00GENE ANALYSIS (ASPARTOACYLASE) 81200 $213.00GENE ANALYSIS (BLOOM SYNDROME, RECQ HELICASE-LIKE) 81209 $177.00GENE ANALYSIS (COAGULATION FACTOR IX) FULL SEQUENC 81238 $2,700.00GENE ANALYSIS (COAGULATION FACTOR V) LEIDEN VARIAN 81241 $104.00GENE ANALYSIS (CYSTIC FIBROSIS TRANSMEMBRANE CONDU 81220 $506.00GENE ANALYSIS (DIHYDROPYRIMIDINE DEHYDROGENASE) FO 81232 $774.00GENE ANALYSIS (EPIDERMAL GROWTH FACTOR RECEPTOR), 81235 $1,269.00GENE ANALYSIS (FRAGILE X MENTAL RETARDATION) ABNOR 81243 $508.00GENE ANALYSIS (GLUCOSE-6-PHOSPHATE DEHYDROGENASE) 81247 $774.00GENE ANALYSIS (GLUCOSE-6-PHOSPHATE DEHYDROGENASE) 81248 $1,689.00GENE ANALYSIS (GLUCOSE-6-PHOSPHATE DEHYDROGENASE) 81249 $2,700.00GENE ANALYSIS (HEMOGLOBIN, SUBUNIT BETA) FOR COMMO 81361 $774.00GENE ANALYSIS (HEMOGLOBIN, SUBUNIT BETA) FOR DUPLI 81363 $911.00GENE ANALYSIS (HEMOGLOBIN, SUBUNIT BETA) FOR KNOWN 81362 $1,689.00GENE ANALYSIS (HEMOGLOBIN, SUBUNIT BETA) FULL SEQU 81364 $1,461.00GENE ANALYSIS (HEXOSAMINIDASE A) COMMON VARIANTS 81255 $232.00GENE ANALYSIS (HUMAN PLATELET ANTIGEN 1) FOR COMMO 81105 $680.00GENE ANALYSIS (HUMAN PLATELET ANTIGEN 15) FOR COMM 81112 $680.00GENE ANALYSIS (HUMAN PLATELET ANTIGEN 2) FOR COMMO 81106 $680.00GENE ANALYSIS (HUMAN PLATELET ANTIGEN 3) FOR COMMO 81107 $680.00GENE ANALYSIS (HUMAN PLATELET ANTIGEN 4) FOR COMMO 81108 $680.00GENE ANALYSIS (HUMAN PLATELET ANTIGEN 5) FOR COMMO 81109 $680.00GENE ANALYSIS (HUMAN PLATELET ANTIGEN 6) FOR COMMO 81110 $680.00GENE ANALYSIS (HUMAN PLATELET ANTIGEN 9) FOR COMMO 81111 $680.00GENE ANALYSIS (INTERFERON, LAMBDA 3) FOR RS1297986 81283 $340.00GENE ANALYSIS (ISOCITRATE DEHYDROGENASE 1 [NADP+], 81120 $870.00GENE ANALYSIS (JANUS KINASE 2) VARIANT 81270 $474.00GENE ANALYSIS (PERIPHERAL MYELIN PROTEIN 22), FULL 81325 $45.00GENE ANALYSIS (PROTHROMBIN, COAGULATION FACTOR II) 81240 $1,711.00GENE ANALYSIS (RUNT RELATED TRANSCRIPTION FACTOR 1 81334 $1,483.00GENE ANALYSIS (T CELL ANTIGEN RECEPTOR BETA) AMPLI 81340 $836.00GENE ANALYSIS (THIOPURINE S-METHYLTRANSFERASE) FOR 81335 $774.00GENE ANALYSIS (THYMIDYLATE SYNTHETASE) FOR COMMON 81346 $774.00GENE ANALYSIS ADDITIONAL VARIANTS 81276 $870.00

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 ChargeGENE ANALYSIS BINDING PROTEIN FULL GENE SEQUENCE 81218 $852.00GENE ANALYSIS COMMON DELETIONS OR VARIANT 81257 $59.00GENE ANALYSIS COMMON VARIANTS 81355 $397.00GENE ANALYSIS FOR CANCER 81311 $1,332.00GENE ANALYSIS OF BREAST TUMOR TISSUE 81520 $13,946.00GENE ANALYSIS OF BREAST TUMOR TISSUE 81521 $17,429.00GENE ANALYSIS OF PROSTATE TUMOR TISSUE 81541 $17,429.00GENE ANALYSIS OF PROSTATE TUMOR TISSUE 81551 $17,429.00GENERATOR NEUROSTIMULATOR EONC 16 CHANNEL IMPLANTA C1767 $91,359.13GENERATOR NEUROSTIMULATOR PRECISION MONTAGE 16 CON C1820 $108,225.00GENERATOR NEUROSTIMULATOR PRECISION SPECTRA IMPLAN C1767 $112,450.00GENERATOR NEUROSTIMULATOR PRECISION SPECTRA TITANI $104,533.00GENERATOR NEUROSTIMULATOR PROCLAIM ELITE THK1.35 C C1767 $90,675.00GENERATOR NEUROSTIMULATOR PROCLAIM L1.34 CM X W4.9 C1721 $126,782.50GENERATOR NEUROSTIMULATOR PRODIGY MRI LITHIUM THK1 C1820 $74,750.00GENERATOR NEUROSTIMULATOR PROTEGE MRI THK11 MM W53 C1820 $74,750.00GENERATOR NEUROSTIMULATOR PROTEGE THK11 MM W53 MM C1820 $74,750.00GENERATOR NEUROSTIMULATOR VNS THERAPY ASPIRESR PUL C1767 $225,200.00GENERATOR NEUROSTIMULATOR VNS THERAPY DEMIPULSE DU C1767 $121,257.50GENERATOR NEUROSTIMULATOR VNS THERAPY PULSE DUO TE C1767 $109,208.00GENERATOR NEUROSTIMULATOR VNS THERAPY TECOTHANE ST C1767 $165,827.81GENETIC TESTING 88274 $269.00GENETIC TESTING 88275 $303.00GENOME-WIDE MICROARRAY ANALYSIS COPY NUMBR & SNGL 81229 $6,708.00GENTAMICIN (ANTIBIOTIC) LEVEL 80170 $90.00GIARDIA ANTIGEN, EIA, STOOL 87329 $86.00GINGIVAL FLAP PLANING D4240 $332.00GINGIVECTOMY/GINGIVOLPLASTY D4210 $1,089.00GINGIVECTOMY/GINGIVOLPLASTY D4211 $922.00GIRDLE COMPRESSION 3XL HIGH $380.25GIRDLE COMPRESSION LYCRA FEMALE 2XL REINFORCE ABDO $347.75GIRDLE COMPRESSION POWERNET FABRIC COTTON 2XL OD45 $607.76GIRDLE COMPRESSION POWERNET FABRIC COTTON 3XL OD49 $687.76GIRDLE COMPRESSION POWERNET FABRIC COTTON 4XL OD53 $687.76GIRDLE COMPRESSION POWERNET FABRIC COTTON LARGE OD $527.76GIRDLE COMPRESSION POWERNET FABRIC COTTON MEDIUM O $479.60GIRDLE COMPRESSION POWERNET FABRIC COTTON SMALL OD $527.76GLUCAGON (PANCREATIC HORMONE) LEVEL 82943 $89.00GLUCOSE - 1 HR OB CHALLENGE 82947 $31.00

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 ChargeGLYCATED PROTEIN LEVEL 82985 $117.00GLYCERIN 100 % LIQD 0.5 ML SYRINGE $5.03GLYCERIN 99.5 % SOLN 473 ML BOTTLE $64.13GLYCOPYRROLATE 0.2 MG/ML SOLN 1 ML VIAL $33.51GLYCOPYRROLATE 0.2 MG/ML SOLN 2 ML VIAL $20.38GLYCOPYRROLATE 0.2 MG/ML SOLN 5 ML VIAL $28.52GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS 84703 $59.00GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE H 83001 $144.00GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) L 83002 $144.00GRAFT BONE ACCELL CONNEXUS NATURALLY DEMINERALIZED C1713 $4,517.50GRAFT BONE ACCELL TBM DEMINERALIZED BONE MATRIX L5 C1713 $5,439.20GRAFT BONE ACCELL TBM DEMINERALIZED BONE MATRIX SQ C1713 $10,862.80GRAFT BONE BIO4 VIABLE BONE MATRIX 1 CC ALLOGRAFT C1713 $1,462.50GRAFT BONE BIO4 VIABLE BONE MATRIX 5 CC ALLOGENEIC C1713 $6,093.10GRAFT BONE CANCELLOUS 1-4 MM 30 CC ALLOGRAFT CHIP C1713 $1,657.50GRAFT BONE CANCELLOUS 1-4 MM 30 ML CHIPS BIOLOGICS C1713 $1,657.50GRAFT BONE CANCELLOUS CORTICAL LORDOTIC L14 MM X W C1713 $5,525.00GRAFT BONE CARTIFORM DISC OD20 MM ALLOGRAFT C1713 $55,250.00GRAFT BONE CORNERSTONE ASR CANCELLOUS CORTICAL D11 C1713 $5,200.00GRAFT BONE CORNERSTONE ASR CANCELLOUS CORTICAL LOR C1713 $5,200.00GRAFT BONE CORNERSTONE ASR CORTICAL LORDOTIC L14 M C1713 $4,225.00GRAFT BONE CORNERSTONE CORTICAL L14 MM X W11 MM X C1713 $5,200.00GRAFT BONE DEMINERALIZED BONE MATRIX 10 CC ALLOGRA C1713 $4,288.77GRAFT BONE DEMINERALIZED BONE MATRIX 100 MM 10 ML C1713 $4,225.00GRAFT BONE DEMINERALIZED BONE MATRIX 100 MM 2.5 ML C1713 $1,462.50GRAFT BONE DEMINERALIZED BONE MATRIX 100 MM 5 ML P C1713 $2,925.00GRAFT BONE DEMINERALIZED BONE MATRIX 2.5 CC ALLOGR C1713 $1,462.50GRAFT BONE DEMINERALIZED BONE MATRIX L30 MM X W10 C1713 $4,550.00GRAFT BONE DEMINERALIZED FIBER 15 ML BIOLOGIC C1713 $7,221.29GRAFT BONE DEMINERALIZED FIBER 30 ML BIOLOGICS C1713 $11,884.52GRAFT BONE DEMINERALIZED FIBER 5 CC BIOLOGICS C1713 $2,725.78GRAFT BONE DEMINERALIZED FIBER 5 ML BIOLOGICS C1713 $2,725.81GRAFT BONE DYNAGRAFT II DEMINERALIZED BONE MATRIX C1713 $2,437.50GRAFT BONE FEMORAL CORTICAL THK3-12 MM HALF L200 M C1713 $7,956.00GRAFT BONE FEMORAL HEAD OD44+ MM ALLOGRAFT FROZEN C1713 $9,798.00GRAFT BONE FEMORAL THK20 MM OD28-60 MM ALLOGRAFT F C1713 $6,672.00GRAFT BONE FIBERFUSE ALLOGRAFT C1713 $9,132.50GRAFT BONE FIBULA SHAFT L100 MM X W14-18 MM ALLOGR C1713 $5,598.00GRAFT BONE FIBULA SHAFT L60 MM X W14-18 MM ALLOGRA C1713 $4,896.00

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 ChargeGRAFT BONE FLEXIGRAFT DEMINERALIZED BONE MATRIX CA C1713 $936.00GRAFT BONE FLEXIGRAFT DEMINERALIZED BONE MATRIX CO C1713 $877.50GRAFT BONE FLEXIGRAFT GRAFTLINK L60-80 MM OD7.5-10 C1713 $14,274.00GRAFT BONE GRAFTON DEMINERALIZED BONE MATRIX 1 ML C1713 $600.00GRAFT BONE GRAFTON DEMINERALIZED BONE MATRIX 5 CC C1713 $3,736.80GRAFT BONE GRAFTON DEMINERALIZED BONE MATRIX 5 ML C1713 $3,000.00GRAFT BONE GRAFTON PLUS DEMINERALIZED BONE MATRIX C1713 $1,036.80GRAFT BONE I FACTOR 1 CC ALLOGRAFT PUTTY SYRINGE C1713 $3,250.00GRAFT BONE I FACTOR 2.5 CC ALLOGRAFT PUTTY SYRINGE C1713 $7,475.00GRAFT BONE I FACTOR 5 CC ALLOGRAFT PUTTY SYRINGE C1713 $11,700.00GRAFT BONE ILIAC CREST TRICORTICAL THK10-12 MM WED C1713 $5,742.00GRAFT BONE ILIAC CREST TRICORTICAL THK13-15 MM WED C1713 $6,396.00GRAFT BONE ILIAC CREST TRICORTICAL THK19-21 MM WED C1713 $7,692.00GRAFT BONE INFUSE RHBMP-2 BOVINE COLLAGEN LARGE L2 C1713 $36,198.50GRAFT BONE INFUSE RHBMP-2 BOVINE COLLAGEN MEDIUM L C1713 $32,487.00GRAFT BONE INFUSE RHBMP-2 BOVINE COLLAGEN SMALL L2 C1713 $23,328.50GRAFT BONE INFUSE RHBMP-2 BOVINE COLLAGEN XS KIT L C1713 $11,667.50GRAFT BONE INTERGRO DEMINERALIZED BONE MATRIX 2 CC C1713 $1,235.00GRAFT BONE INTERGRO PLUS DEMINERALIZED BONE MATRIX C1713 $2,762.50GRAFT BONE LEFT PROXIMAL TIBIAL ALLOGRAFT FROZEN P C1713 $82,152.00GRAFT BONE LORDOTIC L14 MM X W11 MM X H5 MM SPINE C1713 $5,525.00GRAFT BONE MAGNIFUSE DEMINERALIZED BONE MATRIX L10 C1713 $12,480.00GRAFT BONE MAGNIFUSE DEMINERALIZED BONE MATRIX L20 C1713 $21,370.62GRAFT BONE MAGNIFUSE DEMINERALIZED BONE MATRIX L5 C1713 $6,142.50GRAFT BONE MATRIGRAFT FEMORAL HEAD OD43+ MM ALLOGR C1713 $6,740.50GRAFT BONE MATRIGRAFT FIBULA SEGMENT L40 MM OD8-15 C1713 $3,144.05GRAFT BONE MATRIGRAFT FIBULA SEGMENT L60 MM OD8-15 C1713 $3,371.55GRAFT BONE OPTECURE DEMINERALIZED BONE MATRIX 5 ML C1713 $2,437.50GRAFT BONE OPTECURE PLUS CCC DEMINERALIZED BONE MA C1713 $617.50GRAFT BONE ORTHOBLAST II DEMINERALIZED BONE MATRIX C1713 $1,755.00GRAFT BONE OSTEOCEL PLUS CELLULAR BONE MATRIX 5 ML C1713 $11,375.00GRAFT BONE OSTEOCEL PRO CELLULAR BONE MATRIX LARGE C1713 $24,375.00GRAFT BONE OSTEOSPONGE CANCELLOUS DEMINERALIZED BO C1713 $12,707.50GRAFT BONE OSTEOSPONGE L26 MM X W19 MM X H7 MM ALL C1713 $6,370.00GRAFT BONE OSTEOWRAP CORTICAL DEMINERALIZED BONE M C1713 $8,216.00GRAFT BONE PRIMAGEN 10 CC ALLOGRAFT C1713 $16,900.00GRAFT BONE PROFILE COSTAL CARTILAGE THK1.8-2.2 MM C1713 $3,890.25GRAFT BONE PUROS 5 ML ALLOGRAFT C1713 $2,437.50GRAFT BONE PUROS CANCELLOUS CORTICAL 7 D THK5 MM L C1713 $4,225.00

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 ChargeGRAFT BONE PUROS CANCELLOUS CORTICAL 7 D THK6 MM L C1713 $4,225.00GRAFT BONE PUROS CANCELLOUS CORTICAL 7 D THK7 MM L C1713 $4,225.00GRAFT BONE READIGRAFT CANCELLOUS 4-10 MM 30 ML PRE C1713 $2,294.18GRAFT BONE READIGRAFT CANCELLOUS L.5 CM X W.5 CM X C1713 $582.40GRAFT BONE READIGRAFT PRESERVON CANCELLOUS 1-4 MM C1713 $1,504.10GRAFT BONE READIGRAFT PRESERVON CANCELLOUS 4-10 MM C1713 $1,313.98GRAFT BONE RIGHT PROXIMAL TIBIAL OSTEOARTICULAR AL C1713 $84,040.00GRAFT BONE TRINITY ELITE CANCELLOUS DEMINERALIZED C1713 $2,600.00GRAFT BONE TRINITY ELITE CANCELLOUS LARGE ALLOGRAF C1713 $21,352.50GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRA C1713 $11,732.50GRAFT BONE TRINITY ELITE CANCELLOUS SMALL ALLOGRAF C1713 $3,510.00GRAFT BONE TRINITY ELITE CANCELLOUS XL ALLOGRAFT F C1713 $38,343.50GRAFT BONE TRINITY EVOLUTION CANCELLOUS 10 CC ALLO C1713 $21,352.50GRAFT BONE TRINNECT LORDOTIC H6 MM SPINE CERVICAL C1713 $4,387.50GRAFT BONE TRINNECT LORDOTIC H7 MM SPINE CERVICAL C1713 $4,387.50GRAFT BONE TRINNECT LORDOTIC H8 MM SPINE CERVICAL C1713 $4,387.50GRAFT BONE VERTIGRAFT CORTICAL FEMUR L100 MM X H15 C1713 $2,457.00GRAFT BONE VERTIGRAFT CORTICAL FEMUR L200 MM FROZE C1713 $2,780.05GRAFT BONE VERTIGRAFT CORTICAL FEMUR L200 MM X W20 C1713 $2,912.00GRAFT BONE VERTIGRAFT CORTICAL TIBIA L100 MM X W15 C1713 $4,595.50GRAFT BONE VERTIGRAFT CORTICAL TIBIA L200 MM X W20 C1713 $5,206.50GRAFT BONE VERTIGRAFT ILIAC CREST H20 MM FREEZE DR C1713 $5,455.45GRAFT BONE VERTIGRAFT ILIAC CREST L25 MM X H12 MM C1713 $6,524.70GRAFT BONE VIVIGEN CORTICAL CANCELLOUS DEMINERALIZ C1713 $11,830.00GRAFT BONE VIVIGEN FORMABLE CELLULAR BONE MATRIX M C1713 $17,472.00GRAFT BONE VIVIGEN FORMABLE CELLULAR BONE MATRIX S C1713 $3,840.00GRAFT BONE VIVIGEN FORMABLE CELLULAR DEMINERALIZE C1713 $25,751.70GRAFT BONE WEDGE L24 MM X W14 MM X H6 MM ALLOGRAFT C1713 $8,580.00GRAFT CARDIOVASCULAR ARTEGRAFT BOVINE CAROTID ARTE C1768 $11,115.00GRAFT CARDIOVASCULAR DISTAFLO SMALL 2 BRANCH L80 C C1768 $10,640.00GRAFT CARDIOVASCULAR GELSOFT GELATIN HYDROGEL L60 C1768 $2,504.26GRAFT CARDIOVASCULAR GELSOFT GELATIN POLYESTER FAB C1768 $2,504.26GRAFT CARDIOVASCULAR GELSOFT POLYESTER GELATIN STR C1768 $2,673.97GRAFT CARDIOVASCULAR GELSOFT VASCUTEK POLYESTER GE C1768 $2,293.20GRAFT CARDIOVASCULAR GELWEAVE ANTE-FLO L40 CM L15 C1768 $6,045.00GRAFT CARDIOVASCULAR GELWEAVE PLEXUS GELATIN 4 BRA C1768 $9,583.02GRAFT CARDIOVASCULAR GELWEAVE POLYESTER GELATIN WO C1768 $3,765.19GRAFT CARDIOVASCULAR GELWEAVE VASCUTEK ANTEGRADE L C1768 $7,275.45GRAFT CARDIOVASCULAR GELWEAVE VASCUTEK GELATIN POL C1768 $4,149.60

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 ChargeGRAFT CARDIOVASCULAR GELWEAVE VASCUTEK POLYESTER G C1768 $4,025.13GRAFT CARDIOVASCULAR GELWEAVE VASCUTEK POLYESTER S C1768 $4,149.60GRAFT CARDIOVASCULAR HEMASHIELD GOLD 2 VELOUR MICR C1768 $4,682.48GRAFT CARDIOVASCULAR HEMASHIELD GOLD MICROVEL L360 C1768 $2,807.68GRAFT CARDIOVASCULAR HEMASHIELD GOLD MICROVEL L60 C1768 $3,455.60GRAFT CARDIOVASCULAR HEMASHIELD GOLD POLYESTER 2 V C1768 $3,804.52GRAFT CARDIOVASCULAR HEMASHIELD PLATINUM 2 VELOUR C1768 $2,780.25GRAFT CARDIOVASCULAR HEMASHIELD PLATINUM POLYESTER C1768 $4,042.29GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOU C1768 $3,952.00GRAFT CARDIOVASCULAR VASCUTEK GELWEAVE ID7 MM BIFU C1768 $8,577.34GRAFT ENDOVASCULAR AORFIX 90 D L106 MM OD12 MM CON $11,316.50GRAFT ENDOVASCULAR AORFIX 90- D L96 MM L80 MM OD24 $73,151.00GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FE $25,870.00GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FE C1874 $64,967.50GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L $25,870.00GRAFT ENDOVASCULAR EXCLUDER NITINOL EPTFE L7 CM OD $18,135.00GRAFT ENDOVASCULAR GORE EXCLUDER C3 GORE-TEX NITIN $64,967.50GRAFT ENDOVASCULAR GORE EXCLUDER C3 L14 CM OD26 MM $64,967.50GRAFT ENDOVASCULAR GORE EXCLUDER C3 L16 CM OD26 MM $64,967.50GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE $64,967.50GRAFT ENDOVASCULAR GORE EXCLUDER L10 CM OD12 MM CO $25,870.00GRAFT ENDOVASCULAR GORE EXCLUDER L10 CM OD12 MM IL $64,967.50GRAFT ENDOVASCULAR GORE EXCLUDER L12 CM OD12 MM CO $25,870.00GRAFT ENDOVASCULAR GORE EXCLUDER L14 CM OD12 MM CO $25,870.00GRAFT ENDOVASCULAR GORE EXCLUDER L7 CM OD10 MM ILI $18,135.00GRAFT ENDOVASCULAR GORE-TEX EXCLUDER C3 NITINOL FE $18,135.00GRAFT ENDOVASCULAR GORE-TEX EXCLUDER NITINOL FEP L $25,870.00GRAFT ENDOVASCULAR L3.3 CM OD26 MM ID22-23 MM AORT $18,135.00GRAFT ENDOVASCULAR L3.3 CM OD28.5 MM ID24-26 MM AO $18,135.00GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK STAINLESS ST C1874 $52,234.00GRAFT ENDOVASCULAR ZENITH SPIRAL-Z POLYESTER STAIN C1874 $19,051.50GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK L74 MM O C1874 $19,051.50GRAFT NERVE AVANCE L15 MM OD2-3 MM ALLOGRAFT NATUR C1762 $14,950.00GRAFT NERVE AVANCE L30 MM OD1-2 MM ALLOGRAFT NATUR C1762 $21,612.50GRAFT NERVE AVANCE L30 MM OD2-3 MM ALLOGRAFT NATUR C1762 $21,612.50GRAFT NERVE AVANCE L30 MM OD3-4 MM ALLOGRAFT NATUR C1762 $21,612.50GRAFT NERVE AVANCE L50 MM OD1-2 MM ALLOGRAFT NATUR C1762 $31,200.00GRAFT NERVE AVANCE L70 MM OD1-2 MM ALLOGRAFT STERI C1762 $41,275.00GRAFT NERVE AVANCE L70 MM OD2-3 MM ALLOGRAFT STERI C1762 $41,275.00

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 ChargeGRAFT NERVE AVANCE L70 MM OD3-4 MM ALLOGRAFT C1762 $44,362.50GRAFT PORCINE XENMATRIX AQUAPURE ACELLULAR COLLAGE C1763 $47,547.50GRAFT PORCINE XENMATRIX AQUAPURE ACELLULAR COLLAGE C1781 $76,687.00GRAFT SKIN ALLODERM ACELLULAR DERMIS THK.33-.76 MM Q4116 $1.73GRAFT SKIN ALLODERM MEDIUM L4 CM X W2 CM ALLOGRAFT Q4116 $346.94GRAFT SKIN ALLODERM SELECT THK1.2-2.8 MM L20 CM X Q4116 $178.18GRAFT SKIN ALLOPATCH HD ACELLULAR DERMIS THK1.8-3. Q4128 $10,827.83GRAFT SKIN APLIGRAF BOVINE COLLAGEN MATRIX HUMAN F Q4101 $8,417.50GRAFT SKIN DERMAGRAFT 37.5 SQ CM Q4106 $8,125.00GRAFT SKIN FLEX HD ALLOGRAFT PREFORM Q4128 $15,335.84GRAFT SKIN FLEXHD ACELLULAR DERMAL MATRIX THK.8-1. Q4128 $15,098.72GRAFT SKIN FLEXHD ACELLULAR DERMIS THK.8-1.7 MM TH Q4128 $25,471.68GRAFT SKIN FLEXHD DIAMOND ACELLULAR DERMAL MATRIX Q4128 $104,490.88GRAFT SKIN FLEXHD PLIABLE ACELLULAR DERMAL MATRIX Q4128 $15,891.20GRAFT SKIN FLEXHD PLIABLE LARGE ALLOGRAFT KIT Q4128 $29,766.88GRAFT SKIN FLEXHD PLIABLE THK.7-1.4 MM XS THIN L15 Q4128 $16,140.80GRAFT SKIN FLEXHD PLIABLE XL ALLOGRAFT KIT Q4128 $39,846.56GRAFT SKIN FLEXHD STRUCTURAL ACELLULAR DERMAL MATR Q4128 $8,467.55GRAFT SKIN FLEXHD THK.7-1.4 MM THIN MEDIUM L20 CM Q4128 $23,951.20GRAFT SKIN GAMMAGRAFT L4.5 CM X W4 CM ALLOGRAFT Q4111 $1,300.00GRAFT SKIN GRAFTJACKET ACELLULAR DERMAL MATRIX L7 Q4107 $11,184.00GRAFT SKIN PLIABLE LARGE L22 CM X W13 CM ALLOGRAFT Q4128 $31,333.12GRAFT SKIN PLIABLE XL L24 CM X W15 CM ALLOGRAFT PE Q4128 $41,945.28GRAFT SKIN REPLIFORM ACELLULAR DERMAL MATRIX L10 C C1762 $9,334.00GRAFT SKIN REPLIFORM ACELLULAR DERMAL MATRIX L12 C C1762 $11,966.24GRAFT SKIN REPLIFORM ACELLULAR DERMAL MATRIX L17 C C1762 $5,782.92GRAFT SKIN REPLIFORM ACELLULAR DERMAL MATRIX L4 CM $3,426.28GRAFT SKIN THERASKIN L2 IN X W1 IN MESHED ALLOGRAF Q4121 $4,875.00GRAFT SKIN THERASKIN MESH 1.5:1 LARGE L3 IN X W2 I $7,462.00GRAFT SOFT TISSUE ACHILLES TENDON L19.5+ CM X W10- C1762 $12,800.00GRAFT SOFT TISSUE AFFINITY L2.5 CM X W2.5 CM Q4159 $6,467.50GRAFT SOFT TISSUE AMBIODRY2 AMNIOTIC MEMBRANE THIN V2790 $2,994.88GRAFT SOFT TISSUE AMNIOEXCEL AMNIOTIC EXTRACELLULA Q4137 $8,206.25GRAFT SOFT TISSUE AMNIOFILL 500 MG ALLOGRAFT V2790 $7,475.00GRAFT SOFT TISSUE AMNIOFILL PLACENTAL TISSUE 1000 Q4100 $14,625.00GRAFT SOFT TISSUE AMNIOFIX PURION AMNIOTIC MEMBRAN Q4100 $7,800.00GRAFT SOFT TISSUE AMNIOFIX PURION AMNIOTIC MEMBRAN $6,467.50GRAFT SOFT TISSUE AMNIOFIX PURION AMNIOTIC MEMBRAN V2790 $4,855.50GRAFT SOFT TISSUE AMNIOGRAFT AMNIOTIC MEMBRANE B L V2790 $4,127.50

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 ChargeGRAFT SOFT TISSUE AMNIOGRAFT AMNIOTIC MEMBRANE D L V2790 $4,251.00GRAFT SOFT TISSUE AMNIOGRAFT PROKERA AMNIOTIC MEMB V2790 $4,792.00GRAFT SOFT TISSUE AMNIOMATRIX 1 ML ALLOGRAFT Q4139 $9,587.50GRAFT SOFT TISSUE AMNIOMATRIX 2 ML ALLOGRAFT Q4139 $11,505.00GRAFT SOFT TISSUE AMNIOMATRIX 3 ML ALLOGRAFT Q4139 $13,422.50GRAFT SOFT TISSUE ANGIOGRAFT SAPHENOUS VEIN L71-80 C1768 $45,981.00GRAFT SOFT TISSUE ANGIOGRAFT SAPHENOUS VEIN L80+ C C1768 $49,367.50GRAFT SOFT TISSUE ANTERIOR TIBIALIS TENDON L20-38 C1713 $13,158.00GRAFT SOFT TISSUE ARTHROFLEX DECELLULARIZED DERMIS Q4125 $20,020.00GRAFT SOFT TISSUE AVANCE NERVE L15 MM OD1-2 MM ALL C1762 $14,950.00GRAFT SOFT TISSUE AVANCE NERVE L15 MM OD4-5 MM C1762 $18,400.00GRAFT SOFT TISSUE AVANCE NERVE L30 MM OD4-5 MM ALL C1762 $21,612.50GRAFT SOFT TISSUE AVANCE NERVE L50 MM OD4-5 MM ALL C1762 $33,150.00GRAFT SOFT TISSUE AVANCE NERVE L70 MM OD4-5 MM ALL C1762 $44,362.50GRAFT SOFT TISSUE BIODESIGN PORCINE SMALL INTESTIN C1763 $3,217.50GRAFT SOFT TISSUE BIODESIGN SURGISIS PORCINE ACELL C1763 $6,435.00GRAFT SOFT TISSUE BIODESIGN SURGISIS PORCINE SMALL C1763 $6,727.50GRAFT SOFT TISSUE COLLAGEN ELASTIN FIBRONECTIN LAR C1762 $16,841.50GRAFT SOFT TISSUE COLLAGEN MATRIX L20 CM X W16 CM $51,716.86GRAFT SOFT TISSUE CRYOARTERY ID5 MM BIFURCATED L11 $123,500.00GRAFT SOFT TISSUE CRYOVEIN FEMORAL VEIN SUPERFICIA C1768 $35,100.00GRAFT SOFT TISSUE DERMACELL DERMIS L4 CM X W4 CM X Q4122 $7,956.00GRAFT SOFT TISSUE DERMACELL DERMIS THK.75-1.5 MM L Q4122 $64,616.00GRAFT SOFT TISSUE DURAFORM COLLAGEN L1 IN X W1 IN Q4100 $1,108.96GRAFT SOFT TISSUE DURAFORM COLLAGEN L3 IN X W3 IN Q4100 $4,094.34GRAFT SOFT TISSUE DURAFORM COLLAGEN L5 IN X W4 IN Q4100 $9,129.12GRAFT SOFT TISSUE EPIFIX AMNIOTIC MEMBRANE 14 MM D Q4186 $2,067.00GRAFT SOFT TISSUE EPIFIX AMNIOTIC MEMBRANE 16 SQ C Q4186 $19,834.75GRAFT SOFT TISSUE EPIFIX AMNIOTIC MEMBRANE L6 CM X Q4186 $38,935.00GRAFT SOFT TISSUE EPIFIX MIMEDX PURION AMNION CHOR Q4186 $64,025.00GRAFT SOFT TISSUE EPIFIX PURION DEHYDRATED HUMAN A Q4186 $8,417.50GRAFT SOFT TISSUE EPIXL L10 CM X W4 CM $24,927.50GRAFT SOFT TISSUE EPIXL L10 CM X W6 CM $31,167.50GRAFT SOFT TISSUE FLEXHD PLIABLE ACELLULAR DERMIS Q4128 $19,643.52GRAFT SOFT TISSUE FLEXIGRAFT GRACILIS TENDON L230 C1762 $7,488.00GRAFT SOFT TISSUE FLEXIGRAFT POSTERIOR TIBIALIS TE C1762 $10,627.50GRAFT SOFT TISSUE GENTRIX PORCINE EXTRACELLULAR MA C1763 $65,000.00GRAFT SOFT TISSUE GENTRIX PORCINE URINARY BLADDER C1763 $16,588.00GRAFT SOFT TISSUE GRAFIX PRIME L2 CM X W3 CM ALLOG Q4133 $6,734.33

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 ChargeGRAFT SOFT TISSUE GRAFIX PRIME PLACENTAL MEMBRANE Q4133 $17,225.00GRAFT SOFT TISSUE GRAFTJACKET REGENERATIVE TISSUE Q4107 $18,340.53GRAFT SOFT TISSUE HEMAGARD BOVINE TYPE I COLLAGEN C1768 $2,926.55GRAFT SOFT TISSUE HEMIPATELLA BONE TENDON BONE 30- C1713 $21,600.00GRAFT SOFT TISSUE HEMIPATELLA BONE TENDON BONE QUA $16,080.00GRAFT SOFT TISSUE MATRISTEM MICROMATRIX PORCINE UR Q4118 $816.99GRAFT SOFT TISSUE NUCEL HUMAN AMNIOTIC PLACENTAL M C1762 $14,300.00GRAFT SOFT TISSUE NUSHIELD 1.6 CM DISC Q4160 $2,567.50GRAFT SOFT TISSUE NUSHIELD L3 CM X W2 CM ALLOGRAFT $5,167.50GRAFT SOFT TISSUE NUSHIELD L4 CM X W2 CM MEMBRANE Q4160 $6,175.00GRAFT SOFT TISSUE NUSHIELD L4 CM X W3 CM MEMBRANE Q4160 $9,100.00GRAFT SOFT TISSUE NUSHIELD L4 CM X W4 CM ALLOGRAFT Q4160 $12,090.00GRAFT SOFT TISSUE NUSHIELD L6 CM X W4 CM ALLOGRAFT C1763 $16,900.00GRAFT SOFT TISSUE NUSHIELD L6 CM X W6 CM ALLOGRAFT Q4160 $23,075.00GRAFT SOFT TISSUE PERICARDIUM L1 CM X W1 CM X H.5 C1762 $1,787.50GRAFT SOFT TISSUE PERMACOL PORCINE DERMAL COLLAGEN C9364 $48,432.41GRAFT SOFT TISSUE POSTERIOR TIBIALIS TENDON L22-38 C1762 $9,100.00GRAFT SOFT TISSUE PROLAYER ACELLULAR DERMAL MATRIX Q4100 $3,958.50GRAFT SOFT TISSUE READIGRAFT FASCIA LATA LARGE L20 C1762 $12,655.50GRAFT SOFT TISSUE READIGRAFT FASCIA LATA SMALL L60 C1762 $7,033.00GRAFT SOFT TISSUE SCLERA L1 CM X W1 CM PATCH HYDRA V2790 $1,787.50GRAFT SOFT TISSUE SEMITENDINOSUS TENDON L20-25.9 C C1762 $12,800.00GRAFT SOFT TISSUE SURGIMEND BOVINE COLLAGEN MATRIX C9360 $62,400.00GRAFT SOFT TISSUE SURGIMEND FETAL BOVINE DERMIS CO C9358 $5,760.00GRAFT SOFT TISSUE SURGISIS BIODESIGN PORCINE ACELL C1763 $5,050.00GRAFT SOFT TISSUE SYNERGRAFT CRYOVALVE SG PULMONAR C1768 $132,400.00GRAFT SOFT TISSUE TISSUEMEND BOVINE COLLAGEN L3 CM C1762 $7,831.10GRAFT SOFT TISSUE TISSUEMEND COLLAGEN MATRIX L6 CM $15,597.08GRAFT SOFT TISSUE TUTOPLAST IOPATCH SCLERA L3 CM X C1762 $4,850.00GRAFT SOFT TISSUE XCM BIOLOGIC OPTRIX PORCINE COLL Q4142 $106,327.00GRAFT SOFT TISSUE XCM BIOLOGIC PORCINE DERMAL THIC Q4142 $25,860.90GRAFT SOFT TISSUE XCM BIOLOGIC PORCINE DERMIS THIC Q4142 $19,394.44GRAFT SOFT TISSUE XENFORM FETAL BOVINE DERMAL MATR C1763 $9,701.12GRAFT STENT AFX ACTIVESEAL STRATA EPTFE 2 BRANCH L $67,437.50GRAFT STENT AFX ACTIVESEAL STRATA EPTFE BIFURCATED $67,437.50GRAFT STENT AFX ACTIVESEAL STRATA EPTFE STRAIGHT L $14,137.50GRAFT STENT AFX COCR EPTFE 2 BRANCH THIN WALL L70 $67,437.50GRAFT STENT AFX L100 MM L40 MM OD25 MM ODSEC20 MM $67,437.50GRAFT STENT AFX L100 MM L40 MM OD28 MM ODSEC20 MM $67,437.50

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 ChargeGRAFT STENT AFX L110 MM L30 MM OD25 MM ODSEC16 MM $67,437.50GRAFT STENT AFX L120 MM L40 MM OD28 MM ODSEC16 MM $67,437.50GRAFT STENT AFX L120 MM L40 MM OD28 MM ODSEC20 MM $67,437.50GRAFT STENT AFX L80 MM L40 MM OD25 MM ODSEC20 MM S $67,437.50GRAFT STENT AFX L80 MM L40 MM OD28 MM ODSEC20 MM S $67,437.50GRAFT STENT AFX L90 MM L30 MM OD28 MM ODSEC20 MM S $67,437.50GRAFT STENT AFX PTFE 2 BRANCH L70 MM L30 MM OD22 M $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L110 MM L30 MM OD2 $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L120 MM L40 MM OD2 $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L40 MM L40 MM OD22 $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L70 MM L30 MM OD22 $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L70 MM L30 MM OD25 $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L70 MM L30 MM OD28 $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L80 MM L40 MM OD22 $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L90 MM L30 MM OD22 $67,437.50GRAFT STENT AFX STRATA 2 BRANCH L90 MM L30 MM OD25 $67,437.50GRAFT STENT AFX STRATA L55 MM OD16 MM ILIAC LIMB S $14,137.50GRAFT STENT AFX STRATA L55 MM OD20-25 MM ILIAC LIM $14,137.50GRAFT STENT AFX STRATA L55 MM OD25 MM AORTIC EXTEN $14,137.50GRAFT STENT AFX STRATA L55 MM OD28 MM AORTIC EXTEN $14,137.50GRAFT STENT AFX STRATA L65 MM OD20-25 MM ILIAC LIM $14,137.50GRAFT STENT AFX STRATA L88 MM OD20-13 MM ILIAC LIM $14,137.50GRAFT STENT AFX VELA STRATA L100 MM L20 MM OD34 MM $14,137.50GRAFT STENT AFX VELA STRATA L75 MM L20 MM OD25 MM $14,137.50GRAFT STENT AFX VELA STRATA L75 MM L20 MM OD28 MM $14,137.50GRAFT STENT AFX VELA STRATA L75 MM OD25 MM AORTIC $14,137.50GRAFT STENT AFX VELA STRATA L95 MM L20 MM OD28 MM $14,137.50GRAFT STENT AFX VELA STRATA L95 MM OD28 MM AORTIC $14,137.50GRAFT STENT AFX2 2 BRANCH L100 MM L40 MM OD25 MM O $67,437.50GRAFT STENT AFX2 2 BRANCH L100 MM L40 MM OD28 MM O $67,437.50GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL B $58,968.00GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL S $24,024.00GRAFT STENT ANEURX ILIAC EXTENDER CUFF HYDRO DELIV $19,296.00GRAFT STENT AORFIX 90- D L51 MM OD20 MM DISTAL EXT $11,316.50GRAFT STENT AORFIX 90- D L64 MM OD20 MM CONTRALATE $11,316.50GRAFT STENT AORFIX 90- D L98 MM OD20 MM CONTRALATE $11,316.50GRAFT STENT ENDURANT II L102 MM OD25-14 MM ODSEC18 $56,130.16GRAFT STENT ENDURANT II NITINOL POLYESTER 2 BRANCH $56,130.17GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHI $27,711.02

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 ChargeGRAFT STENT ENDURANT II POLYESTER NITINOL 2 BRANCH $56,130.17GRAFT STENT ENDURANT II POLYESTER NITINOL L102 MM $56,130.16GRAFT STENT ENDURANT II POLYESTER NITINOL L124 MM $27,995.50GRAFT STENT ENDURANT II POLYESTER NITINOL L156 MM $36,012.34GRAFT STENT ENDURANT II POLYESTER NITINOL L82 MM O $27,293.76GRAFT STENT ENDURANT IIS NITINOL PLATINUM POLYESTE $56,130.17GRAFT STENT ENDURANT POLYESTER NITINOL L124 MM OD1 $28,782.00GRAFT STENT FLUENCY PLUS CARBON EPTFE ADULT L60 MM C1874 $15,200.00GRAFT STENT FLUENCY PLUS CARBON EPTFE L60 MM L80 C $15,200.00GRAFT STENT FLUENCY PLUS EPTFE CARBON L40 MM L117 $12,226.50GRAFT STENT FLUENCY PLUS EPTFE CARBON L40 MM L80 C $15,200.00GRAFT STENT FLUENCY PLUS EPTFE CARBON L80 MM L117 $12,226.50GRAFT STENT TRIVASCULAR OVATION PRIME 14 ML DELIVE $3,250.00GRAFT STENT TRIVASCULAR OVATION PRIME OVATION IX P $4,000.00GRAFT STENT TRIVASCULAR OVATION PRIME PTFE 14 ML D $1,625.00GRAFT STENT VALIANT CAPTIVIA NITINOL PLATINUM IRID $93,102.04GRAFT STENT VALIANT STRAIGHT SINUSOIDAL L150 MM OD $101,319.34GRAFT STENT VELA L80 MM L20 MM OD34 MM ENDOVASCULA $14,137.50GRAFT STENT VELA L95 MM L20 MM OD25 MM ENDOVASCULA $14,137.50GRAFT SYNTHETIC TISSUE MEDPOR POLYETHYLENE POROUS $6,726.72GRAFT SYNTHETIC TISSUE MIIG CALCIUM SULFATE 15 CC C1713 $13,320.00GRAFT SYNTHETIC TISSUE MIIG X3 CALCIUM SULFATE 7 C C1713 $11,280.00GRAFT SYNTHETIC TISSUE MIIG X3 CALCIUM SULFATE STA $9,056.00GRAFT SYNTHETIC TISSUE OSTEOSET CALCIUM SULFATE OD $2,120.00GRAFT SYNTHETIC TISSUE PRO-DENSE CALCIUM PHOSPHATE $20,352.00GRAFT VASCULAR ACUSEAL PTFE L40 CM OD6 CM 3 LAYER C1768 $8,385.00GRAFT VASCULAR CENTERFLEX VENAFLO II CARBON EPTFE C1768 $3,671.85GRAFT VASCULAR CENTERFLEX VENAFLO II EPTFE CARBON C1768 $3,671.85GRAFT VASCULAR DYNAFLO PTFE SMALL BEAD STANDARD CU C1768 $10,270.96GRAFT VASCULAR EQUI-FLOW VASCUTEK GELSOFT L90 CM L C1768 $8,842.60GRAFT VASCULAR FLIXENE SLIDER PTFE GRADUATED WALL C1768 $8,840.00GRAFT VASCULAR GELSOFT GELATIN POLYESTER 2 BRANCH C1768 $3,398.85GRAFT VASCULAR GELSOFT PLUS VASCUTEK POLYESTER GEL C1768 $2,631.53GRAFT VASCULAR GELSOFT VASCUTEK GELATIN POLYESTER C1768 $3,364.66GRAFT VASCULAR GELWEAVE VASCUTEK GELATIN OD8 MM 4 C1768 $12,142.00GRAFT VASCULAR GORE ACUSEAL L45 CM OD4-7 MM TAPER C1768 $9,815.00GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE PEDIATRI C1768 $7,128.00GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE STANDARD C1768 $8,073.00GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE THIN WAL C1768 $17,855.50

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 ChargeGRAFT VASCULAR GORE INTERING PTFE STANDARD WALL L4 C1768 $3,872.00GRAFT VASCULAR GORE INTERING PTFE STANDARD WALL TA C1768 $4,736.00GRAFT VASCULAR GORE-TEX PEDIATRIC THIN WALL L10 CM C1768 $2,528.00GRAFT VASCULAR GORE-TEX STANDARD WALL L20 CM ID6 M C1768 $2,368.00GRAFT VASCULAR GORE-TEX STANDARD WALL L20 CM L20 C C1768 $5,800.00GRAFT VASCULAR GORE-TEX STANDARD WALL L30 CM L30 C C1768 $7,880.00GRAFT VASCULAR GORE-TEX STANDARD WALL L40 CM ID10 C1768 $4,008.00GRAFT VASCULAR GORE-TEX STANDARD WALL L40 CM ID7 M C1768 $3,976.00GRAFT VASCULAR GORE-TEX STANDARD WALL L40 CM L30 C C1768 $4,840.00GRAFT VASCULAR GORE-TEX STANDARD WALL L80 CM ID10 C1768 $7,384.00GRAFT VASCULAR GORE-TEX STANDARD WALL L80 CM ID6 M C1768 $7,384.00GRAFT VASCULAR GORE-TEX STANDARD WALL L80 CM ID8 M C1768 $5,488.00GRAFT VASCULAR GORE-TEX STANDARD WALL L90 CM L40 C C1768 $16,230.50GRAFT VASCULAR GORE-TEX STANDARD WALL LARGE DIAMET C1768 $6,576.00GRAFT VASCULAR GORE-TEX STANDARD WALL STRAIGHT LAR C1768 $3,128.00GRAFT VASCULAR GORE-TEX STANDARD WALL TAPER L45 CM C1768 $3,776.50GRAFT VASCULAR GORE-TEX THIN WALL L15 CM L5 CM ID4 C1768 $5,416.00GRAFT VASCULAR GORE-TEX THIN WALL L15 CM L5 CM ID5 C1768 $3,816.00GRAFT VASCULAR GORE-TEX THIN WALL L30 CM L30 CM ID C1768 $4,800.00GRAFT VASCULAR GORE-TEX THIN WALL L70 CM L70 CM ID $7,280.00GRAFT VASCULAR GORE-TEX THIN WALL L80 CM ID10 MM P C1768 $6,870.50GRAFT VASCULAR GORE-TEX THIN WALL L80 CM ID6 MM LI C1768 $6,368.00GRAFT VASCULAR GORE-TEX THIN WALL L80 CM ID8 MM LI C1768 $6,368.00GRAFT VASCULAR GORE-TEX THIN WALL TAPER L80 CM ID6 C1768 $5,174.00GRAFT VASCULAR HEMASHIELD GOLD MICROVEL 2 VELOUR C C1768 $4,682.48GRAFT VASCULAR HEMASHIELD GOLD MICROVEL 2 VELOUR P C1768 $2,661.36GRAFT VASCULAR HEMASHIELD GOLD MICROVEL L30 CM OD2 C1768 $3,640.00GRAFT VASCULAR HEMASHIELD PLATINUM 2 VELOUR COLLAG C1768 $4,042.29GRAFT VASCULAR NITINOL PTFE L50 CM L10 CM ID6 MM I C1768 $18,206.50GRAFT VASCULAR NITINOL PTFE L50 CM L5 CM ID6 MM ID C1768 $16,042.00GRAFT VASCULAR PROPATEN GORE-TEX HEPARIN THIN WALL C1768 $9,834.50GRAFT VASCULAR VASCUTEK GELSOFT ERS GELATIN POLYPR C1768 $6,373.12GRAFT VASCULAR VASCUTEK GELSOFT PLUS ERS GELATIN P C1768 $6,545.50GRAFT VASCULAR VASCUTEK GELWEAVE GELATIN FABRIC ST C1768 $4,149.60GRAFT VASCULAR VASCUTEK GELWEAVE GELATIN L40 CM L1 C1768 $9,583.02GRAFT VASCULAR VASCUTEK GELWEAVE L50 CM OD26 MM ST C1768 $3,853.20GRAFT VASCULAR VENAFLO II PTFE STEPPED TAPER L20 C C1768 $3,671.85GRAFT VASCULAR VENAFLO II PTFE STEPPED TAPER L25 C C1768 $3,671.85GRAFT VASCULAR VENAFLO II PTFE STEPPED TAPER L30 C C1768 $3,671.85

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 ChargeGRAFT VASCULAR VENAFLO II PTFE STEPPED TAPER L35 C C1768 $3,671.85GRAFT VASCULAR VENAFLO II PTFE STEPPED TAPER L40 C C1768 $3,671.85GRAFT VASCULAR VENAFLO II PTFE STEPPED TAPER L45 C C1768 $3,671.85GRAFT VASCULAR VENAFLO II PTFE STRAIGHT L20 CM ID6 C1768 $2,567.76GRAFT VASCULAR VENAFLO II PTFE STRAIGHT L20 CM ID7 C1768 $2,567.76GRAFT VASCULAR VENAFLO II PTFE STRAIGHT L30 CM ID6 C1768 $2,901.54GRAFT VASCULAR VENAFLO II PTFE STRAIGHT L30 CM ID7 C1768 $2,901.54GRAFT VASCULAR VENAFLO II PTFE STRAIGHT L40 CM ID6 C1768 $3,286.73GRAFT VASCULAR VENAFLO II PTFE STRAIGHT L40 CM ID7 C1768 $3,286.73GRAFT VASCULAR VENAFLO II PTFE STRAIGHT L50 CM ID7 C1768 $3,671.85GRAFT VASCULAR VENAFLO PTFE STRAIGHT L10 CM ID7 MM C1768 $2,208.25GRIP CABLE BMP COCR LARGE OD2 MM TROCHANTERIC $3,535.48GROSS PULPAL DEBRIDEMENT D3221 $121.00GROUP TREATMENT SPEECH LANGUAGE COMMUNICATION/HEAR 92508 $2,515.00GUARD PIN JURGAN PIN BALL GREEN .054-.062 IN WIRE C1713 $304.00GUARD PIN JURGAN PIN BALL ID.045 IN 6 BALL BB SERI C1713 $39.00GUARD PIN JURGAN PIN BALL OD3/8 IN 6 BALL NONSTERI C1713 $44.00GUARD PIN JURGAN PIN BALL OD3/8 IN 6 BALL WHITE 3/ C1713 $48.00GUIDANCE FOR LOCALIZATION TARGET DELIVERY OF RADIA 77387 $417.00GUIDE DRILL ENCOMPASS OD18 MM $1,267.50GUIDE DRILL OD2.9 MM $732.49GUIDE DRILL OD3.5 MM ODSEC2.7 MM STOP $3,576.76GUIDE DRILL PONTO L26-30 MM OD3-4 MM REMOVABLE SPA $1,173.90GUIDE DRILL SPEEDGUIDE T10 L30- MM OD2.6 MM 3.5 MM $1,749.15GUIDE DRILL SPEEDGUIDE T10 L70 MM STERILE 3.5 MM S $1,365.00GUIDE DRILL SPEEDGUIDE T7 L30 MM STERILE 2 MM PEG $1,365.00GUIDE DRILL SPEEDGUIDE T8 L30- MM OD2 MM 2.4/2.7 M $1,749.15GUIDE DRILL VARIAX SPEEDGUIDE T10 NONSTERILE LATEX $1,365.00GUIDE NERVE NEURAGEN COLLAGEN MATRIX L2 CM ID3 MM C9352 $6,767.48GUIDE NERVE NEURAGEN COLLAGEN MATRIX L2 CM ID4 MM C9352 $6,767.48GUIDE NERVE NEURAGEN COLLAGEN MATRIX L2 CM ID5 MM C9352 $8,121.75GUIDE NERVE NEURAGEN COLLAGEN MATRIX L2 CM ID6 MM C9352 $9,269.98GUIDE NERVE NEURAGEN COLLAGEN MATRIX L2 CM ID7 MM C9352 $8,121.75GUIDE NERVE NEURAGEN COLLAGEN MATRIX L3 CM ID1.5 M C9352 $8,740.88GUIDE NERVE NEURAGEN COLLAGEN MATRIX L3 CM ID2 MM C9352 $9,269.98GUIDE NERVE NEURAGEN COLLAGEN MATRIX L3 CM ID3 MM C9352 $9,269.98GUIDE NERVE NEURAGEN COLLAGEN MATRIX L3 CM ID4 MM C9352 $9,269.98GUIDE NERVE NEURAGEN COLLAGEN MATRIX L3 CM ID5 MM C9352 $9,269.98GUIDE NERVE NEURAGEN COLLAGEN MATRIX L3 CM ID7 MM C9352 $6,767.48

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 ChargeGUIDE PIN ORTHOPEDIC ACE SHORT THREAD L14 IN OD3.2 $561.60GUIDE PIN ORTHOPEDIC COCR L300 MM OD2.8 MM THREAD $516.64GUIDE PIN ORTHOPEDIC DELTA XTEND LARGE L150 MM OD1 $887.58GUIDE PIN ORTHOPEDIC HEMICAP OD2 MM SHOULDER STERI $487.50GUIDE PIN ORTHOPEDIC L230 MM OD3.2 MM NONSTERILE C1713 $414.96GUIDE PIN ORTHOPEDIC L355 MM OD3.2 MM THREAD STERI $486.72GUIDE PIN ORTHOPEDIC OD3.2 MM HIP AVN $1,101.88GUIDE PIN ORTHOPEDIC ORTHOLOCK L110 MM OD3 MM ANCH $406.84GUIDE PIN ORTHOPEDIC PERSONA POSTERIOR STABILIZE $3,250.00GUIDE PIN ORTHOPEDIC SHOULDER HIP DISPOSABLE $487.50GUIDE PIN ORTHOPEDIC STERILE $1,864.00GUIDE PIN ORTHOPEDIC TRUMATCH FEMORAL LEFT STERILE $4,000.00GUIDE PIN ORTHOPEDIC TRUMATCH FEMORAL RIGHT STERIL $4,000.00GUIDE PIN ORTHOPEDIC VERSANAIL BALL L14 IN OD3.6 M $561.60GUIDE PIN ORTHOPEDIC VERSANAIL L444 MM OD3.2 MM HI $695.76GUIDE PIN ORTHOPEDIC XACTPIN L43 CM OD2.4 MM GRAFT $754.00GUIDE PIN ORTHOPEDIC XACTPIN L43.18 CM OD2.4 MM GR $1,007.83GUIDE ROD ORTHOPEDIC STAINLESS STEEL L230 MM OD2.5 $389.03GUIDE SURGICAL IDRIVE INSERTION GUIDE BATTERY NONS $691.21GUIDE SURGICAL SIGNATURE 3-5 CUSTOM MODEL SET TOTA $3,250.00GUIDEWIRE ANGIOGRAPHIC PTFE J CURVE L175 CM L1.5 M C1769 $108.00GUIDEWIRE ENDOSCOPIC ACROBAT HYDROPHILIC L260 CM L C1769 $750.00GUIDEWIRE ENDOSCOPIC ACROBAT HYDROPHILIC L450 CM L C1769 $750.00GUIDEWIRE ENDOSCOPIC ACROBAT HYDROPHILIC PTFE 25 C C1769 $750.00GUIDEWIRE ENDOSCOPIC AGILITY HYDROPHILIC STANDARD $1,250.00GUIDEWIRE ENDOSCOPIC BARRX RFA HALO STAINLESS STEE C1769 $1,118.00GUIDEWIRE ENDOSCOPIC BIWIRE NITINOL HYDROPHILIC ST $1,742.40GUIDEWIRE ENDOSCOPIC COONS-BENTSON2 L145 CM OD.035 C1769 $155.60GUIDEWIRE ENDOSCOPIC DIRECT TRACER METRO HYDROPHIL C1769 $715.00GUIDEWIRE ENDOSCOPIC DREAMWIRE DREAM TIP ENDO-GLID C1769 $1,498.87GUIDEWIRE ENDOSCOPIC HALO STRAIGHT L230 CM OD.038 C1769 $1,170.00GUIDEWIRE ENDOSCOPIC HIWIRE NITINOL HYDROPHILIC AN $1,189.56GUIDEWIRE ENDOSCOPIC HIWIRE NITINOL HYDROPHILIC ST $733.29GUIDEWIRE ENDOSCOPIC JAGWIRE DREAM TIP ANGLE L450 $1,023.75GUIDEWIRE ENDOSCOPIC JAGWIRE DREAM TIP ROUND ANGLE C1769 $1,140.00GUIDEWIRE ENDOSCOPIC JAGWIRE DREAM TIP STRAIGHT L2 C1769 $926.25GUIDEWIRE ENDOSCOPIC JAGWIRE DREAM TIP STRAIGHT L4 C1769 $1,023.75GUIDEWIRE ENDOSCOPIC JAGWIRE STRAIGHT TRIM L260 CM C1769 $926.25GUIDEWIRE ENDOSCOPIC LOOPTIP FUSION NITINOL L205 C C1769 $942.50

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 ChargeGUIDEWIRE ENDOSCOPIC LOOPTIP FUSION NITINOL L260 C C1769 $975.00GUIDEWIRE ENDOSCOPIC LOOPTIP FUSION NITINOL L480 C C1769 $725.00GUIDEWIRE ENDOSCOPIC NOVAGOLD TRITON STRAIGHT L480 C1769 $1,316.25GUIDEWIRE ENDOSCOPIC OD.4 MM STERILE DISPOSABLE BO C1769 $213.92GUIDEWIRE ENDOSCOPIC OD.6 MM STERILE DISPOSABLE C1769 $213.92GUIDEWIRE ENDOSCOPIC OD1.6 MM C1769 $1,057.68GUIDEWIRE ENDOSCOPIC PATHFINDER L450 CM OD.018 IN C1769 $779.16GUIDEWIRE ENDOSCOPIC ROADRUNNER STRAIGHT L480 CM L C1769 $1,092.00GUIDEWIRE ENDOSCOPIC SAVARY-GILLIARD STAINLESS STE C1769 $2.43GUIDEWIRE ENDOSCOPIC TRACER METRO DIRECT AQUA HYDR $740.00GUIDEWIRE ENDOSCOPIC TRACER METRO DIRECT SPIRAL L4 C1769 $880.00GUIDEWIRE ENDOSCOPIC TRACER METRO HYDROPHILIC AQUA C1769 $550.00GUIDEWIRE ENDOSCOPIC TRACER METRO HYDROPHILIC L480 C1769 $740.00GUIDEWIRE ENDOSCOPIC TRACER METRO HYDROPHILIC STRA C1769 $495.00GUIDEWIRE ENDOVASCULAR L260 CM OD.014 IN ANCILLARY C1769 $812.50GUIDEWIRE ORTHOPEDIC ACUTRAK 2 MICRO OD.035 IN PAR $1,264.00GUIDEWIRE ORTHOPEDIC ACUTRAK 2 MINI OD.045 IN PARA $1,176.00GUIDEWIRE ORTHOPEDIC ACUTRAK STAINLESS STEEL STAND $331.50GUIDEWIRE ORTHOPEDIC ASNIS III L150 MM OD1.4 MM TH $397.80GUIDEWIRE ORTHOPEDIC ASNIS III L150 MM OD2 MM HIP $397.80GUIDEWIRE ORTHOPEDIC ASNIS III L300 MM OD3.2 MM FE $695.50GUIDEWIRE ORTHOPEDIC ASNIS III L300 MM OD3.2 MM NO $702.00GUIDEWIRE ORTHOPEDIC COCR L300 MM L12 MM OD2.5 MM $399.88GUIDEWIRE ORTHOPEDIC COCR L460 MM OD3.2 MM FEMORAL $948.48GUIDEWIRE ORTHOPEDIC EVEREST OD1.4 MM DISPOSABLE M $325.00GUIDEWIRE ORTHOPEDIC FIXOS L150 MM OD1.4 MM UNTHRE $421.20GUIDEWIRE ORTHOPEDIC FIXOS L230 MM OD3.2 MM CALIBR $837.20GUIDEWIRE ORTHOPEDIC FIXOS L230 MM OD3.2 MM THREAD $468.00GUIDEWIRE ORTHOPEDIC L13 MM OD3.2 MM TROCAR POINT $962.16GUIDEWIRE ORTHOPEDIC L150 MM OD1.4 MM UNTHREAD $785.20GUIDEWIRE ORTHOPEDIC L18 MM OD3.2 MM $2,790.72GUIDEWIRE ORTHOPEDIC L180 MM L10 MM OD2.8 MM TROCA $427.76GUIDEWIRE ORTHOPEDIC L200 MM L15 MM THREAD $407.68GUIDEWIRE ORTHOPEDIC L230 MM OD2.8 MM THREADED TIP $795.40GUIDEWIRE ORTHOPEDIC L290 MM OD3.2 MM NONSTERILE $529.82GUIDEWIRE ORTHOPEDIC L300 MM OD2.5 MM DRILL TIP NO $388.70GUIDEWIRE ORTHOPEDIC L300 MM OD3.2 MM CALIBRATION $932.75GUIDEWIRE ORTHOPEDIC L330 MM OD3 MM LATERAL ACCESS $325.00GUIDEWIRE ORTHOPEDIC L330 MM OD3 MM SPINE LATERAL $325.00

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 ChargeGUIDEWIRE ORTHOPEDIC L400 MM OD3.2 MM TIBIA THREAD $540.93GUIDEWIRE ORTHOPEDIC L450 MM L300 MM OD2.8 MM TROC $448.50GUIDEWIRE ORTHOPEDIC L5.75 IN OD.035 IN 1 TROCAR C1713 $65.00GUIDEWIRE ORTHOPEDIC L80 CM OD2.6 MM TIBIA BEAD TI $545.28GUIDEWIRE ORTHOPEDIC L98 CM OD3 MM INTRAMEDULLARY $521.04GUIDEWIRE ORTHOPEDIC LCP STAINLESS STEEL L200 MM O $368.10GUIDEWIRE ORTHOPEDIC OD17 MM PERCUTANEOUS NONSTERI $984.96GUIDEWIRE ORTHOPEDIC OD2.5 MM SHOULDER $998.16GUIDEWIRE ORTHOPEDIC OD2.8 MM MULTIPLE THREAD NONS $4,788.56GUIDEWIRE ORTHOPEDIC PARALLEL 7 MM CANNULATED SCRE $4,889.76GUIDEWIRE ORTHOPEDIC PARALLEL ADJUSTABLE NONSTERIL $3,316.56GUIDEWIRE ORTHOPEDIC PEDILOC L150 MM OD2 MM FEMUR $1,760.00GUIDEWIRE ORTHOPEDIC PHOENIX L320 MM OD3.2 MM TIBI $661.44GUIDEWIRE ORTHOPEDIC PHOENIX L460 MM OD3.2 MM TIBI $561.60GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN BLUNT $565.50GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP $533.00GUIDEWIRE ORTHOPEDIC STAINLESS STEEL 1.6 MM OD3.2 $353.15GUIDEWIRE ORTHOPEDIC STAINLESS STEEL FLUTE L450 MM $625.60GUIDEWIRE ORTHOPEDIC STAINLESS STEEL L300 MM L150 $575.58GUIDEWIRE ORTHOPEDIC STAINLESS STEEL L300 MM OD3.2 $825.36GUIDEWIRE ORTHOPEDIC STAINLESS STEEL L330 MM OD2 M $414.00GUIDEWIRE ORTHOPEDIC STAINLESS STEEL L98 CM OD3.2 $761.28GUIDEWIRE ORTHOPEDIC T2 TITANIUM L1000 MM OD3 MM F $1,069.71GUIDEWIRE ORTHOPEDIC T2 TITANIUM L800 MM OD3 MM BA $1,023.04GUIDEWIRE ORTHOPEDIC TITANIUM L800 MM OD2.2 MM HUM $927.42GUIDEWIRE ORTHOPEDIC TITANIUM L800 MM OD2.5 MM HUM $952.46GUIDEWIRE ORTHOPEDIC TITANIUM PARALLEL OD2.8 MM AD $3,509.76GUIDEWIRE ORTHOPEDIC UCSS L24 IN THREAD $325.00GUIDEWIRE ORTHOPEDIC VARIABLE ANGLE CANNULATED SCR $4,286.88GUIDEWIRE ORTHOPEDIC VERSANAIL L100 CM OD3 MM TIBI $716.56GUIDEWIRE ORTHOPEDIC VERSANAIL L38 IN OD3.2 MM NAI $1,070.00GUIDEWIRE ORTHOPEDIC VERSANAIL L80 CM BALL NOSE ST $716.56GUIDEWIRE SPINAL MD-MAX NITINOL UNILATERAL LUMBAR $325.00GUIDEWIRE SURGICAL HOUSE L6.5 IN C1769 $634.86GUIDEWIRE UROLOGICAL AMPLATZ STAINLESS STEEL PTFE C1769 $132.50GUIDEWIRE UROLOGICAL AMPLATZ SUPER STIFF BENTSON P C1769 $155.60GUIDEWIRE UROLOGICAL BENTSON PTFE STRAIGHT L150 CM C1769 $88.21GUIDEWIRE UROLOGICAL LUBRIGLIDE STANDARD L150 CM L C1769 $218.44GUIDEWIRE UROLOGICAL PTFE J L150 CM L3 MM OD.035 I C1769 $144.24

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 ChargeGUIDEWIRE UROLOGICAL PTFE L150 CM OD.035 IN STRAIG C1769 $101.68GUIDEWIRE UROLOGICAL PTFE STRAIGHT L150 CM L3 CM O C1769 $83.44GUIDEWIRE UROLOGICAL PTFE STRAIGHT L150 CM OD.038 C1769 $101.68GUIDEWIRE UROLOGICAL SENSOR DUAL-FLEX NITINOL STAI $991.15GUIDEWIRE UROLOGICAL SENSOR NITINOL STAINLESS STEE C1769 $247.99GUIDEWIRE UROLOGICAL STAINLESS STEEL PTFE STANDARD C1769 $66.75GUIDEWIRE UROLOGICAL ZIPWIRE NITINOL POLYURETHANE C1769 $223.67GUIDEWIRE UROLOGICAL ZIPWIRE NITINOL POLYURETHANE $400.96GUIDEWIRE VASCULAR ADDWIRE FORTE STAINLESS STEEL S C1769 $435.37GUIDEWIRE VASCULAR AGILITY STAINLESS STEEL HYDROPH C1769 $1,743.30GUIDEWIRE VASCULAR AMPLATZ STAINLESS STEEL PTFE 3 C1769 $99.75GUIDEWIRE VASCULAR AMPLATZ STAINLESS STEEL PTFE ST C1769 $155.65GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF STAINLESS S C1769 $1,000.48GUIDEWIRE VASCULAR AMPLATZER STAINLESS STEEL PTFE C1769 $237.10GUIDEWIRE VASCULAR AQUATRACK NITINOL HYDROPHILIC A C1769 $1,211.93GUIDEWIRE VASCULAR ARROW STRAIGHT L9 3/4 IN OD.018 C1769 $88.00GUIDEWIRE VASCULAR ASAHI ASTATO 30 SLIP-COAT PTFE C1769 $812.50GUIDEWIRE VASCULAR ASAHI ASTATO XS 20 SLIP-COAT PT C1769 $812.50GUIDEWIRE VASCULAR ASAHI CONFIANZA PRO 12 TRUTORQ C1769 $650.00GUIDEWIRE VASCULAR ASAHI GAIA SECOND SLIP-COAT STA C1769 $780.00GUIDEWIRE VASCULAR ASAHI GAIA THIRD SLIP-COAT STAI C1769 $780.00GUIDEWIRE VASCULAR ASAHI GLADIUS SLIP-COAT STRAIGH C1769 $880.00GUIDEWIRE VASCULAR ASAHI MIRACLEBROS 6 TRUTORQ HYD C1769 $650.00GUIDEWIRE VASCULAR ASAHI PROWATER TRUTORQ HYBRID S C1769 $345.00GUIDEWIRE VASCULAR ASAHI SION BLUE SLIP-COAT STAIN C1769 $475.00GUIDEWIRE VASCULAR ASAHI SION SLIP-COAT STAINLESS C1769 $780.00GUIDEWIRE VASCULAR ASAHI SOFT TRUTORQ HYDROPHOBIC C1769 $345.00GUIDEWIRE VASCULAR ATTAIN HYBRID PRO/PEL STAINLESS C1769 $800.00GUIDEWIRE VASCULAR BACK-UP MEIER STAINLESS STEEL P C1769 $501.30GUIDEWIRE VASCULAR CHOICE PT GRAPHIX STAINLESS STE C1769 $535.84GUIDEWIRE VASCULAR CHOICE PT STAINLESS STEEL POLYM C1769 $352.50GUIDEWIRE VASCULAR CHOICE STAINLESS STEEL HYDROPHI C1769 $200.93GUIDEWIRE VASCULAR CHOICE STAINLESS STEEL POLYMER C1769 $435.34GUIDEWIRE VASCULAR COPE MANDRIL NITINOL PLATINUM A C1769 $180.10GUIDEWIRE VASCULAR COPE MANDRIL PLATINUM NITINOL A C1769 $186.85GUIDEWIRE VASCULAR COPE MANDRIL PLATINUM STAINLESS C1769 $170.20GUIDEWIRE VASCULAR CORDIS AQUATRACK NITINOL POLYME C1769 $286.59GUIDEWIRE VASCULAR CORDIS ATW DURAGLIDE STAINLESS C1769 $295.00GUIDEWIRE VASCULAR CORDIS EMERALD AMPLATZ SUPER ST C1769 $710.45

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 ChargeGUIDEWIRE VASCULAR CORDIS EMERALD HEPARIN PTFE 3 M C1769 $27.50GUIDEWIRE VASCULAR CORDIS EMERALD PTFE 1.5 MM RADI C1769 $273.00GUIDEWIRE VASCULAR CORDIS EMERALD PTFE 15 MM RADIU C1769 $585.00GUIDEWIRE VASCULAR CORDIS EMERALD PTFE 3 MM RADIUS C1769 $585.00GUIDEWIRE VASCULAR CORDIS EMERALD PTFE 6 MM RADIUS C1769 $585.00GUIDEWIRE VASCULAR CORDIS EMERALD PTFE STRAIGHT L1 C1769 $27.50GUIDEWIRE VASCULAR CORDIS EMERALD PTFE STRAIGHT NE C1769 $234.00GUIDEWIRE VASCULAR CORDIS EMERALD STAINLESS STEEL C1769 $759.85GUIDEWIRE VASCULAR CORDIS EMERALD TEFLON 3 MM RADI C1769 $27.50GUIDEWIRE VASCULAR CORDIS JINDO PTFE STRAIGHT INTE C1769 $2,990.00GUIDEWIRE VASCULAR CORDIS JINDO PTFE STRAIGHT SHOR C1769 $598.00GUIDEWIRE VASCULAR CORDIS SHINOBI DURAGLIDE STAINL C1769 $472.00GUIDEWIRE VASCULAR CORDIS STABILIZER PLUS DURAGLID C1769 $295.00GUIDEWIRE VASCULAR CORDIS STABILIZER XS DURAGLIDE C1769 $1,700.00GUIDEWIRE VASCULAR CORDIS STORQ SLX STAINLESS STEE C1769 $1,075.00GUIDEWIRE VASCULAR CORDIS SV PLATINUM NICKEL STAIN C1769 $1,650.00GUIDEWIRE VASCULAR COUGAR LS HYDRO-TRACK NITINOL S C1769 $300.00GUIDEWIRE VASCULAR COUGAR XT HYDRO-TRACK NITINOL S C1769 $300.00GUIDEWIRE VASCULAR ENROUTE PTFE HYDROPHILIC L5 CM C1769 $942.50GUIDEWIRE VASCULAR FATHOM NITINOL STAINLESS STEEL C1769 $2,030.21GUIDEWIRE VASCULAR FATHOM STAINLESS STEEL NITINOL C1769 $1,322.05GUIDEWIRE VASCULAR FIELDER XT SLIP-COAT POLYMER ST C1769 $600.00GUIDEWIRE VASCULAR GLIDEWIRE ADVANTAGE NITINOL HYD C1769 $825.00GUIDEWIRE VASCULAR GLIDEWIRE GOLD NITINOL POLYURET C1769 $672.50GUIDEWIRE VASCULAR GLIDEWIRE GT NITINOL POLYURETHA C1769 $822.50GUIDEWIRE VASCULAR GLIDEWIRE NITINOL POLYURETHANE C1769 $198.50GUIDEWIRE VASCULAR HI-TORQUE ALL STAR STAINLESS ST C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE BALANCE ELASTINITE HY C1769 $552.00GUIDEWIRE VASCULAR HI-TORQUE BALANCE HEAVYWEIGHT E C1769 $448.50GUIDEWIRE VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE CROSS-IT 100XT STAINL C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE EXTRA SPORT STAINLESS C1769 $552.00GUIDEWIRE VASCULAR HI-TORQUE FLOPPY II STAINLESS S C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE IRON MAN STAINLESS ST C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE PILOT 150 DURASTEEL P C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE PILOT 200 DURASTEEL P C1769 $448.50GUIDEWIRE VASCULAR HI-TORQUE PILOT 50 DURASTEEL PO C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE SPARTACORE MICROGLIDE C1769 $390.00GUIDEWIRE VASCULAR HI-TORQUE STANDARD MICROGLIDE S C1769 $552.00

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 ChargeGUIDEWIRE VASCULAR HI-TORQUE STEELCORE MICROGLIDE C1769 $390.00GUIDEWIRE VASCULAR HI-TORQUE SUPRA CORE MICROGLIDE C1769 $480.00GUIDEWIRE VASCULAR HI-TORQUE TRAVERSE HYDROCOAT ST C1769 $552.00GUIDEWIRE VASCULAR HI-TORQUE VERSACORE STAINLESS S C1769 $177.00GUIDEWIRE VASCULAR HI-TORQUE WHISPER ES DURASTEEL C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE WHISPER LS DURASTEEL C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE WHISPER MS DURASTEEL C1769 $345.00GUIDEWIRE VASCULAR HI-TORQUE WIGGLE MICROGLIDE STA C1769 $345.00GUIDEWIRE VASCULAR HIWIRE NITINOL POLYURETHANE HYD C1769 $207.58GUIDEWIRE VASCULAR INQWIRE PTFE 3 MM RADIUS J CURV C1769 $47.78GUIDEWIRE VASCULAR INTUITION HYDRO-TRACK STAINLESS C1769 $300.00GUIDEWIRE VASCULAR JOURNEY NITINOL HYDROPHILIC STR C1769 $1,046.63GUIDEWIRE VASCULAR KINETIX WORKHORSE NITINOL HYBRI C1769 $623.20GUIDEWIRE VASCULAR LUGE STAINLESS STEEL HYDROPHILI C1769 $535.81GUIDEWIRE VASCULAR LUNDERQUIST STAINLESS STEEL PTF C1769 $2,565.00GUIDEWIRE VASCULAR MAGIC TORQUE GLIDEX STAINLESS S C1769 $371.09GUIDEWIRE VASCULAR MAILMAN STAINLESS STEEL POLYMER C1769 $535.84GUIDEWIRE VASCULAR MERIT LAUREATE NITINOL HYDROPHI C1769 $189.87GUIDEWIRE VASCULAR MIRAGE PLATINUM STAINLESS STEEL C1769 $2,808.00GUIDEWIRE VASCULAR NEUROSCOUT STAINLESS STEEL HYDR C1769 $1,250.00GUIDEWIRE VASCULAR NITREX NITINOL SILICONE 0 D STR C1769 $275.00GUIDEWIRE VASCULAR NITREX NITINOL SILICONE 15 D L1 C1769 $408.33GUIDEWIRE VASCULAR NITREX NITINOL SILICONE 15 D L3 C1769 $408.33GUIDEWIRE VASCULAR NITREX NITINOL SILICONE 15 D L8 C1769 $391.67GUIDEWIRE VASCULAR PERSUADER 3 HYDRO-TRACK STAINLE C1769 $820.00GUIDEWIRE VASCULAR PERSUADER 6 HYDRO-TRACK STAINLE C1769 $820.00GUIDEWIRE VASCULAR PLATINUM PLUS STAINLESS STEEL S C1769 $205.20GUIDEWIRE VASCULAR PLATINUM STAINLESS STEEL L80 CM C1769 $241.02GUIDEWIRE VASCULAR PRESSUREWIRE X HYDROPHILIC PTFE C1769 $3,000.00GUIDEWIRE VASCULAR PROSTREAM TEFLON STAINLESS STEE C1769 $1,103.38GUIDEWIRE VASCULAR PROTRACK STAINLESS STEEL 13 CM C1769 $1,235.00GUIDEWIRE VASCULAR PROVIA HYDRO-TRACK 9 G TAPER L3 C1769 $300.00GUIDEWIRE VASCULAR PROVIA PRO/PEL 12 G TAPER L180 C1769 $300.00GUIDEWIRE VASCULAR PROVIA PRO/PEL 3 G STRAIGHT L18 C1769 $300.00GUIDEWIRE VASCULAR PROVIA PRO/PEL 6 G STRAIGHT L18 C1769 $300.00GUIDEWIRE VASCULAR PROVIA PRO/PEL 9 G TAPER L180 C C1769 $300.00GUIDEWIRE VASCULAR PROWATER SLIP-COAT HYDROPHOBIC C1769 $455.00GUIDEWIRE VASCULAR PT2 NITINOL STAINLESS STEEL POL C1769 $435.37GUIDEWIRE VASCULAR PTFE 15 MM RADIUS J CURVE TAPER C1769 $87.75

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 ChargeGUIDEWIRE VASCULAR PTFE 3 MM RADIUS J CURVE TAPER C1769 $108.00GUIDEWIRE VASCULAR PTFE STRAIGHT L175 CM OD.038 IN C1769 $39.00GUIDEWIRE VASCULAR PTFE STRAIGHT L180 CM L5 CM OD. C1769 $463.32GUIDEWIRE VASCULAR REGALIA XS 1.0 SLIP-COAT POLYME C1769 $812.50GUIDEWIRE VASCULAR ROADRUNNER NITINOL PLATINUM PTF C1769 $514.45GUIDEWIRE VASCULAR ROADRUNNER PC THE FIRM AQ NITIN C1769 $244.64GUIDEWIRE VASCULAR ROADRUNNER PLATINUM NITINOL PTF C1769 $650.00GUIDEWIRE VASCULAR ROTAWIRE WIRECLIP L330 CM L2.2 C1769 $944.00GUIDEWIRE VASCULAR ROTAWIRE WIRECLIP L330 CM L2.8 C1769 $4,720.00GUIDEWIRE VASCULAR RUNTHROUGH NS NITINOL HYDROPHIL C1769 $40.00GUIDEWIRE VASCULAR SAFE-T-J HEPARIN STAINLESS STEE C1769 $156.88GUIDEWIRE VASCULAR SAFE-T-J STAINLESS STEEL 3 MM R C1769 $138.48GUIDEWIRE VASCULAR SAFE-T-J STAINLESS STEEL HEPARI C1769 $110.50GUIDEWIRE VASCULAR SAFE-T-J STAINLESS STEEL PTFE 1 C1769 $66.40GUIDEWIRE VASCULAR SAFE-T-J STAINLESS STEEL PTFE 2 C1769 $120.00GUIDEWIRE VASCULAR SAFE-T-J STAINLESS STEEL PTFE 3 C1769 $79.30GUIDEWIRE VASCULAR SILVERSPEED PLATINUM STAINLESS C1769 $1,300.00GUIDEWIRE VASCULAR SOFTWIRE PTFE XLONG TAPER L145 C1769 $94.25GUIDEWIRE VASCULAR STAINLESS STEEL 3 MM RADIUS J C C1769 $44.50GUIDEWIRE VASCULAR STAINLESS STEEL HEPARIN L80 CM C1769 $560.56GUIDEWIRE VASCULAR STAINLESS STEEL HEPARIN PTFE BE C1769 $94.07GUIDEWIRE VASCULAR STAINLESS STEEL PTFE BENTSON ST C1769 $159.68GUIDEWIRE VASCULAR STAINLESS STEEL PTFE STRAIGHT T C1769 $79.30GUIDEWIRE VASCULAR STAINLESS STEEL STRAIGHT L20 CM C1769 $81.04GUIDEWIRE VASCULAR STAINLESS STEEL STRAIGHT L50 CM C1769 $160.72GUIDEWIRE VASCULAR STARTER PTFE 1.5 MM RADIUS J RO C1769 $109.72GUIDEWIRE VASCULAR STARTER PTFE 3 MM RADIUS J CURV C1769 $105.39GUIDEWIRE VASCULAR STARTER PTFE STRAIGHT BENTSON T C1769 $86.79GUIDEWIRE VASCULAR STARTER PTFE STRAIGHT L150 CM O C1769 $62.70GUIDEWIRE VASCULAR STINGRAY HYDROPHILIC L185 CM L2 C1769 $1,625.00GUIDEWIRE VASCULAR SYNCHRO-10 NITINOL STAINLESS ST C1769 $3,022.50GUIDEWIRE VASCULAR SYNCHRO2 NITINOL STAINLESS STEE C1769 $3,146.00GUIDEWIRE VASCULAR TENOR STAINLESS STEEL HYDROPHIL C1769 $1,592.64GUIDEWIRE VASCULAR THUNDER PRO/PEL STAINLESS STEEL C1769 $300.00GUIDEWIRE VASCULAR TORQ-FLEX STAINLESS STEEL PTFE C1769 $120.00GUIDEWIRE VASCULAR TRANSEND EX SCITANIUM ICE L205 C1769 $2,992.28GUIDEWIRE VASCULAR TRANSEND EX SCITANIUM ICE PLATI C1769 $2,652.00GUIDEWIRE VASCULAR TRANSEND SCITANIUM ICE L200 CM C1769 $2,522.00GUIDEWIRE VASCULAR TRANSEND SCITANIUM ICE L300 CM C1769 $3,146.00

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 ChargeGUIDEWIRE VASCULAR TRANSEND SCITANIUM ICE PLATINUM C1769 $3,146.00GUIDEWIRE VASCULAR TRANSEND SCITANIUM ICE POLYETHY C1769 $1,152.26GUIDEWIRE VASCULAR TREASURE 12 SLIP-COAT PTFE STRA C1769 $812.50GUIDEWIRE VASCULAR TREASURE FLOPPY SLIP-COAT PTFE C1769 $812.50GUIDEWIRE VASCULAR VERRATA GLYDX PTFE J CURVE FLAT C1769 $2,025.00GUIDEWIRE VASCULAR VERRATA GLYDX PTFE STRAIGHT FLA C1769 $3,250.00GUIDEWIRE VASCULAR VERRATA PLUS GLYDX PTFE J CURVE C1769 $5,200.00GUIDEWIRE VASCULAR VERRATA PLUS GLYDX PTFE STRAIGH C1769 $3,250.00GUIDEWIRE VASCULAR VIPERWIRE ADVANCE L200 CM OD.01 C1769 $750.00GUIDEWIRE VASCULAR VIPERWIRE ADVANCE L325 CM OD.01 C1769 $900.00GUIDEWIRE VASCULAR VIPERWIRE ADVANCE L335 CM OD.01 C1769 $750.00GUIDEWIRE VASCULAR VSI NITINOL STAINLESS STEEL L40 C1769 $63.00GUIDEWIRE VASCULAR WHOLEY HYDROPHOBIC PTFE MODIFY C1769 $291.67GUIDEWIRE VASCULAR WHOLEY HYDROPHOBIC PTFE STRAIGH C1769 $290.00GUIDEWIRE VASCULAR X-CELERATOR PLATINUM STAINLESS C1769 $2,509.00GUIDEWIRE VASCULAR X-PEDION PLATINUM STAINLESS STE C1769 $1,300.00GUIDEWIRE VASCULAR ZINGER HYDRO-TRACK STAINLESS ST C1769 $300.00GUIDEWIRE VASCULAR ZINGER PRO/PEL STAINLESS STEEL C1769 $300.00GUIDEWIRE VASCULAR ZIPWIRE NITINOL POLYMER HYDROPH C1769 $363.44HALTER TRACTION HEAD BLOCK COMPATIBLE $4,688.00HANDLE INFLATION ALLIANCE II REUSABLE $2,445.00HANDLE INSTRUMENT PENUMBRA DETACHABLE COIL $1,462.50HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFE 99001 $287.00HANDPIECE BREAST BIOPSY ATEC 20 MM STANDARD L14 CM $1,917.60HANDPIECE BREAST BIOPSY EVIVA 20 MM STANDARD L13 C $975.00HANDPIECE ELECTROSURGICAL HARMONIC NONSTERILE REUS $5,817.50HAPTOGLOBIN (SERUM PROTEIN) LEVEL 83010 $98.00HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIANTS 81269 $911.00HC ADMINISTRATION OF HEPATITIS B VACCINE SUBSEQUEN 90472 $152.00HC ADMINISTRATION OF PNEUMOCOCCAL VACCINE SUBSEQUE 90472 $152.00HC BRACHYTHERAPY SOURCE NON-STRANDED YTTRIUM-90 C2616 $66,504.00HC EGD WITH PLACEMENT OF CLIPS FOR LEAKAGE 43499 $3,047.00HC IMMUNIZATION ADMIN BY INTRANASAL FLU VACCINE IN 90473 $50.00HC IMMUNIZATION ADMIN BY INTRANASAL FLU VACCINE SU 90474 $26.00HC INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION 11107 $6,639.00HC INCISIONAL BIOPSY SKIN SINGLE LESION 11106 $1,257.00HC TONSIL LESION EXCISION 42999 $825.00HDL CHOLESTEROL LEVEL 83718 $64.00HEAD BIPOLAR ACUMATCH OD42 MM ID28 MM ACETABULAR H C1776 $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 ChargeHEAD BIPOLAR ACUMATCH OD57 MM ID28 MM HIP C1776 $3,250.00HEAD BIPOLAR OD48 MM ID28 MM C1776 $3,250.00HEAD BIPOLAR SELF-CENTERING OD43 MM ID28 MM HIP FE C1776 $3,250.00HEAD BIPOLAR SELF-CENTERING OD45 MM ID28 MM HIP FE C1776 $3,250.00HEAD BIPOLAR SELF-CENTERING OD47 MM ID28 MM HIP FE C1776 $3,250.00HEAD BIPOLAR SELF-CENTERING OD52 MM ID28 MM HIP FE C1776 $3,250.00HEAD BIPOLAR STAINLESS STEEL UHMWPE OD51 MM ID28 M C1776 $3,250.00HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD41 MM ID2 C1776 $3,250.00HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD42 MM ID2 C1776 $3,250.00HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD46 MM ID2 C1776 $3,250.00HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID2 C1776 $3,250.00HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID2 C1776 $3,250.00HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID2 C1776 $3,250.00HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD56 MM ID2 C1776 $3,250.00HEAD FEMORAL AMIS MECTACER BIOLOX DELTA 12/1 LARGE C1776 $3,900.00HEAD FEMORAL AMIS MECTACER BIOLOX DELTA 12/1 MEDIU C1776 $3,900.00HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA +1 MM 12/14 C1776 $5,200.00HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA +1.5 MM 12/1 C1776 $4,800.00HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA +12 MM 12/14 C1776 $5,200.00HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA +5 MM 12/14 C1776 $4,800.00HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA +8.5 MM 12/1 C1776 $5,200.00HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA +9 MM 12/14 C1776 $5,200.00HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA TITANIUM +1. C1776 $5,200.00HEAD FEMORAL ARTICUL/EZE BIOLOX DELTA TITANIUM +12 C1776 $5,200.00HEAD FEMORAL ARTICUL/EZE COCR +1 MM 12/14 STANDARD C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +1.5 MM 12/14 OFFSET C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +1.5 MM 12/14 TAPER C1776 $2,548.00HEAD FEMORAL ARTICUL/EZE COCR +12 MM 12/14 TAPER O C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +15.5 MM 12/14 OFFSE C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +15.5 MM 12/14 STAND C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +15.5 MM 12/14 TAPER C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +5 MM 12/14 STANDARD C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +5 MM 12/14 TAPER OD C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +7 MM 12/14 STANDARD C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR +8.5 MM 12/14 TAPER C1776 $2,925.00HEAD FEMORAL ARTICUL/EZE COCR -2 MM 12/14 TAPER OD C1776 $2,925.00HEAD FEMORAL BIOLOX DELTA +0 MM OD36 MM HIP TYPE I C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA +0 MM UNIVERSAL TAPER OD C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA +2.5 MM OFFSET C TAPER O C1776 $3,900.00

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 ChargeHEAD FEMORAL BIOLOX DELTA +3 MM OD32 MM HIP MODULA C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA +3 MM OD36 MM HIP MODULA C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA +3.5 MM 12/14 LARGE OD36 C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA +5 MM OFFSET C TAPER OD3 C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA +6 MM OD36 MM HIP MODULA C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA 0 MM OFFSET C TAPER OD36 C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA -2.5 MM OFFSET C TAPER O C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA -3 MM OD36 MM HIP MODULA C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA -3.5 MM 12/14 SMALL OD32 C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA -3.5 MM 12/14 SMALL OD36 C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA -5 MM OFFSET C TAPER OD3 C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA NEUTRAL OD36 MM HIP FMP C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA OD32 MM HIP OPTION FMP S C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA OPTION OD28 MM HIP C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA OPTION OD40 MM HIP STERI C1776 $3,900.00HEAD FEMORAL BIOLOX DELTA STANDARD OD28 MM HIP MOD C1776 $3,900.00HEAD FEMORAL COCR +0 MM 12/14 OD28 MM HIP TAPERED C1776 $2,925.00HEAD FEMORAL COCR LARGE OD36 MM C1776 $2,925.00HEAD FEMORAL COCR MEDIUM OD28 MM HIP C1776 $2,925.00HEAD FEMORAL COCR MEDIUM OD36 MM C1776 $2,925.00HEAD FEMORAL COCR SMALL OD36 MM HIP C1776 $2,925.00HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD C1776 $2,925.00HEAD FEMORAL G7 BIOLOX DELTA BIOLOX OPTION OD32 MM C1776 $3,900.00HEAD FEMORAL G7 BIOLOX DELTA BIOLOX OPTION OD40 MM C1776 $3,900.00HEAD FEMORAL G7 BIOLOX DELTA OPTION OD36 MM HIP C1776 $3,900.00HEAD FEMORAL G7 COCR +3 MM OFFSET OD28 MM HIP TYPE C1776 $4,000.00HEAD FEMORAL G7 COCR +3 MM OFFSET OD32 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR +3 MM OFFSET OD36 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR +6 MM OFFSET OD28 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR +6 MM OFFSET OD36 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR +9 MM OFFSET OD36 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR -3 MM OFFSET OD32 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR -3 MM OFFSET OD36 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR -6 MM OFFSET OD28 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR -6 MM OFFSET OD32 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR -6 MM OFFSET OD36 MM HIP TYPE C1776 $2,925.00HEAD FEMORAL G7 COCR STANDARD OFFSET OD36 MM HIP T C1776 $2,925.00HEAD FEMORAL G7 FREEDOM COCR -3 MM OFFSET OD36 MM C1776 $6,400.00HEAD FEMORAL LFIT COCR +0 MM OFFSET C TAPER OD28 M C1776 $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 ChargeHEAD FEMORAL LFIT COCR +0 MM OFFSET C TAPER OD32 M C1776 $2,925.00HEAD FEMORAL LFIT COCR +10 MM OFFSET C TAPER OD28 C1776 $2,925.00HEAD FEMORAL LFIT COCR +10 MM OFFSET C TAPER OD36 C1776 $2,925.00HEAD FEMORAL LFIT COCR +5 MM OD26 MM HIP C TAPER O C1776 $2,925.00HEAD FEMORAL LFIT COCR +5 MM OFFSET C TAPER OD28 M C1776 $2,925.00HEAD FEMORAL MECTACER BIOLOX DELTA SMALL OD36 MM H C1776 $3,900.00HEAD FEMORAL METAL +0 MM 14/16 OFFSET TAPER OD36 M C1776 $5,200.00HEAD FEMORAL METASUL -3.5 MM 12/14 OD36 MM C1776 $3,250.00HEAD FEMORAL OXINIUM +8 MM 14/16 OD32 MM HIP TAPER C1776 $3,900.00HEAD FEMORAL QUADRA-R BIOLOX DELTA +4 MM LARGE OD3 C1776 $3,900.00HEAD FEMORAL QUADRA-R BIOLOX DELTA 0 MM MEDIUM OD3 C1776 $3,900.00HEAD FEMORAL QUADRA-R BIOLOX DELTA -4 MM SMALL OD3 C1776 $3,900.00HEAD FEMORAL SELEX M2A-MAGNUM COCR +3 MM OD40 MM H C1776 $2,925.00HEAD FEMORAL SELEX M2A-MAGNUM COCR +6 MM OD40 MM H C1776 $2,925.00HEAD FEMORAL SELEX M2A-MAGNUM COCR -3 MM OD40 MM H C1776 $2,925.00HEAD FEMORAL SELEX M2A-MAGNUM COCR -6 MM OD40 MM H C1776 $2,925.00HEAD FEMORAL SELEX M2A-MAGNUM COCR STANDARD OD40 M C1776 $2,925.00HEAD FEMORAL TRILOGY IT CONTINUUM BIOLOX DELTA +7 C1776 $3,900.00HEAD FEMORAL TRILOGY IT CONTINUUM METASUL +3.5 MM C1776 $2,925.00HEAD FEMORAL V40 BIOLOX DELTA +0 MM OFFSET TAPER O C1776 $3,900.00HEAD FEMORAL V40 BIOLOX DELTA +2.5 MM OFFSET TAPER C1776 $3,900.00HEAD FEMORAL V40 BIOLOX DELTA +4 MM OFFSET TAPER O C1776 $3,900.00HEAD FEMORAL V40 BIOLOX DELTA +5 MM OFFSET TAPER O C1776 $3,900.00HEAD FEMORAL V40 BIOLOX DELTA +7.5 MM OFFSET TAPER C1776 $3,900.00HEAD FEMORAL V40 BIOLOX DELTA -2.5 MM OFFSET TAPER C1776 $3,900.00HEAD FEMORAL V40 BIOLOX DELTA -4 MM OFFSET TAPER O C1776 $3,900.00HEAD FEMORAL V40 BIOLOX DELTA -5 MM OFFSET TAPER O C1776 $3,900.00HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD22 C1776 $2,925.00HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 C1776 $2,925.00HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD32 C1776 $2,925.00HEAD FEMORAL V40 LFIT COCR +12 MM OFFSET TAPER OD2 C1776 $2,925.00HEAD FEMORAL V40 LFIT COCR +12 MM OFFSET TAPER OD4 C1776 $2,925.00HEAD FEMORAL V40 LFIT COCR +3 MM OFFSET TAPER OD22 C1776 $2,925.00HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 C1776 $2,925.00HEAD FEMORAL V40 LFIT COCR +5 MM OFFSET TAPER OD36 C1776 $2,925.00HEAD FEMORAL V40 LFIT COCR +8 MM OFFSET TAPER OD28 C1776 $2,925.00HEAD FEMORAL VERSYS COCR +10.5 MM 12/14 TAPER OD28 C1776 $2,925.00HEAD FEMORAL VERSYS COCR +3.5 MM OD36 MM HIP C1776 $2,925.00HEAD FEMORAL VERSYS COCR 0 MM OD36 MM HIP C1776 $2,925.00

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 ChargeHEAD FEMORAL VERSYS COCR -3.5 MM OD32 MM HIP C1776 $2,925.00HEAD FEMORAL VERSYS CPT COCR +3.5 MM OD32 MM HIP C1776 $5,492.50HEAD FEMORAL VERSYS LEGACY ZIMALOY +7 MM 12/14 OD2 C1776 $2,925.00HEAD FEMORAL VERSYS LEGACY ZIMALOY 12/14 OD52 MM H C1776 $1,950.00HEAD FEMORAL ZIMALOY COCR -5 MM OD28 MM HIP C1776 $3,250.00HEAD GLENOID RSP -4 MM OFFSET OD32 MM SHOULDER RET C1776 $6,500.00HEAD GLENOID RSP NEUTRAL OD32 MM SHOULDER RETAIN S C1776 $6,500.00HEAD GLENOID UNIVERS REVERS +4 MM LATERAL OFFSET O C1776 $13,650.00HEAD HUMERAL AEQUALIS ASCEND FLEX COCR 1.5 MM LOW C1776 $5,850.00HEAD HUMERAL AEQUALIS H16 MM OD43 MM SHOULDER CEME C1776 $5,850.00HEAD HUMERAL BIGLIANI/FLATOW ZIMALOY OFFSET H17 MM C1776 $5,850.00HEAD HUMERAL COMPREHENSIVE VERSA-DIAL H18 MM OD46 C1776 $5,850.00HEAD HUMERAL COMPREHENSIVE VERSA-DIAL H18 MM OD50 C1776 $5,850.00HEAD HUMERAL COMPREHENSIVE VERSA-DIAL H19 MM OD39 C1776 $5,850.00HEAD HUMERAL COMPREHENSIVE VERSA-DIAL H21 MM OD43 C1776 $5,850.00HEAD HUMERAL COMPREHENSIVE VERSA-DIAL H21 MM OD50 C1776 $5,850.00HEAD HUMERAL COMPREHENSIVE VERSA-DIAL H21 MM OD57 C1776 $5,850.00HEAD HUMERAL EQUINOXE SHORT OD44 MM SHOULDER STERI C1776 $5,850.00HEAD HUMERAL EQUINOXE SHORT OD47 MM SHOULDER C1776 $5,850.00HEAD HUMERAL EQUINOXE SHORT OD50 MM SHOULDER STERI C1776 $5,850.00HEAD HUMERAL EQUINOXE TALL OD41 MM SHOULDER C1776 $5,850.00HEAD HUMERAL EQUINOXE TALL OD44 MM SHOULDER C1776 $5,850.00HEAD HUMERAL EQUINOXE TALL OD47 MM SHOULDER C1776 $5,850.00HEAD HUMERAL GLOBAL UNITE ECCENTRIC H15 MM OD40 MM C1776 $5,850.00HEAD HUMERAL GLOBAL UNITE ECCENTRIC H18 MM OD48 MM C1776 $5,850.00HEAD HUMERAL GLOBAL UNITE STANDARD H15 MM OD44 MM C1776 $5,850.00HEAD HUMERAL GLOBAL UNITE STANDARD H15 MM OD48 MM C1776 $5,850.00HEAD HUMERAL GLOBAL UNITE STANDARD H18 MM OD44 MM C1776 $5,850.00HEAD HUMERAL GLOBAL UNITE STANDARD H18 MM OD48 MM C1776 $5,850.00HEAD HUMERAL GLOBAL UNITE STANDARD H21 MM OD52 MM C1776 $5,850.00HEAD HUMERAL REUNION STANDARD H15 MM OD48 MM SHOUL C1776 $6,175.00HEAD HUMERAL REUNION STANDARD H16 MM OD44 MM SHOUL C1776 $6,175.00HEAD HUMERAL REUNION STANDARD H17 MM OD52 MM SHOUL C1776 $6,175.00HEAD RADIAL 2 RADIOCAPITELLAR RECONSTRUCTION C1776 $12,215.78HEAD RADIAL ACUMED ARH ANGLE OD24 MM ELBOW RIGHT A C1776 $15,236.00HEAD RADIAL ACUMED ARH ANGLE OD26 MM ELBOW RIGHT A C1776 $15,236.00HEAD RADIAL EVOLVE PROLINE STANDARD OD22 MM ELBOW C1776 $6,623.50HEAD RADIAL EXPLOR H10 MM OD22 MM ELBOW MODULAR C1776 $8,775.00HEAD RADIAL SLIDE-LOC OD20 MM ELBOW LEFT ANATOMIC C1776 $14,651.00

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 ChargeHEAD RADIAL SLIDE-LOC OD22 MM ELBOW LEFT ANATOMIC C1776 $14,651.00HEAD RADIAL SLIDE-LOC OD22 MM ELBOW RIGHT ANATOMIC C1776 $14,651.00HEAD RADIAL SLIDE-LOC OD24 MM ELBOW RIGHT ANATOMIC C1776 $14,651.00HEAD SCREW MARINER SPINE POLYAXIAL NONSTERILE LATE C1713 $2,600.00HEAD SCREW TITANIUM CONDYLE NONSTERILE C1713 $18,750.00HEAD UNIPOLAR ACUMATCH OD43 MM HIP FEMUR L SERIES C1776 $1,950.00HEAD UNIPOLAR ACUMATCH OD44 MM HIP FEMUR L SERIES C1776 $1,950.00HEAD UNIPOLAR ACUMATCH OD45 MM HIP FEMUR L SERIES C1776 $1,950.00HEAD UNIPOLAR ACUMATCH OD46 MM HIP FEMUR L SERIES C1776 $1,950.00HEAD UNIPOLAR ACUMATCH OD48 MM HIP FEMUR L SERIES C1776 $1,950.00HEAD UNIPOLAR ACUMATCH OD53 MM HIP FEMUR ENDOPROST C1776 $1,950.00HEAD UNIPOLAR BIO-MOORE II ENDO II COCRMO OD53 MM C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD42 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD45 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD46 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD47 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD48 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD49 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD50 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD51 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD52 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD53 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD54 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR CATHCART BALL OD58 MM HIP FEMUR MODU C1776 $1,950.00HEAD UNIPOLAR COCR 12/14 TAPER OD42 MM HIP FEMORAL C1776 $1,950.00HEAD UNIPOLAR COCR 12/14 TAPER OD45 MM HIP FEMORAL C1776 $1,950.00HEAD UNIPOLAR ENDO II COCRMO OD45 MM HIP ACETABULU C1776 $1,950.00HEAD UNIPOLAR ENDO II COCRMO OD46 MM HIP ACETABULU C1776 $1,950.00HEAD UNIPOLAR ENDO II COCRMO OD48 MM HIP ACETABULU C1776 $1,950.00HEAD UNIPOLAR ENDO II COCRMO OD49 MM HIP ACETABULU C1776 $1,950.00HEAD UNIPOLAR ENDO II COCRMO OD50 MM HIP ACETABULU C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD40 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD42 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD43 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD44 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD45 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD46 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD47 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD48 MM HIP FEMORAL MODULAR C1776 $1,950.00

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 ChargeHEAD UNIPOLAR UNITRAX OD50 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD51 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD52 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD53 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD54 MM HIP FEMORAL MODULAR C1776 $1,950.00HEAD UNIPOLAR UNITRAX OD55 MM HIP FEMORAL MODULAR C1776 $1,950.00HEALTH AND BEHAVIOR ASSESSMENT EACH 15 MINUTES 96150 $288.00HEALTH AND BEHAVIOR INTERVENTION, FAMILY AND PATIE 96154 $144.00HEALTH AND BEHAVIOR INTERVENTION, FAMILY EACH 15 M 96155 $305.00HEARING AID DISPENSING FEE V5090 $883.00HEARING AID EXAMINATION AND SELECTION OF BOTH EARS 92591 $184.00HEARING AID EXAMINATION AND SELECTION OF ONE EAR 92590 $181.00HEARING TEST FOR CHILDREN 92579 $428.00HEARING TEST USING EARPHONES 92563 $174.00HEARING TESTS FOR CHILDREN 92582 $428.00HEARING TRAINING AND THERAPY FOR HEARING LOSS AFTE 92633 $712.00HEARING TRAINING AND THERAPY FOR HEARING LOSS PRIO 92630 $458.00HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT O 93226 $322.00HEART RHYTHM SYMPTOM-RELATED TRACING 24-HOUR EKG M 93270 $151.00HEART RHYTHM SYMPTOM-RELATED TRANSM & ANALYSIS 24- 93271 $479.00HEART RHYTHM TRACING OF 48-HOUR EKG 93225 $642.00HEART RHYTHM TRACING OF 48-HOUR EKG 93224 $199.00HEART RHYTHM TRANSMISSION & ANALYSIS OF 24-HOUR EK 93268 $767.00HEAT DELIVERY TO MUSCLE AT ESOPHAGUS AND/OR STOMAC 43257 $5,474.00HELICOBACTER PYLORI ANTIGEN INFECTIOUS AGENT TECH 87338 $36.00HEMODIALYSIS ACCESS BLOOD FLOW STUDY (GRAFT AND AR 90940 $1,796.00HEMOGLOBIN A1C LEVEL 83036 $76.00HEMOGLOBIN ANALYSIS AND MEASUREMENT 83020 $100.00HEMOGLOBIN ANALYSIS AND MEASUREMENT 83021 $139.00HEMOGLOBIN MEASUREMENT 85018 $17.00HEMOSTAT ABSORBABLE ARISTA AH MPH PLANT STARCH 3 G $1,020.00HEMOSTAT ABSORBABLE ARISTA MPH PLANT STARCH 1 GM B $663.00HEMOSTAT ABSORBABLE SURGICEL FIBRILLAR L4 IN X W2 $577.79HEMOSTAT ABSORBABLE SURGICEL FIBRILLAR L4 IN X W4 $739.65HEMOSTAT ABSORBABLE SURGICEL L8 IN X W4 IN FLEXIBL $157.37HEMOSTAT ABSORBABLE SURGICEL NU-KNIT L9 IN X W6 IN $626.06HEMOSTAT ABSORBABLE SURGICEL OXIDIZED REGENERATED $929.25HEMOSTAT ABSORBABLE SURGICEL SNOW L4 IN X W2 IN NO $544.87HEMOSTAT ABSORBABLE SURGICEL SNOW L4 IN X W4 IN NO $681.08

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 ChargeHEMOSTAT ABSORBABLE SURGIFOAM PORCINE GELATIN 1 GM $721.03HEMOSTAT ABSORBABLE VITAGEL RT3 4.5 ML STERILE $3,575.00HEMOSTATIC MATRIX 1 KIT $1,112.99HEMOSTATIC MATRIX 1 KIT KIT $879.81HEPARIN (PORCINE) 1,000 UNIT/ML SOLN 10 ML VIAL J1644 $20.75HEPARIN (PORCINE) 2 UNITS/ML 1,000 UNIT/500 ML SOL J1644 $100.00HEPARIN (PORCINE) 5,000 UNIT/ML SOLN 1 ML VIAL J1644 $20.00HEPARIN (PORCINE) 5,000 UNIT/ML SOLN 10 ML VIAL J1644 $20.45HEPARIN ASSAY 85520 $61.00HEPARIN NEUTRALIZATION TEST 85525 $61.00HEPATITIS A (HAAB) ANTIBODY 86708 $90.00HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML SYRG 1 M 90632 $263.94HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT 86705 $75.00HEPATITIS B CORE ANTIBODY TOTAL 86704 $94.00HEPATITIS B SURFACE ANTIBODY MEASUREMENT 86706 $83.00HEPATITIS B VIRUS VACCINE (PF) 1 ML VIAL 90746 $171.47HEPATITIS BE ANTIBODY MEASUREMENT 86707 $89.00HEPATITIS C ANTIBODY MEASUREMENT 86803 $111.00HEPATITIS C QUANTATIVE NUCLEIC ACID PROBE 87522 $332.00HEREDITARY PERIPHERAL NEUROPATHY GEN SEQ PNL 81448 $3,250.00HEROIN METABOLITE LEVEL 80356 $244.00HERPES SIMPLEX TYPE 2 ANTIBODY 86696 $177.00HIGH DOSE BRACHYTHERAPY , 1 CHANNEL 77770 $3,113.00HIGH DOSE BRACHYTHERAPY , 2- 12 CHANNELS 77771 $3,113.00HIGH DOSE BRACHYTHERAPY , MORE THAN 12 CHANNELS 77772 $3,113.00HINGE EXTERNAL FIXATION COMPASS UNIVERSAL $46,898.72HINGE EXTERNAL FIXATION HIGH PROFILE FEMALE CONNEC $617.52HINGE EXTERNAL FIXATION HIGH PROFILE MALE CONNECTO $601.52HINGE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL A $1,341.12HINGE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL S $651.04HINGE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL T $651.04HINGE EXTERNAL FIXATION LOCK MRI SAFE NONSTERILE $1,559.36HINGE EXTERNAL FIXATION STANDARD 1 HOLE FEMALE CON $1,373.68HINGE EXTERNAL FIXATION STANDARD 1 HOLE MALE CONNE $1,373.68HINGE EXTERNAL FIXATION UNIVERSAL CD $9,484.80HISTOPLASMA AB BY ID 86698 $82.00HIV 1 QUANTIFICATION NUCLEIC ACID PROBE??????????? 87536 $659.00HLA A,B,C,DRB1 TYPING 81378 $1,450.00HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS 81380 $279.00

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 ChargeHLA CLASS I TYPING LOW RESOLUTION ONE LOCUS 81373 $700.00HLA CLASS I TYPING, LOW RESOLUTION ONE ANTIGEN EQU 81374 $458.00HLA CLASS II TYPING HIGH RESOLUTION ONE ALLELE OR 81383 $686.00HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS 81382 $812.00HLA CLASS II TYPING LOW RESOLUTION HLA-DRB1/3/4/5 81375 $1,387.00HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS 81376 $137.00HLA I TYPING HIGH RESOLUTION 1 ALLELE 81381 $733.00HOLDER IMPLANT SCREW NAIL $1,352.00HOMOCYSTEINE 83090 $131.00HOMOVANILLIC ACID (ORGANIC ACID) LEVEL 83150 $150.00HOOK SPINAL 7.5 MM MEDIUM NARROW LAMINAR C1713 $2,800.00HOOK SPINAL ANGLE LARGE LEFT C1713 $2,800.00HOOK SPINAL ANGLE LARGE RIGHT C1713 $2,800.00HOOK SPINAL ANGLE MEDIUM LEFT C1713 $2,800.00HOOK SPINAL ANGLE MEDIUM RIGHT C1713 $2,800.00HOOK SPINAL ANGLE SMALL LEFT C1713 $2,800.00HOOK SPINAL ANGLE SMALL RIGHT C1713 $2,800.00HOOK SPINAL CD HORIZON LEGACY STAINLESS STEEL LARG C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY STAINLESS STEEL LEFT C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY STAINLESS STEEL MEDI C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY STAINLESS STEEL PEDI C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY STAINLESS STEEL SMAL C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY STAINLESS STEEL THOR C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM LARGE PEDIC C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM LARGE WIDE C1713 $2,800.00HOOK SPINAL CD HORIZON LEGACY TITANIUM LEFT OFFSET C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM LORDOTIC PE C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM MEDIUM LUMB C1713 $2,800.00HOOK SPINAL CD HORIZON LEGACY TITANIUM MEDIUM NARR C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM MEDIUM OD5. C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM MEDIUM PEDI C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM MEDIUM SUPR C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM MEDIUM THOR C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM OD5.5 MM LE C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM OD5.5 MM RI C1713 $2,800.00HOOK SPINAL CD HORIZON LEGACY TITANIUM OD6.35 MM T C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM RIGHT OFFSE C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM SMALL LUMBA C1713 $3,200.00HOOK SPINAL CD HORIZON LEGACY TITANIUM SMALL OD5.5 C1713 $3,200.00

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 ChargeHOOK SPINAL CD HORIZON LEGACY TITANIUM SMALL PEDIC C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM LARGE EXTEND BODY C1713 $2,800.00HOOK SPINAL CD HORIZON TITANIUM LARGE LAMINA WIDE C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM LARGE LIP PEDICLE C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM LARGE NARROW BLADE C1713 $2,800.00HOOK SPINAL CD HORIZON TITANIUM MEDIUM EXTENDED BO C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM MEDIUM LAMINA WIDE C1713 $2,800.00HOOK SPINAL CD HORIZON TITANIUM MEDIUM LIP PEDICLE C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM MEDIUM LORDOTIC LU C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM MEDIUM NARROW BLAD C1713 $2,800.00HOOK SPINAL CD HORIZON TITANIUM MEDIUM NARROW THOR C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM MEDIUM THORACIC NA C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM OPEN LEFT OFFSET 6 C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM OPEN RIGHT OFFSET C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM SMALL LIP PEDICLE C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM SMALL LORDOTIC LUM C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM SMALL NARROW BLADE C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM SMALL WIDE BLADE N C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM SMALL WIDE BLADE S C1713 $3,200.00HOOK SPINAL CD HORIZON TITANIUM WIDE BLADE RAMP C1713 $3,200.00HOOK SPINAL DENALI STANDARD W7 MM LAMINAR LUMBAR C1713 $2,800.00HOOK SPINAL DENALI STANDARD W7 MM LAMINAR LUMBAR C C1713 $2,800.00HOOK SPINAL DENALI W9.1 MM LAMINAR LUMBAR NARROW B C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL 3 MM OFFSET L C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL ANGLE LEFT L1 C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL ANGLE LEFT L4 C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL ANGLE LEFT L5 C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL ANGLE LEFT W4 C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL ANGLE LEFT W5 C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL ANGLE RIGHT L C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL ANGLE RIGHT W C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L10 MM PEDICL C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L12 MM PEDICL C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L3 MM OPEN NA C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L3 MM OPEN RE C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L3 MM OPEN WI C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L3 MM PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L4.25 MM OPEN C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L4.25 MM PEDI 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 ChargeHOOK SPINAL EXPEDIUM STAINLESS STEEL L5 MM PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L5.5 MM OPEN C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L5.5 MM PEDIC C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L6.5 MM PEDIC C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L6.75 MM OPEN C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L6.75 MM PEDI C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L8 MM OPEN NA C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L8 MM OPEN WI C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL L8 MM PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL LEFT OFFSET L C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL LEFT OFFSET W C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL NARROW W3 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL NARROW W4.25 C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL NARROW W5.5 M C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL NARROW W6.75 C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL NARROW W8 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL OVERSIZE L10 C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL PEDICLE DOWN C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL PEDICLE OPEN C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL RIGHT OFFSET C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W10 MM PEDICL C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W10 MM TRANSV C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W11 MM PEDICL C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W4.25 MM EXTE C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W4.25 MM OPEN C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W4.25 MM PEDI C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W5 MM PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W5.5 MM EXTEN C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W5.5 MM OPEN C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W5.5 MM PEDIC C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W6.5 MM PEDIC C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W6.75 MM PEDI C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W8 MM PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL W9.5 MM PEDIC C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL WIDE W3 MM CL C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL WIDE W4.25 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL WIDE W5.5 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM STAINLESS STEEL WIDE W6.75 MM 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 ChargeHOOK SPINAL EXPEDIUM STAINLESS STEEL WIDE W8 MM CL C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM 3 MM OPEN L4.25 MM B C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM 3 MM OPEN OFFSET L5. C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM 3 MM OPEN OFFSET L6. C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM ANGLE LEFT L4.25 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM ANGLE LEFT L5.5 IN C C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM ANGLE LEFT L5.5 MM O C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM ANGLE RIGHT L4.25 IN C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM ANGLE RIGHT L4.25 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM ANGLE RIGHT L5.5 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L10 MM PEDICLE ANGLE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L10 MM PEDICLE NARRO C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L10 MM PEDICLE REDUC C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L12 MM PEDICLE NARRO C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L12 MM PEDICLE REDUC C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L12 MM PEDICLE WIDE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L3 MM CLOSED WIDE BL C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L3 MM OPEN REDUCE DI C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L4.25 MM CLOSED NARR C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L4.25 MM CLOSED WIDE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L4.25 MM EXTEND TAB C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L4.25 MM OPEN NARROW C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L4.25 MM OPEN WIDE B C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L4.25 MM PEDICLE EXT C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L4.25 MM PEDICLE OPE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5 MM PEDICLE WIDE B C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM CLOSED NARRO C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM CLOSED WIDE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM EXTEND TAB N C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM EXTEND TAB R C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM EXTEND TAB W C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM OPEN NARROW C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM OPEN REDUCE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM OPEN WIDE BL C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM PEDICLE EXTE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.5 MM PEDICLE OPEN C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L5.55 MM OPEN WIDE B C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.5 MM PEDICLE ANGL C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.5 MM PEDICLE NARR 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 ChargeHOOK SPINAL EXPEDIUM TITANIUM L6.5 MM PEDICLE REDU C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.5 MM PEDICLE WIDE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.75 MM CLOSED NARR C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.75 MM CLOSED WIDE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.75 MM EXTEND TAB C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.75 MM OPEN NARROW C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.75 MM OPEN WIDE B C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.75 MM PEDICLE EXT C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L6.75 MM PEDICLE OPE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L8 MM CLOSED NARROW C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L8 MM CLOSED WIDE BL C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L8 MM OPEN NARROW BL C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L8 MM OPEN WIDE BLAD C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L8 MM PEDICLE ANGLE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L8 MM PEDICLE NARROW C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L8 MM PEDICLE REDUCE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM L8 MM PEDICLE WIDE B C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM LEFT ANGLE PEDICLE N C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM LEFT OFFSET L4.25 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM LEFT OFFSET L5.5 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM LEFT OFFSET PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM NARROW L3 MM CLOSED C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM NARROW L4.25 MM OPEN C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM OD5.5 MM PEDICLE NON C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM OFFSET L4.25 MM SPIN C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM PEDICLE EXTEND BODY C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM PEDICLE EXTEND TAB N C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM PEDICLE NONSTERILE 5 C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM PEDICLE WIDE BLADE N C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM RIGHT ANGLE PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM RIGHT OFFSET L4.25 M C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM RIGHT OFFSET L5.5 MM C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM RIGHT OFFSET PEDICLE C1713 $2,800.00HOOK SPINAL EXPEDIUM TITANIUM SMALL PEDICLE NONSTE C1713 $2,800.00HOOK SPINAL LARGE LAMINAR WIDE BLADE C1713 $2,800.00HOOK SPINAL LARGE LORDOTIC LAMINAR C1713 $3,200.00HOOK SPINAL LARGE NARROW INFRA LAMINA C1713 $2,800.00HOOK SPINAL LARGE NARROW INFRA LAMINA LUMBAR C1713 $2,800.00HOOK SPINAL LARGE NARROW INFRA LAMINA THORACIC 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 ChargeHOOK SPINAL LARGE OD5.5-6 MM WIDE BLADE C1713 $3,200.00HOOK SPINAL LARGE PEDICLE C1713 $2,800.00HOOK SPINAL LARGE STANDARD INFRA LAMINA C1713 $2,800.00HOOK SPINAL LARGE STANDARD INFRA LAMINA LUMBAR C1713 $2,800.00HOOK SPINAL LARGE STANDARD INFRA LAMINA THORACIC C1713 $2,800.00HOOK SPINAL LARGE STANDARD SPINAL LAMINAR LUMBAR G C1713 $2,800.00HOOK SPINAL LEGACY CD HORIZON STAINLESS STEEL ANGL C1713 $3,200.00HOOK SPINAL LEGACY CD HORIZON STAINLESS STEEL LARG C1713 $3,200.00HOOK SPINAL LEGACY CD HORIZON STAINLESS STEEL MEDI C1713 $3,200.00HOOK SPINAL LEGACY CD HORIZON STAINLESS STEEL RIGH C1713 $3,200.00HOOK SPINAL LEGACY CD HORIZON STAINLESS STEEL SMAL C1713 $3,200.00HOOK SPINAL LEGACY CD HORIZON TITANIUM LARGE LIP O C1713 $2,800.00HOOK SPINAL LEGACY CD HORIZON TITANIUM LARGE NARRO C1713 $3,200.00HOOK SPINAL LEGACY CD HORIZON TITANIUM MEDIUM LIP C1713 $2,800.00HOOK SPINAL LEGACY CD HORIZON TITANIUM MEDIUM WIDE C1713 $2,800.00HOOK SPINAL LEGACY CD HORIZON TITANIUM SMALL LIP O C1713 $2,800.00HOOK SPINAL LEGACY CD HORIZON TITANIUM SMALL NARRO C1713 $2,800.00HOOK SPINAL LEGACY STAINLESS STEEL MEDIUM PEDICLE C1713 $2,800.00HOOK SPINAL LORDOTIC C1713 $3,200.00HOOK SPINAL LORDOTIC NARROW BLADE C1713 $3,200.00HOOK SPINAL LORDOTIC PEDICLE C1713 $3,200.00HOOK SPINAL MEDIUM LAMINAR C1713 $3,200.00HOOK SPINAL MEDIUM LAMINAR LUMBAR NARROW BLADE LIG C1713 $2,800.00HOOK SPINAL MEDIUM NARROW INFRA LAMINA C1713 $2,800.00HOOK SPINAL MEDIUM NARROW INFRA LAMINA LUMBAR C1713 $2,800.00HOOK SPINAL MEDIUM NARROW INFRA LAMINA THORACIC C1713 $2,800.00HOOK SPINAL MEDIUM OD5.5-6 MM WIDE BLADE C1713 $3,200.00HOOK SPINAL MEDIUM PEDICLE C1713 $2,800.00HOOK SPINAL MEDIUM PEDICLE 5.5/6 MM ROD C1713 $2,800.00HOOK SPINAL MEDIUM STANDARD INFRA LAMINA C1713 $2,800.00HOOK SPINAL MEDIUM STANDARD INFRA LAMINA LUMBAR C1713 $2,800.00HOOK SPINAL MEDIUM STANDARD INFRA LAMINA THORACIC C1713 $2,800.00HOOK SPINAL MEDIUM THORACIC TRANSVERSE C1713 $2,800.00HOOK SPINAL MEDIUM THORACIC TRANSVERSE PROCESS C1713 $3,200.00HOOK SPINAL MESA D10 MM LAMINAR NONSTERILE C1713 $3,200.00HOOK SPINAL MESA D10 MM NARROW LAMINAR NONSTERILE C1713 $3,200.00HOOK SPINAL MESA D10 MM PEDICLE NONSTERILE C1713 $3,200.00HOOK SPINAL MESA D10 MM TRANSVERSE PROCESS NONSTER C1713 $3,200.00HOOK SPINAL MESA D6 MM LAMINAR NONSTERILE C1713 $3,200.00

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 ChargeHOOK SPINAL MESA D6 MM NARROW LAMINAR NONSTERILE C1713 $3,200.00HOOK SPINAL MESA D6 MM PEDICLE NONSTERILE C1713 $3,200.00HOOK SPINAL MESA D6 MM TRANSVERSE PROCESS STERILE C1713 $3,200.00HOOK SPINAL MESA D8 MM LAMINAR NONSTERILE C1713 $3,200.00HOOK SPINAL MESA D8 MM LEFT ANGLE TRANSVERSE PROCE C1713 $3,200.00HOOK SPINAL MESA D8 MM LEFT OFFSET LAMINAR NONSTER C1713 $3,200.00HOOK SPINAL MESA D8 MM NARROW LAMINAR NONSTERILE C1713 $3,200.00HOOK SPINAL MESA D8 MM PEDICLE NONSTERILE C1713 $3,200.00HOOK SPINAL MESA D8 MM RIGHT ANGLE TRANSVERSE PROC C1713 $3,200.00HOOK SPINAL MESA D8 MM RIGHT OFFSET LAMINAR NONSTE C1713 $3,200.00HOOK SPINAL MESA D8 MM TRANSVERSE PROCESS NONSTERI C1713 $3,200.00HOOK SPINAL OD8.1 MM SPINAL LAMINAR THORACIC LEFT C1713 $2,800.00HOOK SPINAL OD8.5 MM SPINAL LAMINAR THORACIC NARRO C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM ANGLE LAMINA TRANSVERS C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM ANGLE UP LAMINA NONSTE C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM DOWN ANGLE LAMINA NONS C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM LAMINA THORACIC NONSTE C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM LAMINA THORACIC TRANSV C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM LARGE LAMINA NONSTERIL C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM LARGE LAMINA TALL BODY C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM LARGE LAMINAR TRANSVER C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM LEFT OFFSET ANGLE UP L C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM LEFT OFFSET DOWN ANGLE C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM LEFT OFFSET LAMINA NON C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM ANGLE LEFT TRAN C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM ANGLE RIGHT TRA C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM LAMINA NONSTERI C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM LAMINA TALL BOD C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM LAMINAR TRANSVE C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM LEFT OFFSET TRA C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM PEDICLE NONSTER C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM PEDICLE TRANSVE C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM MEDIUM RIGHT OFFSET TR C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM RIGHT OFFSET ANGLE UP C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM RIGHT OFFSET DOWN ANGL C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM RIGHT OFFSET LAMINA NO C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM SMALL LAMINA NONSTERIL C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM SMALL LAMINA TALL BODY C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM SMALL LAMINAR TRANSVER 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 ChargeHOOK SPINAL PANGEA TITANIUM SMALL PEDICLE NONSTERI C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM SMALL PEDICLE TRANSVER C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM XS LAMINA NONSTERILE C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM XS LAMINA TALL BODY NO C1713 $2,800.00HOOK SPINAL PANGEA TITANIUM XS LAMINAR TRANSVERSE C1713 $2,800.00HOOK SPINAL PASS LP LARGE PEDICULAR POLYAXIAL NONS C1713 $2,800.00HOOK SPINAL PASS LP LONG TRANSVERSE COUNTER NONSTE C1713 $2,800.00HOOK SPINAL PASS LP SHORT LAMINAR LUMBAR TRANSVERS C1713 $2,800.00HOOK SPINAL PASS LP SMALL PEDICLE POLYAXIAL NONSTE C1713 $2,800.00HOOK SPINAL POLARIS MEDIUM W7.5 MM LAMINAR DEFORMI C1713 $2,800.00HOOK SPINAL POLARIS STAINLESS STEEL 5 MM UNIVERSAL C1713 $2,800.00HOOK SPINAL POLARIS STAINLESS STEEL 7.3 MM UNIVERS C1713 $2,800.00HOOK SPINAL POLARIS STAINLESS STEEL 9 MM UNIVERSAL C1713 $2,800.00HOOK SPINAL POLARIS STAINLESS STEEL UNIVERSAL LARG C1713 $2,800.00HOOK SPINAL POLARIS STAINLESS STEEL UNIVERSAL MEDI C1713 $2,800.00HOOK SPINAL POLARIS STAINLESS STEEL UNIVERSAL SMAL C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM 5 MM LARGE W9 MM LAMI C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM 5 MM MEDIUM W7.5 MM L C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM 5 MM SMALL W6 MM LAMI C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM 7.3 MM SMALL W6 MM LA C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM LARGE LEFT ANGLE W9 M C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM LARGE LEFT OFFSET W9 C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM LARGE RIGHT ANGLE W9 C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM LARGE RIGHT OFFSET W9 C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM LARGE W9 MM ANGLE BLA C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM LARGE W9 MM EXTEND HE C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM MEDIUM LEFT ANGLE W7. C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM MEDIUM LEFT OFFSET W7 C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM MEDIUM RIGHT ANGLE W7 C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM MEDIUM RIGHT OFFSET W C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM MEDIUM W7.5 MM ANGLE C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM MEDIUM W7.5 MM EXTEND C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM MEDIUM W7.5 MM PEDICL C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM SMALL LEFT ANGLE W6 M C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM SMALL LEFT OFFSET W6 C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM SMALL RIGHT ANGLE W6 C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM SMALL RIGHT OFFSET W6 C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM SMALL W6 MM ANGLE BLA C1713 $2,800.00HOOK SPINAL POLARIS TITANIUM SMALL W6 MM EXTEND HE 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 ChargeHOOK SPINAL POLARIS TITANIUM SMALL W6 MM PEDICLE H C1713 $2,800.00HOOK SPINAL REFORM LATERAL OFFSET L20 MM SPINE PED C1713 $1,625.00HOOK SPINAL REFORM LATERAL OFFSET L30 MM SPINE PED C1713 $1,625.00HOOK SPINAL REVERE SMALL PEDICLE C1713 $2,275.00HOOK SPINAL SMALL LORDOTIC LAMINAR C1713 $3,200.00HOOK SPINAL SMALL LORDOTIC THORACIC TRANSVERSE PRO C1713 $3,200.00HOOK SPINAL SMALL NARROW INFRA LAMINA C1713 $2,800.00HOOK SPINAL SMALL NARROW INFRA LAMINA LUMBAR C1713 $2,800.00HOOK SPINAL SMALL NARROW INFRA LAMINA THORACIC C1713 $2,800.00HOOK SPINAL SMALL PEDICLE C1713 $2,800.00HOOK SPINAL SMALL STANDARD INFRA LAMINA C1713 $2,800.00HOOK SPINAL SMALL STANDARD INFRA LAMINA LUMBAR C1713 $2,800.00HOOK SPINAL SMALL STANDARD INFRA LAMINA THORACIC C1713 $2,800.00HOOK SPINAL SMALL THORACIC TRANSVERSE C1713 $2,800.00HOOK SPINAL SOLERA CD HORIZON TITANIUM LARGE LAMIN C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM LARGE LEFT C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM LARGE NARRO C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM LARGE PEDIC C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM LARGE RIGHT C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM LARGE WIDE C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM MEDIUM LAMI C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM MEDIUM NARR C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM MEDIUM PEDI C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM MEDIUM WIDE C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM SMALL LAMIN C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM SMALL LEFT C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM SMALL NARRO C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM SMALL PEDIC C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM SMALL RIGHT C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM SMALL WIDE C1713 $3,200.00HOOK SPINAL SOLERA CD HORIZON TITANIUM XS PEDICLE C1713 $3,200.00HOOK SPINAL SPINE SYSTEM EVOLUTION LARGE PEDICLE C1713 $2,800.00HOOK SPINAL SPINE SYSTEM EVOLUTION MEDIUM LAMINAR C1713 $2,800.00HOOK SPINAL SPINE SYSTEM EVOLUTION SMALL LAMINAR N C1713 $2,800.00HOOK SPINAL STAINLESS STEEL ANGLE SMALL STATURE LA C1713 $2,800.00HOOK SPINAL STAINLESS STEEL ID3.5 MM LAMINAR C1713 $3,200.00HOOK SPINAL STAINLESS STEEL ID3.5 MM PEDICLE C1713 $3,200.00HOOK SPINAL STAINLESS STEEL ID3.5 MM RAMPED NARROW C1713 $3,200.00HOOK SPINAL STAINLESS STEEL LARGE ID3.5 MM LAMINAR 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 ChargeHOOK SPINAL STAINLESS STEEL LARGE LORDOTIC PEDICLE C1713 $2,800.00HOOK SPINAL STAINLESS STEEL LARGE LORDOTIC WIDE BL C1713 $2,800.00HOOK SPINAL STAINLESS STEEL LARGE NARROW BLADE C1713 $3,200.00HOOK SPINAL STAINLESS STEEL LARGE WIDE BLADE C1713 $2,800.00HOOK SPINAL STAINLESS STEEL LORDOTIC EXTEND BODY C1713 $3,200.00HOOK SPINAL STAINLESS STEEL LORDOTIC LEFT OFFSET C1713 $3,200.00HOOK SPINAL STAINLESS STEEL LORDOTIC LUMBAR ANGLE C1713 $3,200.00HOOK SPINAL STAINLESS STEEL LORDOTIC NARROW BLADE C1713 $3,200.00HOOK SPINAL STAINLESS STEEL LORDOTIC RIGHT OFFSET C1713 $3,200.00HOOK SPINAL STAINLESS STEEL LORDOTIC THORACIC C1713 $3,200.00HOOK SPINAL STAINLESS STEEL LORDOTIC THORACIC RAMP C1713 $3,200.00HOOK SPINAL STAINLESS STEEL MEDIUM EXTENDED BODY C1713 $3,200.00HOOK SPINAL STAINLESS STEEL MEDIUM ID3.5 MM LAMINA C1713 $3,200.00HOOK SPINAL STAINLESS STEEL MEDIUM LORDOSIS WIDE B C1713 $3,200.00HOOK SPINAL STAINLESS STEEL MEDIUM LORDOTIC LUMBAR C1713 $3,200.00HOOK SPINAL STAINLESS STEEL MEDIUM LORDOTIC NARROW C1713 $2,800.00HOOK SPINAL STAINLESS STEEL MEDIUM LORDOTIC PEDICL C1713 $2,800.00HOOK SPINAL STAINLESS STEEL MEDIUM LORDOTIC WIDE B C1713 $3,200.00HOOK SPINAL STAINLESS STEEL MEDIUM RAMPED NARROW B C1713 $3,200.00HOOK SPINAL STAINLESS STEEL PEDICLE C1713 $3,200.00HOOK SPINAL STAINLESS STEEL PEDICLE EXTENDED BODY C1713 $3,200.00HOOK SPINAL STAINLESS STEEL SMALL LORDOTIC WIDE BL C1713 $3,200.00HOOK SPINAL STAINLESS STEEL SMALL NARROW BLADE C1713 $3,200.00HOOK SPINAL STAINLESS STEEL SMALL PEDICLE C1713 $3,200.00HOOK SPINAL STAINLESS STEEL SMALL STATURE TRANSVER C1713 $2,800.00HOOK SPINAL STAINLESS STEEL SMALL WIDE BLADE C1713 $3,200.00HOOK SPINAL STAINLESS STEEL THORACIC LEFT ANGLE C1713 $3,200.00HOOK SPINAL STANDARD OD9.1 MM EXTENDED BODY C1713 $2,800.00HOOK SPINAL STANDARD OD9.1 MM SPINAL LAMINAR LUMBA C1713 $2,800.00HOOK SPINAL STANDARD W5.5 MM LAMINAR LUMBAR C1713 $2,800.00HOOK SPINAL STANDARD W5.5 MM LAMINAR LUMBAR CLOSED C1713 $2,800.00HOOK SPINAL STANDARD W6 MM LAMINA THORACIC C1713 $2,800.00HOOK SPINAL SYNERGY TITANIUM LEFT OFFSET OD4 MM TH C1713 $6,635.52HOOK SPINAL TITANIUM ANGLE RIGHT 5.5 MM ROD C1713 $2,275.00HOOK SPINAL TITANIUM EXTENDED BODY C1713 $3,200.00HOOK SPINAL TITANIUM LARGE LORDOTIC INFRA LAMINAR C1713 $3,200.00HOOK SPINAL TITANIUM LARGE LORDOTIC SUPRA LAMINAR C1713 $3,200.00HOOK SPINAL TITANIUM LARGE LORDOTIC THORACIC PEDIC C1713 $3,200.00HOOK SPINAL TITANIUM LARGE LORDOTIC WIDE BLADE 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 ChargeHOOK SPINAL TITANIUM LARGE NARROW BLADE 6.35 MM RO C1713 $3,200.00HOOK SPINAL TITANIUM LARGE PEDICLE 6.35 MM ROD C1713 $3,200.00HOOK SPINAL TITANIUM LARGE THORACIC TRANSVERSE PRO C1713 $3,200.00HOOK SPINAL TITANIUM LARGE W8 MM PEDICLE C1713 $2,800.00HOOK SPINAL TITANIUM LARGE WIDE BLADE 6.35 MM ROD C1713 $3,200.00HOOK SPINAL TITANIUM LORDOTIC LEFT OFFSET C1713 $3,200.00HOOK SPINAL TITANIUM LORDOTIC LUMBAR C1713 $3,200.00HOOK SPINAL TITANIUM LORDOTIC THORACIC C1713 $3,200.00HOOK SPINAL TITANIUM MEDIUM INFRA LAMINAR THORACIC C1713 $3,200.00HOOK SPINAL TITANIUM MEDIUM LORDOTIC PEDICLE 6.35 C1713 $3,200.00HOOK SPINAL TITANIUM MEDIUM LORDOTIC PEDICLE NARRO C1713 $3,200.00HOOK SPINAL TITANIUM MEDIUM LORDOTIC PEDICLE WIDE C1713 $3,200.00HOOK SPINAL TITANIUM MEDIUM LORDOTIC WIDE BLADE C1713 $3,200.00HOOK SPINAL TITANIUM MEDIUM PEDICLE LIP C1713 $3,200.00HOOK SPINAL TITANIUM MEDIUM PEDICLE LIP WIDE BLADE C1713 $2,800.00HOOK SPINAL TITANIUM MEDIUM SUPRA LAMINAR THORACIC C1713 $3,200.00HOOK SPINAL TITANIUM MEDIUM THORACIC PEDICLE C1713 $3,200.00HOOK SPINAL TITANIUM NARROW BLADE C1713 $3,200.00HOOK SPINAL TITANIUM RIGHT OFFSET LORDOTIC C1713 $3,200.00HOOK SPINAL TITANIUM SMALL LORDOTIC INFRA LAMINAR C1713 $3,200.00HOOK SPINAL TITANIUM SMALL LORDOTIC SUPRA LAMINAR C1713 $3,200.00HOOK SPINAL TITANIUM SMALL LORDOTIC THORACIC PEDIC C1713 $3,200.00HOOK SPINAL TITANIUM SMALL NARROW BLADE 6.35 MM RO C1713 $3,200.00HOOK SPINAL TITANIUM SMALL PEDICLE 6.35 MM ROD C1713 $3,200.00HOOK SPINAL TITANIUM SMALL W6.2 MM PEDICLE C1713 $2,800.00HOOK SPINAL TITANIUM SMALL WIDE BLADE C1713 $3,200.00HOOK SPINAL TITANIUM SMALL WIDE BLADE 6.35 MM ROD C1713 $3,200.00HOOK SPINAL TITANIUM STANDARD W8.5 MM LEFT LAMINAR C1713 $2,800.00HOOK SPINAL TITANIUM W8.5 MM LAMINAR THORACIC C1713 $2,800.00HOOK SPINAL TITANIUM W8.5 MM LAMINAR THORACIC LEFT C1713 $2,800.00HOOK SPINAL TITANIUM W8.5 MM LAMINAR THORACIC RIGH C1713 $2,800.00HOOK SPINAL USS STAINLESS STEEL LARGE LAMINA 2 SID C1713 $2,800.00HOOK SPINAL USS STAINLESS STEEL LARGE SMALL STATUR C1713 $2,800.00HOOK SPINAL USS STAINLESS STEEL MEDIUM LAMINA 2 SI C1713 $2,800.00HOOK SPINAL USS STAINLESS STEEL MEDIUM LAMINA FRON C1713 $2,800.00HOOK SPINAL USS STAINLESS STEEL PEDICLE POSTERIOR C1713 $2,800.00HOOK SPINAL USS STAINLESS STEEL SMALL LAMINA 2 SID C1713 $2,800.00HOOK SPINAL USS STAINLESS STEEL SMALL STATURE LAMI C1713 $2,800.00HOOK SPINAL USS STAINLESS STEEL THORACIC LAMINA 2 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 ChargeHOOK SPINAL VEPTR II TITANIUM 90 D S LEFT CONTOUR C1713 $1,267.68HOOK SPINAL VEPTR II TITANIUM 90 D S RIGHT CONTOUR C1713 $1,267.20HOOK SPINAL VEPTR II TITANIUM LONG SPINE THORAX IL C1713 $4,988.80HOOK SPINAL VEPTR II TITANIUM SMALL SPINE THORAX I C1713 $8,550.40HOOK SPINAL VEPTR II TITANIUM SMALL STANDARD SPINE C1713 $4,988.80HOOK SPINAL VEPTR II TITANIUM SMALL XLONG SPINE TH C1713 $4,988.80HOOK SPINAL VEPTR II TITANIUM SPINE THORAX ILIUM L C1713 $8,550.40HOOK SPINAL VEPTR II TITANIUM STANDARD SPINE THORA C1713 $8,550.40HOOK SPINAL VEPTR II TITANIUM XLONG SPINE THORAX I C1713 $4,988.80HOOK SPINAL VEPTR TITANIUM LEFT OFFSET LAMINA LOW C1713 $3,884.80HOOK SPINAL VEPTR TITANIUM RIGHT OFFSET LAMINA LOW C1713 $3,884.80HOOK SPINAL VEPTR TITANIUM S LEFT CONTOUR NONSTERI C1713 $2,800.00HOOK SPINAL VEPTR TITANIUM S RIGHT CONTOUR NONSTER C1713 $2,800.00HOOK SPINAL VERTEX MAX TITANIUM ID4.5 MM LAMINA LE C1713 $3,200.00HOOK SPINAL VERTEX MAX TITANIUM ID4.5 MM LAMINA NO C1713 $3,200.00HOOK SPINAL VERTEX MAX TITANIUM ID4.5 MM LAMINA RI C1713 $3,200.00HOOK SPINAL VERTEX MAX TITANIUM ID6 MM LAMINA LEFT C1713 $3,200.00HOOK SPINAL VERTEX MAX TITANIUM ID6 MM LAMINA NONS C1713 $3,200.00HOOK SPINAL VERTEX MAX TITANIUM ID6 MM LAMINA RIGH C1713 $2,800.00HOOK SPINAL W5.5 MM LAMINAR LUMBAR NARROW BLADE C1713 $2,800.00HOOK SPINAL W6 MM LAMINAR THORACIC NARROW BLADE C1713 $2,800.00HOOK SPINAL W8.1 MM OD8.1 MM RIGHT LAMINA THORACIC C1713 $2,800.00HOOK SPINAL W9.1 MM LEFT LAMINAR LUMBAR CLOSED OFF C1713 $2,800.00HOOK SPINAL W9.1 MM RIGHT LAMINAR LUMBAR CLOSED OF C1713 $2,800.00HOOK SPINAL W9.5 MM OD5.5 MM LAMINAR THORACOLUMBAR C1713 $4,753.92HOOK SPINAL XIA SMALL PEDICLE SCOLIOSIS C1713 $2,800.00HOOK SPINAL XIA TITANIUM LAMINAR ANGLED BLADE 4.5 C1713 $2,800.00HOOK SPINAL XIA TITANIUM LAMINAR EXTEND 4.5 MM ROD C1713 $2,800.00HOOK SPINAL XIA TITANIUM LAMINAR THORACIC 4.5 MM R C1713 $2,800.00HOOK SPINAL XIA TITANIUM LAMINAR THORACIC LEFT OFF C1713 $2,800.00HOOK SPINAL XIA TITANIUM LAMINAR THORACIC RIGHT OF C1713 $2,800.00HOOK SPINAL XIA TITANIUM LARGE LAMINAR 4.5 MM ROD C1713 $2,800.00HOOK SPINAL XIA TITANIUM LARGE PEDICLE 4.5 MM ROD C1713 $2,800.00HOOK SPINAL XIA TITANIUM LEFT OFFSET TRANSVERSE PR C1713 $2,800.00HOOK SPINAL XIA TITANIUM MEDIUM LAMINAR 4.5 MM ROD C1713 $2,800.00HOOK SPINAL XIA TITANIUM RIGHT OFFSET TRANSVERSE P C1713 $2,800.00HOOK SPINAL XIA TITANIUM SMALL LAMINAR 4.5 MM ROD C1713 $2,800.00HOOK SPINAL XIA TITANIUM SMALL PEDICLE 4.5 MM ROD C1713 $2,800.00HOOK SPINAL XIA TITANIUM SUPRA LAMINAR LEFT OFFSET 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 ChargeHOOK SPINAL XIA TITANIUM SUPRA LAMINAR RIGHT OFFSE C1713 $2,800.00HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMIN BENEAT 96402 $190.00HORMONAL PANEL FOR ADRENAL GLAND ASSESSMENT (ADREN 80400 $252.00HOSPITAL OBSERVATION SERVICE G0378 $119.00HSV 1 AB 86695 $121.00HUMAN GROWTH HORMONE LEVEL 83003 $103.00HYDRATION INFUSION INTO A VEIN 96361 $131.00HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOU 96360 $361.00HYDROCODONE-ACETAMINOPHEN 7.5-325 MG TAB 100 EACH $3.33HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML SOLN 15 $9.90HYDROXYINDOLACETIC ACID (PRODUCT OF METABOLISM) LE 83497 $81.00HYDROXYPROGESTERONE, 17-D (SYNTHETIC HORMONE) LEVE 83498 $171.00HYDROXYZINE PAMOATE 25 MG CAP 100 EACH BOTTLE Q0177 $3.06HYPERTHERMIA TREATMENT BY ORGAN CAVITY PROBES 77620 $1,896.00HYPERTHERMIA TREATMENT, 5 OR FEWER PROBE APPLICATI 77610 $1,896.00HYPERTHERMIA TREATMENT, 5 OR MORE PROBE APPLICATIO 77615 $1,896.00IBUPROFEN 400 MG TAB 750 EACH BLIST PACK $3.04IDENTIFICATION OF ORGANISM USING CHROMATOGRAPHY 87143 $97.00IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS 87149 $155.00IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS 87153 $894.00IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS 87150 $271.00IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSI 87140 $172.00IDENTIFICATION OF RED BLOOD CELL ANTIBODIES 86870 $131.00IDH2 COMMON VARIANTS 81121 $1,332.00IGE (IMMUNE SYSTEM PROTEIN) LEVEL 82785 $128.00ILOPERIDONE 1 MG TAB 60 EACH BOTTLE $61.37ILOPERIDONE 8 MG TAB 60 EACH BOTTLE $61.37IMAGING BRAIN AND SPINAL CORD FLUID FLOW IN BRAIN 78635 $2,215.00IMAGING FOR ABSCESS OR ABNORMAL DRAINAGE TRACT PRO 76080 $1,235.00IMAGING FOR BONE AGE ASSESSMENT 77072 $223.00IMAGING FOR BONE LENGTH ASSESSMENT 77073 $458.00IMAGING FOR EVALUATION OF SWALLOWING FUNCTION 74230 $399.00IMAGING FROM NOSE TO RECTUM, SINGLE VIEW, CHILD 76010 $223.00IMAGING GUIDANCE FOR PROCEDURE, UP TO 1 HOUR 76000 $553.00IMAGING OF 2 OR MORE JOINTS, SINGLE VIEW 77077 $223.00IMAGING OF ABDOMEN AND CHEST 74022 $408.00IMAGING OF ANOGENITAL REGION 74775 $1,013.00IMAGING OF BILE DUCT AND/OR PANCREAS 74301 $104.00IMAGING OF BLOOD VESSEL 75898 $1,200.00

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 ChargeIMAGING OF BLOOD VESSEL OF GLAND OF KIDNEY 78075 $4,619.00IMAGING OF BLOOD VESSELS IN BACK OF EYE USING FLUO 92235 $701.00IMAGING OF BLOOD VESSELS IN BACK OF EYE USING INDO 92240 $701.00IMAGING OF BONE MARROW LIMITED AREA 78102 $1,353.00IMAGING OF BONE MARROW MULTIPLE AREAS 78103 $1,353.00IMAGING OF BONE MARROW WHOLE BODY 78104 $1,353.00IMAGING OF BRAIN AND SPINAL CORD FLUID FLOW AT BAS 78630 $2,215.00IMAGING OF BRAIN AND SPINAL CORD FLUID FLOW SHUNT 78645 $1,165.00IMAGING OF BRAIN AND SPINAL CORD FLUID LEAKAGE DET 78650 $4,811.00IMAGING OF BRAIN WITH BLOOD FLOW, LESS THAN 4 STAT 78601 $2,215.00IMAGING OF BRAIN WITH BLOOD FLOW, MINIMUM OF 4 STA 78605 $1,277.00IMAGING OF BRAIN WITH BLOOD FLOW, MINIMUM OF 4 STA 78606 $2,215.00IMAGING OF BRAIN, BLOOD FLOW 78610 $1,165.00IMAGING OF BRAIN, LESS THAN 4 STATIC VIEWS 78600 $1,277.00IMAGING OF COLON USING ENEMA 74283 $594.00IMAGING OF DIGESTIVE TRACT DONE FROM THE INSIDE OF 91110 $3,443.00IMAGING OF ESOPHAGUS DONE FROM THE INSIDE OF THE E 91111 $3,989.00IMAGING OF ESOPHAGUS USING RADIOISOTOPES 78258 $1,240.00IMAGING OF GALLBLADDER WITH CONTRAST 74290 $399.00IMAGING OF JAWS AND SKULL FOR ORTHODONTIC PURPOSES 70350 $223.00IMAGING OF JOINT WITH STRESSING BY PHYSICIAN 77071 $223.00IMAGING OF KIDNEY 78700 $1,609.00IMAGING OF LIVER 78201 $4,811.00IMAGING OF LIVER AND BILE DUCT SYSTEM 78226 $1,519.00IMAGING OF LIVER AND BILE DUCT SYSTEM WITH USE OF 78227 $1,229.00IMAGING OF LIVER AND SPLEEN 78215 $1,386.00IMAGING OF LIVER AND SPLEEN WITH BLOOD FLOW 78216 $1,386.00IMAGING OF LIVER BLOOD FLOW 78202 $4,811.00IMAGING OF LYMPHATIC TISSUE AND LYMPH NODE 78195 $1,233.00IMAGING OF ORGAN 76120 $553.00IMAGING OF ORGAN 76125 $114.00IMAGING OF PARATHYROID 78070 $1,125.00IMAGING OF PARATHYROID WITH CT AND NUCLEAR MEDICIN 78072 $1,557.00IMAGING OF PARATHYROID WITH NUCLEAR MEDICINE STUDY 78071 $1,419.00IMAGING OF PELVIS 74710 $343.00IMAGING OF SALIVARY GLAND 78230 $1,240.00IMAGING OF SALIVARY GLAND 78231 $1,240.00IMAGING OF SMALL INTESTINE 74260 $399.00IMAGING OF SPLEEN 78185 $1,353.00

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 ChargeIMAGING OF STOMACH LINING 78261 $1,132.00IMAGING OF SURGICAL SPECIMEN 76098 $1,168.00IMAGING OF URINARY TRACT 74420 $916.00IMAGING OF URINARY TRACT USING INFUSION TECHNIQUE 74410 $1,013.00IMAGING OF URINARY TRACT WITH INJECTION OF CONTRAS 74400 $1,013.00IMAGING OF VOICE BOX WITH SPEECH EVALUATION 70371 $553.00IMAGING URINARY TRACT USING INFUSION TECHNIQUE WIT 74415 $1,013.00IMMOBILIZER ORTHOPEDIC CANVAS L19 IN KNEE 3 PANEL L1830 $168.32IMMOBILIZER ORTHOPEDIC DELUXE CANVAS UNIVERSAL L14 L1830 $124.24IMMOBILIZER ORTHOPEDIC FOAM SMALL SHOULDER HOOK LO L3670 $52.32IMMOBILIZER ORTHOPEDIC PLASTER L240 IN X W2 IN ROL $359.65IMMOBILIZER ORTHOPEDIC PLASTER L240 IN X W3 IN FOO $408.27IMMOBILIZER ORTHOPEDIC PLASTER L240 IN X W4 IN FOO $478.53IMMOBILIZER ORTHOPEDIC TRICOT FOAM L1.5 IN SMALL L L1830 $175.44IMMUN GLOB G(IGG)-GLY-IGA OV50 10 % SOLN 200 ML VI J1569 $7,362.00IMMUNE COMPLEX MEASUREMENT 86332 $188.00IMMUNOASSAY ANALYTE QUANT RIA 83519 $36.00IMMUNOASSAY NONANTIBODY 83516 $89.00IMMUNOGLOBULIN A 82784 $72.00IMMUNOGLOBULIN G 82784 $72.00IMMUNOGLOBULIN M 82784 $72.00IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE 86812 $200.00IMMUNOLOGIC ANALYSIS FOR DETECTION OF ANTIGEN OR A 86331 $93.00IMMUNOLOGIC ANALYSIS FOR DETECTION OF ORGANISM 87449 $93.00IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGE 86300 $162.00IMMUNOLOGIC ANALYSIS TECHNIQUE ON BODY FLUID 86335 $228.00IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM 86334 $174.00IMPLANT BREAST COHESIVE I MEMORYGEL P5.8 CM ULTRA L8600 $5,070.00IMPLANT BREAST COHESIVE I MEMORYGEL SILICONE P3.4 L8600 $5,070.00IMPLANT BREAST COHESIVE I MEMORYGEL SILICONE P4.8 L8600 $5,070.00IMPLANT BREAST COHESIVE I SILICONE P3.1 CM MODERAT L8600 $5,070.00IMPLANT BREAST COHESIVE I SILICONE P4.2 CM MODERAT L8600 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.2 L8600 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.3 L8600 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.5 L8600 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.6 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.7 L8600 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.8 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.9 L8600 $5,070.00

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 ChargeIMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4 CM L8600 $6,240.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4.2 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4.3 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4.4 L8600 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4.5 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4.5 L8600 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4.6 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4.7 L8600 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P5.1 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P5.5 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P5.7 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P5.8 C1789 $5,070.00IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P6.1 L8600 $6,240.00IMPLANT BREAST MEMORYGEL COHESIVE III CPG SILICONE L8600 $7,637.50IMPLANT BREAST MEMORYGEL P3.4 CM MODERATE CLASSIC L8600 $5,070.00IMPLANT BREAST MEMORYGEL P6.6 CM ULTRA HIGH PROFIL C1789 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P2.8 CM MODERATE L8600 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P2.9 CM MODERATE L8600 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P2.9 CM MODERATE C1789 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P3 CM MODERATE C C1789 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P3.1 CM MODERATE C1789 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P3.2 CM MODERATE C1789 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P3.3 CM MODERATE C1789 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P3.4 CM MODERATE C1789 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P3.5 CM ROUND HI L8600 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P4 CM HIGH PROFI L8600 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P4 CM MODERATE P C1789 $6,240.00IMPLANT BREAST MEMORYGEL SILICONE P4.8 CM HIGH PRO L8600 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P5 CM HIGH PROFI L8600 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P5.3 CM HIGH PRO L8600 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P5.6 CM HIGH PRO C1789 $5,070.00IMPLANT BREAST MEMORYGEL SILICONE P6.4 CM ULTRA HI L8600 $5,070.00IMPLANT BREAST MEMORYGEL SILTEX P3.3 CM MODERATE P L8600 $5,070.00IMPLANT BREAST MEMORYSHAPE COHESIVE III MEMORYGEL L8600 $7,637.50IMPLANT BREAST MENTOR MEMORYGEL P4 CM MODERATE PLU L8600 $9,824.00IMPLANT BREAST MENTOR MEMORYGEL P5 CM HIGH PROFILE L8600 $6,480.00IMPLANT BREAST MENTOR MEMORYGEL P6.5 CM HIGH PROFI L8600 $5,265.00IMPLANT BREAST MENTOR MEMORYGEL P6.5 CM ULTRA HIGH C1789 $5,070.00IMPLANT BREAST NATRELLE BIOCELL SILICONE P4 CM HIG C1789 $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 ChargeIMPLANT BREAST NATRELLE INSPIRA 560 CC COHESIVE ST L8600 $6,370.00IMPLANT BREAST NATRELLE INSPIRA COHESIVE 560 CC ST L8600 $6,370.00IMPLANT BREAST NATRELLE INSPIRA COHESIVE 600 CC ST L8600 $6,370.00IMPLANT BREAST NATRELLE INSPIRA SILICONE FULL PROF L8600 $6,370.00IMPLANT BREAST NATRELLE INSPIRA SOFT TOUCH MODERAT L8600 $6,370.00IMPLANT BREAST NATRELLE SILICONE P3.2 CM MODERATE C1789 $4,888.00IMPLANT BREAST NATRELLE SILICONE P3.5 CM HIGH PROF C1789 $4,888.00IMPLANT BREAST NATRELLE SILICONE P4.7 CM MODERATE C1789 $4,888.00IMPLANT BREAST NATRELLE SILICONE P5.2 CM HIGH PROF C1789 $4,888.00IMPLANT BREAST NATRELLE SILICONE P5.2 CM MODERATE C1789 $4,888.00IMPLANT BREAST SALINE P5.6-6.5 CM MODERATE PLUS PR C1789 $2,665.00IMPLANT BREAST SALINE P5.8-6.6 CM MODERATE PLUS PR C1789 $2,665.00IMPLANT BREAST SALINE P5.9-6.8 CM MODERATE PLUS PR C1789 $2,665.00IMPLANT BREAST SALINE P6-7 CM MODERATE PLUS PROFIL C1789 $2,665.00IMPLANT BREAST SILTEX SILICONE P3.8 CM HIGH PROFIL L8600 $5,070.00IMPLANT BREAST SILTEX SILICONE P4.1 CM HIGH PROFIL L8600 $5,070.00IMPLANT BREAST SILTEX SPECTRUM SALINE P6.6-8.2 CM C1789 $7,475.00IMPLANT COCHLEAR 1J L8614 $107,250.00IMPLANT COCHLEAR BAHA L14 MM OD4 MM ABUTMENT STERI L8693 $17,259.45IMPLANT COCHLEAR BAHA TITANIUM L6 MM OD3 MM ABUTME L8693 $15,631.72IMPLANT COCHLEAR BAHA TITANIUM OD3 MM STERILE BA30 L8693 $6,844.50IMPLANT COCHLEAR BAHA TITANIUM OD4 MM ABUTMENT B13 L8693 $6,844.50IMPLANT COCHLEAR COCHLEAR BAHA DERMALOCK TITANIUM L8693 $11,058.45IMPLANT COCHLEAR DERMALOCK BAHA TITANIUM HA H10 MM L8690 $17,259.45IMPLANT COCHLEAR DERMALOCK BAHA TITANIUM HA H10 MM L8693 $11,058.45IMPLANT COCHLEAR DERMALOCK BAHA TITANIUM HA H12 MM L8690 $11,058.45IMPLANT COCHLEAR DERMALOCK BAHA TITANIUM HA H6 MM L8690 $17,259.45IMPLANT COCHLEAR DERMALOCK BAHA TITANIUM HA H6 MM L8693 $11,058.45IMPLANT COCHLEAR DERMALOCK BAHA TITANIUM HA H8 MM L8690 $11,058.45IMPLANT COCHLEAR HIRES 90K HIFOCUS MID SCALA ELECT L8614 $107,250.00IMPLANT COCHLEAR NUCLEUS CONTOUR ADVANCE CI512 L8614 $94,250.00IMPLANT COCHLEAR NUCLEUS FREEDOM EDUCATIONAL STUFF L8614 $0.07IMPLANT COCHLEAR NUCLEUS SLIM STRAIGHT ELECTRODE C L8614 $94,250.00IMPLANT COCHLEAR NUCLEUS SLIM STRAIGHT ELECTRODE S L8614 $94,250.00IMPLANT CRANIAL LARGE CUSTOM C1713 $99,660.60IMPLANT CRANIAL LARGE KIT CUSTOM C1713 $99,660.60IMPLANT CRANIAL OSTEOMATCH PEEK-OPTIMA 150-200 SQ C1713 $90,431.25IMPLANT CRANIAL PEEK MEDIUM CUSTOMIZE PRIORITY NON C1713 $89,317.80IMPLANT DENTAL ENCOMPASS HA L19 MM $10,793.25

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 ChargeIMPLANT FIXATION FREEDOM 1 WRIST RIGHT RADIAL C1776 $33,195.50IMPLANT FIXATION L17 MM METATARSOPHALANGEAL RESURF C1713 $10,793.25IMPLANT FIXATION MATRIXRIB TITANIUM LARGE W5 MM IN C1713 $4,107.20IMPLANT FIXATION MATRIXRIB TITANIUM MEDIUM W4 MM I C1713 $4,107.20IMPLANT FIXATION MATRIXRIB TITANIUM SMALL W3 MM IN C1713 $4,107.20IMPLANT FIXATION PHALINX TITANIUM 0 D THK1.9 MM SM C1713 $4,225.00IMPLANT FIXATION SUBFIX OD8 MM FOOT ANKLE C1776 $9,639.50IMPLANT FIXATION TOETAC MEDIUM L14 MM L7-7 MM OD3- C1776 $7,064.20IMPLANT MAINTENANCE PROCEDURES D6080 $314.00IMPLANT NASAL PROPEL MOMETASONE FUROATE 370 MCG CO C2625 $4,387.50IMPLANT NASAL PROPEL MOMETASONE FUROATE CONTOUR 37 $4,387.50IMPLANT NASAL SPIROX LATERA POLY 70:30 COPOLYMER L $6,467.50IMPLANT OPHTHALMIC BAERVELDT SILICONE 250 SQ MM AN C1783 $4,056.00IMPLANT OPHTHALMIC BAERVELDT SILICONE 350 SQ MM AN L8612 $3,900.00IMPLANT ORTHOPEDIC REMOTION SMALL WRIST CARPAL C1713 $19,575.08IMPLANT OTOLOGIC PONTO BHX L14 MM L4 MM OD4.5 MM A L8693 $15,795.00IMPLANT OTOLOGIC PONTO BHX L4 MM L12 MM OD4.5 MM 1 L8693 $15,795.00IMPLANT OTOLOGIC PONTO BHX L4 MM L9 MM OD4.5 MM PR L8693 $15,795.00IMPLANT OTOLOGIC PONTO BHX L6 MM L4 MM OD4.5 MM AB L8690 $15,795.00IMPLANT OTOLOGIC PONTO BHX WIDE L3 MM L6 MM OD4.5 L8690 $15,795.00IMPLANT OTOLOGIC PONTO BHX WIDE L3 MM L9 MM OD4.5 L8690 $15,795.00IMPLANT PECTORAL ELONGATE STABILIZER C1713 $3,856.00IMPLANT SOFT TISSUE ENDURAGEN PORCINE DERMAL COLLA C1763 $2,680.00IMPLANT SPINAL PASS LP 13 MM OPEN CLOSED DOMINO ST C1713 $1,625.00IMPLANT SPINAL PASS LP 16.5 MM OPEN CLOSED DOMINO C1713 $1,625.00IMPLANT SPINAL REFORM MODULAR TULIP C1713 $2,600.00IMPLANT SPINAL REFORM T25 L20 MM OD5.5 MM LATERAL C1713 $1,625.00IMPLANT SPINAL REFORM T25 L40 MM OD5.5 MM LATERAL $1,625.00IMPLANT TOE JOINT OSTEOMED ENCOMPASS HA OD18 MM ST C1776 $10,793.25IMPLANT TOE JOINT PHALINX TITANIUM 0 D MEDIUM L14. C1713 $4,225.00IMPLANT TOE JOINT TOETAC SMALL STERILE C1776 $7,064.20IMPLANT UROLOGICAL AMS 800 INHIBIZONE 61-70 CM SPH C1815 $15,132.00IMPLANT UROLOGICAL AMS 800 INHIBIZONE SILICONE ELA C1815 $31,860.40IMPLANT UROLOGICAL DEFLUX 1 ML INJECTABLE GEL SYRI $17,682.32IMPLANT UROLOGICAL UROLIFT L8699 $6,337.50IMPLANT VOCAL CORD PROLARYN GEL 1 ML WATER BASE IN C1878 $4,062.50IMPLANT VOCAL CORD PROLARYN PLUS SYNTHETIC CALCIUM C1878 $4,600.00IMPLANTATION OF GRAFT TO ENLARGE CHIN BONE 21120 $12,096.00IMPLANTATION OR REPLACEMENT OF PROGRAMMABLE SPINAL 62362 $52,059.00

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 ChargeIMPLANTATION SPINAL NEUROSTIMULATOR ELECTRODES, AC 63650 $16,231.00IMPLANTATION, REVISION, OR REPOSITIONING SPINAL CA 62350 $11,994.00IMPRESSION AND CUSTOM PREPARATION OF FACIAL PROSTH 21088 $12,096.00IMPRESSION AND CUSTOM PREPARATION OF LOWER JAW BON 21081 $12,096.00IMPRESSION AND CUSTOM PREPARATION OF NASAL PROSTHE 21087 $12,096.00IMPRESSION AND CUSTOM PREPARATION OF OUTER EAR PRO 21085 $1,840.00IMPRESSION AND CUSTOM PREPARATION OF OUTER EAR PRO 21086 $12,096.00IMPRESSION AND CUSTOM PREPARATION OF PERMANENT ORA 21080 $12,097.00IMPRESSION AND CUSTOM PREPARATION OF ROOF OF MOUTH 21083 $12,096.00IMPRESSION AND CUSTOM PREPARATION OF SPEECH AID PR 21084 $12,096.00IMPRESSION AND CUSTOM PREPARATION OF TEMPORARY ORA 21079 $12,096.00IMPRESSION AND CUSTOM PREPARATION PROSTHESIS FOR R 21082 $12,096.00IMPRESSION AND PREPARATION OF EYE SOCKET PROSTHESI 21077 $12,096.00INCISION AND DRAINAGE EXTRAORAL D7520 $405.00INCISION AND DRAINAGE INTRAORAL D7510 $424.00INCISION AND DRAINAGE LEG OR ANKLE DEEP ABSCESS 27603 $9,514.00INCISION AND DRAINAGE OF ABSCESS IN SCROTAL SAC OF 55100 $2,677.00INCISION AND DRAINAGE OF EAR CANAL ABSCESS 69020 $2,292.00INCISION AND DRAINAGE OF EXTERNAL EAR ABSCESS OR B 69000 $463.00INCISION AND DRAINAGE OF EXTERNAL EAR ABSCESS OR B 69005 $2,677.00INCISION AND DRAINAGE OF EYE CYST 68020 $3,234.00INCISION AND DRAINAGE OF EYELID ABSCESS 67700 $1,035.00INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSC 56420 $438.00INCISION AND DRAINAGE OF FEMALE GENITALS ABSCESS 56405 $492.00INCISION AND DRAINAGE OF KIDNEY ABSCESS, OPEN PROC 50020 $8,521.00INCISION AND DRAINAGE OF PELVIC ABSCESS 57010 $6,493.00INCISION AND DRAINAGE OF PROSTATE GLAND ABSCESS 55720 $8,521.00INCISION AND DRAINAGE OF ROOF OF MOUTH OR ITS SOFT 42000 $848.00INCISION AND DRAINAGE OF SPERM RESERVOIR, TESTIS, 54700 $7,825.00INCISION AND EXPLORATION OF CHEST CAVITY 32100 $3,942.00INCISION EXTENSOR TENDON SHEATH WRIST 25000 $5,255.00INCISION OF ABSCESS, CYST, OR BLOOD ACCUMULATION I 40800 $463.00INCISION OF ABSCESS, CYST, OR BLOOD ACCUMULATION I 40801 $1,840.00INCISION OF BLADDER WITH DRAINAGE 51040 $6,736.00INCISION OF BURN TISSUE 16035 $1,321.00INCISION OF CORNER OF EYE AT EYELIDS 67715 $5,047.00INCISION OF EARDRUM WITH INSERT EARDRUM TUBE UNDER 69433 $2,225.00INCISION OF ENGORGED EXTERNAL HEMORRHOID 46083 $633.00INCISION OF EXTERNAL URINARY OPENING 53020 $2,029.00

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 ChargeINCISION OF EXTERNAL URINARY OPENING, INFANT 53025 $2,482.00INCISION OF FLUID CANALS OF INNER EAR WITH INFUSIO 69801 $4,233.00INCISION OF NASAL SINUS USING AN ENDOSCOPE 31256 $7,477.00INCISION OF PANCREATIC OUTLET MUSCLE USING AN ENDO 43262 $7,711.00INCISION OF PENILE FORESKIN 54001 $5,681.00INCISION OF TENDON TO REPAIR ELBOW JOINT, ACCESSED 24357 $8,510.00INCISION OF TISSUE CONNECTING TONGUE AND FLOOR OF 41010 $1,840.00INCISION OF VEIN FOR INSERTION OF NEEDLE OR CATHET 36425 $1,321.00INCISION OF VEIN FOR INSERTION OF NEEDLE/CATHETER 36420 $112.00INCISION OR REMOVAL OF NERVE TO TONGUE 64740 $4,960.00INCISION TO RELEASE TISSUE AND MUSCLE OF SOLE OF F 28250 $5,843.00INCISION, ASPIRATION, AND/OR INFLATION OF EARDRUM 69420 $1,026.00INCISION, STRETCHING, AND SUTURE OF FOREHEAD SKIN 15824 $5,571.00INCISION, STRETCHING, AND SUTURE OF SKIN 15828 $5,571.00INCISIONAL REMOVAL OF EYELASHES 67830 $2,748.00INCISIONS TO CORNEA TO CORRECT ASTIGMATISM 65772 $4,167.00INDIUM 111-PENTETREOTIDE 3-10 MCI/ML-MCG KIT 1 EAC A9572 $25,077.50INDIUM IN-111 OXYQUINOLINE 1 MCI/ML (37 MBQ/ML)(1 A9547 $12,362.60INDUCED ABORTION BY INSERTION OF VAGINAL SUPPOSITO 59855 $1,359.00INDUCTION OF ABNORMAL HEART RHYTHM BY SMALL ELECTR 93618 $3,409.00INFECTIOUS AGENT ANTIBODY QUANTITATIVE PNEUMO AB I 86317 $116.00INFECTIOUS AGENT DRUG SUSCEPTIBILITY ANALYSIS 87900 $1,010.00INFLUENZA A ANTIBODIES, RAPID 86710 $86.00INFRARED ANALYSIS OF STONE 82365 $100.00INFUSION DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE 96417 $361.00INFUSION FOR THERAPY OR PREVENTION, BENEATH THE SK 96371 $190.00INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR D 96366 $131.00INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR D 96365 $707.00INFUSION INTO TISSUE FOR THERAPY OR PREVENTION UP 96369 $707.00INFUSION INTO TISSUE FOR THERAPY OR PREVENTION, BE 96370 $145.00INFUSION INTO VEIN THERAPY PREVENTION/DIAGNOSIS AD 96367 $190.00INFUSION INTO VEIN THERAPY PREVENTION/DIAGNOSIS CO 96368 $65.00INFUSION OF CHEMICAL AGENT INTO THE ARTERY OF BRAI 61650 $2,379.00INFUSION OF CHEMICAL AGENT INTO THE ARTERY OF BRAI 61651 $3,476.00INFUSION OF CHEMOTHERAPY INTO A VEIN 96415 $190.00INFUSION OF CHEMOTHERAPY INTO A VEIN UP TO 1 HOUR 96413 $1,114.00INFUSION OF CHEMOTHERAPY INTO A VEIN USING PUSH TE 96409 $707.00INFUSION OF CHEMOTHERAPY INTO AN ARTERY UP TO 1 HO 96422 $1,114.00INFUSION OF CHEMOTHERAPY INTO ARTERY 96423 $149.00

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 ChargeINFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTAN 96411 $361.00INFUSION OF DRUG INTO VEIN TO DISSOLVE BLOOD CLOT 37195 $771.00INFUSION OF DRUG INTO VEIN TO DISSOLVE CORONARY BL 92977 $835.00INFUSION OF HEART ARTERY TO DISSOLVE BLOOD CLOT WI 92975 $1,348.00INFUSION PLASMA PROTEIN FRACTION (HUMAN) 5% 50ML P9043 $91.00INFUSION PLASMA PROTEIN FRACTION HUMAN 5% 250ML P9048 $211.00INFUSION/INSTILLATION OF RADIOELEMENT SOLUTION W/3 77750 $868.00INHALATION OF MEDICATIONS WITH ALLERGIC REACTION A 95070 $869.00INHALED PNEUMONIA TREATMENT 94642 $450.00INHIBIN A (REPRODUCTIVE ORGAN HORMONE) MEASUREMENT 86336 $120.00INITIATION & MANAGEMENT CONTINUED PRESSURED RESPIR 94660 $746.00INITIATION OF EXTERNAL VEIN TO ARTERY BLOOD CIRCUL 33947 $5,934.00INITIATION OF EXTERNAL VEIN TO VEIN BLOOD CIRCULAT 33946 $5,344.00INJECT BONE CEMENT INTO BODY OF LOWER SPINE BONE A 22514 $31,101.00INJECT BONE CEMENT INTO BODY OF MIDDLE OR LOWER SP 22512 $8,276.00INJECT BONE CEMENT INTO BODY OF MIDDLE OR LOWER SP 22515 $441.00INJECT BONE CEMENT INTO BODY OF MIDDLE SPINE BONE 22510 $12,800.00INJECT BONE CEMENT INTO BODY OF MIDDLE SPINE BONE 22511 $5,915.00INJECT BONE CEMENT INTO BODY OF MIDDLE SPINE BONE 22513 $31,101.00INJECT BY CONTINUOUS INFUSION ANESTHETIC AGENT BRA 64416 $2,087.00INJECT BY CONTINUOUS INFUSION OF ANESTHETIC AGENT 64449 $2,087.00INJECT CHEMICAL DESTRUCTION OF SALIVARY GLANDS ON 64611 $674.00INJECT CHEMICAL FOR DESTRUCTION NERVE MUSCLE ON AR 64644 $2,159.00INJECT CHEMICAL FOR DESTRUCTION NERVE MUSCLE ON AR 64645 $384.00INJECT CHEMICAL FOR DESTRUCTION OF FACIAL & NECK N 64615 $1,001.00INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64616 $984.00INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64642 $2,159.00INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64643 $330.00INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64646 $2,160.00INJECT CHEMICAL FOR DESTRUCTION OF NERVE MUSCLES O 64647 $2,160.00INJECT DIAGNOSTIC OR THERAPEUTIC SUBSTANCES OR MAR 43253 $7,006.00INJECT FOR X-RAY IMAGE OF HEART VESSEL GRAFTS DURI 93564 $195.00INJECT FOR X-RAY IMAGING HEART BLOOD VESSEL DEFECT 93563 $191.00INJECT OF BILE DUCT FOR X-RAY IMAGING PROCEDURE AC 47531 $11,645.00INJECT OF BILE DUCT FOR X-RAY IMAGING PROCEDURE AC 47532 $9,736.00INJECT OF DIFFERENT DRUG/SUBSTANCE INTO VEIN THERA 96375 $190.00INJECT OF DRUG/SUBSTANCE INTO VEIN THERAPY/DIAGNOS 96376 $190.00INJECT OF RADIOACTIVE CONTRAST MATERIAL IN VEIN FO 78808 $950.00INJECT PROCEDURE FOR X-RAY IMAGING OF BLADDER AND 51605 $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 ChargeINJECT PROCEDURE FOR X-RAY IMAGING OF KIDNEY AND U 50430 $2,346.00INJECT PROCEDURE FOR X-RAY IMAGING OF KIDNEY AND U 50431 $2,346.00INJECT PROCEDURE THROUGH THE BLADDER AND BLADDER C 51610 $169.00INJECTION BENEATH SKIN OR INTO MUSCLE FOR THERAPY 96372 $190.00INJECTION BY CONTINUOUS INFUSION OF ANESTHETIC AGE 64446 $2,087.00INJECTION BY CONTINUOUS INFUSION OF ANESTHETIC AGE 64448 $2,087.00INJECTION DRUG OR SUBSTANCE INTO A VEIN FOR THERAP 96374 $190.00INJECTION FOR REMOVAL OF BLOOD CLOT FROM EXTERNAL 36860 $2,451.00INJECTION FOR REPAIR OF ABNORMAL MUSCLE DRAINAGE T 20500 $332.00INJECTION FOR X-RAY IMAGING OF AORTA ABOVE HEART V 93567 $142.00INJECTION FOR X-RAY IMAGING OF BREAST DUCT 19030 $197.00INJECTION FOR X-RAY IMAGING OF HINGED JOINT OF UPP 21116 $137.00INJECTION FOR X-RAY IMAGING OF LEFT UPPER OR LOWER 93565 $148.00INJECTION FOR X-RAY IMAGING OF PULMONARY (LUNG) AR 93568 $127.00INJECTION FOR X-RAY IMAGING OF RIGHT UPPER OR LOWE 93566 $125.00INJECTION FOR X-RAY IMAGING PROCEDURE ON VEINS OF 36005 $128.00INJECTION FOR X-RAY STUDY OF PANCREAS DURING SURGE 48400 $385.00INJECTION INTO ARTERY FOR THERAPY, DIAGNOSIS, OR P 96373 $145.00INJECTION INTO CONJUNCTIVA 68200 $216.00INJECTION NON-COMPOUND SCLEROSANT MULTIPLE INCOMPE 36466 $6,273.00INJECTION NON-COMPOUNDED SCLEROSANT SINGLE INCOMPE 36465 $6,273.00INJECTION OF 1 CC OR LESS FILLING MATERIAL INTO TI 11950 $927.00INJECTION OF 1.1 TO 5.0 CC FILLING MATERIAL, BENEA 11951 $1,953.00INJECTION OF 5.1 TO 10.0 CC FILLING MATERIAL INTO 11954 $1,244.00INJECTION OF ABNORMAL FLUID ACCUMULATION 49185 $4,012.00INJECTION OF ABNORMAL MUSCLE DRAINAGE TRACT FOR X- 20501 $332.00INJECTION OF AGENT TO DESTROY ABDOMINAL SYMPATHETI 64680 $3,160.00INJECTION OF AGENT TO DESTROY RIB NERVE 64620 $3,160.00INJECTION OF AGENT TO DESTROY SACRAL NERVE BUNDLE 64681 $3,160.00INJECTION OF AIR OR LIQUID INTO EYE 66020 $5,041.00INJECTION OF AIR OR X-RAY CONTRAST MATERIAL INTO A 49400 $440.00INJECTION OF ALCOHOL INTO CAVITY BEHIND EYE 67505 $834.00INJECTION OF ALLERGENIC EXTRACTS INTO SKIN FOR IMM 95024 $120.00INJECTION OF ALLERGENIC EXTRACTS INTO SKIN WITH DE 95028 $120.00INJECTION OF ANESTHETIC AGENT NECK NERVE BUNDLE 64413 $2,174.00INJECTION OF ANESTHETIC AGENT OF MULTIPLE RIB NERV 64421 $2,087.00INJECTION OF ANESTHETIC AGENT UNDERARM (AXILLARY) 64417 $1,076.00INJECTION OF ANESTHETIC AGENT, ABDOMINAL SYMPATHET 64530 $2,525.00INJECTION OF ANESTHETIC AGENT, BRACHIAL (ARM) NERV 64415 $1,006.00

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 ChargeINJECTION OF ANESTHETIC AGENT, COLLAR BONE NERVE 64418 $2,174.00INJECTION OF ANESTHETIC AGENT, FACIAL NERVE 64402 $674.00INJECTION OF ANESTHETIC AGENT, GREATER OCCIPITAL N 64405 $1,076.00INJECTION OF ANESTHETIC AGENT, GROIN NERVES 64425 $1,302.00INJECTION OF ANESTHETIC AGENT, MIDDLE OR LOWER SPI 64520 $1,895.00INJECTION OF ANESTHETIC AGENT, OF RIB NERVE 64420 $1,076.00INJECTION OF ANESTHETIC AGENT, OTHER PERIPHERAL NE 64450 $1,076.00INJECTION OF ANESTHETIC AGENT, PUDENDAL (EXTERNAL 64430 $2,087.00INJECTION OF ANESTHETIC AGENT, SACRAL NERVE BUNDLE 64517 $2,087.00INJECTION OF ANESTHETIC AGENT, SCIATIC NERVE 64445 $1,775.00INJECTION OF ANESTHETIC AGENT, SYMPATHETIC NERVE B 64510 $2,525.00INJECTION OF ANESTHETIC AGENT, THIGH NERVE 64447 $931.00INJECTION OF ANESTHETIC AGENT, TRIGEMINAL NERVE 64400 $674.00INJECTION OF ANESTHETIC AGENT, TRIGEMINAL NERVE BU 64505 $816.00INJECTION OF BLADDER AND URINARY DUCT (URETER) FOR 50690 $182.00INJECTION OF BLOOD OR BLOOD CLOT INTO SPINAL CANAL 62273 $2,734.00INJECTION OF CARPAL TUNNEL 20526 $757.00INJECTION OF CHEMICAL AGENT INTO MULTIPLE VEINS OF 36471 $1,244.00INJECTION OF CHEMICAL FOR DESTRUCTION OF EYE MUSCL 67345 $875.00INJECTION OF CHEMICAL FOR DESTRUCTION OF NERVE MUS 64612 $1,001.00INJECTION OF CHEMOTHERAPY USING PUSH TECHNIQUE INT 96420 $361.00INJECTION OF CONTRAST FOR X-RAY IMAGING OF TEAR SA 68850 $1,215.00INJECTION OF CONTRAST THROUGH ABDOMINAL CAVITY CAT 49424 $100.00INJECTION OF DILATED ESOPHAGEAL VEINS USING AN END 43204 $5,710.00INJECTION OF DILATED VEINS OF STOMACH AND/OR ESOPH 43243 $2,783.00INJECTION OF DRUG INTO ERECTILE TISSUE AT SIDES AN 54220 $705.00INJECTION OF DRUG INTO EYE 67028 $1,035.00INJECTION OF DYE FOR X-RAY IMAGING AND/OR CT OF LO 62284 $344.00INJECTION OF DYE FOR X-RAY IMAGING OF ELBOW JOINT 24220 $217.00INJECTION OF DYE FOR X-RAY IMAGING OF HIP JOINT 27093 $225.00INJECTION OF DYE FOR X-RAY IMAGING OF SHOULDER JOI 23350 $130.00INJECTION OF DYE FOR X-RAY IMAGING OF SPINE DISC 62290 $563.00INJECTION OF DYE FOR X-RAY IMAGING OF SPINE DISC 62291 $542.00INJECTION OF DYE FOR X-RAY IMAGING OF WRIST JOINT 25246 $237.00INJECTION OF DYE FOR X-RAY OF SALIVARY GLANDS 42550 $164.00INJECTION OF ENZYME IN PALM TISSUE 20527 $979.00INJECTION OF HEMORRHOIDS 46500 $1,622.00INJECTION OF MEDICATION INTO CAVITY BEHIND EYE 67500 $646.00INJECTION OF MEDICATION INTO EYE 66030 $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 ChargeINJECTION OF MEDICATION OR SUBSTANCE INTO MEMBRANE 67515 $1,035.00INJECTION OF MORE THAN 7 SKIN GROWTHS 11901 $264.00INJECTION OF RADIOACTIVE DYE FOR X-RAY IDENTIFICAT 38792 $877.00INJECTION OF SEMEN INTO UTERUS 58322 $863.00INJECTION OF SPINAL CANAL TO DESTROY NERVE 62281 $3,824.00INJECTION OF SPINAL CANAL TO DESTROY NERVE 62282 $3,824.00INJECTION OF SUBSTANCE INTO SPINAL CANAL OF LOWER 62322 $2,159.00INJECTION OF SUBSTANCE INTO SPINAL CANAL OF LOWER 62323 $2,159.00INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER 62320 $2,159.00INJECTION OF SUBSTANCE INTO SPINAL CANAL TO DESTRO 62280 $2,525.00INJECTION OF SUBSTAND INTO SPINAL CANAL OF UPPER O 62321 $2,159.00INJECTION OF SYNTHETIC EYE FLUID 67025 $13,006.00INJECTION OF UP TO 7 SKIN GROWTHS 11900 $264.00INJECTION OF URINARY DUCT (URETER) FOR X-RAY IMAGI 50684 $346.00INJECTION OF VOCAL CORDS USING AN ENDOSCOPE 31570 $10,467.00INJECTION OR IMPLANT OF SYNTHETIC MATERIAL INTO BL 51715 $8,755.00INJECTION OR MECHANICAL REMOVAL OF SPINAL CANAL SC 62264 $3,824.00INJECTION PROCEDURE FOR X-RAY IMAGING OF HIP UNDER 27095 $332.00INJECTION PROCEDURE FOR X-RAY IMAGING OF PENILE ER 54230 $9,997.00INJECTION PROCEDURE FOR X-RAY IMAGING OF THE BLADD 51600 $115.00INJECTION PROCEDURE FOR X-RAY IMAGING OF THE LYMPH 38790 $269.00INJECTION PROCEDURE FOR X-RAY IMAGING OF THE SPLEE 38200 $462.00INJECTION PROCEDURE TO INDUCE ERECTION 54235 $563.00INJECTION SACROILIAC JOINT THERAPEUTIC AGENT 27096 $3,221.00INJECTION TO CAUSE BLOOD CLOT IN A DISEASED OR BUL 36002 $2,451.00INJECTIONS ESOPHAGUS, STOMACH, AND/OR UPPER SMALL 43236 $3,044.00INJECTIONS INTO ESOPHAGUS USING AN ENDOSCOPE 43201 $213.00INJECTIONS INTO LARGE BOWEL USING AN ENDOSCOPE 45335 $104.00INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO 64455 $674.00INJECTIONS OF LARGE BOWEL USING AN ENDOSCOPE 45381 $3,086.00INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT US 64493 $2,525.00INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT US 64494 $816.00INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT US 64495 $816.00INJECTIONS OF TENDON ATTACHMENT TO BONE 20551 $674.00INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE M 20550 $674.00INJECTIONS OF TRIGGER POINTS IN 1 OR 2 MUSCLES 20552 $674.00INJECTIONS OF TRIGGER POINTS IN 3 OR MORE MUSCLES 20553 $1,039.00INJECTIONS OF UPPER OR MIDDLE SPINE FACET JOINT US 64490 $2,525.00INJECTIONS OF UPPER OR MIDDLE SPINE FACET JOINT US 64491 $816.00

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 ChargeINJECTIONS OF UPPER OR MIDDLE SPINE FACET JOINT US 64492 $816.00INJECTIONS SACRUM FOR ENLARGEMENT 1 OR MORE NEEDLE 0200T $22,426.00INJECTS OF ANESTHETIC/STEROID DRUG INTO LOWER OR S 64483 $2,525.00INJECTS OF ANESTHETIC/STEROID DRUG INTO LOWER OR S 64484 $1,302.00INJECTS OF ANESTHETIC/STEROID DRUG INTO UPPER OR M 64479 $2,525.00INJECTS OF ANESTHETIC/STEROID DRUG INTO UPPER OR M 64480 $1,302.00INSERT ACETABULAR ADM MDM MOBILE BEARING HIP X3 H1 C1776 $4,582.50INSERT ACETABULAR ADM MDM MOBILE BEARING HIP X3 H6 C1776 $4,582.50INSERT ACETABULAR ADM MDM MOBILE BEARING HIP X3 H8 C1776 $4,582.50INSERT ACETABULAR ADM MDM MOBILE BEARING HIP X3 H9 C1776 $4,582.50INSERT ACETABULAR ADM MDM MOBILE BEARING HIP X3 OD C1776 $4,582.50INSERT ACETABULAR ADM MOBILE BEARING HIP RESTORATI C1776 $4,582.50INSERT ACETABULAR DURATION ADM X3 0 D H12.9 MM OD6 C1776 $4,582.50INSERT ACETABULAR MOBILE BEARING HIP X3 HIP ANATOM C1776 $4,582.50INSERT ACETABULAR RESTORATION ADM MOBILE BEARING H C1776 $4,582.50INSERT ACETABULAR TRIDENT ALL POLY COCR TITANIUM 0 C1776 $13,892.97INSERT ARTERIAL CATHETER FOR BLOOD SAMPLE OR INFUS 36620 $104.00INSERT ARTICULAR GENDER SOLUTIONS NATURAL-KNEE FLE C1776 $3,900.00INSERT ARTICULAR JOURNEY II XLPE 1-2 H9 MM LEFT BI C1776 $3,900.00INSERT ARTICULAR JOURNEY II XLPE 1-2 H9 MM RIGHT B C1776 $3,900.00INSERT ARTICULAR JOURNEY II XLPE 3-4 H12 MM RIGHT C1776 $3,900.00INSERT ARTICULAR JOURNEY II XLPE 5-6 H9 MM LEFT BI C1776 $3,900.00INSERT ARTICULAR JOURNEY II XLPE 5-6 H9 MM RIGHT B C1776 $3,900.00INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 1-2 C C1776 $9,750.00INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 3-4 E C1776 $9,750.00INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 5-6 G C1776 $9,750.00INSERT ARTICULAR MOST II B H17 MM KNEE ROTATING HI C1776 $15,054.00INSERT ARTICULAR MOST II B H23 MM KNEE ROTATING HI C1776 $15,054.00INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 1-2 C C1776 $10,400.00INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 3-4 C C1776 $9,750.00INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 5-6 E C1776 $9,750.00INSERT ARTICULAR NEXGEN ZIMALOY UHMWPE 1-6 B L58 M C1776 $11,537.50INSERT ARTICULAR NEXGEN ZIMALOY UHMWPE 2-6 C L64 M C1776 $11,537.50INSERT ARTICULAR NEXGEN ZIMALOY UHMWPE 3-6 D L70 M C1776 $10,562.50INSERT ARTICULAR NEXGEN ZIMALOY UHMWPE 4-6 E L74 M C1776 $11,537.50INSERT ARTICULAR NEXGEN ZIMALOY UHMWPE 5-6 F L77 M C1776 $11,537.50INSERT ARTICULAR PERSONA POLYETHYLENE 3-11 E-F H10 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-11 E-F H11 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-11 E-F H12 C1776 $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 ChargeINSERT ARTICULAR PERSONA POLYETHYLENE 3-11 E-F H13 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-11 E-F H14 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-5 C-D H10 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-5 C-D H12 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-5 C-D H13 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-5 C-D H18 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-7 C-D H10 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-7 C-D H11 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-7 C-D H12 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-7 C-D H14 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-7 C-D H16 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-7 C-D H18 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-9 C-D H10 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-9 CD H10 M C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-9 C-D H11 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-9 C-D H12 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-9 C-D H13 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-9 C-D H14 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 3-9 C-D H16 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 4-11 E-F H10 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 4-11 E-F H11 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 4-11 E-F H12 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 4-11 E-F H13 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 4-11 E-F H14 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 4-11 E-F H18 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 6-9 CD H11 M C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 7-12 G-H H10 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 7-12 G-H H11 C1776 $3,250.00INSERT ARTICULAR PERSONA POLYETHYLENE 7-12 G-H H12 C1776 $3,250.00INSERT ARTICULAR PERSONA VITAMIN E 6-9 EF H12 MM K C1776 $9,100.00INSERT ARTICULAR PERSONA VIVACIT-E 3-11 EF H10 MM C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 3-11 EF H11 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 3-11 EF H13 MM C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 3-7 CD H11 MM K C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 3-7 CD H18 MM K C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 3-9 CD H10 MM K C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 3-9 CD H11 MM K C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 3-9 CD H12 MM K C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 4-5 C-D H10 MM C1776 $3,900.00

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 ChargeINSERT ARTICULAR PERSONA VIVACIT-E 4-5 C-D H11 MM C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 4-5 CD H12 MM K C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 4-5 CD H16 MM K C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 6-7 C-D H10 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 6-7 C-D H11 MM C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 6-7 C-D H12 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 6-7 C-D H13 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 6-7 CD H14 MM K C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 6-7 CD H20 MM K C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 6-9 EF H10 MM K C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 7-12 GH H12 MM C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 7-12 GH H14 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 8-11 E-F H10 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 8-11 E-F H11 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 8-11 E-F H12 MM C1776 $3,900.00INSERT ARTICULAR PERSONA VIVACIT-E 8-11 EF H13 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 8-11 E-F H13 MM C1776 $5,850.00INSERT ARTICULAR PERSONA VIVACIT-E 8-9 C-D H12 MM C1776 $5,850.00INSERT BALLOON CATHETER FOR REMOVAL OF BLOOD CLOT 36861 $11,962.00INSERT BUMPER GMRS 3 D KNEE PROXIMAL MODULAR ROTAT C1776 $3,767.40INSERT CATHETER FOR RECORDING AND PACING RIGHT UPP 93619 $15,843.00INSERT CATHETER HEART CHAMBERS FOR EVALUATION OF C 93532 $12,805.00INSERT CATHETER HEART CHAMBERS FOR EVALUATION OF C 93533 $12,805.00INSERT CATHETER IN RIGHT HEART FOR X-RAY IMAGING O 93456 $12,805.00INSERT CATHETER INTO ARTERY ON ONE SIDE OF CHEST F 36225 $9,909.00INSERT CATHETER INTO ARTERY ON ONE SIDE OF NECK FO 36222 $7,977.00INSERT CATHETER INTO ARTERY ON ONE SIDE OF NECK FO 36223 $7,977.00INSERT CATHETER INTO ARTERY ON ONE SIDE OF NECK FO 36224 $13,046.00INSERT CATHETER INTO ARTERY ON ONE SIDE OF NECK FO 36227 $283.00INSERT CATHETER INTO ARTERY ON ONE SIDE OF NECK OR 36228 $774.00INSERT CATHETER INTO HEART CHAMBERS FOR EVAL OF CO 93531 $12,805.00INSERT CATHETER INTO RIGHT UPPER HEART CHAMBER AND 93503 $5,590.00INSERT CATHETER LEFT HEART IMAGING BLOOD VESSELS/G 93458 $12,805.00INSERT CATHETER LEFT HEART IMAGING BLOOD VESSELS/G 93459 $12,805.00INSERT CATHETER RIGHT & LEFT HEART IMAG BLOOD VESS 93460 $12,805.00INSERT CATHETER RIGHT & LEFT HEART IMAG BLOOD VESS 93461 $10,884.00INSERT CATHETER RIGHT UPPER HEART CHAMBER EVALUATI 93530 $12,805.00INSERT CATHETERS ASSESS HEART PACING REC OR ATTEMP 93624 $18,956.00INSERT CATHETERS FOR RECORD PACE & ATTEMPTED INDUC 93620 $14,218.00

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 ChargeINSERT CATHETERS FOR RECORD PACE & ATTEMPTED INDUC 93621 $396.00INSERT CATHETERS FOR RECORDING PACE & ATTEMPTED IN 93622 $586.00INSERT CATHETERS INTO MAIN & ACCESSORY ARTERIES OF 36252 $9,909.00INSERT CATHETERS INTO MAIN & ACCESSORY ARTERIES OF 36254 $9,909.00INSERT CATHETERS INTO MAIN AND ACCESSORY ARTERIES 36251 $9,909.00INSERT CATHETERS INTO MAIN AND ACCESSORY ARTERIES 36253 $7,977.00INSERT CENTRAL VENOUS CATHETER & IMPLANTED DEVICE 36561 $8,333.00INSERT CENTRAL VENOUS CATHETER & IMPLANTED DEVICE 36563 $9,945.00INSERT CENTRAL VENOUS CATHETER & IMPLANTED DEVICE 36566 $9,945.00INSERT CENTRAL VENOUS CATHETER & IMPLANTED DEVICE 36560 $9,945.00INSERT CENTRAL VENOUS CATHETER FOR INFUSION W/PORT 36571 $7,830.00INSERT CENTRAL VENOUS CATHETER FOR INFUSION W/PORT 36570 $7,830.00INSERT DEVICE INTO ABDOMEN WITH MEASUREMENT OF PRE 51797 $563.00INSERT ELECTRONIC DEVICE INTO BLADDER W/MEASUREMEN 51726 $857.00INSERT ELECTRONIC DEVICE INTO BLADDER W/VOID & BLA 51729 $857.00INSERT ELECTRONIC DEVICE INTO BLADDER WITH BLADDER 51727 $2,263.00INSERT GUIDE WIRE THROUGH KIDNEY INTO URINARY DUCT 52334 $6,860.00INSERT HARDWARE TO BROKEN FOOT BONE W/MANIPULATION 28476 $10,581.00INSERT HARDWARE TO TOE JOINT DISLOCATION W/MANIPUL 28666 $7,042.00INSERT HUMERAL REUNION X3 STANDARD H4 MM OD36 MM S C1776 $7,442.50INSERT HUMERAL REUNION X3 THK6 MM STANDARD OD36 MM C1776 $7,442.50INSERT HUMERAL TRABECULAR METAL 2 TAPER SHOULDER R C1776 $3,250.00INSERT HUMERAL UNIVERS REVERS +3 MM SMALL OD36 MM C1776 $6,597.50INSERT HUMERAL UNIVERS REVERS +6 MM MEDIUM OD39 MM C1776 $6,597.50INSERT HUMERAL X3 STANDARD H6 MM OD32 MM SHOULDER C1776 $7,442.50INSERT INTRAVASCULAR STENTS IN ARTERY OPEN OR ACCE 37236 $42,042.00INSERT INTRAVASCULAR STENTS IN ARTERY OPEN OR ACCE 37237 $1,181.00INSERT INTRAVASCULAR STENTS IN VEIN OPEN OR ACCESS 37238 $42,042.00INSERT INTRAVASCULAR STENTS IN VEIN OPEN OR ACCESS 37239 $825.00INSERT LARGE BOWEL TUBE 49442 $5,709.00INSERT LEFT HEART ELECTRODE W/ATTACHMENT PACEMKR/P 33224 $38,991.00INSERT NEEDLES & SKIN ELECTRODES FOR MEASUREMENT & 95938 $889.00INSERT NEW/REPLACEMENT PERMANENT PACEMKR W/UPPER & 33208 $38,991.00INSERT PROBE ESOPHAGUS CONTINUOUS HEART US MONIT & 93318 $2,700.00INSERT PROBE IN ESOPHAGUS FOR CONGENITAL HEART ULT 93315 $2,244.00INSERT PROBE IN ESOPHAGUS FOR HEART ULTRASOUND EXA 93312 $2,377.00INSERT PROBE INTO ESOPHAGUS FOR RECORD & PACE UPPE 93616 $1,740.00INSERT PROBE INTO ESOPHAGUS FOR RECORD OF ELECTRIC 93615 $331.00INSERT SCREW HOLE LISS TITANIUM L5 MM FEMORAL C1713 $676.16

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 ChargeINSERT SOCKET ALTIVATE REVERSE E-PLUS NEUTRAL OD32 C1776 $4,550.00INSERT SOCKET DJO SURGICAL ALTIVATE REVERSE E-PLUS C1776 $5,200.00INSERT SOCKET RSP DJO SURGICAL HXE+ +4 MM HUMERAL C1776 $5,200.00INSERT SOCKET RSP DJO SURGICAL HXE+ HUMERAL SEMICO C1776 $5,200.00INSERT SOCKET RSP DJO SURGICAL HXE+ STANDARD HUMER C1776 $5,200.00INSERT STENT & BLOOD CLOT PROTECTION DEVICE IN NEC 37215 $4,086.00INSERT STENT REMOVAL OF PLAQUE AND/OR BALLOON DILA 92937 $25,101.00INSERT STENT REMOVAL OF PLAQUE AND/OR BALLOON DILA 92938 $24,681.00INSERT STENT REMOVAL OF PLAQUE AND/OR BALLOON DILA 92943 $25,101.00INSERT STENT REMOVAL OF PLAQUE AND/OR BALLOON DILA 92944 $23,612.00INSERT STENT REMOVAL PLAQUE/BALLOON DIL CORONARY V 92941 $25,101.00INSERT STENTS IN ARTERY IN ONE SIDE OF GROIN ENDOV 37221 $38,643.00INSERT STENTS INTO ARTERIES IN ONE LEG ENDOVASCULA 37226 $38,643.00INSERT STENTS INTO GROIN ARTERY ENDOVASCULAR 37223 $14,458.00INSERT STOMACH TUBE (ACCESSED THROUGH THE SKIN) US 49440 $4,627.00INSERT TIBIAL 1 H11 MM KNEE CRUCIATE RETAINING C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 3 H20 MM KNEE POSTERIOR S C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 3 H5 MM KNEE CRUCIATE RET C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 4 H5 MM KNEE CRUCIATE RET C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 4 H6 MM KNEE CRUCIATE RET C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 5 H5 MM KNEE CRUCIATE RET C1776 $4,800.00INSERT TIBIAL ATTUNE AOX 5 H6 MM KNEE CRUCIATE RET C1776 $4,800.00INSERT TIBIAL ATTUNE AOX 5 H7 MM KNEE CRUCIATE RET C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 5 H8 MM KNEE FIX BEARING C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 6 H10 MM KNEE CRUCIATE RE C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 6 H14 MM KNEE FIX BEARING C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 6 H5 MM KNEE CRUCIATE RET C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 6 H6 MM KNEE CRUCIATE RET C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 6 H6 MM KNEE POSTERIOR ST C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 6 H7 MM KNEE FIX BEARING C1776 $4,800.00INSERT TIBIAL ATTUNE AOX 7 H10 MM KNEE CRUCIATE RE C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 7 H5 MM KNEE CRUCIATE RET C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 7 H6 MM KNEE CRUCIATE RET C1776 $3,900.00INSERT TIBIAL ATTUNE AOX 8 H5 MM KNEE CRUCIATE RET C1776 $4,800.00INSERT TIBIAL ATTUNE AOX 8 H6 MM KNEE CRUCIATE RET C1776 $4,800.00INSERT TIBIAL ATTUNE AOX 8 H8 MM KNEE FIX BEARING C1776 $3,900.00INSERT TIBIAL COLUMBUS T0/0+ H10 MM KNEE HIGH CONS C1776 $7,800.00INSERT TIBIAL COLUMBUS T1/1+ H12 MM KNEE HIGH CONS C1776 $7,800.00INSERT TIBIAL COLUMBUS T2/2+ H12 MM KNEE HIGH CONS 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 ChargeINSERT TIBIAL COLUMBUS T2/2+ H16 MM KNEE HIGH CONS C1776 $7,800.00INSERT TIBIAL COLUMBUS T2/T2+ H10 MM KNEE ULTRACON C1776 $3,900.00INSERT TIBIAL COLUMBUS T2/T2+ H12 MM KNEE ULTRACON C1776 $3,900.00INSERT TIBIAL COLUMBUS T2/T2+ H14 MM KNEE ULTRACON C1776 $3,900.00INSERT TIBIAL GMK 2 H10 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H10 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H11 MM KNEE RIGHT SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H11 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H12 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H12 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H14 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 2 H14 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H14 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H17 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 2 H17 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 2 H23 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 3 H10 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 3 H10 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 3 H10 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 3 H11 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 3 H12 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 3 H12 MM LEFT SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 3 H12 MM RIGHT SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 3 H13 MM KNEE LEFT FIX SPHERE FL C1776 $3,900.00INSERT TIBIAL GMK 3 H14 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 3 H14 MM LEFT SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 3 H14 MM RIGHT SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 3 H17 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 3 H17 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 3 H20 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 3 H26 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 4 H10 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 4 H10 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H10 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H11 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H11 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H12 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 4 H12 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H12 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00

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 ChargeINSERT TIBIAL GMK 4 H13 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H13 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H14 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 4 H14 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H14 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H17 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 4 H17 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 4 H17 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H10 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 5 H10 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H10 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H11 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H11 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H12 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H12 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H14 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H14 MM RIGHT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 5 H17 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 5 H23 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 5 H26 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK 6 H11 MM LEFT FIXED SPHERE FLEX C1776 $3,900.00INSERT TIBIAL GMK 6 H23 MM KNEE FIXED REVISION SEM C1776 $7,800.00INSERT TIBIAL GMK HINGE 2 H14 MM FIXED BEARING NON C1776 $11,736.73INSERT TIBIAL GMK HINGE 2 H17 MM FIXED BEARING NON C1776 $11,736.70INSERT TIBIAL GMK HINGE 3 H12 MM FIXED BEARING NON C1776 $11,736.73INSERT TIBIAL GMK HINGE 4 H14 MM FIXED BEARING NON C1776 $11,736.73INSERT TIBIAL GMK HINGE 4 H17 MM FIXED BEARING NON C1776 $11,736.73INSERT TIBIAL GMK HINGE 5 H17 MM FIXED BEARING NON C1776 $11,736.73INSERT TIBIAL GMK SPHERE C1776 $650.00INSERT TIBIAL GMK SPHERE 5 RIGHT SET C1776 $650.00INSERT TIBIAL GMK THK11 MM 1 SPHERE RIGHT FLEXIBLE C1776 $3,900.00INSERT TIBIAL GMK THK13 MM 2 SPHERE LEFT FLEXIBLE C1776 $3,900.00INSERT TIBIAL GMRS THK20 MM S1 S2 PROXIMAL MODULAR C1776 $7,004.40INSERT TIBIAL LEGION XLPE 3-4 H11 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL LEGION XLPE 3-4 H9 MM KNEE DISHED C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 1 H15 MM KNEE POSTERIO C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 2 H13 MM KNEE POSTERIO C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 2 H15 MM KNEE POSTERIO C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 2.5 H11 MM KNEE POSTER C1776 $3,900.00

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 ChargeINSERT TIBIAL LOGIC HI-FLEX 2.5 H13 MM KNEE POSTER C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 2.5 H15 MM KNEE POSTER C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 2.5 H9 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 3 H11 MM KNEE POSTERIO C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 3 POSTERIOR STABILIZE C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 3.5 H11 MM KNEE POSTER C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 3.5 H13 MM KNEE POSTER C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 3.5 H15 MM KNEE POSTER C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 3.5 H9 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 4 H15 MM KNEE POSTERIO C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 4 POSTERIOR STABILIZE C1776 $3,900.00INSERT TIBIAL LOGIC HI-FLEX 5 POSTERIOR STABILIZE C1776 $3,900.00INSERT TIBIAL MOTO 2 H8 MM KNEE LEFT MEDIAL FIX ST C1776 $3,900.00INSERT TIBIAL MOTO 2 H8 MM KNEE RIGHT MEDIAL FIX S C1776 $3,900.00INSERT TIBIAL MOTO 5 H8 MM KNEE RIGHT MEDIAL FIX S C1776 $3,900.00INSERT TIBIAL NEXGEN UHMWPE 3 L66 MM X W42 MM X H1 C1776 $5,850.00INSERT TIBIAL NEXGEN UHMWPE 4 L66 MM X W46 MM X H1 C1776 $5,850.00INSERT TIBIAL NEXGEN UHMWPE 5 L74 MM X W46 MM X H1 C1776 $5,850.00INSERT TIBIAL NEXGEN UHMWPE 7 L82 MM X W51 MM X H1 C1776 $5,850.00INSERT TIBIAL OPTETRACK 2 H11 MM KNEE POSTERIOR ST C1776 $3,900.00INSERT TIBIAL OPTETRAK 2 H11 MM KNEE CRUCIATE RETA C1776 $3,900.00INSERT TIBIAL OPTETRAK 2 H13 MM KNEE CRUCIATE RETA C1776 $3,900.00INSERT TIBIAL OPTETRAK 3 H11 MM KNEE CRUCIATE RETA C1776 $3,900.00INSERT TIBIAL OPTETRAK 3 H11 MM KNEE POSTERIOR STA C1776 $3,900.00INSERT TIBIAL OPTETRAK 4 H11 MM KNEE CRUCIATE RETA C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 0 NEUTRAL H11 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 0 NEUTRAL H13 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 0 NEUTRAL H15 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 0 NEUTRAL H9 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1 H11 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1 H13 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1 H15 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1 H9 MM KNEE POSTERIO C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1 NEUTRAL H11 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1 NEUTRAL H13 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1 NEUTRAL H15 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1 NEUTRAL H9 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1.5 NEUTRAL H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 1.5 NEUTRAL H13 MM KN C1776 $3,900.00

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 ChargeINSERT TIBIAL OPTETRAK LOGIC 1.5 NEUTRAL H15 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2 H11 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2 H13 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2 H15 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2 H9 MM KNEE POSTERIO C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2 NEUTRAL H11 IN KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2 NEUTRAL H13 IN KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2 NEUTRAL H9 IN KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2.5 H11 MM KNEE POSTE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2.5 H13 MM KNEE POSTE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2.5 H9 MM KNEE POSTER C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2.5 NEUTRAL H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2.5 NEUTRAL H15 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 2.5 NEUTRAL H9 MM KNE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3 H11 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3 H13 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3 H15 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3 H17 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3 NEUTRAL H11 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3 NEUTRAL H13 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3 NEUTRAL H15 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3 NEUTRAL H9 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3.5 H11 MM KNEE POSTE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3.5 H13 MM KNEE POSTE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3.5 H9 MM KNEE POSTER C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3.5 NEUTRAL H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3.5 NEUTRAL H13 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3.5 NEUTRAL H15 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 3.5 NEUTRAL H9 MM KNE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 4 H11 MM POSTERIOR ST C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 4 H13 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 4 H15 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 4 H9 MM KNEE POSTERIO C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 4 NEUTRAL H11 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 4 NEUTRAL H15 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 5 H11 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 5 H13 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 5 H15 MM KNEE POSTERI C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 5 H9 MM KNEE POSTERIO C1776 $3,900.00

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 ChargeINSERT TIBIAL OPTETRAK LOGIC 5 NEUTRAL H13 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 5 NEUTRAL H9 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 6 NEUTRAL H11 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 6 NEUTRAL H13 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC 6 NEUTRAL H15 MM KNEE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 0 H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 0 H13 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 0 H9 MM KNE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 1 H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 1 H13 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 1 H9 MM KNE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 1.5 H11 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 1.5 H13 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 1.5 H9 MM K C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 2 H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 2 H13 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 2 H9 MM KNE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 2.5 H11 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 2.5 H13 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 2.5 H9 MM K C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 3 H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 3 H13 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 3 H9 MM KNE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 3.5 H11 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 3.5 H13 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 3.5 H9 MM K C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 4 H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 4 H13 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 4 H9 MM KNE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 5 H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 5 H13 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 5 H9 MM KNE C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 6 H11 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE+ 6 H13 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 0 H11 MM K C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 0 H13 MM K C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 0 H9 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 1 H9 MM KN C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 1.5 H11 MM C1776 $3,900.00

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 ChargeINSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 1.5 H13 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 1.5 H9 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 2.5 H11 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 2.5 H13 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 2.5 H9 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 3 H11 MM K C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 3.5 H11 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 3.5 H13 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 3.5 H9 MM C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 4 H13 MM K C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 6 H11 MM K C1776 $3,900.00INSERT TIBIAL OPTETRAK LOGIC CR SLOPE++ 6 H13 MM K C1776 $3,900.00INSERT TIBIAL PERSONA POLYETHYLENE 3-9 C-D H11 MM C1776 $3,250.00INSERT TIBIAL PERSONA VIVACIT-E 6-9 CD H12 MM KNEE C1776 $9,100.00INSERT TIBIAL PERSONA VIVACIT-E H10 MM STERILE C1776 $5,850.00INSERT TIBIAL PFC SIGMA GVF 2.5 H15 MM KNEE ROTATE C1776 $3,900.00INSERT TIBIAL PFC SIGMA GVF UHMWPE 2 H17.5 MM KNEE C1776 $3,900.00INSERT TIBIAL PFC SIGMA GVF UHMWPE 4 H15 MM KNEE R C1776 $3,900.00INSERT TIBIAL PFC SIGMA TC3 UHMWPE 1.5 H22.5 MM KN C1776 $8,775.00INSERT TIBIAL PFC SIGMA TC3 UHMWPE 2 H12.5 MM KNEE C1776 $8,775.00INSERT TIBIAL PFC SIGMA TC3 UHMWPE 2.5 H17.5 MM KN C1776 $8,775.00INSERT TIBIAL PFC SIGMA UHMWPE 2 H10 MM KNEE FIX B C1776 $4,550.00INSERT TIBIAL PFC SIGMA UHMWPE 2.5 H17.5 MM KNEE F C1776 $4,550.00INSERT TIBIAL PFC SIGMA XLK 1.5 H8 MM KNEE FIX BEA C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 2 CURVE H12.5 MM KNEE C1776 $5,600.00INSERT TIBIAL PFC SIGMA XLK 2 H10 MM KNEE FIX BEAR C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 2 H12.5 MM KNEE FIX BE C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 2 H8 MM KNEE FIX BEARI C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 2.5 CURVE H12.5 MM KNE C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 2.5 CURVE H8 MM KNEE F C1776 $4,550.00INSERT TIBIAL PFC SIGMA XLK 2.5 H10 MM KNEE FIX BE C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 2.5 H12.5 MM KNEE FIX C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 2.5 H8 MM KNEE FIX BEA C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 3 CURVE H10 MM KNEE FI C1776 $5,600.00INSERT TIBIAL PFC SIGMA XLK 3 CURVE H8 MM KNEE FIX C1776 $5,600.00INSERT TIBIAL PFC SIGMA XLK 3 H10 MM KNEE FIX BEAR C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 3 H8 MM KNEE FIX BEARI C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 4 CURVE H10 MM KNEE FI C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 4 CURVE H8 MM KNEE FIX C1776 $5,600.00

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 ChargeINSERT TIBIAL PFC SIGMA XLK 4 H10 MM KNEE FIX BEAR C1776 $3,900.00INSERT TIBIAL PFC SIGMA XLK 4 H8 MM KNEE FIX BEARI C1776 $3,900.00INSERT TIBIAL POLYETHYLENE B KNEE SEGMENTAL C1776 $2,069.93INSERT TIBIAL SIGMA AOX 2.5 H12.5 MM KNEE ROTATE P C1776 $3,900.00INSERT TIBIAL SIGMA AOX 4 H10 MM KNEE ROTATE PLATF C1776 $3,900.00INSERT TIBIAL SIGMA TC3 GVF UHMWPE 2 H15 MM KNEE R C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 2 H17.5 MM KNEE C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 2.5 H10 MM KNEE C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 2.5 H12.5 MM KN C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 2.5 H17.5 MM KN C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 3 H12.5 MM KNEE C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 3 H17.5 MM KNEE C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 3 H22.5 MM KNEE C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 4 H15 MM KNEE R C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 4 H17.5 MM KNEE C1776 $10,848.50INSERT TIBIAL SIGMA TC3 GVF UHMWPE 4 H20 MM KNEE R C1776 $10,848.50INSERT TIBIAL SIGMA XLK 2 CURVE PLUS H10 MM KNEE F C1776 $3,900.00INSERT TIBIAL SIGMA XLK 2 CURVE PLUS H12.5 MM KNEE C1776 $3,900.00INSERT TIBIAL SIGMA XLK 2 CURVE PLUS H20 MM KNEE F C1776 $3,900.00INSERT TIBIAL SIGMA XLK 2 CURVE PLUS H8 MM KNEE FI C1776 $3,900.00INSERT TIBIAL SIGMA XLK 2.5 CURVE PLUS H10 MM KNEE C1776 $3,900.00INSERT TIBIAL SIGMA XLK 2.5 CURVE PLUS H12.5 MM KN C1776 $3,900.00INSERT TIBIAL SIGMA XLK 2.5 CURVE PLUS H15 MM KNEE C1776 $3,900.00INSERT TIBIAL SIGMA XLK 2.5 CURVE PLUS H8 MM KNEE C1776 $3,900.00INSERT TIBIAL SIGMA XLK 3 CURVE PLUS H10 MM KNEE F C1776 $3,900.00INSERT TIBIAL SIGMA XLK 3 CURVE PLUS H12.5 MM KNEE C1776 $3,900.00INSERT TIBIAL SIGMA XLK 3 CURVE PLUS H15 MM KNEE F C1776 $3,900.00INSERT TIBIAL SIGMA XLK 3 CURVE PLUS H8 MM KNEE FI C1776 $3,900.00INSERT TIBIAL SIGMA XLK 4 CURVE PLUS H10 MM KNEE F C1776 $3,900.00INSERT TIBIAL SIGMA XLK 4 CURVE PLUS H12.5 MM KNEE C1776 $3,900.00INSERT TIBIAL SIGMA XLK 4 CURVE PLUS H8 MM KNEE C1776 $3,900.00INSERT TIBIAL SIGMA XLK 5 CURVE PLUS H8 MM KNEE FI C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 1 H11 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 1 H9 MM KNEE CONDYLAR S C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 2 H11 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 2 H13 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 2 H16 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 2 H16 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 2 H31 MM KNEE TOTAL STA C1776 $10,969.14

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 ChargeINSERT TIBIAL TRIATHLON X3 2 H9 MM KNEE CRUCIATE R C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 2 H9 MM KNEE CRUCIATE S C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 2 H9 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H11 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H11 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H11 MM KNEE TOTAL STA C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 3 H13 MM KNEE CONDYLAR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H13 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H13 MM KNEE TOTAL STA C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 3 H16 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H19 MM KNEE CONDYLAR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H19 MM KNEE TOTAL STA C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 3 H25 MM KNEE TOTAL STA C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 3 H28 MM KNEE TOTAL STA C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 3 H31 MM KNEE TOTAL STA C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 3 H9 MM KNEE CONDYLAR S C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H9 MM KNEE CRUCIATE R C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H9 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 3 H9 MM KNEE TOTAL STAB C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 4 H11 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 4 H11 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 4 H11 MM KNEE TOTAL STA C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 4 H13 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 4 H13 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 4 H16 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 4 H9 MM KNEE CRUCIATE S C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 4 H9 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 4 H9 MM KNEE TOTAL STAB C1776 $10,969.14INSERT TIBIAL TRIATHLON X3 5 H11 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 5 H11 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 5 H13 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 5 H16 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 5 H19 MM CRUCIATE SUBST C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 5 H9 MM KNEE CRUCIATE R C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 5 H9 MM KNEE CRUCIATE S C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 5 H9 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 6 H11 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 6 H13 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 6 H16 MM KNEE CRUCIATE C1776 $3,900.00

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 ChargeINSERT TIBIAL TRIATHLON X3 6 H9 MM KNEE CRUCIATE S C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 7 H11 MM KNEE CRUCIATE C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 7 H11 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 7 H13 MM KNEE POSTERIOR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 7 H9 MM KNEE CRUCIATE R C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 7 H9 MM KNEE CRUCIATE S C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 8 H11 MM KNEE CONDYLAR C1776 $3,900.00INSERT TIBIAL TRIATHLON X3 8 H9 MM KNEE CONDYLAR S C1776 $3,900.00INSERTION ABDOMINAL CAVITY CATHETER FOR DRAINAGE O 49421 $10,085.00INSERTION AND REMOVAL OF WIRE OR PIN WITH BONE TRA 20650 $8,510.00INSERTION CATHETER FOR RECORDING TO IDENTIFY ORIGI 93609 $333.00INSERTION CATHETERS FOR 3D MAPPING OF ELECTRICAL I 93613 $1,324.00INSERTION CENTRAL VENOUS CATHETER FOR INFUSION PAT 36555 $2,900.00INSERTION CENTRAL VENOUS CATHETER FOR INFUSION PAT 36557 $7,830.00INSERTION CENTRAL VENOUS CATHETER FOR INFUSION PAT 36568 $2,900.00INSERTION CENTRAL VENOUS CATHETERS FOR INFUSION TW 36565 $8,977.00INSERTION ELECTRODE FOR PERMANENT PACEMAKER OR PAC 33216 $15,718.00INSERTION ELECTRODES FOR PERMANENT PACEMAKER OR PA 33217 $16,812.00INSERTION HARDWARE TO BROKEN FINGER OR THUMB W/MAN 26727 $493.00INSERTION HARDWARE TO BROKEN THUMB W/MANIPULATION 26650 $7,042.00INSERTION HARDWARE TO DISLOCATED FINGER JOINT W/MA 26776 $7,040.00INSERTION INTO WINDPIPE OF NEEDLE WIRE DILATOR STE 31730 $5,295.00INSERTION NEEDLE INTO UPPER LEG OR NECK VEIN, PATI 36400 $52.00INSERTION OF ABDOMINAL CATHETER THROUGH THE SKIN U 49418 $10,085.00INSERTION OF ARTERIAL CATHETER FOR BLOOD SAMPLING 36625 $13,717.00INSERTION OF ASSISTIVE HEART BLOOD FLOW DEVICE INT 33967 $830.00INSERTION OF CATHETER (ACCESSED THROUGH THE SKIN) 47490 $7,288.00INSERTION OF CATHETER FOR DIAGNOSTIC EVALUATION OF 93451 $14,537.00INSERTION OF CATHETER FOR IMAGING OF HEART BLOOD V 93454 $12,805.00INSERTION OF CATHETER FOR IMAGING OF HEART BLOOD V 93455 $12,486.00INSERTION OF CATHETER FOR RECORDING OF RIGHT LOWER 93603 $3,409.00INSERTION OF CATHETER FOR RECORDING UPPER HEART RH 93600 $3,409.00INSERTION OF CATHETER FOR RECORDING UPPER HEART RH 93602 $21,258.00INSERTION OF CATHETER FOR SUCTION OF SECRETIONS 31720 $332.00INSERTION OF CATHETER IN RIGHT HEART FOR IMAGING O 93457 $10,884.00INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG 36245 $918.00INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG 36246 $869.00INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG 36247 $1,262.00INSERTION OF CATHETER INTO AN ARTERY IN NAVEL, NEW 36660 $351.00

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 ChargeINSERTION OF CATHETER INTO AN ARTERY OF A LOBE OF 36015 $559.00INSERTION OF CATHETER INTO AORTA 36200 $554.00INSERTION OF CATHETER INTO ARTERY FOR DRUG INFUSIO 37211 $17,060.00INSERTION OF CATHETER INTO ARTERY/VEIN FOR DRUG IN 37213 $6,304.00INSERTION OF CATHETER INTO CHEST AORTA FOR DIAGNOS 36221 $8,424.00INSERTION OF CATHETER INTO CHEST ARTERY FOR DIAGNO 36226 $13,046.00INSERTION OF CATHETER INTO CHEST OR ARM ARTERY 36215 $781.00INSERTION OF CATHETER INTO CHEST OR ARM ARTERY 36216 $889.00INSERTION OF CATHETER INTO CHEST OR ARM ARTERY 36217 $1,333.00INSERTION OF CATHETER INTO CHEST OR ARM ARTERY 36218 $192.00INSERTION OF CATHETER INTO EACH ADDITIONAL ABDOMIN 36248 $164.00INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSI 93452 $10,884.00INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSI 93462 $12,248.00INSERTION OF CATHETER INTO LEFT OR RIGHT PULMONARY 36014 $482.00INSERTION OF CATHETER INTO PORTAL VEIN OF LIVER, A 36481 $929.00INSERTION OF CATHETER INTO RIGHT AND LEFT HEART FO 93453 $12,805.00INSERTION OF CATHETER INTO RIGHT HEART OR MAIN PUL 36013 $425.00INSERTION OF CATHETER INTO URINARY DUCT (URETER) U 52005 $5,572.00INSERTION OF CATHETER INTO VEIN 36011 $526.00INSERTION OF CATHETER INTO VEIN 36012 $461.00INSERTION OF CATHETER INTO VEIN FOR DRUG INFUSION 37212 $9,971.00INSERTION OF CATHETER INTO VEIN OF NAVEL, NEWBORN 36510 $201.00INSERTION OF CATHETER INTO VEIN WITH COLLECTION OF 36500 $466.00INSERTION OF CATHETER OR TUBE IN ESOPHAGUS STOMACH 43241 $2,783.00INSERTION OF CATHETER THROUGH THE CERVIX INTO FALL 58345 $6,493.00INSERTION OF CATHETERS FOR CREATION OF COMPLETE HE 93650 $15,843.00INSERTION OF CATHETERS FOR TREATMENT OF ABNORMAL H 93655 $1,420.00INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, 36556 $3,932.00INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, 36558 $9,971.00INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, 36569 $2,900.00INSERTION OF DEFIBRILLATOR ELECTRODE 33271 $32,196.00INSERTION OF DEVICE INTO BLADDER TO MEASURE PRESSU 51725 $857.00INSERTION OF DRUG AGENT OR PACKING TO CONTROL VAGI 57180 $438.00INSERTION OF DRUG DELIVERY IMPLANT INTO TISSUE 11981 $183.00INSERTION OF ELECTRONIC DEVICE INTO BLADDER WITH V 51728 $857.00INSERTION OF EXTERNAL DRAINS FROM GALLBLADDER, BIL 48000 $8,940.00INSERTION OF EXTERNAL TUBE FROM ARTERY TO VEIN FOR 36810 $11,962.00INSERTION OF EXTERNAL TUBE FROM VEIN TO VEIN FOR D 36800 $11,962.00INSERTION OF FEEDING TUBE (ACCESSED BENEATH THE SK 44372 $4,088.00

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 ChargeINSERTION OF FEEDING TUBE OR CATHETER INTO UPPER S 44015 $618.00INSERTION OF GUIDE WIRE FOR DILATION OF ESOPHAGUS 43226 $4,137.00INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS 43248 $2,783.00INSERTION OF HARDWARE TO BROKEN FINGER OR THUMB, A 26756 $7,042.00INSERTION OF HARDWARE TO BROKEN FINGER, ACCESSED T 26608 $7,042.00INSERTION OF HORMONE PELLETS BENEATH THE SKIN 11980 $1,949.00INSERTION OF IMPLANT OUTSIDE EYE MUSCLES 67550 $10,450.00INSERTION OF IMPLANT TO CLOSE NASAL PASSAGE 30220 $4,233.00INSERTION OF IMPLANTS TO BLOCK BOTH FALLOPIAN TUBE 58565 $12,564.00INSERTION OF INDWELLING BLADDER CATHETER 51702 $192.00INSERTION OF INDWELLING BLADDER CATHETER 51703 $332.00INSERTION OF INDWELLING CATHETER ADMIN OF SUBSTANC 62324 $2,720.00INSERTION OF INDWELLING CATHETER ADMIN OF SUBSTANC 62326 $2,720.00INSERTION OF LEFT HEART ELECTRODE FOR PACING DEFIB 33225 $43,523.00INSERTION OF LENS PROSTHESIS 66985 $7,724.00INSERTION OF NASAL OR ORAL STOMACH TUBE USING FLUO 43752 $510.00INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS 36901 $2,912.00INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS 36902 $20,541.00INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS 36903 $41,516.00INSERTION OF NEEDLE FOR INFUSION INTO BONE 36680 $629.00INSERTION OF NEEDLE INTO SCALP VEIN, PATIENT YOUNG 36405 $55.00INSERTION OF NEEDLE INTO VEIN, PATIENT 3 YEARS OR 36410 $26.00INSERTION OF NEEDLE INTO VEIN, PATIENT YOUNGER THA 36406 $33.00INSERTION OF NEEDLE OR CATHETER INTO A VEIN 36000 $37.00INSERTION OF NEEDLE OR CATHETER INTO AN ARTERY OF 36140 $332.00INSERTION OF NEEDLE OR CATHETER INTO AORTA 36160 $413.00INSERTION OF NEEDLE OR CATHETER INTO THE CAROTID O 36100 $519.00INSERTION OF PACEMAKER PULSE GENERATOR WITH EXISTI 33212 $29,517.00INSERTION OF PACEMAKER PULSE GENERATOR WITH EXISTI 33213 $34,438.00INSERTION OF PACEMAKER PULSE GENERATOR WITH EXISTI 33221 $37,284.00INSERTION OF PACING DEFIBRILLATOR PULSE GENERATOR 33230 $108,798.00INSERTION OF PACING DEFIBRILLATOR PULSE GENERATOR 33240 $31,956.00INSERTION OF PERMANENT CATHETER FOR DRAINAGE OF LU 32550 $10,917.00INSERTION OF PROBE FOR SALIVARY GLAND DUCT DILATIO 42650 $4,233.00INSERTION OF PROBE IN ESOPHAGUS FOR HEART ULTRASOU 93355 $1,915.00INSERTION OF PROBE INTO THE TEAR DUCT 68810 $855.00INSERTION OF RADIATION DELIVERY DEVICE INTO HEART 92974 $202.00INSERTION OF RECTAL OR LARGE BOWEL STENT USING AN 45327 $9,450.00INSERTION OF SHUNT FROM JUGULAR VEIN TO ABDOMINAL 49425 $1,098.00

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 ChargeINSERTION OF SHUNTS TO BYPASS BLOOD FLOW TO LIVER 37182 $16,010.00INSERTION OF SPINAL NEUROSTIMULATOR PULSE GENERATO 63685 $60,484.00INSERTION OF STENT IN DIALYSIS SEGMENT WITH IMAGIN 36908 $854.00INSERTION OF STENT IN URINARY DUCT (URETER) USING 52332 $5,886.00INSERTION OF STENTS IN NECK ARTERY, OPEN OR ACCESS 37216 $9,627.00INSERTION OF STENTS INTO ARTERY IN ONE LEG ENDOVAS 37230 $32,847.00INSERTION OF STENTS INTO ARTERY IN ONE LEG ENDOVAS 37234 $15,266.00INSERTION OF STENTS INTO VERTEBRAL ARTERY VIA CATH 0075T $2,160.00INSERTION OF STENTS INTO VERTEBRAL ARTERY VIA CATH 0076T $598.00INSERTION OF STENTS INTO WINDPIPE USING AN ENDOSCO 31631 $19,457.00INSERTION OF STOMACH FEEDING TUBE, OPEN PROCEDURE 43830 $39.00INSERTION OF STOMACH TUBE AND ASPIRATIONS OF GASTR 43753 $996.00INSERTION OF STOMACH TUBE USING AN ENDOSCOPE 43246 $4,137.00INSERTION OF TEMPORARY BLADDER CATHETER 51701 $183.00INSERTION OF VENA CAVA FILTER BY ENDOVASCULAR APPR 37191 $12,425.00INSERTION OR REPLACEMENT OF DEFIBRILLATOR WITH ELE 33270 $123,849.00INSERTION OR REPLACEMENT PERMANENT PACEMAKER AND L 33207 $36,739.00INSERTION OR REPLACEMENT PERMANENT PACEMAKER AND U 33206 $36,739.00INSERTION OR REPLACEMENT SINGLE OR DUAL CHAMBER PA 33249 $123,849.00INSERTION PACING DEFIBRILLATOR PULSE GENERATOR WIT 33231 $108,798.00INSERTION PICC W IMAGE GUDIANCE FOR 5 YR+ 36573 $4,375.00INSERTION PICC W/RS&I 5 YR/> 31648 $5,801.00INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG 33285 $29,617.00INSERTION TEMPORARY PACEMAKER ELECTRODE FOR DIAGNO 93610 $21,258.00INSERTION TEMPORARY PACEMAKER ELECTRODE FOR DIAGNO 93612 $21,258.00INSTRUMENT EXTERNAL FIXATION DFS STAINLESS STEEL M $10,180.80INSULIN ANTIBODY MEASUREMENT 86337 $81.00INSULIN MEASUREMENT 83525 $112.00INTACT PARATHYROID 83970 $319.00INTERACTIVE COMPLEXITY 90785 $275.00INTERNAL SHOCK TO HEART TO REGULATE HEART BEAT 92961 $1,615.00INTERP (16+ MARKERS) 88189 $100.00INTERPRETATION AND REPORT OF GENETIC TESTING 88291 $150.00INTERPRETATION AND REPORT OF HEART ULTRASOUND EXAM 93314 $656.00INTESTINE IMAGING 78290 $1,240.00INTRA-OPERATIVE HEART PACING & MAPPING ABNORM HEAR 93631 $332.00INTRINSIC FACTOR (STOMACH PROTEIN) ANTIBODY MEASUR 86340 $117.00INTRO GUIDE RENAL PELVIS/URETER W/DILAT ESTAB NEPH 50395 $253.00INTRODUCER CATHETER CHECK-FLO PERFORMER L35 CM OD1 C1894 $948.96

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 ChargeINTRODUCER CATHETER CHECK-FLO PERFORMER L40 CM OD1 C1894 $563.77INTRODUCER CATHETER CHECK-FLO PERFORMER NITINOL PL C1894 $235.82INTRODUCER CATHETER FAST-CATH .038 IN L5 CM OD6 FR C1894 $148.80INTRODUCER CATHETER FLEXOR CHECK-FLO L55 CM OD6 FR C1894 $275.70INTRODUCER CATHETER FLEXOR SHUTTLE AQ L90 CM OD7 F $363.10INTRODUCER CATHETER PASSIVE $2,464.00INTRODUCER CATHETER PEEL-APART PTFE L10.5 CM OD5 F C1894 $360.00INTRODUCER CATHETER PEEL-APART PTFE L13 CM OD7 FR C1894 $360.00INTRODUCER CATHETER QUINTON PULL-APART OD12 FR PER C1892 $241.42INTRODUCER CATHETER RESPONSE AGILIS NXT COURNAND C C1730 $5,720.00INTRODUCER CATHETER SOLOPATH HYDROPHILIC L25 CM L2 C1894 $3,445.00INTRODUCER CATHETER SOLOPATH HYDROPHILIC L35 CM L3 C1894 $4,240.00INTRODUCER LEAD L13 CM DELIVERY SYSTEM LATEX FREE $2,444.00INTRODUCER LEAD OD10.5 FR PERCUTANEOUS PEELABLE C1894 $39.00INTRODUCER LEAD SAFESHEATH CSG WORLEY JUMBO CURVE C1892 $2,002.00INTRODUCER LEAD SAFESHEATH ULTRA SILICONE L13 CM O C1892 $338.00INTRODUCER LEAD SAFESHEATH ULTRA SILICONE LOW PROF C1892 $1,690.00INTRODUCER LEAD TEAR AWAY SAFESHEATH L13 CM L20 CM C1892 $338.00INTRODUCER LEAD WORLEY TEAR-AWAY STANDARD L40 CM B C1892 $2,002.00INTRODUCER NEPHROSTOMY AMPLATZ L16 CM L30 CM OD18 C1892 $287.36INTRODUCER SHEATH ACCUSTICK II NITINOL PLATINUM .0 C1769 $194.58INTRODUCER SHEATH AGILIS NXT .032 IN 22.4 MM MEDIU C1766 $2,683.85INTRODUCER SHEATH AGILIS NXT 16.8 MM OD8.5 FR CARD C1766 $4,480.00INTRODUCER SHEATH AGILIS NXT 22.4 MM OD8.5 FR CARD C1766 $5,824.00INTRODUCER SHEATH AGILIS NXT DUAL REACH .032 IN LA C1766 $4,480.00INTRODUCER SHEATH AGILIS NXT DUAL REACH .032 IN LA C1776 $2,683.85INTRODUCER SHEATH AVANTI L5.5 CM OD4 FR ENDOVASCUL C1894 $136.50INTRODUCER SHEATH AVANTI L5.5 CM OD6 FR ENDOVASCUL C1894 $52.00INTRODUCER SHEATH AVANTI+ .038 IN L11 CM OD10 FR F C1894 $37.50INTRODUCER SHEATH AVANTI+ .038 IN L11 CM OD5 FR MI C1894 $37.50INTRODUCER SHEATH AVANTI+ FEP SILICONE .038 IN L11 C1894 $37.50INTRODUCER SHEATH AVANTI+ LONG MULTIPURPOSE CURVE C1894 $92.50INTRODUCER SHEATH AVANTI+ MID LENGTH L23 CM OD10 F C1894 $140.00INTRODUCER SHEATH AVANTI+ MINI L23 CM OD10 FR ENDO C1894 $299.00INTRODUCER SHEATH AVANTI+ MINI L23 CM OD11 FR ENDO C1894 $299.00INTRODUCER SHEATH AVANTI+ MINI L23 CM OD4 FR ENDOV C1894 $299.00INTRODUCER SHEATH AVANTI+ MINI L23 CM OD7 FR ENDOV C1894 $1,225.00INTRODUCER SHEATH AVANTI+ MINI L5.5 CM OD5 FR ENDO C1894 $136.50INTRODUCER SHEATH AVANTI+ MINI L5.5 CM OD7 FR ENDO C1894 $260.00

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 ChargeINTRODUCER SHEATH AVANTI+ SLIX .035 IN L11 CM OD4 C1894 $37.50INTRODUCER SHEATH AVANTI+ SLIX .038 IN L11 CM OD9 C1894 $37.50INTRODUCER SHEATH AVANTI+ SLIX MID LENGTH L23 CM L C1894 $87.50INTRODUCER SHEATH AVANTI+ STAINLESS STEEL .038 IN C1894 $37.50INTRODUCER SHEATH AVANTI+ STAINLESS STEEL MINI STA C1894 $37.50INTRODUCER SHEATH AVANTI+ STANDARD L11 CM OD8 FR R C1894 $37.50INTRODUCER SHEATH BRITE TIP SILICONE L23 CM ID6 FR C1887 $80.00INTRODUCER SHEATH BRITE TIP SLIX SILICONE 3 MM L23 C1894 $80.00INTRODUCER SHEATH BRITE TIP STAINLESS STEEL NYLON C1894 $266.50INTRODUCER SHEATH CHECK-FLO FLEXOR .038 IN L55 CM C1894 $1,050.80INTRODUCER SHEATH CHECK-FLO FLEXOR HYDROPHILIC .03 C1894 $290.20INTRODUCER SHEATH CHECK-FLO FLEXOR OPTIC-LOC HYDRO C1894 $337.22INTRODUCER SHEATH CHECK-FLO HYDROPHILIC L30 CM OD1 C1894 $368.25INTRODUCER SHEATH CORDIS AVANTI+ MID LENGTH L11 CM C1894 $40.00INTRODUCER SHEATH CORDIS AVANTI+ PEDIATRIC L5.5 CM C1894 $40.00INTRODUCER SHEATH CORDIS AVANTI+ SLIX MID LENGTH L C1894 $260.00INTRODUCER SHEATH CORDIS AVANTI+ STANDARD LENGTH L C1894 $200.00INTRODUCER SHEATH CORDIS BRITE TIP SILICONE L11 CM C1894 $60.00INTRODUCER SHEATH CORDIS BRITE TIP SILICONE L23 CM C1894 $80.00INTRODUCER SHEATH CORDIS BRITE TIP SILICONE L35 CM C1894 $80.00INTRODUCER SHEATH CORDIS BRITE TIP SILICONE L45 CM C1894 $80.00INTRODUCER SHEATH CORDIS BRITE TIP SILICONE L5.5 C C1894 $50.00INTRODUCER SHEATH CORDIS BRITE TIP SILICONE L55 CM C1894 $160.00INTRODUCER SHEATH CORDIS BRITE TIP SILICONE L90 CM C1894 $80.00INTRODUCER SHEATH FAST-CATH .032 IN L60 CM OD10 FR C1893 $325.00INTRODUCER SHEATH FAST-CATH .038 IN 3 MM RAMP-1 CU C1893 $720.00INTRODUCER SHEATH FAST-CATH .038 IN L30 CM OD12 FR C1894 $175.50INTRODUCER SHEATH FAST-CATH .038 IN L5 CM OD5 FR T C1894 $148.80INTRODUCER SHEATH FAST-CATH .038 IN L5 CM OD8 FR T C1894 $148.80INTRODUCER SHEATH FAST-CATH .038 IN SEPT CURVE L60 C1893 $936.00INTRODUCER SHEATH FAST-CATH 135 D L50 CM OD8 FR TR C1894 $390.00INTRODUCER SHEATH FAST-CATH CATH-LOCK .038 IN STAN C1894 $69.50INTRODUCER SHEATH FAST-CATH SWARTZ .032 IN 3 MM SL C1893 $720.00INTRODUCER SHEATH FAST-CATH SWARTZ .032 IN L180 CM C1893 $720.00INTRODUCER SHEATH FAST-CATH SWARTZ .038 IN 3 MM J C1893 $936.00INTRODUCER SHEATH FAST-CATH SWARTZ .038 IN 3 MM SR C1893 $720.00INTRODUCER SHEATH FAST-CATH SWARTZ .038 IN SR0 CUR C1893 $720.00INTRODUCER SHEATH FAST-CATH SWARTZ .038 IN SR2 CUR C1893 $720.00INTRODUCER SHEATH FAST-CATH WYSHAM .038 IN L5 CM O C1894 $148.80

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 ChargeINTRODUCER SHEATH FLEXOR CHECK-FLO L80 CM OD12 FR C1894 $604.11INTRODUCER SHEATH INPUT PS PEBAX HYDROPEL .038 IN C1894 $260.00INTRODUCER SHEATH INPUT TS SILICONE .038 IN DUAL D C1894 $52.00INTRODUCER SHEATH INPUT TS SILICONE .038 IN J CURV C1894 $68.00INTRODUCER SHEATH INPUT TS SILICONE L23 CM OD9 FR C1894 $68.00INTRODUCER SHEATH MULLINS ADULT .032 IN L60 CM L67 C1894 $403.00INTRODUCER SHEATH MULLINS ADULT OD8 FR INTRACARDIA C1893 $310.00INTRODUCER SHEATH OPTISEAL L13 CM OD6 FR VALVE PEE C1892 $338.00INTRODUCER SHEATH OPTISEAL L13 CM OD7 FR VALVE PEE C1892 $338.00INTRODUCER SHEATH OPTISEAL L13 CM OD9 FR C1892 $338.00INTRODUCER SHEATH PEEL-AWAY DI-LOCK .038 IN L14 CM C1892 $100.00INTRODUCER SHEATH PEEL-AWAY L15.5 CM L20 CM OD11 F C1894 $324.16INTRODUCER SHEATH PEEL-AWAY L15.5 CM L20 CM OD14 F C1894 $324.16INTRODUCER SHEATH PEEL-AWAY L15.5 CM OD12 FR PERCU C1894 $324.16INTRODUCER SHEATH PEEL-AWAY LARGE L13 CM L20 CM OD C1894 $249.35INTRODUCER SHEATH PEEL-AWAY LARGE L15.5 CM L20 CM C1894 $241.90INTRODUCER SHEATH PEEL-AWAY OD14 FR RADIOPAQUE STE C1892 $491.40INTRODUCER SHEATH PERFORMER CHECK-FLO AQ L30 CM L4 C1894 $535.60INTRODUCER SHEATH PERFORMER L30 CM OD18 FR ID5.9 M C1894 $541.00INTRODUCER SHEATH PRELUDE SHORT L4 CM OD5 FR RADIO C1894 $60.60INTRODUCER SHEATH PRELUDE SHORT L4 CM OD6 FR RADIO C1894 $60.60INTRODUCER SHEATH PRELUDE SHORT L4 CM OD7 FR ODSEC C1894 $60.60INTRODUCER SHEATH SAFESHEATH II L19.5 CM L13 CM OD C1892 $338.00INTRODUCER SHEATH SAFESHEATH L13 CM L20 CM OD9 FR C1894 $260.00INTRODUCER SHEATH SAFESHEATH TEAR-AWAY L13 CM OD7 C1892 $478.40INTRODUCER SHEATH SNAPLOCK FAST-CATH .038 IN STAND C1894 $69.50INTRODUCER SHEATH SWARTZ .032 IN SL0 CURVE L63 CM C1893 $820.00INTRODUCER SHEATH SWARTZ .032 IN SL3 CURVE L81 CM C1893 $1,312.00INTRODUCER SHEATH SWARTZ SL ULTIMUM .032 IN SL1 CU C1893 $820.00INTRODUCER SHEATH ULTIMUM .035 IN TAPER L30 CM OD1 C1894 $390.00INTRODUCER SHEATH ULTIMUM EV .035 IN L35 CM OD16 F C1894 $480.00INTRODUCER SUPRAPUBIC L17 CM L20 CM OD18 FR ID22 F C1894 $340.00INTRODUCER TUBE FROVA RAPI-FIT ANGLE L65 CM OD14 F $332.63INTRODUCER TUBE FROVA RAPI-FIT ANGLE L70 CM OD14 F $235.62INTRODUCTION CONTRAST MATERIAL FOR X-RAY IMAGING O 58340 $445.00INTRODUCTION OF CATHETER INTO THE UPPER OR LOWER M 36010 $353.00IOBENGUANE SULFATE I-123 10 MCI/5 ML (370 MBQ/5 ML A9582 $8,265.64IPILIMUMAB 50 MG/10 ML (5 MG/ML) SOLN 10 ML VIAL J9228 $31,890.90IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 M $5.63

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 ChargeIRON BINDING CAPACITY 83550 $68.00IRRADIATION OF BLOOD PRODUCT, EACH UNIT 86945 $94.00IRRIGATION AND SUCTION OF LUNG AIRWAYS TO OBTAIN C 31624 $3,410.00IRRIGATION OF ABDOMINAL CAVITY 49084 $2,974.00IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVER 96523 $181.00IRRIGATION OF NASAL SINUS 31000 $848.00IRRIGATOR SUCTION DA VINCI SI ENDOWRIST ONE OD8 MM $1,430.00IRRIGATOR SUCTION ENDOWRIST OD8 MM STERILE LATEX F $2,120.00ISONAZID 80299 $76.00JOINT EXTERNAL FIXATION HEIDELBERG CARDAN $20,991.60JOINT EXTERNAL FIXATION HEIDELBERG HINGE $23,806.80JOINT EXTERNAL FIXATION ILIZAROV STAINLESS STEEL S $3,496.48JOINT EXTERNAL FIXATION LARGE COMPOSITE HINGE $5,283.60JOINT EXTERNAL FIXATION LARGE HINGE MALE $5,283.60JOINT EXTERNAL FIXATION STANDARD $7,274.00JOINT FINGER SILASTIC 40 INTERPHALANGEAL PROXIMAL C1776 $7,795.32JOINT TOE IPP-ON 1 PROXIMAL INTERPHALANGEAL STERIL C1776 $5,512.00JOINT TOE SMALL METATARSOPHALANGEAL HEMIARTHROPLAS C1776 $5,516.55JOINT TOE SMART TOE TITANIUM NITINOL NEUTRAL L19 M C1776 $5,476.00JOINT TOE SWANSON SILASTIC TITANIUM 2S LATERAL MET C1776 $3,802.50JOINT TOE SWANSON SILASTIC TITANIUM 3S LATERAL MET C1776 $3,802.50JOINT TOE SWANSON SILICONE 5-0 METATARSOPHALANGEAL C1713 $4,563.00JOINT TOE SWANSON SMALL FOOT FLEXIBLE HINGE GROMME C1713 $2,860.00KETAMINE AND NORKETAMINE LEVELS 80357 $244.00KETONE BODIES ANALYSIS 82010 $63.00KIT ACCESSORY ADVANCE POLYPROPYLENE MALE SUBURETHR C1771 $36,129.60KIT ACCESSORY AMS 700 PENILE PROSTHESIS $4,430.40KIT ACCESSORY AMS 800 STERILE LATEX FREE DISPOSABL $6,593.60KIT ACCESSORY ASCENDA 2 ATTACH COLLET SPINAL SEGME $3,250.00KIT ACCESSORY ASCENDA 2 ATTACHED COLLET CATHETER C $1,170.00KIT ACCESSORY DA VINCI SI OD8 MM 4 ARM CAMERA CANN $1,300.00KIT ACCESSORY INJEX SILICONE BARIUM SULFATE H.133 $1,543.75KIT ADAPTER L25.5 CM X H16.6 MM L33.8 MM 1 X 4 POC C1883 $2,470.00KIT ARTHROSCOPIC FIXATION BUTTON DRILL PIN INSERTE $5,525.00KIT ARTHROSCOPIC FIXATION DISPOSABLE 3 MM SUTURETA C1713 $1,040.00KIT ARTHROSCOPIC FIXATION INTERNALBRACE FIBERTAPE $6,987.50KIT ARTHROSCOPIC FIXATION JUGGERKNOT CURVE OD1.5 M C1713 $1,524.90KIT ARTHROSCOPIC FIXATION JUGGERKNOT DRILL GUIDE O $1,524.90KIT ARTHROSCOPIC FIXATION JUGGERKNOT SHORT OD1.4 M C1713 $1,779.57

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 ChargeKIT ARTHROSCOPIC FIXATION SEQUENT MENISCUS SUTURE $598.00KIT ARTHROSCOPIC FIXATION TENDON DISTAL BICEPS $6,831.83KIT ARTHROSCOPIC FIXATION TIGERTAPE SUTURELASSO 2 $7,312.50KIT ARTHROSCOPIC FIXATION TIGHTROPE KIRSCHNER MINI C1713 $3,412.50KIT ARTHROSCOPIC FIXATION TIGHTROPE STAINLESS STEE $5,720.00KIT ARTHROSCOPIC FIXATION TIGHTROPE TITANIUM UHMWP C1713 $5,720.00KIT ARTHROSCOPIC FIXATION TOGGLELOC ZIPLOOP $8,323.32KIT ARTHROSCOPIC FIXATION TOGGLELOC ZIPLOOP MAXBRA $7,492.49KIT ARTHROSCOPIC PINN-ACL ACL DISPOSABLE $812.50KIT ASPIRATOR LATEX FREE 1E STERILANT PROCESS SYST $563.16KIT AUTOTRANSFUSION BOWL BRAT 2 120 UM 135 ML LOW $794.43KIT BALLOON DILATATION INFLATOR $1,017.64KIT BIOPSY BARD MARQUEE L5.8 CM L10 CM L6.3 CM OD1 $270.00KIT BIOPSY L20 CM X W3.5 CM ENDOCAVITY NEEDLE GUID $1,872.00KIT BIOPSY NEEDLE PASSIVE $3,250.00KIT BIOPSY TLAB METAL STRAIGHT CURVE L60 CM L65 CM $4,400.00KIT BLOOD PRESSURE L12 IN K SOUND MICROPHONE DISPO $780.00KIT BONE BIOPSY IVAS L10 MM OD10 GA BALLOON CATHET $6,675.18KIT BONE BIOPSY IVAS L15 MM OD8 GA LATEX FREE $6,675.18KIT BONE BIOPSY IVAS L5 IN OD10 GA STERILE LATEX F $439.11KIT BONE BIOPSY TRAUMACEM V+ SYRINGE STERILE $898.56KIT BONE CEMENT ACM BREAK-AWAY 180 GM MIX BOWL BAS $400.00KIT BONE CEMENT FEMUR RESTRICTOR STERILE $954.20KIT BONE CEMENT SMALL DIAMETER PREP $923.00KIT BONE CEMENT STAGEONE STAINLESS STEEL SILICONE $7,442.50KIT BONE CEMENT VERTAPLEX HV AUTOPLEX WITHOUT NEED $4,861.29KIT BONE GRAFT INFUSE RHBMP-2 BOVINE COLLAGEN 2XS C1713 $7,184.00KIT BONE GRAFT INFUSE RHBMP-2 BOVINE COLLAGEN LARG C1713 $44,552.00KIT BONE GRAFT OSTEOSET CALCIUM SULFATE 25 CC 2 MO C1713 $4,270.50KIT BONE GRAFT OSTEOSET CALCIUM SULFATE MINI 5 CC C1713 $2,548.00KIT BONE GRAFT OSTEOSET CALCIUM SULFATE MINI STAND C1713 $3,136.00KIT BONE GRAFT OSTEOSET CALCIUM SULFATE STANDARD 2 C1713 $5,256.00KIT BREAST PUMP AMEDA 1 HAND 2 CONTOUR COTTON PAD $2,915.64KIT BREAST PUMP HYGIENIKIT ALUMINUM 2 MILK COLLECT $509.99KIT BREAST PUMP LARGE FEED HYGIENE MILK COLLECTION $529.88KIT BREAST PUMP SYMPHONY PERSONALFIT OD24 MM 35 ML $2,229.60KIT CATHETER 3MAX PENUMBRA SYSTEM REPERFUSION HIFL $11,180.00KIT CATHETER ARES ANTIBIOTIC STERILE LATEX FREE $4,550.00KIT CATHETER ARROWG+ARD BLUE BLUE FLEXTIP POLYURET C1751 $439.25

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 ChargeKIT CATHETER ARROWG+ARD BLUE BLUE FLEXTIP POLYURET C1752 $1,398.41KIT CATHETER ARROWG+ARD BLUE FLEXTIP POLYURETHANE C1752 $1,313.05KIT CATHETER ARROWG+ARD BLUE PLUS BLUE FLEXTIP POL C1751 $212.14KIT CATHETER BIOFLO DURAMAX ENDEXO POLYURETHANE AD C1750 $10,237.50KIT CATHETER BIOFLO ENDEXO NITINOL REVERSE TAPER L C1751 $315.00KIT CATHETER BROVIAC SILICONE PEDIATRIC L57 CM OD6 $2,416.80KIT CATHETER CHOICE-PAK PRO-FLO OD7 FR LATEX FREE $411.13KIT CATHETER CHOICE-PAK PRO-FLO OD7 FR SOFT TIP LA $411.13KIT CATHETER CHOICE-PAK PRO-FLO PRO-FLO XT OD6 FR $411.13KIT CATHETER CHOICE-PAK PRO-FLO XT OD5 FR SOFT TIP $411.13KIT CATHETER CHOICE-PAK PRO-FLO XT OD6 FR SOFT TIP $411.13KIT CATHETER CHOICE-PAK PRO-FLO XT OD7 FR SOFT TIP $411.13KIT CATHETER CODMAN BACTISEAL BARIUM SILICONE L120 C1729 $4,696.00KIT CATHETER DRAGONFLY HYDROPHILIC .014 IN L135 CM $4,000.00KIT CATHETER DURAFLOW EMBOSAFE DURATHANE ADULT L32 $1,235.00KIT CATHETER DURAMAX SAFESHEATH D-PRO DURATHANE AD C1750 $1,235.00KIT CATHETER FLEXTIP PLUS L9.84 CM OD17 GA ODSEC19 C1755 $216.53KIT CATHETER HEMOSPLIT AIRGUARD POLYURETHANE PTFE C1750 $1,050.00KIT CATHETER HEMOSTAR AIRGUARD POLYURETHANE PTFE S C1750 $1,050.00KIT CATHETER HEMOSTAR BIOBLOC L23 CM OD14.5 FR STR C1750 $1,200.00KIT CATHETER HEMOSTAR XK BIOBLOC L23 CM OD16 FR ST C1750 $1,200.00KIT CATHETER HICKMAN PEEL-APART SILICONE PEDIATRIC $1,112.00KIT CATHETER HICKMAN SILICONE L40 CM OD13.5 FR 2 L $1,064.00KIT CATHETER L20 CM OD7 FR CENTRAL VENOUS CUSTOM 3 C1751 $704.00KIT CATHETER LEONARD SILICONE L90 CM OD10 FR 2 LUM $1,573.00KIT CATHETER MAC ARROWG+ARD BLUE POLYURETHANE .035 C1751 $531.45KIT CATHETER MAHURKAR DOUBLE-D ULTEM VITACUFF SILI C1752 $431.60KIT CATHETER PALINDROME CARBOTHANE SILVER ION .038 C1750 $2,976.00KIT CATHETER PLEURX 1000 ML PERITONEAL STARTER STE $5,135.00KIT CATHETER PLEURX PERITONEAL C1729 $3,542.50KIT CATHETER POWERGLIDE NITINOL POLYURETHANE .018 C1751 $5,850.00KIT CATHETER POWERGLIDE POLYURETHANE NITINOL .014 C1751 $4,875.00KIT CATHETER POWERGLIDE POLYURETHANE NITINOL .014 $5,850.00KIT CATHETER POWERGLIDE PRO BIOPATCH L10 CM OD18 G C1751 $552.00KIT CATHETER POWERGLIDE PRO BIOPATCH L8 CM OD18 GA C1751 $552.00KIT CATHETER POWERGLIDE PRO BIOPATCH L8 CM OD20 GA C1751 $552.00KIT CATHETER POWERPICC SOLO 2 RADSTIC NITINOL L70 $680.00KIT CATHETER PRO-FLO 145 D OD6 FR LATEX FREE ANGIO $411.13KIT CATHETER PRO-FLO CHOICE-PAK OD6 FR LATEX FREE $411.13

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 ChargeKIT CATHETER PRO-FLO CHOICE-PAK OD7 FR LATEX FREE $411.13KIT CATHETER PRO-FLO CHOICE-PAK OD7 FR SOFT TIP LA $411.13KIT CATHETER PRO-FLO OD6 FR LATEX FREE $411.13KIT CATHETER PRO-FLO OD6 FR LATEX FREE ANGIOGRAPHY $411.13KIT CATHETER PRO-FLO XT CHOICE-PAK OD6 FR SOFT TIP $411.13KIT CATHETER PRO-FLO XT CHOICE-PAK OD7 FR SOFT TIP $411.13KIT CATHETER PRO-LINE L60 CM OD5 FR BASIC 5 CM FRO $1,480.38KIT CATHETER PRO-LINE POLYURETHANE L60 CM OD6 FR 1 C1750 $1,480.38KIT CATHETER PULL-APART QUINTON PERMCATH STAINLESS C1750 $1,001.00KIT CATHETER QUATTRO L45 CM OD9.3 FR TRIP 3 INFUSI C1751 $4,597.95KIT CATHETER QUINTON ARGYLE CURL CATH PULL-APART S $803.04KIT CATHETER REPAIR BROVIAC SILICONE L71 CM OD2.7 C1751 $1,192.00KIT CATHETER REPAIR BROVIAC SILICONE L71 CM OD4.2 C1751 $1,192.00KIT CATHETER REPAIR BROVIAC SILICONE L90 CM OD6.6 C1751 $1,192.00KIT CATHETER REPAIR HICKMAN SILICONE OD7 FR CENTRA $1,360.00KIT CATHETER SWAN NECK CURL CATH L62.5 CM PERITONE C1750 $1,430.00KIT CATHETER TAL PALINDROME RUBY L45 CM OD28 FR ST C1750 $2,976.00KIT CATHETER UROMAX ULTRA QUADRA-FOLD ENCORE HYDRO C1726 $1,541.41KIT CATHETER VAXCEL PLUS CARBOTHANE POLYURETHANE . C1750 $3,041.12KIT CATHETERIZATION ARROWG+ARD BLUE BLUE FLEXTIP E C1752 $1,316.80KIT CATHETERIZATION ARROWG+ARD BLUE BLUE FLEXTIP P C1751 $418.17KIT CATHETERIZATION ARROWG+ARD BLUE PLUS BLUE FLEX C1751 $330.26KIT CATHETERIZATION BLUE FLEXTIP ARROWG+ARD BLUE P C1751 $350.46KIT CATHETERIZATION BLUE FLEXTIP PEDIATRIC L8 CM O C1751 $253.34KIT CATHETERIZATION DRAGONFLY OPTIS HYDROPHILIC 20 $4,000.00KIT CENTRIFUGAL ANGEL BLOOD ACCESS $1,137.50KIT CENTRIFUGAL ANGEL PLATELET RICH PLASMA PROCESS $1,917.50KIT CENTRIFUGAL GPS III 30 ML 1 PLATELET CONCENTRA $1,956.50KIT CHOLANGIOGRAM ARROW-KARLAN POLYURETHANE L60 CM C1769 $581.52KIT DECOMPRESSION .035 IN L175 CM OD14 FR ODSEC6 F C1729 $550.00KIT DRAINAGE ACCUSTICK II APD FLEXIMA PLATINUM L25 C1729 $1,150.00KIT DRAINAGE EDM L80 CM LUMBAR CATHETER OPEN TIP M $2,332.80KIT DRAINAGE FLEXIMA POLYURETHANE REGULAR L35 CM O $1,150.00KIT DRAINAGE L6.44 IN OD8 FR ODSEC22 GA 10 ML PNEU $344.50KIT DRAINAGE PLEURAGUIDE THORACIC ALL IN ONE CHEST $237.00KIT DRAINAGE PLEURX 1000 ML STARTER $1,325.00KIT DRAINAGE PLEURX 1000 ML VACUUM BOTTLE $344.50KIT DRAINAGE PLEURX PLEURAL $2,725.00KIT DRESSING CHANGE STERILE LATEX FREE DISPOSABLE $784.60

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 ChargeKIT DRESSING GRANUFOAM SENSATRAC VAC HYDROPHOBIC T $1,597.60KIT DRESSING GRANUFOAM SENSATRAC VAC POLYURETHANE $348.56KIT DRESSING GRANUFOAM SILVER SENSATRAC VAC POLYUR $503.46KIT DRESSING GRANUFOAM VAC SENSATRAC HYDROPHOBIC T $2,431.15KIT DRESSING VAC GRANUFOAM SILVER SENSATRAC POLYUR $503.46KIT DRESSING WHITEFOAM SENSATRAC VAC POLYVINYL ALC $256.99KIT DRILL BIT OD2 MM ODSEC3.2 MM $487.50KIT DRILL BIT SPEED OD2 MM GUIDE HANDLE LOCATOR PI $1,783.93KIT DRUG DELIVERY ON-Q SILVERSOAKER DEHP L7.5 IN C $773.50KIT ELECTRODE ENSITE NAVX SURFACE NONSTERILE LATEX $1,670.00KIT ELECTRODE ZAP NEXDRIVE TBED $2,428.40KIT ELECTROTHERAPY L100 MM L4 MM OD17 GA 2 BURETTE $7,995.00KIT EMBOLIC PROTECTION CORDIS OPTEASE NITINOL L55 C1880 $3,000.00KIT EMBOLIC PROTECTION CORDIS TRAPEASE NITINOL L55 C1880 $3,000.00KIT EMBOLIC PROTECTION CORDIS TRAPEASE NITINOL L90 C1880 $4,550.00KIT ENDOSCOPE BASIN CPC SUCTION BIOPSY INLET AIR P $6,007.95KIT ENDOSCOPIC FIXATION SONICANCHOR 2 C-7 L10 MM O C1713 $3,094.00KIT ENDOSCOPIC INSTRUMENT BIO-SUTURETAK OD2.4 MM A $1,137.50KIT ENDOSCOPIC INSTRUMENT HIP 7 PIECE KIT NONSTERI $3,575.00KIT ENDOSCOPIC INSTRUMENT MASTER L1.5 MM OD14 GA H $2,925.00KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1 $1,430.00KIT ENDOSCOPIC L10 MM L105 CM L115 CM OD1.95 MM OD $4,995.36KIT ENDOSCOPIC L105 CM L115 CM OD2.55 MM GUIDE SHE $1,361.84KIT ENDOSCOPIC OD1.4 MM LEVEL 1 RETRACTOR STAINLES $6,500.00KIT ENDOSCOPIC STARTER ORDER $39,507.00KIT EPIDURAL FLEXTIP PLUS L8.89 CM OD17 GA ODSEC19 C1755 $88.83KIT EXERCISE ANKLE DELUXE DOOR STRAP TUBING $598.00KIT EXTERNAL DRAINAGE BECKER EDMS CSF ASSEMBLY PAT $408.85KIT EXTERNAL DRAINAGE CODMAN LUMBAR II CATHETER ST C1729 $762.00KIT GASTROSTOMY CORGRIP RETENTION 10 FR FEED TUBE B4082 $396.50KIT HEMOSTATIC FLOSEAL 10 ML MATRIX MALLEABLE TRIM $2,517.46KIT HEMOSTATIC FLOSEAL GELATIN MATRIX 10 ML NEEDLE $2,019.38KIT IMMUNOLOGY TEST IMMUNOCARD MYCOPLASMA PNEUMONI $1,860.30KIT IMMUNOLOGY TEST OSOM MONONUCLEOSIS CE MARK 2 E $460.79KIT IMMUNOLOGY TEST RAPID FFN POSITIVE NEGATIVE CO $400.00KIT IMPLANT BLOM-SINGER OD20 FR TRACHEOESOPHAGEAL L8515 $105.00KIT IMPLANT PEEK MEDIUM CRANIAL CUSTOM SUTURE DRAI $83,467.80KIT IMPLANT PEEK XL CRANIAL CUSTOM C1713 $118,994.85KIT IMPLANT SPEEDARC 12/10 L11 MM L1.5 MM X W1.3 M $6,337.50

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 ChargeKIT IMPLANT TITAN LOCK-OUT BIOFLEX SILICONE HYDROP $2,775.50KIT INFUSION PORT MINILOC L.75 IN OD20 GA Y SITE A C1788 $31.80KIT INFUSION PORT POWERLOC MAX L.75 IN OD22 GA Y S C1788 $55.00KIT INFUSION PUMP MYPTM SYNCHROMED II L3.7 IN X W2 $3,575.00KIT INFUSION SYNCHROMED DACRON MESH POUCH DRUG DEL $520.00KIT INSERTION SUTURETAK NITINOL L1.1 MM OD17 GA OD $1,267.50KIT INSTRUMENT ACL HALL SAW BLADE DISPOSABLE TRANS $1,462.50KIT INSTRUMENT ACL TRANSTIBIAL DISPOSABLE $942.50KIT INSTRUMENT BIO-TENODESIS BIOABSORBABLE STERILE $1,267.50KIT INSTRUMENT DA VINCI SI L20 IN X W13 IN X H10.5 $1,000.00KIT INSTRUMENT DISPOSABLE 4.5/14 MM BIOCOMPOSITE C $1,608.00KIT INSTRUMENT GENERAL KNEE $1,300.00KIT INSTRUMENT GMK SPHERE T4 I3 TIBIAL INSERT DISP $650.00KIT INSTRUMENT JUGGERKNOT GUIDE FLEXIBLE DRILL BIT $1,524.90KIT INSTRUMENT JUGGERKNOT OD2.9 MM GUIDE DRILL BIT $1,650.48KIT INSTRUMENT JUGGERKNOT STRAIGHT OD1.5 MM GUIDE $1,524.90KIT INSTRUMENT METAL OD2.9 MM DRILL SPEAR STERILE $1,400.00KIT INSTRUMENT OD2.4 MM STEP DRILL GUIDE DISPOSABL $942.50KIT INSTRUMENT TRIM-IT DRILL PIN KIRSCHNER L100 MM $1,365.00KIT INTERVENTIONAL ENROUTE TRANSCAROTID NEUROPROTE $20,475.00KIT INTRAMEDULLARY NAIL GAMMA TITANIUM 125 D LONG $9,750.00KIT INTRAMEDULLARY NAIL GAMMA TITANIUM 130 D LONG C1713 $9,750.00KIT INTRAMEDULLARY NAIL OD.062 IN SLOTTED AWL LOCK $2,088.32KIT INTRAMEDULLARY NAIL TITANIUM 125 D R1.5 L320 M C1713 $9,750.00KIT INTRAMEDULLARY NAIL TITANIUM 125 D R1.5 LONG L C1713 $9,750.00KIT INTRAMEDULLARY NAIL TITANIUM 130 D LONG L360 M C1713 $9,750.00KIT INTRAMEDULLARY NAIL TITANIUM 130 D R1.5 L360 M C1713 $9,750.00KIT INTRAMEDULLARY NAIL TITANIUM 130 D R1.5 LONG L C1713 $9,750.00KIT INTRATHECAL PUMP ASCENDA 2 ATTACH COLLET PUMP $2,925.00KIT INTRATHECAL PUMP REPAIR DRUG DELIVERY SYSTEM $720.00KIT INTRATHECAL PUMP SYNCHROMED CONNECTOR ACCESSOR $640.00KIT INTRODUCER ARROW-FLEX ARROWG+ARD BLUE POLYURET C1894 $198.14KIT INTRODUCER ARROW-FLEX POLYURETHANE .035 IN L4 C1894 $197.95KIT INTRODUCER ARROWG+ARD BLUE ARROW-FLEX POLYURET C1894 $281.29KIT INTRODUCER ARROWG+ARD BLUE POLYURETHANE .035 I C1894 $378.61KIT INTRODUCER GLIDESHEATH HYDROPHILIC .021 IN L10 C1894 $178.50KIT INTRODUCER GLIDESHEATH HYDROPHILIC .021 IN L25 C1894 $185.00KIT INTRODUCER GLIDESHEATH SLENDER PLASTIC .021 IN C1894 $583.38KIT INTRODUCER GLIDESHEATH SLENDER STAINLESS STEEL $160.50

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 ChargeKIT INTRODUCER GROSHONG PTFE L15 CM OD8 FR PERCUTA C1894 $680.00KIT INTRODUCER SAFESHEATH II L13 CM OD8 FR C1894 $338.00KIT INTRODUCER SAFESHEATH ULTRA SILICONE .038 IN L C1892 $338.00KIT LAPAROSCOPIC LIGATOR FALOPE-RING L32 CM OD8 MM $2,240.00KIT LEAD ADAPTER L38 MM PACING UNIPOLAR TO PULSE G C1883 $1,300.00KIT MICROBIOLOGY TEST BD BBL BD STREPTOCARD STREPT $1,003.21KIT MICROBIOLOGY TEST BD DIRECTIGEN MENINGITIS 30 $3,827.20KIT MICROBIOLOGY TEST BD DIRECTIGEN STREPTOCOCCUS $1,045.72KIT MICROBIOLOGY TEST IMMUNOCARD CLOSTRIDIUM DIFFI $3,900.00KIT MICROBIOLOGY TEST QUICKVUE CHLAMYDIA POSITIVE $1,556.30KIT MICROCATHETER ITRACK MICRO CANALOPLASTY $6,467.50KIT MICROINTRODUCER CAPELLA NITINOL GOLD TUNGSTEN C1894 $105.00KIT MICROINTRODUCER FLEXURA MICROEZ UNIVERSAL L50 C1894 $227.50KIT MICROINTRODUCER L7 CM OD21 GA NEEDLE C1894 $585.00KIT MICROINTRODUCER MICROEZ STAINLESS STEEL UNIVER C1894 $593.04KIT MICROINTRODUCER VSI STAINLESS STEEL .018 IN TA C1894 $114.00KIT NEPHROSTOMY ACCUSTICK II APD FLEXIMA PLATINUM C1729 $1,150.00KIT NEPHROSTOMY FLEXIMA POLYURETHANE HYDROPHILIC P C1729 $934.38KIT NEPHROSTOMY FLEXIMA POLYURETHANE PIGTAIL CURVE C1729 $1,150.00KIT NEPHROSTOMY NEPHROMAX AMPLATZ ENCORE PTFE SILI $1,594.91KIT NERVE BLOCK PROLONG BLOCK BEVEL L100 MM OD19 G C1755 $95.76KIT NERVE STIMULATOR CLIK ANCHOR STERILE SPINAL CO $1,412.45KIT NEUROSTIMULATOR 2 PORT HEADER 2 BATTERY 1 MAGN $1,950.00KIT NEUROSTIMULATOR AXIUM L30 CM TUNNEL TOOL STERI $1,950.00KIT NEUROSTIMULATOR CONNECTOR CABLE $2,600.00KIT NEUROSTIMULATOR FREEDOM L45 CM OD1.35 MM .25 G $6,500.00KIT NEUROSTIMULATOR FREELINK PATIENT PROGRAMMER $5,200.00KIT NEUROSTIMULATOR FREELINK REMOTE CONTROL NONSTE $5,200.00KIT NEUROSTIMULATOR INTERSTIM EVALUATION $825.50KIT NEUROSTIMULATOR INTERSTIM L3.5 IN LEAD INTRODU $1,820.00KIT NEUROSTIMULATOR INTERSTIM L50 CM LEAD 32 CONTA C1778 $19,500.00KIT NEUROSTIMULATOR INTERSTIM SACRAL NERVE PERIPHE C1897 $237.25KIT NEUROSTIMULATOR INTERSTIM SACRAL NERVE TEST UR $1,917.50KIT NEUROSTIMULATOR INTERSTIM SACRUM TEST UROLOGY C1897 $2,652.00KIT NEUROSTIMULATOR L70 CM 32 CONTACT PADDLE TIGHT C1778 $19,500.00KIT NEUROSTIMULATOR NEVRO 5 MM SPACING L70 CM TRAI C1778 $6,000.00KIT NEUROSTIMULATOR NEVRO IMPLANATABLE PULSE GENER $721.50KIT NEUROSTIMULATOR NEVRO REMOTE NONSTERILE LATEX $5,200.00KIT NEUROSTIMULATOR OCTRODE L60 CM PERCUTANEOUS 8 C1778 $13,000.00

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 ChargeKIT NEUROSTIMULATOR PRECISION CHARGE $7,800.00KIT NEUROSTIMULATOR PRECISION INFINION L50 CM 1 X C1897 $7,800.00KIT NEUROSTIMULATOR PRECISION L70 CM STEER CAP STI $661.70KIT NEUROSTIMULATOR PRECISION NOVI TITANIUM SILICO $87,750.00KIT NEUROSTIMULATOR PRECISION SPECTRA REMOTE CONTR C1787 $5,200.00KIT NEUROSTIMULATOR PRECISION SPECTRA TRIAL $578.50KIT NEUROSTIMULATOR QUATTRODE L60 CM 4 CHANNEL TRI C1897 $3,900.00KIT NEUROSTIMULATOR SAFESHEATH II OD12 FR $1,690.00KIT NEUROSTIMULATOR SAFESHEATH II OD12.5 FR $338.00KIT NEUROSTIMULATOR SENZA CHARGER NONSTERILE LATEX C1822 $5,200.00KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE D C1822 $115,303.50KIT NEUROSTIMULATOR SPECTRA WAVEWRITER $117,000.00KIT NEUROSTIMULATOR STIMQ FREEDOM-8A L45 CM OD1.35 $6,500.00KIT OCCULT BLOOD TEST HEMOCCULT II DISPENSAPAK PLU $622.77KIT ORAL CARE CHLORHEXIDINE GLUCONATE HYDROGEN PER $970.50KIT PACEMAKER ADAPTA LARGE 2 CHAMBER 2 LEAD $26,000.00KIT PACING L37 CM BIPOLAR IS-1 $962.00KIT PAIN PUMP ON-Q SILVERSOAKER DEHP 4 ML/HR L5 IN $1,072.50KIT PEG ENDOVIVE SILICONE STANDARD UNIVERSAL OD20 $749.87KIT PEG ENDOVIVE XYLOCAINE SILICONE OD20 FR 5 ML P $877.50KIT PEG ENDOVIVE XYLOCAINE SILICONE OD24 FR 5 ML P $1,037.56KIT PEG MIC SECUR-LOK SILICONE OD20 FR PULL METHOD $350.00KIT PEG SECUR-LOK MIC SILICONE OD24 FR PULL METHOD $560.00KIT PEG SILICONE L30 CM OD20 FR REPLACEMENT INSERT $750.00KIT PEG SILICONE L60 CM OD21 FR INITIAL PLACEMENT $720.00KIT PERICARDIOCENTESIS PERIVAC LIDOCAINE STRAIGHT $400.00KIT PERICARDIOCENTESIS PIGTAIL L60 CM OD6 FR ID.03 $474.30KIT POSITIONING PAD DISPOSABLE HIP DISTRACTION SYS $1,625.00KIT PREP HIP $692.06KIT PREP QUIK-USE POLYETHYLENE BARIUM SULFATE FEMU $735.80KIT PRESSURE MONITOR CAMINO OD4 FR INTRACRANIAL AC $5,348.85KIT PROCEDURE ECTRA II CARPAL LIGAMENT PROBE RETRO $1,345.50KIT PROCEDURE PRO-DENSE 15 CC CORE DECOMPRESSION $21,824.00KIT REPAIR QUINTON ARGYLE PERI-PATCH BETA-CAP SILI $458.24KIT REVISION COONRAD/MORREY TIVANIUM PLASMA SPRAY C1776 $4,290.00KIT SCREW EQUINOXE SQUARE SHOULDER TORQUE DEFINING C1713 $1,300.00KIT SCREW SHOULDER REVERSE TORQUE DEFINE C1713 $1,300.00KIT SEROLOGY TEST GAMMA ELU-KIT II ELUTION OF IMMU $1,520.00KIT SHUNT ARGYLE PVC STRAIGHT L6 IN OD8-14 FR CARO $1,989.78

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 ChargeKIT SHUNT AXIEM CRANIUM DISPOSABLE $3,320.46KIT SHUNT DLP EMERGENCY STERILE LATEX FREE $408.85KIT SHUNT INNERVISION REGULAR REPLACEMENT ENDOSCOP $7,218.90KIT SHUNT SPETZLER TUOHY ADULT L80 CM L3.5 IN OD14 $3,611.40KIT SNARE AMPLATZ GOOSE NECK NITINOL L120 CM L102 C1773 $1,325.00KIT SNARE AMPLATZ GOOSE NECK NITINOL MICRO L175 CM C1773 $4,062.50KIT SNARE AMPLATZ GOOSENECK MICRO L175 CM L150 CM C1773 $4,062.50KIT SNARE AMPLATZ GOOSENECK NITINOL L120 CM L102 C C1773 $1,325.00KIT SNARE AMPLATZ GOOSENECK NITINOL MICRO L200 CM C1773 $3,150.00KIT SNARE AMPLATZ GOOSENECK NITINOL TUNGSTEN GOLD C1773 $3,150.00KIT SNARE AMPLATZ GOOSENECK NITINOL TUNGSTEN GOLD $3,125.00KIT SNARE ATRIEVE VASCULAR SNARE NITINOL PLATINUM C1773 $2,800.00KIT SPINAL MARS 3V DISPOSABLE $23,808.00KIT SPINAL MAS LIGHT CABLE SELF RETAINING TLIF $2,522.00KIT SPINAL XLIF NEUROVISION DILATOR DISPOSABLE M5 $5,844.74KIT STENT FLEXIMA GLIDEX .038 IN LARGE REGULAR PIG C2617 $1,049.17KIT STENT FLEXIMA GLIDEX .038 IN LARGE REGULAR PIG $1,304.49KIT STEREOTACTIC NEXPROBE STERILE LATEX FREE DISPO $2,206.75KIT STIMULATOR L40 CM OD4.8 MM DEEP BRAIN TUNNELIN $825.50KIT STIMULATOR PRECISION INFINION L50 CM 1 X 16 SP C1778 $20,800.00KIT STIMULATOR SURPASS L70 CM LEAD STERILE LATEX F $13,000.00KIT SURGICAL CARDIOVASCULAR STERILE LATEX DISPOSAB $3,802.50KIT SURGICAL INTERPHLEX SILICONE INTER PHALANGEAL $959.40KIT SURGICAL MAXCESS 4 SPINE STERILE DISPOSABLE $9,092.66KIT SURGICAL PIK PAK EYE CATARACT $1,545.12KIT SURGICAL REVERE PEDICLE ACCESS SPINE $3,061.50KIT SUTURE COR-KNOT MINI COMBO STERILE $4,235.40KIT SUTURE DEKNATEL V-PAK SILKY II POLYDEK 2-0 C-2 $1,530.98KIT SUTURE DISPOSABLE MINI SUTURETAK $1,137.50KIT SUTURE E-PACK $672.54KIT SUTURE FIBERLOOP OD3.2 MM DRILL PIN NEEDLE SHO $4,387.50KIT SYRINGE ACP ALCOHOL ANGEL WING OD19 GA 2 SYRIN $1,137.50KIT THORACENTESIS ARROW-CLARKE PLEURA-SEAL SHARPSA C1729 $170.00KIT THROMBECTOMY PENUMBRA SYSTEM 5MAX ACE L132 CM C1757 $15,340.00KIT THROMBOLYTIC ARROW-TREROTOLA PTD 9 MM L65 CM O $3,737.50KIT THROMBOLYTIC ARROW-TREROTOLA PTD POLYURETHANE $3,450.00KIT THROMBOLYTIC ARROW-TREROTOLA PTD POLYURETHANE C1757 $3,315.00KIT TISSUE CLOSURE COSEAL 4 ML SEALANT STERILE LAT $3,804.40KIT TISSUE CLOSURE DUO TISSEEL 10 ML LATEX FREE $2,626.00

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 ChargeKIT TISSUE CLOSURE DUO TISSEEL 2 ML PREFILL SYRING C9250 $638.37KIT TISSUE CLOSURE DUO TISSEEL 4 ML LATEX FREE $1,925.04KIT TISSUE CLOSURE DUPLOJECT TISSEEL 10 ML 4 SYRIN $4,887.92KIT TISSUE CLOSURE DUPLOJECT TISSEEL 2 ML 4 SYRING $952.71KIT TISSUE CLOSURE DUPLOJECT TISSEEL 2 ML FREEZE D $952.71KIT TISSUE CLOSURE EVICEL CO2 PRESSURE REGULATOR $17,573.92KIT TISSUE CLOSURE EVICEL FIBRIN 1 ML SEALANT $687.77KIT TISSUE CLOSURE EVICEL FIBRIN 20 SQ CM 1 ML SEA $6,875.38KIT TISSUE CLOSURE EVICEL FIBRIN 40 SQ CM 2 ML SEA $12,731.81KIT TISSUE CLOSURE EVICEL FIBRIN 5 ML SEALANT $2,929.29KIT TISSUE CLOSURE EVICEL FIBRIN SEALANT 5 ML PRES $2,928.40KIT TISSUE CLOSURE PROGEL 4 ML PLEURA SEALANT ADHE $5,525.00KIT TRACHEOSTOMY PER-FIT OD12.3 MM ID9.0 MM PERCUT $2,206.80KIT TRACHEOSTOMY PER-FIT PORTEX L82 MM OD9.6 MM ID $2,206.80KIT TRACHEOSTOMY PORTEX BIVONA FOME-CUF CMD SILICO $798.24KIT TRAUMA FIXATION DRILL GUIDE OBTURATOR DISPOSAB $600.00KIT TRAUMA FIXATION SBFS 1.1 MM OD.045 IN $1,696.76KIT TRAUMA FIXATION TIMBERLINE $4,862.00KIT URINALYSIS TEST GLASSTIC 10 CHAMBER ECONOMY TU $766.61KIT UTERINE NOVASURE ENDOMETRIUM 3 SURESOUND DEVIC $7,500.22KIT VENTRICULOSTOMY GHAJAR GUIDE VENTRICULAR CATHE C1729 $3,389.76KIT VENTRICULOSTOMY REGULAR OD6 MM CSF BURR HOLE S C1729 $1,832.00KIT VENTRICULOSTOMY STANDARD RAZOR SPONGE STICK DR $1,696.50KIT VITRECTOMY PERFLUORON 5 ML LIQUID $3,008.00KNIFE ENDOSCOPIC USA ELITE SYSTEM STRAIGHT COLD BL $1,004.25KNIFE SURGICAL L160 MM SHEATHED $1,118.00LABCORP 5-HIAA 83497 $81.00LABCORP ACETYLCHOLINESTERASE 82013 $86.00LABCORP ACTIVATED PROTEIN C RESISTANCE ASSAY 85307 $110.00LABCORP ADENOSINE CYLIC AMP 82030 $40.00LABCORP ADENOVIRUS AB 86603 $100.00LABCORP ADENOVIRUS ANTIGEN INFECTIOUS AGENT IMMUNO 87301 $93.00LABCORP AFB BY ID DNA PROBE 87149 $52.00LABCORP AG DETECT LEGIONELLA EIA, URINE 87449 $93.00LABCORP ALDOLASE 82085 $76.00LABCORP ALKALINE PHOSPHATASE 84075 $144.00LABCORP ALKALINE PHOSPHATASE ISOENZYME 84080 $40.00LABCORP ALLERGEN 86003 $34.00LABCORP ALPHA FETOPROTEIN AMNIOTIC 82106 $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 ChargeLABCORP ALPHA FETOPROTEIN, TUMOR MARKER 82105 $130.00LABCORP ALPHA-1 ANTITRYPSIN 82103 $104.00LABCORP ALPHA-1 ANTITRYPSIN 82104 $90.00LABCORP ALUMINUM 82108 $66.00LABCORP AMIKACIN - PEAK 80150 $73.00LABCORP AMIKACIN - RANDOM 80150 $73.00LABCORP AMIKACIN - TROUGH 80150 $73.00LABCORP AMIODARONE 80299 $86.00LABCORP AMITRIPTYLINE AND NORTRIPTYLINE 80335 $244.00LABCORP AMYLASE ISOENZYMES 82150 $64.00LABCORP AMYLASE, URINE 82150 $64.00LABCORP ANDROSTENEDIONE 82157 $193.00LABCORP ANTIMYOCARDIAL AB 86256 $94.00LABCORP ANTINUCLEAR ANTIBODY SCREEN 86038 $94.00LABCORP ANTISTREPTOLYSIN O 86060 $56.00LABCORP ANTITHROMBIN III ACTIVITY 85300 $85.00LABCORP ARSENIC 82175 $119.00LABCORP ARSENIC URINE 82175 $119.00LABCORP B2 GLYCOPROTEIN AB IGA 86146 $90.00LABCORP B2 GLYCOPROTEIN AB IGG 86146 $90.00LABCORP B2 GLYCOPROTEIN AB IGM 86146 $90.00LABCORP BARTONELLA ANTIBODY (CAT SCRATCH) 86611 $79.00LABCORP BETA-2 MICROGLOBULIN 82232 $126.00LABCORP BILE ACIDS 82239 $109.00LABCORP BIOTINIDASE 82261 $131.00LABCORP BK VIRUS 87799 $281.00LABCORP BK VIRUS URINE 87799 $281.00LABCORP BLASTOMYCES ANTIBODY 86612 $100.00LABCORP BRUCELLA ANTIBODY 86622 $69.00LABCORP C. DIFF TOXIN AG 87324 $117.00LABCORP C1 ESTERASE INHIBITOR 86160 $93.00LABCORP CA 125 86304 $162.00LABCORP CA 19 9 86301 $162.00LABCORP CADMIUM 82300 $179.00LABCORP CADMIUM URINE 82300 $179.00LABCORP CAFFEINE THERAPUTIC DRUG ANALYSIS 80155 $232.00LABCORP CALCITONIN 82308 $168.00LABCORP CALCIUM IONIZED 82330 $133.00LABCORP CARBAMAZEPINE 80156 $90.00

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 ChargeLABCORP CAROTENE 82380 $171.00LABCORP CATECHOLAMINES FRACTION 82384 $196.00LABCORP CATECHOLAMINES FRACTION URINE 82384 $196.00LABCORP CHLAMYDIA ANTIBODY IGG 86631 $92.00LABCORP CHLAMYDIA ANTIBODY IGM 86632 $98.00LABCORP CLOMIPRAMINE 80335 $244.00LABCORP CLONAZEPAM LEVEL 80346 $124.00LABCORP CLOZAPINE (CLOZARIL) 80159 $139.00LABCORP COAGULATION/FIBRINOLYSIS EA ANALYTE 85397 $141.00LABCORP COLD AGGLUTININ TITER 86157 $63.00LABCORP COMPLEMENT C1Q 86160 $93.00LABCORP COMPLEMENT C2 86160 $93.00LABCORP COMPLEMENT C3 86160 $93.00LABCORP COMPLEMENT C5 86160 $93.00LABCORP COMPLEMENT C6 86160 $93.00LABCORP COMPLEMENT TOTAL 86162 $148.00LABCORP COMPLIMENT C8 86160 $93.00LABCORP CORTISOL FREE, URINE 82530 $105.00LABCORP CORTISOL LC/MS 82533 $127.00LABCORP CORTISOL, AM 82533 $127.00LABCORP CORTISOL, PM 82533 $127.00LABCORP C-PEPTIDE 84681 $162.00LABCORP C-REACTIVE PROTEIN 86140 $40.00LABCORP C-REACTIVE PROTEIN HIGH SENSITIVITY 86141 $100.00LABCORP CREATINE KINASE (CK) ISOENZYME 82552 $104.00LABCORP CREATINE KINASE (CPK) 82550 $64.00LABCORP CRYOGLOBULIN 82595 $50.00LABCORP CRYPTOCOCCUS ANTIGEN CSF 87899 $73.00LABCORP CRYPTOCOCCUS ANTIGEN TITER CSF 87449 $93.00LABCORP CULTURE AFB 87116 $151.00LABCORP CULTURE CMV 87254 $151.00LABCORP CULTURE FUNGUS 87101 $54.00LABCORP CULTURE FUNGUS BLOOD 87103 $66.00LABCORP CULTURE STOOL 87045 $66.00LABCORP CULTURE STOOL ADDITIONAL 87046 $63.00LABCORP CULTURE VIRUS 87252 $172.00LABCORP CULTURE VIRUS ID NON IMMUNOLOGIC 87255 $224.00LABCORP CYCLIC CITRUL PEPTIDE (CCP) ANTIBODY 86200 $100.00LABCORP CYCLOSPORA SMEAR 87206 $42.00

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 ChargeLABCORP CYCLOSPORINE 80158 $139.00LABCORP CYSTINE URINE 24 HOUR 82131 $106.00LABCORP CYTOMEGALOVIRUS NUCLEIC ACID PROBE AMPLIFI 87496 $221.00LABCORP CYTOMEGALOVIRUS QUANTITATIVBE NUCLEIC ACID 87497 $332.00LABCORP DEOXYRIBONUCLEASE ANTIBODY 86215 $102.00LABCORP DHEA-S 82627 $172.00LABCORP DRUG TEST PRESUMPTIVE 80307 $382.00LABCORP ECHINOCOCCUS AB IGG 86682 $82.00LABCORP EOSINOPHIL URINE 87205 $33.00LABCORP ERYTHROPOIETIN 82668 $146.00LABCORP ESTRADIOL 82670 $216.00LABCORP ESTRIOL 82677 $152.00LABCORP ESTRONE 82679 $194.00LABCORP ETHOSUXIMIDE 80168 $127.00LABCORP F5 (COAGULATION FACTOR V) GENE LEIDEN VARI 81241 $104.00LABCORP F-ACTIN AB IGG 83516 $89.00LABCORP FACTOR 9 ASSAY 85250 $111.00LABCORP FACTOR VII STABLE FACTOR 85230 $85.00LABCORP FACTOR VIII ASSAY 85240 $110.00LABCORP FACTOR X STUART PROWER 85260 $82.00LABCORP FACTOR XI ASSAY 85270 $82.00LABCORP FAT QUALITATIVE FECES 82705 $32.00LABCORP FAT QUANTITATIVE FECES 82710 $130.00LABCORP FDP/FSP AGGLUTINATION SEMIQUANTITATIVE 85362 $36.00LABCORP FELBAMATE 80339 $244.00LABCORP FERRITIN 82728 $105.00LABCORP FLOW CYTOMETRY 2 TO 8 MARKERS, INTERP 88187 $167.00LABCORP FLUOXETINE 80332 $244.00LABCORP FOLIC ACID 82746 $114.00LABCORP FOLIC ACID RBC 82747 $17.00LABCORP FREE LIGHT CHAIN, SERUM 83883 $36.00LABCORP FSH 83001 $144.00LABCORP G6-PD QUANT 82955 $21.00LABCORP GABAPENTIN BLD/SRM/PLASMA THERAPUTIC DRUG 80171 $81.00LABCORP GASTRIN 82941 $113.00LABCORP GENTAMICIN THERAPEUTIC DRUG ANALYSIS - PEA 80170 $90.00LABCORP GENTAMICIN THERAPEUTIC DRUG ANALYSIS - TRO 80170 $90.00LABCORP GGT (GLUTAMYLTRANSFERASE GAMMA) 82977 $70.00LABCORP GIARDIA ANTIGEN 87329 $86.00

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 ChargeLABCORP GLUCAGON 82943 $89.00LABCORP GLUCOSE BODY FLUID 82945 $31.00LABCORP GLUTAMIC ACID DECARBOXYLASE AB 83516 $89.00LABCORP GROWTH HORMONE 83003 $103.00LABCORP HALOPERIDOL (HALDOL) THERAPUTIC DRUG ANALY 80173 $90.00LABCORP HAPTOGLOBIN 83010 $98.00LABCORP HAPTOGLOBIN QUANT 83010 $98.00LABCORP HCG QUANTITATIVE TUMOR MARKER 84702 $117.00LABCORP HEMATOCRIT 85014 $133.00LABCORP HEMOGLOBIN CHROMATOGRAPHY 83021 $139.00LABCORP HEP B SURFACE AB 86706 $79.00LABCORP HEPARIN ASSAY 85520 $61.00LABCORP HEPATITIS A (HAAB) ANTIBODY 86708 $90.00LABCORP HEPATITIS B CORE ANTIBODY TOTAL 86704 $100.00LABCORP HEPATITIS B QUANTATIVE NUCLEIC ACID PROBE 87517 $332.00LABCORP HEPATITIS BE ANTIBODY 86707 $79.00LABCORP HEPATITIS BE ANTIGEN INFECTIOUS AGENT IMMU 87350 $87.00LABCORP HEPATITIS C ANTIBODY CONFIRM (RIBA) 86804 $120.00LABCORP HERPES (HSV) NUCLEIC ACID PROBE AMPLIFIED 87529 $232.00LABCORP HERPES SIMPLEX TYPE 2 ANTIBODY 86696 $177.00LABCORP HGB A2 83021 $139.00LABCORP HGB LCA INTERP 85660 $39.00LABCORP HISTOPLASMA AG 87385 $80.00LABCORP HISTOPLASMA ANTIBODY 86698 $82.00LABCORP HIV 1 ANTIBODY???????????????????????????? 86701 $69.00LABCORP HIV 2 ANTIBODY???????????????????????????? 86702 $82.00LABCORP HIV GENOTYPE ANALYSIS BY DNA OR RNA 87901 $1,697.00LABCORP HIV PHENOTYPE W/CULTURE 87903 $3,070.00LABCORP HIV PHENOTYPE W/CULTURE ADDITIONAL 87904 $202.00LABCORP HIV1 NUCLEIC ACID PROBE AMPLIFIED 87535 $289.00LABCORP HIV1 QNT PCR 87536 $659.00LABCORP HLA-B5701 81381 $733.00LABCORP HOMOCYSTEIN 83090 $131.00LABCORP HSV 1 AB IGG 86695 $121.00LABCORP HSV 1/2 AB IGM 86694 $90.00LABCORP HSV 1/2 AB IGM CSF 86694 $90.00LABCORP IGE GAMMAGLOBULIN 82785 $128.00LABCORP IGH/BCL2 FISH 88366 $1,062.00LABCORP IMIPRAMINE 80335 $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 ChargeLABCORP IMMUNOGLOBULIN A 82784 $72.00LABCORP IMMUNOGLOBULIN G 82784 $72.00LABCORP IMMUNOGLOBULIN M 82784 $72.00LABCORP IN SITU HYBRIDIZATION PER SPECIMEN MAN EA 88377 $1,017.00LABCORP INSULIN ANTIBODY 86337 $81.00LABCORP INTRINSIC FACTOR ANTIBODY 86340 $117.00LABCORP KOH SMEAR FLUORESCENT/ACID STAIN 87206 $42.00LABCORP LACTATE DEHYDROGENASE (LDH) 83615 $47.00LABCORP LAMOTRIGINE (LAMICTAL) 80175 $82.00LABCORP LD BLOOD 83615 $47.00LABCORP LD ISOENZYME 83625 $71.00LABCORP LEAD BLOOD 83655 $77.00LABCORP LEAD URINE 83655 $77.00LABCORP LEAD WHOLE BLOOD 83655 $77.00LABCORP LEGIONELLA ANTIBODY 86713 $118.00LABCORP LEGIONELLA ANTIGEN IMMUNOFLUORESCENT 87278 $77.00LABCORP LEVETIRACETAM (KEPRA) 80177 $82.00LABCORP LIDOCAINE 80176 $99.00LABCORP LIPASE 83690 $53.00LABCORP LIPOPROTEIN (A) 83695 $77.00LABCORP LITHIUM 80178 $51.00LABCORP LIVER KIDNEY MICROSOME AB 86376 $113.00LABCORP LUTEINIZING HORMONE 83002 $144.00LABCORP LYME DISEASE AB CONFIRM 86617 $120.00LABCORP LYME DISEASE ANTIBODY 86618 $132.00LABCORP LYSOZYME (MURAMIDASE) 85549 $110.00LABCORP M MARINUM SUSC 87186 $85.00LABCORP MAC SUSC 87186 $85.00LABCORP MAGNESIUM URINE 83735 $65.00LABCORP MATERNAL SCREEN QUAD 81511 $82.00LABCORP METANEPHRINE FRACTIONATED 83835 $131.00LABCORP METANEPHRINE FRACTIONATED, URINE 83835 $131.00LABCORP MEXILETINE 80299 $86.00LABCORP MIC PER PLATE 87186 $85.00LABCORP MIC PER PLATE RAPID 87186 $85.00LABCORP MIC PER PLATE SLOW 87186 $85.00LABCORP MICROALBUMIN URINE QUANTITATIVE 82043 $45.00LABCORP MITOCHONDRIAL M2 AB IGG 83516 $89.00LABCORP MMA URINE 83921 $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 ChargeLABCORP MOLECULAR CYTO HER-2/NEU 88271 $166.00LABCORP MTB AST CONFIRM 87190 $44.00LABCORP MTB SUSC BROTH 87188 $563.00LABCORP MTHFR (5,10-METHYLENETETRAHYDROFOLATE REDU 81291 $427.00LABCORP MUMPS ANTIBODY IGG 86735 $85.00LABCORP MUMPS ANTIBODY IGM 86735 $85.00LABCORP MYCO TB PROBE 87556 $172.00LABCORP MYCOBACTERIA TB NUCLEIC ACID PROBE AMPLIFI 87556 $221.00LABCORP MYCOPLASMA PNEUMONIA, IGG 86738 $372.00LABCORP MYCOPLASMA PNEUMONIA, IGM 86738 $86.00LABCORP NEPHELOMETRY 83883 $36.00LABCORP NORTRIPTYLINE 80335 $244.00LABCORP ORGANISM ID 87153 $894.00LABCORP OSMOLALITY 83930 $51.00LABCORP OSMOLALITY STOOL 84999 $112.00LABCORP OSMOLALITY, URINE 83935 $53.00LABCORP OXALATE, URINE 24 HOUR 83945 $100.00LABCORP OXCARBAZEPINE (TRILEPTAL) 80183 $82.00LABCORP PARIETAL CELL ANTIBODY IGG 83516 $89.00LABCORP PARTIAL THROMBOPLASTIN SUBSTITUTION 85732 $271.00LABCORP PARVOVIRUS B19 IGG 86747 $93.00LABCORP PARVOVIRUS B19 IGM 86747 $93.00LABCORP PH STOOL 83986 $28.00LABCORP PHENOTYPE PREDICT 87900 $1,010.00LABCORP PHOSPHOROUS URINE 84105 $40.00LABCORP PINWORM EXAM 87172 $27.00LABCORP PLASMINOGEN ASSAY 85420 $47.00LABCORP PLT AB PROFILE 86022 $143.00LABCORP PNEUMOCYSTIS CARINII ANTIGEN IMMUNOFLUORES 87281 $80.00LABCORP PORPHOBILINOGEN URINE QUALITATIVE 84106 $33.00LABCORP PORPHOBILINOGEN URINE QUANTITATIVE 84110 $32.00LABCORP PORPHYRIN 84311 $412.00LABCORP PORPHYRINS URINE QUANTITATIVE FRACTIONATIO 84120 $94.00LABCORP PRIMIDONE 80188 $129.00LABCORP PROCAINAMIDE W/NAPA 80192 $130.00LABCORP PROCALCITONIN 84145 $168.00LABCORP PROGESTERONE 84144 $162.00LABCORP PROLACTIN 84146 $150.00LABCORP PROSTATIC ACID PHOSPHATASE 84066 $62.00

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 ChargeLABCORP PROTEIN C ACTIVITY 85303 $114.00LABCORP PROTEIN C ANTIGEN 85302 $86.00LABCORP PROTEIN ELECTROPHORESIS 84165 $83.00LABCORP PROTEIN ELECTROPHORESIS URINE 84166 $29.00LABCORP PROTEIN S FREE 85306 $110.00LABCORP PROTEIN S FUNCTIONAL 85306 $110.00LABCORP PROTEIN S TOTAL 85305 $83.00LABCORP PROTEIN TOTAL 84155 $33.00LABCORP PROTEIN TOTAL URINE 84156 $29.00LABCORP PSA SCREEN 84153 $143.00LABCORP PSA TOTAL 84153 $143.00LABCORP PSEUDOCHOLINESTERASE 82480 $61.00LABCORP PTT-LA MIX 85730 $54.00LABCORP PYRUVATE 84210 $84.00LABCORP PYRUVATE KINASE 84220 $73.00LABCORP QUINIDINE 80194 $113.00LABCORP RBC COUNT AUTOMATED ONLY 85041 $76.00LABCORP RENIN 84244 $170.00LABCORP RETIC COUNT AUTOMATED 85045 $29.00LABCORP RHEUMATOID FACTOR QUANT 86431 $44.00LABCORP ROTAVIRUS ANTIGEN INFECTIOUS AGENT IMMUNOA 87425 $77.00LABCORP RUBELLA ANTIBODY IGG 86762 $112.00LABCORP RUBELLA ANTIBODY IGM 86762 $112.00LABCORP RUBEOLA AB, IGG 86765 $100.00LABCORP RUSSELL VIPER VENOM DILUTED 85613 $68.00LABCORP SHIGA LIKE TOXIN 87427 $70.00LABCORP SICKLE CELL RBC 85660 $39.00LABCORP SIROLIMUS (RAPAMYCIN) 80195 $106.00LABCORP SMEAR FLUORESCENT/ACID STAIN 87015 $52.00LABCORP SMEAR FLUORESCENT/ACID STAIN 87206 $42.00LABCORP SOMATOMEDIN - C 84305 $114.00LABCORP SS-A IGG 86235 $33.00LABCORP SS-B IGG 86235 $90.00LABCORP SSDNA AB 84156 $29.00LABCORP STOOL WBC STAIN 87205 $33.00LABCORP STREP GROUP B W/DIRECT OPTICAL OBSERVATION 87802 $93.00LABCORP STREP PNEUMO AG 87899 $73.00LABCORP T GONDII AB IGG 86777 $112.00LABCORP T GONDII AB IGM 86778 $96.00

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 ChargeLABCORP T3 REVERSE 84482 $106.00LABCORP T3 UPTAKE 84479 $36.00LABCORP TACROLIMUS 80197 $106.00LABCORP TEICHOIC ACID AB 86609 $32.00LABCORP TESTOSTERONE 84403 $200.00LABCORP TESTOSTERONE FREE 84402 $197.00LABCORP TETANUS/DIPHTHERIA AB 86317 $116.00LABCORP THROMBIN CLOTTING TIME 85670 $34.00LABCORP THYROGLOBULIN 84432 $102.00LABCORP THYROGLOBULIN ANTIBODY 86800 $124.00LABCORP THYROID STIMULATING IMMUNOGLOBULINS 84445 $143.00LABCORP THYROXINE BINDING GLOBULIN (TBG) 84442 $101.00LABCORP TISSUE GRINDING 87176 $46.00LABCORP TOBRAMYCIN PEAK 80200 $90.00LABCORP TOBRAMYCIN TROUGH 80200 $90.00LABCORP TRANSFERRIN 84466 $99.00LABCORP TREPONEMA PALLIDUM ANTIBODY 86780 $129.00LABCORP TREPONEMA PALLIDUM FTA ABS 86780 $129.00LABCORP TROFILE CO-RECEPTOR 87906 $998.00LABCORP TROFILE DNA PDF 87901 $1,697.00LABCORP URIC ACID URINE 84560 $37.00LABCORP URINE 82570 $40.00LABCORP VALPROIC ACID TOTAL 80164 $105.00LABCORP VANILLYMANDELIC ACID (VMA) URINE 84585 $98.00LABCORP VARICELLA ZOSTER ANTIBODY IGG 86787 $110.00LABCORP VDRL CSF 86592 $33.00LABCORP VITAMIN A 84590 $113.00LABCORP VITAMIN B-1 (THIAMINE) 84425 $165.00LABCORP VITAMIN B12 82607 $117.00LABCORP VITAMIN B-2 (RIBOFLAVIN) 84252 $128.00LABCORP VITAMIN B6 (PYRIDOXINE) 84207 $110.00LABCORP VITAMIN C (ASCORBIC ACID) 82180 $56.00LABCORP VITAMIN D (1 25 HYDROXY) 82652 $298.00LABCORP VITAMIN D-3 25-OH 82306 $230.00LABCORP VITAMIN E (ALPHA TOCOPHEROL) 84446 $110.00LABCORP VON WILLEBRAND FACTOR AG 85246 $141.00LABCORP VONWILLEBRAND FACTOR ACT 85245 $141.00LABCORP VZV BY PCR 87798 $1,125.00LABCORP WET PREP 87210 $33.00

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 ChargeLABCORP ZINC 84630 $88.00LABCORP ZINC URINE 84630 $88.00LABCORP ZONISAMIDE (ZONEGRAN) THERAPUTIC DRUG ANAL 80203 $100.00LABCORPISLET CELL ANTIBODY 86341 $153.00LABCORP-THYROID PEROXIDASE TPO AB 86376 $113.00LABIAL VENEER RESIN LAMINATE D2961 $738.00LACOSAMIDE 10 MG/ML SOLN 200 ML BOTTLE $57.55LACOSAMIDE 200 MG TAB 60 EACH BLIST PACK $13.51LACOSAMIDE 50 MG TAB 60 EACH BLIST PACK $32.63LACTATE DEHYDROGENASE (ENZYME) MEASUREMENT 83625 $71.00LACTATE,CSF 83605 $104.00LACTIC ACID LEVEL 83605 $104.00LAMELLAR BODY DENSITY SENDOUT 83664 $147.00LAMIVUDINE-ZIDOVUDINE 150-300 MG TAB 60 EACH BOTTL $40.01LAMOTRIGINE LEVEL 80175 $82.00LANGUAGE EXPRESSION FUNCTIONAL LIMIT CURRENT STATU G9162 $0.01LANGUAGE EXPRESSION FUNCTIONAL LIMIT DISCHARGE STA G9164 $0.01LANGUAGE EXPRESSION FUNCTIONAL LIMIT GOAL STATUS G9163 $0.01LANGUAGE FUNCTIONAL LIMIT CURRENT STATUS G9159 $0.01LANGUAGE FUNCTIONAL LIMIT DISCHARGE STATUS G9161 $0.01LANGUAGE FUNCTIONAL LIMIT GOAL STATUS G9160 $0.01LARYNGOSCOPY DIRECT WITH OR WITHOUT TRACHEOSCOPY W 31527 $706.00LARYNGOSCOPY FLEXIBLE FIBEROPTIC WITH REMOVAL OF F 31577 $1,245.00LARYNGOSCOPY INDIRECT WITH REMOVAL OF FOREIGN BODY 31511 $527.00LASER DESTRUCTION OF ANAL GROWTHS 46917 $6,329.00LASER DESTRUCTION OF CERVIX 57513 $5,366.00LASER DESTRUCTION OF EYE FLUID (VITREOUS) BETWEEN 67040 $10,749.00LASER DESTRUCTION OF INCOMPETENT VEIN OF ARM OR LE 36478 $9,971.00LASER DESTRUCTION OF INSUFFICIENT VEIN OF ARM OR L 36479 $175.00LASER DESTRUCTION OF LEAKING RETINAL BLOOD VESSELS 67228 $1,833.00LASER DESTRUCTION OF RETINAL GROWTH, 1 OR MORE SES 67210 $1,833.00LASER RELEASE OF SCAR TISSUE BETWEEN THE LENS AND 67031 $1,833.00LASER REMOVAL OF SCAR TISSUE IN EYE 65860 $1,833.00LASER REPAIR TO IMPROVE EYE FLUID FLOW, 1 OR MORE 65855 $1,833.00LASER VAPORIZATION OF PROSTATE INCLUDING CONTROL B 52648 $14,557.00LDH CSF 83615 $47.00LDL CHOLESTEROL LEVEL 83721 $66.00LEAD DEFIBRILLATOR DURATA SJ4 OPTIM 21 CM SPACE L6 C1895 $15,000.00LEAD DEFIBRILLATOR DURATA STEROID ELUTING 17 CM SP C1777 $15,000.00

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 ChargeLEAD DEFIBRILLATOR DURATA STEROID ELUTING SILICONE C1777 $19,500.00LEAD DEFIBRILLATOR ENDOTAK RELIANCE S STEROID SILI C1777 $22,750.00LEAD DEFIBRILLATOR ENDOTAK RELIANCE STEROID SILICO C1895 $22,750.00LEAD DEFIBRILLATOR TENSI-LOCK SPRINT QUATTRO SECUR C1777 $16,500.00LEAD DEFIBRILLATOR TRANSVENE SILICONE MEDIUM L50 C C1896 $6,175.00LEAD ICD LINOXSMART S DX DEXAMETHASONE ACETATE L65 C1777 $19,500.00LEAD ICD SPRINT QUATTRO DEXAMETHASONE ACETATE L55 C1895 $21,450.00LEAD ICD SPRINT QUATTRO SECURE S L62 CM RIGHT VENT C1777 $25,350.00LEAD ICD SPRINT QUATTRO TENSI-LOCK ISOGLIDE STEROI C1895 $21,450.00LEAD ICD TENSI-LOCK SPRINT QUATTRO ISOGLIDE STEROI C1895 $21,450.00LEAD ICD VOLTA 1 COIL 1CR65 C1777 $18,564.00LEAD ICD VOLTA 2 COIL 2CR60/16 C1777 $18,564.00LEAD ICD VOLTA 2 COIL 2CR65/18 C1777 $18,564.00LEAD LEVEL 83655 $77.00LEAD NEUROSTIMULATOR INTERSTIM 3 MM SPACE STRAIGHT C1778 $18,720.00LEAD NEUROSTIMULATOR INTERSTIM L28 CM QUADRIPOLAR C1778 $18,720.00LEAD NEUROSTIMULATOR INTERSTIM L41 CM SPINAL CORD C1778 $18,720.00LEAD NEUROSTIMULATOR INTERSTIM SPINAL CORD TEST ST C1778 $728.00LEAD NEUROSTIMULATOR INTERSTIM TEST STIMULATION ST C1778 $75.83LEAD NEUROSTIMULATOR INTRODE-AK 4 MM SPACE L60 CM C1897 $3,900.00LEAD NEUROSTIMULATOR L90 CM L8 CM X W1 CM OD5 MM E C1778 $12,935.00LEAD NEUROSTIMULATOR LAMITRODE 4 MM SPACE L60 CM 4 C1778 $15,600.00LEAD NEUROSTIMULATOR OCTAD L60 CM SPINAL CORD PERM C1778 $9,750.00LEAD NEUROSTIMULATOR OCTRODE 3 MM 4 MM SPACE L90 C C1778 $13,000.00LEAD NEUROSTIMULATOR ON-POINT W6.6 MM X H1.4 MM CO C1778 $14,400.00LEAD NEUROSTIMULATOR PENTA 3 MM L60 CM PADDLE 16 C C1778 $27,625.00LEAD NEUROSTIMULATOR PERENNIAFLEX SILICONE L43 CM C1778 $54,624.00LEAD NEUROSTIMULATOR PRECISION .014 IN L50 CM TRIA C1778 $5,200.00LEAD NEUROSTIMULATOR PRECISION ARTISAN PLATNALOCK C1778 $19,500.00LEAD NEUROSTIMULATOR PRECISION STRAIGHT L30 CM PER C1778 $9,750.00LEAD NEUROSTIMULATOR PRECISION STRAIGHT L50 CM PER C1778 $9,750.00LEAD NEUROSTIMULATOR PRECISION STRAIGHT L70 CM PER C1778 $9,750.00LEAD NEUROSTIMULATOR QUATTRODE 4 MM SPACE L60 CM O C1778 $12,041.25LEAD NEUROSTIMULATOR QUATTRODE L90 CM 4 CHANNEL WI C1778 $12,041.25LEAD NEUROSTIMULATOR RESTOREULTRA OCTAD 4 MM L45 C C1778 $9,750.00LEAD NEUROSTIMULATOR STRAIGHT CYLINDER FIRM STERIL C1778 $18,089.50LEAD NEUROSTIMULATOR VECTRIS L60 CM OD5 MM 1 X 8 E C1778 $12,935.00LEAD NEUROSTIMULATOR VECTRIS L60 CM OD5 MM 1 X 8 E C1897 $4,550.00LEAD PACING ATTAIN ABILITY PLUS STEROID ELUTING PO C1900 $11,225.00

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 ChargeLEAD PACING ATTAIN ABILITY STEROID L88 CM OD4 FR V C1900 $9,500.00LEAD PACING ATTAIN ABILITY STRAIGHT L88 CM CORONAR C1900 $14,592.50LEAD PACING ATTAIN PERFORMA MRI SURESCAN STEROID P C1900 $14,592.50LEAD PACING ATTAIN PERFORMA MRI SURESCAN STEROID S C1900 $12,350.00LEAD PACING ATTAIN STARFIX STEROID ELUTING POLYURE C1900 $11,225.00LEAD PACING ATTAIN STEROID ELUTING ANGLE L88 CM OD C1900 $8,455.00LEAD PACING CAPSURE EPI L35 CM EPICARDIUM UNIPOLAR C1898 $3,736.00LEAD PACING CAPSURE SENSE STEROID ELUTING L52 CM A C1898 $3,035.50LEAD PACING CAPSURE SENSE STEROID ELUTING L58 CM O C1898 $3,035.50LEAD PACING CAPSUREFIX NOVUS L110 CM ATRIUM VENTRI C1898 $2,567.50LEAD PACING CAPSUREFIX NOVUS L25 CM ATRIOVENTRICUL C1898 $2,567.50LEAD PACING CAPSUREFIX NOVUS L65 CM ATRIUM VENTRIC C1898 $3,035.50LEAD PACING CAPSUREFIX NOVUS MRI SURESCAN STEROID C1898 $2,567.50LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING PLATI C1898 $2,567.50LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING POLYU C1898 $2,567.50LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING SILIC C1898 $3,035.50LEAD PACING CELERITY SILICONE 2D L87 CM LEFT VENTR C1900 $13,260.00LEAD PACING CELERITY SILICONE 3D HELIX L87 CM LEFT C1900 $13,260.00LEAD PACING CELERITY SILICONE L87 CM LEFT VENTRICU C1900 $13,260.00LEAD PACING DURATA STEROID ELUTING L60 CM OD7 FR E C1895 $24,000.00LEAD PACING DURATA STEROID ELUTING L65 CM OD7 FR E C1895 $24,000.00LEAD PACING ENDOTAK RELIANCE 4-SITE GORE STEROID E C1777 $22,750.00LEAD PACING ENDOTAK RELIANCE GORE STEROID ELUTING C1895 $22,750.00LEAD PACING ENDOTAK RELIANCE STEROID ELUTING SILIC C1895 $22,750.00LEAD PACING ISOFLEX OPTIM STEROID ELUTING 10 MM SP C1898 $2,275.00LEAD PACING ISOFLEX S SILICONE STRAIGHT L58 CM OD7 C1898 $2,880.00LEAD PACING L30 CM 8 ELECTRODE 2 4 CHANNEL ADAPTER C1883 $5,526.63LEAD PACING L88 CM VEIN 2 ELECTRODE OTW C1900 $11,225.00LEAD PACING LINOX SMART S DXA SILICONE L65 CM L17 C1777 $19,500.00LEAD PACING QUARTET OPTIM 47 MM SPACE TRADITIONAL $6,500.00LEAD PACING QUARTET OPTIM LOW PROFILE S CURVE NARR C1900 $6,500.00LEAD PACING SELECTSECURE L69 CM ATRIUM VENTRICLE B C1898 $3,035.50LEAD PACING SETROX S DXA SILICONE 10 MM J STRAIGHT C1898 $2,405.00LEAD PACING SETROX S DXA SILICONE 10 MM TIP TO RIN C1898 $2,405.00LEAD PACING SILICONE HELIX L45 CM ATRIAL TILDA C1887 $3,471.00LEAD PACING SILICONE HELIX L53 CM ATRIAL TILDA C1887 $3,471.00LEAD PACING SILICONE HELIX L60 CM VENTRICLE TILDA C1887 $3,471.00LEAD PACING SILICONE L35 CM OD6.6 FR MYOCARDIUM IS C1898 $2,567.50LEAD PACING SILICONE L53 CM OD6.6 FR MYOCARDIUM UN C1898 $3,035.50

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 ChargeLEAD PACING SILICONE L58 CM L33 CM OD7.5 FR ODSEC1 C1896 $10,125.00LEAD PACING SOLIA S L53 CM ENDOCARDIAL PROMRI $2,800.00LEAD PACING SOLIA S STEROID ELUTING L45 CM BIPOLAR C1898 $2,800.00LEAD PACING SPRINT QUATTRO SECURE DEXAMETHASONE SO C1777 $25,350.00LEAD PACING SPRINT QUATTRO SECURE L58 CM 1 COIL DE C1777 $25,350.00LEAD PACING SPRINT QUATTRO SECURE S L55 CM RIGHT V C1777 $25,350.00LEAD PACING SPRINT QUATTRO SECURE STEROID ELUTING C1895 $19,500.00LEAD PACING SPRINT QUATTRO SECURE STEROID ELUTING C1777 $16,500.00LEAD PACING STREAMLINE L53 CM MYOCARDIUM TEMPORARY $280.00LEAD PACING TENDRIL ST OPTIM STERIOD ELUTING SILIC C1898 $1,750.00LEAD PACING TENDRIL ST OPTIM STEROID ELUTING TITAN C1898 $1,750.00LEAD PACING TENDRIL STS STEROID ELUTING HELIX L58 C1898 $1,750.00LEAD PACING TENDRIL STS TITANIUM NITRIDE OPTIM L46 C1898 $1,750.00LEAD PACING TENDRIL STS TITANIUM NITRIDE OPTIM L52 C1898 $2,275.00LEAD PACING TILDA SILICONE J L45 CM PASSIVE FIXATI C1898 $3,471.00LEAD PACING TILDA SILICONE J L53 CM PASSIVE FIXATI C1898 $3,471.00LEAD PACING TILDA SILICONE STRAIGHT L53 CM PASSIVE C1898 $3,471.00LEAD PACING TILDA SILICONE STRAIGHT L60 CM PASSIVE C1898 $3,471.00LEGIONELLA AB,IGG 86713 $118.00LENS INTRAOCULAR ACRYSOF IQ 0 D +3 CYLINDER BICONV V2787 $3,217.50LENS INTRAOCULAR ACRYSOF IQ 0 D MODIFY L BICONVEX V2632 $968.50LENS INTRAOCULAR ACRYSOF IQ ACRYLIC 0 D +2.25 CYLI V2787 $3,217.50LENS INTRAOCULAR ACRYSOF IQ NATURAL ACRYLIC 0 D +2 V2632 $1,192.00LENS INTRAOCULAR ACRYSOF IQ NATURAL STABLEFORCE AC V2632 $1,192.00LENS INTRAOCULAR ACRYSOF IQ RESTOR STABLEFORCE ACR V2788 $5,817.50LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRY V2787 $3,217.50LENS INTRAOCULAR ACRYSOF NATURAL EXPAND MONOFLEX 5 V2632 $968.50LENS INTRAOCULAR ACRYSOF NATURAL IQ RESTOR STABLEF V2788 $5,817.50LENS INTRAOCULAR ACRYSOF NATURAL STABLEFORCE ACRYL V2632 $968.50LENS INTRAOCULAR KELMAN MULTIFLEX III PMMA +6.5 DI V2630 $552.50LENS INTRAOCULAR SLANT PMMA 5 D +21.5 DIOPTER BICO V2632 $325.00LENS INTRAOCULAR TECNIS PROTEC HYDROPHOBIC ACRYLIC V2632 $760.50LEUPROLIDE (6 MONTH) 45 MG SYKT 1 EACH KIT J9217 $29,472.65LEVALBUTEROL 1.25 MG/3 ML NEBU 3 ML VIAL $8.78LEVETIRACETAM LEVEL 80177 $82.00LEVOFLOXACIN IN D5W 750 MG/150 ML PGBK 150 ML BAG J1956 $72.00LIDOCAINE 10 MG/ML (1 %) SOLN 20 ML VIAL $20.05LIDOCAINE 2 % SOLN 15 ML CUP $3.00LIDOCAINE LEVEL 80176 $99.00

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 ChargeLIDOCAINE-EPINEPHRINE 1 %-1:100,000 SOLN 20 ML VIA $20.06LIDOCAINE-EPINEPHRINE BIT 2 %-1:100,000 CRTG 1.7 M $20.49LIFTER SURGICAL ORISE INTERJECT GEL 23 G 10 ML SYR $1,267.50LIGATOR ENDOSCOPIC POLYLOOP NYLON L2300 MM OD30 MM $746.45LIGATOR ENDOSCOPIC SPEEDBAND SUPERVIEW SUPER 7 2.8 $762.50LIMITED GROSS AND/OR MICROSCOPIC AUTOPSY 88036 $760.00LIMITED GROSS AND/OR MICROSCOPIC AUTOPSY SINGLE OR 88037 $760.00LIMITED ORAL EVALUATION D0140 $100.00LINER ACETABULAR CONNEXION GXL 15 G ID32 MM HIP C1776 $3,900.00LINER ACETABULAR DJO SURGICAL HXE+ MP5 NEUTRAL OD3 C1776 $3,900.00LINER ACETABULAR DJO SURGICAL HXE+ MP6 NEUTRAL OD3 C1776 $3,900.00LINER ACETABULAR DJO SURGICAL HXE+ MP8 NEUTRAL OD4 C1776 $3,900.00LINER ACETABULAR DJO SURGICAL HXE+ MP9 NEUTRAL HIP C1776 $3,900.00LINER ACETABULAR DURALOC BANTAM ENDURON 10 D OD40 C1776 $4,709.25LINER ACETABULAR DURALOC BANTAM ENDURON 10 D OD42 C1776 $4,709.25LINER ACETABULAR DURALOC MARATHON 10 D +4 MM NEUTR C1776 $9,750.00LINER ACETABULAR FREEDOM ARCOM 23 +5 MM STANDARD F C1776 $15,200.00LINER ACETABULAR G7 A ID28 MM HIP HIGH WALL C1776 $4,225.00LINER ACETABULAR G7 ARCOMXL E NEUTRAL ID36 MM HIP C1776 $4,225.00LINER ACETABULAR G7 ARCOMXL G NEUTRAL ID36 MM HIP C1776 $4,225.00LINER ACETABULAR G7 C NEUTRAL ID32 MM HIP C1776 $4,225.00LINER ACETABULAR G7 COCR D ID40 MM HIP 2 MOBILITY C1776 $4,225.00LINER ACETABULAR G7 COCR E ID42 MM HIP 2 MOBILITY C1776 $4,225.00LINER ACETABULAR G7 COCR F ID44 MM HIP 2 MOBILITY C1776 $4,225.00LINER ACETABULAR G7 COCR G ID46 MM HIP 2 MOBILITY C1776 $4,225.00LINER ACETABULAR G7 COCR H ID50 MM HIP 2 MOBILITY C1776 $4,225.00LINER ACETABULAR G7 D NEUTRAL ID36 MM HIP C1776 $4,225.00LINER ACETABULAR G7 E NEUTRAL ID36 MM HIP C1776 $4,225.00LINER ACETABULAR G7 E1 D ID36 MM HIP HIGH WALL C1776 $4,225.00LINER ACETABULAR G7 E1 E ID36 MM HIP HIGH WALL C1776 $4,225.00LINER ACETABULAR G7 E1 F ID36 MM HIP HIGH WALL C1776 $4,225.00LINER ACETABULAR G7 E1 F NEUTRAL ID40 MM HIP C1776 $4,225.00LINER ACETABULAR G7 E1 G ID36 MM HIP HIGH WALL C1776 $4,225.00LINER ACETABULAR G7 F NEUTRAL ID36 MM HIP C1776 $4,225.00LINER ACETABULAR G7 G NEUTRAL ID36 MM HIP C1776 $4,225.00LINER ACETABULAR G7 H NEUTRAL ID36 MM HIP C1776 $4,225.00LINER ACETABULAR HIGHCROSS DMG OD54 MM ODSEC28 MM C1776 $3,900.00LINER ACETABULAR LONGEVITY 45 D KK OD56 MM ID32 MM C1776 $13,000.00LINER ACETABULAR LONGEVITY D1 MM 1.8 MM OFFSET OD6 C1776 $12,350.00

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 ChargeLINER ACETABULAR LONGEVITY D1 MM 1.8 MM OFFSET OD7 C1776 $12,350.00LINER ACETABULAR LONGEVITY GG ELEVATED RIM OD48 MM C1776 $4,225.00LINER ACETABULAR LONGEVITY GG NEUTRAL OD46 MM ID28 C1776 $4,225.00LINER ACETABULAR LONGEVITY II NEUTRAL OD52 MM ID36 C1776 $4,225.00LINER ACETABULAR LONGEVITY JJ NEUTRAL OD54 MM ID36 C1776 $4,225.00LINER ACETABULAR LONGEVITY KK ELEVATED RIM OD56 MM C1776 $4,225.00LINER ACETABULAR LONGEVITY KK NEUTRAL OD56 MM ID36 C1776 $4,550.00LINER ACETABULAR LONGEVITY KK NEUTRAL OD56 MM ID40 C1776 $4,225.00LINER ACETABULAR LONGEVITY LL NEUTRAL OD58 MM ID36 C1776 $4,550.00LINER ACETABULAR LONGEVITY MM NEUTRAL OD60 MM ID36 C1776 $4,225.00LINER ACETABULAR LONGEVITY OO NEUTRAL OD64 MM ID36 C1776 $4,225.00LINER ACETABULAR MAX-ROM E-POLY +3 MM 22 ID32 MM H C1776 $4,225.00LINER ACETABULAR MAX-ROM E-POLY +3 MM 23 ID36 MM H C1776 $4,225.00LINER ACETABULAR MAX-ROM E-POLY +3 MM 24 ID40 MM H C1776 $4,225.00LINER ACETABULAR MAX-ROM E-POLY +3 MM 25 ID40 MM H C1776 $4,225.00LINER ACETABULAR MAX-ROM E-POLY +3 MM 26 ID40 MM H C1776 $4,225.00LINER ACETABULAR MDM COCR D ID38 MM HIP 22.2 MM FE C1776 $4,719.00LINER ACETABULAR MDM COCR E OD42 MM HIP 2 MOBILITY C1776 $4,719.00LINER ACETABULAR MDM COCR F ID46 MM HIP 28 MM FEMO C1776 $4,719.00LINER ACETABULAR MDM COCR G OD48 MM HIP 2 MOBILITY C1776 $4,719.00LINER ACETABULAR MPACT UHMWPE HIGHCROSS C OD32 MM C1776 $3,900.00LINER ACETABULAR MPACT UHMWPE HIGHCROSS D OD32 MM C1776 $3,900.00LINER ACETABULAR MPACT UHMWPE HIGHCROSS E OD32 MM C1776 $3,900.00LINER ACETABULAR MPACT UHMWPE HIGHCROSS E OD36 MM C1776 $3,900.00LINER ACETABULAR MPACT UHMWPE HIGHCROSS F OD48 MM C1776 $3,900.00LINER ACETABULAR MPACT UHMWPE HIGHCROSS G OD52 MM C1776 $3,900.00LINER ACETABULAR NOVATION CROWN CUP CONNEXION GXL C1776 $3,900.00LINER ACETABULAR OPTI-FIX XLPE +4 MM OD50-54 MM ID C1776 $3,900.00LINER ACETABULAR OPTIFIX XLPE 20 D OD50-54 MM ID28 C1776 $3,900.00LINER ACETABULAR OPTI-FIX XLPE 20 D OD56-62 MM ID3 C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX +4 MM NEUTRAL OD48 C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX +4 MM NEUTRAL OD50 C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX +4 MM NEUTRAL OD52 C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX +4 MM NEUTRAL OD56 C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX +4 MM NEUTRAL OD60 C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX +4 NEUTRAL OD54 MM C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX 10 D +4 MM OD46 MM C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX 10 D +4 MM OD54 MM C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX 10 D +4 MM OD56 MM C1776 $3,900.00

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 ChargeLINER ACETABULAR PINNACLE ALTRX 10 D +4 MM OD58 MM C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX 10 D +4 MM OD60 MM C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX 10 D +4 MM OD64 MM C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX 10 D +4 OD48 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX 10 D +4 OD50 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX 10 D +4 OD52 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX LD +4 MM NEUTRAL O C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX LD +4 NEUTRAL OD56 C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD44 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD48 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD50 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD52 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD54 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD56 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD58 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ALTRX NEUTRAL OD62 MM ID C1776 $3,900.00LINER ACETABULAR PINNACLE ESC GVF TITANIUM +4 NEUT C1776 $14,300.00LINER ACETABULAR PINNACLE ESC GVF TITANIUM 10 D +4 C1776 $14,300.00LINER ACETABULAR REFLECTION XLPE 0 D F OD54-56 MM C1776 $3,900.00LINER ACETABULAR RINGLOC E-POLY +3 MM 22 ID32 MM H C1776 $4,225.00LINER ACETABULAR RINGLOC E-POLY +3 MM 23 ID36 MM H C1776 $4,225.00LINER ACETABULAR RINGLOC E-POLY +3 MM 24 ID40 MM H C1776 $4,225.00LINER ACETABULAR RINGLOC E-POLY +3 MM 25 ID40 MM H C1776 $4,225.00LINER ACETABULAR RINGLOC E-POLY +3 MM 26 ID40 MM H C1776 $4,225.00LINER ACETABULAR RINGLOC MAX-ROM 24 STANDARD ID36 C1776 $4,225.00LINER ACETABULAR RINGLOC MAX-ROM ARCOMXL 23 ID32 M C1776 $4,225.00LINER ACETABULAR TRIDENT X3 0 D D H3.9 MM ID36 MM C1776 $3,900.00LINER ACETABULAR TRIDENT X3 0 D D H5.6 MM ID22 MM C1776 $13,892.97LINER ACETABULAR TRIDENT X3 0 D E H5.9 MM ID36 MM C1776 $3,900.00LINER ACETABULAR TRIDENT X3 0 D E H7.5 MM ID22 MM C1776 $13,892.97LINER ACETABULAR TRIDENT X3 0 D F H6.5 MM ID28 MM C1776 $13,892.97LINER ACETABULAR TRIDENT X3 0 D F H7.9 MM ID36 MM C1776 $3,900.00LINER ACETABULAR TRIDENT X3 0 D G H8.1 MM ID28 MM C1776 $13,892.97LINER ACETABULAR TRIDENT X3 0 D G H9.4 MM ID36 MM C1776 $3,900.00LINER ACETABULAR TRIDENT X3 0 D H H7.8 MM ID32 MM C1776 $13,892.97LINER ACETABULAR TRIDENT X3 10 D E ID36 MM HIP C1776 $3,900.00LINER ACETABULAR TRILOGY LONGEVITY 10 D ELEVATED R C1776 $4,225.00LINER ACETABULAR TRILOGY LONGEVITY H10.8 MM OD62 M C1776 $12,350.00LINER ACETABULAR TRILOGY LONGEVITY H7.3 MM OD50 MM C1776 $12,350.00

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 ChargeLINER ACETABULAR TRILOGY LONGEVITY STANDARD H7.9 M C1776 $4,225.00LINER ACETABULAR TRILOGY LONGEVITY STANDARD H9.9 M C1776 $4,225.00LINER ACETABULAR VIVACIT-E II NEUTRAL OD52 MM ID36 C1776 $5,850.00LINER ACETABULAR X3 0 D C H4.9 MM ID32 MM HIP C1776 $3,900.00LINER ACETABULAR X3 0 D H H11.2 MM OD66 MM ID36 MM C1776 $3,900.00LINER ACETABULAR X3 0 D I H12.7 MM ID36 MM HIP C1776 $3,900.00LINER ACETABULAR X3 0 D J H14.7 MM ID36 MM HIP C1776 $3,900.00LINER CAST SPICA SKINZ 18-48 MONTH 6 L0-30 IN HIP $1,136.00LINER CAST SPICA SKINZ 2 9 MONTH L0-18 IN HIP BREA $1,024.00LINER CAST SPICA SKINZ 4 6-24 YR L0-22 IN HIP BREA $1,024.00LINER CAST SPICA SKINZ EPTFE 8 36+ MOTNH L0-34 IN $1,136.00LINER HUMERAL EQUINOXE +0 MM OD38 MM SHOULDER REVE C1776 $4,550.00LINER HUMERAL EQUINOXE +0 MM OD42 MM SHOULDER REVE C1776 $4,550.00LINER HUMERAL EQUINOXE +2.5 MM OD38 MM SHOULDER RE C1776 $4,550.00LINER HUMERAL EQUINOXE +2.5 MM OD42 MM SHOULDER RE C1776 $4,550.00LINK SPINAL CROSSLINK VERTEX MAX TITANIUM SMALL SP C1713 $4,000.00LIPASE BODY FLUID 83690 $53.00LIPOPROTEIN (A) LEVEL 83695 $77.00LIPOPROTEIN NUMBER/SUBCLASS 83704 $199.00LIPOPRTN DIR MEAS SD LDL CHL 83722 $110.00LITHIUM LEVEL 80178 $51.00LIVER ENZYME (SGOT), LEVEL 84450 $50.00LIVER ENZYME (SGPT), LEVEL 84460 $42.00LOCAL ANESTHESIA D9215 $15.00LOCK CRADLE VEPTR TITANIUM SPINE NONSTERILE BLUE C1713 $1,603.20LOOP ENDOSCOPIC USA ELITE SYSTEM USA SERIES .012 I $422.34LOW COST SKIN SUBSTITUTE FACE SCALP EYELID NECK GE C5275 $1,953.00LOW COST SKIN SUBSTITUTE FACE SCALP EYELID NECK GE C5276 $430.00LOW COST SKIN SUBSTITUTE FACE SCALP EYELID NECK GE C5277 $1,953.00LOW COST SKIN SUBSTITUTE FACE SCALP EYELID NECK GE C5278 $318.00LOW COST SKIN SUBSTITUTE TRUNK ARMS LEGS C5271 $2,196.00LOW COST SKIN SUBSTITUTE TRUNK ARMS LEGS C5272 $442.00LOW COST SKIN SUBSTITUTE TRUNK ARMS LEGS C5273 $6,274.00LOW COST SKIN SUBSTITUTE TRUNK ARMS LEGS C5274 $712.00LOW FREQUENCY NON-CONTACT NON-THERMAL ULTRASOUND W 97610 $973.00LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) SO $166,250.00MACHAON PLATELET AGGEGATION 85576 $4,455.00MAGIC MOUTHWASH ORAL SUSPENSION (UMC) 120 ML BOTTL $380.04MAGNESIUM GLUCONATE (27 MG ELEMENTAL MG) 27 MG MAG $3.12

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 ChargeMAGNET COCHLEAR BAHA CONE 4 SYSTEM STERILE DISPOSA $9,717.50MAGNET COCHLEAR BAHA TECAPEEK MT L4.55 MM OD29.5 M $633.75MAGNETIC RESONANCE IMAGING OF FETUS, EACH ADDITION 74713 $224.00MAGNETIC RESONANCE IMAGING OF FETUS, SINGLE OR FIR 74712 $947.00MALARIA ANTIGEN W/REFLEX TO SMEAR 87899 $73.00MAMMOGRAPHY OF BOTH BREASTS 77066 $434.00MAMMOGRAPHY OF BOTH BREASTS 77067 $359.00MAMMOGRAPHY OF ONE BREAST 77065 $341.00MANAGEMENT AND SUPERVISION OF OXYGEN CHAMBER THERA G0277 $538.00MANAGEMENT AND SUPERVISION OF OXYGEN CHAMBER THERA 99183 $316.00MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING 77301 $5,108.00MANAGEMENT OF RADIATION THERAPY SIMULATION, SIMPLE 77280 $557.00MANAGEMENT OF RADIATION THERAPY, 3D 77295 $5,108.00MANAGEMENT OF RADIATION THERAPY, INTERMEDIATE 77262 $4,297.00MANAGEMENT OF RADIATION THERAPY, SIMULATION, COMPL 77290 $1,547.00MANAGEMENT OF RADIATION THERAPY, SIMULATION, INTER 77285 $1,547.00MANDIBLE/MAXILLA GRAFT D7950 $5,843.00MANGANESE (HEAVY METAL) LEVEL 83785 $165.00MANIPULATION OF HINGED JOINTS OF UPPER AND LOWER J 21073 $6,639.00MANIPULATOR ENDOSCOPIC KOH-EFFICIENT RUMI II OD3 C $600.60MANIPULATOR ENDOSCOPIC KOH-EFFICIENT RUMI II OD3.5 $600.60MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE 97140 $101.00MANUAL MANEUVERS TO CHEST WALL TO ASSIST MOVEMENT 94668 $157.00MANUAL MUSCLE TESTING OF ARM, LEG OR TRUNK 95831 $46.00MANUAL MUSCLE TESTING OF HAND 95832 $52.00MANUAL MUSCLE TESTING OF WHOLE BODY 95833 $72.00MANUAL MUSCLE TESTING OF WHOLE BODY INCLUDING HAND 95834 $105.00MANUAL URINALYSIS TEST WITH EXAMINATION USING MICR 81001 $24.00MAPPING ELECTRCL BRAIN WAVE ACTIV PROV SEIZR ACTIV 95962 $68.00MARKER BREAST BIOPSY BIOMARC STAINLESS STEEL ZIRCO $503.44MARKER BREAST BIOPSY GEL MARK ULTRACOR BARD POLYLA A4648 $419.25MARKER BREAST BIOPSY GEL MARK ULTRACOR POLYLACTIC A4648 $419.25MARKER BREAST BIOPSY HYDROMARK TITANIUM BUTTERFLY $372.30MARKER BREAST BIOPSY HYDROMARK TITANIUM OPEN COIL $372.30MARKER BREAST BIOPSY MAMMOMARK CORMARK COLLAGEN TI $592.50MARKER BREAST BIOPSY SECURMARK STAINLESS STEEL ULT $275.00MARKER BREAST BIOPSY SECURMARK TITANIUM TOP HAT L1 $275.00MARKER BREAST BIOPSY SENOMARK ULTRA BARD BIODUR 10 A4648 $422.50MARKER BREAST BIOPSY SENOMARK ULTRA BARD POLYGLYCO A4648 $422.50

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 ChargeMARKER BREAST BIOPSY ULTRACLIP BARD BIODUR 108 POL $322.50MARKER BREAST BIOPSY ULTRACLIP BARD INCONEL 625 PO $322.50MARKER BREAST BIOPSY ULTRACLIP BARD POLYVINYL ALCO $322.50MARKER BREAST BIOPSY ULTRACLIP II TITANIUM 3 MM RI $516.00MARKER FIDUCIAL GOLD CYLINDER L20 CM L3 MM OD17 GA A4648 $968.50MARKER RADIOLOGY CT-SPOT WIDE OD2 MM .2 LB MARK SC $768.00MARKER STEREOTACTIC UNIBODY 10 MM FIDUCIAL DEEP BR $346.78MASK CPAP PERFORMAX PEDIATRIC SMALL LEAK 2 ENTRAIN $2,000.80MASK LARYNGEAL AMBU AURAONCE 2.5 CURVE CUFF PILOT $427.20MASK POSITIONING TYPE-S THERMOPLASTIC THK3.2 MM HE $616.20MASS SPECTROMETRY (LABORATORY TESTING METHOD) 83789 $109.00MASSAGE OF HEART MUSCLE THROUGH CHEST CAVITY 32160 $3,561.00MATERIAL SPLINTING SYNERGY THK1/8 IN L36 IN X W24 $897.68MATRIX TISSUE ACELL PORCINE BLADDER L12 CM X W9 CM Q4118 $11,635.65MATRIX TISSUE ALLODERM ACELLULAR DERMIS MEDIUM L7 Q4116 $174.57MATRIX TISSUE ALLODERM ACELLULAR DERMIS THK.23-.51 Q4116 $346.94MATRIX TISSUE ALLODERM ACELLULAR DERMIS THK.53-1.0 Q4116 $2,762.50MATRIX TISSUE ALLODERM ACELLULAR DERMIS THK1.04-2. Q4116 $178.09MATRIX TISSUE ALLODERM ACELLULAR DERMIS THK2.3-3.3 Q4116 $346.94MATRIX TISSUE ALLODERM SELECT ACELLULAR DERMIS THK Q4116 $168.49MATRIX TISSUE ALLODERM SELECT DUO ACELLULAR DERMIS Q4116 $178.14MATRIX TISSUE ALLODERM THK.8-1.2 MM THIN L16 CM X Q4116 $168.49MATRIX TISSUE CYTAL PORCINE BLADDER L10 CM X W7 CM Q4166 $1,706.58MATRIX TISSUE CYTAL PORCINE BLADDER L15 CM X W10 C Q4166 $3,637.14MATRIX TISSUE CYTAL PORCINE BLADDER L5 CM X W5 CM Q4166 $4,533.10MATRIX TISSUE CYTAL PORCINE BLADDER L7 CM X W3 CM Q4166 $783.97MATRIX TISSUE DURAGEN BOVINE COLLAGEN L5 IN X W4 I $7,328.00MATRIX TISSUE GENTRIX PORCINE BLADDER L10 CM X W7 C1763 $9,100.00MATRIX TISSUE GENTRIX PORCINE BLADDER THIN L12 CM C1763 $5,429.97MATRIX TISSUE GENTRIX PORCINE BLADDER THIN L15 CM C1763 $16,968.64MATRIX TISSUE MICROMATRIX PORCINE BLADDER 100 MG M Q4118 $1,706.58MATRIX TISSUE MICROMATRIX PORCINE BLADDER 1000 MG Q4118 $14,399.13MATRIX TISSUE MICROMATRIX PORCINE BLADDER 200 MG M Q4118 $3,413.15MATRIX TISSUE STRATTICE POLYSORBATE 20 PORCINE DER Q4130 $90,389.00MATRIX TISSUE STRATTICE PORCINE DERMIS L10 CM X W1 Q4130 $23,413.00MATRIX TISSUE STRATTICE PORCINE DERMIS L10 CM X W2 Q4130 $30,101.50MATRIX TISSUE STRATTICE PORCINE DERMIS L15 CM X W2 Q4130 $56,439.50MATRIX TISSUE STRATTICE PORCINE DERMIS L16 CM X W1 Q4130 $24,082.50MATRIX TISSUE STRATTICE PORCINE DERMIS L20 CM X W1 Q4130 $48,158.50

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 ChargeMATRIX TISSUE STRATTICE PORCINE DERMIS L20 CM X W2 Q4130 $60,203.00MATRIX TISSUE STRATTICE PORCINE DERMIS L20 CM X W4 Q4130 $120,406.00MATRIX TISSUE STRATTICE PORCINE DERMIS L25 CM X W2 Q4130 $75,250.50MATRIX TISSUE STRATTICE PORCINE DERMIS L25 CM X W4 Q4130 $150,507.50MATRIX TISSUE STRATTICE PORCINE DERMIS L30 CM X W1 Q4130 $67,723.50MATRIX TISSUE STRATTICE PORCINE DERMIS L30 CM X W3 Q4130 $135,453.50MATRIX TISSUE STRATTICE PORCINE DERMIS L5 CM X W16 Q4130 $12,044.50MATRIX TISSUE STRATTICE PORCINE DERMIS L6 CM X W10 Q4130 $9,672.00MATRIX TISSUE STRATTICE PORCINE DERMIS L6 CM X W16 Q4130 $14,449.50MATRIX TISSUE STRATTICE PORCINE DERMIS L6 CM X W6 Q4130 $5,804.50MATRIX TISSUE STRATTICE PORCINE DERMIS L6 CM X W8 Q4130 $7,039.50MATRIX TISSUE STRATTICE PORCINE DERMIS L8 CM X W15 Q4130 $12,311.00MATRIX TISSUE STRATTICE PORCINE DERMIS L8 CM X W16 Q4130 $19,259.50MATRIX TISSUE SURGIMEND BOVINE COLLAGEN THK3 MM RE C9360 $28,800.00MATRIX TISSUE SURGIMEND PRS BOVINE DERMIS COLLAGEN C9358 $24,064.00MATRIX TISSUE XCM BIOLOGIC OPTRIX PORCINE COLLAGEN Q4142 $15,516.54MAYO MYELIN OLIGO. GLYCOPROTEIN FACS,S-MOGFS 86255 $88.00MEASURE & GRAPHIC RECORDINGS SPEED OF BREATHED AIR 94070 $869.00MEASURE & RECORD OF BRAIN WAVE (EEG) ACTIVITY CERE 95824 $1,778.00MEASURE LARGEST AMOUNT OF AIR BREATHED IN AN OUT O 94200 $218.00MEASUREMENT & GRAPHIC REC AMOUNT&SPEED BREATHED AI 94060 $488.00MEASUREMENT AND GRAPHIC RECORDING OF TOTAL AND TIM 94010 $282.00MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTI 95816 $996.00MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTI 95819 $996.00MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTI 95822 $996.00MEASUREMENT AND RECORDING OF BREATHING PATTERN OVE 94772 $921.00MEASUREMENT BLOOD COAGULATION AND FIBRINOLYSIS (CL 85397 $141.00MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF IN 86140 $40.00MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF IN 86141 $100.00MEASUREMENT FOR STREP ANTIBODY (STREP THROAT) 86060 $56.00MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANC 86003 $34.00MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANC 86008 $100.00MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMU 86039 $86.00MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMU 86235 $90.00MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS A 86200 $100.00MEASUREMENT OF ANTIBODY TO NONINFECTIOUS AGENT 86256 $94.00MEASUREMENT OF BLOOD FLOW IN HEART MUSCLE AT REST 0482T $4,811.00MEASUREMENT OF BRAIN ACTIVITY (EEG) DURING SURGERY 95829 $368.00MEASUREMENT OF BRAIN WAVE (EEG) ACTIVITY GREATER T 95813 $996.00

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 ChargeMEASUREMENT OF BRAIN WAVE (EEG) ACTIVITY, 41-60 MI 95812 $996.00MEASUREMENT OF COLD AGGLUTININ (PROTEIN) TO DETECT 86157 $63.00MEASUREMENT OF COLD AGGLUTININ (PROTEIN) TO SCREEN 86156 $52.00MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS) 86160 $93.00MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS) 86162 $148.00MEASUREMENT OF COMPLEMENT FUNCTION (IMMUNE SYSTEM 86161 $73.00MEASUREMENT OF CORNEAL CURVATURE AND DEPTH OF EYE 92136 $421.00MEASUREMENT OF DNA ANTIBODY 86225 $106.00MEASUREMENT OF ELECTRICAL ACTIVITY (EEG) OUTSIDE T 95955 $169.00MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT 91010 $1,335.00MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT 91013 $1,351.00MEASUREMENT OF EXHALED CARBON DIOXIDE GAS 94770 $869.00MEASUREMENT OF FIELD OF VISION DURING DAYLIGHT CON 92081 $234.00MEASUREMENT OF FIELD OF VISION DURING DAYLIGHT CON 92082 $234.00MEASUREMENT OF FIELD OF VISION DURING DAYLIGHT CON 92083 $124.00MEASUREMENT OF HEART BLOOD FLOW AND RESPIRATION 93701 $386.00MEASUREMENT OF HEPATITIS A ANTIBODY (IGM) 86709 $71.00MEASUREMENT OF HYDROGEN IN BREATH TO TEST FOR GI S 91065 $606.00MEASUREMENT OF IMMUNE SUBSTANCE (OLIGOCLONAL BANDS 83916 $127.00MEASUREMENT OF INHALED NITRIC OXIDE GAS 95012 $712.00MEASUREMENT OF LARGEST AMOUNT OF AIR EXHALED FROM 94150 $231.00MEASUREMENT OF LUNG DIFFUSING CAPACITY 94729 $292.00MEASUREMENT OF LUNG STRETCHING CAPACITY 94750 $231.00MEASUREMENT OF NERVE CONDUCTION PATTERNS OF EYE BL 95933 $426.00MEASUREMENT OF OXYGEN SATURATION IN BLOOD USING EA 94760 $11.00MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQ 83519 $36.00MEASUREMENT OF URINE FLOW IN KIDNEYS AND URINARY D 50396 $6,783.00MECHANICAL CHEST WALL MANIPULATION FOR IMPROVEMENT 94669 $383.00MECHANICAL REMOVAL OF OBSTRUCTIVE MATERIAL FROM CE 36595 $7,066.00MECHANICAL REMOVAL OF SPINAL CANAL SCAR TISSUE PER 62263 $3,824.00MECHANICAL REMOVAL TISSUE OR OBSTRUCTIVE MATERIAL 36596 $3,509.00MECHANICAL REMOVE OBSTRUCTIVE MATERIAL IN STOMACH 49460 $1,962.00MECHANICAL SEPARATION OF PLASMA AND ABNORMAL ANTIB 36516 $12,895.00MECHANICAL SEPARATION OF PLASMA FROM OPENING BLOOD 36514 $3,608.00MECHANICAL SEPARATION OF PLATELET CELLS FROM BLOOD 36513 $4,244.00MECHANICAL SEPARATION OF RED BLOOD CELLS FROM BLOO 36512 $4,988.00MECHANICAL SEPARATION OF WHITE BLOOD CELLS AND PLA 36522 $12,895.00MECHANICAL SEPARATION OF WHITE BLOOD CELLS FROM TH 36511 $4,244.00MEDICAL NUTRITION THERAPY PERFORMED IN A GROUP SET 97804 $77.00

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 ChargeMEDICAL NUTRITION THERAPY RE-ASSESSMENT AND INTERV 97803 $136.00MEDICAL NUTRITION THERAPY, ASSESSMENT AND INTERVEN 97802 $163.00MEDICAL TESTIMONY 99075 $1,610.00MEDROXYPROGESTERONE 1 ML VIAL J1050 $133.02MEMORY FUNCTIONAL LIMITED CURRENT STATUS G9168 $0.01MEMORY FUNCTIONAL LIMITED DISCHARGE STATUS G9170 $0.01MEMORY FUNCTIONAL LIMITED PROJECTED GOAL STATUS G9169 $0.01MEPOLIZUMAB 100 MG SOLR 1 EACH VIAL J2182 $8,927.13MERCURY LEVEL 83825 $103.00MEROPENEM 1 GRAM SOLR 1 EACH VIAL J2185 $35.23MESH CRANIAL GSP TITANIUM STANDARD L90 MM X W90 MM C1713 $9,074.72MESH CRANIAL LEIBINGER UNIVERSAL 2 GSP TITANIUM L9 C1713 $9,074.72MESH CRANIAL MATRIXNEURO TITANIUM CIRCLE CONTOUR H C1713 $5,712.00MESH CRANIAL MATRIXNEURO TITANIUM CIRCLE H.6 MM OD C1713 $11,821.60MESH CRANIAL MATRIXNEURO TITANIUM CONTOUR H.4 MM T C1713 $5,712.00MESH CRANIAL MATRIXNEURO TITANIUM CONTOUR L100 MM C1713 $15,456.00MESH CRANIAL MATRIXNEURO TITANIUM CONTOUR L200 MM C1713 $63,330.40MESH CRANIAL MATRIXNEURO TITANIUM CONTOUR L45 MM X C1713 $12,056.40MESH CRANIAL MATRIXNEURO TITANIUM L200 MM X W200 M C1713 $59,192.00MESH CRANIAL MATRIXNEURO TITANIUM LARGE ARC CONTOU C1713 $8,898.40MESH CRANIAL RAPIDSORB L100 MM X W100 MM X H.25 MM C1713 $27,024.00MESH CRANIAL TITANIUM L85 MM X W50 MM X H.3 MM SMA C1713 $4,995.68MESH CRANIAL TITANIUM L85 MM X W54 MM X H.2 MM SCR C1713 $3,367.36MESH CRANIAL TITANIUM STANDARD L90 MM X W90 MM X H C1713 $9,074.72MESH CRANIAL UNIVERSAL NEURO 2 TITANIUM MICRO ULTR C1713 $3,741.04MESH CRANIAL UNIVERSAL NEURO III TITANIUM MICRO L6 C1713 $3,039.60MESH DYNAMIC MATRIXNEURO TITANIUM CIRCLE H.4 MM OD C1713 $14,739.20MESH DYNAMIC MATRIXNEURO TITANIUM MEDIUM L45 MM X C1713 $6,266.40MESH DYNAMIC MATRIXNEURO TITANIUM SMALL L39 MM X H C1713 $5,538.40MESH DYNAMIC TITANIUM L100 MM X W100 MM X H.4 MM C C1713 $10,723.04MESH GYNECOLOGICAL GYNECARE TVT L45 CM X W1.1 CM R C1771 $9,848.00MESH SURGICAL BARD 3DMAX POLYPROPYLENE LARGE CURVE C1781 $1,272.00MESH SURGICAL BARD 3DMAX POLYPROPYLENE MEDIUM CURV C1781 $1,168.00MESH SURGICAL BARD MARLEX POLYPROPYLENE MONOFILAME C1781 $180.96MESH SURGICAL BARD MARLEX POLYPROPYLENE RECTANGLE C1781 $385.32MESH SURGICAL BARD MARLEX POLYPROPYLENE SQUARE L6 C1781 $322.56MESH SURGICAL BARD PERFIX POLYPROPYLENE LARGE L1.6 C1781 $1,081.84MESH SURGICAL BARD POLYPROPYLENE L14 IN X W10 IN G C1781 $461.24MESH SURGICAL BARD POLYPROPYLENE L4 IN X W2 IN GRO C1781 $240.00

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 ChargeMESH SURGICAL BARD POLYPROPYLENE LARGE L1.55 IN X C1781 $712.00MESH SURGICAL BARD POLYPROPYLENE LARGE L5.4 IN X W C1781 $331.80MESH SURGICAL C-QUR L12 IN X W8 IN HERNIA C1781 $5,795.00MESH SURGICAL C-QUR TACSHIELD POLYPROPYLENE OMEGA C1781 $2,375.00MESH SURGICAL DUALMESH EPTFE THK1 MM OVAL L19 CM X C1781 $5,960.00MESH SURGICAL DUALMESH GORE-TEX THK1 MM L15 CM X W C1781 $2,968.00MESH SURGICAL DUALMESH PLUS CHLORHEXIDINE DIACETAT C1781 $2,990.00MESH SURGICAL DUALMESH PLUS GORE-TEX CHLORHEXIDINE C1781 $5,544.50MESH SURGICAL ETHICON PHYSIOMESH MACROPOROUS L15 C C1781 $3,335.67MESH SURGICAL ETHICON PHYSIOMESH MACROPOROUS ROUND C1781 $2,140.19MESH SURGICAL ETHICON PHYSIOMESH OVAL L15 CM X W10 C1781 $2,906.41MESH SURGICAL ETHICON PHYSIOMESH OVAL L25 CM X W20 C1781 $8,548.15MESH SURGICAL ETHICON PHYSIOMESH OVAL L35 CM X W25 C1781 $12,154.16MESH SURGICAL FLAT L4.5 IN X W2.5 IN KNIT FLEXIBLE C1781 $937.43MESH SURGICAL GORE BIO-A SYNTHETIC L10 CM X W7 CM C1781 $3,107.00MESH SURGICAL GYNECARE GYNEMESH PS PROLENE L15 CM C1781 $3,494.40MESH SURGICAL INTEPRO POLYPROPYLENE Y SLING C1781 $4,550.00MESH SURGICAL PARIETEX COLLAGEN SMALL OD4.6 CM COM C1781 $2,021.76MESH SURGICAL PARIETEX COLLAGEN SMALL OD6.6 CM COM C1781 $2,423.01MESH SURGICAL PARIETEX COLLAGEN SMALL OD8.6 CM COM C1781 $3,112.53MESH SURGICAL PARIETEX MACROPOROUS POLYESTER RECTA C1781 $345.58MESH SURGICAL PARIETEX POLYESTER 3D L12 IN X W12 I C1781 $1,212.45MESH SURGICAL PARIETEX POLYESTER 3D L6 IN X W6 IN C1781 $745.03MESH SURGICAL PARIETEX POLYESTER COLLAGEN HYDROPHI C1781 $7,789.41MESH SURGICAL PARIETEX POLYESTER COLLAGEN RECTANGL C1781 $5,806.32MESH SURGICAL PARIETEX POLYESTER COLLAGEN ROUND OD C1781 $1,736.61MESH SURGICAL PARIETEX POLYESTER HYDROPHILIC L20 C C1781 $4,663.75MESH SURGICAL PARIETEX POLYESTER RECTANGLE L37 CM C1781 $9,426.76MESH SURGICAL PARIETEX POLYESTER RECTANGLE OVAL L3 C1781 $7,938.52MESH SURGICAL PARIETEX POLYESTER ROUND L8 IN OD20 C1781 $4,583.93MESH SURGICAL PARIETEX PROGRIP POLYESTER L4.7 IN X C1781 $673.05MESH SURGICAL PARIETEX PROGRIP POLYESTER RECTANGLE C1781 $1,346.15MESH SURGICAL PARIETEX PROGRIP POLYLACTIC ACID POL C1781 $1,847.04MESH SURGICAL PERFIX POLYPROPYLENE SMALL L1.35 IN C1781 $712.00MESH SURGICAL PHASIX POLY-4-HYDROXYBUTERATE RECTAN C1781 $76,240.00MESH SURGICAL PHYSIOMESH L20 CM X W15 CM FLEXIBLE C1781 $5,278.52MESH SURGICAL PHYSIOMESH MONOCRYL -3 CM-+6 CM HEXA C1781 $6,119.30MESH SURGICAL PHYSIOMESH MONOCRYL HEXAGONAL L25 CM C1781 $9,607.07MESH SURGICAL PHYSIOMESH MONOCRYL LOW PROFILE OVAL C1781 $13,830.64

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 ChargeMESH SURGICAL PHYSIOMESH MONOCRYL RECTANGLE L30 CM C1781 $9,220.38MESH SURGICAL POLYPROPYLENE L6 IN X W3 IN SOFT LAR C1781 $312.00MESH SURGICAL PROCEED OVAL L15 CM X W10 CM HERNIA C1781 $2,855.00MESH SURGICAL PROCEED OVAL L25 CM X W20 CM HERNIA C1781 $8,358.22MESH SURGICAL PROCEED PROLENE OXIDIZED CELLULOSE L C1781 $12,515.62MESH SURGICAL PROCEED PROLENE OXIDIZED CELLULOSE O C1781 $5,167.37MESH SURGICAL PROGRIP 70% COLLAGEN 30% GLYCEROL PO C1781 $2,386.15MESH SURGICAL PROGRIP LEFT SELF FIXATION ANATOMIC C1781 $3,059.20MESH SURGICAL PROLENE 4 IN 3D L4 15/16 IN X W2 5/3 $1,655.14MESH SURGICAL PROLENE FLAT L14 IN X W12 IN KNIT NO C1781 $18,812.43MESH SURGICAL PROLENE FLAT L6 IN X W3 IN SOFT KNIT C1781 $834.98MESH SURGICAL PROLENE FLAT L6 IN X W6 IN SOFT KNIT C1781 $2,625.16MESH SURGICAL PROLENE FLAT RECTANGLE L6 IN X W3 IN C1781 $1,048.53MESH SURGICAL PROLENE FLAT SQUARE L12 IN X W12 IN C1781 $2,361.91MESH SURGICAL PROLENE FLAT SQUARE L6 IN X W6 IN CU C1781 $1,154.92MESH SURGICAL PROLENE LARGE L10 CM X W4.5 CM H1.3 C1781 $1,655.14MESH SURGICAL PROLENE MEDIUM L10 CM X W4.5 CM H1.3 C1781 $3,028.61MESH SURGICAL PROLENE POLYPROPYLENE FLAT L4 IN X W C1781 $1,115.00MESH SURGICAL PROLENE POLYPROPYLENE SQUARE FLAT L1 C1781 $2,382.92MESH SURGICAL RESTORELLE DIRECTFIX POSTERIOR ULTRA C1781 $7,475.00MESH SURGICAL RESTORELLE SMARTMESH Y CONTOUR L24 C C1781 $5,655.00MESH SURGICAL RESTORELLE SMARTMESH Y FLAT L24 CM X C1781 $5,122.00MESH SURGICAL RESTORELLE Y CONTOUR MERIDIAN VPS PO C1781 $7,663.50MESH SURGICAL SYMBOTEX COLLAGEN POLYESTER L42 CM X C1781 $11,877.84MESH SURGICAL SYMBOTEX POLYESTER 3D L3.3 MM X W2.3 C1781 $2,488.53MESH SURGICAL SYMBOTEX POLYESTER COLLAGEN 3D L30 C C1781 $8,335.41MESH SURGICAL SYMBOTEX POLYESTER COLLAGEN 3D L37 C C1781 $9,897.88MESH SURGICAL SYMBOTEX POLYESTER COLLAGEN 3D RECTA C1781 $2,381.21MESH SURGICAL SYMBOTEX POLYESTER COLLAGEN 3D ROUND C1781 $2,619.57MESH SURGICAL SYMBOTEX POLYESTER COLLAGEN L25 CM X C1781 $6,096.48MESH SURGICAL SYMBOTEX POLYESTER COLLAGEN ROUND L3 C1781 $3,428.88MESH SURGICAL SYMBOTEX POLYETHYLENE TEREPHTHALATE C1781 $3,820.12MESH SURGICAL ULTRAPRO FLAT L12 IN X W12 IN PARTIA C1781 $1,108.45MESH SURGICAL ULTRAPRO FLAT L6 IN X W6 IN PARTIAL C1781 $1,812.20MESH SURGICAL ULTRAPRO LARGE L4.7 IN X W2.4 IN OD4 C1781 $1,715.72MESH SURGICAL ULTRAPRO LARGE OD4 IN PARTIAL ABSORB C1781 $1,715.70MESH SURGICAL ULTRAPRO MEDIUM L4.7 IN X W2.4 IN OD C1781 $1,714.20MESH SURGICAL ULTRAPRO MEDIUM OD3 IN PARTIAL ABSOR C1781 $1,715.70MESH SURGICAL ULTRAPRO OVAL L4.7 IN X W2.4 IN L4.7 C1781 $1,715.72

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 ChargeMESH SURGICAL ULTRAPRO POLIGLECAPRONE-25 POLYPROPY C1781 $458.14MESH SURGICAL UPSYLON THK200 UM 2.8 SQ MM Y L35.4 C1763 $4,914.00MESH SURGICAL VENTRALIGHT ST ECHO PS POLYPROPYLENE C1781 $7,516.00MESH SURGICAL VENTRALIGHT ST ECHO PS SEPRAFILM POL C1781 $25,072.00MESH SURGICAL VENTRALIGHT ST SEPRA ECHO PS SEPRAFI C1781 $4,072.00MESH SURGICAL VICRYL FLAT L12 IN X W12 IN ABSORBAB C1781 $19,470.96MESH SURGICAL VICRYL FLAT L6 IN X W6 IN ABSORBABLE C1781 $4,640.24MESH TRANSVAGINAL RESTORELLE DIRECTFIX SMARTMESH A C1781 $7,475.00MESH TRANSVAGINAL UPHOLD LITE CAPIO SLIM C1781 $12,298.00METANEPHRINES LEVEL 83835 $131.00METHADONE LEVEL 80358 $110.00METHYLENEDIOXYAMPHETAMINES LEVELS 80359 $244.00METHYLPHENIDATE HCL 5 MG TAB 100 EACH BOTTLE $3.41METHYLPHENIDATE LEVEL 80360 $130.00METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML SOLR 1 EAC J2920 $31.04METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLR 1 J2930 $20.00METOPROLOL 5 MG/5 ML SOLN 5 ML VIAL $22.88METRONIDAZOLE 1 % GLWP 55 G BOTTLE $1,301.08MGMT (O-6-METHYLGUANINE-DNA METHYLTRANSFERASE) GEN 81287 $845.00MICROCATHETER CEREBROVASCULAR EXCELSIOR 1018 HYDRO $5,297.50MICROCATHETER CEREBROVASCULAR EXCELSIOR SL-10 HYDR C1751 $5,297.50MICROCATHETER CEREBROVASCULAR EXCELSIOR XT-27 MICR C1751 $5,817.50MICROCATHETER CEREBROVASCULAR EXCELSIOR XT-27 STRA C1751 $5,817.50MICROCATHETER CEREBROVASCULAR HEADWAY HYDROPHILIC $5,850.00MICROCATHETER CEREBROVASCULAR MARATHON L165 CM OD2 $4,413.50MICROCATHETER CEREBROVASCULAR PROWLER 10 NYLON PTF $4,128.60MICROCATHETER CEREBROVASCULAR PROWLER 14 TRUELUMEN $4,128.60MICROCATHETER CEREBROVASCULAR PROWLER SELECT PLUS $3,975.00MICROCATHETER CEREBROVASCULAR RAPIDTRANSIT PTFE HY $1,875.00MICROCATHETER CEREBROVASCULAR TRANSIT NYLON PTFE H $1,799.00MICROCATHETER INFUSION ASAHI CORSAIR POLYMER HYDRO C1887 $4,250.00MICROCATHETER INFUSION ASAHI CORSAIR PRO L135 CM O C1887 $4,250.00MICROCATHETER INFUSION DIREXION FATHOM-16 NITINOL C1887 $4,022.35MICROCATHETER INFUSION DIREXION NITINOL PTFE .035 C1887 $2,858.00MICROCATHETER INFUSION HEADWAY DUO HYDROPHILIC STR C1887 $4,836.00MICROCATHETER INFUSION HEADWAY HYDROPHILIC L150 CM C1887 $3,802.50MICROCATHETER INFUSION HEADWAY HYDROPHILIC STRAIGH C1887 $4,056.00MICROCATHETER INFUSION RENEGADE HI-FLO FATHOM FATH C1887 $5,020.64MICROCATHETER INFUSION RENEGADE HI-FLO HYDROPHILIC C1887 $2,003.76

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 ChargeMICROCATHETER INFUSION RENEGADE HI-FLO VORTEC PLUS C1887 $5,017.35MICROCATHETER INFUSION RENEGADE STC 18 HYDROPASS P C1887 $2,246.73MICROCATHETER PRESSURE NAVVUS 11-15 PSI L335 CM L1 $3,500.00MICROSATELLITE INSTABILITY ANALYSIS 81301 $1,438.00MICROSCOPIC EVALUATION OF DEEP CELLS OF THE EYE 92286 $358.00MICROSCOPIC EXAM OF ESOPHAGUS STOMACH/UPPER SMALL 43252 $3,346.00MICROSCOPIC EXAMINATION FOR WHITE BLOOD CELLS WITH 85007 $18.00MICROSCOPIC EXAMINATION OF ESOPHAGUS USING AN ENDO 43206 $5,710.00MICROSCOPIC GENETIC ANALYSIS OF TUMOR 88360 $208.00MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT 86376 $113.00MIDAZOLAM (PF) 1 MG/ML SOLN 2 ML VIAL J2250 $20.08MIDODRINE 2.5 MG TAB 100 EACH BOTTLE $6.01MILRINONE IN 5 % DEXTROSE 40 MG/200 ML (200 MCG/ML J2260 $128.00MIRROR INSPECTION ALUMINUM PLASTIC L6 IN X W4 IN K $533.00MIXER BONE CEMENT MIXEVAC III STERILE LATEX FREE D $4,000.00MOBILITY CURRENT STATUS G8978 $0.01MOBILITY DISCHARGE STATUS G8980 $0.01MOBILITY GOAL STATUS G8979 $0.01MODERATE SEDATION SERVICES OTHER MD ADDITIONAL 15 99157 $253.00MODERATE SEDATION SERVICES OTHER MD INITIAL 15 MIN 99155 $409.00MODERATE SEDATION SERVICES OTHER MD INITIAL 15 MIN 99156 $335.00MODERATE SEDATION SERVICES SAME MD ADDITIONAL 15 M 99153 $47.00MODERATE SEDATION SERVICES SAME MD INITIAL 15 MIN 99151 $104.00MODERATE SEDATION SERVICES SAME MD INITIAL 15 MIN 99152 $54.00MODULATOR FLOW ENK L7.5 CM OD6 FR SET O2 CATHETER $951.79MOIST PREP 87210 $33.00MOLD CEMENT STAGEONE SELECT SILICONE OD56 MM HIP S $5,947.50MOLD CEMENT STAGEONE SILICONE 0 HIP SPACER NECK AD $1,495.00MOLD CEMENT STAGEONE SILICONE OD48 MM HIP SPACER S $5,947.50MOLD CEMENT STAGEONE SILICONE POLYMETHYL METHACRYL $4,598.75MOLD CEMENT STAGEONE SILICONE UNIVERSAL OD65 MM KN $9,620.00MOLD CEMENT STAGEONE SILICONE UNIVERSAL OD70 MM KN $9,620.00MOLD CEMENT STAGEONE SILICONE UNIVERSAL OD75 MM KN $9,620.00MOLD CEMENT STAGEONE SILICONE UNIVERSAL OD80 MM KN $4,598.75MOLD FEMORAL HEAD STAGEONE SELECT SILICONE OD52 MM $5,947.50MOLD FEMORAL STEM STAGEONE SELECT STAINLESS STEEL C1776 $7,442.50MOLECULAR PATHOLOGY PROCEDURE 81479 $325.00MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 81400 $1,107.00MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 81401 $1,668.00

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 ChargeMOLECULAR PATHOLOGY PROCEDURE LEVEL 4 81403 $767.00MONITOR & RECORD GASTROESOPHAGEAL REFLUX THROUGH N 91034 $1,351.00MONITOR & RECORD GASTROESOPHAGEAL REFLUX WITH PH E 91035 $442.00MONITORING & LOCALIZATION OF SEIZURE ACTIVITY OVER 95950 $3,599.00MONITORING & LOCALIZATION SEIZURE ACTIV OVER 24-HR 95951 $3,599.00MONITORING & LOCALIZATION SEIZURE ACTIV OVER 24-HR 95953 $3,599.00MONITORING OF GASTROESOPHAGEAL REFLUX PROLONGED 91038 $1,351.00MORCELLATOR LAPAROSCOPIC MORCELLEX SIGMA TISSUE HA C1782 $5,100.23MORCELLATOR SURGICAL TRUCLEAR ROTARY DISPOSABLE HY $2,920.78MOTOR SPEECH FUNCTIONAL LIMIT CURRENT STATUS G8999 $0.01MOTOR SPEECH FUNCTIONAL LIMIT DISCHARGE STATUS G9158 $0.01MOTOR SPEECH FUNCTIONAL LIMIT GOAL STATUS G9186 $0.01MOXIFLOXACIN 80299 $86.00MR ANGIOGRAPHY ABDOMEN WITH & WITHOUT CONTRAST 74185 $2,655.00MR ANGIOGRAPHY ABDOMEN WITH CONTRAST 74185 $2,196.00MR ANGIOGRAPHY ABDOMEN WITHOUT CONTRAST 74185 $1,635.00MR ANGIOGRAPHY CHEST WITH & WITHOUT CONTRAST 71555 $2,655.00MR ANGIOGRAPHY CHEST WITH CONTRAST 71555 $2,196.00MR ANGIOGRAPHY CHEST WITHOUT CONTRAST 71555 $1,635.00MR ANGIOGRAPHY LOWER EXTREMITY WITH & WITHOUT CONT 73725 $2,655.00MR ANGIOGRAPHY LOWER EXTREMITY WITH CONTRAST 73725 $2,196.00MR ANGIOGRAPHY LOWER EXTREMITY WITHOUT CONTRAST 73725 $1,635.00MR ANGIOGRAPHY PELVIS WITH & WITHOUT CONTRAST 72198 $2,655.00MR ANGIOGRAPHY PELVIS WITH CONTRAST 72198 $2,196.00MR ANGIOGRAPHY PELVIS WITHOUT CONTRAST 72198 $1,635.00MR ANGIOGRAPHY SPINE 72159 $2,196.00MR ANGIOGRAPHY UPPER EXTREMITY 73225 $1,635.00MRA SCAN OF HEAD BLOOD VESSELS 70544 $1,635.00MRA SCAN OF HEAD BLOOD VESSELS BEFORE AND AFTER CO 70546 $2,655.00MRA SCAN OF HEAD BLOOD VESSELS WITH CONTRAST 70545 $2,196.00MRA SCAN OF NECK BLOOD VESSELS 70547 $1,635.00MRA SCAN OF NECK BLOOD VESSELS BEFORE AND AFTER CO 70549 $2,472.00MRA SCAN OF NECK BLOOD VESSELS WITH CONTRAST 70548 $1,809.00MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL 77048 $224.00MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL 77047 $922.00MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL 77049 $2,655.00MRI GUIDANCE FOR DESTRUCTION OF TISSUE 77022 $718.00MRI OF BLOOD FLOW OF HEART 75565 $181.00MRI OF HEART 75557 $1,635.00

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 ChargeMRI OF HEART BEFORE AND AFTER CONTRAST 75561 $2,655.00MRI OF HEART BEFORE AND AFTER CONTRAST WITH STRESS 75563 $2,655.00MRI OF HEART WITH STRESS IMAGING 75559 $930.00MRI SCAN BONES OF THE EYE, FACE, AND/OR NECK 70540 $1,705.00MRI SCAN BONES OF THE EYE, FACE, AND/OR NECK BEFOR 70543 $3,072.00MRI SCAN BONES OF THE EYE, FACE, AND/OR NECK WITH 70542 $2,288.00MRI SCAN BRAIN 70551 $1,635.00MRI SCAN OF ABDOMEN 74181 $1,635.00MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST 74183 $2,655.00MRI SCAN OF ABDOMEN WITH CONTRAST 74182 $2,196.00MRI SCAN OF ARM 73218 $1,635.00MRI SCAN OF ARM BEFORE AND AFTER CONTRAST 73220 $2,655.00MRI SCAN OF ARM JOINT 73221 $1,635.00MRI SCAN OF ARM JOINT BEFORE AND AFTER CONTRAST 73223 $2,655.00MRI SCAN OF ARM JOINT WITH CONTRAST 73222 $2,196.00MRI SCAN OF ARM WITH CONTRAST 73219 $2,196.00MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST 70553 $2,655.00MRI SCAN OF BRAIN WITH CONTRAST 70552 $2,196.00MRI SCAN OF BRAIN WITH CONTRAST, DURING OPEN BRAIN 70558 $1,011.00MRI SCAN OF BRAIN, DURING OPEN BRAIN PROCEDURE 70557 $930.00MRI SCAN OF BRAIN, DURING OPEN BRAIN PROCEDURE BEF 70559 $1,011.00MRI SCAN OF CHEST 71550 $1,635.00MRI SCAN OF CHEST BEFORE AND AFTER CONTRAST 71552 $2,655.00MRI SCAN OF CHEST WITH CONTRAST 71551 $2,196.00MRI SCAN OF JAW JOINTS 70336 $1,635.00MRI SCAN OF LEG 73718 $1,635.00MRI SCAN OF LEG BEFORE AND AFTER CONTRAST 73720 $2,655.00MRI SCAN OF LEG JOINT 73721 $1,635.00MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST 73723 $2,655.00MRI SCAN OF LEG JOINT WITH CONTRAST 73722 $2,196.00MRI SCAN OF LEG WITH CONTRAST 73719 $2,196.00MRI SCAN OF LOWER SPINAL CANAL 72148 $1,635.00MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CO 72158 $2,655.00MRI SCAN OF LOWER SPINAL CANAL WITH CONTRAST 72149 $2,196.00MRI SCAN OF MIDDLE SPINAL CANAL 72146 $1,635.00MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER C 72157 $2,655.00MRI SCAN OF MIDDLE SPINAL CANAL WITH CONTRAST 72147 $2,196.00MRI SCAN OF PELVIS 72195 $1,635.00MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST 72197 $2,655.00

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 ChargeMRI SCAN OF PELVIS WITH CONTRAST 72196 $2,196.00MRI SCAN OF UPPER SPINAL CANAL 72141 $1,635.00MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CO 72156 $2,655.00MRI SCAN OF UPPER SPINAL CANAL WITH CONTRAST 72142 $2,196.00MRI STUDY 76390 $2,851.00MULTIANALYTE ASSAY PROCEDURE WITH ALGORITHMIC ANAL 81599 $98.00MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS O 37765 $9,971.00MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS O 37766 $10,287.00MULTIPLE MEASUREMENTS OXYGEN SATURATION IN BLOOD U 94761 $15.00MULTIPLE PUNCTURES OF CORNEA 65600 $6,185.00MYD88 GENE P.LEU265PRO VRNT 81305 $790.00MYELIN BASIC PROTEIN (NERVE PROTEIN) LEVEL, SPINAL 83873 $109.00MYOGLOBIN (MUSCLE PROTEIN) LEVEL - LABCORP 83874 $100.00NAIL FIXATION TITANIUM 130 D SHORT L170 MM OD11-17 C1713 $6,722.82NAIL INTRAMEDULLARY 125 D LONG GLINDING C1713 $10,983.60NAIL INTRAMEDULLARY 125 D SMALL L18 CM OD17-11 MM C1713 $10,530.00NAIL INTRAMEDULLARY 125 D SMALL L22 CM OD17-11 MM C1713 $9,363.60NAIL INTRAMEDULLARY 125 D STANDARD GLINDING C1713 $9,363.60NAIL INTRAMEDULLARY 135 D LONG GLINDING C1713 $12,117.60NAIL INTRAMEDULLARY 135 D SMALL L22 CM OD17-11 MM C1713 $9,363.60NAIL INTRAMEDULLARY 135 D STANDARD GLINDING C1713 $9,363.60NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L34 CM OD11 C1713 $11,751.48NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L34 CM OD13 C1713 $11,561.94NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L36 CM OD11 C1713 $11,759.28NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L380 MM OD1 C1713 $11,759.28NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L380 MM OD9 C1713 $11,758.50NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L400 MM OD1 C1713 $11,759.28NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L400 MM OD9 C1713 $11,759.28NAIL INTRAMEDULLARY AFFIXUS 130 D LONG L440 MM OD1 C1713 $11,758.50NAIL INTRAMEDULLARY AFFIXUS 130 D SHORT L180 MM OD C1713 $8,271.12NAIL INTRAMEDULLARY AFFIXUS GOAL POST 130 D LONG L C1713 $11,759.28NAIL INTRAMEDULLARY ENDER ADULT L34 CM OD3.5 MM OR C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L22 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L22 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L23 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L23 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L24 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L24 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L25 CM OD3.5 MM HUMERUS C1713 $2,090.72

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 ChargeNAIL INTRAMEDULLARY ENDER L25 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L26 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L26 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L27 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L27 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L27 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L28 CM OD3.5 MM ORTHOPED C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L28 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L29 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L29 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L30 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L30 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L31 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L31 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L32 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L32 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L32 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L33 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L33 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L33 CM OD4.5 MM C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L34 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L34 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L35 CM OD3.5 MM ORTHOPED C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L35 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L36 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L36 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L37 CM OD3.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L37 CM OD4 MM HUMERUS TI C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L37 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L39 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L40 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L41 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L43 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L44 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L45 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L46 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L47 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L48 CM OD4.5 MM HUMERUS C1713 $2,090.72NAIL INTRAMEDULLARY ENDER L49 CM OD4.5 MM HUMERUS C1713 $2,090.72

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 ChargeNAIL INTRAMEDULLARY EXPERT TITANIUM 120 D HELICAL C1713 $11,181.30NAIL INTRAMEDULLARY EXPERT TITANIUM ADULT 120 D HE C1713 $10,409.76NAIL INTRAMEDULLARY EXPERT TITANIUM FLUTE BARREL L C1713 $10,674.96NAIL INTRAMEDULLARY EXPERT TITANIUM FLUTE L345 MM C1713 $7,928.70NAIL INTRAMEDULLARY EXPERT TITANIUM HELICAL FLUTE C1713 $10,811.76NAIL INTRAMEDULLARY EXPERT TITANIUM L150 MM OD13 M C1713 $10,674.96NAIL INTRAMEDULLARY EXPERT TITANIUM L180 MM OD13 M C1713 $10,674.96NAIL INTRAMEDULLARY EXPERT TITANIUM NIOBIUM ALUMIN C1713 $10,409.76NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND BARREL L C1713 $12,371.28NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L20 C1713 $12,156.96NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L24 C1713 $12,308.80NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L28 C1713 $12,308.80NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L30 C1713 $12,308.80NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L32 C1713 $12,308.80NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L34 C1713 $12,308.80NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L40 C1713 $12,308.80NAIL INTRAMEDULLARY FASSIER-DUVAL TELESCOPIC IM SY C1713 $7,200.00NAIL INTRAMEDULLARY G3 TITANIUM 125 D LONG L440 MM C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA TITANIUM 125 D LONG L340 C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA TITANIUM 125 D LONG L400 C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA TITANIUM 125 D LONG R1.5 C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA TITANIUM 125 D R1/5 LONG C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 120 D L180 MM C1713 $6,285.24NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D L170 MM C1713 $6,500.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D L180 MM C1713 $6,285.24NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D L340 MM C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D L360 MM C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D L380 MM C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D L400 MM C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D LONG L32 C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D LONG L40 C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 125 D LONG L42 C1713 $9,750.00NAIL INTRAMEDULLARY GAMMA3 TITANIUM 130 D L180 MM C1713 $6,285.24NAIL INTRAMEDULLARY GAMMA3 TITANIUM 130 D LONG L32 C1713 $9,750.00NAIL INTRAMEDULLARY L24 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L240 MM OD13.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L25 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L250 MM OD7.5 MM TIBIA LOCK C1713 $9,957.12NAIL INTRAMEDULLARY L26 CM OD13.5 MM TIBIA C1713 $9,957.12

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 ChargeNAIL INTRAMEDULLARY L260 MM OD7.5 MM TIBIA LOCK C1713 $9,957.12NAIL INTRAMEDULLARY L27 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L28 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L28 CM OD3.5 MM FEMUR C1713 $7,050.24NAIL INTRAMEDULLARY L280 MM OD10.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L280 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L280 MM OD9 MM RIGHT PIRIFORMI C1713 $10,755.84NAIL INTRAMEDULLARY L29 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L290 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L290 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L30 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L300 MM OD10.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L300 MM OD9 MM FEMUR RETROGRAD C1713 $11,735.04NAIL INTRAMEDULLARY L300 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L31 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L310 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L32 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L320 MM OD10.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L320 MM OD10.5 MM TIBIAL STERI C1713 $9,957.12NAIL INTRAMEDULLARY L320 MM OD12 MM FEMUR RIGHT CA C1713 $3,246.75NAIL INTRAMEDULLARY L320 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L33 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L330 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L330 MM OD9 MM TIBIA C1713 $8,090.16NAIL INTRAMEDULLARY L34 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L340 MM OD10.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L340 MM OD9 MM FEMUR RETROGRAD C1713 $11,735.04NAIL INTRAMEDULLARY L340 MM OD9 MM FEMUR TROCHANTE C1713 $16,066.56NAIL INTRAMEDULLARY L35 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L350 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L350 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L36 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L360 MM OD10.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L360 MM OD10.5 MM FEMUR TROCHA C1713 $14,446.08NAIL INTRAMEDULLARY L360 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L360 MM OD13.5 MM RIGHT FEMORA C1713 $10,755.84NAIL INTRAMEDULLARY L360 MM OD9 MM FEMUR RETROGRAD C1713 $9,534.72NAIL INTRAMEDULLARY L360 MM OD9 MM FEMUR TROCHANTE C1713 $14,446.08NAIL INTRAMEDULLARY L360 MM OD9 MM TIBIA C1713 $9,957.12

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 ChargeNAIL INTRAMEDULLARY L37 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L370 MM OD10.5 MM ANKLE LOCK C1713 $9,957.12NAIL INTRAMEDULLARY L370 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L38 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L380 MM OD10.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L380 MM OD10.5 MM FEMUR TROCHA C1713 $14,446.08NAIL INTRAMEDULLARY L380 MM OD10.5 MM RIGHT PIRIFO C1713 $10,755.84NAIL INTRAMEDULLARY L380 MM OD10.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L380 MM OD13.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L380 MM OD13.5 MM RIGHT FEMORA C1713 $10,755.84NAIL INTRAMEDULLARY L380 MM OD9 MM FEMUR RETROGRAD C1713 $11,735.04NAIL INTRAMEDULLARY L380 MM OD9 MM RIGHT TROCHANTE C1713 $14,446.08NAIL INTRAMEDULLARY L380 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L39 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L390 MM OD9 MM ANKLE LOCK C1713 $9,957.12NAIL INTRAMEDULLARY L40 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L400 MM OD10.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L400 MM OD12 MM FEMUR TROCHANT C1713 $14,446.08NAIL INTRAMEDULLARY L400 MM OD13.5 MM FEMUR RETROG C1713 $11,735.04NAIL INTRAMEDULLARY L400 MM OD13.5 MM RIGHT FEMORA C1713 $10,755.84NAIL INTRAMEDULLARY L400 MM OD9 MM FEMUR TROCHANTE C1713 $14,446.08NAIL INTRAMEDULLARY L41 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L410 MM OD10.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L410 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L42 CM OD13.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY L420 MM OD10.5 MM FEMUR TROCHA C1713 $14,446.08NAIL INTRAMEDULLARY L420 MM OD12 MM FEMUR TROCHANT C1713 $14,446.08NAIL INTRAMEDULLARY L420 MM OD13.5 MM RIGHT FEMORA C1713 $10,755.84NAIL INTRAMEDULLARY L440 MM OD13.5 MM RIGHT FEMORA C1713 $10,755.84NAIL INTRAMEDULLARY L460 MM OD13.5 MM FEMUR TROCHA C1713 $14,446.08NAIL INTRAMEDULLARY L460 MM OD13.5 MM RIGHT FEMORA C1713 $10,755.84NAIL INTRAMEDULLARY L480 MM OD13.5 MM FEMUR TROCHA C1713 $14,446.08NAIL INTRAMEDULLARY L480 MM OD13.5 MM RIGHT FEMORA C1713 $10,755.84NAIL INTRAMEDULLARY MULTILOC TITANIUM NIOBIUM ALUM C1713 $10,270.26NAIL INTRAMEDULLARY NAIL-EX TITANIUM ALUMINUM NIOB C1713 $11,181.30NAIL INTRAMEDULLARY NATURAL NAIL TI6AL4V 130 D CCD C1713 $7,185.36NAIL INTRAMEDULLARY PEDIATRIC L32 CM OD5.5 MM LOCK C1713 $7,050.24NAIL INTRAMEDULLARY PEDIATRIC L32 CM OD6.5 MM LOCK C1713 $7,050.24NAIL INTRAMEDULLARY PEDIATRIC L33 CM OD5.5 MM LOCK C1713 $7,050.24

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 ChargeNAIL INTRAMEDULLARY PEDIATRIC L34 MM OD6.5 MM FEMU C1713 $7,050.24NAIL INTRAMEDULLARY PEDIATRIC L36 CM OD6.5 MM FEMU C1713 $7,050.24NAIL INTRAMEDULLARY PEDIATRIC L38 CM OD6.5 MM FEMU C1713 $7,050.24NAIL INTRAMEDULLARY PEDIATRIC L42 CM OD5.5 MM FEMU C1713 $7,050.24NAIL INTRAMEDULLARY PEDIATRIC L42 CM OD6.5 MM KNEE C1713 $7,050.24NAIL INTRAMEDULLARY PEDIATRIC L80 CM OD5.5 MM FEMU C1713 $7,050.24NAIL INTRAMEDULLARY PHOENIX 340 MM OD13.5 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX CORELOCK L32 CM OD9 MM C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX CORELOCK L380 MM OD12 C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L240 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L260 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L280 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L300 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L320 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L340 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L360 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L380 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L400 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L420 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L440 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK TITANIUM L460 C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX CORELOCK UNIVERSAL L28 C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L240 MM OD10.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L240 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L240 MM OD9 MM FEMUR R C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L240 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L250 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L250 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L250 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L260 MM OD10.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L260 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L260 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L260 MM OD13.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L260 MM OD9 MM FEMUR R C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L260 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L270 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L270 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L270 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L270 MM OD9 MM TIBIA C1713 $9,957.12

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 ChargeNAIL INTRAMEDULLARY PHOENIX L280 MM OD10.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L280 MM OD13.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L280 MM OD9 MM FEMUR R C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L280 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L280 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L280 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L29 CM OD10.5 MM C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L290 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L300 MM OD10.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L300 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L300 MM OD10.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L300 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L300 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L300 MM OD12 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L300 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L300 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L300 MM OD13.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L300 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L300 MM OD13.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L300 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L300 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L300 MM OD15 MM RIGHT C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L300 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L300 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L300 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L300 MM OD9 MM RIGHT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L310 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L310 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L320 MM OD10.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L320 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L320 MM OD10.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L320 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L320 MM OD12 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L320 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L320 MM OD13.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L320 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L320 MM OD13.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L320 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L320 MM OD15 MM LEFT P C1713 $10,755.84

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 ChargeNAIL INTRAMEDULLARY PHOENIX L320 MM OD15 MM RIGHT C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L320 MM OD9 MM FEMUR R C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L320 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L320 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L320 MM OD9 MM RIGHT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L33 CM OD10.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L33 CM OD7.5 MM TIBIAL C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L34 CM OD10.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L34 CM OD9 MM TIBIAL K C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L340 MM OD10.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L340 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L340 MM OD10.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L340 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L340 MM OD12 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L340 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L340 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L340 MM OD13.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L340 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L340 MM OD13.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L340 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L340 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L340 MM OD15 MM RIGHT C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L340 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L340 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L340 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L340 MM OD9 MM RIGHT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L35 CM OD10.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L350 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L36 MM OD9 MM PIRIFORM C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L360 MM OD10.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L360 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L360 MM OD10.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L360 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L360 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L360 MM OD12 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L360 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L360 MM OD13.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L360 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L360 MM OD15 MM FEMUR C1713 $14,446.08

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 ChargeNAIL INTRAMEDULLARY PHOENIX L360 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L360 MM OD15 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L360 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L360 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L360 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L37 CM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L370 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L38 MM OD9 MM PIRIFORM C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L380 MM OD10.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L380 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L380 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L380 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L380 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L380 MM OD13.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L380 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L380 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L380 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L380 MM OD15 MM RIGHT C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L380 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L380 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L380 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L39 CM OD10.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L39 CM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L40 CM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L400 MM OD10.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L400 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L400 MM OD10.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L400 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L400 MM OD12 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L400 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L400 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L400 MM OD13.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L400 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L400 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L400 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L400 MM OD15 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L400 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L400 MM OD9 MM FEMUR R C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L400 MM OD9 MM FEMUR T C1713 $14,446.08

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 ChargeNAIL INTRAMEDULLARY PHOENIX L400 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L400 MM OD9 MM RIGHT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L410 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L420 MM OD10.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L420 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L420 MM OD10.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L420 MM OD10.5 MM TIBI C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L420 MM OD12 MM FEMUR C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L420 MM OD12 MM LEFT P C1713 $10,759.84NAIL INTRAMEDULLARY PHOENIX L420 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L420 MM OD12 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L420 MM OD13.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L420 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L420 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L420 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L420 MM OD15 MM RIGHT C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L420 MM OD7.5 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L420 MM OD9 MM FEMUR R C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L420 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L420 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L420 MM OD9 MM RIGHT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L420 MM OD9 MM TIBIA C1713 $9,957.12NAIL INTRAMEDULLARY PHOENIX L44 MM OD10.5 MM PIRIF C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L440 MM OD10.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L440 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L440 MM OD10.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L440 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L440 MM OD12 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L440 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L440 MM OD13.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L440 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L440 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L440 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L440 MM OD15 MM RIGHT C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L440 MM OD9 MM FEMORAL C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L440 MM OD9 MM FEMUR R C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L440 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L440 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L460 MM OD10.5 MM FEMU C1713 $14,446.08

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 ChargeNAIL INTRAMEDULLARY PHOENIX L460 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L460 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L460 MM OD12 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L460 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L460 MM OD13.5 MM FEMU C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L460 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L460 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L460 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L460 MM OD15 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L460 MM OD9 MM FEMORAL C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L460 MM OD9 MM FEMUR R C1713 $11,735.04NAIL INTRAMEDULLARY PHOENIX L460 MM OD9 MM FEMUR T C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L460 MM OD9 MM LEFT PI C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L480 MM OD10.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L480 MM OD10.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L480 MM OD10.5 MM RIGH C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L480 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L480 MM OD12 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L480 MM OD12 MM RIGHT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L480 MM OD13.5 MM FEMU C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L480 MM OD13.5 MM LEFT C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L480 MM OD15 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX L480 MM OD15 MM LEFT P C1713 $10,755.84NAIL INTRAMEDULLARY PHOENIX L480 MM OD15 MM RIGHT C1713 $14,446.08NAIL INTRAMEDULLARY PHOENIX TITANIUM L15 CM OD10 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L15 CM OD11 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L15 CM OD12 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L180 MM OD11 C1713 $17,155.84NAIL INTRAMEDULLARY PHOENIX TITANIUM L21 CM OD10 M C1713 $14,314.56NAIL INTRAMEDULLARY PHOENIX TITANIUM L21 CM OD11 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L21 CM OD12 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L210 MM OD10 C1713 $13,939.12NAIL INTRAMEDULLARY PHOENIX TITANIUM L24 CM OD10 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L24 CM OD11 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L24 CM OD12 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L27 CM OD10 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L27 CM OD11 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L27 CM OD12 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L30 CM OD10 M C1713 $17,617.92

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 ChargeNAIL INTRAMEDULLARY PHOENIX TITANIUM L30 CM OD11 M C1713 $17,617.92NAIL INTRAMEDULLARY PHOENIX TITANIUM L30 CM OD12 M C1713 $17,617.92NAIL INTRAMEDULLARY POLARUS 3 L150 MM LEFT PROXIMA C1713 $10,361.00NAIL INTRAMEDULLARY POLARUS 3 TITANIUM 4 D TAPER L C1713 $10,361.00NAIL INTRAMEDULLARY STAINLESS STEEL 11 D CLOVERLEA C1713 $8,383.20NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD1.5 C1713 $1,835.36NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD15 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L300 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD15 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L320 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD15 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L340 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD15 M C1713 $8,335.68

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 ChargeNAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L360 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD15 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L380 MM OD19 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD15 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L400 MM OD19 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD11 M C1713 $7,980.00NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD12 M C1713 $7,419.12NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD15 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L420 MM OD19 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD15 M C1713 $8,335.68

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 ChargeNAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD19 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD2 MM C1713 $1,964.16NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD2.5 C1713 $2,111.36NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD3 MM C1713 $2,226.40NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD3.5 C1713 $2,359.76NAIL INTRAMEDULLARY STAINLESS STEEL L440 MM OD4 MM C1713 $2,530.00NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD15 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L460 MM OD19 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD10 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD11 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD12 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD13 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD14 M C1713 $7,756.56NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD15 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD16 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD17 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD18 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L480 MM OD19 M C1713 $8,335.68NAIL INTRAMEDULLARY STAINLESS STEEL L63 MM OD6 MM C1713 $2,503.44NAIL INTRAMEDULLARY STAINLESS STEEL LONG CANNULATE C1713 $3,588.00NAIL INTRAMEDULLARY STAINLESS STEEL OLECRANON END C1713 $3,519.75NAIL INTRAMEDULLARY STAINLESS STEEL SHORT CANNULAT C1713 $3,588.00NAIL INTRAMEDULLARY STRAIGHT L240 MM OD7.5 MM TIBI C1713 $416.00NAIL INTRAMEDULLARY T2 L200 MM OD10 MM SUPRACONDYL C1713 $9,878.90NAIL INTRAMEDULLARY T2 L200 MM OD14 MM SUPRACONDYL C1713 $9,878.90NAIL INTRAMEDULLARY T2 L28 CM OD11 MM SUPRACONDYLA C1713 $9,878.90NAIL INTRAMEDULLARY T2 L320 MM OD11 MM FEMORAL R15 C1713 $8,657.03NAIL INTRAMEDULLARY T2 L340 MM OD11 MM SUPRACONDYL C1713 $9,878.90

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 ChargeNAIL INTRAMEDULLARY T2 L340 MM OD13 MM SUPRACONDYL C1713 $9,878.90NAIL INTRAMEDULLARY T2 L340 MM OD14 MM SUPRACONDYL C1713 $9,878.90NAIL INTRAMEDULLARY T2 L360 MM OD14 MM SUPRACONDYL C1713 $9,878.90NAIL INTRAMEDULLARY T2 L380 MM OD12 MM SUPRACONDYL C1713 $9,878.90NAIL INTRAMEDULLARY T2 L400 MM OD13 MM SUPRACONDYL C1713 $9,878.90NAIL INTRAMEDULLARY T2 TITANIUM ANTEGRADE L40 CM O C1713 $8,657.03NAIL INTRAMEDULLARY T2 TITANIUM L19 CM OD7 MM HUME C1713 $7,440.23NAIL INTRAMEDULLARY T2 TITANIUM L260 MM OD9 MM HUM C1713 $7,440.23NAIL INTRAMEDULLARY T2 TITANIUM L27 CM OD7 MM HUME C1713 $7,440.23NAIL INTRAMEDULLARY T2 TITANIUM L32 CM OD9 MM FEMU C1713 $10,654.80NAIL INTRAMEDULLARY T2 TITANIUM L34 CM OD13 MM FEM C1713 $8,657.03NAIL INTRAMEDULLARY T2 TITANIUM L34.5 CM OD10 MM T C1713 $7,528.95NAIL INTRAMEDULLARY T2 TITANIUM L340 MM OD11 MM FE C1713 $9,691.31NAIL INTRAMEDULLARY T2 TITANIUM L360 MM OD11 MM LE C1713 $10,472.28NAIL INTRAMEDULLARY T2 TITANIUM L360 MM OD9 MM FEM C1713 $9,691.31NAIL INTRAMEDULLARY T2 TITANIUM L380 MM OD13 MM LE C1713 $10,472.28NAIL INTRAMEDULLARY T2 TITANIUM L400 MM OD11 MM FE C1713 $9,691.31NAIL INTRAMEDULLARY T2 TITANIUM L400 MM OD13 MM RI C1713 $10,472.28NAIL INTRAMEDULLARY T2 TITANIUM L420 MM OD11 MM HI C1713 $10,327.59NAIL INTRAMEDULLARY T2 TITANIUM L440 MM OD13 MM FE C1713 $9,691.31NAIL INTRAMEDULLARY T2 TITANIUM LONG L40 CM OD13 M C1713 $9,878.90NAIL INTRAMEDULLARY T2 TITANIUM STANDARD L280 MM O C1713 $7,528.95NAIL INTRAMEDULLARY T2 TITANIUM STANDARD L300 MM O C1713 $7,528.95NAIL INTRAMEDULLARY T2 TITANIUM STANDARD L315 MM O C1713 $7,528.95NAIL INTRAMEDULLARY T2 TITANIUM STANDARD L330 MM O C1713 $7,528.95NAIL INTRAMEDULLARY T2 TITANIUM STANDARD L345 MM O C1713 $7,528.95NAIL INTRAMEDULLARY T2 TITANIUM STANDARD L360 MM O C1713 $7,528.95NAIL INTRAMEDULLARY T2 TITANIUM STANDARD L375 MM O C1713 $7,528.95NAIL INTRAMEDULLARY TFN-ADVANCED LATERAL RELIEF CU C1713 $10,189.98NAIL INTRAMEDULLARY TITANIUM 125 D L235 MM OD10-17 C1713 $8,548.80NAIL INTRAMEDULLARY TITANIUM 125 D L235 MM OD11-17 C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 125 D L235 MM OD12-17 C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 125 D L300 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 125 D L300 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L300 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L320 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 125 D L320 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L320 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L340 MM OD10-17 C1713 $11,593.92

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 ChargeNAIL INTRAMEDULLARY TITANIUM 125 D L340 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L340 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L360 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 125 D L360 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L380 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 125 D L380 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L380 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L400 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 125 D L400 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L420 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 125 D L420 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L440 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 125 D L440 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L440 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L460 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 125 D L460 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D L460 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D LONG L340 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D LONG L360 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D LONG L400 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D LONG L420 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D LONG L440 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 125 D SHORT L170 MM O C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 130 D L235 MM OD10-17 C1713 $8,548.80NAIL INTRAMEDULLARY TITANIUM 130 D L235 MM OD11-17 C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 130 D L300 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D L300 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L320 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D L320 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L340 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D L340 MM OD11 MM C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L340 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L360 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D L360 MM OD11 MM C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L360 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L380 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D L380 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L380 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L400 MM OD11-17 C1713 $8,845.46

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 ChargeNAIL INTRAMEDULLARY TITANIUM 130 D L420 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D L420 MM OD11 MM C1713 $8,845.46NAIL INTRAMEDULLARY TITANIUM 130 D L440 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D L440 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D L460 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D LONG L300 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D LONG L320 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D LONG L340 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D LONG L360 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D LONG L380 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D LONG L400 MM OD C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 130 D LONG L420 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D LONG L440 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D LONG L460 MM OD C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 130 D SHORT L170 MM O C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 130 D SHORT L235 MM O C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 135 D L235 MM OD10-17 C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 135 D L300 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 135 D L300 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L300 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L320 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 135 D L320 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L320 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L340 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 135 D L340 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L340 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L360 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 135 D L360 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L360 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L380 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 135 D L380 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L380 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L400 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 135 D L400 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L400 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L420 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 135 D L420 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L420 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L440 MM OD10-17 C1713 $11,593.92

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 ChargeNAIL INTRAMEDULLARY TITANIUM 135 D L440 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L440 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L460 MM OD10-17 C1713 $11,593.92NAIL INTRAMEDULLARY TITANIUM 135 D L460 MM OD11-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D L460 MM OD12-17 C1713 $10,886.72NAIL INTRAMEDULLARY TITANIUM 135 D SHORT L170 MM O C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 135 D SHORT L235 MM O C1713 $8,274.24NAIL INTRAMEDULLARY TITANIUM 5 D UNIVERSAL BEND FL C1713 $12,073.60NAIL INTRAMEDULLARY TITANIUM 7% NIOBIUM 6% ALUMINU C1713 $7,524.00NAIL INTRAMEDULLARY TITANIUM ALLOY PEDIATRIC L40 C C1713 $7,050.24NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L240 MM C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L300 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L320 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L340 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L360 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L380 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L400 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L420 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L440 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L460 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM FLUTE BARREL L480 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM L15 CM OD8 MM HUMERUS C1713 $11,956.00NAIL INTRAMEDULLARY TITANIUM L150 MM OD7.5 MM HUME C1713 $11,956.00NAIL INTRAMEDULLARY TITANIUM L24 CM OD9.5 MM HUMER C1713 $12,073.60NAIL INTRAMEDULLARY TITANIUM L25.5 CM OD10 MM TIBI C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L25.5 CM OD11 MM TIBI C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L25.5 CM OD12 MM TIBI C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L25.5 CM OD13 MM TIBI C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L25.5 CM OD9 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L255 MM OD8 MM TIBIAL C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L26 CM OD9.5 MM HUMER C1713 $12,073.60NAIL INTRAMEDULLARY TITANIUM L27 CM OD10 MM TIBIA C1713 $7,680.40NAIL INTRAMEDULLARY TITANIUM L27 CM OD11 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L27 CM OD12 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L27 CM OD7.5 MM HUMER C1713 $12,073.60NAIL INTRAMEDULLARY TITANIUM L27 CM OD8 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L27 CM OD9 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L270 MM OD10 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L270 MM OD13 MM TIBIA C1713 $9,452.80

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 ChargeNAIL INTRAMEDULLARY TITANIUM L28.5 CM OD10 MM TIBI C1713 $7,680.40NAIL INTRAMEDULLARY TITANIUM L28.5 CM OD11 MM TIBI C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L28.5 CM OD8 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L28.5 CM OD9 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L280 MM OD7.5 MM HUME C1713 $12,409.60NAIL INTRAMEDULLARY TITANIUM L285 MM OD10 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L285 MM OD12 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L285 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L29.5 CM OD7.5 MM HUM C1713 $12,409.60NAIL INTRAMEDULLARY TITANIUM L29.5 CM OD9.5 MM HUM C1713 $12,073.60NAIL INTRAMEDULLARY TITANIUM L30 CM OD10 MM TIBIA C1713 $7,680.40NAIL INTRAMEDULLARY TITANIUM L30 CM OD12 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L30 CM OD4 MM FEMUR C1713 $7,050.24NAIL INTRAMEDULLARY TITANIUM L30 CM OD8 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L30 CM OD9 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L300 MM OD1.5 MM DIAP C1713 $2,129.76NAIL INTRAMEDULLARY TITANIUM L300 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L300 MM OD10 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L300 MM OD11 MM FEMOR C1713 $7,524.00NAIL INTRAMEDULLARY TITANIUM L300 MM OD11 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L300 MM OD12 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L300 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L300 MM OD9 MM FEMORA C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L31 CM OD7.5 MM HUMER C1713 $12,409.60NAIL INTRAMEDULLARY TITANIUM L31 CM OD9.5 MM HUMER C1713 $12,409.60NAIL INTRAMEDULLARY TITANIUM L31.5 CM OD10 MM TIBI C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L31.5 CM OD12 MM TIBI C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L31.5 CM OD8 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L315 MM OD11 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L315 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L315 MM OD9 MM TIBIAL C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L32 CM OD9 MM FEMUR S C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L320 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L320 MM OD11 MM FEMOR C1713 $7,524.00NAIL INTRAMEDULLARY TITANIUM L320 MM OD12 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L33 CM OD10 MM TIBIA C1713 $7,680.40NAIL INTRAMEDULLARY TITANIUM L33 CM OD12 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L33 CM OD8 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L330 MM OD10 MM TIBIA C1713 $9,318.40

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 ChargeNAIL INTRAMEDULLARY TITANIUM L330 MM OD11 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L330 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L330 MM OD9 MM TIBIAL C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L34 CM OD9 MM FEMUR S C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L34.5 CM OD10 MM TIBI C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L34.5 CM OD11 MM TIBI C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L34.5 CM OD12 MM TIBI C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L34.5 CM OD8 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L34.5 CM OD9 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L340 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L340 MM OD11 MM FEMOR C1713 $7,524.00NAIL INTRAMEDULLARY TITANIUM L345 MM OD10 MM TIBIA C1713 $8,688.42NAIL INTRAMEDULLARY TITANIUM L345 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L36 CM OD10 MM TIBIA C1713 $7,680.40NAIL INTRAMEDULLARY TITANIUM L36 CM OD12 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L36 CM OD8 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L36 CM OD9 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L360 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L360 MM OD10 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L360 MM OD11 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L360 MM OD11 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L360 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L360 MM OD9 MM FEMORA C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L38 CM OD10 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L38 CM OD11 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L38 CM OD12 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L38 CM OD8 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L38 CM OD9 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L380 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L380 MM OD10 MM TIBIA C1713 $7,680.40NAIL INTRAMEDULLARY TITANIUM L380 MM OD11 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L380 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L380 MM OD9 MM FEMORA C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L40 CM OD10 MM TIBIA C1713 $7,680.40NAIL INTRAMEDULLARY TITANIUM L40 CM OD12 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L40 CM OD8 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L400 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L400 MM OD10 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L400 MM OD11 MM FEMOR C1713 $7,812.00

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 ChargeNAIL INTRAMEDULLARY TITANIUM L400 MM OD11 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L400 MM OD12 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L400 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L400 MM OD9 MM FEMORA C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L400 MM OD9 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L42 CM OD10 MM TIBIA C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L42 CM OD11 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L42 CM OD12 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L42 CM OD9 MM TIBIA S C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L420 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L420 MM OD11 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L420 MM OD12 MM FEMOR C1713 $7,524.00NAIL INTRAMEDULLARY TITANIUM L420 MM OD13 MM TIBIA C1713 $9,452.80NAIL INTRAMEDULLARY TITANIUM L420 MM OD8 MM TIBIAL C1713 $9,318.40NAIL INTRAMEDULLARY TITANIUM L420 MM OD9 MM FEMUR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L44 CM OD11 MM FEMUR C1713 $7,105.93NAIL INTRAMEDULLARY TITANIUM L44 CM OD9 MM FEMUR S C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L440 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L440 MM OD11 MM FEMOR C1713 $7,524.00NAIL INTRAMEDULLARY TITANIUM L440 MM OD12 MM FEMOR C1713 $7,524.00NAIL INTRAMEDULLARY TITANIUM L440 MM OD12 MM FEMUR C1713 $14,446.08NAIL INTRAMEDULLARY TITANIUM L46 CM OD11 MM FEMUR C1713 $7,105.93NAIL INTRAMEDULLARY TITANIUM L46 CM OD9 MM FEMUR S C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L460 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L460 MM OD11 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L460 MM OD12 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L480 MM OD10 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L480 MM OD11 MM FEMOR C1713 $7,524.00NAIL INTRAMEDULLARY TITANIUM L480 MM OD12 MM FEMOR C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM L480 MM OD9 MM FEMORA C1713 $7,812.00NAIL INTRAMEDULLARY TITANIUM OD4 MM ORTHOPEDIC CAN C1713 $1,251.20NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L30 CM OD6. C1713 $7,050.24NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L300 MM OD1 C1713 $1,453.86NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L36 CM OD5. C1713 $7,050.24NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L38 MM OD5. C1713 $7,050.24NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L440 MM OD2 C1713 $1,904.40NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L440 MM OD3 C1713 $2,166.56NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L440 MM OD4 C1713 $2,456.40NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L16 CM O C1713 $12,156.96

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 ChargeNAIL INTRAMEDULLARY TITANIUM ROUND BARREL L240 MM C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L280 MM C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L300 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L320 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L340 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L360 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L380 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L400 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L420 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L440 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L460 MM C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM ROUND BARREL L480 MM C1713 $9,129.12NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L160 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L180 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L180 MM OD9 C1713 $12,156.96NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L200 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L220 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L220 MM OD9 C1713 $12,156.96NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L240 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L260 MM OD1 C1713 $11,837.76NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L260 MM OD9 C1713 $12,156.96NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L280 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L300 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L320 MM OD1 C1713 $9,788.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L340 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L360 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L360 MM OD9 C1713 $11,837.76NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L380 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L380 MM OD9 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L400 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L420 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L440 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L460 MM OD1 C1713 $12,308.80NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L460 MM OD9 C1713 $12,156.96NAIL INTRAMEDULLARY TRABECULAR METAL L9 CM OD10 MM C1713 $16,595.80NAIL INTRAMEDULLARY TRIGEN L36 CM OD4 MM NONSTERIL C1713 $2,090.72NAIL INTRAMEDULLARY UHN TITANIUM L190 MM OD7.5 MM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM L190 MM OD9.5 MM C1713 $12,073.60NAIL INTRAMEDULLARY UHN TITANIUM L205 MM OD9.5 MM C1713 $12,409.60

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 ChargeNAIL INTRAMEDULLARY UHN TITANIUM L220 MM OD9.5 MM C1713 $12,073.60NAIL INTRAMEDULLARY UHN TITANIUM L230 MM OD9.5 MM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM L240 MM OD9.5 MM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM L250 MM OD9.5 MM C1713 $12,073.60NAIL INTRAMEDULLARY UHN TITANIUM L270 MM OD9.5 MM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM L280 MM OD7.5 MM C1713 $12,073.60NAIL INTRAMEDULLARY UHN TITANIUM L280 MM OD9.5 MM C1713 $12,073.60NAIL INTRAMEDULLARY UHN TITANIUM L295 MM OD9.5 MM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM L310 MM OD7.5 MM C1713 $12,073.60NAIL INTRAMEDULLARY UHN TITANIUM L310 MM OD9.5 MM C1713 $12,073.60NAIL INTRAMEDULLARY UHN TITANIUM L325 MM OD7.5 MM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM L325 MM OD9.5 MM C1713 $12,073.60NAIL INTRAMEDULLARY UHN TITANIUM UNIVERSAL L19 CM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM UNIVERSAL L22 CM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM UNIVERSAL L28 CM C1713 $12,409.60NAIL INTRAMEDULLARY UHN TITANIUM UNIVERSAL L29.5 C C1713 $12,073.60NAIL INTRAMEDULLARY UNIFLEX TITANIUM L22 CM OD8 MM C1713 $7,812.48NAIL INTRAMEDULLARY UNIFLEX TITANIUM L24 CM OD8 MM C1713 $7,812.48NAIL INTRAMEDULLARY UNIFLEX TITANIUM L26 CM OD8 MM C1713 $7,812.48NAIL INTRAMEDULLARY UNIFLEX TITANIUM L28 CM OD8 MM C1713 $12,039.56NAIL INTRAMEDULLARY VERSANAIL L36 CM OD9 MM TIBIA C1713 $6,558.24NAIL INTRAMEDULLARY VERSANAIL TIMAX L15 CM OD10 MM C1713 $8,115.12NAIL INTRAMEDULLARY VERSANAIL TIMAX L33 CM OD9 MM C1713 $6,558.24NAIL INTRAMEDULLARY VERSANAIL TIMAX UNIVERSAL L30 C1713 $11,281.92NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEI 83880 $224.00NECROSECTOMY, ENDOSCOPIC 48999 $2,292.00NEEDLE ASPIRATION ARCPOINT METAL L137 MM OD21 GA O $7,600.00NEEDLE ASPIRATION BNX NITINOL OD19 GA 4 BEVEL PREL $2,717.00NEEDLE ASPIRATION BNX PEBAX FINE OD22 GA 4 BEVEL P $1,612.00NEEDLE ASPIRATION EXCELON L15 MM L130 CM OD19 GA O $526.58NEEDLE ASPIRATION EXCELON L15 MM L130 CM OD21 GA O $684.55NEEDLE ASPIRATION OF BLADDER 51100 $2,263.00NEEDLE ASPIRATION VIZISHOT L700 MM L40 MM OD21 GA $3,125.00NEEDLE ASPIRATION VIZISHOT L700 MM L40 MM OD22 GA $621.03NEEDLE BIOPSY ACHIEVE 20 MM L6 CM OD18 GA SOFT TIS $993.27NEEDLE BIOPSY ACHIEVE 20 MM L9 CM OD14 GA SOFT TIS $1,045.53NEEDLE BIOPSY ACHIEVE L6 CM L11 CM L5 CM OD14 GA O $543.90NEEDLE BIOPSY ACQUIRE OD22 GA FINE ENDOSCOPIC ULTR $3,760.00NEEDLE BIOPSY ADJUSTABLE COAXIAL TEMNO L15 CM L14 $2,562.04

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 ChargeNEEDLE BIOPSY BARD MAGNUM SMALL ULTRA SHARP TIP 2 $5,557.50NEEDLE BIOPSY BEACON FNA NITINOL OD19 GA $2,598.70NEEDLE BIOPSY BEACON FNA STAINLESS STEEL OD22 GA $1,105.00NEEDLE BIOPSY BEACON FNA STAINLESS STEEL OD25 GA $1,105.00NEEDLE BIOPSY ECHOTIP PROCORE L8- CM OD20 GA ODSEC $1,150.00NEEDLE BIOPSY ECHOTIP PROCORE L8- CM OD22 GA ODSEC $1,537.50NEEDLE BIOPSY ECHOTIP PROCORE L8- CM OD25 GA ODSEC $1,150.00NEEDLE BIOPSY JAMSHIDI L6 IN OD11 GA BONE MARROW R $575.07NEEDLE BIOPSY LIVER STERILE $2,848.00NEEDLE BIOPSY OF ABDOMINAL CAVITY GROWTH, ACCESSED 49180 $2,565.00NEEDLE BIOPSY OF KIDNEY, ACCESSED THROUGH THE SKIN 50200 $2,389.00NEEDLE BIOPSY OF LINING OF LUNG, ACCESSED THROUGH 32400 $3,186.00NEEDLE BIOPSY OF LIVER 47001 $328.00NEEDLE BIOPSY OF LIVER, ACCESSED THROUGH THE SKIN 47000 $3,186.00NEEDLE BIOPSY OF LUNG OR CHEST TISSUE, ACCESSED TH 32405 $3,186.00NEEDLE BIOPSY OF LUNG USING AN ENDOSCOPE 31633 $2,818.00NEEDLE BIOPSY OF MUSCLE, ACCESSED THROUGH THE SKIN 20206 $2,307.00NEEDLE BIOPSY OF PANCREAS, ACCESSED THROUGH THE SK 48102 $2,565.00NEEDLE BIOPSY OF SALIVARY GLAND 42400 $2,248.00NEEDLE BIOPSY OF SPINAL CORD, ACCESSED BENEATH THE 62269 $3,186.00NEEDLE BIOPSY OF THYROID, ACCESSED THROUGH THE SKI 60100 $1,243.00NEEDLE BIOPSY OF WINDPIPE CARTILAGE, AIRWAY, AND/O 31629 $7,019.00NEEDLE BIOPSY OR REMOVAL OF LYMPH NODES 38505 $2,306.00NEEDLE BIOPSY PROCORE ECHOTIP FINE L5 CM L2 MM OD2 $1,200.00NEEDLE BIOPSY TEMNO STANDARD L11 CM L6 CM OD20 GA $2,544.00NEEDLE BIOPSY TEMNO STANDARD L15 CM OD20 GA COAXIA $1,923.92NEEDLE BIOPSY TEMNO STANDARD L2 3/8 IN OD18 GA PRO $724.23NEEDLE ENDOSCOPIC CLEARVIEW NITINOL PLASTIC L1.8 M $1,400.00NEEDLE ENDOSCOPIC ECHOTIP ULTRA L5- CM OD22 GA ODS $975.00NEEDLE ENDOSCOPIC ECHOTIP ULTRA L8- CM OD19 GA ODS $1,000.00NEEDLE ENDOSCOPIC ECHOTIP ULTRA L8- CM OD20 GA ODS $1,170.00NEEDLE ENDOSCOPIC ECHOTIP ULTRA L8- CM OD25 GA ODS $1,000.00NEEDLE ENDOSCOPIC ECHOTIP ULTRA OD25 GA ODSEC5.2 F $1,000.00NEEDLE ENDOSCOPIC EXPECT SLIMLINE COCR SILICONE 2. $1,852.50NEEDLE ENDOSCOPIC EXPECT SLIMLINE NITINOL L8- CM L $3,230.40NEEDLE ENDOSCOPIC PKS TAPER L33 CM OD5 MM CORD TAP $2,325.60NEEDLE ENDOSCOPIC SHARKCORE LG NITINOL OD19 GA 6 D $3,250.00NEEDLE ENDOSCOPIC SHARKCORE OD22 GA 6 DISTAL CUT E $2,089.10NEEDLE ENDOSCOPIC SHARKCORE OD25 GA 6 DISTAL CUT E $2,089.10

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 ChargeNEEDLE EPIDURAL L6 IN OD14 GA LATEX FREE $370.50NEEDLE INJECTION INJETAK ANGLE L35 CM OD4.8 FR 3 B $448.50NEEDLE INSUFFLATION VERSASTEP STANDARD L150 MM OD1 $1,318.20NEEDLE INTRAOSSEOUS EZ-IO EZ-CONNECT STAINLESS STE $786.24NEEDLE INTRODUCER PRECISION L4 IN INSERTION $559.00NEEDLE INTRODUCER PRECISION L5 IN INSERTION $559.00NEEDLE MEASURE & RECORD ELECTRICL ACTIVITY OF MUSC 51785 $563.00NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY OF 95860 $385.00NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY OF 95861 $385.00NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY OF 95887 $209.00NEEDLE MEASUREMENT & REC ELECTRCL ACTIV MUSCLE ARM 95870 $209.00NEEDLE MEASUREMENT & REC ELECTRCL ACTIV MUSCLES AR 95885 $385.00NEEDLE NERVE BLOCK ECHOBRIGHT PLASTIC L4 IN OD20 G $845.98NEEDLE NERVE STIMULATOR ENTRADA SPINAL CORD SYSTEM $1,412.13NEEDLE OR TROCAR BONE MARROW BIOPSY 38221 $5,393.00NEEDLE PORT GRIPPER PLUS DELTEC PORT-A-CATH HUBER $514.08NEEDLE PORT GRIPPER PLUS DELTEC PORT-A-CATH PLASTI $514.08NEEDLE PROCEDURE STAINLESS STEEL ADULT 50 D BRK CU $995.00NEEDLE PROCEDURE STAINLESS STEEL ADULT BRK1 CURVE $1,250.00NEEDLE RADIOLOGY COUPLED L20 CM L3 MM OD17 GA ODSE $2,015.00NEEDLE RADIOLOGY COUPLED XTHIN WALL L20 CM L3 MM O A4648 $1,007.50NEEDLE RADIOLOGY GOLD KNURL L20 CM L3 MM OD17 GA O $513.50NEEDLE SCLEROTHERAPY CARR-LOCKE TEFLON STAINLESS S $504.00NEEDLE SPINAL OD8 GA BEVEL TIP $487.50NEEDLE STEREOTACTIC AND IMAGE-GUIDED BIOPSY OF PRO 55706 $10,788.00NEEDLE SUTURE MULTIFIRE SCORPION $1,360.00NEEDLE SUTURE RICHARD-ALLAN MAYO STAINLESS STEEL C $1,279.85NEEDLE SUTURE RICHARD-ALLAN STAINLESS STEEL 4 1/2 $2,144.81NEEDLE SUTURE SCORPION $910.00NEEDLE SUTURE SCORPION KNEE $1,267.50NEEDLE SUTURE SCORPION SUREFIRE ROTATOR CUFF $910.00NEEDLE SUTURE SPECTRUM AUTOPASS PASSER HI-FI $1,358.50NEEDLE TRANSSEPTAL BRK-1 STAINLESS STEEL ADULT 30 $995.00NEEDLE TRANSSEPTAL BRK-1 STAINLESS STEEL ADULT L71 $995.00NEEDLE TRANSSEPTAL NRG CURVE C1 L71 CM RADIOFREQUE $3,087.50NEGATIVE PRESSURE WOUND THERAPY SURFACE AREA < OR 97605 $457.00NEGATIVE PRESSURE WOUND THERAPY SURFACE AREA < OR 97607 $719.00NEGATIVE PRESSURE WOUND THERAPY SURFACE AREA GREAT 97606 $4,330.00NEGATIVE PRESSURE WOUND THERAPY SURFACE AREA GREAT 97608 $719.00

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 ChargeNEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) SYRG J2710 $27.56NERVE BIOPSY 88304 $204.00NERVE TRANSMISSION STUDIES, 11-12 STUDIES 95912 $1,778.00NERVE TRANSMISSION STUDIES, 1-2 STUDIES 95907 $628.00NERVE TRANSMISSION STUDIES, 13 OR MORE STUDIES 95913 $1,778.00NERVE TRANSMISSION STUDIES, 5-6 STUDIES 95909 $996.00NERVE TRANSMISSION STUDIES, 7-8 STUDIES 95910 $996.00NERVE TRANSMISSION STUDIES, 9-10 STUDIES 95911 $1,778.00NET SPECIMEN RETRIEVAL ROTH NET MINI L160 CM L4.5 $650.00NET SPECIMEN RETRIEVAL ROTH NET PLATINUM UNIVERSAL $682.50NEUROBEHAVIORAL STATUS EXAM INTERP & REP PSYCHOLOG 96116 $857.00NEUROFUNCTIONAL TESTING DURING FUNCTIONAL MRI OF T 96020 $131.00NEUROPLASTY AND/OR TRANSPOSITION 64721 $6,526.00NEUROSTIMULATOR IMPLANTABLE ACTIVA PC MULTIPROGRAM C1767 $114,400.00NEUROSTIMULATOR IMPLANTABLE ACTIVA RC 10.5-V 2-250 C1820 $169,604.50NEUROSTIMULATOR IMPLANTABLE ACTIVA SC 0-10.5V 2-25 $57,492.50NEUROSTIMULATOR IMPLANTABLE ACTIVA SC 0-10.5V 2-25 C1767 $57,492.50NEUROSTIMULATOR IMPLANTABLE BOOT KIT ACCESSORY $573.30NEUROSTIMULATOR IMPLANTABLE INTERSTIM II THK.3 IN C1767 $67,925.00NEUROSTIMULATOR IMPLANTABLE ITREL 4 THK.4 IN 3.2V C1767 $44,850.00NEUROSTIMULATOR IMPLANTABLE RESTORESENSOR D0-4 CM C1820 $94,250.00NEUROSTIMULATOR IMPLANTABLE RESTORESENSOR SURESCAN C1820 $100,100.00NEUROSTIMULATOR IMPLANTABLE RESTOREULTRA SURESCAN C1820 $78,000.00NEUROSTIMULATOR IMPLANTABLE STRETCH-COIL L40 CM 1X C1778 $3,250.00NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99201 $220.00NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99202 $285.00NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99203 $358.00NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99204 $474.00NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPI 99205 $648.00NFCT DS CHRNC HCV 6 ASSAYS 81596 $325.00NICARDIPINE 25 MG/10 ML SOLN 10 ML VIAL $54.15NICKEL LEVEL 83885 $190.00NIVOLUMAB 100 MG/10 ML SOLN 10 ML VIAL J9299 $14,435.00NIVOLUMAB 40 MG/4 ML SOLN 4 ML VIAL J9299 $4,846.00NON-CARDIAC VASCULAR FLOW IMAGING 78445 $1,200.00NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY BENEATH 96401 $190.00NON-IMAGING DETERMINATION OF CARDIOVASCULAR FUNCTI 78414 $1,494.00NONINTEFACED LEAD URINE 83655 $77.00NON-NEEDLE MEASURE & RECORD OF ELECTRICAL ACTIVITY 51784 $332.00

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 ChargeNUCLEAR MEDICINE ADDITIONAL STUDIES FOR THYROID CA 78016 $1,450.00NUCLEAR MEDICINE BACKWASH OF URINE INTO KIDNEY 78740 $1,467.00NUCLEAR MEDICINE IMAGING FOR THYROID UPTAKE MEASUR 78012 $1,398.00NUCLEAR MEDICINE IMAGING FOR THYROID UPTAKE MEASUR 78014 $1,026.00NUCLEAR MEDICINE IMAGING FROM SKULL BASE TO MID-TH 78812 $5,747.00NUCLEAR MEDICINE IMAGING OF THYROID 78013 $661.00NUCLEAR MEDICINE IMAGING WHOLE BODY 78813 $5,747.00NUCLEAR MEDICINE KIDNEY FUNCTION STUDY 78725 $950.00NUCLEAR MEDICINE LIMITED STUDY FOR THYROID CANCER 78015 $1,450.00NUCLEAR MEDICINE MULTIPLE STUDIES VESSELS OF HEART 78454 $3,285.00NUCLEAR MEDICINE SINGLE STUDY OF VESSELS OF HEART 78453 $3,285.00NUCLEAR MEDICINE STUDY BRAIN WITH METABOLIC EVALUA 78608 $5,104.00NUCLEAR MEDICINE STUDY FOR THYROID CANCER 78020 $201.00NUCLEAR MEDICINE STUDY HEART FUNCTION REST/STRESS 78496 $76.00NUCLEAR MEDICINE STUDY HEART MUSCLE AT REST AND/OR 78492 $5,104.00NUCLEAR MEDICINE STUDY HEART MUSCLE AT REST OR STR 78491 $5,104.00NUCLEAR MEDICINE STUDY HEART MUSCLE FOLLOW HEART A 78468 $1,494.00NUCLEAR MEDICINE STUDY HEART MUSCLE WITH METABOLIC 78459 $5,104.00NUCLEAR MEDICINE STUDY HEART WALL MOTION REST W/BL 78494 $1,494.00NUCLEAR MEDICINE STUDY HEART WALL MOTION REST/STRE 78472 $1,866.00NUCLEAR MEDICINE STUDY HEART WALL MOTION REST/STRE 78481 $1,494.00NUCLEAR MEDICINE STUDY HEART WALL MOTION REST/STRE 78483 $1,494.00NUCLEAR MEDICINE STUDY LIMITED AREA 78811 $5,747.00NUCLEAR MEDICINE STUDY OF BLOOD 78122 $2,106.00NUCLEAR MEDICINE STUDY OF BLOOD CIRCULATION IN THE 78580 $974.00NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT 78320 $1,265.00NUCLEAR MEDICINE STUDY OF BRAIN 78607 $2,215.00NUCLEAR MEDICINE STUDY OF DIGESTIVE TRACT 78267 $45.00NUCLEAR MEDICINE STUDY OF DIGESTIVE TRACT 78268 $378.00NUCLEAR MEDICINE STUDY OF HEART FUNCTION WALL MOTI 78473 $1,494.00NUCLEAR MEDICINE STUDY OF HEART MUSCLE 0399T $612.00NUCLEAR MEDICINE STUDY OF HEART MUSCLE FOLLOWING H 78466 $1,494.00NUCLEAR MEDICINE STUDY OF HEART MUSCLE FOLLOWING H 78469 $1,494.00NUCLEAR MEDICINE STUDY OF KIDNEY 78710 $1,609.00NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT O 78701 $1,467.00NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT O 78707 $1,609.00NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT O 78708 $1,207.00NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT O 78709 $1,530.00NUCLEAR MEDICINE STUDY OF LIVER 78205 $4,811.00

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 ChargeNUCLEAR MEDICINE STUDY OF LIVER WITH BLOOD FLOW 78206 $1,519.00NUCLEAR MEDICINE STUDY OF LUNG VENTILATION 78579 $1,068.00NUCLEAR MEDICINE STUDY OF LUNG VENTILATION & BLOOD 78582 $1,626.00NUCLEAR MEDICINE STUDY OF PLATELET 78191 $950.00NUCLEAR MEDICINE STUDY OF RADIOACTIVE MATERIAL DIS 78803 $1,823.00NUCLEAR MEDICINE STUDY OF RED BLOOD CELL 78120 $2,106.00NUCLEAR MEDICINE STUDY OF RED BLOOD CELL 78121 $2,106.00NUCLEAR MEDICINE STUDY OF RED BLOOD CELL 78130 $2,106.00NUCLEAR MEDICINE STUDY OF RED BLOOD CELL 78135 $2,106.00NUCLEAR MEDICINE STUDY OF RED BLOOD CELL 78140 $2,106.00NUCLEAR MEDICINE STUDY OF REMAINING URINE IN BLADD 78730 $552.00NUCLEAR MEDICINE STUDY OF SALIVARY GLAND 78232 $1,240.00NUCLEAR MEDICINE STUDY OF TEAR DRAINAGE STRUCTURE 78660 $1,277.00NUCLEAR MEDICINE STUDY OF TESTICLES AND BLOOD VESS 78761 $1,609.00NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78800 $1,450.00NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78801 $2,215.00NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78802 $2,215.00NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78804 $4,211.00NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78805 $4,811.00NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78806 $2,429.00NUCLEAR MEDICINE STUDY RADIOACTIVE MATERIAL DISTRI 78807 $2,429.00NUCLEAR MEDICINE STUDY VESSELS OF HEART USING DRUG 78451 $3,285.00NUCLEAR MEDICINE STUDY VESSELS OF HEART USING DRUG 78452 $3,275.00NUCLEAR MEDICINE STUDY W/MEASURE BLOOD CIRCULATION 78598 $1,626.00NUCLEAR MEDICINE STUDY WITH CT IMAGING 78814 $5,747.00NUCLEAR MEDICINE STUDY WITH CT IMAGING SKULL BASE 78815 $5,747.00NUCLEAR MEDICINE STUDY WITH CT IMAGING WHOLE BODY 78816 $5,747.00NUCLEAR MEDICINE STUDY WITH MEASUREMENT OF BLOOD C 78597 $974.00NUCLEAR MEDICINE WHOLE BODY STUDY FOR THYROID CANC 78018 $1,450.00NUT EXTERNAL FIXATION DFS MINI LENGTHEN DISTRACTIO $604.80NUT EXTERNAL FIXATION SQUARE MRI SAFE $584.16NUT EXTERNAL FIXATION TRIANGULAR SMALL BONE FIXATO $875.20NUT LOCK EXPEDIUM STAINLESS STEEL DOME SPINE NONST C1713 $400.00NUT LOCK EXPEDIUM STAINLESS STEEL STRAIGHT SPINE 4 C1713 $400.00NUT LOCK EXPEDIUM TITANIUM DOME SPINE 4.5 MM ROD C1713 $400.00NUT LOCK EXPEDIUM TITANIUM STRAIGHT SPINE NONSTERI C1713 $400.00NUT LOCK PEDIATRIC SELF LOCK C1713 $691.60NUT LOCK STAINLESS STEEL W10.5 MM SPINE 12 POINT N C1713 $400.00NUT LOCK SYNAPSE TITANIUM OD7.5 MM SPINE CAP NONST C1713 $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 ChargeNUT LOCK VANTAGE TITANIUM ANTERIOR THORACOLUMBAR S C1713 $325.00NUT ORTHOPEDIC COMPRESS C1713 $2,684.00NUT ORTHOPEDIC FEMUR TIBIAL PROXIMAL DISTAL C1713 $780.00NUT ORTHOPEDIC FEMUR TIBIAL PROXIMAL DISTAL CLAMP C1713 $390.00NUT ORTHOPEDIC LCP STAINLESS STEEL L12 MM OD4 MM S C1713 $893.23NUT ORTHOPEDIC MRI SAFE NONSTERILE C1713 $1,122.40NUT ORTHOPEDIC T2 TITANIUM OD5 MM CONDYLE STERILE C1713 $1,024.14NUT ORTHOPEDIC TITANIUM OD5 MM TIBIA PROXIMAL MEDI C1713 $1,099.36NUT ORTHOPEDIC TITANIUM W8 MM OD11 MM NONSTERILE 4 C1713 $202.40NUT SPINAL MOUNTAINEER SPINE OCCIPITOCERVICOTHORAC C1713 $400.00NUT SPINAL PASS LP BREAKAWAY NONSTERILE C1713 $325.00NUT SPINAL PASS LP REVISION POST NONSTERILE C1713 $4,550.00NUT SPINAL PASS OCT BREAKAWAY NONSTERILE C1713 $325.00NUT SPINAL PASS TULIP BREAKOFF SET SCREW NONSTERIL C1713 $325.00NUT SPINAL TIGER OCCIPITAL CERVICAL THORACIC POSTE C1713 $325.00NUT SPINAL TIGER RETENTION HEAD TO HEAD CONNECTOR C1713 $325.00NUT SPINAL VAIL TITANIUM XS NONSTERILE OCT FIXATIO C1713 $325.00OBSERVATION AND RECORDING FROM MULTIPLE POSITIONS 92542 $315.00OBSERVATION AND RECORDING OF ABNORMAL EYE MOVEMENT 92541 $315.00OBSERVATION, TESTING, AND RECORDING OF ABNORMAL EY 92540 $638.00OBTURATOR PROSTHESIS D5931 $3,029.00OCC MED SCREENING $3,951.00OCCLUDER CARDIOVASCULAR AMPLATZER NITINOL POLYESTE C1817 $28,080.00OCCLUSAL ORTHOTIC APPLIANCE D7880 $1,916.00OCCLUSION OF ABNORMAL ARTERY, ACCESSED THROUGH THE 61624 $2,830.00OCCLUSION OF ARTERIAL OR VENOUS HEMORRHAGE 37244 $43,497.00OCCLUSION OF ARTERY 37242 $32,148.00OCCLUSION OF HEAD OR NECK ARTERY, ACCESSED THROUGH 61626 $29,108.00OCCLUSION OF TUMORS OR OBSTRUCTED BLOOD VESSEL 37243 $35,015.00OCCLUSION OF VENOUS MALFORMATIONS 37241 $43,496.00OCTREOTIDE,MICROSPHERES 20 MG SSRR 1 EACH VIAL J2353 $3,617.21OCULAR PROSTHESIS D5916 $1,272.00OLARATUMAB 10 MG/ML SOLN 19 ML VIAL J9285 $4,624.25OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAP 120 EACH BOTT $8.22ONABOTULINUMTOXINA (COSMETIC) 50 UNIT SOLR 1 EACH J0585 $1,502.00ONLAY CAST HIGH NOBLE METAL D6611 $244.00OPEN AXILLARY/SUBCLAVIAN ARTERY EXPOS DELIVERY EV 34715 $1,288.00OPEN OR PERCUTANEOUS CATHETER REMOVAL OF PLAQUE FR 0236T $34,244.00OPEN OR PERCUTANEOUS CATHETER REMOVAL OF PLAQUE FR 0237T $34,244.00

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 ChargeOPEN TREATMENT FOR BROKEN JAW BONE WITH INSERT HAR 21470 $12,096.00OPEN TREATMENT OF BROKEN FINGER 26615 $11,619.00OPEN TREATMENT OF BROKEN FINGER OR THUMB 26765 $8,803.00OPEN TREATMENT OF BROKEN FOREARM BONE AT ELBOW 24655 $1,471.00OPEN TREATMENT OF BROKEN GREAT TOE 28505 $7,042.00OPEN TREATMENT OF BROKEN HAND OR FINGER 26746 $7,042.00OPEN TREATMENT OF BROKEN JAW BONE WITH PLACEMENT O 21454 $12,096.00OPEN TREATMENT OF DISLOCATED FINGER JOINT 26785 $10,495.00OPEN TREATMENT PHALANGEAL SHAFT FRACTUREW/FIXATION 26735 $10,495.00OPENING OF WINDPIPE THROUGH NECK FOR INSERTION OF 31600 $8,299.00OPIATES LEVELS 80361 $130.00OPIOIDS LEVELS 80362 $244.00OR LEVEL 1 1ST 15 MINUTES $4,259.00OR LEVEL 1 EACH ADDITIONAL 15 MINUTES $267.00OR LEVEL 2 1ST 15 MINUTES $8,518.00OR LEVEL 2 EACH ADDITIONAL 15 MINUTES $636.00OR LEVEL 3 1ST 15 MINUTES $12,776.00OR LEVEL 3 EACH ADDITIONAL 15 MINUTES $879.00OR LEVEL 4 1ST 15 MINUTES $17,035.00OR LEVEL 4 EACH ADDITIONAL 15 MINUTES $949.00OR LEVEL 5 1ST 15 MINUTES $21,294.00OR LEVEL 5 EACH ADDITIONAL 15 MINUTES $1,019.00OR LEVEL 6 1ST 15 MINUTES $25,553.00OR LEVEL 6 EACH ADDITIONAL 15 MINUTES $1,089.00OR LEVEL 7 1ST 15 MINUTES $29,838.00OR LEVEL 7 EACH ADDITIONAL 15 MINUTES $1,159.00OR LEVEL 8 1ST 15 MINUTES $34,097.00OR LEVEL 8 EACH ADDITIONAL 15 MINUTES $1,229.00OR ROBOTICS/HIGH TECH $10,156.00ORAL ADMINISTRATION OF RADIOACTIVE MATERIAL THERAP 79005 $1,143.00ORAL HYGIENE INSTRUCTIONS D1330 $100.00ORAL INTRODUCTION OF LONG DRAINAGE TUBE INTO SMALL 44500 $1,962.00ORGANIC ACID LEVEL 83921 $128.00ORGANIC ACIDS LEVEL 83918 $128.00ORTHODONTIC TREATMENT D8210 $494.00ORTHODONTIC TREATMENT D8220 $594.00OSSEOUS SURGERY D4260 $1,995.00OTHER PRIMARY FUNCTION LIMIT CURRENT STATUS G8990 $0.01OTHER PRIMARY FUNCTION LIMIT DISCHARGE STATUS G8992 $0.01

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 ChargeOTHER PRIMARY FUNCTION LIMIT GOAL STATUS G8991 $0.01OTHER SPEECH/LANGUAGE FUNCTIONAL LIMIT CURRENT STA G9174 $0.01OTHER SPEECH/LANGUAGE FUNCTIONAL LIMIT DISCHARGE S G9176 $0.01OTHER SPEECH/LANGUAGE FUNCTIONAL LIMIT GOAL STATUS G9175 $0.01OTHER SUBSEQUENT FUNCTION LIMIT CURRENT STATUS G8993 $0.01OTHER SUBSEQUENT FUNCTION LIMIT DISCHARGE STATUS G8995 $0.01OTHER SUBSEQUENT FUNCTION LIMIT GOAL STATUS G8994 $0.01OVA & PARASITES 87177 $68.00OVERNIGHT MEASUREMENT OXYGEN SATURATION IN BLOOD U 94762 $238.00OVERTUBE ENDOSCOPIC GUARDUS STANDARD TAPER L25 CM $3,802.50OVERTUBE ENDOSCOPIC GUARDUS STANDARD TAPER L50 CM $4,387.50OXALATE LEVEL 83945 $100.00OXALIPLATIN 100 MG SOLR 1 EACH VIAL J9263 $1,145.66OXCARBAZEPINE LEVEL 80183 $82.00OXFORD TSPOT TB 86481 $580.00OXYCODONE LEVELS 80365 $244.00OXYCODONE-ACETAMINOPHEN 5-325 MG TAB 1 EACH BLIST $3.09OXYMORPHONE 15 MG TB12 100 EACH BOTTLE $18.44PACEMAKER CARDIAC 1 CHAMBER REPLY SR C1786 $21,879.00PACEMAKER CARDIAC ADAPTA DR 12.1 CC 27.1 GM 2 CHAM C1785 $18,577.00PACEMAKER CARDIAC ADAPTA DR LITHIUM IODINE 2.8V .9 C1785 $18,577.00PACEMAKER CARDIAC ADAPTA DR MVP D7.5 MM W52.3 MM X C1785 $16,500.00PACEMAKER CARDIAC ADAPTA DR MVP PARYLENE 2.8V L47. $18,577.00PACEMAKER CARDIAC ADAPTA DR THK7.5 MM SMALL W47.9 C1785 $26,000.00PACEMAKER CARDIAC ADAPTA DR THK7.5 MM W47.9 MM X H C1785 $26,000.00PACEMAKER CARDIAC ADAPTA SR ATRIUM VENTRICLE IMPLA C1786 $21,274.50PACEMAKER CARDIAC ADAPTA SR LITHIUM IODINE 2.8V D7 C1786 $19,012.50PACEMAKER CARDIAC ADAPTA SR PARYLENE D7.5 MM W42.9 C1786 $19,012.50PACEMAKER CARDIAC ADVANTIO RIGHTRATE THK.3 IN MODI C1785 $18,785.00PACEMAKER CARDIAC ADVISA DR MRI SURESCAN 12.7 ML 2 C1786 $22,750.00PACEMAKER CARDIAC ADVISA DR MRI SURESCAN TITANIUM C1785 $26,000.00PACEMAKER CARDIAC ASSURITY INVISILINK MERLIN@HOME C1785 $21,450.00PACEMAKER CARDIAC ASSURITY MRI H47 CM X W50 MM 6 M C1785 $20,280.00PACEMAKER CARDIAC ASSURITY MRI THK6 MM W50 MM X H4 C1786 $23,400.00PACEMAKER CARDIAC ASSURITY MRI W50 MM X H47 MM 20 C1785 $21,450.00PACEMAKER CARDIAC ASSURITY THK6 MM SMALL W50 MM X C1786 $19,012.50PACEMAKER CARDIAC ASSURITY THK6 MM SMALL W50 MM X C1785 $31,680.00PACEMAKER CARDIAC AZURE S SR MRI SURESCAN TITANIUM C1786 $19,012.50PACEMAKER CARDIAC ELUNA SR-T PROMRI C1786 $22,960.00

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 ChargePACEMAKER CARDIAC ENDURITY THK6 MM SMALL W50 MM X C1785 $21,450.00PACEMAKER CARDIAC ENTOVIS DR-T L53 MM X W44.5 MM X C1785 $22,425.00PACEMAKER CARDIAC ENTOVIS SR-T L53 MM X W39 MM X H C1786 $18,655.00PACEMAKER CARDIAC IDENTITY ADX DR THK6 MM W44 MM X C1785 $37,424.00PACEMAKER CARDIAC IDENTITY ADX XL DR THK6 MM W52 M C1785 $41,560.00PACEMAKER CARDIAC INGENIO RYTHMIQ THK.3 IN MODIFY C1785 $23,660.00PACEMAKER CARDIAC MICRONY II SR+ BEAT-BY-BEAT AUTO C1786 $19,440.00PACEMAKER CARDIAC PROMRI 2 CHAMBER ELUNA DR-T C1785 $26,400.00PACEMAKER CARDIAC REPLY DR 2 CHAMBER C1785 $31,161.00PACEMAKER CARDIAC VIVA CRT-P L12 MM X H6 MM 2 CHAM C2621 $42,250.00PACEMAKER CARDIAC ZEPHYR SR THK6 MM L44 MM X W41 M C1786 $19,440.00PACEMAKER CARDIAC ZEPHYR XL DR THK6 MM W52 MM X H4 C1785 $16,500.00PACK BATTERY LITHIUM PRECHARGE STERILE DISPOSABLE $1,201.20PACK BATTERY QUICKDRIVE $975.00PACK PERFUSION CUSTOM $2,925.00PACK SURGICAL 2.4 MM CATARACT JEFFERSON SURGERY $1,231.95PACK SURGICAL ACF $388.77PACK SURGICAL BMAC 60 ML BONE MARROW STERILE LATEX $15,496.00PACK SURGICAL BURN STERILE LATEX FREE DISPOSABLE $472.80PACK SURGICAL C SECTION $419.64PACK SURGICAL C SECTION STERILE LATEX FREE DISPOSA $639.09PACK SURGICAL CATARACT STERILE LATEX FREE DISPOSAB $472.00PACK SURGICAL CATHETER INSERTION $659.04PACK SURGICAL CDS CUSTOM SHUNT LATEX FREE $1,035.60PACK SURGICAL CDS CUSTOM TOTAL KNEE $1,897.60PACK SURGICAL CDS FLAP $5,280.96PACK SURGICAL CDS OR GYN ROBOTIC UROLOGY DISPOSABL $1,515.76PACK SURGICAL CDS OR GYN ROBOTIC UROLOGY NONSTERIL $1,293.68PACK SURGICAL CDS OR LAMINECTOMY DISPOSABLE $1,346.24PACK SURGICAL CDS OR LAMINECTOMY NONSTERILE LATEX $2,692.48PACK SURGICAL CDS OR TOTAL HIP DISPOSABLE $3,022.40PACK SURGICAL CDS OR TOTAL HIP NONSTERILE LATEX DI $3,079.60PACK SURGICAL CDS OR TOTAL KNEE LATEX DISPOSABLE $1,900.40PACK SURGICAL CDS OR VASCULAR ACCESS DISPOSABLE $321.72PACK SURGICAL CDS OR VASCULAR ACCESS NONSTERILE LA $321.72PACK SURGICAL CENTURION CATARACT $1,174.42PACK SURGICAL CONVERTORS TIBURON L95 IN X W28 IN L $428.45PACK SURGICAL CORONARY ANGIOGRAM STERILE LATEX FRE $523.52PACK SURGICAL CRANIOTOMY HAZARDOUS $1,386.39

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 ChargePACK SURGICAL CUSTOM EYE $1,096.60PACK SURGICAL ECLIPSE L114 IN X W77 IN L100 IN X W $1,482.00PACK SURGICAL EYE CUSTOM $445.60PACK SURGICAL FAST-LOAD CTA 2 SYRINGE STERILE LATE $1,690.00PACK SURGICAL GYN LAP STERILE LATEX DISPOSABLE LCM $261.45PACK SURGICAL GYN LAPAROSCOPY $350.09PACK SURGICAL ILH OPEN HEART STERILE LATEX DISPOSA $2,187.40PACK SURGICAL LUMBAR LAMI $507.59PACK SURGICAL MAJOR OR STERILE LATEX FREE DISPOSAB $697.84PACK SURGICAL MEDLINE INDUSTRIES INC ARTHROSCOPY S $254.82PACK SURGICAL ORTHO DISPOSABLE LCMC HEALTH $314.00PACK SURGICAL PERI CARDIOVASCULAR $1,415.34PACK SURGICAL PROCEDURE CUSTOM CABG $1,251.71PACK SURGICAL SILS L46 MM ADVANCEMENT CLINCH CHOLE $4,387.50PACK SURGICAL TOTAL JOINT $634.27PACK SURGICAL UNIVERSAL DISPOSABLE UNIVERSITY MEDI $255.75PACK SURGICAL Y-KNOT SHOULDER RESTORATION SYSTEM T $1,859.26PACK VITRECTOMY ACCURUS OD25 GA PROBE LIGHT PIPE $3,992.00PACK VITRECTOMY ACCURUS TOTAL PLUS INNOVIT 3 WAY S $2,169.60PACK VITRECTOMY ACCURUS TOTAL PLUS OD23 GA $3,896.00PACK VITRECTOMY ACCURUS TOTAL PLUS OD25 GA EYE PRO $4,544.00PACK VITRECTOMY CONSTELLATION ENGAUGE RUBBER OD25 $472.00PACK VITRECTOMY CONSTELLATION ENGAUGE V-LOCITY C3F $552.00PACK VITRECTOMY CONSTELLATION OD20 GA PROBE FRAGME $539.60PACK VITRECTOMY CONSTELLATION TOTAL PLUS 5000 CPM $4,552.40PACK VITRECTOMY INFINITI ANTERIOR STERILE DISPOSAB $780.00PACK VITRECTOMY TOTAL PLUS CONSTELLATION 5000 CPM $3,504.00PACKING NASAL BLU GLIDE POLYVINYL ALCOHOL FOAM SLI $946.08PACKING NASAL MEROCEL HYAFF L4 CM X W4 CM SINUS ST $280.50PACKING NASAL MEROGEL HYAFF L4 CM X W4 CM DRESSING $983.45PACKING NASAL NASOPORE FOAM L8 CM SINUS ABSORBENT $1,369.60PACKING NASAL NASOPORE FOAM STANDARD L8 CM SINUS $1,332.44PACKING NASAL RAPID RHINO HYDROCOLLOID FABRIC L4.5 $2,520.00PACKING NASAL RAPID RHINO HYDROCOLLOID FABRIC L5.5 $2,632.00PACKING NASAL XEROGEL CHITOSAN PEG THK.3 CM L4 CM $767.00PAD ABDOMINAL CELLULOSE L10 IN X W8 IN ABSORBENT N A6253 $0.31PAD BURN GAUZE CELLULOSE L36 IN X W24 IN 7 PLY MUL A6253 $48.43PAD DRESSING IODOFLEX CADEXOMER IODINE L2 3/8 IN X A6222 $12.95PAD EXTERNAL FIXATION VELCRO ROCKER BOTTOM SOLE ST $969.60

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 ChargePADDING CAST FELT POLYESTER THK1/8 IN L36 IN X W21 $824.00PADDING CAST SIFOAM FOAM CONTOUR CURVE L9 IN X W8 $763.84PADDING CAST WEBRIL II COTTON L4 YD X W4 IN UNDERC $432.16PALATAL LIFT PROSTHESIS D5958 $289.00PANTOPRAZOLE 40 MG SOLR 1 EACH VIAL C9113 $27.47PAP TEST 88175 $143.00PAP TEST 88177 $62.00PAP TEST (PAP SMEAR) 88142 $106.00PAPILLOTOME ENDOSCOPIC APOLLO 3AC SHORT NOSE TAPER $920.00PARAINFLUENZA 1, FA 87279 $74.00PARAINFLUENZA 2, FA 87279 $74.00PARAINFLUENZA 3, FA 87279 $74.00PARTIAL EXCISION DEEP PELVIS 23071 $5,502.00PARTIAL OSTECTOMY FOR BONE REMOVAL D7550 $3,698.00PARTIAL PROTHROMBIN TIME LA 85730 $54.00PARTIAL RECONSTRUCTION OF LOWER JAW OR CHEEK BONE 21248 $12,096.00PARTIAL REMOVAL OF BONE WITH RELEASE OF SPINAL COR 63035 $1,702.00PARTIAL REMOVAL OF FINGER BONE 26236 $5,196.00PARTIAL REMOVAL OF ROOF OF MOUTH 42120 $12,195.00PARTIAL REMOVAL OF TOE BONE 28124 $5,400.00PARTIAL REMOVAL OF TOE JOINT 28160 $10,380.00PARTIAL REMOVE BONE W/RELEASE OF SPINAL CORD OR SP 63030 $13,867.00PARTIAL THROMBIN TIME LA 85611 $23.00PARTICLES EMBOLIZATION CONTOUR PVA 355-500 UM 2 VI $778.05PARTICLES EMBOLIZATION EMBOSPHERE TRISACRYL GELATI $1,115.73PARTICLES EMBOLIZATION LC BEAD 100-300 UM 2 ML VIA $10,500.00PARTICLES EMBOLIZATION PVA FOAM 90-180 UM 1 ML VIA $438.73PASSER SURGICAL ON-Q PAINBUSTER L38 CM CATHETER $585.00PASSER SUTURE ARTHREX SUTURESNARE 90 D STRAIGHT ST $1,787.50PASSER SUTURE SPECTRUM II 45 D ANGLE LEFT HOOK LOC $494.00PASSER SUTURE SPECTRUM II 45 D ANGLE RIGHT HOOK LO $494.00PASSER SUTURE SPECTRUM II 45 D CRESCENT L20 MM OD4 $494.00PASSER SUTURE SUTURELASSO SD NITINOL 25 D TIGHT LE $1,120.00PASSER SUTURE SUTURELASSO SD NITINOL 25 D TIGHT RI $1,120.00PASSER SUTURE SUTURELASSO SD NITINOL 45 D LEFT CUR $1,120.00PASSER SUTURE SUTURELASSO SD NITINOL 45 D RIGHT CU $1,120.00PASSER SUTURE SUTURELASSO SD NITINOL 90 D UP STRAI $1,600.00PASSER SUTURE SUTURELASSO SD NITINOL SMALL CRESCEN $1,120.00PASSER SUTURE SUTURELASSO STAINLESS STEEL NITINOL $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 ChargePATCH CARDIOVASCULAR ACUSEAL GORE-TEX THK.5 MM L7. C1768 $1,371.50PATCH CARDIOVASCULAR ACUSEAL GORE-TEX THK.5 MM L9 C1768 $1,371.50PATCH CARDIOVASCULAR GORE-TEX THK.4 MM L6 CM X W3 C1768 $1,880.00PATCH CARDIOVASCULAR GORE-TEX THK.6 MM L15 CM X W2 C1768 $2,248.00PATCH CARDIOVASCULAR GORE-TEX THK.6 MM L15 CM X W5 C1768 $4,568.00PATCH CARDIOVASCULAR GORE-TEX THK.6 MM L7.5 CM X W C1768 $2,320.00PATCH CARDIOVASCULAR GORE-TEX THK.8 MM L7.5 CM X W C1768 $2,320.00PATCH CARDIOVASCULAR HEMACAROTID INTERVASCULAR COL C1768 $534.95PATCH CARDIOVASCULAR HEMACAROTID INTERVASCULAR POL C1768 $808.00PATCH CARDIOVASCULAR HEMACAROTID PATCH ULTRATHIN I C1768 $643.50PATCH CARDIOVASCULAR HEMAGARD CAROTID ULTRATHIN PO C1768 $796.06PATCH CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER U C1768 $650.39PATCH CARDIOVASCULAR HEMAGARD POLYESTER BOVINE TYP C1768 $838.24PATCH CARDIOVASCULAR HEMASHIELD PLATINUM FINESSE P C1768 $859.95PATCH CARDIOVASCULAR PERI-GUARD BOVINE PERICARDIAL C1768 $1,670.40PATCH CARDIOVASCULAR PHOTOFIX DECELLULARIZED BOVIN C1768 $7,160.00PATCH CARDIOVASCULAR PRECLUDE GORE-TEX THK.1 MM L2 $9,282.00PATCH CARDIOVASCULAR SUPPLE PERI-GUARD APEX PROCES C1768 $1,670.40PATCH CARDIOVASCULAR SUPPLE PERI-GUARD BOVINE PERI C1768 $2,875.60PATCH CARDIOVASCULAR VASCU-GUARD BOVINE PERICARDIU C1768 $1,683.12PATCH CARDIOVASCULAR VASCUTEK FLUOROPASSIV MACROPO C1768 $1,159.34PATCH DURAL DURA-GUARD BOVINE PERICARDIAL L4 CM X Q4100 $1,384.50PATCH DURAL DURAMATRIX COLLAGEN MATRIX L3 IN X W3 $5,652.40PATCH DURAL DURAMATRIX COLLAGEN MATRIX L5 IN X W4 $7,058.35PATCH DURAL DURAMATRIX L3 IN X W3 IN SATURABLE Q4100 $4,003.48PATCH DURAL DURAMATRIX-ONLAY COLLAGEN MATRIX L1 IN Q4100 $2,545.60PATCH DURAL DURAMATRIX-ONLAY COLLAGEN MATRIX L3 IN Q4100 $5,590.33PATCH DURAL DURAMATRIX-ONLAY COLLAGEN MATRIX L5 IN $7,257.19PATCH DURAL DURAMATRIX-ONLAY L7 IN X W5 IN LATEX F Q4100 $11,017.50PATCH DURAL DUREPAIR BOVINE COLLAGEN MATRIX L3 IN $3,744.00PATCH ICD TRANSVENE SILICONE LARGE L50 CM ENDOCARD C1896 $6,175.00PATCH OTOLOGIC EPIFILM HYALURONIC ACID L2.5 CM X W C1763 $1,285.70PATCH SOFT TISSUE GORE-TEX THK1 MM L15 CM X W10 CM C1781 $4,360.00PATCH SOFT TISSUE GORE-TEX THK1 MM OVAL L10 CM X W C1781 $1,720.00PATCH SOFT TISSUE GORE-TEX THK2 MM L15 CM X W10 CM C1781 $7,528.00PATCH SURGICAL BARD KUGEL POLYPROPYLENE MEDIUM OVA C1781 $1,880.00PATCH SURGICAL BARD KUGEL POLYPROPYLENE SMALL OVAL C1781 $1,575.20PATCH SURGICAL CRURASOFT BARD EPTFE PTFE LARGE L4. C1781 $1,954.40PATCH SURGICAL CRURASOFT EPTFE SMALL L7 CM X W6 CM C1781 $1,954.40

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 ChargePATCH SURGICAL EVARREST FIBRIN L4 IN X W2 IN SEALA $5,037.50PATCH SURGICAL GORE-TEX THK2 MM L10 CM X W5 CM SOF C1781 $2,736.00PATCH SURGICAL PROCEED POLYDIOXANONE MEDIUM CONTOU C1781 $2,685.22PATCH SURGICAL PROCEED POLYDIOXANONE SMALL CIRCLE C1781 $2,245.20PATCH SURGICAL PTFE THK1.65 MM L6 IN X W1 IN STERI C1768 $150.15PATCH SURGICAL VENTRALEX SEPRA SORBAFLEX POLYPROPY C1781 $3,360.00PATCH SURGICAL VENTRALEX ST SEPRA SORBAFLEX POLYPR C1781 $4,290.40PATCH SURGICAL VENTRIO ST SEPRA SORBAFLEX POLYPROP C1781 $4,068.80PATCH SURGICAL WITTMANN PATCH L40 CM X W20 CM L40 $22,100.00PATCH VASCULAR VASCU-GUARD BOVINE PERICARDIUM L10 Q4100 $1,118.00PATCH VASCULAR VASCU-GUARD BOVINE PERICARDIUM L8 C C1768 $1,004.80PATCH VASCULAR VASCU-GUARD BOVINE PERICARDIUM L9 C Q4100 $1,154.40PATCH VASCULAR XENOSURE BOVINE PERICARDIAL GLUTARA C1781 $1,820.00PATCH VASCULAR XENOSURE BOVINE PERICARDIUM THK.35- C1768 $1,369.88PATHOGEN(S) TEST FOR PLATELETS P9100 $102.00PATHOLOGY EXAM OF TISSUE USING A MICROSCOPE MODERA 88304 $204.00PATHOLOGY EXAM OF TISSUE USING A MICROSCOPE MODERA 88307 $1,234.00PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE 88300 $69.00PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE 88302 $129.00PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE 88305 $230.00PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE 88309 $2,233.00PCA-3 86255 $88.00PEG FIXATION ACU-LOC TITANIUM L18 MM OD2.3 MM CORT C1713 $487.50PEG FIXATION ACU-LOC TITANIUM L20 MM OD2.3 MM CORT C1713 $487.50PEG FIXATION ACU-LOC TITANIUM L22 MM OD2.3 MM CORT C1713 $487.50PEG FIXATION ACU-LOC TITANIUM L24 MM OD2.3 MM CORT C1713 $487.50PEG FIXATION ALPS TIMAX FULL THREAD L14 MM OD2.5 M C1713 $439.40PEG FIXATION ALPS TIMAX FULL THREAD L16 MM OD2.5 M C1713 $439.40PEG FIXATION ALPS TIMAX FULL THREAD L18 MM OD2.5 M C1713 $439.40PEG FIXATION ALPS TIMAX FULL THREAD L22 MM OD2.5 M C1713 $439.40PEG FIXATION ALPS TIMAX FULL THREAD L24 MM OD2.5 M C1713 $439.40PEG FIXATION ALPS TIMAX FULL THREAD L26 MM OD2.5 M C1713 $439.40PEG FIXATION DVR COCR L20 MM OD2.5 MM KNEE THREAD C1713 $774.02PEG FIXATION DVR L12 MM OD2 MM SMOOTH LOCKING NONS C1713 $439.40PEG FIXATION DVR L14 MM OD2 MM SMOOTH LOCK NONSTER C1713 $439.40PEG FIXATION DVR L16 MM OD2 MM SMOOTH LOCK NONSTER C1713 $439.40PEG FIXATION DVR L18 MM OD2 MM SMOOTH LOCK NONSTER C1713 $439.40PEG FIXATION DVR L18 MM OD2.2 MM RADIUS DISTAL VOL C1713 $503.62PEG FIXATION DVR L20 MM OD2 MM SMOOTH LOCK NONSTER C1713 $439.40

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 ChargePEG FIXATION DVR L20 MM OD2.2 MM RADIUS DISTAL VOL C1713 $503.62PEG FIXATION DVR L22 MM OD2 MM SMOOTH LOCK NONSTER C1713 $439.40PEG FIXATION DVR L22 MM OD2.2 MM RADIUS DISTAL VOL C1713 $503.62PEG FIXATION DVR L24 MM OD2 MM SMOOTH LOCK NONSTER C1713 $439.40PEG FIXATION DVR L24 MM OD2.2 MM RADIUS DISTAL VOL C1713 $503.62PEG FIXATION F3 FULL THREAD L20 MM OD2.5 MM FOOT L C1713 $439.40PEG FIXATION GLOBAL AP PREMIERON OD40 MM GLENOID A C1776 $5,200.00PEG FIXATION GLOBAL AP PREMIERON OD48 MM GLENOID A C1776 $5,200.00PEG FIXATION GLOBAL AP PREMIERON OD52 MM GLENOID A C1776 $5,200.00PEG FIXATION L12 MM OD2.5 MM SELF TAP TIP SQUARE D C1713 $439.40PEG FIXATION L26 MM OD2 MM LOCK SMOOTH NONSTERILE C1713 $439.40PEG FIXATION L32 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L36 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L38 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L40 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L42 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L44 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L46 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L48 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L50 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L56 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION L60 MM OD3.2 MM LOCK NONSTERILE GOLD C1713 $591.50PEG FIXATION PARTIAL THREAD L16 MM OD2.5 MM NONSTE C1713 $439.40PEG FIXATION PARTIAL THREAD L18 MM OD2.5 MM NONSTE C1713 $439.40PEG FIXATION PARTIAL THREAD L20 MM OD2.5 MM NONSTE C1713 $439.40PEG FIXATION PARTIAL THREAD L22 MM OD2.5 MM NONSTE C1713 $439.40PEG FIXATION PARTIAL THREAD L24 MM OD2.5 MM NONSTE C1713 $439.40PEG FIXATION PARTIAL THREAD L26 MM OD2.5 MM NONSTE C1713 $439.40PEG FIXATION TITANIUM L20 MM OD2.5 MM SCREW NONSTE C1713 $439.40PELVIC EXAMINATION UNDER ANESTHESIA 57410 $9,092.00PENTETATE INDIUM DISOD. IN-111 1.5 MCI/1.5 ML SOLN A9548 $4,338.50PERCUTANEOUS ACCESS & CLOSURE FEMORAL ART FOR DELI 34713 $550.00PERCUTANEOUS BREAST BIOPSY W/DEVICE ADDL LESION 19082 $1,586.00PERCUTANEOUS INSERT SMALL BOWEL TUBE 49441 $3,517.00PERICARDIAL PATCH GRAFT TO FEMORAL ARTERY 35286 $17,507.00PERIODIC ORAL EVALUATION D0120 $100.00PERIODONTAL SCALING AND ROOT PLANING D4341 $550.00PERIODONTAL SCALING AND ROOT PLANING D4342 $347.00PERIODONTAL STENT D5982 $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 ChargePERITONEAL DIALYSIS CAPD 90945 $746.00PERITONEAL DIALYSIS CCPD 90945 $746.00PERITONEAL DIALYSIS NON-CAPD 90945 $746.00PERITONEAL-VENOUS SHUNT PATENCY TEST 78291 $1,240.00PERMANENT BLOCKAGE OF DIALYSIS CIRCUIT WITH IMAGIN 36909 $811.00PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 43762 $319.00PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC 43763 $926.00PERQ TRANSCATH SEPTAL REDUXN 93583 $3,623.00PH URINE 83986 $28.00PHENCYCLIDINE (PCP), URINE 83992 $114.00PHENOBARBITAL LEVEL 80184 $88.00PHENYTOIN LEVEL 80185 $129.00PHENYTOIN LEVEL 80186 $87.00PHOSPHATASE (ENZYME) LEVEL 84075 $40.00PHOSPHATASE (ENZYME) MEASUREMENT 84080 $144.00PHOSPHATASE (ENZYME) MEASUREMENT 84060 $57.00PHOSPHATASE, PROSTATIC (PROSTATE ENZYME) LEVEL 84066 $62.00PHOSPHATE LEVEL 84100 $37.00PHOSPHOLIPID ANTIBODY (AUTOIMMUNE ANTIBODY) MEASUR 86148 $90.00PHOSPHOLIPID TEST 85598 $79.00PHOSPHOROUS URINE 84105 $40.00PHOSPHORUS URINE 84105 $40.00PHOTOGRAPHY OF CONTENT OF EYES 92285 $234.00PHOTOGRAPHY OF THE RETINA 92250 $420.00PHYSICAL PERFORMANCE TEST OR MEASUREMENT WITH REPO 97750 $126.00PHYSICAL THERAPY TREATMENT TO 1 OR MORE AREAS HUBB 97036 $116.00PHYTONADIONE (VITAMIN K1) 5 MG TAB 100 EACH BOTTLE $3.00PILLOW ABDUCTION NYLON FOAM UNIVERSAL SHOULDER KIT L3670 $121.95PILLOW ABDUCTION UNIVERSAL SHOULDER INFLATE BLADDE $416.85PIN DISTRACTION CASPAR TITANIUM STRAIGHT L14 MM OD C1713 $146.25PIN DISTRACTOR L14 MM OD14 MM NONSTERILE ANTERIOR C1713 $379.60PIN DRILL JET-X 4 MM SHORT OD4 MM DRILL UNILATERAL $550.80PIN DRILL NEXGEN L75 MM OD3.2 MM ODSEC2.5 MM TROCA $325.00PIN DRILL RETROBUTTON TIGHTROPE OD4 MM KNEE ACL OP $1,163.50PIN EXTERNAL FIXATION APEX STAINLESS STEEL HA L150 $1,104.00PIN FIXATION APEX HA L200 MM OD5 MM BLUNT THREAD S $1,212.00PIN FIXATION APEX HA STAINLESS STEEL L120 MM L30 M $1,168.00PIN FIXATION APEX HA STAINLESS STEEL L120 MM L35 M $1,104.00PIN FIXATION APEX HA STAINLESS STEEL L150 MM L20 M $1,104.00

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 ChargePIN FIXATION APEX HA STAINLESS STEEL L150 MM L25 M $1,168.00PIN FIXATION APEX HA STAINLESS STEEL L150 MM L30 M $1,168.00PIN FIXATION APEX HA STAINLESS STEEL L150 MM L40 M $1,168.00PIN FIXATION APEX HA STAINLESS STEEL L150 MM L60 M $1,104.00PIN FIXATION APEX HA STAINLESS STEEL L150 MM L80 M $1,168.00PIN FIXATION APEX HA STAINLESS STEEL L180 MM L60 M $1,168.00PIN FIXATION APEX HA STAINLESS STEEL L200 MM L25 M $1,212.00PIN FIXATION APEX HA STAINLESS STEEL L200 MM L30 M $1,168.00PIN FIXATION APEX HA STAINLESS STEEL L200 MM L35 M $1,212.00PIN FIXATION APEX HA STAINLESS STEEL L200 MM L40 M $1,212.00PIN FIXATION APEX HA STAINLESS STEEL L200 MM L50 M $1,168.00PIN FIXATION APEX HA STAINLESS STEEL L200 MM L60 M $1,212.00PIN FIXATION APEX HA STAINLESS STEEL L250 MM L70 M $1,212.00PIN FIXATION APEX HA STAINLESS STEEL L250 MM L80 M $1,212.00PIN FIXATION APEX HA STAINLESS STEEL L250 MM L90 M $1,212.00PIN FIXATION APEX HOFFMANN II L300 MM L50 MM OD6 M $1,024.00PIN FIXATION APEX STAINLESS STEEL BLUNT L180 MM L5 $572.00PIN FIXATION APEX STAINLESS STEEL HA L150 MM L35 M $1,104.00PIN FIXATION APEX STAINLESS STEEL HA L200 MM L70 M $1,104.00PIN FIXATION APEX STAINLESS STEEL L120 MM L35 MM O $572.00PIN FIXATION APEX STAINLESS STEEL L180 MM L50 MM O C1713 $788.00PIN FIXATION APEX STAINLESS STEEL L180 MM L60 MM O $976.00PIN FIXATION APEX STAINLESS STEEL L200 MM L35 MM O $908.00PIN FIXATION APEX STAINLESS STEEL L250 MM L35 MM O $908.00PIN FIXATION APEX STAINLESS STEEL L300 MM L70 MM O $908.00PIN FIXATION APEX STAINLESS STEEL L80 MM L10 MM OD $1,192.00PIN FIXATION APEX TRANSFIX L300 MM L40 MM OD5/6 MM $737.75PIN FIXATION ASSOX 3.1 MM LOCKING SET $767.00PIN FIXATION ATTUNE THREAD PACK HEAD HEADLESS $1,596.80PIN FIXATION CHECKMATE KIT STERILE $799.50PIN FIXATION COMPRESS L20 MM FEMORAL TRANSVERSE RE $564.67PIN FIXATION COMPRESS L28 MM FEMORAL TRANSVERSE RE $3,388.00PIN FIXATION COMPRESS L32 MM FEMORAL TRANSVERSE RE $3,388.00PIN FIXATION COMPRESS L36 MM FEMORAL TRANSVERSE RE $564.67PIN FIXATION COMPRESS L40 MM FEMORAL TRANSVERSE RE $3,388.00PIN FIXATION COMPRESS L44 MM FEMORAL TRANSVERSE RE $564.67PIN FIXATION HALF L90 MM OD6 MM $1,048.56PIN FIXATION JET-X TITANIUM NITRIDE LONG L40 MM L1 $1,031.12PIN FIXATION KNOWLES STAINLESS STEEL L3.25 IN OD1/ $847.76

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 ChargePIN FIXATION L100 MM L16 MM OD6.35 MM HIP CANNULAT $2,140.96PIN FIXATION L105 MM HIP CANNULATED $2,140.96PIN FIXATION L11.5 IN OD5/32 IN ORTHOPEDIC THREAD $771.93PIN FIXATION L110 MM L16 MM OD6.35 MM HIP CANNULAT $2,140.96PIN FIXATION L115 MM L16 MM OD6.35 MM HIP CANNULAT $2,140.96PIN FIXATION L120 MM L16 MM OD3 MM ORTHOPEDIC COVE $674.16PIN FIXATION L120 MM L22 MM OD3 MM ORTHOPEDIC COVE $674.16PIN FIXATION L125 MM HIP CANNULATED $2,140.96PIN FIXATION L130 MM HIP CANNULATED $2,140.96PIN FIXATION L135 MM HIP CANNULATED $2,140.96PIN FIXATION L160 MM LATERAL LUMBAR FUSION $487.50PIN FIXATION L160 MM SPINE LATERAL LUMBAR FUSION $487.50PIN FIXATION L24 MM DISTAL LOCK $1,669.41PIN FIXATION L28 MM DISTAL LOCK $1,669.41PIN FIXATION L30 MM DISTAL LOCK $1,669.41PIN FIXATION L30 MM HIP CANNULATED $2,140.96PIN FIXATION L34 MM DISTAL LOCK $1,669.41PIN FIXATION L35 MM HIP CANNULATED $2,140.96PIN FIXATION L350 MM OD2.7 MM TRANSFIXING SMOOTH $969.60PIN FIXATION L36 MM DISTAL LOCK $1,669.41PIN FIXATION L38 MM DISTAL LOCK $1,669.41PIN FIXATION L40 MM DISTAL LOCK $1,669.41PIN FIXATION L40 MM HIP CANNULATED $2,140.96PIN FIXATION L42 MM DISTAL LOCK $1,669.41PIN FIXATION L44 MM DISTAL LOCK $1,669.41PIN FIXATION L45 MM HIP CANNULATED $2,140.96PIN FIXATION L46 MM DISTAL LOCK $1,669.41PIN FIXATION L50 MM DISTAL LOCK $1,669.41PIN FIXATION L50 MM HIP CANNULATED $2,140.96PIN FIXATION L50 MM MIDFACIAL MOUNT NONSTERILE EXT C1713 $1,864.00PIN FIXATION L52 MM DISTAL LOCK $1,669.41PIN FIXATION L55 MM HIP CANNULATED $2,140.96PIN FIXATION L60 MM DISTAL LOCK $1,669.41PIN FIXATION L60 MM HIP CANNULATED $2,140.96PIN FIXATION L65 MM HIP CANNULATED $2,140.96PIN FIXATION L70 MM DISTAL LOCK $1,669.41PIN FIXATION L70 MM L16 MM OD6.35 MM HIP CANNULATE $2,140.96PIN FIXATION L75 MM HIP CANNULATED $2,140.96PIN FIXATION L80 MM L16 MM OD6.35 MM HIP CANNULATE $2,140.96

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 ChargePIN FIXATION L85 MM L16 MM OD6.35 MM HIP CANNULATE $2,140.96PIN FIXATION L9 IN OD7/64 IN ORTHOPEDIC TROCAR POI $862.08PIN FIXATION L90 MM L16 MM OD6.35 MM HIP CANNULATE $2,140.96PIN FIXATION L95 MM L16 MM OD6.35 MM HIP CANNULATE $2,140.96PIN FIXATION LCP STAINLESS STEEL T8 L12 MM OD1.8 M $725.63PIN FIXATION LCP STAINLESS STEEL T8 L14 MM OD1.8 M $678.16PIN FIXATION LCP STAINLESS STEEL T8 L16 MM OD1.8 M $678.16PIN FIXATION LCP STAINLESS STEEL T8 L18 MM OD1.8 M $725.63PIN FIXATION LCP STAINLESS STEEL T8 L20 MM OD1.8 M $725.63PIN FIXATION LCP STAINLESS STEEL T8 L22 MM OD1.8 M $725.63PIN FIXATION LCP STAINLESS STEEL T8 L24 MM OD1.8 M $678.16PIN FIXATION LCP STAINLESS STEEL T8 L26 MM OD1.8 M $678.16PIN FIXATION LCP STAINLESS STEEL T8 L28 MM OD1.8 M $678.16PIN FIXATION LCP STAINLESS STEEL T8 L30 MM OD1.8 M $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L12 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L14 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L16 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L18 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L20 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L22 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L24 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L26 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L28 MM OD1.8 $678.16PIN FIXATION LCP TITANIUM T8 BUTTRESS L30 MM OD1.8 $678.16PIN FIXATION LCS SIGMA HIP QUICK DRILL STERILE $1,297.40PIN FIXATION LCS SIGMA HIP THREAD HEAD STERILE $1,297.40PIN FIXATION ORTHOLOCK EX-PIN L150 MM OD4 MM STERI $545.03PIN FIXATION ORTHOPEDIC TROCAR POINT ONE END K-DON $771.93PIN FIXATION OSS POLYETHYLENE KNEE LOCK COMPRESSIO $1,804.00PIN FIXATION PINABALL L90 MM OD3.18 MM PRELOAD STE C1713 $2,275.00PIN FIXATION RUSH STAINLESS STEEL A L10.2 CM OD3.2 C1713 $540.80PIN FIXATION RUSH STAINLESS STEEL A L2.5 CM OD2.4 C1713 $499.20PIN FIXATION RUSH STAINLESS STEEL G L17.8 CM OD3.2 C1713 $540.80PIN FIXATION RUSH STAINLESS STEEL H L19.1 CM OD3.2 C1713 $540.80PIN FIXATION RUSH STAINLESS STEEL L L24.1 CM OD3.2 C1713 $540.80PIN FIXATION RUSH STAINLESS STEEL M L10.2 CM OD2.4 C1713 $559.12PIN FIXATION RUSH STAINLESS STEEL M L25.4 CM OD3.2 C1713 $540.80PIN FIXATION SKYLINE STRAIGHT $600.00PIN FIXATION SPINE TEMPORARY SCREWDRIVER $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 ChargePIN FIXATION STAINLESS STEEL FLUTE SQUARE L3.5 IN $960.00PIN FIXATION STAINLESS STEEL L115 MM L16 MM OD6.86 $2,140.96PIN FIXATION STAINLESS STEEL L70 MM OD1.6 MM TENSI C1713 $286.00PIN FIXATION STAINLESS STEEL OD2.4 MM BEATH STERIL $370.50PIN FIXATION STEINMANN L9 IN OD3.2 MM $325.00PIN FIXATION STEINMANN L9 IN OD3.2 MM THREAD ACCES $325.00PIN FIXATION STEINMANN STAINLESS STEEL CENTRAL THR $874.00PIN FIXATION STEINMANN STAINLESS STEEL DIAMOND L9 C1713 $110.40PIN FIXATION STEINMANN STAINLESS STEEL L120 MM OD4 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L150 MM OD4 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L150 MM OD5 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L180 MM OD4 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L180 MM OD5 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L2.5 IN OD1 $325.00PIN FIXATION STEINMANN STAINLESS STEEL L200 MM OD4 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L200 MM OD5 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L225 MM OD4 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L225 MM OD5 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L225 MM OD6 $979.76PIN FIXATION STEINMANN STAINLESS STEEL L250 MM OD4 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L250 MM OD5 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L275 MM OD4 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L275 MM OD5 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L300 MM OD4 $579.60PIN FIXATION STEINMANN STAINLESS STEEL L300 MM OD5 $579.60PIN FIXATION TITANIUM BUTTRESS L18 MM OD1.8 MM HAN $434.64PIN FIXATION TITANIUM OD3.5 MM ORTHOPEDIC THREADED $1,242.00PIN FIXATION TITANIUM SPINE TEMPORARY BUTREX BUTTR $695.50PIN FIXATION TITANIUM STERNAL EMERGENCY RELEASE NO $595.04PIN FIXATION TITANIUM STERNUM EMERGENCY RELEASE ST $571.20PIN FIXATION TITANIUM STRAIGHT OD3.5 MM CERCLAGE P $1,242.00PIN HALF APEX HA L180 MM OD5 MM EXTERNAL FIXATION $1,104.00PIN HALF APEX HA STAINLESS STEEL L150 MM L25 MM OD C1713 $1,104.00PIN HALF APEX HA STAINLESS STEEL L150 MM L50 MM OD C1713 $1,168.00PIN HALF APEX HA STAINLESS STEEL L180 MM L30 MM OD C1713 $1,168.00PIN HALF APEX HA STAINLESS STEEL L180 MM L40 MM OD $1,168.00PIN HALF APEX HA STAINLESS STEEL L180 MM L50 MM OD C1713 $1,168.00PIN HALF APEX HOFFMANN II STAINLESS STEEL BLUNT L1 $976.00PIN HALF APEX HOFFMANN II STAINLESS STEEL BLUNT L1 C1713 $976.00

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 ChargePIN HALF APEX HOFFMANN II STAINLESS STEEL BLUNT L2 C1713 $976.00PIN HALF APEX HOFFMANN II STAINLESS STEEL L150 MM $640.25PIN HALF APEX HOFFMANN II STAINLESS STEEL L150 MM C1713 $976.00PIN HALF APEX HOFFMANN II STAINLESS STEEL L180 MM C1713 $793.00PIN HALF APEX HOFFMANN II STAINLESS STEEL L200 MM $844.00PIN HALF APEX HOFFMANN II STAINLESS STEEL L200 MM C1713 $976.00PIN HALF APEX HOFFMANN II STAINLESS STEEL L250 MM C1713 $976.00PIN HALF APEX HOFFMANN II STAINLESS STEEL L250 MM $976.00PIN HALF APEX HOFFMANN L150 MM OD3 MM SMOOTH TRANS $908.00PIN HALF APEX HOFFMANN STAINLESS STEEL BLUNT L180 C1713 $488.40PIN HALF APEX HOFFMANN STAINLESS STEEL L120 MM L50 $976.00PIN HALF APEX L120 MM L35 MM OD4 MM SELF DRILL HOF $788.00PIN HALF APEX STAINLESS STEEL BLUNT L120 MM L30 MM $572.00PIN HALF APEX STAINLESS STEEL BLUNT L150 MM L50 MM $572.00PIN HALF APEX STAINLESS STEEL BLUNT L150 MM L50 MM C1713 $976.00PIN HALF APEX STAINLESS STEEL BLUNT L250 MM L80 MM C1713 $976.00PIN HALF APEX STAINLESS STEEL HA L180 MM L30 MM OD $1,104.00PIN HALF APEX STAINLESS STEEL HA L180 MM L50 MM OD C1713 $1,104.00PIN HALF APEX STAINLESS STEEL HA L250 MM L70 MM OD C1713 $1,168.00PIN HALF APEX STAINLESS STEEL L110 MM L10 MM OD3 M $572.00PIN HALF APEX STAINLESS STEEL L110 MM L25 MM OD3 M $572.00PIN HALF APEX STAINLESS STEEL L120 MM L30 MM OD4 M $640.25PIN HALF APEX STAINLESS STEEL L120 MM L30 MM OD5 M $976.00PIN HALF APEX STAINLESS STEEL L120 MM L35 MM OD5 M $976.00PIN HALF APEX STAINLESS STEEL L150 MM L40 MM OD4 M $572.00PIN HALF APEX STAINLESS STEEL L150 MM L40 MM OD5 M $1,104.00PIN HALF APEX STAINLESS STEEL L150 MM L40 MM OD5 M C1713 $793.00PIN HALF APEX STAINLESS STEEL L150 MM L50 MM OD4 M $788.00PIN HALF APEX STAINLESS STEEL L150 MM L50 MM OD5 M $793.00PIN HALF APEX STAINLESS STEEL L150 MM L50 MM OD6 M $976.00PIN HALF APEX STAINLESS STEEL L180 MM L40 MM OD4 M $572.00PIN HALF APEX STAINLESS STEEL L180 MM L60 MM OD5 M C1713 $976.00PIN HALF APEX STAINLESS STEEL L180 MM L60 MM OD5 M $976.00PIN HALF APEX STAINLESS STEEL L180 MM L60 MM OD6 M $976.00PIN HALF APEX STAINLESS STEEL L200 MM L40 MM OD4 M $908.00PIN HALF APEX STAINLESS STEEL L200 MM L40 MM OD5 M $1,212.00PIN HALF APEX STAINLESS STEEL L200 MM L50 MM OD5 M C1713 $976.00PIN HALF APEX STAINLESS STEEL L200 MM L50 MM OD5 M $908.00PIN HALF APEX STAINLESS STEEL L200 MM L60 MM OD5 M $976.00

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 ChargePIN HALF APEX STAINLESS STEEL L200 MM L70 MM OD6 M $976.00PIN HALF APEX STAINLESS STEEL L200 MM OD3 MM TRANS C1713 $737.75PIN HALF APEX STAINLESS STEEL L250 MM L40 MM OD5 M $908.00PIN HALF APEX STAINLESS STEEL L250 MM L50 MM OD5 M $908.00PIN HALF APEX STAINLESS STEEL L250 MM L60 MM OD5 M $908.00PIN HALF APEX STAINLESS STEEL L250 MM L70 MM OD5 M $976.00PIN HALF APEX STAINLESS STEEL L250 MM L80 MM OD5 M C1713 $1,212.00PIN HALF APEX STAINLESS STEEL L250 MM L90 MM OD5 M $1,212.00PIN HALF APEX STAINLESS STEEL L300 MM L50 MM OD5 M C1713 $908.00PIN HALF APEX STAINLESS STEEL L60 MM L10 MM OD3 MM $572.00PIN HALF APEX STAINLESS STEEL L80 MM L10 MM OD3 MM $572.00PIN HALF APEX STAINLESS STEEL L80 MM L15 MM OD3 MM $572.00PIN HALF APEX STAINLESS STEEL L80 MM L20 MM OD3 MM $572.00PIN HALF APEX STAINLESS STEEL L90 MM L10 MM OD4 MM $572.00PIN HALF APEX STAINLESS STEEL L90 MM L20 MM OD4 MM $572.00PIN HALF APEX STAINLESS STEEL L90 MM L30 MM OD4 MM $572.00PIN HALF HA L150 MM L10 MM OD4.5 MM EXTERNAL FIXAT $1,037.84PIN HALF HA L150 MM L15 MM OD6 MM ORTHOPEDIC EXTER $1,037.84PIN HALF HA L150 MM L20 MM OD4.5 MM EXTERNAL FIXAT $1,037.84PIN HALF HA L150 MM L20 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L25 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L30 MM OD4.5 MM ORTHOPEDIC THR $1,037.84PIN HALF HA L150 MM L30 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L40 MM OD4.5 MM ORTHOPEDIC THR $1,037.84PIN HALF HA L150 MM L40 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L45 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L50 MM OD4.5 MM ORTHOPEDIC THR $1,037.84PIN HALF HA L150 MM L50 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L55 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L60 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L65 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L150 MM L70 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L200 MM L20 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L200 MM L25 MM OD6 MM ORTHOPEDIC EXTER $1,037.84PIN HALF HA L200 MM L30 MM OD6 MM ORTHOPEDIC EXTER $1,037.84PIN HALF HA L200 MM L35 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L200 MM L40 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L200 MM L50 MM OD6 MM EXTERNAL FIXATIO $1,037.84PIN HALF HA L200 MM L80 MM OD6 MM EXTERNAL FIXATIO $1,037.84

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 ChargePIN HALF HEX-FIX RANCHO TITANIUM L25 MM OD4 MM ORT C1713 $1,333.12PIN HALF HEX-FIX RANCHO TITANIUM L30 MM OD4 MM THR $1,333.12PIN HALF HEX-FIX RANCHO TITANIUM L40 MM L40 MM OD6 C1713 $1,722.80PIN HALF HEX-FIX RANCHO TITANIUM L45 MM OD5 MM ORT C1713 $1,333.12PIN HALF HEX-FIX RANCHO TITANIUM L50 MM OD6 MM ORT C1713 $1,722.80PIN HALF HEX-FIX RANCHO TITANIUM L55 MM OD5 MM ORT C1713 $1,333.12PIN HALF HEX-FIX RANCHO TITANIUM L60 MM OD5 MM ORT C1713 $1,333.12PIN HALF HEX-FIX RANCHO TITANIUM L60 MM OD6 MM ORT C1713 $1,333.12PIN HALF HEX-FIX RANCHO TITANIUM L65 MM OD5 MM ORT C1713 $995.52PIN HALF HEX-FIX RANCHO TITANIUM OD4 MM ORTHOPEDIC C1713 $1,333.12PIN HALF HEX-FIX RANCHO TITANIUM UNIVERSAL L20 MM C1713 $1,333.12PIN HALF HEX-FIX STAINLESS STEEL L20 MM OD5 MM ORT C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L20 MM OD6 MM ORT $1,342.32PIN HALF HEX-FIX STAINLESS STEEL L25 MM L25 MM OD5 C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L25 MM OD4 MM ORT C1713 $930.24PIN HALF HEX-FIX STAINLESS STEEL L25 MM OD6 MM $461.04PIN HALF HEX-FIX STAINLESS STEEL L30 MM OD4 MM ORT C1713 $522.24PIN HALF HEX-FIX STAINLESS STEEL L30 MM OD5 MM ORT C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L30 MM OD6 MM $922.08PIN HALF HEX-FIX STAINLESS STEEL L35 MM OD5 MM ORT C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L35 MM OD6 MM $522.24PIN HALF HEX-FIX STAINLESS STEEL L40 MM L40 MM OD5 C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L40 MM OD4 MM ORT C1713 $930.24PIN HALF HEX-FIX STAINLESS STEEL L40 MM OD6 MM ORT C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L45 MM L45 MM OD5 C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L45 MM OD4 MM ORT C1713 $930.24PIN HALF HEX-FIX STAINLESS STEEL L45 MM OD6 MM ORT $1,342.32PIN HALF HEX-FIX STAINLESS STEEL L50 MM OD4 MM ORT C1713 $930.24PIN HALF HEX-FIX STAINLESS STEEL L50 MM OD5 MM ORT C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L50 MM OD6 MM ORT C1713 $838.16PIN HALF HEX-FIX STAINLESS STEEL L55 MM OD6 MM $522.24PIN HALF HEX-FIX STAINLESS STEEL L60 MM OD5 MM ORT C1713 $385.60PIN HALF HEX-FIX STAINLESS STEEL L60 MM OD6 MM ORT C1713 $950.00PIN HALF HEX-FIX STAINLESS STEEL L65 MM OD5 MM ORT C1713 $930.24PIN HALF HEX-FIX STAINLESS STEEL L65 MM OD6 MM ORT $762.96PIN HALF HEX-FIX STAINLESS STEEL L70 MM OD5 MM ORT C1713 $385.60PIN HALF HEX-FIX STAINLESS STEEL L70 MM OD6 MM ORT C1713 $930.24PIN HALF HEX-FIX STAINLESS STEEL L75 MM OD6 MM ORT $762.96PIN HALF HEX-FIX STAINLESS STEEL L85 MM OD6 MM ORT $762.96

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 ChargePIN HALF HEX-FIX STAINLESS STEEL L90 MM OD5 MM ORT C1713 $385.60PIN HALF HEX-FIX STAINLESS STEEL L90 MM OD6 MM ORT C1713 $930.24PIN HALF HEX-FIX TITANIUM L20 MM OD6 MM ORTHOPEDIC $1,333.12PIN HALF HEX-FIX TITANIUM L25 MM OD6 MM ORTHOPEDIC $1,333.12PIN HALF HEX-FIX TITANIUM L35 MM OD4 MM ORTHOPEDIC C1713 $1,333.12PIN HALF HEX-FIX TITANIUM L45 MM OD4 MM ORTHOPEDIC C1713 $873.12PIN HALF HEX-FIX TITANIUM L45 MM OD6 MM $881.28PIN HALF HEX-FIX TITANIUM L50 MM OD4 MM C1713 $1,048.56PIN HALF HEX-FIX TITANIUM L50 MM OD5 MM ORTHOPEDIC C1713 $1,333.12PIN HALF HEX-FIX TITANIUM L55 MM OD6 MM $881.28PIN HALF HEX-FIX TITANIUM L65 MM OD6 MM ORTHOPEDIC $1,342.32PIN HALF HEX-FIX TITANIUM L70 MM OD5 MM ORTHOPEDIC C1713 $734.40PIN HALF HEX-FIX TITANIUM L75 MM OD5 MM NONSTERILE C1713 $1,048.56PIN HALF HEX-FIX TITANIUM L75 MM OD6 MM ORTHOPEDIC $1,342.32PIN HALF HEX-FIX TITANIUM L80 MM OD5 MM $1,048.56PIN HALF HEX-FIX TITANIUM L80 MM OD6 MM C1713 $881.28PIN HALF HEX-FIX TITANIUM L85 MM OD5 MM ORTHOPEDIC C1713 $881.28PIN HALF HEX-FIX TITANIUM L85 MM OD6 MM ORTHOPEDIC $1,342.32PIN HALF HEX-FIX TITANIUM L90 MM OD5 MM ORTHOPEDIC C1713 $1,048.56PIN HALF HEX-FIX TITANIUM PARTIAL THREAD L20 MM OD C1713 $1,722.80PIN HALF HEX-FIX TITANIUM PARTIAL THREAD L25 MM L2 C1713 $1,722.80PIN HALF HEX-FIX TITANIUM PARTIAL THREAD L30 MM OD C1713 $1,722.80PIN HALF HEX-FIX TITANIUM PARTIAL THREAD L35 MM OD C1713 $1,722.80PIN HALF HEX-FIX TITANIUM PARTIAL THREAD L40 MM OD C1713 $1,722.80PIN HALF HOFFMANN II APEX STAINLESS STEEL L180 MM C1713 $788.00PIN HALF HOFFMANN II APEX STAINLESS STEEL L300 MM C1713 $908.00PIN HALF HYDROXYAPATITE L150 MM L20 MM OD6 MM ORTH $1,301.12PIN HALF HYDROXYAPATITE L200 MM L15 MM OD6 MM ORTH $1,141.52PIN HALF HYDROXYAPATITE L200 MM L45 MM OD6 MM EXTE $1,037.84PIN HALF HYDROXYAPATITE L200 MM L55 MM OD6 MM EXTE $1,037.84PIN HALF HYDROXYAPATITE L200 MM L60 MM OD6 MM EXTE $1,037.84PIN HALF HYDROXYAPATITE L200 MM L65 MM OD6 MM EXTE $1,037.84PIN HALF HYDROXYAPATITE L200 MM L70 MM OD6 MM ORTH $1,037.84PIN HALF HYDROXYAPATITE L200 MM L90 MM OD6 MM ORTH $1,037.84PIN HALF HYDROXYAPATITE OD6 MM ORTHOPEDIC C1713 $200.24PIN HALF ILIZAROV ID150 MM ORTHOPEDIC CIRCULAR EXT $7,048.80PIN HALF ILIZAROV ID180 MM ORTHOPEDIC CIRCULAR EXT $7,048.80PIN HALF ILIZAROV ID200 MM ORTHOPEDIC CIRCULAR EXT $7,048.80PIN HALF ILIZAROV STAINLESS STEEL L180 MM OD5 MM A $1,349.04

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 ChargePIN HALF ILIZAROV TITANIUM L30 MM OD6 MM $1,333.12PIN HALF ILIZAROV TITANIUM L35 MM OD6 MM $1,333.12PIN HALF JET-X L15 MM OD3 MM RADIAL DISTAL C1713 $1,266.16PIN HALF JET-X L20 MM OD3 MM RADIAL DISTAL C1713 $1,266.16PIN HALF JET-X STAINLESS STEEL L10 MM OD3 MM ORTHO $585.36PIN HALF JET-X STAINLESS STEEL L17.5 CM L30 MM OD5 $911.36PIN HALF JET-X STAINLESS STEEL L17.5 CM L35 MM OD5 $911.36PIN HALF JET-X STAINLESS STEEL L17.5 CM L40 MM OD5 $911.36PIN HALF JET-X STAINLESS STEEL L17.5 CM L45 MM OD5 $911.36PIN HALF JET-X STAINLESS STEEL L175 MM L40 MM OD5 $1,204.08PIN HALF JET-X STAINLESS STEEL L20 MM OD4 MM ORTHO $619.68PIN HALF JET-X STAINLESS STEEL L20 MM OD6 MM ORTHO $1,648.32PIN HALF JET-X STAINLESS STEEL L200 MM L50 MM OD5 $3,273.04PIN HALF JET-X STAINLESS STEEL L25 MM OD4 MM ORTHO $619.68PIN HALF JET-X STAINLESS STEEL L25 MM OD5 MM ORTHO $1,562.64PIN HALF JET-X STAINLESS STEEL L30 MM OD5 MM ORTHO $1,562.64PIN HALF JET-X STAINLESS STEEL L30 MM OD6 MM ORTHO $1,854.36PIN HALF JET-X STAINLESS STEEL L35 MM OD4 MM ORTHO $619.68PIN HALF JET-X STAINLESS STEEL L40 MM OD6 MM ORTHO $1,854.36PIN HALF JET-X STAINLESS STEEL L5 CM OD5 MM ORTHOP C1713 $1,596.56PIN HALF JET-X STAINLESS STEEL L50 MM OD6 MM ORTHO $1,648.32PIN HALF JET-X STAINLESS STEEL L95 MM L15 MM OD4 M $619.68PIN HALF JET-X STAINLESS STEEL LONG L225 MM L40 MM $911.36PIN HALF JET-X STAINLESS STEEL LONG L255 MM L30 MM $911.36PIN HALF JET-X STAINLESS STEEL LONG L255 MM L35 MM $911.36PIN HALF JET-X STAINLESS STEEL LONG L255 MM L45 MM $911.36PIN HALF JET-X STAINLESS STEEL LONG L255 MM L50 MM $911.36PIN HALF JET-X STAINLESS STEEL LONG L255 MM L55 MM $911.36PIN HALF JET-X STAINLESS STEEL LONG L60 MM OD5 MM $911.36PIN HALF JET-X STAINLESS STEEL LONG L65 MM OD5 MM $911.36PIN HALF JET-X STAINLESS STEEL LONG L70 MM OD5 MM $911.36PIN HALF JET-X STAINLESS STEEL PEDIATRIC L200 MM L $2,139.36PIN HALF JET-X STAINLESS STEEL SHORT L15 MM OD3 MM $585.36PIN HALF JET-X STAINLESS STEEL SHORT L175 MM L50 M $911.36PIN HALF JET-X STAINLESS STEEL SHORT L175 MM L55 M $911.36PIN HALF JET-X STAINLESS STEEL SHORT L20 MM OD3 MM $585.36PIN HALF JET-X STAINLESS STEEL SHORT L25 MM OD3 MM $585.36PIN HALF JET-X STAINLESS STEEL SHORT L30 MM OD4 MM $619.68PIN HALF JET-X STAINLESS STEEL SHORT L60 MM OD5 MM $911.36

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 ChargePIN HALF JET-X STAINLESS STEEL SHORT L65 MM OD5 MM $911.36PIN HALF JET-X STAINLESS STEEL SHORT L70 MM OD5 MM $911.36PIN HALF JET-X TITANIUM L10 MM OD3 MM ORTHOPEDIC E $725.04PIN HALF JET-X TITANIUM L15 MM OD3 MM ORTHOPEDIC E $725.04PIN HALF JET-X TITANIUM L15 MM OD4 MM ORTHOPEDIC E $758.40PIN HALF JET-X TITANIUM L20 MM OD3 MM ORTHOPEDIC E $725.04PIN HALF JET-X TITANIUM L20 MM OD4 MM ORTHOPEDIC E $758.40PIN HALF JET-X TITANIUM L25 MM OD3 MM ORTHOPEDIC E $725.04PIN HALF JET-X TITANIUM L25 MM OD4 MM ORTHOPEDIC E $758.40PIN HALF JET-X TITANIUM L30 MM OD4 MM ORTHOPEDIC E $758.40PIN HALF JET-X TITANIUM L35 MM OD4 MM ORTHOPEDIC E $758.40PIN HALF JET-X TITANIUM L55 MM ORTHOPEDIC C1713 $1,072.35PIN HALF JET-X TITANIUM L60 MM ORTHOPEDIC C1713 $1,072.35PIN HALF JET-X TITANIUM LONG L20 MM ORTHOPEDIC C1713 $1,072.35PIN HALF JET-X TITANIUM LONG L30 MM ORTHOPEDIC C1713 $1,072.35PIN HALF JET-X TITANIUM LONG L40 MM ORTHOPEDIC C1713 $953.20PIN HALF JET-X TITANIUM LONG L45 MM ORTHOPEDIC C1713 $953.20PIN HALF JET-X TITANIUM LONG L50 MM ORTHOPEDIC C1713 $953.20PIN HALF JET-X TITANIUM LONG L60 MM ORTHOPEDIC C1713 $953.20PIN HALF JET-X TITANIUM NITRIDE L40 MM OD5 MM ORTH $1,444.56PIN HALF JET-X TITANIUM NITRIDE LONG L20 MM OD5 MM $1,012.32PIN HALF JET-X TITANIUM NITRIDE LONG L30 MM OD5 MM $1,017.84PIN HALF JET-X TITANIUM NITRIDE LONG L35 MM OD5 MM $1,017.84PIN HALF JET-X TITANIUM NITRIDE LONG L40 MM OD5 MM $1,017.84PIN HALF JET-X TITANIUM NITRIDE LONG L45 MM OD5 MM $1,017.84PIN HALF JET-X TITANIUM NITRIDE LONG L45 MM OD6 MM $804.00PIN HALF JET-X TITANIUM NITRIDE LONG L50 MM OD5 MM $804.00PIN HALF JET-X TITANIUM NITRIDE LONG L50 MM OD6 MM $1,031.12PIN HALF JET-X TITANIUM NITRIDE LONG L55 MM OD5 MM $804.00PIN HALF JET-X TITANIUM NITRIDE LONG L55 MM OD6 MM $804.00PIN HALF JET-X TITANIUM NITRIDE LONG L60 MM OD5 MM $804.00PIN HALF JET-X TITANIUM NITRIDE LONG L60 MM OD6 MM $804.00PIN HALF JET-X TITANIUM NITRIDE LONG L65 MM OD5 MM $792.00PIN HALF JET-X TITANIUM NITRIDE LONG L70 MM OD5 MM $804.00PIN HALF JET-X TITANIUM NITRIDE SHORT L10 MM OD3 M $654.24PIN HALF JET-X TITANIUM NITRIDE SHORT L15 MM OD3 M $654.24PIN HALF JET-X TITANIUM NITRIDE SHORT L15 MM OD4 M $691.84PIN HALF JET-X TITANIUM NITRIDE SHORT L20 MM OD3 M $654.24PIN HALF JET-X TITANIUM NITRIDE SHORT L20 MM OD4 M $691.84

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 ChargePIN HALF JET-X TITANIUM NITRIDE SHORT L20 MM OD5 M $929.52PIN HALF JET-X TITANIUM NITRIDE SHORT L20 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L25 MM OD3 M $654.24PIN HALF JET-X TITANIUM NITRIDE SHORT L25 MM OD4 M $691.84PIN HALF JET-X TITANIUM NITRIDE SHORT L25 MM OD5 M $929.52PIN HALF JET-X TITANIUM NITRIDE SHORT L25 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L30 MM L110 $1,017.84PIN HALF JET-X TITANIUM NITRIDE SHORT L30 MM OD4 M $691.84PIN HALF JET-X TITANIUM NITRIDE SHORT L30 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L35 MM OD4 M $1,017.84PIN HALF JET-X TITANIUM NITRIDE SHORT L35 MM OD5 M $1,017.84PIN HALF JET-X TITANIUM NITRIDE SHORT L35 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L40 MM OD5 M $1,017.84PIN HALF JET-X TITANIUM NITRIDE SHORT L40 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L45 MM OD5 M $1,017.84PIN HALF JET-X TITANIUM NITRIDE SHORT L45 MM OD6 M $1,021.92PIN HALF JET-X TITANIUM NITRIDE SHORT L50 MM OD5 M $804.00PIN HALF JET-X TITANIUM NITRIDE SHORT L50 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L55 MM OD5 M $804.00PIN HALF JET-X TITANIUM NITRIDE SHORT L55 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L60 MM OD5 M $804.00PIN HALF JET-X TITANIUM NITRIDE SHORT L60 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L65 MM OD5 M $804.00PIN HALF JET-X TITANIUM NITRIDE SHORT L65 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE SHORT L70 MM OD5 M $804.00PIN HALF JET-X TITANIUM NITRIDE SHORT L70 MM OD6 M $941.36PIN HALF JET-X TITANIUM NITRIDE XSHORT L30 MM OD5 $527.04PIN HALF JET-X TITANIUM NITRIDE XSHORT L35 MM OD5 $527.52PIN HALF JET-X TITANIUM NITRIDE XSHORT L40 MM L40 $1,270.56PIN HALF JET-X TITANIUM NITRIDE XSHORT L40 MM OD5 $527.84PIN HALF JET-X TITANIUM NITRIDE XSHORT L45 MM OD5 $528.32PIN HALF L150 MM L35 MM OD4 MM SKELETAL TRACTION C $510.19PIN HALF L28 MM L28 MM OD3 MM DISTAL RADIAL COVE P C1713 $674.16PIN HALF SCHANZ TITANIUM L100 MM L30 MM OD5 MM ORT $1,462.80PIN HALF SCHANZ TITANIUM L125 MM L40 MM OD5 MM ORT $1,462.80PIN HALF SCHANZ TITANIUM L125 MM L40 MM OD6 MM ORT $1,564.00PIN HALF SCHANZ TITANIUM L175 MM L40 MM OD4 MM ORT $1,274.16PIN HALF SCHANZ TITANIUM L175 MM L60 MM OD6 MM ORT $1,564.00PIN HALF SCHANZ TITANIUM L250 MM L80 MM OD5 MM ORT $1,462.80

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 ChargePIN HALF SCHANZ TITANIUM L250 MM L80 MM OD6 MM ORT $1,564.00PIN HALF STAINLESS STEEL L200 MM L20 MM OD6 MM ORT $2,139.36PIN HALF STAINLESS STEEL L200 MM L30 MM OD6 MM ORT $2,139.36PIN HALF STAINLESS STEEL L200 MM L40 MM OD6 MM ORT $2,139.36PIN HALF STAINLESS STEEL L200 MM L50 MM OD6 MM ORT $2,139.36PIN HALF STAINLESS STEEL L35 MM OD4 MM ORTHOPEDIC C1713 $522.24PIN HALF STAINLESS STEEL L55 MM OD5 MM ORTHOPEDIC C1713 $632.40PIN HALF STAINLESS STEEL L75 MM OD5 MM ORTHOPEDIC C1713 $632.40PIN HALF STAINLESS STEEL L80 MM OD5 MM ORTHOPEDIC C1713 $632.40PIN HALF STAINLESS STEEL L80 MM OD6 MM ORTHOPEDIC C1713 $522.24PIN HALF TITANIUM L50 MM OD5 MM STERILE $1,596.56PIN HALF TITANIUM LONG L30 MM OD5 MM $1,012.32PIN HALF TITANIUM LONG L35 MM OD5 MM $1,012.32PIN HALF TITANIUM LONG L40 MM OD5 MM $1,012.32PIN HALF TITANIUM LONG L45 MM OD5 MM $1,099.08PIN HALF TITANIUM LONG L50 MM OD5 MM $1,012.32PIN HALF TITANIUM LONG L55 MM OD5 MM $1,012.32PIN HALF TITANIUM LONG L60 MM OD5 MM $1,012.32PIN HALF TITANIUM LONG L65 MM OD5 MM $1,012.32PIN HALF TITANIUM LONG L70 MM OD5 MM $1,012.32PIN HALF TITANIUM SHORT L30 MM OD5 MM $1,009.12PIN HALF TITANIUM SHORT L35 MM OD5 MM $1,009.12PIN HALF TITANIUM SHORT L40 MM OD5 MM $1,009.12PIN HALF TITANIUM SHORT L45 MM OD5 MM $929.52PIN HALF TITANIUM SHORT L50 MM OD5 MM $929.52PIN HALF TITANIUM SHORT L55 MM OD5 MM $929.52PIN HALF TITANIUM SHORT L60 MM OD5 MM $929.52PIN HALF TITANIUM SHORT L65 MM OD5 MM $929.52PIN HALF TITANIUM SHORT L70 MM OD5 MM $929.52PIN POSITIONING LCP STAINLESS STEEL OD4.5 MM CERCL $1,009.13PIN POSITIONING STAINLESS STEEL OD3.5 MM CERCLAGE $1,242.00PIN POSITIONING STAINLESS STEEL OD4.5 MM CERCLAGE $1,242.00PIN POSITIONING STAINLESS STEEL OD5 MM CRIMP STERI $1,867.60PIN POSITIONING STAINLESS STEEL OD7.3 MM CRIMP STE $1,867.60PIN POSITIONING TITANIUM L40 MM CRANIAL NONSTERILE $1,208.00PIN POSITIONING TITANIUM OD5 MM CRIMP STERILE 1.7 $1,867.60PIN RETENTION D2951 $130.00PIN SKULL MAYFIELD STEEL PEDIATRIC CRANIAL RIGID F $2,610.73PINWORM TEST 87172 $27.00

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 ChargePISTON OSSICULAR ECLIPSE NITINOL FLUOROPLASTIC L4. L8613 $1,946.36PISTON OSSICULAR NITINOL L4 MM OD.6 MM L8613 $1,946.35PISTON OSSICULAR PLATINUM TITANIUM L4.25 MM OD.5 M L8613 $1,257.75PISTON OSSICULAR SMART NITINOL FLUOROPLASTIC L3.75 L8613 $1,758.64PISTON OSSICULAR SMART NITINOL FLUOROPLASTIC L4 MM L8613 $1,738.88PISTON OSSICULAR SMART NITINOL FLUOROPLASTIC L4.25 L8613 $1,738.88PISTON OSSICULAR SMART NITINOL FLUOROPLASTIC L4.5 L8613 $1,738.88PISTON OSSICULAR SMART NITINOL FLUOROPLASTIC L4.75 L8613 $1,758.64PLACE ACCESS DEVICE INTO BILIARY TRACT 47541 $11,645.00PLACE BREAST LOCALIZATION DEVICE ACCESSED THROUGH 19281 $2,292.00PLACE BREAST LOCALIZATION DEVICE ACCESSED THROUGH 19282 $332.00PLACE BREAST LOCALIZATION DEVICE ACCESSED THROUGH 19283 $2,292.00PLACE BREAST LOCALIZATION DEVICE ACCESSED THROUGH 19284 $332.00PLACE BREAST LOCALIZATION DEVICE ACCESSED THROUGH 19285 $2,292.00PLACE BREAST LOCALIZATION DEVICE ACCESSED THROUGH 19286 $332.00PLACE EAR PROBE COMPUTERIZED MEASURE SOUND W/INTER 92587 $315.00PLACE GRAFT FOR REPAIR OF AORTA W/ RADIOLOGICAL S& 34702 $7,852.00PLACE GRAFT FOR REPAIR OF AORTA W/RADIOLOGICAL S&I 34701 $5,257.00PLACE INTERSTITIAL DEVICE C9728 $3,346.00PLACE SCALP ELECTRODES ASSESS&REC RESPONSE SEVRL A 92585 $889.00PLACE SCALP ELECTRODES ASSESS&REC RESPONSE SEVRL A 92586 $385.00PLACEMENT BREAST LOCALIZATION DEVICES ACCESSED THR 19287 $2,292.00PLACEMENT BREAST LOCALIZATION DEVICES ACCESSED THR 19288 $223.00PLACEMENT CATHETER OF GALLBLADDER & PANCREAS UNDER 74330 $155.00PLACEMENT CATHETER OF KIDNEY AND URINARY TUBE 50433 $6,736.00PLACEMENT EAR PROBE FOR COMPUTERIZED COCHLEAR ASSE 92588 $315.00PLACEMENT EAR PROBE FOR COMPUTERIZED MEASUREMENT 92558 $199.00PLACEMENT ENDOSTEAL IMPLANT D6010 $2,029.00PLACEMENT EOPSTEAL IMPLANT D6040 $3,174.00PLACEMENT EXTENSION PROSTH FOR ENDOVASCULAR REPAIR 34709 $1,386.00PLACEMENT OCCLUSIVE DEVICE G0269 $682.00PLACEMENT OF CATHETER OF KIDNEY ACCESSED THROUGH T 50432 $6,736.00PLACEMENT OF DRAINAGE CATHETER OF BILIARY DUCT ACC 47533 $9,736.00PLACEMENT OF DRAINAGE CATHETER OF BILIARY DUCT ACC 47534 $9,736.00PLACEMENT OF INTRA-UTERINE DEVICE (IUD) FOR PREGNA 58300 $415.00PLACEMENT OF STENT AND DRAINAGE CATHETER OF BILIAR 47540 $18,416.00PLACEMENT OF STENT IN ESOPHAGUS STOMACH AND/OR UPP 43266 $1,271.00PLACEMENT OF STENT OF BILIARY DUCT ACCESSED THROUG 47538 $18,416.00PLACEMENT OF STENT OF BILIARY DUCT ACCESSED THROUG 47539 $18,416.00

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 ChargePLACEMENT OF STENT OF URINARY DUCT 50693 $10,033.00PLACEMENT OF STENT OF URINARY DUCT 50694 $10,033.00PLACEMENT OF STENT OF URINARY DUCT ACCESSED THROUG 50695 $10,033.00PLACEMENT OF STENT ON ESOPHAGUS USING AN ENDOSCOPE 43212 $1,247.00PLACEMENT OF STENT PANCREATIC OR BILE DUCT USING A 43274 $15,618.00PLACEMENT OF TEMPORARY PACEMAKER LEADS 33210 $16,812.00PLACEMENT OF TEMPORARY PACEMAKER LEADS 33211 $16,812.00PLACEMENT SOFT TISSUE LOCALIZATION DEVICE ACCESSD 10035 $2,296.00PLACEMENT SOFT TISSUE LOCALIZATION DEVICE ACCESSED 10036 $148.00PLACEMENT TRANSOSTEAL IMPLANT D6050 $3,800.00PLASTIC REPAIR OF TEAR DUCTS 68700 $5,047.00PLATE ANCHOR TITANIUM 4 HOLE DOMED DESIGN C1713 $1,350.00PLATE ANCHOR TITANIUM 5 HOLE DOMED DESIGN C1713 $1,350.00PLATE ANCHOR TITANIUM MIDFACE 4 HOLE BRACKET DESIG C1713 $1,350.00PLATE BLADE DCP TITANIUM 130 D L90 MM ORTHOPEDIC 6 C1713 $3,748.96PLATE BONE 1/3 TUBULAR L107 MM FOOT ANKLE 9 HOLE N C1713 $2,173.21PLATE BONE 1/3 TUBULAR L119 MM FOOT ANKLE 10 HOLE C1713 $2,173.21PLATE BONE 1/3 TUBULAR L143 MM FOOT ANKLE 12 HOLE C1713 $2,173.21PLATE BONE 1/3 TUBULAR L47 MM FOOT ANKLE 4 HOLE ST C1713 $1,579.50PLATE BONE 1/3 TUBULAR L59 MM FOOT ANKLE 5 HOLE ST C1713 $1,579.50PLATE BONE 1/3 TUBULAR L71 MM FOOT ANKLE 6 HOLE NO C1713 $1,579.50PLATE BONE 1/3 TUBULAR L71 MM FOOT ANKLE 6 HOLE ST C1713 $1,579.50PLATE BONE 1/3 TUBULAR L83 MM FOOT ANKLE 7 HOLE NO C1713 $1,579.50PLATE BONE 1/3 TUBULAR L83 MM FOOT ANKLE 7 HOLE ST C1713 $1,579.50PLATE BONE 1/3 TUBULAR L95 MM FOOT ANKLE 8 HOLE ST C1713 $1,579.50PLATE BONE 135 D L110 MM ANKLE 6 HOLE C1713 $1,625.00PLATE BONE 135 D L62 MM ANKLE 2 HOLE C1713 $1,625.00PLATE BONE 135 D L78 MM ANKLE 4 HOLE C1713 $1,625.00PLATE BONE 135 D L94 MM 5 HOLE APS C1713 $1,625.00PLATE BONE 135 D L94 MM ANKLE 5 HOLE C1713 $1,625.00PLATE BONE 140 D L110 MM ANKLE 6 HOLE C1713 $2,112.50PLATE BONE 140 D L78 MM ANKLE 4 HOLE C1713 $2,112.50PLATE BONE 140 D L94 MM ANKLE 5 HOLE C1713 $2,112.50PLATE BONE 150 D L110 MM ANKLE 6 HOLE C1713 $2,632.50PLATE BONE 150 D L78 MM 4 HOLE APS C1713 $2,632.50PLATE BONE 150 D L78 MM ANKLE 4 HOLE C1713 $2,632.50PLATE BONE 150 D L94 MM ANKLE 5 HOLE C1713 $2,632.50PLATE BONE 2 X 36 HOLE STRUT SCALLOP RAPID RESORBA C1713 $11,328.00PLATE BONE 20 HOLE SCALLOP ADAPTATION RAPID RESORB C1713 $2,118.00

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 ChargePLATE BONE 8 HOLE SCALLOP ADAPTATION RAPID RESORBA C1713 $1,458.00PLATE BONE ACCUFIT TITANIUM ALUMINUM VANADIUM L34 C1713 $14,625.00PLATE BONE ACU-LOC 2 NARROW L49 MM X W21 MM RADIAL C1713 $5,362.50PLATE BONE ACU-LOC 2 NARROW L51 MM X W22 MM RADIAL C1713 $5,362.50PLATE BONE ACU-LOC 2 STANDARD L49 MM X W24 MM RADI C1713 $5,362.50PLATE BONE ACU-LOC 2 STANDARD L51 MM X W25 MM RADI C1713 $5,362.50PLATE BONE ACU-LOC 2 WIDE L57 MM X W27 MM RADIAL L C1713 $5,362.50PLATE BONE ACU-LOC 2 WIDE L57 MM X W27 MM RADIAL R C1713 $5,362.50PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL L C1713 $5,362.50PLATE BONE ACU-LOC KIRSCHNER TITANIUM STANDARD ULN C1713 $4,940.00PLATE BONE ALPS TIMAX CONTOUR L142 MM TIBIAL RIGHT C1713 $7,517.12PLATE BONE ALPS TIMAX CONTOUR L74 MM X W10.7 MM X C1713 $5,353.92PLATE BONE ALPS TIMAX CONTOUR L79 MM X W10.7 MM X C1713 $5,049.72PLATE BONE ALPS TIMAX CONTOUR L88 MM X W10.9 MM X C1713 $5,353.92PLATE BONE ALPS TIMAX L124.6 MM X W10.3 MM X H3.7 C1713 $1,193.14PLATE BONE ALPS TIMAX L133 MM HUMERUS LEFT PROXIMA C1713 $8,788.00PLATE BONE ALPS TIMAX L190 MM HUMERUS LEFT PROXIMA C1713 $10,478.00PLATE BONE ALPS TIMAX L90 MM HUMERUS LEFT PROXIMAL C1713 $7,774.00PLATE BONE AMBI 140 D STANDARD BARREL L80 MM L38.1 C1713 $2,643.92PLATE BONE AMBI CHS STAINLESS STEEL 130 D SHORT BA C1713 $2,780.40PLATE BONE AMBI CHS STAINLESS STEEL 130 D STANDARD C1713 $2,643.92PLATE BONE AMBI CHS STAINLESS STEEL 135 D SHORT BA C1713 $2,780.40PLATE BONE AMBI CHS STAINLESS STEEL 135 D STANDARD C1713 $2,557.68PLATE BONE AMBI CHS STAINLESS STEEL 140 D SHORT BA C1713 $2,780.40PLATE BONE AMBI CHS STAINLESS STEEL 140 D STANDARD C1713 $2,643.92PLATE BONE AMBI CHS STAINLESS STEEL 145 D SHORT BA C1713 $2,780.40PLATE BONE AMBI CHS STAINLESS STEEL 145 D STANDARD C1713 $2,643.92PLATE BONE AMBI CHS STAINLESS STEEL 150 D SHORT BA C1713 $2,780.40PLATE BONE AMBI CHS STAINLESS STEEL 150 D STANDARD C1713 $2,557.68PLATE BONE AMBI CHS STAINLESS STEEL 90 D L124 MM L C1713 $4,440.00PLATE BONE ANCHORAGE T8 METATARSOPHALANGEAL LEFT L C1713 $15,410.85PLATE BONE ANCHORAGE T8 METATARSOPHALANGEAL RIGHT C1713 $15,410.85PLATE BONE ANCHORAGE TITANIUM H1.3 MM METATARSOPHA C1713 $7,933.64PLATE BONE ANCHORAGE TITANIUM LONG H1.3 MM METATAR C1713 $7,510.36PLATE BONE ANCHORAGE TITANIUM NEUTRAL H1.5 MM RIGH C1713 $7,104.05PLATE BONE ANCHORAGE TITANIUM STRAIGHT L28 MM X H1 C1713 $6,257.68PLATE BONE ANODYNE H10 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H11 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H12 MM SPINE CERVICAL ANTERIOR C1713 $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 ChargePLATE BONE ANODYNE H13 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H14 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H16 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H18 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H24 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H26 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H28 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H30 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H32 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H34 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H36 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H38 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H40 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H42 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H44 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H46 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE H48 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H50 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H52 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H54 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H58 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H60 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H64 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H68 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE H72 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE L11 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE L26 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE ANODYNE L44 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE L48 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE ANODYNE L50 MM SPINE CERVICAL ANTERIOR C1713 $5,200.00PLATE BONE APTUS TITANIUM SHORT BEND H1.6 MM WRIST C1713 $3,932.50PLATE BONE ASSURE L18 MM SPINE CERVICAL LEVEL 1 NO C1713 $4,225.00PLATE BONE ASSURE L22 MM SPINE CERVICAL LEVEL 1 NO C1713 $4,225.00PLATE BONE ASSURE L24 MM SPINE CERVICAL LEVEL 1 NO C1713 $4,225.00PLATE BONE ASSURE L32 MM SPINE CERVICAL LEVEL 2 NO C1713 $4,225.00PLATE BONE ASSURE L36 MM SPINE CERVICAL LEVEL 2 NO C1713 $4,225.00PLATE BONE ASSURE L38 MM SPINE CERVICAL LEVEL 2 NO C1713 $4,225.00PLATE BONE ASSURE L42 MM SPINE CERVICAL LEVEL 2 NO C1713 $4,225.00PLATE BONE ASSURE L44 MM SPINE CERVICAL LEVEL 2 NO C1713 $4,225.00

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 ChargePLATE BONE ASSURE L46 MM SPINE CERVICAL LEVEL 2 NO C1713 $4,225.00PLATE BONE ASSURE L51 MM SPINE CERVICAL LEVEL 3 NO C1713 $4,875.00PLATE BONE ASSURE L57 MM SPINE CERVICAL LEVEL 3 NO C1713 $4,875.00PLATE BONE ASSURE L68 MM SPINE CERVICAL LEVEL 4 NO C1713 $4,875.00PLATE BONE ASSURE L69 MM SPINE CERVICAL LEVEL 3 NO C1713 $4,875.00PLATE BONE ASSURE L76 MM SPINE CERVICAL LEVEL 4 NO C1713 $4,875.00PLATE BONE ASSURE TITANIUM L10 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L100 MM SPINE CERVICAL C1713 $4,875.00PLATE BONE ASSURE TITANIUM L12 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L14 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L16 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L20 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L24 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L26 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L28 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L30 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L34 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L39 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L40 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE ASSURE TITANIUM L42 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L45 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L48 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L54 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L60 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L63 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L66 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L72 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L80 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L84 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L88 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L92 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ASSURE TITANIUM L96 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ATLANTIS VISION ELITE L25 MM SPINE CERV C1713 $5,600.00PLATE BONE ATLANTIS VISION ELITE L40 MM SPINE CERV C1713 $5,600.00PLATE BONE ATLANTIS VISION ELITE TITANIUM L23 MM S C1713 $5,600.00PLATE BONE ATOLL LARGE L38-48 MM SPINE OCCIPITAL C1713 $9,750.00PLATE BONE AXSOS 3 TITANIUM L121 MM TIBIA LEFT PRO C1713 $10,010.46PLATE BONE AXSOS 3 TITANIUM L121 MM TIBIAL LEFT PR C1713 $10,010.46PLATE BONE AXSOS 3 TITANIUM L121 MM TIBIAL RIGHT P C1713 $10,010.46

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 ChargePLATE BONE AXSOS 3 TITANIUM L123 MM TIBIAL RIGHT D C1713 $9,918.09PLATE BONE AXSOS 3 TITANIUM L127 MM TIBIA RIGHT DI C1713 $9,949.94PLATE BONE AXSOS 3 TITANIUM L127 MM TIBIAL RIGHT D C1713 $9,949.94PLATE BONE AXSOS 3 TITANIUM L86 MM HUMERUS LEFT PR C1713 $10,212.93PLATE BONE AXSOS 3 TITANIUM L86 MM HUMERUS RIGHT P C1713 $10,212.93PLATE BONE AXSOS 3 TITANIUM L95 MM TIBIAL RIGHT PR C1713 $9,800.25PLATE BONE AXSOS 3 TITANIUM L97 MM TIBIA RIGHT DIS C1713 $9,383.01PLATE BONE AXSOS 3 TITANIUM L97 MM TIBIAL RIGHT DI C1713 $9,383.01PLATE BONE AXSOS 3 TITANIUM L99 MM HUMERUS LEFT PR C1713 $10,212.93PLATE BONE AXSOS STAINLESS STEEL NARROW L115 MM WA C1713 $627.90PLATE BONE AXSOS STAINLESS STEEL STANDARD L112 MM C1713 $5,935.80PLATE BONE AXSOS STAINLESS STEEL STANDARD L120 MM C1713 $5,245.50PLATE BONE AXSOS STAINLESS STEEL STANDARD L146 MM C1713 $5,245.50PLATE BONE AXSOS STAINLESS STEEL STANDARD L149 MM C1713 $5,442.45PLATE BONE AXSOS STAINLESS STEEL STANDARD L201 MM C1713 $5,713.50PLATE BONE AXSOS STAINLESS STEEL STANDARD L202 MM C1713 $6,269.25PLATE BONE AXSOS STAINLESS STEEL STANDARD L225 MM C1713 $5,185.05PLATE BONE AXSOS STAINLESS STEEL STANDARD L238 MM C1713 $6,269.25PLATE BONE CAPTURED HIP TIMAX L97 MM 4 HOLE C1713 $2,478.00PLATE BONE CD HORIZON SOLERA X10 CROSSLINK MULTI-S C1713 $4,800.00PLATE BONE CD HORIZON SOLERA X10 CROSSLINK TITANIU C1713 $4,800.00PLATE BONE CERES TITANIUM ALUMINUM VANADIUM STANDA C1713 $5,200.00PLATE BONE CFX TITANIUM MICRO L L13 MM CRANIOMAXIL C1713 $1,200.00PLATE BONE CFX TITANIUM MICRO STRAIGHT L21 MM CRAN C1713 $1,040.00PLATE BONE CHS STAINLESS STEEL PEDIATRIC 100 D L10 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 100 D L50 C1713 $5,661.36PLATE BONE CHS STAINLESS STEEL PEDIATRIC 100 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 100 D L76 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 110 D L10 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 110 D L50 C1713 $5,661.36PLATE BONE CHS STAINLESS STEEL PEDIATRIC 110 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 110 D L76 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 120 D L10 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 120 D L50 C1713 $5,661.36PLATE BONE CHS STAINLESS STEEL PEDIATRIC 120 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 120 D L76 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 130 D L10 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 130 D L12 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 130 D L50 C1713 $5,661.36

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 ChargePLATE BONE CHS STAINLESS STEEL PEDIATRIC 130 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 130 D L76 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 135 D L10 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 135 D L12 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 135 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 135 D L76 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 140 D L10 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 140 D L12 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 140 D L50 C1713 $5,661.36PLATE BONE CHS STAINLESS STEEL PEDIATRIC 140 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 140 D L76 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 145 D L10 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 145 D L12 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 145 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 145 D L76 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 150 D L10 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 150 D L12 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 150 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 150 D L76 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 90 D L102 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 90 D L50 C1713 $5,661.36PLATE BONE CHS STAINLESS STEEL PEDIATRIC 90 D L55 C1713 $4,346.56PLATE BONE CHS STAINLESS STEEL PEDIATRIC 90 D L76 C1713 $4,346.56PLATE BONE CLASSIC CHS STAINLESS STEEL 135 D STAND C1713 $2,879.76PLATE BONE CLASSIC CHS STAINLESS STEEL 145 D STAND C1713 $2,879.76PLATE BONE CLASSIC CHS STAINLESS STEEL 150 D STAND C1713 $3,003.12PLATE BONE CLAVICLE 10 HOLE 3.5 MM SCREW C1713 $2,730.00PLATE BONE CLAVICLE 10 HOLE MOLD C1713 $390.00PLATE BONE CLAVICLE 6 HOLE MOLD C1713 $344.50PLATE BONE CLAVICLE 8 HOLE MOLD C1713 $344.50PLATE BONE COMBI STAINLESS STEEL L57 MM X W10 MM X C1713 $5,336.00PLATE BONE COMBI STAINLESS STEEL L78 MM X W10 MM X C1713 $5,851.20PLATE BONE COMBI STAINLESS STEEL STRAIGHT L104 MM C1713 $4,379.20PLATE BONE COMBI STAINLESS STEEL STRAIGHT L117 MM C1713 $4,540.16PLATE BONE COMBI STAINLESS STEEL STRAIGHT L130 MM C1713 $4,705.76PLATE BONE COMBI STAINLESS STEEL STRAIGHT L143 MM C1713 $4,871.36PLATE BONE COMBI STAINLESS STEEL STRAIGHT L156 MM C1713 $5,027.76PLATE BONE COMBI STAINLESS STEEL STRAIGHT L169 MM C1713 $5,193.36PLATE BONE COMBI STAINLESS STEEL STRAIGHT L182 MM C1713 $5,368.16

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 ChargePLATE BONE COMBI STAINLESS STEEL STRAIGHT L195 MM C1713 $5,529.20PLATE BONE COMBI STAINLESS STEEL STRAIGHT L208 MM C1713 $5,690.16PLATE BONE COMBI STAINLESS STEEL STRAIGHT L234 MM C1713 $5,855.76PLATE BONE COMBI STAINLESS STEEL STRAIGHT L260 MM C1713 $6,026.00PLATE BONE COMBI STAINLESS STEEL STRAIGHT L39 MM X C1713 $3,551.20PLATE BONE COMBI STAINLESS STEEL STRAIGHT L52 MM X C1713 $3,735.20PLATE BONE COMBI STAINLESS STEEL STRAIGHT L65 MM X C1713 $3,900.80PLATE BONE COMBI STAINLESS STEEL STRAIGHT L78 MM X C1713 $4,057.20PLATE BONE COMBI STAINLESS STEEL STRAIGHT L91 MM X C1713 $4,213.60PLATE BONE CROSSLINK CD HORIZON MULTI-SPAN STAINLE C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON MULTI-SPAN TITANIU C1713 $4,000.00PLATE BONE CROSSLINK CD HORIZON STAINLESS STEEL L. C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON STAINLESS STEEL L1 C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON STAINLESS STEEL OF C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON TITANIUM L.625 IN C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON TITANIUM L.75 IN S C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON TITANIUM L.875 IN C1713 $4,000.00PLATE BONE CROSSLINK CD HORIZON TITANIUM L1 IN SPI C1713 $4,000.00PLATE BONE CROSSLINK CD HORIZON TITANIUM L1.125 IN C1713 $4,000.00PLATE BONE CROSSLINK CD HORIZON TITANIUM L1.25 IN C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON TITANIUM L1.375 IN C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON TITANIUM L1.5 IN S C1713 $4,800.00PLATE BONE CROSSLINK CD HORIZON TITANIUM OFFSET L. C1713 $4,800.00PLATE BONE CSLP TITANIUM PREBENT L85 MM X W18 MM X C1713 $5,200.00PLATE BONE CSLP TITANIUM SMALL STATURE NARROW WIDT C1713 $5,200.00PLATE BONE C-TEK MAXAN TITANIUM ALUMINUM VANADIUM C1713 $5,850.00PLATE BONE C-TEK MAXAN TITANIUM PRECONTOUR L52 MM C1713 $5,850.00PLATE BONE CURVE L8 MM MAXILLOFACIAL 6 HOLE MEDIUM C1713 $1,615.68PLATE BONE DALL-MILES VITALLIUM 2 MM MEDIUM L100 M C1713 $5,470.92PLATE BONE DALL-MILES VITALLIUM 2 MM MEDIUM L150 M C1713 $7,128.03PLATE BONE DALL-MILES VITALLIUM 2 MM MEDIUM L200 M C1713 $8,823.36PLATE BONE DCP CAPOS STAINLESS STEEL 100 D 10 MM D C1713 $3,583.36PLATE BONE DCP CAPOS STAINLESS STEEL 100 D 15 MM D C1713 $3,583.36PLATE BONE DCP CAPOS STAINLESS STEEL 115 D 5 MM DI C1713 $2,056.16PLATE BONE DCP CAPOS STAINLESS STEEL 130 D L104 MM C1713 $3,794.96PLATE BONE DCP CAPOS STAINLESS STEEL 130 D L152 MM C1713 $4,098.56PLATE BONE DCP CAPOS STAINLESS STEEL 130 D L60 MM C1713 $3,583.36PLATE BONE DCP CAPOS STAINLESS STEEL 90 D 10 MM DI C1713 $3,923.76PLATE BONE DCP CAPOS STAINLESS STEEL 90 D 12 MM DI C1713 $3,417.76

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 ChargePLATE BONE DCP CAPOS STAINLESS STEEL 90 D 15 MM DI C1713 $3,583.36PLATE BONE DCP CAPOS STAINLESS STEEL 90 D 7 MM DIS C1713 $3,077.36PLATE BONE DCP CAPOS STAINLESS STEEL 95 D L124 MM C1713 $3,638.56PLATE BONE DCP CAPOS STAINLESS STEEL 95 D L156 MM C1713 $3,896.16PLATE BONE DCP CAPOS STAINLESS STEEL 95 D L92 MM L C1713 $3,477.60PLATE BONE DCP CAPOS STAINLESS STEEL INFANT 90 D 1 C1713 $3,077.36PLATE BONE DCP CAPOS STAINLESS STEEL PEDIATRIC 100 C1713 $3,583.36PLATE BONE DCP CAPOS STAINLESS STEEL PEDIATRIC 80 C1713 $3,583.36PLATE BONE DCP CAPOS STAINLESS STEEL PEDIATRIC 90 C1713 $3,583.36PLATE BONE DCP STAINLESS STEEL 100 D 10 MM DISPLAC C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 110 D L65 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 110 D L75 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 110 D L85 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 120 D L65 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 120 D L75 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 120 D L85 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L100 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L104 MM L50 M C1713 $3,399.36PLATE BONE DCP STAINLESS STEEL 130 D L104 MM L60 M C1713 $3,399.36PLATE BONE DCP STAINLESS STEEL 130 D L104 MM L70 M C1713 $3,399.36PLATE BONE DCP STAINLESS STEEL 130 D L104 MM L80 M C1713 $3,399.36PLATE BONE DCP STAINLESS STEEL 130 D L104 MM L90 M C1713 $3,399.36PLATE BONE DCP STAINLESS STEEL 130 D L105 MM X H94 C1713 $4,189.12PLATE BONE DCP STAINLESS STEEL 130 D L154 MM L70 M C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L154 MM L80 M C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L154 MM L90 M C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L200 MM L70 M C1713 $4,310.16PLATE BONE DCP STAINLESS STEEL 130 D L200 MM L80 M C1713 $4,310.16PLATE BONE DCP STAINLESS STEEL 130 D L200 MM L90 M C1713 $4,310.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L100 M C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L105 M C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L110 M C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L50 MM C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L60 MM C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L70 MM C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L75 MM C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L80 MM C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L85 MM C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L60 MM L90 MM C1713 $3,160.16

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 ChargePLATE BONE DCP STAINLESS STEEL 130 D L60 MM L95 MM C1713 $3,160.16PLATE BONE DCP STAINLESS STEEL 130 D L65 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L70 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L75 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L80 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L85 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L90 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 130 D L95 MM X H94 C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 90 D 10 MM DISPLACE C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 90 D 15 MM DISPLACE C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 90 D 20 MM DISPLACE C1713 $3,748.96PLATE BONE DCP STAINLESS STEEL 90 D L124 MM L35 MM C1713 $5,976.64PLATE BONE DCP STAINLESS STEEL 90 D L92 MM L35 MM C1713 $5,976.64PLATE BONE DCP STAINLESS STEEL 95 D L124 MM L50 MM C1713 $3,836.40PLATE BONE DCP STAINLESS STEEL 95 D L124 MM L60 MM C1713 $3,836.40PLATE BONE DCP STAINLESS STEEL 95 D L124 MM L70 MM C1713 $3,836.40PLATE BONE DCP STAINLESS STEEL 95 D L124 MM L80 MM C1713 $3,836.40PLATE BONE DCP STAINLESS STEEL 95 D L156 MM L50 MM C1713 $4,020.40PLATE BONE DCP STAINLESS STEEL 95 D L156 MM L60 MM C1713 $4,020.40PLATE BONE DCP STAINLESS STEEL 95 D L156 MM L70 MM C1713 $4,020.40PLATE BONE DCP STAINLESS STEEL 95 D L156 MM L80 MM C1713 $4,020.40PLATE BONE DCP STAINLESS STEEL 95 D L204 MM L50 MM C1713 $4,379.20PLATE BONE DCP STAINLESS STEEL 95 D L204 MM L60 MM C1713 $4,379.20PLATE BONE DCP STAINLESS STEEL 95 D L204 MM L70 MM C1713 $4,379.20PLATE BONE DCP STAINLESS STEEL 95 D L204 MM L80 MM C1713 $4,379.20PLATE BONE DCP STAINLESS STEEL 95 D L235 MM L50 MM C1713 $6,559.60PLATE BONE DCP STAINLESS STEEL 95 D L235 MM L60 MM C1713 $6,559.60PLATE BONE DCP STAINLESS STEEL 95 D L235 MM L70 MM C1713 $6,559.60PLATE BONE DCP STAINLESS STEEL 95 D L235 MM L80 MM C1713 $6,559.60PLATE BONE DCP STAINLESS STEEL 95 D L267 MM L60 MM C1713 $6,936.80PLATE BONE DCP STAINLESS STEEL 95 D L267 MM L70 MM C1713 $6,936.80PLATE BONE DCP STAINLESS STEEL 95 D L267 MM L80 MM C1713 $6,936.80PLATE BONE DCP STAINLESS STEEL 95 D L299 MM L60 MM C1713 $7,677.36PLATE BONE DCP STAINLESS STEEL 95 D L299 MM L70 MM C1713 $7,677.36PLATE BONE DCP STAINLESS STEEL 95 D L299 MM L80 MM C1713 $7,677.36PLATE BONE DCP STAINLESS STEEL 95 D L92 MM L50 MM C1713 $3,638.56PLATE BONE DCP STAINLESS STEEL 95 D L92 MM L60 MM C1713 $3,638.56PLATE BONE DCP STAINLESS STEEL 95 D L92 MM L70 MM C1713 $3,638.56PLATE BONE DCP STAINLESS STEEL 95 D L92 MM L80 MM C1713 $3,638.56

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 ChargePLATE BONE DCP STAINLESS STEEL 95 D SMALL STATURE C1713 $3,638.56PLATE BONE DCP STAINLESS STEEL ADULT 110 D L65 MM C1713 $4,089.36PLATE BONE DCP STAINLESS STEEL ADULT 110 D L85 MM C1713 $4,089.36PLATE BONE DCP STAINLESS STEEL ADULT 130 D L75 MM C1713 $4,089.36PLATE BONE DCP STAINLESS STEEL ADULT 130 D L85 MM C1713 $4,075.60PLATE BONE DCP STAINLESS STEEL ADULT 130 D L95 MM C1713 $4,089.36PLATE BONE DCP STAINLESS STEEL ADULT 90 D 10 MM DI C1713 $4,089.36PLATE BONE DCP STAINLESS STEEL ANGLE LEFT L BUTTRE C1713 $2,810.56PLATE BONE DCP STAINLESS STEEL ANGLE RIGHT L L86 M C1713 $2,810.56PLATE BONE DCP STAINLESS STEEL BROAD L103 MM X W16 C1713 $1,545.60PLATE BONE DCP STAINLESS STEEL BROAD L119 MM X W16 C1713 $1,591.60PLATE BONE DCP STAINLESS STEEL BROAD L135 MM X W16 C1713 $1,932.00PLATE BONE DCP STAINLESS STEEL BROAD L151 MM X W16 C1713 $1,932.00PLATE BONE DCP STAINLESS STEEL BROAD L167 MM X W16 C1713 $1,932.00PLATE BONE DCP STAINLESS STEEL BROAD L199 MM X W16 C1713 $2,033.20PLATE BONE DCP STAINLESS STEEL BROAD L231 MM X W16 C1713 $2,033.20PLATE BONE DCP STAINLESS STEEL BROAD L263 MM X W16 C1713 $2,346.88PLATE BONE DCP STAINLESS STEEL BROAD L326 MM X W16 C1713 $3,514.40PLATE BONE DCP STAINLESS STEEL BROAD L358 MM X W16 C1713 $4,037.12PLATE BONE DCP STAINLESS STEEL BROAD L390 MM X W16 C1713 $4,322.88PLATE BONE DCP STAINLESS STEEL BUTTRESS L118 MM X C1713 $4,839.20PLATE BONE DCP STAINLESS STEEL BUTTRESS L128 MM CO C1713 $4,949.60PLATE BONE DCP STAINLESS STEEL BUTTRESS L149 MM X C1713 $5,198.00PLATE BONE DCP STAINLESS STEEL BUTTRESS L158 MM X C1713 $5,184.16PLATE BONE DCP STAINLESS STEEL BUTTRESS L181 MM X C1713 $5,547.60PLATE BONE DCP STAINLESS STEEL BUTTRESS L190 MM X C1713 $5,607.36PLATE BONE DCP STAINLESS STEEL BUTTRESS L221 MM X C1713 $6,408.32PLATE BONE DCP STAINLESS STEEL BUTTRESS L240 MM X C1713 $6,136.40PLATE BONE DCP STAINLESS STEEL BUTTRESS L285 MM X C1713 $6,773.12PLATE BONE DCP STAINLESS STEEL H L12 MM X W11 MM 4 C1713 $1,145.36PLATE BONE DCP STAINLESS STEEL L L17 MM X W5 MM X C1713 $395.60PLATE BONE DCP STAINLESS STEEL L L32 MM X W7 MM X C1713 $381.76PLATE BONE DCP STAINLESS STEEL L100 MM X W8 MM X H C1713 $1,890.56PLATE BONE DCP STAINLESS STEEL L109 MM X W10 MM X C1713 $1,251.20PLATE BONE DCP STAINLESS STEEL L118 MM X W14 MM X C1713 $4,839.20PLATE BONE DCP STAINLESS STEEL L121 MM X W10 MM X C1713 $1,260.40PLATE BONE DCP STAINLESS STEEL L125 MM X W14 MM X C1713 $4,153.76PLATE BONE DCP STAINLESS STEEL L145 MM X W10 MM X C1713 $1,462.80PLATE BONE DCP STAINLESS STEEL L161 MM X W14 MM X C1713 $4,678.16

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 ChargePLATE BONE DCP STAINLESS STEEL L169 MM X W10 MM X C1713 $2,690.96PLATE BONE DCP STAINLESS STEEL L170 MM 8 HOLE SHAF C1713 $4,420.16PLATE BONE DCP STAINLESS STEEL L186 MM 9 HOLE SHAF C1713 $4,705.92PLATE BONE DCP STAINLESS STEEL L194 MM X W10 MM X C1713 $3,095.76PLATE BONE DCP STAINLESS STEEL L197 MM X W14 MM X C1713 $5,331.36PLATE BONE DCP STAINLESS STEEL L20 MM X W8 MM X H2 C1713 $828.00PLATE BONE DCP STAINLESS STEEL L202 MM 10 HOLE COB C1713 $4,961.28PLATE BONE DCP STAINLESS STEEL L217 MM X W10 MM X C1713 $3,463.76PLATE BONE DCP STAINLESS STEEL L218 MM 11 HOLE SHA C1713 $5,228.80PLATE BONE DCP STAINLESS STEEL L22 MM X W5 MM X H1 C1713 $1,159.20PLATE BONE DCP STAINLESS STEEL L221 MM X W16 MM X C1713 $7,315.88PLATE BONE DCP STAINLESS STEEL L233 MM X W14 MM X C1713 $5,956.96PLATE BONE DCP STAINLESS STEEL L242 MM X W10 MM X C1713 $3,818.00PLATE BONE DCP STAINLESS STEEL L25 MM X W10 MM X H C1713 $920.00PLATE BONE DCP STAINLESS STEEL L253 MM X W16 MM X C1713 $6,596.80PLATE BONE DCP STAINLESS STEEL L26 MM X W8 MM X H2 C1713 $984.40PLATE BONE DCP STAINLESS STEEL L265 MM X W10 MM X C1713 $4,167.60PLATE BONE DCP STAINLESS STEEL L269 MM X W14 MM X C1713 $6,642.40PLATE BONE DCP STAINLESS STEEL L27 MM X W5 MM X H1 C1713 $1,200.56PLATE BONE DCP STAINLESS STEEL L285 MM X W16 MM X C1713 $6,773.12PLATE BONE DCP STAINLESS STEEL L32 MM X W5 MM X H1 C1713 $1,255.76PLATE BONE DCP STAINLESS STEEL L36 MM X W8 MM X H2 C1713 $933.76PLATE BONE DCP STAINLESS STEEL L37 MM X W10 MM X H C1713 $942.96PLATE BONE DCP STAINLESS STEEL L37 MM X W5 MM X H1 C1713 $1,320.16PLATE BONE DCP STAINLESS STEEL L39 MM X W5 MM X H1 C1713 $1,919.58PLATE BONE DCP STAINLESS STEEL L42 MM X W5 MM X H1 C1713 $1,356.96PLATE BONE DCP STAINLESS STEEL L44 MM X W13 MM X H C1713 $482.96PLATE BONE DCP STAINLESS STEEL L44 MM X W8 MM X H2 C1713 $1,067.20PLATE BONE DCP STAINLESS STEEL L49 MM X W10 MM X H C1713 $975.20PLATE BONE DCP STAINLESS STEEL L52 MM X W8 MM X H2 C1713 $1,150.00PLATE BONE DCP STAINLESS STEEL L57 MM X W10 MM X H C1713 $5,860.40PLATE BONE DCP STAINLESS STEEL L60 MM X W8 MM X H2 C1713 $1,315.60PLATE BONE DCP STAINLESS STEEL L61 MM 4 HOLE NONST C1713 $3,169.36PLATE BONE DCP STAINLESS STEEL L61 MM X W10 MM X H C1713 $1,044.16PLATE BONE DCP STAINLESS STEEL L68 MM X W8 MM X H2 C1713 $1,462.80PLATE BONE DCP STAINLESS STEEL L73 MM X W10 MM X H C1713 $1,090.16PLATE BONE DCP STAINLESS STEEL L76 MM X W8 MM X H2 C1713 $1,518.00PLATE BONE DCP STAINLESS STEEL L78 MM X W10 MM X H C1713 $6,430.80PLATE BONE DCP STAINLESS STEEL L84 MM X W8 MM X H2 C1713 $1,683.60

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 ChargePLATE BONE DCP STAINLESS STEEL L85 MM X W10 MM X H C1713 $1,131.60PLATE BONE DCP STAINLESS STEEL L97 MM X W10 MM X H C1713 $1,177.60PLATE BONE DCP STAINLESS STEEL NARROW L103 MM X W1 C1713 $1,159.20PLATE BONE DCP STAINLESS STEEL NARROW L119 MM X W1 C1713 $1,159.20PLATE BONE DCP STAINLESS STEEL NARROW L135 MM X W1 C1713 $1,159.20PLATE BONE DCP STAINLESS STEEL NARROW L151 MM X W1 C1713 $1,159.20PLATE BONE DCP STAINLESS STEEL NARROW L167 MM X W1 C1713 $1,531.76PLATE BONE DCP STAINLESS STEEL NARROW L183 MM X W1 C1713 $1,659.84PLATE BONE DCP STAINLESS STEEL NARROW L199 MM X W1 C1713 $1,531.76PLATE BONE DCP STAINLESS STEEL NARROW L231 MM X W1 C1713 $1,976.00PLATE BONE DCP STAINLESS STEEL NARROW L326 MM X W1 C1713 $3,118.80PLATE BONE DCP STAINLESS STEEL NARROW L39 MM X W12 C1713 $1,021.20PLATE BONE DCP STAINLESS STEEL NARROW L71 MM X W12 C1713 $1,021.20PLATE BONE DCP STAINLESS STEEL NARROW L87 MM X W12 C1713 $1,021.20PLATE BONE DCP STAINLESS STEEL OBLIQUE LEFT L L19 C1713 $408.48PLATE BONE DCP STAINLESS STEEL OBLIQUE LEFT L L34 C1713 $343.85PLATE BONE DCP STAINLESS STEEL OBLIQUE RIGHT L L19 C1713 $408.48PLATE BONE DCP STAINLESS STEEL OBLIQUE RIGHT L L34 C1713 $423.20PLATE BONE DCP STAINLESS STEEL T BUTTRESS L80 MM 4 C1713 $3,210.80PLATE BONE DCP STAINLESS STEEL T L18 MM 2 HOLE HEA C1713 $310.18PLATE BONE DCP STAINLESS STEEL T L32 MM X W7 MM X C1713 $343.85PLATE BONE DCP STAINLESS STEEL T L65 MM X H1.2 MM C1713 $1,821.14PLATE BONE DCP TITANIUM 100 D 10 MM DISPLACEMENT L C1713 $4,130.80PLATE BONE DCP TITANIUM 110 D L65 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 110 D L75 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 110 D L85 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 120 D L65 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 120 D L75 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 120 D L85 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L100 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L104 MM L50 MM 6 HOL C1713 $3,748.96PLATE BONE DCP TITANIUM 130 D L104 MM L60 MM 6 HOL C1713 $3,748.96PLATE BONE DCP TITANIUM 130 D L104 MM L70 MM 6 HOL C1713 $3,748.96PLATE BONE DCP TITANIUM 130 D L104 MM L80 MM 6 HOL C1713 $3,748.96PLATE BONE DCP TITANIUM 130 D L105 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L110 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L152 MM L70 MM 9 HOL C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L152 MM L80 MM 9 HOL C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L152 MM L90 MM 9 HOL C1713 $4,130.80

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 ChargePLATE BONE DCP TITANIUM 130 D L200 MM L70 MM 12 HO C1713 $4,747.20PLATE BONE DCP TITANIUM 130 D L200 MM L80 MM 12 HO C1713 $4,747.20PLATE BONE DCP TITANIUM 130 D L200 MM L90 MM 12 HO C1713 $4,747.20PLATE BONE DCP TITANIUM 130 D L60 MM L100 MM 4 HOL C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L105 MM 4 HOL C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L110 MM 4 HOL C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L50 MM 4 HOLE C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L60 MM 4 HOLE C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L70 MM 4 HOLE C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L75 MM 4 HOLE C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L80 MM 4 HOLE C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L85 MM 4 HOLE C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L90 MM 4 HOLE C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L60 MM L95 MM 4 HOLE C1713 $3,505.20PLATE BONE DCP TITANIUM 130 D L65 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L70 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L75 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L80 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L85 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L90 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 130 D L95 MM 4 HOLE BLADE C1713 $4,130.80PLATE BONE DCP TITANIUM 2.7 MM L84 MM X W8 MM X H2 C1713 $3,850.16PLATE BONE DCP TITANIUM 90 D 10 MM DISPLACEMENT L4 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 10 MM DISPLACEMENT L5 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 10 MM DISPLACEMENT L6 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 10 MM DISPLACEMENT L7 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 15 MM DISPLACEMENT L4 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 15 MM DISPLACEMENT L5 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 15 MM DISPLACEMENT L6 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 15 MM DISPLACEMENT L7 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 15 MM DISPLACEMENT L8 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 20 MM DISPLACEMENT L5 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 20 MM DISPLACEMENT L6 C1713 $4,130.80PLATE BONE DCP TITANIUM 90 D 20 MM DISPLACEMENT L7 C1713 $4,130.80PLATE BONE DCP TITANIUM 95 D L124 MM L50 MM CONDYL C1713 $4,186.00PLATE BONE DCP TITANIUM 95 D L124 MM L60 MM CONDYL C1713 $4,186.00PLATE BONE DCP TITANIUM 95 D L124 MM L70 MM CONDYL C1713 $4,186.00PLATE BONE DCP TITANIUM 95 D L124 MM L80 MM CONDYL C1713 $4,186.00PLATE BONE DCP TITANIUM 95 D L156 MM L50 MM CONDYL C1713 $4,392.96

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 ChargePLATE BONE DCP TITANIUM 95 D L156 MM L60 MM CONDYL C1713 $4,392.96PLATE BONE DCP TITANIUM 95 D L156 MM L70 MM CONDYL C1713 $4,462.00PLATE BONE DCP TITANIUM 95 D L156 MM L80 MM CONDYL C1713 $4,462.00PLATE BONE DCP TITANIUM 95 D L204 MM L50 MM CONDYL C1713 $4,857.60PLATE BONE DCP TITANIUM 95 D L204 MM L60 MM CONDYL C1713 $4,857.60PLATE BONE DCP TITANIUM 95 D L204 MM L70 MM CONDYL C1713 $4,857.60PLATE BONE DCP TITANIUM 95 D L204 MM L80 MM CONDYL C1713 $4,857.60PLATE BONE DCP TITANIUM 95 D L92 MM L50 MM CONDYLA C1713 $4,002.00PLATE BONE DCP TITANIUM 95 D L92 MM L60 MM CONDYLA C1713 $4,002.00PLATE BONE DCP TITANIUM 95 D L92 MM L70 MM CONDYLA C1713 $4,002.00PLATE BONE DCP TITANIUM 95 D L92 MM L80 MM CONDYLA C1713 $4,002.00PLATE BONE DCP TITANIUM ADULT 90 D 10 MM DISPLACEM C1713 $4,620.80PLATE BONE DCP TITANIUM ANGLE CONTOUR L43 MM X W5 C1713 $3,444.00PLATE BONE DCP TITANIUM ANGLE LEFT L L86 MM X W14 C1713 $2,810.56PLATE BONE DCP TITANIUM ANGLE RIGHT L L86 MM X W14 C1713 $2,884.16PLATE BONE DCP TITANIUM CONTOUR L30 MM X W5 MM X H C1713 $2,178.00PLATE BONE DCP TITANIUM CONTOUR L32 MM X W5 MM X H C1713 $2,364.00PLATE BONE DCP TITANIUM CONTOUR L42 MM X W5 MM X H C1713 $2,390.40PLATE BONE DCP TITANIUM CONTOUR L48 MM X W5 MM X H C1713 $2,568.00PLATE BONE DCP TITANIUM CONTOUR L54 MM X W5 MM X H C1713 $2,898.00PLATE BONE DCP TITANIUM H L12 MM X W11 MM CONDYLAR C1713 $1,513.36PLATE BONE DCP TITANIUM L OBLIQUE LEFT CONTOUR L34 C1713 $430.08PLATE BONE DCP TITANIUM L OBLIQUE RIGHT CONTOUR L3 C1713 $430.08PLATE BONE DCP TITANIUM L100 MM X W8 MM X H2.5 MM C1713 $4,268.80PLATE BONE DCP TITANIUM L20 MM X W8 MM X H2 MM FOO C1713 $1,853.76PLATE BONE DCP TITANIUM L22 MM X W5 MM X H.9 MM ZY C1713 $1,754.40PLATE BONE DCP TITANIUM L22 MM X W5 MM X H1 MM 4 H C1713 $1,545.60PLATE BONE DCP TITANIUM L26 MM X W8 MM X H2 MM FOO C1713 $1,932.00PLATE BONE DCP TITANIUM L27 MM X W5 MM X H.9 MM ZY C1713 $1,822.40PLATE BONE DCP TITANIUM L27 MM X W5 MM X H1 MM 5 H C1713 $1,706.56PLATE BONE DCP TITANIUM L32 MM X W5 MM X H.9 MM ZY C1713 $1,958.40PLATE BONE DCP TITANIUM L32 MM X W5 MM X H1 MM 6 H C1713 $1,862.96PLATE BONE DCP TITANIUM L36 MM X W8 MM X H2 MM FOO C1713 $2,318.40PLATE BONE DCP TITANIUM L37 MM X W5 MM X H1.5 MM 7 C1713 $2,019.36PLATE BONE DCP TITANIUM L39 MM X W5 MM X H1.2 MM C C1713 $2,092.96PLATE BONE DCP TITANIUM L42 MM X W5 MM X H1.5 MM 8 C1713 $2,166.56PLATE BONE DCP TITANIUM L44 MM X W8 MM X H2 MM FOO C1713 $2,612.80PLATE BONE DCP TITANIUM L52 MM X W8 MM X H2 MM FOO C1713 $2,801.36PLATE BONE DCP TITANIUM L60 MM X W8 MM X H2.5 MM F C1713 $3,114.16

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 ChargePLATE BONE DCP TITANIUM L68 MM X W8 MM X H2.5 MM F C1713 $3,261.36PLATE BONE DCP TITANIUM L76 MM X W8 MM X H2.5 MM F C1713 $3,551.20PLATE BONE DCP TITANIUM MINI L22 MM CRANIOFACIAL 4 C1713 $1,985.60PLATE BONE DCP TITANIUM MINI L27 MM CRANIOFACIAL 5 C1713 $2,189.60PLATE BONE DCP TITANIUM MINI L32 MM CRANIOFACIAL 6 C1713 $2,393.60PLATE BONE DCP TITANIUM MINI L37 MM CRANIOFACIAL 7 C1713 $2,570.40PLATE BONE DCP TITANIUM MINI L42 MM CRANIOFACIAL 8 C1713 $2,788.00PLATE BONE DCP TITANIUM T L32 MM X W7 MM X H1.2 MM C1713 $430.08PLATE BONE DCS DCP STAINLESS STEEL 95 D SHORT BARR C1713 $6,444.56PLATE BONE DHS DCP STAINLESS STEEL 130 D SHORT BAR C1713 $3,726.00PLATE BONE DHS DCP STAINLESS STEEL 130 D STANDARD C1713 $4,949.60PLATE BONE DHS DCP STAINLESS STEEL 135 D SHORT BAR C1713 $3,726.00PLATE BONE DHS DCP STAINLESS STEEL 135 D STANDARD C1713 $6,766.56PLATE BONE DHS DCP STAINLESS STEEL 140 D SHORT BAR C1713 $3,726.00PLATE BONE DHS DCP STAINLESS STEEL 140 D STANDARD C1713 $4,949.60PLATE BONE DHS DCP STAINLESS STEEL 145 D SHORT BAR C1713 $3,726.00PLATE BONE DHS DCP STAINLESS STEEL 145 D STANDARD C1713 $4,949.60PLATE BONE DHS DCP STAINLESS STEEL 150 D SHORT BAR C1713 $3,726.00PLATE BONE DHS DCP STAINLESS STEEL 150 D STANDARD C1713 $4,949.60PLATE BONE DIVERGENCE TITANIUM MINI L17.5 MM SPINE C1713 $5,200.00PLATE BONE DURANGO TITANIUM ZERO H16 MM SPINE NONS C1713 $13,000.00PLATE BONE DVR KIRSCHNER TITANIUM L59.5 MM X W24.4 C1713 $3,253.25PLATE BONE DVR KIRSCHNER TITANIUM L62.6 MM X W28.2 C1713 $3,253.25PLATE BONE DVR KIRSCHNER TITANIUM NARROW L57.2 MM C1713 $4,022.20PLATE BONE DVR KIRSCHNER TITANIUM SHORT NARROW L48 C1713 $3,253.25PLATE BONE DVR KIRSCHNER TITANIUM STANDARD L89.5 M C1713 $4,022.20PLATE BONE DVR KIRSCHNER TITANIUM STANDARD SHORT L C1713 $4,022.20PLATE BONE DVR KIRSCHNER TITANIUM WIDE L62.6 MM X C1713 $4,022.20PLATE BONE DVR L55 MM X W24 MM RADIUS LEFT DISTAL C1713 $7,246.72PLATE BONE DVR MINI NARROW L51 MM X W22 MM RADIUS C1713 $4,268.94PLATE BONE DVR STANDARD CONTOUR L51 MM X W24 MM RA C1713 $4,268.94PLATE BONE DVR TITANIUM L59.5 MM X W24.4 MM RADIUS C1713 $4,022.20PLATE BONE DVR TITANIUM NARROW L57.2 MM X W21.6 MM C1713 $4,022.20PLATE BONE DVR TITANIUM SHORT NARROW L48.9 MM X W2 C1713 $3,253.25PLATE BONE DVR TITANIUM STANDARD SHORT L51.3 MM X C1713 $3,253.25PLATE BONE DYNAFIX VS L10 MM TIBIAL LEFT 4 HOLE NO C1713 $7,392.32PLATE BONE DYNAFIX VS L10 MM TIBIAL RIGHT 4 HOLE N C1713 $7,392.32PLATE BONE DYNAFIX VS L11.25 MM LEFT 4 HOLE NONSTE C1713 $7,392.32PLATE BONE DYNAFIX VS L11.25 MM RIGHT 4 HOLE NONST C1713 $7,392.32

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 ChargePLATE BONE DYNAFIX VS L12.5 MM TIBIAL RIGHT 4 HOLE C1713 $7,392.32PLATE BONE DYNAFIX VS L15 MM TIBIAL LEFT 6 HOLE NO C1713 $7,392.32PLATE BONE DYNAFIX VS L15 MM TIBIAL RIGHT 6 HOLE N C1713 $7,392.32PLATE BONE DYNAFIX VS L17.5 MM TIBIAL LEFT 6 HOLE C1713 $7,392.32PLATE BONE DYNAFIX VS L17.5 MM TIBIAL RIGHT 6 HOLE C1713 $7,392.32PLATE BONE DYNAFIX VS L20 MM TIBIAL LEFT 6 HOLE NO C1713 $7,392.32PLATE BONE DYNAFIX VS L20 MM TIBIAL RIGHT 6 HOLE N C1713 $7,392.32PLATE BONE DYNAFIX VS L22.5 MM TIBIAL LEFT 6 HOLE C1713 $7,392.32PLATE BONE DYNAFIX VS L22.5 MM TIBIAL RIGHT 6 HOLE C1713 $7,392.32PLATE BONE DYNAFIX VS L5 MM TIBIAL LEFT 4 HOLE NON C1713 $7,392.32PLATE BONE DYNAFIX VS L5 MM TIBIAL RIGHT 4 HOLE NO C1713 $7,392.32PLATE BONE DYNAFIX VS L6.25 MM 4 HOLE NONSTERILE O C1713 $7,392.32PLATE BONE DYNAFIX VS L6.25 MM TIBIAL LEFT 4 HOLE C1713 $7,392.32PLATE BONE DYNAFIX VS L7.5 MM TIBIAL LEFT 4 HOLE N C1713 $7,392.32PLATE BONE DYNAFIX VS L7.5 MM TIBIAL RIGHT 4 HOLE C1713 $7,392.32PLATE BONE DYNAFIX VS L8.75 MM TIBIAL LEFT 4 HOLE C1713 $7,392.32PLATE BONE DYNAFIX VS L8.75 MM TIBIAL RIGHT 4 HOLE C1713 $7,392.32PLATE BONE EQUINOXE 10 D GLENOID SUPERIOR AUGMENT C1713 $10,400.00PLATE BONE F3 HAFNIUM STRAIGHT 3D CONTOUR L50.1 MM C1713 $2,883.14PLATE BONE FEMUR TIBIA PROXIMAL DISTAL CLAMP NUT C1713 $390.00PLATE BONE FEMUR TIBIA PROXIMAL DISTAL EXTRACTION C1713 $2,340.00PLATE BONE FEMUR TIBIA PROXIMAL DISTAL NUT C1713 $780.00PLATE BONE FEMUR TIBIA PROXIMAL DISTAL T HANDLE C1713 $780.00PLATE BONE FEMUR TIBIAL PROXIMAL DISTAL EXTRACTION C1713 $2,340.00PLATE BONE FEMUR TIBIAL PROXIMAL DISTAL T HANDLE C1713 $780.00PLATE BONE FIBULA 4 HOLE MOLD C1713 $344.50PLATE BONE FIBULA 6 HOLE MOLD C1713 $390.00PLATE BONE FIBULA 8 HOLE MOLD C1713 $390.00PLATE BONE FREEDOM TITANIUM 1 WRIST CARPAL C1713 $17,511.00PLATE BONE GAP TITANIUM 2Y LOW PROFILE L8 MM CRANI C1713 $1,461.92PLATE BONE GRIFFIN LINDORF TITANIUM L3 MM CHIN MOD C1713 $1,266.88PLATE BONE GRIFFIN LINDORF TITANIUM L5 MM CHIN MOD C1713 $1,266.88PLATE BONE GRIFFIN LINDORF TITANIUM L7 MM CHIN MOD C1713 $1,266.88PLATE BONE GRIFFIN LINDORF TITANIUM L9 MM CHIN MOD C1713 $1,266.88PLATE BONE H2 MM MANDIBLE 11 HOLE RECONSTRUCTION T C1713 $14,010.23PLATE BONE HELIX R L24 MM SPINE 1 LEVEL NONSTERILE C1713 $5,200.00PLATE BONE HELIX R L34 MM SPINE 2 LEVEL NONSTERILE C1713 $5,200.00PLATE BONE HELIX R L36 MM SPINE 2 LEVEL NONSTERILE C1713 $5,200.00PLATE BONE HELIX R L38 MM SPINE 2 LEVEL NONSTERILE C1713 $5,200.00

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 ChargePLATE BONE HELIX R L52 MM SPINE 2 LEVEL NONSTERILE C1713 $5,200.00PLATE BONE HELIX R L64 MM SPINE 3 LEVEL NONSTERILE C1713 $5,850.00PLATE BONE HELIX R L68 MM SPINE 4 LEVEL NONSTERILE C1713 $5,850.00PLATE BONE HUMERAL DISTAL DORSOLATERAL 5 HOLE MOLD C1713 $344.50PLATE BONE HUMERAL DISTAL MEDIAL 8 HOLE MOLD C1713 $344.50PLATE BONE HUMERUS DISTAL DORSOLATERAL 5 HOLE MOLD C1713 $344.50PLATE BONE HUMERUS DISTAL MEDIAL 8 HOLE MOLD C1713 $344.50PLATE BONE HYBRID MMF SMALL MAXILLOMANDIBULAR NONS C1713 $2,340.00PLATE BONE ILS TITANIUM L90 MM CLAVICLE 8 HOLE MUL C1713 $2,193.75PLATE BONE INVIZIA L22 MM SPINE 1 LEVEL NONSTERILE C1713 $4,550.00PLATE BONE INVIZIA L51 MM SPINE 3 LEVEL NONSTERILE C1713 $5,200.00PLATE BONE L CRANIOMAXILLOFACIAL 9 HOLE LOCK C1713 $4,176.00PLATE BONE L100 MM X W100 MM X H.5 MM CONTOURABLE C1713 $18,945.60PLATE BONE L100 MM X W100 MM X H.5 MM STRAIGHT ROW C1713 $15,478.96PLATE BONE L12.5 MM SPINE LEFT 4 HOLE C1713 $7,392.32PLATE BONE L150 MM X W150 MM X H.5 MM CONTOURABLE C1713 $45,544.00PLATE BONE L35 MM X W35 MM ORBITAL FLOOR BEND TEMP C1713 $7,664.00PLATE BONE L6 MM X H2 MM MANDIBLE 6 HOLE BAR NONST C1713 $4,199.30PLATE BONE LC-DCP PRO-PAK STAINLESS STEEL L35 MM X C1713 $2,160.72PLATE BONE LC-DCP PRO-PAK STAINLESS STEEL L51 MM X C1713 $2,436.35PLATE BONE LC-DCP PRO-PAK STAINLESS STEEL L67 MM X C1713 $2,633.23PLATE BONE LC-DCP PRO-PAK TITANIUM L24 MM X W5.5 M C1713 $1,683.60PLATE BONE LC-DCP PRO-PAK TITANIUM L35 MM X H1.7 M C1713 $2,341.36PLATE BONE LC-DCP PRO-PAK TITANIUM L36 MM X W5.5 M C1713 $1,982.56PLATE BONE LC-DCP PRO-PAK TITANIUM L48 MM X W5.5 M C1713 $1,827.61PLATE BONE LC-DCP PRO-PAK TITANIUM L51 MM X H1.7 M C1713 $2,631.20PLATE BONE LC-DCP PRO-PAK TITANIUM L67 MM X H1.7 M C1713 $2,842.80PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L121 C1713 $515.20PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L145 C1713 $538.16PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L25 C1713 $390.96PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L37 C1713 $400.16PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L49 C1713 $464.56PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L61 C1713 $464.56PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L73 C1713 $478.40PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L85 C1713 $478.40PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L97 C1713 $496.80PLATE BONE LC-DCP STAINLESS STEEL ANGLE LEFT L BUT C1713 $3,891.60PLATE BONE LC-DCP STAINLESS STEEL ANGLE RIGHT L BU C1713 $4,097.92PLATE BONE LC-DCP STAINLESS STEEL BROAD L106 MM X C1713 $1,816.96

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 ChargePLATE BONE LC-DCP STAINLESS STEEL BROAD L124 MM X C1713 $1,968.80PLATE BONE LC-DCP STAINLESS STEEL BROAD L142 MM X C1713 $2,189.60PLATE BONE LC-DCP STAINLESS STEEL BROAD L160 MM X C1713 $2,189.60PLATE BONE LC-DCP STAINLESS STEEL BROAD L178 MM X C1713 $2,189.60PLATE BONE LC-DCP STAINLESS STEEL BROAD L196 MM X C1713 $2,350.56PLATE BONE LC-DCP STAINLESS STEEL BROAD L214 MM X C1713 $2,350.56PLATE BONE LC-DCP STAINLESS STEEL BROAD L250 MM X C1713 $2,350.56PLATE BONE LC-DCP STAINLESS STEEL BROAD L286 MM X C1713 $2,668.00PLATE BONE LC-DCP STAINLESS STEEL BROAD L332 MM X C1713 $3,017.60PLATE BONE LC-DCP STAINLESS STEEL BROAD L358 MM X C1713 $4,420.56PLATE BONE LC-DCP STAINLESS STEEL BROAD L394 MM X C1713 $5,046.40PLATE BONE LC-DCP STAINLESS STEEL BUTTRESS T L112 C1713 $3,491.36PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L104 C1713 $2,258.56PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L120 C1713 $2,934.80PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L136 C1713 $3,187.76PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L152 C1713 $3,431.60PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L168 C1713 $3,643.20PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L200 C1713 $3,937.60PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L88 M C1713 $2,116.00PLATE BONE LC-DCP STAINLESS STEEL CURVE L118 MM X C1713 $3,316.56PLATE BONE LC-DCP STAINLESS STEEL CURVE L142 MM X C1713 $3,454.56PLATE BONE LC-DCP STAINLESS STEEL CURVE L166 MM X C1713 $3,873.20PLATE BONE LC-DCP STAINLESS STEEL CURVE L190 MM X C1713 $4,121.60PLATE BONE LC-DCP STAINLESS STEEL CURVE L214 MM X C1713 $4,443.60PLATE BONE LC-DCP STAINLESS STEEL CURVE L70 MM X W C1713 $2,907.20PLATE BONE LC-DCP STAINLESS STEEL CURVE L94 MM X W C1713 $3,150.96PLATE BONE LC-DCP STAINLESS STEEL D15 MM L58 MM X C1713 $4,871.36PLATE BONE LC-DCP STAINLESS STEEL D15 MM L77 MM X C1713 $5,225.60PLATE BONE LC-DCP STAINLESS STEEL D18 MM L58 MM X C1713 $4,871.36PLATE BONE LC-DCP STAINLESS STEEL D18 MM L77 MM X C1713 $5,225.60PLATE BONE LC-DCP STAINLESS STEEL L L87 MM X W14 M C1713 $4,408.00PLATE BONE LC-DCP STAINLESS STEEL L103 MM X W11 MM C1713 $1,113.20PLATE BONE LC-DCP STAINLESS STEEL L104 MM X H2.6 M C1713 $1,237.36PLATE BONE LC-DCP STAINLESS STEEL L106 MM 9 HOLE R C1713 $2,999.20PLATE BONE LC-DCP STAINLESS STEEL L113 MM X H2.6 M C1713 $1,283.36PLATE BONE LC-DCP STAINLESS STEEL L116 MM X W11 MM C1713 $1,163.76PLATE BONE LC-DCP STAINLESS STEEL L118 MM 10 HOLE C1713 $3,022.16PLATE BONE LC-DCP STAINLESS STEEL L129 MM X W11 MM C1713 $1,470.04PLATE BONE LC-DCP STAINLESS STEEL L130 MM 11 HOLE C1713 $3,178.56

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 ChargePLATE BONE LC-DCP STAINLESS STEEL L142 MM 12 HOLE C1713 $3,316.56PLATE BONE LC-DCP STAINLESS STEEL L142 MM X W11 MM C1713 $1,283.36PLATE BONE LC-DCP STAINLESS STEEL L154 MM 13 HOLE C1713 $3,468.40PLATE BONE LC-DCP STAINLESS STEEL L155 MM X W11 MM C1713 $1,366.16PLATE BONE LC-DCP STAINLESS STEEL L166 MM 14 HOLE C1713 $3,601.76PLATE BONE LC-DCP STAINLESS STEEL L178 MM 15 HOLE C1713 $3,739.76PLATE BONE LC-DCP STAINLESS STEEL L181 MM X W11 MM C1713 $2,530.00PLATE BONE LC-DCP STAINLESS STEEL L190 MM 16 HOLE C1713 $3,900.80PLATE BONE LC-DCP STAINLESS STEEL L195 MM X W11 MM C1713 $2,654.16PLATE BONE LC-DCP STAINLESS STEEL L208 MM X W11 MM C1713 $2,907.20PLATE BONE LC-DCP STAINLESS STEEL L214 MM 18 HOLE C1713 $4,075.60PLATE BONE LC-DCP STAINLESS STEEL L233 MM X W11 MM C1713 $3,252.16PLATE BONE LC-DCP STAINLESS STEEL L238 MM 20 HOLE C1713 $4,944.96PLATE BONE LC-DCP STAINLESS STEEL L25 MM X W11 MM C1713 $860.16PLATE BONE LC-DCP STAINLESS STEEL L259 MM X W11 MM C1713 $3,601.76PLATE BONE LC-DCP STAINLESS STEEL L263 MM 22 HOLE C1713 $5,147.36PLATE BONE LC-DCP STAINLESS STEEL L27 MM X H1.2 MM C1713 $1,560.23PLATE BONE LC-DCP STAINLESS STEEL L33 MM X H1.2 MM C1713 $1,653.79PLATE BONE LC-DCP STAINLESS STEEL L37 MM X H2.6 MM C1713 $924.56PLATE BONE LC-DCP STAINLESS STEEL L38 MM X W11 MM C1713 $883.20PLATE BONE LC-DCP STAINLESS STEEL L39 MM X H1.2 MM C1713 $1,826.02PLATE BONE LC-DCP STAINLESS STEEL L45 MM X H1.2 MM C1713 $1,953.99PLATE BONE LC-DCP STAINLESS STEEL L46 MM 4 HOLE RE C1713 $2,295.36PLATE BONE LC-DCP STAINLESS STEEL L50 MM X H2.6 MM C1713 $956.80PLATE BONE LC-DCP STAINLESS STEEL L51 MM X H1.2 MM C1713 $2,096.77PLATE BONE LC-DCP STAINLESS STEEL L51 MM X W11 MM C1713 $906.16PLATE BONE LC-DCP STAINLESS STEEL L55 MM X H2.6 MM C1713 $1,002.80PLATE BONE LC-DCP STAINLESS STEEL L58 MM 5 HOLE RE C1713 $2,336.80PLATE BONE LC-DCP STAINLESS STEEL L60 MM X H1.2 MM C1713 $3,868.69PLATE BONE LC-DCP STAINLESS STEEL L64 MM X W11 MM C1713 $799.83PLATE BONE LC-DCP STAINLESS STEEL L68 MM X H2.6 MM C1713 $1,044.16PLATE BONE LC-DCP STAINLESS STEEL L70 MM 6 HOLE RE C1713 $2,681.76PLATE BONE LC-DCP STAINLESS STEEL L70 MM X H1.2 MM C1713 $3,947.44PLATE BONE LC-DCP STAINLESS STEEL L77 MM X H2.6 MM C1713 $1,094.80PLATE BONE LC-DCP STAINLESS STEEL L77 MM X W11 MM C1713 $1,021.20PLATE BONE LC-DCP STAINLESS STEEL L82 MM 7 HOLE RE C1713 $2,810.56PLATE BONE LC-DCP STAINLESS STEEL L86 MM X H2.6 MM C1713 $1,122.40PLATE BONE LC-DCP STAINLESS STEEL L90 MM X W11 MM C1713 $1,058.00PLATE BONE LC-DCP STAINLESS STEEL L94 MM 8 HOLE RE C1713 $2,930.16

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 ChargePLATE BONE LC-DCP STAINLESS STEEL L95 MM X H2.6 MM C1713 $1,182.16PLATE BONE LC-DCP STAINLESS STEEL NARROW L106 MM X C1713 $1,338.56PLATE BONE LC-DCP STAINLESS STEEL NARROW L124 MM X C1713 $1,338.56PLATE BONE LC-DCP STAINLESS STEEL NARROW L142 MM X C1713 $1,338.56PLATE BONE LC-DCP STAINLESS STEEL NARROW L160 MM X C1713 $1,338.56PLATE BONE LC-DCP STAINLESS STEEL NARROW L178 MM X C1713 $1,738.80PLATE BONE LC-DCP STAINLESS STEEL NARROW L196 MM X C1713 $1,738.80PLATE BONE LC-DCP STAINLESS STEEL NARROW L214 MM X C1713 $1,738.80PLATE BONE LC-DCP STAINLESS STEEL NARROW L250 MM X C1713 $1,738.80PLATE BONE LC-DCP STAINLESS STEEL NARROW L286 MM X C1713 $2,088.40PLATE BONE LC-DCP STAINLESS STEEL NARROW L34 MM X C1713 $1,186.80PLATE BONE LC-DCP STAINLESS STEEL NARROW L358 MM X C1713 $4,420.56PLATE BONE LC-DCP STAINLESS STEEL NARROW L52 MM X C1713 $1,228.16PLATE BONE LC-DCP STAINLESS STEEL NARROW L70 MM X C1713 $1,186.80PLATE BONE LC-DCP STAINLESS STEEL NARROW L88 MM X C1713 $1,186.80PLATE BONE LC-DCP STAINLESS STEEL OBLIQUE ANGLE T C1713 $1,688.16PLATE BONE LC-DCP STAINLESS STEEL OBLIQUE T L53 MM C1713 $1,536.40PLATE BONE LC-DCP STAINLESS STEEL OBLIQUE T L63 MM C1713 $1,770.96PLATE BONE LC-DCP STAINLESS STEEL OBLIQUE T L75 MM C1713 $1,812.40PLATE BONE LC-DCP STAINLESS STEEL RIGHT ANGLE T L1 C1713 $1,780.16PLATE BONE LC-DCP STAINLESS STEEL RIGHT ANGLE T L5 C1713 $896.96PLATE BONE LC-DCP STAINLESS STEEL RIGHT ANGLE T L6 C1713 $1,025.76PLATE BONE LC-DCP STAINLESS STEEL RIGHT ANGLE T L7 C1713 $1,191.36PLATE BONE LC-DCP STAINLESS STEEL RIGHT ANGLE T L9 C1713 $1,531.76PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L104 MM C1713 $2,898.00PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L109 MM C1713 $3,054.40PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L117 MM C1713 $2,971.60PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L125 MM C1713 $3,210.80PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L130 MM C1713 $2,985.36PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L141 MM C1713 $3,445.36PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L143 MM C1713 $3,150.96PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L156 MM C1713 $3,275.20PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L157 MM C1713 $3,610.96PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L169 MM C1713 $3,431.60PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L173 MM C1713 $3,739.76PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L182 MM C1713 $3,560.40PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L189 MM C1713 $3,910.00PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L195 MM C1713 $3,739.76PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L205 MM C1713 $4,162.96

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 ChargePLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L208 MM C1713 $3,905.36PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L221 MM C1713 $4,278.00PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L234 MM C1713 $4,070.96PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L260 MM C1713 $4,885.20PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L39 MM C1713 $2,194.16PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L45 MM C1713 $2,428.80PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L52 MM C1713 $2,295.36PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L61 MM C1713 $2,525.36PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L65 MM C1713 $2,396.56PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L77 MM C1713 $2,755.36PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L78 MM C1713 $2,649.60PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L91 MM C1713 $2,782.96PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L93 MM C1713 $2,920.96PLATE BONE LC-DCP STAINLESS STEEL T L100 MM 5 HOLE C1713 $2,334.72PLATE BONE LC-DCP STAINLESS STEEL T L116 MM 6 HOLE C1713 $2,447.20PLATE BONE LC-DCP STAINLESS STEEL T L148 MM 8 HOLE C1713 $3,312.00PLATE BONE LC-DCP STAINLESS STEEL T L68 MM 3 HOLE C1713 $1,659.84PLATE BONE LC-DCP STAINLESS STEEL T L84 MM 4 HOLE C1713 $2,046.96PLATE BONE LC-DCP STAINLESS STEEL Y L87 MM X H2 MM C1713 $3,947.44PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L109 MM X W C1713 $524.40PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L121 MM X W C1713 $524.40PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L145 MM X W C1713 $565.76PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L25 MM X W9 C1713 $402.48PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L37 MM X W9 C1713 $414.00PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L49 MM X W9 C1713 $487.60PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L61 MM X W9 C1713 $487.60PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L73 MM X W9 C1713 $506.00PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L85 MM X W9 C1713 $506.00PLATE BONE LC-DCP TITANIUM 1/3 TUBULAR L97 MM X W9 C1713 $524.40PLATE BONE LC-DCP TITANIUM BROAD L106 MM X W17.5 M C1713 $1,867.60PLATE BONE LC-DCP TITANIUM BROAD L124 MM X W17.5 M C1713 $2,024.00PLATE BONE LC-DCP TITANIUM BROAD L142 MM X W17.5 M C1713 $2,249.36PLATE BONE LC-DCP TITANIUM BROAD L160 MM X W17.5 M C1713 $2,249.36PLATE BONE LC-DCP TITANIUM BROAD L178 MM X W17.5 M C1713 $2,249.36PLATE BONE LC-DCP TITANIUM BROAD L196 MM X W17.5 M C1713 $2,355.20PLATE BONE LC-DCP TITANIUM BROAD L214 MM X W17.5 M C1713 $2,355.20PLATE BONE LC-DCP TITANIUM BROAD L250 MM X W17.5 M C1713 $2,419.60PLATE BONE LC-DCP TITANIUM BROAD L286 MM X W17.5 M C1713 $2,663.36PLATE BONE LC-DCP TITANIUM BROAD L322 MM X W17.5 M C1713 $2,925.60

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 ChargePLATE BONE LC-DCP TITANIUM BROAD L358 MM X W17.5 M C1713 $4,291.76PLATE BONE LC-DCP TITANIUM BROAD L394 MM X W17.5 M C1713 $4,622.96PLATE BONE LC-DCP TITANIUM BROAD L430 MM X W17.5 M C1713 $4,949.60PLATE BONE LC-DCP TITANIUM CLOVERLEAF L104 MM X W1 C1713 $2,336.80PLATE BONE LC-DCP TITANIUM CLOVERLEAF L120 MM X W1 C1713 $2,934.80PLATE BONE LC-DCP TITANIUM CLOVERLEAF L136 MM X W1 C1713 $3,187.76PLATE BONE LC-DCP TITANIUM CLOVERLEAF L152 MM X W1 C1713 $3,431.60PLATE BONE LC-DCP TITANIUM CLOVERLEAF L168 MM X W1 C1713 $3,643.20PLATE BONE LC-DCP TITANIUM CLOVERLEAF L200 MM X W1 C1713 $3,937.60PLATE BONE LC-DCP TITANIUM CLOVERLEAF L88 MM X W15 C1713 $2,184.96PLATE BONE LC-DCP TITANIUM CRESCENT L35 MM X W6.5 C1713 $4,515.20PLATE BONE LC-DCP TITANIUM CRESCENT L38 MM X W6.5 C1713 $4,056.00PLATE BONE LC-DCP TITANIUM CRESCENT L50 MM X W6.5 C1713 $4,909.60PLATE BONE LC-DCP TITANIUM D15 MM L58 MM X W10 MM C1713 $5,009.36PLATE BONE LC-DCP TITANIUM D15 MM L77 MM X W10 MM C1713 $5,372.80PLATE BONE LC-DCP TITANIUM D18 MM L58 MM X W10 MM C1713 $5,009.36PLATE BONE LC-DCP TITANIUM D18 MM L77 MM X W10 MM C1713 $5,372.80PLATE BONE LC-DCP TITANIUM L106 MM 9 HOLE RECONSTR C1713 $3,445.36PLATE BONE LC-DCP TITANIUM L118 MM 10 HOLE RECONST C1713 $3,500.56PLATE BONE LC-DCP TITANIUM L130 MM 11 HOLE RECONST C1713 $3,578.80PLATE BONE LC-DCP TITANIUM L130 MM X H4.5 MM TIBIA C1713 $5,336.00PLATE BONE LC-DCP TITANIUM L142 MM X W11 MM X H3.3 C1713 $1,283.36PLATE BONE LC-DCP TITANIUM L155 MM X W11 MM X H3.3 C1713 $1,366.16PLATE BONE LC-DCP TITANIUM L166 MM X H4.5 MM TIBIA C1713 $5,713.20PLATE BONE LC-DCP TITANIUM L177 MM X W17.5 MM X H6 C1713 $6,476.80PLATE BONE LC-DCP TITANIUM L181 MM X W11 MM X H3.3 C1713 $2,530.00PLATE BONE LC-DCP TITANIUM L195 MM X W11 MM X H3.3 C1713 $2,654.16PLATE BONE LC-DCP TITANIUM L202 MM X H4.5 MM TIBIA C1713 $6,136.40PLATE BONE LC-DCP TITANIUM L208 MM X W11 MM X H3.3 C1713 $2,907.20PLATE BONE LC-DCP TITANIUM L213 MM X W17.5 MM X H6 C1713 $6,665.36PLATE BONE LC-DCP TITANIUM L233 MM X W11 MM X H3.3 C1713 $3,252.16PLATE BONE LC-DCP TITANIUM L238 MM X H4.5 MM TIBIA C1713 $6,527.36PLATE BONE LC-DCP TITANIUM L249 MM X W17.5 MM X H6 C1713 $6,826.40PLATE BONE LC-DCP TITANIUM L25 MM X W11 MM X H3.3 C1713 $860.16PLATE BONE LC-DCP TITANIUM L259 MM X W11 MM X H3.3 C1713 $3,601.76PLATE BONE LC-DCP TITANIUM L274 MM X H4.5 MM TIBIA C1713 $6,794.16PLATE BONE LC-DCP TITANIUM L285 MM X W17.5 MM X H6 C1713 $7,051.76PLATE BONE LC-DCP TITANIUM L321 MM X W17.5 MM X H6 C1713 $7,332.40PLATE BONE LC-DCP TITANIUM L35 MM X W6.5 MM X H1.6 C1713 $4,100.40

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 ChargePLATE BONE LC-DCP TITANIUM L38 MM X W11 MM X H3.3 C1713 $883.20PLATE BONE LC-DCP TITANIUM L39 MM X W6.5 MM X H1.6 C1713 $4,515.20PLATE BONE LC-DCP TITANIUM L51 MM X W11 MM X H3.3 C1713 $906.16PLATE BONE LC-DCP TITANIUM L51 MM X W6.5 MM X H1.6 C1713 $4,554.00PLATE BONE LC-DCP TITANIUM L58 MM 5 HOLE RECONSTRU C1713 $2,663.36PLATE BONE LC-DCP TITANIUM L60 MM X H1.2 MM CALCAN C1713 $3,790.40PLATE BONE LC-DCP TITANIUM L64 MM X W11 MM X H3.3 C1713 $952.16PLATE BONE LC-DCP TITANIUM L70 MM 6 HOLE RECONSTRU C1713 $3,072.80PLATE BONE LC-DCP TITANIUM L70 MM X H1.2 MM CALCAN C1713 $3,882.40PLATE BONE LC-DCP TITANIUM L82 MM 7 HOLE RECONSTRU C1713 $3,155.60PLATE BONE LC-DCP TITANIUM L94 MM 8 HOLE RECONSTRU C1713 $3,344.16PLATE BONE LC-DCP TITANIUM NARROW L103 MM X W11 MM C1713 $1,113.20PLATE BONE LC-DCP TITANIUM NARROW L106 MM X W13.5 C1713 $1,380.00PLATE BONE LC-DCP TITANIUM NARROW L116 MM X W11 MM C1713 $1,200.56PLATE BONE LC-DCP TITANIUM NARROW L124 MM X W11 MM C1713 $2,405.76PLATE BONE LC-DCP TITANIUM NARROW L124 MM X W13.5 C1713 $1,380.00PLATE BONE LC-DCP TITANIUM NARROW L129 MM X W11 MM C1713 $1,214.40PLATE BONE LC-DCP TITANIUM NARROW L142 MM X W13.5 C1713 $1,380.00PLATE BONE LC-DCP TITANIUM NARROW L160 MM X W13.5 C1713 $1,343.20PLATE BONE LC-DCP TITANIUM NARROW L178 MM X W13.5 C1713 $1,738.80PLATE BONE LC-DCP TITANIUM NARROW L196 MM X W13.5 C1713 $1,794.00PLATE BONE LC-DCP TITANIUM NARROW L214 MM X W13.5 C1713 $1,738.80PLATE BONE LC-DCP TITANIUM NARROW L232 MM X W13.5 C1713 $2,083.76PLATE BONE LC-DCP TITANIUM NARROW L250 MM X W13.5 C1713 $2,024.00PLATE BONE LC-DCP TITANIUM NARROW L268 MM X W13.5 C1713 $2,083.76PLATE BONE LC-DCP TITANIUM NARROW L286 MM X W13.5 C1713 $2,083.76PLATE BONE LC-DCP TITANIUM NARROW L305 MM X W13.5 C1713 $3,058.96PLATE BONE LC-DCP TITANIUM NARROW L323 MM X W13.5 C1713 $3,058.96PLATE BONE LC-DCP TITANIUM NARROW L34 MM X W13.5 M C1713 $1,232.80PLATE BONE LC-DCP TITANIUM NARROW L358 MM X W13.5 C1713 $4,291.76PLATE BONE LC-DCP TITANIUM NARROW L394 MM X W13.5 C1713 $4,622.96PLATE BONE LC-DCP TITANIUM NARROW L52 MM X W13.5 M C1713 $1,232.80PLATE BONE LC-DCP TITANIUM NARROW L70 MM X W13.5 M C1713 $1,232.80PLATE BONE LC-DCP TITANIUM NARROW L77 MM X W11 MM C1713 $1,021.20PLATE BONE LC-DCP TITANIUM NARROW L88 MM X W13.5 M C1713 $1,232.80PLATE BONE LC-DCP TITANIUM NARROW L90 MM X W11 MM C1713 $1,058.00PLATE BONE LC-DCP TITANIUM RIGHT ANGLE T L50 MM X C1713 $892.40PLATE BONE LC-DCP TITANIUM RIGHT ANGLE T L56 MM X C1713 $924.56PLATE BONE LC-DCP TITANIUM RIGHT ANGLE T L67 MM X C1713 $1,021.20

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 ChargePLATE BONE LC-DCP TITANIUM RIGHT ANGLE T L75 MM X C1713 $1,191.36PLATE BONE LC-DCP TITANIUM SEMITUBULAR L103 MM X W C1713 $625.60PLATE BONE LC-DCP TITANIUM SEMITUBULAR L119 MM X W C1713 $648.56PLATE BONE LC-DCP TITANIUM SEMITUBULAR L135 MM X W C1713 $708.40PLATE BONE LC-DCP TITANIUM SEMITUBULAR L151 MM X W C1713 $791.20PLATE BONE LC-DCP TITANIUM SEMITUBULAR L167 MM X W C1713 $795.76PLATE BONE LC-DCP TITANIUM SEMITUBULAR L183 MM X W C1713 $850.96PLATE BONE LC-DCP TITANIUM SEMITUBULAR L199 MM X W C1713 $878.56PLATE BONE LC-DCP TITANIUM SEMITUBULAR L39 MM X W1 C1713 $482.96PLATE BONE LC-DCP TITANIUM SEMITUBULAR L55 MM X W1 C1713 $515.20PLATE BONE LC-DCP TITANIUM SEMITUBULAR L71 MM X W1 C1713 $556.56PLATE BONE LC-DCP TITANIUM SEMITUBULAR L87 MM X W1 C1713 $588.80PLATE BONE LC-DCP TITANIUM T L100 MM 5 HOLE SHAFT C1713 $2,208.00PLATE BONE LC-DCP TITANIUM T L112 MM BUTTRESS 6 HO C1713 $3,491.36PLATE BONE LC-DCP TITANIUM T L116 MM 6 HOLE SHAFT C1713 $2,511.60PLATE BONE LC-DCP TITANIUM T L148 MM 8 HOLE SHAFT C1713 $3,312.00PLATE BONE LC-DCP TITANIUM T L68 MM 3 HOLE SHAFT N C1713 $1,936.56PLATE BONE LC-DCP TITANIUM T L80 MM BUTTRESS 4 HOL C1713 $3,210.80PLATE BONE LC-DCP TITANIUM T L84 MM 4 HOLE SHAFT N C1713 $2,106.80PLATE BONE LC-DCP TITANIUM T L96 MM BUTTRESS 5 HOL C1713 $8,760.00PLATE BONE LC-DCP TITANIUM T OBLIQUE ANGLE L53 MM C1713 $1,527.20PLATE BONE LC-DCP TITANIUM T OBLIQUE ANGLE L63 MM C1713 $1,619.20PLATE BONE LC-DCP TITANIUM T OBLIQUE L75 MM X W10 C1713 $1,665.20PLATE BONE LC-DCP TITANIUM Y L87 MM X H2 MM CALCAN C1713 $3,882.40PLATE BONE LCP COMBI PHILOS LONG STAINLESS STEEL L C1713 $10,082.88PLATE BONE LCP COMBI PHILOS LONG TITANIUM L142 MM C1713 $10,424.16PLATE BONE LCP COMBI PHILOS LONG TITANIUM L160 MM C1713 $10,838.88PLATE BONE LCP COMBI PHILOS LONG TITANIUM L196 MM C1713 $11,253.60PLATE BONE LCP COMBI PHILOS LONG TITANIUM L232 MM C1713 $11,672.64PLATE BONE LCP COMBI PHILOS LONG TITANIUM L268 MM C1713 $12,078.72PLATE BONE LCP COMBI PHILOS STAINLESS STEEL STANDA C1713 $7,865.91PLATE BONE LCP COMBI PHILOS TITANIUM STANDARD L114 C1713 $10,329.12PLATE BONE LCP COMBI PHILOS TITANIUM STANDARD L90 C1713 $10,013.76PLATE BONE LCP COMBI STAINLESS STEEL +20 D L L43 M C1713 $2,793.47PLATE BONE LCP COMBI STAINLESS STEEL +20 D L L52 M C1713 $2,927.69PLATE BONE LCP COMBI STAINLESS STEEL +90 D L L40 M C1713 $2,793.47PLATE BONE LCP COMBI STAINLESS STEEL +90 D L L49 M C1713 $2,927.69PLATE BONE LCP COMBI STAINLESS STEEL 1/3 TUBULAR L C1713 $833.43PLATE BONE LCP COMBI STAINLESS STEEL -20 D L L43 M C1713 $2,793.47

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL -20 D L L52 M C1713 $2,927.69PLATE BONE LCP COMBI STAINLESS STEEL 5 D L28 MM RA C1713 $4,135.36PLATE BONE LCP COMBI STAINLESS STEEL 5 D L34 MM RA C1713 $4,135.36PLATE BONE LCP COMBI STAINLESS STEEL 5 D L40 MM RA C1713 $4,254.96PLATE BONE LCP COMBI STAINLESS STEEL 5 D L46 MM RA C1713 $4,254.96PLATE BONE LCP COMBI STAINLESS STEEL 5 D L50 MM RA C1713 $4,333.20PLATE BONE LCP COMBI STAINLESS STEEL 5 D L56 MM RA C1713 $4,328.56PLATE BONE LCP COMBI STAINLESS STEEL -90 D L L40 M C1713 $2,793.47PLATE BONE LCP COMBI STAINLESS STEEL -90 D L L49 M C1713 $2,927.69PLATE BONE LCP COMBI STAINLESS STEEL BROAD CURVE L C1713 $4,834.56PLATE BONE LCP COMBI STAINLESS STEEL BROAD L116 MM C1713 $2,833.60PLATE BONE LCP COMBI STAINLESS STEEL BROAD L134 MM C1713 $3,008.40PLATE BONE LCP COMBI STAINLESS STEEL BROAD L152 MM C1713 $3,680.00PLATE BONE LCP COMBI STAINLESS STEEL BROAD L170 MM C1713 $3,978.96PLATE BONE LCP COMBI STAINLESS STEEL BROAD L188 MM C1713 $3,475.88PLATE BONE LCP COMBI STAINLESS STEEL BROAD L206 MM C1713 $3,700.13PLATE BONE LCP COMBI STAINLESS STEEL BROAD L224 MM C1713 $3,928.08PLATE BONE LCP COMBI STAINLESS STEEL BROAD L260 MM C1713 $4,372.88PLATE BONE LCP COMBI STAINLESS STEEL BROAD L296 MM C1713 $5,310.96PLATE BONE LCP COMBI STAINLESS STEEL BROAD L332 MM C1713 $7,958.00PLATE BONE LCP COMBI STAINLESS STEEL BROAD L368 MM C1713 $8,786.00PLATE BONE LCP COMBI STAINLESS STEEL BROAD L404 MM C1713 $9,627.76PLATE BONE LCP COMBI STAINLESS STEEL CONDYLAR 6 HO C1713 $3,019.90PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L106 C1713 $9,614.00PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L107 C1713 $9,728.96PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L109 C1713 $8,771.88PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L112 C1713 $4,333.20PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L116 C1713 $9,871.60PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L118 C1713 $7,912.26PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L119 C1713 $9,710.56PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L125 C1713 $3,569.28PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L133 C1713 $9,839.36PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L138 C1713 $6,389.36PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L142 C1713 $9,982.00PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L145 C1713 $9,825.60PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L151 C1713 $4,609.20PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L154 C1713 $8,005.73PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L159 C1713 $9,945.20PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L163 C1713 $9,093.31

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L164 C1713 $6,587.20PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L168 C1713 $10,078.56PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L171 C1713 $9,936.00PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L177 C1713 $4,678.16PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L178 C1713 $9,844.00PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L185 C1713 $10,078.56PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L189 C1713 $6,775.76PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L190 C1713 $8,087.95PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L194 C1713 $10,184.40PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L197 C1713 $10,041.76PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L199 C1713 $9,717.50PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L203 C1713 $4,238.33PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L206 C1713 $8,831.68PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L211 C1713 $10,184.40PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L214 C1713 $9,949.76PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L215 C1713 $6,890.80PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L220 C1713 $10,294.80PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L223 C1713 $10,166.00PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L226 C1713 $8,185.13PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L229 C1713 $4,298.13PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L237 C1713 $10,897.36PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L246 C1713 $10,432.80PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L249 C1713 $10,874.40PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L250 C1713 $10,418.96PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L262 C1713 $8,271.06PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L275 C1713 $11,265.36PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L286 C1713 $10,529.36PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L298 C1713 $10,911.20PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L299 C1713 $4,298.13PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L301 C1713 $11,633.36PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L322 C1713 $10,635.20PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L334 C1713 $11,118.16PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L370 C1713 $11,334.40PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L73 M C1713 $4,140.00PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L76 M C1713 $8,084.18PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L81 M C1713 $9,609.36PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L82 M C1713 $9,618.56PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L86 M C1713 $4,208.96PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L91 M C1713 $8,652.28

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L93 M C1713 $9,581.76PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L99 M C1713 $3,468.40PLATE BONE LCP COMBI STAINLESS STEEL CURVE L159 MM C1713 $9,414.93PLATE BONE LCP COMBI STAINLESS STEEL CURVE L195 MM C1713 $9,599.01PLATE BONE LCP COMBI STAINLESS STEEL CURVE L230 MM C1713 $10,047.70PLATE BONE LCP COMBI STAINLESS STEEL CURVE L242 MM C1713 $11,108.96PLATE BONE LCP COMBI STAINLESS STEEL CURVE L266 MM C1713 $10,254.79PLATE BONE LCP COMBI STAINLESS STEEL CURVE L278 MM C1713 $11,348.16PLATE BONE LCP COMBI STAINLESS STEEL CURVE L301 MM C1713 $10,945.09PLATE BONE LCP COMBI STAINLESS STEEL CURVE L314 MM C1713 $11,582.80PLATE BONE LCP COMBI STAINLESS STEEL CURVE L336 MM C1713 $11,159.85PLATE BONE LCP COMBI STAINLESS STEEL CURVE L350 MM C1713 $9,590.43PLATE BONE LCP COMBI STAINLESS STEEL CURVE L370 MM C1713 $11,884.67PLATE BONE LCP COMBI STAINLESS STEEL CURVE L386 MM C1713 $10,124.86PLATE BONE LCP COMBI STAINLESS STEEL CURVE L405 MM C1713 $14,622.86PLATE BONE LCP COMBI STAINLESS STEEL CURVE L422 MM C1713 $12,976.56PLATE BONE LCP COMBI STAINLESS STEEL CURVE L439 MM C1713 $15,692.82PLATE BONE LCP COMBI STAINLESS STEEL CURVE L458 MM C1713 $13,183.60PLATE BONE LCP COMBI STAINLESS STEEL D12 MM L70 MM C1713 $5,317.60PLATE BONE LCP COMBI STAINLESS STEEL D12 MM L85 MM C1713 $5,561.36PLATE BONE LCP COMBI STAINLESS STEEL D15 MM L112 M C1713 $5,961.60PLATE BONE LCP COMBI STAINLESS STEEL D15 MM L70 MM C1713 $5,317.60PLATE BONE LCP COMBI STAINLESS STEEL D15 MM L85 MM C1713 $5,561.36PLATE BONE LCP COMBI STAINLESS STEEL D15 MM L99 MM C1713 $5,717.76PLATE BONE LCP COMBI STAINLESS STEEL D18 MM L112 M C1713 $5,961.60PLATE BONE LCP COMBI STAINLESS STEEL D18 MM L70 MM C1713 $5,317.60PLATE BONE LCP COMBI STAINLESS STEEL D18 MM L85 MM C1713 $5,561.36PLATE BONE LCP COMBI STAINLESS STEEL D18 MM L99 MM C1713 $5,717.76PLATE BONE LCP COMBI STAINLESS STEEL L100 MM ANKLE C1713 $6,949.44PLATE BONE LCP COMBI STAINLESS STEEL L105 MM FIBUL C1713 $5,276.96PLATE BONE LCP COMBI STAINLESS STEEL L106 MM TIBIA C1713 $8,196.31PLATE BONE LCP COMBI STAINLESS STEEL L108 MM CLAVI C1713 $6,122.56PLATE BONE LCP COMBI STAINLESS STEEL L109 MM TIBIA C1713 $7,893.60PLATE BONE LCP COMBI STAINLESS STEEL L110 MM CLAVI C1713 $6,283.60PLATE BONE LCP COMBI STAINLESS STEEL L110 MM X W11 C1713 $7,626.80PLATE BONE LCP COMBI STAINLESS STEEL L111 MM X W11 C1713 $2,309.20PLATE BONE LCP COMBI STAINLESS STEEL L112 MM TIBIA C1713 $9,618.18PLATE BONE LCP COMBI STAINLESS STEEL L112 MM X W10 C1713 $3,698.40PLATE BONE LCP COMBI STAINLESS STEEL L112 MM X W11 C1713 $6,242.16

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL L116 MM ANKLE C1713 $7,136.40PLATE BONE LCP COMBI STAINLESS STEEL L116 MM OLECR C1713 $6,136.00PLATE BONE LCP COMBI STAINLESS STEEL L116 MM X W11 C1713 $7,626.80PLATE BONE LCP COMBI STAINLESS STEEL L118 MM FIBUL C1713 $5,530.07PLATE BONE LCP COMBI STAINLESS STEEL L120 MM CLAVI C1713 $6,444.56PLATE BONE LCP COMBI STAINLESS STEEL L122 MM EXTRA C1713 $6,720.03PLATE BONE LCP COMBI STAINLESS STEEL L123 MM CLAVI C1713 $6,283.60PLATE BONE LCP COMBI STAINLESS STEEL L124 MM X W11 C1713 $1,954.68PLATE BONE LCP COMBI STAINLESS STEEL L125 MM X W11 C1713 $6,348.00PLATE BONE LCP COMBI STAINLESS STEEL L126 MM X W10 C1713 $3,900.80PLATE BONE LCP COMBI STAINLESS STEEL L132 MM TIBIA C1713 $10,188.96PLATE BONE LCP COMBI STAINLESS STEEL L135 MM CLAVI C1713 $6,444.56PLATE BONE LCP COMBI STAINLESS STEEL L135 MM TIBIA C1713 $7,702.96PLATE BONE LCP COMBI STAINLESS STEEL L136 MM X W11 C1713 $8,234.00PLATE BONE LCP COMBI STAINLESS STEEL L137 MM X W11 C1713 $2,479.36PLATE BONE LCP COMBI STAINLESS STEEL L138 MM X W11 C1713 $6,453.76PLATE BONE LCP COMBI STAINLESS STEEL L139 MM FEMUR C1713 $7,665.58PLATE BONE LCP COMBI STAINLESS STEEL L140 MM X W10 C1713 $3,836.40PLATE BONE LCP COMBI STAINLESS STEEL L142 MM OLECR C1713 $5,852.21PLATE BONE LCP COMBI STAINLESS STEEL L142 MM TIBIA C1713 $9,714.06PLATE BONE LCP COMBI STAINLESS STEEL L142 MM X W11 C1713 $8,234.00PLATE BONE LCP COMBI STAINLESS STEEL L143 MM X W11 C1713 $8,574.40PLATE BONE LCP COMBI STAINLESS STEEL L147 MM TIBIA C1713 $11,803.60PLATE BONE LCP COMBI STAINLESS STEEL L150 MM X W11 C1713 $2,585.20PLATE BONE LCP COMBI STAINLESS STEEL L151 MM X W11 C1713 $6,559.60PLATE BONE LCP COMBI STAINLESS STEEL L154 MM X W10 C1713 $4,153.76PLATE BONE LCP COMBI STAINLESS STEEL L158 MM EXTRA C1713 $7,688.01PLATE BONE LCP COMBI STAINLESS STEEL L158 MM TIBIA C1713 $10,285.60PLATE BONE LCP COMBI STAINLESS STEEL L160 MM HUMER C1713 $6,715.09PLATE BONE LCP COMBI STAINLESS STEEL L161 MM TIBIA C1713 $7,777.71PLATE BONE LCP COMBI STAINLESS STEEL L163 MM HUMER C1713 $6,918.34PLATE BONE LCP COMBI STAINLESS STEEL L163 MM X W11 C1713 $2,732.40PLATE BONE LCP COMBI STAINLESS STEEL L164 MM X W11 C1713 $8,468.56PLATE BONE LCP COMBI STAINLESS STEEL L168 MM X W10 C1713 $4,250.40PLATE BONE LCP COMBI STAINLESS STEEL L169 MM OLECR C1713 $6,136.00PLATE BONE LCP COMBI STAINLESS STEEL L170 MM X W17 C1713 $8,465.41PLATE BONE LCP COMBI STAINLESS STEEL L173 MM HUMER C1713 $6,715.09PLATE BONE LCP COMBI STAINLESS STEEL L173 MM TIBIA C1713 $12,429.20PLATE BONE LCP COMBI STAINLESS STEEL L175 MM FEMUR C1713 $7,815.08

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL L176 MM X W11 C1713 $3,146.40PLATE BONE LCP COMBI STAINLESS STEEL L182 MM X W10 C1713 $4,600.00PLATE BONE LCP COMBI STAINLESS STEEL L184 MM TIBIA C1713 $10,400.56PLATE BONE LCP COMBI STAINLESS STEEL L186 MM HUMER C1713 $6,715.09PLATE BONE LCP COMBI STAINLESS STEEL L187 MM TIBIA C1713 $7,859.93PLATE BONE LCP COMBI STAINLESS STEEL L189 MM HUMER C1713 $6,918.34PLATE BONE LCP COMBI STAINLESS STEEL L189 MM X W11 C1713 $4,098.56PLATE BONE LCP COMBI STAINLESS STEEL L190 MM X W11 C1713 $8,740.00PLATE BONE LCP COMBI STAINLESS STEEL L194 MM EXTRA C1713 $8,158.93PLATE BONE LCP COMBI STAINLESS STEEL L196 MM X W10 C1713 $4,774.80PLATE BONE LCP COMBI STAINLESS STEEL L199 MM HUMER C1713 $6,707.42PLATE BONE LCP COMBI STAINLESS STEEL L201 MM X W11 C1713 $8,473.20PLATE BONE LCP COMBI STAINLESS STEEL L202 MM X W11 C1713 $4,383.76PLATE BONE LCP COMBI STAINLESS STEEL L206 MM X W17 C1713 $8,618.68PLATE BONE LCP COMBI STAINLESS STEEL L208 MM X W11 C1713 $8,473.20PLATE BONE LCP COMBI STAINLESS STEEL L210 MM TIBIA C1713 $10,538.56PLATE BONE LCP COMBI STAINLESS STEEL L211 MM FEMUR C1713 $7,972.06PLATE BONE LCP COMBI STAINLESS STEEL L213 MM TIBIA C1713 $7,945.93PLATE BONE LCP COMBI STAINLESS STEEL L215 MM X W11 C1713 $4,590.80PLATE BONE LCP COMBI STAINLESS STEEL L216 MM X W11 C1713 $8,924.00PLATE BONE LCP COMBI STAINLESS STEEL L224 MM X W10 C1713 $5,174.96PLATE BONE LCP COMBI STAINLESS STEEL L230 MM EXTRA C1713 $8,637.33PLATE BONE LCP COMBI STAINLESS STEEL L236 MM TIBIA C1713 $10,998.56PLATE BONE LCP COMBI STAINLESS STEEL L239 MM TIBIA C1713 $8,323.38PLATE BONE LCP COMBI STAINLESS STEEL L241 MM X W11 C1713 $5,147.36PLATE BONE LCP COMBI STAINLESS STEEL L242 MM X W11 C1713 $8,740.00PLATE BONE LCP COMBI STAINLESS STEEL L242 MM X W17 C1713 $8,943.81PLATE BONE LCP COMBI STAINLESS STEEL L247 MM FEMUR C1713 $8,360.76PLATE BONE LCP COMBI STAINLESS STEEL L252 MM X W10 C1713 $5,423.36PLATE BONE LCP COMBI STAINLESS STEEL L262 MM TIBIA C1713 $11,081.36PLATE BONE LCP COMBI STAINLESS STEEL L266 MM EXTRA C1713 $9,867.00PLATE BONE LCP COMBI STAINLESS STEEL L267 MM X W11 C1713 $5,713.20PLATE BONE LCP COMBI STAINLESS STEEL L278 MM X W17 C1713 $11,228.56PLATE BONE LCP COMBI STAINLESS STEEL L280 MM X W10 C1713 $6,578.00PLATE BONE LCP COMBI STAINLESS STEEL L283 MM FEMUR C1713 $9,235.33PLATE BONE LCP COMBI STAINLESS STEEL L288 MM TIBIA C1713 $11,191.76PLATE BONE LCP COMBI STAINLESS STEEL L293 MM X W11 C1713 $5,717.76PLATE BONE LCP COMBI STAINLESS STEEL L302 MM EXTRA C1713 $10,864.88PLATE BONE LCP COMBI STAINLESS STEEL L308 MM X W10 C1713 $6,835.60

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL L314 MM X W17 C1713 $11,840.40PLATE BONE LCP COMBI STAINLESS STEEL L319 MM FEMUR C1713 $9,489.48PLATE BONE LCP COMBI STAINLESS STEEL L33 MM X W11 C1713 $1,775.60PLATE BONE LCP COMBI STAINLESS STEEL L350 MM X W17 C1713 $12,074.96PLATE BONE LCP COMBI STAINLESS STEEL L355 MM FEMUR C1713 $10,248.23PLATE BONE LCP COMBI STAINLESS STEEL L386 MM X W17 C1713 $12,318.80PLATE BONE LCP COMBI STAINLESS STEEL L391 MM FEMUR C1713 $10,554.70PLATE BONE LCP COMBI STAINLESS STEEL L43 MM X W7.5 C1713 $5,054.25PLATE BONE LCP COMBI STAINLESS STEEL L46 MM X W11 C1713 $1,844.56PLATE BONE LCP COMBI STAINLESS STEEL L48 MM RADIUS C1713 $6,938.40PLATE BONE LCP COMBI STAINLESS STEEL L50.5 MM RADI C1713 $4,829.44PLATE BONE LCP COMBI STAINLESS STEEL L56 MM X W10. C1713 $2,990.00PLATE BONE LCP COMBI STAINLESS STEEL L58 MM X W11 C1713 $6,246.80PLATE BONE LCP COMBI STAINLESS STEEL L59 MM X W11 C1713 $1,927.36PLATE BONE LCP COMBI STAINLESS STEEL L59.5 MM RADI C1713 $4,982.32PLATE BONE LCP COMBI STAINLESS STEEL L61 MM X W7.5 C1713 $5,352.05PLATE BONE LCP COMBI STAINLESS STEEL L62 MM 3 HOLE C1713 $3,680.00PLATE BONE LCP COMBI STAINLESS STEEL L62 MM ULNA 6 C1713 $6,637.80PLATE BONE LCP COMBI STAINLESS STEEL L65 MM X W11 C1713 $6,246.80PLATE BONE LCP COMBI STAINLESS STEEL L66 MM RADIUS C1713 $7,467.04PLATE BONE LCP COMBI STAINLESS STEEL L68.5 MM RADI C1713 $5,127.36PLATE BONE LCP COMBI STAINLESS STEEL L69 MM CLAVIC C1713 $5,860.40PLATE BONE LCP COMBI STAINLESS STEEL L70 MM X W10. C1713 $2,925.60PLATE BONE LCP COMBI STAINLESS STEEL L72 MM X W11 C1713 $2,116.00PLATE BONE LCP COMBI STAINLESS STEEL L73 MM OLECRA C1713 $5,204.10PLATE BONE LCP COMBI STAINLESS STEEL L76 MM ULNA 8 C1713 $6,637.80PLATE BONE LCP COMBI STAINLESS STEEL L79 MM FIBULA C1713 $4,832.10PLATE BONE LCP COMBI STAINLESS STEEL L80 MM TIBIAL C1713 $10,308.56PLATE BONE LCP COMBI STAINLESS STEEL L81 MM CLAVIC C1713 $5,952.40PLATE BONE LCP COMBI STAINLESS STEEL L83 MM X W11 C1713 $6,936.80PLATE BONE LCP COMBI STAINLESS STEEL L84 MM X W10. C1713 $3,380.96PLATE BONE LCP COMBI STAINLESS STEEL L85 MM X W11 C1713 $1,719.25PLATE BONE LCP COMBI STAINLESS STEEL L86 MM X W11 C1713 $6,035.20PLATE BONE LCP COMBI STAINLESS STEEL L90 MM OLECRA C1713 $5,852.21PLATE BONE LCP COMBI STAINLESS STEEL L90 MM X W11 C1713 $6,936.80PLATE BONE LCP COMBI STAINLESS STEEL L92 MM FIBULA C1713 $5,039.19PLATE BONE LCP COMBI STAINLESS STEEL L94 MM CLAVIC C1713 $6,053.60PLATE BONE LCP COMBI STAINLESS STEEL L98 MM X W10. C1713 $3,546.56PLATE BONE LCP COMBI STAINLESS STEEL L98 MM X W11 C1713 $1,786.53

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL L99 MM X W11 C1713 $6,154.80PLATE BONE LCP COMBI STAINLESS STEEL LARGE BEND L1 C1713 $9,936.49PLATE BONE LCP COMBI STAINLESS STEEL LARGE BEND L2 C1713 $11,497.33PLATE BONE LCP COMBI STAINLESS STEEL LARGE BEND L8 C1713 $8,640.26PLATE BONE LCP COMBI STAINLESS STEEL LONG L108 MM C1713 $6,431.30PLATE BONE LCP COMBI STAINLESS STEEL LONG L111 MM C1713 $6,918.34PLATE BONE LCP COMBI STAINLESS STEEL LONG L121 MM C1713 $6,715.09PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L82 MM C1713 $6,715.09PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L85 MM C1713 $6,918.34PLATE BONE LCP COMBI STAINLESS STEEL NARROW L116 M C1713 $2,654.16PLATE BONE LCP COMBI STAINLESS STEEL NARROW L118 M C1713 $6,242.16PLATE BONE LCP COMBI STAINLESS STEEL NARROW L134 M C1713 $3,072.80PLATE BONE LCP COMBI STAINLESS STEEL NARROW L136 M C1713 $6,348.00PLATE BONE LCP COMBI STAINLESS STEEL NARROW L152 M C1713 $2,642.38PLATE BONE LCP COMBI STAINLESS STEEL NARROW L154 M C1713 $6,453.76PLATE BONE LCP COMBI STAINLESS STEEL NARROW L170 M C1713 $3,404.00PLATE BONE LCP COMBI STAINLESS STEEL NARROW L172 M C1713 $6,559.60PLATE BONE LCP COMBI STAINLESS STEEL NARROW L188 M C1713 $3,001.18PLATE BONE LCP COMBI STAINLESS STEEL NARROW L190 M C1713 $8,468.56PLATE BONE LCP COMBI STAINLESS STEEL NARROW L206 M C1713 $3,232.91PLATE BONE LCP COMBI STAINLESS STEEL NARROW L208 M C1713 $8,551.36PLATE BONE LCP COMBI STAINLESS STEEL NARROW L224 M C1713 $3,475.88PLATE BONE LCP COMBI STAINLESS STEEL NARROW L226 M C1713 $8,740.00PLATE BONE LCP COMBI STAINLESS STEEL NARROW L260 M C1713 $4,797.76PLATE BONE LCP COMBI STAINLESS STEEL NARROW L262 M C1713 $9,176.96PLATE BONE LCP COMBI STAINLESS STEEL NARROW L296 M C1713 $5,607.36PLATE BONE LCP COMBI STAINLESS STEEL NARROW L298 M C1713 $9,347.20PLATE BONE LCP COMBI STAINLESS STEEL NARROW L332 M C1713 $6,808.00PLATE BONE LCP COMBI STAINLESS STEEL NARROW L334 M C1713 $9,770.40PLATE BONE LCP COMBI STAINLESS STEEL NARROW L368 M C1713 $8,657.20PLATE BONE LCP COMBI STAINLESS STEEL NARROW L404 M C1713 $9,448.40PLATE BONE LCP COMBI STAINLESS STEEL NARROW L44 MM C1713 $2,198.80PLATE BONE LCP COMBI STAINLESS STEEL NARROW L51 MM C1713 $5,637.45PLATE BONE LCP COMBI STAINLESS STEEL NARROW L62 MM C1713 $2,226.40PLATE BONE LCP COMBI STAINLESS STEEL NARROW L80 MM C1713 $2,346.00PLATE BONE LCP COMBI STAINLESS STEEL NARROW L98 MM C1713 $2,506.96PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE RIGHT C1713 $2,396.56PLATE BONE LCP COMBI STAINLESS STEEL RIGHT ANGLE T C1713 $2,138.96PLATE BONE LCP COMBI STAINLESS STEEL SHORT L69 MM C1713 $6,715.09

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL SHORT L72 MM C1713 $6,918.34PLATE BONE LCP COMBI STAINLESS STEEL SMALL BEND L1 C1713 $10,051.54PLATE BONE LCP COMBI STAINLESS STEEL SMALL BEND L2 C1713 $11,704.42PLATE BONE LCP COMBI STAINLESS STEEL SMALL BEND L8 C1713 $8,640.26PLATE BONE LCP COMBI STAINLESS STEEL STANDARD L45 C1713 $6,105.93PLATE BONE LCP COMBI STAINLESS STEEL STANDARD L47 C1713 $5,706.48PLATE BONE LCP COMBI STAINLESS STEEL STANDARD L54 C1713 $5,921.24PLATE BONE LCP COMBI STAINLESS STEEL STANDARD L55 C1713 $5,921.24PLATE BONE LCP COMBI STAINLESS STEEL STANDARD L66 C1713 $6,561.42PLATE BONE LCP COMBI STAINLESS STEEL STANDARD L68 C1713 $6,132.17PLATE BONE LCP COMBI STAINLESS STEEL STANDARD L75 C1713 $6,066.97PLATE BONE LCP COMBI STAINLESS STEEL STANDARD L77 C1713 $6,066.97PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L113 C1713 $3,500.56PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L132 C1713 $3,666.16PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L151 C1713 $3,850.16PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L170 C1713 $4,126.16PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L189 C1713 $4,324.00PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L208 C1713 $4,466.56PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L227 C1713 $4,678.16PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L246 C1713 $4,977.20PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L265 C1713 $5,115.20PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L284 C1713 $5,326.80PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L303 C1713 $5,469.36PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L48 C1713 $2,738.94PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L56 C1713 $2,902.56PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L57 C1713 $2,889.94PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L75 C1713 $3,036.00PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L94 C1713 $3,279.76PLATE BONE LCP COMBI STAINLESS STEEL T 3 HOLE HEAD C1713 $2,597.53PLATE BONE LCP COMBI STAINLESS STEEL T 4 HOLE HEAD C1713 $2,597.53PLATE BONE LCP COMBI STAINLESS STEEL T L115 MM 6 H C1713 $4,705.76PLATE BONE LCP COMBI STAINLESS STEEL T L132 MM TIB C1713 $8,813.60PLATE BONE LCP COMBI STAINLESS STEEL T L147 MM 8 H C1713 $5,437.20PLATE BONE LCP COMBI STAINLESS STEEL T L184 MM TIB C1713 $9,402.40PLATE BONE LCP COMBI STAINLESS STEEL T L236 MM TIB C1713 $9,747.36PLATE BONE LCP COMBI STAINLESS STEEL T L40 MM X W6 C1713 $2,889.94PLATE BONE LCP COMBI STAINLESS STEEL T L49 MM X W6 C1713 $3,007.38PLATE BONE LCP COMBI STAINLESS STEEL T L64 MM TIBI C1713 $5,092.16PLATE BONE LCP COMBI STAINLESS STEEL T L83 MM 4 HO C1713 $4,107.76

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 ChargePLATE BONE LCP COMBI STAINLESS STEEL T L90 MM TIBI C1713 $5,290.00PLATE BONE LCP COMBI STAINLESS STEEL T OBLIQUE LEF C1713 $2,401.20PLATE BONE LCP COMBI STAINLESS STEEL XLONG L134 MM C1713 $6,431.30PLATE BONE LCP COMBI STAINLESS STEEL XLONG L137 MM C1713 $6,918.34PLATE BONE LCP COMBI STAINLESS STEEL XLONG L147 MM C1713 $6,715.09PLATE BONE LCP COMBI TITANIUM +20 D L L43 MM X W6. C1713 $2,610.72PLATE BONE LCP COMBI TITANIUM +20 D L L52 MM X W6. C1713 $2,736.16PLATE BONE LCP COMBI TITANIUM +90 D L L40 MM X W6. C1713 $2,610.72PLATE BONE LCP COMBI TITANIUM +90 D L L49 MM X W6. C1713 $2,736.16PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L105 MM C1713 $1,292.56PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L117 MM C1713 $1,251.20PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L148 MM C1713 $1,297.20PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L33 MM X C1713 $993.60PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L45 MM X C1713 $1,145.36PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L57 MM X C1713 $1,145.36PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L69 MM X C1713 $1,145.36PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L81 MM X C1713 $1,168.40PLATE BONE LCP COMBI TITANIUM 1/3 TUBULAR L93 MM X C1713 $1,232.80PLATE BONE LCP COMBI TITANIUM -20 D L L43 MM X W6. C1713 $2,610.72PLATE BONE LCP COMBI TITANIUM -20 D L L52 MM X W6. C1713 $2,736.16PLATE BONE LCP COMBI TITANIUM 5 D L28 MM RADIAL HE C1713 $4,135.36PLATE BONE LCP COMBI TITANIUM 5 D L34 MM RADIAL HE C1713 $4,135.36PLATE BONE LCP COMBI TITANIUM 5 D L40 MM RADIAL HE C1713 $4,254.96PLATE BONE LCP COMBI TITANIUM 5 D L46 MM RADIAL HE C1713 $4,254.96PLATE BONE LCP COMBI TITANIUM 5 D L50 MM RADIAL HE C1713 $4,333.20PLATE BONE LCP COMBI TITANIUM 5 D L56 MM RADIAL HE C1713 $4,328.56PLATE BONE LCP COMBI TITANIUM -90 D L L40 MM X W6. C1713 $2,610.72PLATE BONE LCP COMBI TITANIUM -90 D L L49 MM X W6. C1713 $2,736.16PLATE BONE LCP COMBI TITANIUM BROAD CURVE L229 MM C1713 $4,834.56PLATE BONE LCP COMBI TITANIUM BROAD CURVE L247 MM C1713 $5,124.40PLATE BONE LCP COMBI TITANIUM BROAD CURVE L265 MM C1713 $5,382.00PLATE BONE LCP COMBI TITANIUM BROAD CURVE L282 MM C1713 $5,975.36PLATE BONE LCP COMBI TITANIUM BROAD CURVE L300 MM C1713 $6,536.56PLATE BONE LCP COMBI TITANIUM BROAD CURVE L318 MM C1713 $6,849.36PLATE BONE LCP COMBI TITANIUM BROAD CURVE L336 MM C1713 $7,465.76PLATE BONE LCP COMBI TITANIUM BROAD CURVE L372 MM C1713 $8,818.16PLATE BONE LCP COMBI TITANIUM BROAD CURVE L408 MM C1713 $9,627.76PLATE BONE LCP COMBI TITANIUM BROAD CURVE L443 MM C1713 $10,451.20PLATE BONE LCP COMBI TITANIUM BROAD CURVE L479 MM C1713 $11,288.40

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 ChargePLATE BONE LCP COMBI TITANIUM BROAD L116 MM X W17. C1713 $2,833.60PLATE BONE LCP COMBI TITANIUM BROAD L134 MM X W17. C1713 $3,008.40PLATE BONE LCP COMBI TITANIUM BROAD L152 MM X W17. C1713 $3,680.00PLATE BONE LCP COMBI TITANIUM BROAD L170 MM X W17. C1713 $3,978.96PLATE BONE LCP COMBI TITANIUM BROAD L188 MM X W17. C1713 $4,278.00PLATE BONE LCP COMBI TITANIUM BROAD L206 MM X W17. C1713 $4,554.00PLATE BONE LCP COMBI TITANIUM BROAD L224 MM X W17. C1713 $4,834.56PLATE BONE LCP COMBI TITANIUM BROAD L260 MM X W17. C1713 $5,382.00PLATE BONE LCP COMBI TITANIUM BROAD L296 MM X W17. C1713 $6,536.56PLATE BONE LCP COMBI TITANIUM BROAD L332 MM X W17. C1713 $7,695.76PLATE BONE LCP COMBI TITANIUM BROAD L368 MM X W17. C1713 $8,500.80PLATE BONE LCP COMBI TITANIUM BROAD L404 MM X W17. C1713 $9,319.60PLATE BONE LCP COMBI TITANIUM CONTOUR L106 MM TIBI C1713 $9,614.00PLATE BONE LCP COMBI TITANIUM CONTOUR L107 MM TIBI C1713 $9,728.96PLATE BONE LCP COMBI TITANIUM CONTOUR L112 MM OLEC C1713 $6,738.96PLATE BONE LCP COMBI TITANIUM CONTOUR L118 MM TIBI C1713 $9,738.16PLATE BONE LCP COMBI TITANIUM CONTOUR L119 MM TIBI C1713 $9,710.56PLATE BONE LCP COMBI TITANIUM CONTOUR L133 MM TIBI C1713 $9,839.36PLATE BONE LCP COMBI TITANIUM CONTOUR L138 MM OLEC C1713 $6,614.80PLATE BONE LCP COMBI TITANIUM CONTOUR L142 MM TIBI C1713 $9,733.60PLATE BONE LCP COMBI TITANIUM CONTOUR L145 MM TIBI C1713 $9,825.60PLATE BONE LCP COMBI TITANIUM CONTOUR L154 MM TIBI C1713 $9,853.20PLATE BONE LCP COMBI TITANIUM CONTOUR L159 MM TIBI C1713 $9,945.20PLATE BONE LCP COMBI TITANIUM CONTOUR L164 MM OLEC C1713 $7,286.40PLATE BONE LCP COMBI TITANIUM CONTOUR L171 MM TIBI C1713 $9,936.00PLATE BONE LCP COMBI TITANIUM CONTOUR L178 MM TIBI C1713 $9,844.00PLATE BONE LCP COMBI TITANIUM CONTOUR L185 MM TIBI C1713 $10,078.56PLATE BONE LCP COMBI TITANIUM CONTOUR L189 MM OLEC C1713 $7,134.56PLATE BONE LCP COMBI TITANIUM CONTOUR L190 MM TIBI C1713 $9,954.40PLATE BONE LCP COMBI TITANIUM CONTOUR L197 MM TIBI C1713 $10,041.76PLATE BONE LCP COMBI TITANIUM CONTOUR L211 MM TIBI C1713 $10,184.40PLATE BONE LCP COMBI TITANIUM CONTOUR L214 MM TIBI C1713 $9,949.76PLATE BONE LCP COMBI TITANIUM CONTOUR L215 MM OLEC C1713 $7,263.36PLATE BONE LCP COMBI TITANIUM CONTOUR L223 MM TIBI C1713 $10,166.00PLATE BONE LCP COMBI TITANIUM CONTOUR L226 MM TIBI C1713 $10,074.00PLATE BONE LCP COMBI TITANIUM CONTOUR L237 MM TIBI C1713 $10,543.20PLATE BONE LCP COMBI TITANIUM CONTOUR L249 MM TIBI C1713 $10,520.16PLATE BONE LCP COMBI TITANIUM CONTOUR L250 MM TIBI C1713 $10,078.56PLATE BONE LCP COMBI TITANIUM CONTOUR L262 MM TIBI C1713 $10,179.76

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 ChargePLATE BONE LCP COMBI TITANIUM CONTOUR L275 MM TIBI C1713 $10,892.80PLATE BONE LCP COMBI TITANIUM CONTOUR L286 MM TIBI C1713 $10,184.40PLATE BONE LCP COMBI TITANIUM CONTOUR L301 MM TIBI C1713 $11,256.16PLATE BONE LCP COMBI TITANIUM CONTOUR L322 MM TIBI C1713 $10,285.60PLATE BONE LCP COMBI TITANIUM CONTOUR L81 MM TIBIA C1713 $9,609.36PLATE BONE LCP COMBI TITANIUM CONTOUR L82 MM TIBIA C1713 $9,618.56PLATE BONE LCP COMBI TITANIUM CONTOUR L86 MM OLECR C1713 $6,140.96PLATE BONE LCP COMBI TITANIUM CONTOUR L93 MM TIBIA C1713 $9,581.76PLATE BONE LCP COMBI TITANIUM D12 MM L70 MM CLAVIC C1713 $5,464.80PLATE BONE LCP COMBI TITANIUM D12 MM L85 MM CLAVIC C1713 $5,717.76PLATE BONE LCP COMBI TITANIUM D15 MM L112 MM CLAVI C1713 $6,131.76PLATE BONE LCP COMBI TITANIUM D15 MM L70 MM CLAVIC C1713 $5,464.80PLATE BONE LCP COMBI TITANIUM D15 MM L85 MM CLAVIC C1713 $5,717.76PLATE BONE LCP COMBI TITANIUM D15 MM L99 MM CLAVIC C1713 $5,878.80PLATE BONE LCP COMBI TITANIUM D18 MM L112 MM CLAVI C1713 $6,131.76PLATE BONE LCP COMBI TITANIUM D18 MM L70 MM CLAVIC C1713 $5,464.80PLATE BONE LCP COMBI TITANIUM D18 MM L85 MM CLAVIC C1713 $5,717.76PLATE BONE LCP COMBI TITANIUM D18 MM L99 MM CLAVIC C1713 $5,878.80PLATE BONE LCP COMBI TITANIUM L100 MM ANKLE ANTERI C1713 $6,992.00PLATE BONE LCP COMBI TITANIUM L106 MM TIBIAL LEFT C1713 $10,087.76PLATE BONE LCP COMBI TITANIUM L106 MM TIBIAL RIGHT C1713 $10,087.76PLATE BONE LCP COMBI TITANIUM L108 MM CLAVICLE LEF C1713 $6,122.56PLATE BONE LCP COMBI TITANIUM L108 MM CLAVICLE RIG C1713 $6,122.56PLATE BONE LCP COMBI TITANIUM L110 MM CLAVICLE LEF C1713 $6,283.60PLATE BONE LCP COMBI TITANIUM L110 MM CLAVICLE RIG C1713 $6,283.60PLATE BONE LCP COMBI TITANIUM L110 MM X W11 MM X H C1713 $7,884.40PLATE BONE LCP COMBI TITANIUM L111 MM X W11 MM X H C1713 $2,309.20PLATE BONE LCP COMBI TITANIUM L112 MM X W10.1 MM X C1713 $3,776.56PLATE BONE LCP COMBI TITANIUM L112 MM X W11 MM X H C1713 $6,416.96PLATE BONE LCP COMBI TITANIUM L116 MM ANKLE ANTERI C1713 $6,992.00PLATE BONE LCP COMBI TITANIUM L116 MM X W11 MM X H C1713 $7,884.40PLATE BONE LCP COMBI TITANIUM L116 MM X W13.5 MM X C1713 $10,852.80PLATE BONE LCP COMBI TITANIUM L120 MM CLAVICLE LEF C1713 $6,444.56PLATE BONE LCP COMBI TITANIUM L120 MM CLAVICLE RIG C1713 $6,444.56PLATE BONE LCP COMBI TITANIUM L122 MM EXTRAARTICUL C1713 $8,611.20PLATE BONE LCP COMBI TITANIUM L123 MM CLAVICLE LEF C1713 $6,283.60PLATE BONE LCP COMBI TITANIUM L123 MM CLAVICLE RIG C1713 $6,283.60PLATE BONE LCP COMBI TITANIUM L125 MM X W11 MM X H C1713 $6,522.80PLATE BONE LCP COMBI TITANIUM L126 MM X W10.1 MM X C1713 $3,974.40

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 ChargePLATE BONE LCP COMBI TITANIUM L132 MM TIBIAL LEFT C1713 $10,188.96PLATE BONE LCP COMBI TITANIUM L132 MM TIBIAL RIGHT C1713 $10,188.96PLATE BONE LCP COMBI TITANIUM L135 MM CLAVICLE LEF C1713 $6,444.56PLATE BONE LCP COMBI TITANIUM L135 MM CLAVICLE RIG C1713 $6,444.56PLATE BONE LCP COMBI TITANIUM L136 MM X W11 MM X H C1713 $8,514.56PLATE BONE LCP COMBI TITANIUM L137 MM X W11 MM X H C1713 $2,479.36PLATE BONE LCP COMBI TITANIUM L138 MM X W11 MM X H C1713 $6,633.20PLATE BONE LCP COMBI TITANIUM L140 MM X W10.1 MM X C1713 $3,910.00PLATE BONE LCP COMBI TITANIUM L142 MM X W11 MM X H C1713 $8,514.56PLATE BONE LCP COMBI TITANIUM L150 MM X W11 MM X H C1713 $2,658.80PLATE BONE LCP COMBI TITANIUM L151 MM X W11 MM X H C1713 $6,738.96PLATE BONE LCP COMBI TITANIUM L154 MM X W10.1 MM X C1713 $4,236.56PLATE BONE LCP COMBI TITANIUM L158 MM EXTRAARTICUL C1713 $9,802.56PLATE BONE LCP COMBI TITANIUM L158 MM TIBIAL LEFT C1713 $10,285.60PLATE BONE LCP COMBI TITANIUM L158 MM TIBIAL RIGHT C1713 $10,285.60PLATE BONE LCP COMBI TITANIUM L163 MM X W11 MM X H C1713 $2,732.40PLATE BONE LCP COMBI TITANIUM L164 MM X W11 MM X H C1713 $8,698.56PLATE BONE LCP COMBI TITANIUM L168 MM X W10.1 MM X C1713 $4,250.40PLATE BONE LCP COMBI TITANIUM L176 MM X W11 MM X H C1713 $3,247.60PLATE BONE LCP COMBI TITANIUM L182 MM X W10.1 MM X C1713 $4,600.00PLATE BONE LCP COMBI TITANIUM L184 MM TIBIAL LEFT C1713 $10,400.56PLATE BONE LCP COMBI TITANIUM L184 MM TIBIAL RIGHT C1713 $10,400.56PLATE BONE LCP COMBI TITANIUM L189 MM X W11 MM X H C1713 $4,098.56PLATE BONE LCP COMBI TITANIUM L190 MM X W11 MM X H C1713 $8,983.76PLATE BONE LCP COMBI TITANIUM L194 MM EXTRAARTICUL C1713 $10,382.16PLATE BONE LCP COMBI TITANIUM L196 MM X W10.1 MM X C1713 $4,774.80PLATE BONE LCP COMBI TITANIUM L201 MM X W11 MM X H C1713 $8,753.76PLATE BONE LCP COMBI TITANIUM L202 MM X W11 MM X H C1713 $4,383.76PLATE BONE LCP COMBI TITANIUM L208 MM X W11 MM X H C1713 $8,753.76PLATE BONE LCP COMBI TITANIUM L210 MM TIBIAL LEFT C1713 $10,538.56PLATE BONE LCP COMBI TITANIUM L210 MM TIBIAL RIGHT C1713 $10,538.56PLATE BONE LCP COMBI TITANIUM L215 MM X W11 MM X H C1713 $4,590.80PLATE BONE LCP COMBI TITANIUM L216 MM X W11 MM X H C1713 $9,176.96PLATE BONE LCP COMBI TITANIUM L220 MM X W13.5 MM X C1713 $11,320.96PLATE BONE LCP COMBI TITANIUM L224 MM X W10.1 MM X C1713 $5,174.96PLATE BONE LCP COMBI TITANIUM L230 MM EXTRAARTICUL C1713 $10,970.96PLATE BONE LCP COMBI TITANIUM L236 MM TIBIAL LEFT C1713 $10,998.56PLATE BONE LCP COMBI TITANIUM L236 MM TIBIAL RIGHT C1713 $10,998.56PLATE BONE LCP COMBI TITANIUM L241 MM X W11 MM X H C1713 $5,147.36

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 ChargePLATE BONE LCP COMBI TITANIUM L242 MM X W11 MM X H C1713 $8,983.76PLATE BONE LCP COMBI TITANIUM L246 MM X W13.5 MM X C1713 $11,813.44PLATE BONE LCP COMBI TITANIUM L252 MM X W10.1 MM X C1713 $5,423.36PLATE BONE LCP COMBI TITANIUM L262 MM TIBIAL LEFT C1713 $11,081.36PLATE BONE LCP COMBI TITANIUM L262 MM TIBIAL RIGHT C1713 $11,081.36PLATE BONE LCP COMBI TITANIUM L266 MM EXTRAARTICUL C1713 $12,484.40PLATE BONE LCP COMBI TITANIUM L267 MM X W11 MM X H C1713 $5,713.20PLATE BONE LCP COMBI TITANIUM L280 MM X W10.1 MM X C1713 $6,578.00PLATE BONE LCP COMBI TITANIUM L288 MM TIBIAL LEFT C1713 $11,191.76PLATE BONE LCP COMBI TITANIUM L288 MM TIBIAL RIGHT C1713 $11,191.76PLATE BONE LCP COMBI TITANIUM L293 MM X W11 MM X H C1713 $5,717.76PLATE BONE LCP COMBI TITANIUM L302 MM EXTRAARTICUL C1713 $13,712.56PLATE BONE LCP COMBI TITANIUM L308 MM X W10.1 MM X C1713 $6,706.80PLATE BONE LCP COMBI TITANIUM L33 MM X W11 MM X H3 C1713 $1,775.60PLATE BONE LCP COMBI TITANIUM L43 MM X W7.5 MM X H C1713 $5,054.25PLATE BONE LCP COMBI TITANIUM L46 MM X W11 MM X H3 C1713 $1,844.56PLATE BONE LCP COMBI TITANIUM L48 MM RADIUS LEFT D C1713 $6,938.40PLATE BONE LCP COMBI TITANIUM L48 MM RADIUS RIGHT C1713 $6,938.40PLATE BONE LCP COMBI TITANIUM L50.5 MM RADIUS LEFT C1713 $5,167.50PLATE BONE LCP COMBI TITANIUM L50.5 MM RADIUS RIGH C1713 $5,167.50PLATE BONE LCP COMBI TITANIUM L56 MM X W10.1 MM X C1713 $2,953.20PLATE BONE LCP COMBI TITANIUM L58 MM X W11 MM X H2 C1713 $6,462.96PLATE BONE LCP COMBI TITANIUM L59 MM X W11 MM X H3 C1713 $1,927.36PLATE BONE LCP COMBI TITANIUM L59.5 MM RADIUS LEFT C1713 $5,331.08PLATE BONE LCP COMBI TITANIUM L59.5 MM RADIUS RIGH C1713 $4,982.32PLATE BONE LCP COMBI TITANIUM L61 MM X W7.5 MM X H C1713 $5,001.92PLATE BONE LCP COMBI TITANIUM L62 MM 3 HOLE LOW PR C1713 $3,680.00PLATE BONE LCP COMBI TITANIUM L65 MM X W11 MM X H2 C1713 $6,462.96PLATE BONE LCP COMBI TITANIUM L66 MM RADIUS LEFT D C1713 $7,467.04PLATE BONE LCP COMBI TITANIUM L66 MM RADIUS RIGHT C1713 $7,467.04PLATE BONE LCP COMBI TITANIUM L68.5 MM RADIUS LEFT C1713 $5,127.36PLATE BONE LCP COMBI TITANIUM L68.5 MM RADIUS RIGH C1713 $5,127.36PLATE BONE LCP COMBI TITANIUM L69 MM CLAVICLE LEFT C1713 $5,860.40PLATE BONE LCP COMBI TITANIUM L69 MM CLAVICLE RIGH C1713 $5,860.40PLATE BONE LCP COMBI TITANIUM L70 MM X W10.1 MM X C1713 $2,976.16PLATE BONE LCP COMBI TITANIUM L72 MM X W11 MM X H3 C1713 $1,987.20PLATE BONE LCP COMBI TITANIUM L80 MM TIBIAL LEFT D C1713 $10,308.56PLATE BONE LCP COMBI TITANIUM L80 MM TIBIAL RIGHT C1713 $10,308.56PLATE BONE LCP COMBI TITANIUM L81 MM CLAVICLE LEFT C1713 $5,952.40

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 ChargePLATE BONE LCP COMBI TITANIUM L81 MM CLAVICLE RIGH C1713 $5,952.40PLATE BONE LCP COMBI TITANIUM L83 MM X W11 MM X H2 C1713 $7,166.80PLATE BONE LCP COMBI TITANIUM L84 MM X W10.1 MM X C1713 $3,440.80PLATE BONE LCP COMBI TITANIUM L85 MM X W11 MM X H3 C1713 $2,116.00PLATE BONE LCP COMBI TITANIUM L86 MM X W11 MM X H3 C1713 $6,210.00PLATE BONE LCP COMBI TITANIUM L90 MM X W11 MM X H2 C1713 $7,166.80PLATE BONE LCP COMBI TITANIUM L94 MM CLAVICLE LEFT C1713 $6,053.60PLATE BONE LCP COMBI TITANIUM L94 MM CLAVICLE RIGH C1713 $6,053.60PLATE BONE LCP COMBI TITANIUM L98 MM X W10.1 MM X C1713 $3,620.16PLATE BONE LCP COMBI TITANIUM L98 MM X W11 MM X H3 C1713 $2,198.80PLATE BONE LCP COMBI TITANIUM L99 MM X W11 MM X H3 C1713 $6,324.96PLATE BONE LCP COMBI TITANIUM NARROW L116 MM X W13 C1713 $2,654.16PLATE BONE LCP COMBI TITANIUM NARROW L134 MM X W13 C1713 $3,072.80PLATE BONE LCP COMBI TITANIUM NARROW L152 MM X W13 C1713 $3,252.16PLATE BONE LCP COMBI TITANIUM NARROW L170 MM X W13 C1713 $3,404.00PLATE BONE LCP COMBI TITANIUM NARROW L188 MM X W13 C1713 $3,693.76PLATE BONE LCP COMBI TITANIUM NARROW L206 MM X W13 C1713 $3,978.96PLATE BONE LCP COMBI TITANIUM NARROW L224 MM X W13 C1713 $4,278.00PLATE BONE LCP COMBI TITANIUM NARROW L242 MM X W13 C1713 $4,563.20PLATE BONE LCP COMBI TITANIUM NARROW L260 MM X W13 C1713 $4,797.76PLATE BONE LCP COMBI TITANIUM NARROW L278 MM X W13 C1713 $5,216.40PLATE BONE LCP COMBI TITANIUM NARROW L296 MM X W13 C1713 $5,607.36PLATE BONE LCP COMBI TITANIUM NARROW L332 MM X W13 C1713 $6,582.56PLATE BONE LCP COMBI TITANIUM NARROW L368 MM X W13 C1713 $8,367.36PLATE BONE LCP COMBI TITANIUM NARROW L404 MM X W13 C1713 $9,140.16PLATE BONE LCP COMBI TITANIUM NARROW L44 MM X W13. C1713 $2,129.76PLATE BONE LCP COMBI TITANIUM NARROW L62 MM X W13. C1713 $2,152.80PLATE BONE LCP COMBI TITANIUM NARROW L80 MM X W13. C1713 $2,346.00PLATE BONE LCP COMBI TITANIUM NARROW L98 MM X W13. C1713 $2,506.96PLATE BONE LCP COMBI TITANIUM OBLIQUE RIGHT T L107 C1713 $3,187.76PLATE BONE LCP COMBI TITANIUM OBLIQUE RIGHT T L52 C1713 $2,474.80PLATE BONE LCP COMBI TITANIUM OBLIQUE RIGHT T L63 C1713 $2,589.76PLATE BONE LCP COMBI TITANIUM OBLIQUE RIGHT T L74 C1713 $2,700.16PLATE BONE LCP COMBI TITANIUM OBLIQUE RIGHT T L85 C1713 $2,902.56PLATE BONE LCP COMBI TITANIUM OBLIQUE RIGHT T L96 C1713 $2,934.80PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L100 M C1713 $4,370.00PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L50 MM C1713 $2,212.56PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L56 MM C1713 $2,281.60PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L57 MM C1713 $2,350.56

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 ChargePLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L67 MM C1713 $2,506.96PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L77 MM C1713 $2,999.20PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L78 MM C1713 $2,925.60PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L87 MM C1713 $3,666.16PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L89 MM C1713 $3,762.80PLATE BONE LCP COMBI TITANIUM RIGHT ANGLE T L97 MM C1713 $4,383.76PLATE BONE LCP COMBI TITANIUM STANDARD L45 MM RADI C1713 $6,674.08PLATE BONE LCP COMBI TITANIUM STANDARD L47 MM RADI C1713 $6,674.08PLATE BONE LCP COMBI TITANIUM STANDARD L54 MM RADI C1713 $6,938.40PLATE BONE LCP COMBI TITANIUM STANDARD L55 MM RADI C1713 $6,938.40PLATE BONE LCP COMBI TITANIUM STANDARD L66 MM RADI C1713 $7,198.00PLATE BONE LCP COMBI TITANIUM STANDARD L68 MM RADI C1713 $7,701.86PLATE BONE LCP COMBI TITANIUM STANDARD L75 MM RADI C1713 $7,467.04PLATE BONE LCP COMBI TITANIUM STANDARD L77 MM RADI C1713 $7,989.73PLATE BONE LCP COMBI TITANIUM STRAIGHT L113 MM 6 H C1713 $3,390.16PLATE BONE LCP COMBI TITANIUM STRAIGHT L132 MM 7 H C1713 $3,542.00PLATE BONE LCP COMBI TITANIUM STRAIGHT L151 MM 8 H C1713 $3,726.00PLATE BONE LCP COMBI TITANIUM STRAIGHT L170 MM 9 H C1713 $3,988.16PLATE BONE LCP COMBI TITANIUM STRAIGHT L189 MM 10 C1713 $4,181.36PLATE BONE LCP COMBI TITANIUM STRAIGHT L208 MM 11 C1713 $4,319.36PLATE BONE LCP COMBI TITANIUM STRAIGHT L227 MM 12 C1713 $4,526.40PLATE BONE LCP COMBI TITANIUM STRAIGHT L246 MM 13 C1713 $4,816.16PLATE BONE LCP COMBI TITANIUM STRAIGHT L265 MM 14 C1713 $4,949.60PLATE BONE LCP COMBI TITANIUM STRAIGHT L284 MM 15 C1713 $5,156.56PLATE BONE LCP COMBI TITANIUM STRAIGHT L303 MM 16 C1713 $5,294.56PLATE BONE LCP COMBI TITANIUM STRAIGHT L48 MM X W6 C1713 $2,559.76PLATE BONE LCP COMBI TITANIUM STRAIGHT L56 MM 3 HO C1713 $2,801.36PLATE BONE LCP COMBI TITANIUM STRAIGHT L57 MM X W6 C1713 $2,700.88PLATE BONE LCP COMBI TITANIUM STRAIGHT L75 MM 4 HO C1713 $2,934.80PLATE BONE LCP COMBI TITANIUM STRAIGHT L94 MM 5 HO C1713 $3,174.00PLATE BONE LCP COMBI TITANIUM T L115 MM 6 HOLE LIM C1713 $4,705.76PLATE BONE LCP COMBI TITANIUM T L147 MM 8 HOLE LIM C1713 $5,437.20PLATE BONE LCP COMBI TITANIUM T L40 MM X W6.3 MM X C1713 $2,700.88PLATE BONE LCP COMBI TITANIUM T L49 MM X W6.3 MM X C1713 $2,810.64PLATE BONE LCP COMBI TITANIUM T L83 MM 4 HOLE LIMI C1713 $4,107.76PLATE BONE LCP COMBI TITANIUM T OBLIQUE LEFT L107 C1713 $3,256.80PLATE BONE LCP COMBI TITANIUM T OBLIQUE LEFT L52 M C1713 $2,608.16PLATE BONE LCP COMBI TITANIUM T OBLIQUE LEFT L63 M C1713 $2,732.40PLATE BONE LCP COMBI TITANIUM T OBLIQUE LEFT L74 M C1713 $2,847.36

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 ChargePLATE BONE LCP COMBI TITANIUM T OBLIQUE LEFT L85 M C1713 $2,966.96PLATE BONE LCP COMBI TITANIUM T OBLIQUE LEFT L96 M C1713 $3,086.56PLATE BONE LCP PRO-PAK STAINLESS STEEL L L32 MM LE C1713 $2,658.80PLATE BONE LCP PRO-PAK STAINLESS STEEL L L32 MM RI C1713 $2,658.80PLATE BONE LCP PRO-PAK STAINLESS STEEL L L40 MM LE C1713 $2,690.96PLATE BONE LCP PRO-PAK STAINLESS STEEL L L40 MM RI C1713 $2,690.96PLATE BONE LCP PRO-PAK STAINLESS STEEL L OBLIQUE L C1713 $2,658.80PLATE BONE LCP PRO-PAK STAINLESS STEEL L31 MM 4 HO C1713 $1,860.52PLATE BONE LCP PRO-PAK STAINLESS STEEL L36 MM 4 HO C1713 $2,839.95PLATE BONE LCP PRO-PAK STAINLESS STEEL L38 MM 5 HO C1713 $1,860.52PLATE BONE LCP PRO-PAK STAINLESS STEEL L40 MM 4 HO C1713 $2,801.36PLATE BONE LCP PRO-PAK STAINLESS STEEL L44 MM 5 HO C1713 $2,839.95PLATE BONE LCP PRO-PAK STAINLESS STEEL L45 MM 6 HO C1713 $1,860.52PLATE BONE LCP PRO-PAK STAINLESS STEEL L49 MM 5 HO C1713 $2,801.36PLATE BONE LCP PRO-PAK STAINLESS STEEL L52 MM 6 HO C1713 $2,839.95PLATE BONE LCP PRO-PAK STAINLESS STEEL L52 MM 7 HO C1713 $1,860.52PLATE BONE LCP PRO-PAK STAINLESS STEEL L54 MM COND C1713 $5,586.43PLATE BONE LCP PRO-PAK STAINLESS STEEL L58 MM 6 HO C1713 $2,801.36PLATE BONE LCP PRO-PAK STAINLESS STEEL L59 MM 8 HO C1713 $1,860.52PLATE BONE LCP PRO-PAK STAINLESS STEEL L59 MM COND C1713 $4,262.45PLATE BONE LCP PRO-PAK STAINLESS STEEL L60 MM 7 HO C1713 $2,839.95PLATE BONE LCP PRO-PAK STAINLESS STEEL L66 MM COND C1713 $4,342.40PLATE BONE LCP PRO-PAK STAINLESS STEEL L67 MM 7 HO C1713 $2,801.36PLATE BONE LCP PRO-PAK STAINLESS STEEL L68 MM 8 HO C1713 $2,839.95PLATE BONE LCP PRO-PAK STAINLESS STEEL L73 MM 10 H C1713 $1,776.80PLATE BONE LCP PRO-PAK STAINLESS STEEL L81 MM 12 H C1713 $3,002.42PLATE BONE LCP PRO-PAK STAINLESS STEEL L84 MM 10 H C1713 $2,839.95PLATE BONE LCP PRO-PAK STAINLESS STEEL L88 MM 12 H C1713 $3,307.58PLATE BONE LCP PRO-PAK STAINLESS STEEL L94 MM 10 H C1713 $2,801.36PLATE BONE LCP PRO-PAK STAINLESS STEEL L97 MM 12 H C1713 $3,091.20PLATE BONE LCP PRO-PAK STAINLESS STEEL OBLIQUE LEF C1713 $2,690.96PLATE BONE LCP PRO-PAK STAINLESS STEEL OBLIQUE RIG C1713 $2,690.96PLATE BONE LCP PRO-PAK STAINLESS STEEL STRAIGHT L3 C1713 $1,845.71PLATE BONE LCP PRO-PAK STAINLESS STEEL STRAIGHT L7 C1713 $2,175.52PLATE BONE LCP PRO-PAK STAINLESS STEEL T L32 MM 2 C1713 $4,876.00PLATE BONE LCP PRO-PAK STAINLESS STEEL T L53 MM 2 C1713 $3,140.24PLATE BONE LCP PRO-PAK STAINLESS STEEL T L53 MM 3 C1713 $3,140.24PLATE BONE LCP PRO-PAK STAINLESS STEEL T L54 MM CA C1713 $1,919.58PLATE BONE LCP PRO-PAK STAINLESS STEEL T L58 MM 2 C1713 $5,217.32

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 ChargePLATE BONE LCP PRO-PAK STAINLESS STEEL T L58 MM 3 C1713 $5,217.32PLATE BONE LCP PRO-PAK STAINLESS STEEL Y L46 MM X C1713 $1,771.92PLATE BONE LCP PRO-PAK STAINLESS STEEL Y L54 MM CA C1713 $2,136.15PLATE BONE LCP PRO-PAK STAINLESS STEEL Y L55 MM 3 C1713 $3,140.24PLATE BONE LCP PRO-PAK STAINLESS STEEL Y L60 MM 3 C1713 $5,217.32PLATE BONE LCP PRO-PAK TITANIUM L L32 MM LEFT 2 HO C1713 $2,658.80PLATE BONE LCP PRO-PAK TITANIUM L L32 MM RIGHT 2 H C1713 $2,658.80PLATE BONE LCP PRO-PAK TITANIUM L L40 MM LEFT 2 HO C1713 $2,750.80PLATE BONE LCP PRO-PAK TITANIUM L L40 MM RIGHT 2 H C1713 $2,750.80PLATE BONE LCP PRO-PAK TITANIUM L OBLIQUE L35 MM L C1713 $2,658.80PLATE BONE LCP PRO-PAK TITANIUM L OBLIQUE L35 MM R C1713 $2,658.80PLATE BONE LCP PRO-PAK TITANIUM L31 MM 4 HOLE LOW C1713 $1,738.80PLATE BONE LCP PRO-PAK TITANIUM L36 MM 4 HOLE LOW C1713 $2,654.16PLATE BONE LCP PRO-PAK TITANIUM L38 MM 5 HOLE LOW C1713 $1,860.52PLATE BONE LCP PRO-PAK TITANIUM L40 MM 4 HOLE LOW C1713 $2,801.36PLATE BONE LCP PRO-PAK TITANIUM L44 MM 5 HOLE LOW C1713 $2,839.95PLATE BONE LCP PRO-PAK TITANIUM L45 MM 6 HOLE LOW C1713 $1,738.80PLATE BONE LCP PRO-PAK TITANIUM L49 MM 5 HOLE LOW C1713 $2,801.36PLATE BONE LCP PRO-PAK TITANIUM L52 MM 6 HOLE LOW C1713 $2,654.16PLATE BONE LCP PRO-PAK TITANIUM L52 MM 7 HOLE LOW C1713 $1,860.52PLATE BONE LCP PRO-PAK TITANIUM L54 MM CONDYLAR 7 C1713 $5,220.96PLATE BONE LCP PRO-PAK TITANIUM L58 MM 6 HOLE LOW C1713 $2,801.36PLATE BONE LCP PRO-PAK TITANIUM L59 MM 7 HOLE SHAF C1713 $3,983.60PLATE BONE LCP PRO-PAK TITANIUM L59 MM 8 HOLE LOW C1713 $1,738.80PLATE BONE LCP PRO-PAK TITANIUM L60 MM 7 HOLE LOW C1713 $2,839.95PLATE BONE LCP PRO-PAK TITANIUM L66 MM CONDYLAR 7 C1713 $4,342.40PLATE BONE LCP PRO-PAK TITANIUM L67 MM 7 HOLE LOW C1713 $2,801.36PLATE BONE LCP PRO-PAK TITANIUM L68 MM 8 HOLE LOW C1713 $2,654.16PLATE BONE LCP PRO-PAK TITANIUM L73 MM 10 HOLE LOW C1713 $1,660.56PLATE BONE LCP PRO-PAK TITANIUM L76 MM 8 HOLE LOW C1713 $2,801.36PLATE BONE LCP PRO-PAK TITANIUM L81 MM 12 HOLE ADA C1713 $3,002.42PLATE BONE LCP PRO-PAK TITANIUM L84 MM 10 HOLE LOW C1713 $2,654.16PLATE BONE LCP PRO-PAK TITANIUM L88 MM 12 HOLE ADA C1713 $3,091.20PLATE BONE LCP PRO-PAK TITANIUM L94 MM 10 HOLE LOW C1713 $2,801.36PLATE BONE LCP PRO-PAK TITANIUM L97 MM 12 HOLE ADA C1713 $3,091.20PLATE BONE LCP PRO-PAK TITANIUM OBLIQUE LEFT L L42 C1713 $2,750.80PLATE BONE LCP PRO-PAK TITANIUM OBLIQUE RIGHT L L4 C1713 $2,750.80PLATE BONE LCP PRO-PAK TITANIUM STRAIGHT L36 MM CA C1713 $1,724.96PLATE BONE LCP PRO-PAK TITANIUM STRAIGHT L72 MM CA C1713 $1,651.98

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 ChargePLATE BONE LCP PRO-PAK TITANIUM T L32 MM 2 HOLE HE C1713 $4,876.00PLATE BONE LCP PRO-PAK TITANIUM T L53 MM 2 HOLE HE C1713 $2,384.53PLATE BONE LCP PRO-PAK TITANIUM T L53 MM 3 HOLE HE C1713 $2,384.53PLATE BONE LCP PRO-PAK TITANIUM T L54 MM CARPUS ME C1713 $1,932.00PLATE BONE LCP PRO-PAK TITANIUM T L58 MM 2 HOLE HE C1713 $4,876.00PLATE BONE LCP PRO-PAK TITANIUM T L58 MM 3 HOLE HE C1713 $4,876.00PLATE BONE LCP PRO-PAK TITANIUM Y L46 MM X W4 MM X C1713 $1,656.00PLATE BONE LCP PRO-PAK TITANIUM Y L54 MM CARPUS ME C1713 $2,136.15PLATE BONE LCP PRO-PAK TITANIUM Y L55 MM 3 HOLE HE C1713 $2,934.80PLATE BONE LCP PRO-PAK TITANIUM Y L60 MM 3 HOLE HE C1713 $4,876.00PLATE BONE LCP STAINLESS STEEL 0 D L53 MM FIRST ME C1713 $9,277.58PLATE BONE LCP STAINLESS STEEL 0 D MEDIUM L52 MM F C1713 $7,353.38PLATE BONE LCP STAINLESS STEEL 0 D SMALL L42 MM FI C1713 $6,872.32PLATE BONE LCP STAINLESS STEEL 1/3 TUBULAR L81 MM C1713 $949.33PLATE BONE LCP STAINLESS STEEL 10 D MEDIUM L52 MM C1713 $6,872.32PLATE BONE LCP STAINLESS STEEL 10 D SMALL L42 MM F C1713 $6,872.32PLATE BONE LCP STAINLESS STEEL 3 MM SPACE FOREFOOT C1713 $6,405.04PLATE BONE LCP STAINLESS STEEL 4 MM SPACE FOREFOOT C1713 $6,405.04PLATE BONE LCP STAINLESS STEEL 5 D LARGE L57 MM FI C1713 $7,816.32PLATE BONE LCP STAINLESS STEEL 5 D MEDIUM L52 MM F C1713 $6,872.32PLATE BONE LCP STAINLESS STEEL 5 D SMALL L42 MM FI C1713 $7,353.38PLATE BONE LCP STAINLESS STEEL 5 MM SPACE FOREFOOT C1713 $6,405.04PLATE BONE LCP STAINLESS STEEL 6 MM SPACE FOREFOOT C1713 $6,584.40PLATE BONE LCP STAINLESS STEEL CONTOUR CUBOID LEFT C1713 $7,816.32PLATE BONE LCP STAINLESS STEEL CONTOUR CUBOID RIGH C1713 $7,816.32PLATE BONE LCP STAINLESS STEEL CONTOUR NAVICULAR L C1713 $7,816.32PLATE BONE LCP STAINLESS STEEL CURVE L106 MM X W10 C1713 $5,474.00PLATE BONE LCP STAINLESS STEEL CURVE L129 MM X W10 C1713 $5,731.60PLATE BONE LCP STAINLESS STEEL CURVE L149 MM X W10 C1713 $6,002.96PLATE BONE LCP STAINLESS STEEL CURVE L166 MM X W10 C1713 $6,738.96PLATE BONE LCP STAINLESS STEEL CURVE L180 MM X W10 C1713 $7,203.60PLATE BONE LCP STAINLESS STEEL CURVE L190 MM X W10 C1713 $7,764.80PLATE BONE LCP STAINLESS STEEL CURVE L55 MM X W10. C1713 $4,664.40PLATE BONE LCP STAINLESS STEEL CURVE L82 MM X W10. C1713 $5,046.16PLATE BONE LCP STAINLESS STEEL FOREFOOT MIDFOOT 5 C1713 $11,772.48PLATE BONE LCP STAINLESS STEEL H L31 MM X W24 MM H C1713 $5,945.78PLATE BONE LCP STAINLESS STEEL H L45 MM X W24 MM H C1713 $6,073.75PLATE BONE LCP STAINLESS STEEL L109 MM TIBIA RIGHT C1713 $8,031.60PLATE BONE LCP STAINLESS STEEL L109 MM TIBIAL LEFT C1713 $8,031.60

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 ChargePLATE BONE LCP STAINLESS STEEL L109 MM TIBIAL RIGH C1713 $8,372.00PLATE BONE LCP STAINLESS STEEL L125 MM RADIUS LEFT C1713 $7,475.20PLATE BONE LCP STAINLESS STEEL L125 MM RADIUS RIGH C1713 $7,475.20PLATE BONE LCP STAINLESS STEEL L133 MM FEMUR PROXI C1713 $10,929.60PLATE BONE LCP STAINLESS STEEL L140 MM TIBIAL LEFT C1713 $10,556.96PLATE BONE LCP STAINLESS STEEL L140 MM TIBIAL RIGH C1713 $10,556.96PLATE BONE LCP STAINLESS STEEL L145 MM TIBIAL LEFT C1713 $8,312.16PLATE BONE LCP STAINLESS STEEL L145 MM TIBIAL RIGH C1713 $8,312.16PLATE BONE LCP STAINLESS STEEL L154 MM RADIUS LEFT C1713 $7,653.56PLATE BONE LCP STAINLESS STEEL L154 MM RADIUS RIGH C1713 $7,653.56PLATE BONE LCP STAINLESS STEEL L156 MM FEMUR LEFT C1713 $10,556.96PLATE BONE LCP STAINLESS STEEL L156 MM FEMUR RIGHT C1713 $10,556.96PLATE BONE LCP STAINLESS STEEL L169 MM FEMUR PROXI C1713 $11,081.36PLATE BONE LCP STAINLESS STEEL L180 MM TIBIAL LEFT C1713 $10,768.56PLATE BONE LCP STAINLESS STEEL L180 MM TIBIAL RIGH C1713 $10,768.56PLATE BONE LCP STAINLESS STEEL L181 MM TIBIAL LEFT C1713 $8,330.56PLATE BONE LCP STAINLESS STEEL L181 MM TIBIAL RIGH C1713 $8,330.56PLATE BONE LCP STAINLESS STEEL L184 MM RADIUS LEFT C1713 $8,121.75PLATE BONE LCP STAINLESS STEEL L184 MM RADIUS RIGH C1713 $8,121.75PLATE BONE LCP STAINLESS STEEL L196 MM FEMUR LEFT C1713 $10,768.56PLATE BONE LCP STAINLESS STEEL L196 MM FEMUR RIGHT C1713 $10,768.56PLATE BONE LCP STAINLESS STEEL L205 MM FEMUR PROXI C1713 $11,256.16PLATE BONE LCP STAINLESS STEEL L213 MM RADIUS LEFT C1713 $8,577.21PLATE BONE LCP STAINLESS STEEL L213 MM RADIUS RIGH C1713 $8,577.21PLATE BONE LCP STAINLESS STEEL L217 MM TIBIAL LEFT C1713 $8,914.80PLATE BONE LCP STAINLESS STEEL L217 MM TIBIAL RIGH C1713 $8,914.80PLATE BONE LCP STAINLESS STEEL L220 MM TIBIAL LEFT C1713 $10,998.56PLATE BONE LCP STAINLESS STEEL L220 MM TIBIAL RIGH C1713 $10,998.56PLATE BONE LCP STAINLESS STEEL L236 MM FEMUR LEFT C1713 $10,998.56PLATE BONE LCP STAINLESS STEEL L236 MM FEMUR RIGHT C1713 $10,998.56PLATE BONE LCP STAINLESS STEEL L240 MM RADIUS LEFT C1713 $8,032.57PLATE BONE LCP STAINLESS STEEL L240 MM RADIUS RIGH C1713 $8,032.57PLATE BONE LCP STAINLESS STEEL L241 MM FEMUR PROXI C1713 $11,670.16PLATE BONE LCP STAINLESS STEEL L253 MM TIBIA LEFT C1713 $8,850.40PLATE BONE LCP STAINLESS STEEL L253 MM TIBIAL LEFT C1713 $9,190.80PLATE BONE LCP STAINLESS STEEL L253 MM TIBIAL RIGH C1713 $8,850.40PLATE BONE LCP STAINLESS STEEL L260 MM TIBIAL LEFT C1713 $11,210.16PLATE BONE LCP STAINLESS STEEL L260 MM TIBIAL RIGH C1713 $11,210.16PLATE BONE LCP STAINLESS STEEL L276 MM FEMUR LEFT C1713 $11,210.16

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 ChargePLATE BONE LCP STAINLESS STEEL L276 MM FEMUR RIGHT C1713 $11,210.16PLATE BONE LCP STAINLESS STEEL L277 MM FEMUR PROXI C1713 $12,268.16PLATE BONE LCP STAINLESS STEEL L300 MM TIBIAL LEFT C1713 $11,426.40PLATE BONE LCP STAINLESS STEEL L300 MM TIBIAL RIGH C1713 $11,426.40PLATE BONE LCP STAINLESS STEEL L313 MM FEMUR PROXI C1713 $12,668.40PLATE BONE LCP STAINLESS STEEL L316 MM FEMUR LEFT C1713 $11,426.40PLATE BONE LCP STAINLESS STEEL L316 MM FEMUR RIGHT C1713 $11,426.40PLATE BONE LCP STAINLESS STEEL L349 MM FEMUR PROXI C1713 $12,815.60PLATE BONE LCP STAINLESS STEEL L36 MM X W3.5 MM X C1713 $2,091.81PLATE BONE LCP STAINLESS STEEL L385 MM FEMUR PROXI C1713 $13,243.36PLATE BONE LCP STAINLESS STEEL L391 MM FEMUR LEFT C1713 $10,831.28PLATE BONE LCP STAINLESS STEEL L41 MM TIBIAL LEFT C1713 $7,990.16PLATE BONE LCP STAINLESS STEEL L41 MM TIBIAL RIGHT C1713 $7,990.16PLATE BONE LCP STAINLESS STEEL L421 MM FEMUR PROXI C1713 $13,666.56PLATE BONE LCP STAINLESS STEEL L43 MM TARSOMETATAR C1713 $5,073.71PLATE BONE LCP STAINLESS STEEL L47 MM X W6.3 MM X C1713 $5,054.25PLATE BONE LCP STAINLESS STEEL L48 MM X W6.3 MM X C1713 $5,054.25PLATE BONE LCP STAINLESS STEEL L65 MM X W6.3 MM X C1713 $5,352.05PLATE BONE LCP STAINLESS STEEL L66 MM X W6.3 MM X C1713 $5,352.05PLATE BONE LCP STAINLESS STEEL L73 MM TIBIAL LEFT C1713 $8,017.76PLATE BONE LCP STAINLESS STEEL L73 MM TIBIAL RIGHT C1713 $8,017.76PLATE BONE LCP STAINLESS STEEL L95 MM RADIUS LEFT C1713 $7,296.84PLATE BONE LCP STAINLESS STEEL L95 MM RADIUS RIGHT C1713 $7,296.84PLATE BONE LCP STAINLESS STEEL LARGE X L36 MM FORE C1713 $7,217.02PLATE BONE LCP STAINLESS STEEL LONG CLOVERLEAF L64 C1713 $6,244.56PLATE BONE LCP STAINLESS STEEL LONG L L62 MM FOREF C1713 $6,428.64PLATE BONE LCP STAINLESS STEEL LONG L48 MM FIRST T C1713 $6,872.32PLATE BONE LCP STAINLESS STEEL LONG L76 MM X H2 MM C1713 $5,320.64PLATE BONE LCP STAINLESS STEEL LONG T L61 MM FOREF C1713 $6,244.56PLATE BONE LCP STAINLESS STEEL LONG T L92 MM FOREF C1713 $7,816.32PLATE BONE LCP STAINLESS STEEL MEDIUM X L32 MM FOR C1713 $7,020.06PLATE BONE LCP STAINLESS STEEL MINI L64 MM X H2 MM C1713 $4,454.37PLATE BONE LCP STAINLESS STEEL PEDIATRIC 100 D L73 C1713 $3,730.56PLATE BONE LCP STAINLESS STEEL PEDIATRIC 100 D L90 C1713 $3,877.76PLATE BONE LCP STAINLESS STEEL PEDIATRIC 110 D L73 C1713 $3,730.56PLATE BONE LCP STAINLESS STEEL PEDIATRIC 110 D L90 C1713 $3,877.76PLATE BONE LCP STAINLESS STEEL PEDIATRIC 120 D L75 C1713 $3,730.56PLATE BONE LCP STAINLESS STEEL PEDIATRIC 120 D L95 C1713 $3,877.76PLATE BONE LCP STAINLESS STEEL PEDIATRIC 150 D L58 C1713 $3,730.56

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 ChargePLATE BONE LCP STAINLESS STEEL PEDIATRIC 150 D L74 C1713 $3,877.76PLATE BONE LCP STAINLESS STEEL SHORT BEND L118 MM C1713 $9,224.15PLATE BONE LCP STAINLESS STEEL SHORT CLOVERLEAF L3 C1713 $5,942.48PLATE BONE LCP STAINLESS STEEL SHORT L L37 MM FORE C1713 $6,107.68PLATE BONE LCP STAINLESS STEEL SHORT L69 MM X H2 M C1713 $4,990.91PLATE BONE LCP STAINLESS STEEL SHORT T L35 MM FORE C1713 $6,358.45PLATE BONE LCP STAINLESS STEEL SMALL X L27 MM FORE C1713 $6,560.80PLATE BONE LCP STAINLESS STEEL STANDARD BEND L118 C1713 $9,224.15PLATE BONE LCP STAINLESS STEEL STANDARD CLOVERLEAF C1713 $6,098.24PLATE BONE LCP STAINLESS STEEL STANDARD L L44 MM F C1713 $6,268.16PLATE BONE LCP STAINLESS STEEL STANDARD L39 MM FIR C1713 $6,872.32PLATE BONE LCP STAINLESS STEEL STANDARD T L42 MM F C1713 $6,098.24PLATE BONE LCP STAINLESS STEEL STRAIGHT L112 MM WR C1713 $11,352.80PLATE BONE LCP STAINLESS STEEL STRAIGHT L170 MM WR C1713 $6,996.60PLATE BONE LCP STAINLESS STEEL STRAIGHT L27 MM FOR C1713 $5,314.72PLATE BONE LCP STAINLESS STEEL STRAIGHT L40 MM FOR C1713 $6,015.03PLATE BONE LCP STAINLESS STEEL STRAIGHT WRIST 9 HO C1713 $7,336.96PLATE BONE LCP STAINLESS STEEL XLONG L81 MM X H2 M C1713 $5,502.80PLATE BONE LCP STAINLESS STEEL XS X L24 MM FOREFOO C1713 $6,560.80PLATE BONE LCP TITANIUM H L31 MM X W24 MM HINDFOOT C1713 $5,945.78PLATE BONE LCP TITANIUM H L45 MM X W24 MM HINDFOOT C1713 $5,676.40PLATE BONE LCP TITANIUM L118 MM X W11 MM X H4.2 MM C1713 $6,416.96PLATE BONE LCP TITANIUM L125 MM RADIUS LEFT DISTAL C1713 $9,200.24PLATE BONE LCP TITANIUM L125 MM RADIUS RIGHT DISTA C1713 $9,200.24PLATE BONE LCP TITANIUM L136 MM X W11 MM X H4.2 MM C1713 $6,522.80PLATE BONE LCP TITANIUM L140 MM TIBIAL LEFT PROXIM C1713 $10,828.40PLATE BONE LCP TITANIUM L140 MM TIBIAL RIGHT PROXI C1713 $10,828.40PLATE BONE LCP TITANIUM L154 MM RADIUS LEFT DISTAL C1713 $9,419.76PLATE BONE LCP TITANIUM L154 MM RADIUS RIGHT DISTA C1713 $9,419.76PLATE BONE LCP TITANIUM L154 MM X W11 MM X H4.2 MM C1713 $6,633.20PLATE BONE LCP TITANIUM L156 MM FEMUR LEFT DISTAL C1713 $10,556.96PLATE BONE LCP TITANIUM L156 MM FEMUR RIGHT DISTAL C1713 $10,556.96PLATE BONE LCP TITANIUM L172 MM X W11 MM X H4.2 MM C1713 $6,738.96PLATE BONE LCP TITANIUM L180 MM TIBIAL LEFT PROXIM C1713 $11,049.20PLATE BONE LCP TITANIUM L180 MM TIBIAL RIGHT PROXI C1713 $11,049.20PLATE BONE LCP TITANIUM L184 MM RADIUS LEFT DISTAL C1713 $9,996.00PLATE BONE LCP TITANIUM L184 MM RADIUS RIGHT DISTA C1713 $9,996.00PLATE BONE LCP TITANIUM L190 MM X W11 MM X H4.2 MM C1713 $8,698.56PLATE BONE LCP TITANIUM L196 MM FEMUR LEFT DISTAL C1713 $10,768.56

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 ChargePLATE BONE LCP TITANIUM L196 MM FEMUR RIGHT DISTAL C1713 $10,768.56PLATE BONE LCP TITANIUM L208 MM X W11 MM X H4.2 MM C1713 $8,786.00PLATE BONE LCP TITANIUM L213 MM RADIUS LEFT DISTAL C1713 $10,752.56PLATE BONE LCP TITANIUM L213 MM RADIUS RIGHT DISTA C1713 $10,752.56PLATE BONE LCP TITANIUM L220 MM TIBIA LEFT PROXIMA C1713 $11,274.56PLATE BONE LCP TITANIUM L220 MM TIBIAL LEFT PROXIM C1713 $11,614.96PLATE BONE LCP TITANIUM L220 MM TIBIAL RIGHT PROXI C1713 $11,274.56PLATE BONE LCP TITANIUM L226 MM X W11 MM X H4.2 MM C1713 $8,983.76PLATE BONE LCP TITANIUM L236 MM FEMUR LEFT DISTAL C1713 $10,998.56PLATE BONE LCP TITANIUM L236 MM FEMUR RIGHT DISTAL C1713 $10,998.56PLATE BONE LCP TITANIUM L240 MM RADIUS LEFT DISTAL C1713 $9,886.24PLATE BONE LCP TITANIUM L240 MM RADIUS RIGHT DISTA C1713 $9,886.24PLATE BONE LCP TITANIUM L260 MM TIBIAL LEFT PROXIM C1713 $11,490.80PLATE BONE LCP TITANIUM L260 MM TIBIAL RIGHT PROXI C1713 $11,490.80PLATE BONE LCP TITANIUM L262 MM X W11 MM X H4.2 MM C1713 $9,176.96PLATE BONE LCP TITANIUM L276 MM FEMUR LEFT DISTAL C1713 $11,210.16PLATE BONE LCP TITANIUM L276 MM FEMUR RIGHT DISTAL C1713 $11,210.16PLATE BONE LCP TITANIUM L298 MM X W11 MM X H4.2 MM C1713 $9,347.20PLATE BONE LCP TITANIUM L300 MM TIBIAL LEFT PROXIM C1713 $11,720.80PLATE BONE LCP TITANIUM L300 MM TIBIAL RIGHT PROXI C1713 $11,720.80PLATE BONE LCP TITANIUM L316 MM FEMUR LEFT DISTAL C1713 $11,426.40PLATE BONE LCP TITANIUM L316 MM FEMUR RIGHT DISTAL C1713 $11,426.40PLATE BONE LCP TITANIUM L334 MM X W11 MM X H4.2 MM C1713 $9,770.40PLATE BONE LCP TITANIUM L36 MM X W3.5 MM X H.9 MM C1713 $2,097.60PLATE BONE LCP TITANIUM L39 MM X W5 MM X H1.2 MM C C1713 $2,208.00PLATE BONE LCP TITANIUM L95 MM RADIUS LEFT DISTAL C1713 $8,980.72PLATE BONE LCP TITANIUM L95 MM RADIUS RIGHT DISTAL C1713 $8,980.72PLATE BONE LCP TITANIUM SHORT BEND L118 MM WRIST F C1713 $11,352.80PLATE BONE LCP TITANIUM STANDARD BEND L118 MM WRIS C1713 $11,352.80PLATE BONE LCP TITANIUM STRAIGHT L112 MM WRIST FUS C1713 $11,352.80PLATE BONE LEGACY CROSSLINK CD HORIZON STAINLESS S C1713 $4,800.00PLATE BONE LEGACY CROSSLINK CD HORIZON TITANIUM L1 C1713 $4,800.00PLATE BONE LEGACY X10 CROSSLINK CD HORIZON MULTI-S C1713 $3,250.00PLATE BONE LEGACY X10 CROSSLINK CD HORIZON STAINLE C1713 $4,800.00PLATE BONE LEGACY X10 CROSSLINK CD HORIZON TITANIU C1713 $4,800.00PLATE BONE LEIBINGER UNIVERSAL 2 TITANIUM LARGE WI C1713 $2,566.20PLATE BONE LEIBINGER UNIVERSAL 2 TITANIUM MINI STR C1713 $2,566.48PLATE BONE LEIBINGER UNIVERSAL 2 TITANIUM SMALL WI C1713 $2,327.91PLATE BONE LEIBINGER UNIVERSAL 2 TITANIUM STRAIGHT C1713 $3,795.36

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 ChargePLATE BONE LEIBINGER UNIVERSAL 2 TITANIUM XL CRANI C1713 $1,461.92PLATE BONE LEVEL ONE MATRIXMIDFACE TITANIUM MINI L C1713 $663.04PLATE BONE LEVEL ONE MATRIXMIDFACE TITANIUM MINI M C1713 $1,166.24PLATE BONE LEVEL ONE MATRIXMIDFACE TITANIUM MINI S C1713 $1,586.56PLATE BONE LEVEL ONE MATRIXMIDFACE TITANIUM MINI X C1713 $1,166.24PLATE BONE LEVEL ONE THREADLOCK TS SMART TITANIUM C1713 $2,934.66PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM 120 D C1713 $7,092.16PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM 155 D C1713 $6,843.52PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM 90 D M C1713 $1,089.28PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM ANGLE C1713 $12,881.92PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM CURVE C1713 $2,882.80PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM L43 MM C1713 $3,735.52PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM LEFT A C1713 $11,354.56PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM LONG C C1713 $5,215.52PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI C C1713 $3,220.48PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI H C1713 $1,195.84PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI L C1713 $2,072.00PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI M C1713 $2,563.36PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI R C1713 $3,830.24PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI S C1713 $1,132.80PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI X C1713 $1,166.24PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM MINI Y C1713 $1,195.84PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM RIGHT C1713 $1,089.28PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM SHORT C1713 $2,847.52PLATE BONE LEVEL ONE THREADLOCK TS TITANIUM STRAIG C1713 $5,943.68PLATE BONE LEVEL ONE TITANIUM 100 D MICRO LONG L H C1713 $1,166.24PLATE BONE LEVEL ONE TITANIUM 100 D MINI L H.7 MM C1713 $1,089.28PLATE BONE LEVEL ONE TITANIUM ALUMINUM VANADIUM ST C1713 $2,723.20PLATE BONE LEVEL ONE TITANIUM LONG L H1 MM CRANIOM C1713 $1,858.88PLATE BONE LEVEL ONE TITANIUM MEDIUM L H1 MM CRANI C1713 $1,858.88PLATE BONE LEVEL ONE TITANIUM MICRO REGULAR STRAIG C1713 $734.08PLATE BONE LEVEL ONE TITANIUM MICRO REGULAR T H.6 C1713 $1,166.24PLATE BONE LEVEL ONE TITANIUM MICRO SHORT 2Y H.6 M C1713 $1,337.92PLATE BONE LEVEL ONE TITANIUM MICRO SHORT STRAIGHT C1713 $663.04PLATE BONE LISS TITANIUM L140 MM TIBIAL LEFT PROXI C1713 $11,476.96PLATE BONE LISS TITANIUM L140 MM TIBIAL RIGHT PROX C1713 $11,476.96PLATE BONE LISS TITANIUM L156 MM FEMUR LEFT DISTAL C1713 $11,476.96PLATE BONE LISS TITANIUM L156 MM FEMUR RIGHT DISTA C1713 $11,476.96PLATE BONE LISS TITANIUM L220 MM TIBIAL LEFT PROXI C1713 $9,325.03

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 ChargePLATE BONE LISS TITANIUM L220 MM TIBIAL RIGHT PROX C1713 $11,476.96PLATE BONE LISS TITANIUM L236 MM FEMUR LEFT DISTAL C1713 $11,476.96PLATE BONE LISS TITANIUM L236 MM FEMUR RIGHT DISTA C1713 $11,476.96PLATE BONE LISS TITANIUM L300 MM TIBIAL LEFT PROXI C1713 $11,476.96PLATE BONE LISS TITANIUM L300 MM TIBIAL RIGHT PROX C1713 $11,476.96PLATE BONE LISS TITANIUM L316 MM FEMUR LEFT DISTAL C1713 $11,476.96PLATE BONE LISS TITANIUM L316 MM FEMUR RIGHT DISTA C1713 $11,476.96PLATE BONE LOCKING PLATES STAINLESS STEEL ANKLE 6 C1713 $4,888.00PLATE BONE LONG CALCANEUS MOLD C1713 $344.50PLATE BONE LOW PROFILE MTP PLATE TITANIUM LONG CON C1713 $5,200.00PLATE BONE LOW PROFILE MTP PLATE TITANIUM SHORT CO C1713 $5,200.00PLATE BONE LOW PROFILE MTP PLATE TITANIUM STANDARD C1713 $5,200.00PLATE BONE M3-X TITANIUM ANGLE LEFT L L30 MM 2 X 4 C1713 $2,640.00PLATE BONE M3-X TITANIUM ANGLE RIGHT L L40 MM 2 X C1713 $2,640.00PLATE BONE M3-X TITANIUM OBLIQUE LEFT T L33 MM 2 X C1713 $2,640.00PLATE BONE M3-X TITANIUM OBLIQUE RIGHT T L18 MM HA C1713 $2,640.00PLATE BONE M3-X TITANIUM QUAD L15 MM 2 X 3 HOLE 1. C1713 $2,640.00PLATE BONE M3-X TITANIUM T L30 MM 3 X 4 HOLE COMPR C1713 $928.00PLATE BONE MATRIXMANDIBLE TITANIUM 2 ANGLE LARGE H C1713 $17,496.00PLATE BONE MATRIXMANDIBLE TITANIUM 2 ANGLE MEDIUM C1713 $15,532.80PLATE BONE MATRIXMANDIBLE TITANIUM 2 ANGLE SMALL H C1713 $15,726.00PLATE BONE MATRIXMANDIBLE TITANIUM ANGLE H1.25 MM C1713 $3,678.00PLATE BONE MATRIXMANDIBLE TITANIUM ANGLE H1.5 MM M C1713 $6,834.00PLATE BONE MATRIXMANDIBLE TITANIUM BOX H1 MM MANDI C1713 $2,010.00PLATE BONE MATRIXMANDIBLE TITANIUM BROAD ANGLE H2 C1713 $7,104.00PLATE BONE MATRIXMANDIBLE TITANIUM BROAD CRESCENT C1713 $4,818.00PLATE BONE MATRIXMANDIBLE TITANIUM CRESCENT H1.25 C1713 $3,306.00PLATE BONE MATRIXMANDIBLE TITANIUM CRESCENT H1.5 M C1713 $6,393.60PLATE BONE MATRIXMANDIBLE TITANIUM H1 MM MANDIBLE C1713 $4,590.00PLATE BONE MATRIXMANDIBLE TITANIUM H1.25 MM MANDIB C1713 $4,932.00PLATE BONE MATRIXMANDIBLE TITANIUM LEFT ANGLE H2 M C1713 $13,584.00PLATE BONE MATRIXMANDIBLE TITANIUM LEFT ANGLE H2.5 C1713 $14,622.00PLATE BONE MATRIXMANDIBLE TITANIUM LEFT ANGLE H2.8 C1713 $17,910.00PLATE BONE MATRIXMANDIBLE TITANIUM MINI BROAD H1 M C1713 $3,330.00PLATE BONE MATRIXMANDIBLE TITANIUM MINI CURVE H1 M C1713 $3,948.00PLATE BONE MATRIXMANDIBLE TITANIUM MINI NARROW H1 C1713 $2,568.00PLATE BONE MATRIXMANDIBLE TITANIUM MINI PREBENT H1 C1713 $2,748.00PLATE BONE MATRIXMANDIBLE TITANIUM RIGHT ANGLE H2 C1713 $13,584.00PLATE BONE MATRIXMANDIBLE TITANIUM RIGHT ANGLE H2. C1713 $17,910.00

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 ChargePLATE BONE MATRIXMANDIBLE TITANIUM STRAIGHT H1.25 C1713 $2,332.80PLATE BONE MATRIXMANDIBLE TITANIUM STRAIGHT H1.5 M C1713 $3,775.20PLATE BONE MATRIXMANDIBLE TITANIUM STRAIGHT H2 MM C1713 $3,666.00PLATE BONE MATRIXMANDIBLE TITANIUM STRAIGHT H2.5 M C1713 $6,561.60PLATE BONE MATRIXMANDIBLE TITANIUM STRAIGHT H2.8 M C1713 $8,244.00PLATE BONE MATRIXMIDFACE MATRIXORBITAL TITANIUM LA C1713 $9,090.90PLATE BONE MATRIXMIDFACE MATRIXORBITAL TITANIUM SM C1713 $8,790.60PLATE BONE MATRIXMIDFACE TITANIUM H.2 MM ORBITAL F C1713 $7,012.20PLATE BONE MATRIXMIDFACE TITANIUM H.3 MM ORBITAL F C1713 $7,012.20PLATE BONE MATRIXMIDFACE TITANIUM H.4 MM ORBITAL F C1713 $9,228.00PLATE BONE MATRIXMIDFACE TITANIUM LARGE H.3 MM ORB C1713 $6,758.70PLATE BONE MATRIXMIDFACE TITANIUM MEDIUM H.3 MM OR C1713 $8,318.40PLATE BONE MATRIXMIDFACE TITANIUM SMALL H.3 MM ORB C1713 $6,758.70PLATE BONE MATRIXMIDFACE TITANIUM STANDARD LARGE H C1713 $1,972.80PLATE BONE MATRIXMIDFACE TITANIUM STANDARD LARGE L C1713 $1,602.90PLATE BONE MATRIXMIDFACE TITANIUM STANDARD LARGE T C1713 $1,878.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MEDIUM C1713 $1,602.90PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MICRO 2 C1713 $2,106.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MICRO B C1713 $2,076.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MICRO H C1713 $1,957.80PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MICRO X C1713 $2,076.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MICRO Y C1713 $2,076.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MINI 2Y C1713 $2,106.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MINI BO C1713 $1,583.40PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MINI H C1713 $2,106.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MINI H. C1713 $2,409.60PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MINI L C1713 $2,232.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MINI T C1713 $1,878.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MINI X C1713 $2,076.00PLATE BONE MATRIXMIDFACE TITANIUM STANDARD MINI Y C1713 $2,076.00PLATE BONE MATRIXMIDFACE TITANIUM UNIVERSAL H.4 MM C1713 $8,892.00PLATE BONE MATRIXMIDFACE TITANIUM UNIVERSAL H.5 MM C1713 $8,892.00PLATE BONE MATRIXNEURO TITANIUM 2Y L18 MM X H.4 MM C1713 $1,752.80PLATE BONE MATRIXNEURO TITANIUM 2Y L21 MM X H.4 MM C1713 $1,752.80PLATE BONE MATRIXNEURO TITANIUM BOX L10 MM X W16 M C1713 $1,668.80PLATE BONE MATRIXNEURO TITANIUM BOX L14 MM X W14 M C1713 $1,752.80PLATE BONE MATRIXNEURO TITANIUM BOX L16 MM X W16 M C1713 $1,752.80PLATE BONE MATRIXNEURO TITANIUM CONTOUR H.4 MM OD3 C1713 $5,712.00PLATE BONE MATRIXNEURO TITANIUM CONTOUR H.4 MM OD7 C1713 $11,821.60

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 ChargePLATE BONE MATRIXNEURO TITANIUM CONTOUR L100 MM X C1713 $15,456.00PLATE BONE MATRIXNEURO TITANIUM CONTOUR L200 MM X C1713 $71,876.00PLATE BONE MATRIXNEURO TITANIUM H.4 MM CRANIAL 20 C1713 $3,886.40PLATE BONE MATRIXNEURO TITANIUM H.4 MM CRANIAL 5 H C1713 $1,573.60PLATE BONE MATRIXNEURO TITANIUM H.4 MM CRANIAL 7 H C1713 $1,948.80PLATE BONE MATRIXNEURO TITANIUM H.4 MM CRANIAL CON C1713 $5,242.80PLATE BONE MATRIXNEURO TITANIUM L24 MM X W14 MM X C1713 $3,015.12PLATE BONE MATRIXNEURO TITANIUM L34 MM X W14 MM X C1713 $4,317.60PLATE BONE MATRIXNEURO TITANIUM L38 MM X W45 MM X C1713 $9,928.80PLATE BONE MATRIXNEURO TITANIUM LARGE ARC L78 MM X C1713 $8,898.40PLATE BONE MATRIXNEURO TITANIUM LARGE L55 MM X H.4 C1713 $6,904.80PLATE BONE MATRIXNEURO TITANIUM SMALL ARC L48 MM X C1713 $5,712.00PLATE BONE MATRIXNEURO TITANIUM STRAIGHT L12 MM X C1713 $349.60PLATE BONE MATRIXNEURO TITANIUM STRAIGHT L24 MM X C1713 $463.04PLATE BONE MATRIXNEURO TITANIUM STRAIGHT L9 MM X H C1713 $459.20PLATE BONE MATRIXNEURO TITANIUM X H.4 MM CRANIAL 4 C1713 $1,752.80PLATE BONE MATRIXNEURO TITANIUM Y H.4 MM CRANIAL 5 C1713 $992.16PLATE BONE MATRIXORTHOGNATHIC TITANIUM 10 MM LEFT C1713 $3,060.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 10 MM OFFSE C1713 $2,496.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 10 MM RIGHT C1713 $3,060.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 2 MM LEFT O C1713 $2,870.40PLATE BONE MATRIXORTHOGNATHIC TITANIUM 2 MM RIGHT C1713 $3,060.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 4 MM LEFT O C1713 $3,060.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 4 MM OFFSET C1713 $2,496.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 4 MM RIGHT C1713 $3,060.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 6 MM LEFT O C1713 $2,870.40PLATE BONE MATRIXORTHOGNATHIC TITANIUM 6 MM OFFSET C1713 $2,496.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 6 MM RIGHT C1713 $3,060.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 8 MM LEFT O C1713 $2,870.40PLATE BONE MATRIXORTHOGNATHIC TITANIUM 8 MM OFFSET C1713 $2,496.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 8 MM RIGHT C1713 $3,060.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 90 D LONG L C1713 $1,830.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 90 D MEDIUM C1713 $1,830.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM 90 D SHORT C1713 $1,723.20PLATE BONE MATRIXORTHOGNATHIC TITANIUM CURVE L10 M C1713 $2,658.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM CURVE L12 M C1713 $2,491.20PLATE BONE MATRIXORTHOGNATHIC TITANIUM CURVE L6 MM C1713 $2,658.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM CURVE L8 MM C1713 $2,491.20PLATE BONE MATRIXORTHOGNATHIC TITANIUM L33 MM X H. C1713 $3,345.60

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 ChargePLATE BONE MATRIXORTHOGNATHIC TITANIUM LONG L L12 C1713 $1,998.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM LONG L OBLI C1713 $1,908.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM MEDIUM L L8 C1713 $1,998.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM MEDIUM L OB C1713 $1,908.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM SHORT L L4 C1713 $1,998.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM SHORT L OBL C1713 $1,908.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM STRAIGHT L1 C1713 $2,616.00PLATE BONE MATRIXORTHOGNATHIC TITANIUM STRAIGHT L6 C1713 $2,452.80PLATE BONE MATRIXORTHOGNATHIC TITANIUM STRAIGHT L8 C1713 $2,616.00PLATE BONE MATRIXRIB TITANIUM H1.5 MM EIGHTH RIB N C1713 $11,369.60PLATE BONE MATRIXRIB TITANIUM H1.5 MM FOURTH RIB F C1713 $11,369.60PLATE BONE MATRIXRIB TITANIUM H1.5 MM SIXTH RIB SE C1713 $11,369.60PLATE BONE MATRIXRIB TITANIUM H1.5 MM THIRD RIB LE C1713 $11,369.60PLATE BONE MATRIXRIB TITANIUM H1.5 MM THIRD RIB RI C1713 $11,369.60PLATE BONE MATRIXRIB TITANIUM UNIVERSAL 8 HOLE NON C1713 $7,745.20PLATE BONE MAXAN TITANIUM ALUMINUM VANADIUM PRECON C1713 $5,200.00PLATE BONE MAXAN TITANIUM PRECONTOUR L30 MM SPINE C1713 $5,200.00PLATE BONE NCB PROTASUL-64 95 D SCALLOP L278 MM FE C1713 $6,422.00PLATE BONE NCB PROTASUL-64 L167 MM FEMUR LEFT DIST C1713 $6,489.60PLATE BONE NEURO LOW PROFILE TITANIUM 2Y L18 MM X C1713 $1,652.00PLATE BONE NEURO LOW PROFILE TITANIUM 2Y L21 MM X C1713 $1,652.00PLATE BONE NEURO LOW PROFILE TITANIUM BOX L14 MM X C1713 $1,652.00PLATE BONE NEURO LOW PROFILE TITANIUM BOX L16 MM X C1713 $1,652.00PLATE BONE NEURO LOW PROFILE TITANIUM CONTOUR H.4 C1713 $4,076.80PLATE BONE NEURO LOW PROFILE TITANIUM CURVE OBLIQU C1713 $2,178.00PLATE BONE NEURO LOW PROFILE TITANIUM H.4 MM OD100 C1713 $13,927.20PLATE BONE NEURO LOW PROFILE TITANIUM H.4 MM OD30 C1713 $5,404.00PLATE BONE NEURO LOW PROFILE TITANIUM H.4 MM OD70 C1713 $11,172.00PLATE BONE NEURO LOW PROFILE TITANIUM H.5 MM CRANI C1713 $3,662.40PLATE BONE NEURO LOW PROFILE TITANIUM H.6 MM OD100 C1713 $13,927.20PLATE BONE NEURO LOW PROFILE TITANIUM H.6 MM OD30 C1713 $5,404.00PLATE BONE NEURO LOW PROFILE TITANIUM H.6 MM OD70 C1713 $11,172.00PLATE BONE NEURO LOW PROFILE TITANIUM L LEFT OBLIQ C1713 $1,818.00PLATE BONE NEURO LOW PROFILE TITANIUM L RIGHT OBLI C1713 $1,818.00PLATE BONE NEURO LOW PROFILE TITANIUM L100 MM X W1 C1713 $10,098.88PLATE BONE NEURO LOW PROFILE TITANIUM L200 MM X W2 C1713 $56,823.20PLATE BONE NEURO LOW PROFILE TITANIUM L45 MM X W38 C1713 $9,385.60PLATE BONE NEURO LOW PROFILE TITANIUM LARGE ARC H. C1713 $8,411.20PLATE BONE NEURO LOW PROFILE TITANIUM LARGE H.4 MM C1713 $4,519.68

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 ChargePLATE BONE NEURO LOW PROFILE TITANIUM MEDIUM H.4 M C1713 $5,404.00PLATE BONE NEURO LOW PROFILE TITANIUM SMALL ARC H. C1713 $5,404.00PLATE BONE NEURO LOW PROFILE TITANIUM STRAIGHT L12 C1713 $324.80PLATE BONE NEURO LOW PROFILE TITANIUM STRAIGHT L21 C1713 $414.40PLATE BONE NEURO LOW PROFILE TITANIUM STRAIGHT L9 C1713 $324.80PLATE BONE NEURO LOW PROFILE TITANIUM X H.5 MM CRA C1713 $1,652.00PLATE BONE NEURO LOW PROFILE TITANIUM Y H.5 MM CRA C1713 $1,652.00PLATE BONE NI-LOCK L10 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE NI-LOCK L12 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE NI-LOCK L16 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE NI-LOCK L18 MM SPINE CERVICAL ANTERIOR C1713 $4,550.00PLATE BONE OLECRANON 10 HOLE MOLD C1713 $455.00PLATE BONE OLECRANON 12 HOLE MOLD C1713 $455.00PLATE BONE OLECRANON 6 HOLE MOLD C1713 $344.50PLATE BONE OLECRANON 8 HOLE MOLD C1713 $390.00PLATE BONE OMEGA 3 STAINLESS STEEL 130 D STANDARD C1713 $2,714.40PLATE BONE OPTILOCK L333 MM FEMUR RIGHT DISTAL LAT C1713 $7,983.56PLATE BONE OPTIO-C H6 MM SPINE STERILE C1713 $3,250.00PLATE BONE OPTIO-C H7 MM SPINE STERILE C1713 $3,250.00PLATE BONE OPTIO-C H8 MM SPINE STERILE C1713 $3,250.00PLATE BONE ORTHOLOC TITANIUM T L34/41 MM X W5 MM X C1713 $2,502.50PLATE BONE PASS LP LARGE SPINE 1 LEVEL ROD NONSTER C1713 $5,600.00PLATE BONE PASS LP LARGE SPINE 2 LEVEL ROD NONSTER C1713 $5,600.00PLATE BONE PASS LP SMALL SPINE 1 LEVEL ROD NONSTER C1713 $5,600.00PLATE BONE PASS LP SMALL SPINE 2 LEVEL ROD NONSTER C1713 $5,600.00PLATE BONE PASS LP SPINE SACRAL LEFT NONSTERILE C1713 $5,600.00PLATE BONE PASS LP SPINE SACRAL RIGHT NONSTERILE C1713 $5,600.00PLATE BONE PEANUT TITANIUM ARCH L12 MM EPIPHYSIS L C1713 $2,084.16PLATE BONE PEANUT TITANIUM ARCH L16 MM EPIPHYSIS L C1713 $2,084.16PLATE BONE PEANUT TITANIUM L12 MM EPIPHYSIS LOW PR C1713 $2,084.16PLATE BONE PEANUT TITANIUM L16 MM EPIPHYSIS LOW PR C1713 $2,084.16PLATE BONE PEDIATRIC 100 D L1 7/8 IN HIP 2 HOLE OS C1713 $3,032.40PLATE BONE PEDIATRIC 100 D L2 5/8 IN HIP 3 HOLE OS C1713 $3,032.40PLATE BONE PEDIATRIC 100 D L3 3/8 IN HIP 4 HOLE OS C1713 $3,032.40PLATE BONE PEDIATRIC 120 D L1 7/8 IN HIP 2 HOLE OS C1713 $3,032.40PLATE BONE PEDIATRIC 120 D L2 5/8 IN HIP 3 HOLE OS C1713 $3,032.40PLATE BONE PEDIATRIC 120 D L3 3/8 IN HIP 4 HOLE OS C1713 $3,032.40PLATE BONE PEDIATRIC 150 D L1 7/8 IN HIP 2 HOLE OS C1713 $3,032.40PLATE BONE PEDIATRIC 150 D L2 5/8 IN HIP 3 HOLE OS C1713 $3,032.40

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 ChargePLATE BONE PEDIATRIC 150 D L3 3/8 IN HIP 4 HOLE OS C1713 $3,032.40PLATE BONE PEDIPLATES STAINLESS STEEL PEDIATRIC I C1713 $4,384.00PLATE BONE PEDIPLATES STAINLESS STEEL PEDIATRIC O C1713 $4,384.00PLATE BONE PERI TIMAX OFFSET SPIDER W25 MM LOWER E C1713 $580.13PLATE BONE PIRANHA TITANIUM ALUMINUM VANADIUM LORD C1713 $4,550.00PLATE BONE PLYMOUTH L19 MM SPINE THORACOLUMBAR NON C1713 $13,000.00PLATE BONE PLYMOUTH L21 MM SPINE THORACOLUMBAR NON C1713 $13,000.00PLATE BONE PROLOCK II RADIUS RIGHT 5 HOLE C1713 $1,924.65PLATE BONE PROLOCK II TITANIUM L49 MM RADIAL RIGHT C1713 $1,924.65PLATE BONE PROLOCK II TITANIUM L49 MM X W11-25 MM C1713 $1,924.65PLATE BONE PROLOCK II TITANIUM L63 MM RADIAL LEFT C1713 $1,924.65PLATE BONE PROLOCK II TITANIUM L63 MM RADIAL RIGHT C1713 $1,924.65PLATE BONE PROLOCK II TITANIUM PRECONTOUR L63 MM R C1713 $1,924.65PLATE BONE PROLOCK SMALL 4 HOLE MOLD C1713 $344.50PLATE BONE PROLOCK SMALL 6 HOLE MOLD C1713 $344.50PLATE BONE PROLOCK SMALL L25 MM RADIUS RIGHT 4 HOL C1713 $1,877.66PLATE BONE PROLOCK SMALL RADIUS RIGHT 6 HOLE LOCK C1713 $1,877.66PLATE BONE PROLOCK TITANIUM OBLONG L103 MM X W10 M C1713 $2,135.25PLATE BONE PROLOCK TITANIUM OBLONG L133 MM X W10 M C1713 $2,232.75PLATE BONE PROLOCK TITANIUM OBLONG L83 MM X W10 MM C1713 $2,135.25PLATE BONE PROLOCK TITANIUM SMALL L25 MM RADIAL RI C1713 $1,877.66PLATE BONE PROLOCK TITANIUM SMALL L25 MM RADIAL ST C1713 $1,877.66PLATE BONE PROLOCK TITANIUM SMALL RADIAL RIGHT 10 C1713 $2,301.00PLATE BONE PROLOCK TITANIUM WIDE L32 MM RADIAL STY C1713 $1,877.66PLATE BONE PROLOCK TITANIUM WIDE RADIAL LEFT 8 HOL C1713 $2,184.00PLATE BONE PROLOCK WIDE 4 HOLE MOLD C1713 $344.50PLATE BONE PROLOCK WIDE 6 HOLE MOLD C1713 $344.50PLATE BONE PRO-PAK STAINLESS STEEL H L22 MM LEFT 8 C1713 $1,845.71PLATE BONE PRO-PAK STAINLESS STEEL H L22 MM RIGHT C1713 $1,845.71PLATE BONE PRO-PAK STAINLESS STEEL STRAIGHT L29 MM C1713 $1,530.70PLATE BONE PRO-PAK STAINLESS STEEL STRAIGHT L35 MM C1713 $1,683.32PLATE BONE PRO-PAK STAINLESS STEEL STRAIGHT L59 MM C1713 $1,934.30PLATE BONE PRO-PAK STAINLESS STEEL T L44 MM X W4 M C1713 $1,771.92PLATE BONE PRO-PAK STAINLESS STEEL T L53 MM X W5 M C1713 $1,845.71PLATE BONE PRO-PAK STAINLESS STEEL Y L55 MM X W5 M C1713 $2,013.06PLATE BONE PRO-PAK TITANIUM H L22 MM LEFT 8 HOLE L C1713 $1,724.96PLATE BONE PRO-PAK TITANIUM H L22 MM RIGHT 8 HOLE C1713 $1,845.71PLATE BONE PRO-PAK TITANIUM STRAIGHT L29 MM X W3.8 C1713 $1,162.33PLATE BONE PRO-PAK TITANIUM STRAIGHT L35 MM X W5 M C1713 $1,573.20

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 ChargePLATE BONE PRO-PAK TITANIUM STRAIGHT L59 MM X W3.8 C1713 $1,571.62PLATE BONE PRO-PAK TITANIUM STRAIGHT L71 MM X W5 M C1713 $1,635.61PLATE BONE PRO-PAK TITANIUM T L44 MM X W4 MM X H1 C1713 $1,656.00PLATE BONE PRO-PAK TITANIUM T L53 MM X W5 MM X H1. C1713 $1,845.71PLATE BONE PRO-PAK TITANIUM Y L55 MM X W5 MM X H1. C1713 $1,881.36PLATE BONE RADIUS 7 HOLE STRAIGHT C1713 $1,410.83PLATE BONE RAPIDSORB 2Y L28.7 MM X W18.7 MM X H.8 C1713 $2,616.00PLATE BONE RAPIDSORB BOX L15 MM X W15 MM CRANIOMAX C1713 $2,616.00PLATE BONE RAPIDSORB H.5 MM OD100 MM CRANIOMAXILLO C1713 $18,945.60PLATE BONE RAPIDSORB H.5 MM OD50 MM CRANIOMAXILLOF C1713 $12,544.00PLATE BONE RAPIDSORB H.8 MM OD100 MM CRANIOMAXILLO C1713 $19,948.80PLATE BONE RAPIDSORB H.8 MM OD50 MM CRANIOMAXILLOF C1713 $13,048.00PLATE BONE RAPIDSORB H1.2 MM OD50 MM CRANIOMAXILLO C1713 $14,232.00PLATE BONE RAPIDSORB L OBLIQUE LEFT L45.6 MM X W21 C1713 $2,616.00PLATE BONE RAPIDSORB L OBLIQUE RIGHT L45.6 MM X W2 C1713 $2,616.00PLATE BONE RAPIDSORB L100 MM X W100 MM X H.5 MM CR C1713 $24,416.00PLATE BONE RAPIDSORB L100 MM X W100 MM X H.8 MM CR C1713 $27,232.00PLATE BONE RAPIDSORB L102 MM X W7 MM X H1.2 MM CRA C1713 $2,078.40PLATE BONE RAPIDSORB L108 MM X W13 MM X H1.2 MM CR C1713 $5,984.00PLATE BONE RAPIDSORB L150 MM X W150 MM X H.8 MM CR C1713 $32,452.80PLATE BONE RAPIDSORB L24 MM X W24 MM X H.5 MM ORBI C1713 $7,120.00PLATE BONE RAPIDSORB L25 MM X W7 MM X H.5 MM SELLA C1713 $2,400.00PLATE BONE RAPIDSORB L25 MM X W7 MM X H.8 MM SELLA C1713 $2,400.00PLATE BONE RAPIDSORB L30 MM X W30 MM X H.5 MM ORBI C1713 $7,408.00PLATE BONE RAPIDSORB L34 MM X W6 MM X H.8 MM CRANI C1713 $1,944.00PLATE BONE RAPIDSORB L40.2 MM X W6 MM X H.8 MM ORB C1713 $2,616.00PLATE BONE RAPIDSORB L42 MM X W7 MM X H1.2 MM CRAN C1713 $2,024.00PLATE BONE RAPIDSORB L48 MM X W48 MM X H1.2 MM CRA C1713 $13,048.00PLATE BONE RAPIDSORB L48.4 MM X W7 MM X H1.2 MM OR C1713 $2,616.00PLATE BONE RAPIDSORB L50 MM X W11 MM X H.8 MM CRAN C1713 $4,592.00PLATE BONE RAPIDSORB L50 MM X W50 MM X H.25 MM CRA C1713 $12,544.00PLATE BONE RAPIDSORB L50 MM X W50 MM X H.5 MM CRAN C1713 $11,448.00PLATE BONE RAPIDSORB L50 MM X W50 MM X H.8 MM CRAN C1713 $11,960.00PLATE BONE RAPIDSORB L60 MM X W13 MM X H1.2 MM CRA C1713 $4,848.00PLATE BONE RAPIDSORB L78 MM X W78 MM X H1.2 MM CRA C1713 $20,376.00PLATE BONE RAPIDSORB L82 MM X W6 MM X H.8 MM CRANI C1713 $2,824.00PLATE BONE RAPIDSORB L90 MM X W11 MM X H.8 MM CRAN C1713 $5,688.00PLATE BONE RAPIDSORB LARGE L35 MM X W35 MM X H.5 M C1713 $7,664.00PLATE BONE RAPIDSORB MEDIUM L30 MM X W30 MM X H.5 C1713 $5,169.60

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 ChargePLATE BONE RAPIDSORB POLY STRAIGHT L100 MM X W100 C1713 $24,416.00PLATE BONE RAPIDSORB POLY STRAIGHT L50 MM X W50 MM C1713 $11,448.00PLATE BONE RAPIDSORB POLY STRAIGHT L75 MM X W75 MM C1713 $17,432.00PLATE BONE RAPIDSORB SCALLOP L50 MM X W10 MM X H.8 C1713 $4,600.00PLATE BONE RAPIDSORB SCALLOP L90 MM X W10 MM X H.8 C1713 $5,688.00PLATE BONE RAPIDSORB SMALL L24 MM X W24 MM X H.5 M C1713 $7,072.00PLATE BONE RAPIDSORB STRAIGHT L18 MM X W6 MM X H.8 C1713 $1,184.00PLATE BONE RAPIDSORB STRAIGHT L19 MM X W7 MM X H1. C1713 $1,224.00PLATE BONE RAPIDSORB STRAIGHT L26 MM X W6 MM X H.8 C1713 $1,728.00PLATE BONE RAPIDSORB T L18 MM X W14 MM X H.8 MM CR C1713 $2,616.00PLATE BONE RAPIDSORB X L14.1 MM X H.8 MM CRANIOMAX C1713 $1,752.00PLATE BONE RAPIDSORB X L19 MM X W24 MM X H.8 MM CR C1713 $2,488.00PLATE BONE RAPIDSORB Y L32.7 MM X W24.4 MM X H.8 M C1713 $2,616.00PLATE BONE RAPIDSORB Y L39.8 MM X W29.6 MM X H1.2 C1713 $2,616.00PLATE BONE ROI-A PEEK-OPTIMA MEDIUM H16 MM SPINE L C1713 $14,625.00PLATE BONE ROI-A PEEK-OPTIMA SHORT H13 MM SPINE LO C1713 $14,625.00PLATE BONE ROI-A PEEK-OPTIMA SHORT SPINE LOCK ANCH C1713 $14,625.00PLATE BONE ROI-C STANDARD H5-7 MM SPINE 2 LEVEL LO C1713 $4,712.50PLATE BONE SHORT CALCANEUS MOLD C1713 $344.50PLATE BONE SHORT SPINE STARTER AWL STERILE 5-7 MM C1713 $2,600.00PLATE BONE SMALL 4 HOLE MOLD PILON C1713 $390.00PLATE BONE SMALL 6 HOLE MOLD PILON C1713 $455.00PLATE BONE SMALL 8 HOLE MOLD PILON C1713 $455.00PLATE BONE SMALL HUMERAL 3 HOLE HEAD MOLD C1713 $390.00PLATE BONE SMALL HUMERAL 4 HOLE HEAD MOLD C1713 $455.00PLATE BONE SMALL T OBLIQUE ANGLE L39 MM 3 HOLE HEA C1713 $971.75PLATE BONE SMALL T OBLIQUE L39 MM 3 HOLE HEAD 3 HO C1713 $971.75PLATE BONE SMART LOCK LEIBINGER UNIVERSAL 2 TITANI C1713 $712.88PLATE BONE SNOWCAP TITANIUM PRECONTOUR L20 MM X W1 C1713 $4,550.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L22 MM X W1 C1713 $4,550.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L24 MM X W1 C1713 $4,550.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L36 MM X W1 C1713 $4,550.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L38 MM X W1 C1713 $4,550.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L41 MM X W1 C1713 $4,550.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L44 MM X W1 C1713 $4,550.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L53 MM X W1 C1713 $5,200.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L56 MM X W1 C1713 $5,200.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L68 MM X W1 C1713 $5,200.00PLATE BONE SNOWCAP TITANIUM PRECONTOUR L72 MM X W1 C1713 $5,200.00

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 ChargePLATE BONE SPIDER TITANIUM L22 MM SPINE CERVICAL A C1713 $5,850.00PLATE BONE SPIDER TITANIUM L24 MM SPINE CERVICAL A C1713 $5,850.00PLATE BONE SPIDER TITANIUM L39 MM SPINE CERVICAL A C1713 $6,175.00PLATE BONE SPS STAINLESS STEEL 1/3 TUBULAR L77 MM C1713 $284.77PLATE BONE SPS STAINLESS STEEL L120 MM 10 HOLE REC C1713 $2,046.98PLATE BONE STAINLESS STEEL 1/4 TUBULAR L23 MM X W7 C1713 $580.80PLATE BONE STAINLESS STEEL 1/4 TUBULAR L31 MM X W7 C1713 $620.17PLATE BONE STAINLESS STEEL 1/4 TUBULAR L39 MM X W7 C1713 $611.76PLATE BONE STAINLESS STEEL 1/4 TUBULAR L47 MM X W7 C1713 $708.77PLATE BONE STAINLESS STEEL 1/4 TUBULAR L55 MM X W7 C1713 $757.99PLATE BONE STAINLESS STEEL 1/4 TUBULAR L63 MM X W7 C1713 $782.56PLATE BONE STAINLESS STEEL 100 D BARREL HIP 3 HOLE C1713 $1,803.06PLATE BONE STAINLESS STEEL 108 MM RADIUS CURVE L10 C1713 $3,192.40PLATE BONE STAINLESS STEEL 108 MM RADIUS CURVE L13 C1713 $3,445.36PLATE BONE STAINLESS STEEL 108 MM RADIUS CURVE L15 C1713 $3,716.80PLATE BONE STAINLESS STEEL 108 MM RADIUS CURVE L18 C1713 $3,997.36PLATE BONE STAINLESS STEEL 108 MM RADIUS CURVE L20 C1713 $4,278.00PLATE BONE STAINLESS STEEL 108 MM RADIUS CURVE L78 C1713 $2,939.36PLATE BONE STAINLESS STEEL 88 MM RADIUS CURVE L104 C1713 $3,192.40PLATE BONE STAINLESS STEEL 88 MM RADIUS CURVE L130 C1713 $3,445.36PLATE BONE STAINLESS STEEL 88 MM RADIUS CURVE L156 C1713 $3,716.80PLATE BONE STAINLESS STEEL 88 MM RADIUS CURVE L182 C1713 $3,997.36PLATE BONE STAINLESS STEEL 88 MM RADIUS CURVE L208 C1713 $4,278.00PLATE BONE STAINLESS STEEL 88 MM RADIUS CURVE L78 C1713 $2,939.36PLATE BONE STAINLESS STEEL 88 MM RADIUS J L130 MM C1713 $4,894.40PLATE BONE STAINLESS STEEL 88 MM RADIUS J L156 MM C1713 $5,170.40PLATE BONE STAINLESS STEEL 88 MM RADIUS J L182 MM C1713 $5,450.96PLATE BONE STAINLESS STEEL 88 MM RADIUS J L208 MM C1713 $5,763.76PLATE BONE STAINLESS STEEL 90 D L106 MM L30 MM X W C1713 $6,968.96PLATE BONE STAINLESS STEEL 90 D L106 MM L35 MM X W C1713 $6,968.96PLATE BONE STAINLESS STEEL 90 D L106 MM L40 MM X W C1713 $6,968.96PLATE BONE STAINLESS STEEL 90 D L106 MM L45 MM X W C1713 $6,968.96PLATE BONE STAINLESS STEEL 90 D L132 MM L30 MM X W C1713 $7,382.96PLATE BONE STAINLESS STEEL 90 D L132 MM L35 MM X W C1713 $7,382.96PLATE BONE STAINLESS STEEL 90 D L132 MM L40 MM X W C1713 $7,382.96PLATE BONE STAINLESS STEEL 90 D L132 MM L45 MM X W C1713 $7,382.96PLATE BONE STAINLESS STEEL 90 D L30 MM X W11.7 MM C1713 $6,237.60PLATE BONE STAINLESS STEEL 90 D L40 MM X W11.7 MM C1713 $6,237.60PLATE BONE STAINLESS STEEL 90 D L50 MM X W11.7 MM C1713 $6,237.60

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 ChargePLATE BONE STAINLESS STEEL 90 D L54 MM L30 MM X W9 C1713 $5,888.00PLATE BONE STAINLESS STEEL 90 D L54 MM L35 MM X W9 C1713 $5,888.00PLATE BONE STAINLESS STEEL 90 D L54 MM L40 MM X W9 C1713 $5,888.00PLATE BONE STAINLESS STEEL 90 D L54 MM L45 MM X W9 C1713 $5,888.00PLATE BONE STAINLESS STEEL 90 D L60 MM X W11.7 MM C1713 $6,237.60PLATE BONE STAINLESS STEEL 90 D L67 MM L30 MM X W9 C1713 $6,223.76PLATE BONE STAINLESS STEEL 90 D L67 MM L35 MM X W9 C1713 $6,223.76PLATE BONE STAINLESS STEEL 90 D L67 MM L40 MM X W9 C1713 $6,223.76PLATE BONE STAINLESS STEEL 90 D L67 MM L45 MM X W9 C1713 $6,223.76PLATE BONE STAINLESS STEEL 90 D L80 MM L30 MM X W9 C1713 $6,495.20PLATE BONE STAINLESS STEEL 90 D L80 MM L35 MM X W9 C1713 $6,495.20PLATE BONE STAINLESS STEEL 90 D L80 MM L40 MM X W9 C1713 $6,495.20PLATE BONE STAINLESS STEEL 90 D L80 MM L45 MM X W9 C1713 $6,495.20PLATE BONE STAINLESS STEEL BROAD L135 MM 8 HOLE NO C1713 $2,808.96PLATE BONE STAINLESS STEEL BROAD L155 MM 8 HOLE NO C1713 $2,808.96PLATE BONE STAINLESS STEEL BROAD L165 MM 8 HOLE NO C1713 $2,808.96PLATE BONE STAINLESS STEEL BROAD L179 MM 10 HOLE N C1713 $2,900.16PLATE BONE STAINLESS STEEL BROAD L199 MM 10 HOLE N C1713 $3,240.64PLATE BONE STAINLESS STEEL BROAD L209 MM 10 HOLE N C1713 $3,240.64PLATE BONE STAINLESS STEEL BROAD L249 MM 10 HOLE N C1713 $3,374.40PLATE BONE STAINLESS STEEL BUTTON L17 MM X W10 MM C1713 $2,175.23PLATE BONE STAINLESS STEEL CONTOUR 4 HOLE LOCK ATT C1713 $3,399.36PLATE BONE STAINLESS STEEL CONTOUR 4 HOLE LOW PROF C1713 $3,399.36PLATE BONE STAINLESS STEEL CONTOUR 8 HOLE LOCK ATT C1713 $3,716.80PLATE BONE STAINLESS STEEL CONTOUR 8 HOLE LOW PROF C1713 $3,716.80PLATE BONE STAINLESS STEEL CUBOID LOW PROFILE PREC C1713 $2,711.98PLATE BONE STAINLESS STEEL FOOT LEFT CUBOID LOCK N C1713 $5,290.00PLATE BONE STAINLESS STEEL FOOT LEFT CUBOID LOCK S C1713 $5,630.40PLATE BONE STAINLESS STEEL FOOT NAVICULAR LOCK NON C1713 $5,437.20PLATE BONE STAINLESS STEEL FOOT NAVICULAR LOCK STE C1713 $5,777.60PLATE BONE STAINLESS STEEL FOOT RIGHT CUBOID LOCK C1713 $5,290.00PLATE BONE STAINLESS STEEL FOOT TALUS LOCK NONSTER C1713 $5,230.16PLATE BONE STAINLESS STEEL FOOT TALUS LOCK STERILE C1713 $5,570.56PLATE BONE STAINLESS STEEL H L19 MM X H.5 MM HAND C1713 $1,724.96PLATE BONE STAINLESS STEEL H L6 MM X W8.2 MM L9 MM C1713 $1,624.26PLATE BONE STAINLESS STEEL L104 MM FIBULA LEFT DIS C1713 $4,712.50PLATE BONE STAINLESS STEEL L104 MM FIBULA RIGHT DI C1713 $4,712.50PLATE BONE STAINLESS STEEL L110 MM TROCHANTER 3 HO C1713 $5,499.52PLATE BONE STAINLESS STEEL L111 MM TIBIAL LEFT PRO C1713 $8,348.96

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 ChargePLATE BONE STAINLESS STEEL L111 MM TIBIAL RIGHT PR C1713 $8,348.96PLATE BONE STAINLESS STEEL L112 MM X W8 MM X H3.3 C1713 $2,985.36PLATE BONE STAINLESS STEEL L121 MM X W11 MM X H3.3 C1713 $4,365.36PLATE BONE STAINLESS STEEL L128 MM X W8 MM X H3.3 C1713 $3,247.60PLATE BONE STAINLESS STEEL L130 MM FIBULA LEFT DIS C1713 $5,167.50PLATE BONE STAINLESS STEEL L130 MM FIBULA RIGHT DI C1713 $5,167.50PLATE BONE STAINLESS STEEL L137 MM TIBIA RIGHT PRO C1713 $8,394.96PLATE BONE STAINLESS STEEL L137 MM TIBIAL LEFT PRO C1713 $8,394.96PLATE BONE STAINLESS STEEL L137 MM TIBIAL RIGHT PR C1713 $8,735.36PLATE BONE STAINLESS STEEL L144 MM X W8 MM X H3.3 C1713 $4,584.32PLATE BONE STAINLESS STEEL L147 MM X W11 MM X H3.3 C1713 $4,981.76PLATE BONE STAINLESS STEEL L160 MM X W8 MM X H3.3 C1713 $4,912.64PLATE BONE STAINLESS STEEL L163 MM TIBIAL LEFT PRO C1713 $8,712.40PLATE BONE STAINLESS STEEL L163 MM TIBIAL RIGHT PR C1713 $9,052.80PLATE BONE STAINLESS STEEL L173 MM X W11 MM X H3.3 C1713 $5,561.36PLATE BONE STAINLESS STEEL L176 MM X W8 MM X H3.3 C1713 $5,721.28PLATE BONE STAINLESS STEEL L180 MM FIBULA RIGHT DI C1713 $5,590.00PLATE BONE STAINLESS STEEL L189 MM TIBIAL LEFT PRO C1713 $8,896.40PLATE BONE STAINLESS STEEL L189 MM TIBIAL RIGHT PR C1713 $8,896.40PLATE BONE STAINLESS STEEL L192 MM X W8 MM X H3.3 C1713 $6,438.72PLATE BONE STAINLESS STEEL L199 MM X W11 MM X H3.3 C1713 $6,210.00PLATE BONE STAINLESS STEEL L215 MM TIBIAL LEFT PRO C1713 $9,080.40PLATE BONE STAINLESS STEEL L215 MM TIBIAL RIGHT PR C1713 $9,080.40PLATE BONE STAINLESS STEEL L225 MM X W11 MM X H3.3 C1713 $7,028.80PLATE BONE STAINLESS STEEL L251 MM X W11 MM X H3.3 C1713 $7,672.80PLATE BONE STAINLESS STEEL L254 MM TROCHANTERIC LA C1713 $21,040.50PLATE BONE STAINLESS STEEL L31 MM X H1.2 MM HINDFO C1713 $1,656.00PLATE BONE STAINLESS STEEL L310 MM TROCHANTERIC 11 C1713 $6,577.48PLATE BONE STAINLESS STEEL L45 MM X H1.2 MM HINDFO C1713 $1,711.20PLATE BONE STAINLESS STEEL L48 MM X W8 MM X H3.3 M C1713 $2,125.20PLATE BONE STAINLESS STEEL L57 MM X H1.25 MM CONDY C1713 $2,037.71PLATE BONE STAINLESS STEEL L57 MM X W7 MM X H1.5 M C1713 $1,964.16PLATE BONE STAINLESS STEEL L60 MM TIBIAL LEFT PROX C1713 $8,059.20PLATE BONE STAINLESS STEEL L60 MM TIBIAL RIGHT PRO C1713 $8,059.20PLATE BONE STAINLESS STEEL L64 MM X W8 MM X H2.5 M C1713 $2,447.20PLATE BONE STAINLESS STEEL L64 MM X W8 MM X H3.3 M C1713 $2,198.80PLATE BONE STAINLESS STEEL L72 MM X W8 MM X H2.5 M C1713 $2,534.56PLATE BONE STAINLESS STEEL L79 MM FIBULA LEFT DIST C1713 $3,575.00PLATE BONE STAINLESS STEEL L79 MM FIBULA RIGHT DIS C1713 $3,575.00

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 ChargePLATE BONE STAINLESS STEEL L80 MM X W8 MM X H3.3 M C1713 $2,350.56PLATE BONE STAINLESS STEEL L85 MM TIBIA LEFT PROXI C1713 $8,427.20PLATE BONE STAINLESS STEEL L85 MM TIBIAL LEFT PROX C1713 $8,086.80PLATE BONE STAINLESS STEEL L85 MM TIBIAL RIGHT PRO C1713 $8,086.80PLATE BONE STAINLESS STEEL L91 MM FIBULA LEFT DIST C1713 $4,225.00PLATE BONE STAINLESS STEEL L91 MM FIBULA RIGHT DIS C1713 $4,225.00PLATE BONE STAINLESS STEEL L95 MM X W11 MM X H3.3 C1713 $3,753.60PLATE BONE STAINLESS STEEL L96 MM X W8 MM X H3.3 M C1713 $5,224.00PLATE BONE STAINLESS STEEL L98 MM ANKLE LATERAL 5 C1713 $4,550.00PLATE BONE STAINLESS STEEL LARGE X L36 MM X W20 MM C1713 $5,867.02PLATE BONE STAINLESS STEEL LONG L148 MM OD12.6 MM C1713 $3,877.76PLATE BONE STAINLESS STEEL MEDIUM X L30 MM X W20 M C1713 $5,788.27PLATE BONE STAINLESS STEEL NARROW L175 MM 8 HOLE N C1713 $2,091.52PLATE BONE STAINLESS STEEL PELVIC 1 HOLE SPRING NO C1713 $1,536.40PLATE BONE STAINLESS STEEL PELVIC 1 HOLE SPRING ST C1713 $1,876.80PLATE BONE STAINLESS STEEL PELVIC 2 HOLE SPRING NO C1713 $1,665.20PLATE BONE STAINLESS STEEL PELVIC 2 HOLE SPRING ST C1713 $2,005.60PLATE BONE STAINLESS STEEL PELVIC 3 HOLE LOW PROFI C1713 $1,826.16PLATE BONE STAINLESS STEEL PELVIC 3 HOLE SPRING ST C1713 $2,166.56PLATE BONE STAINLESS STEEL SCALLOP L104 MM TIBIAL C1713 $2,088.40PLATE BONE STAINLESS STEEL SCALLOP L120 MM TIBIAL C1713 $2,226.40PLATE BONE STAINLESS STEEL SCALLOP L136 MM TIBIAL C1713 $2,355.20PLATE BONE STAINLESS STEEL SCALLOP L152 MM TIBIAL C1713 $2,470.16PLATE BONE STAINLESS STEEL SCALLOP L168 MM TIBIAL C1713 $2,594.40PLATE BONE STAINLESS STEEL SCALLOP L184 MM TIBIAL C1713 $2,810.56PLATE BONE STAINLESS STEEL SCALLOP L200 MM TIBIAL C1713 $2,916.40PLATE BONE STAINLESS STEEL SCALLOP L216 MM TIBIAL C1713 $3,599.36PLATE BONE STAINLESS STEEL SCALLOP L232 MM TIBIAL C1713 $3,800.00PLATE BONE STAINLESS STEEL SCALLOP L248 MM TIBIAL C1713 $4,043.20PLATE BONE STAINLESS STEEL SCALLOP L264 MM TIBIAL C1713 $4,262.08PLATE BONE STAINLESS STEEL SCALLOP L74 MM TIBIAL D C1713 $1,849.20PLATE BONE STAINLESS STEEL SCALLOP L88 MM TIBIAL D C1713 $1,968.80PLATE BONE STAINLESS STEEL SEMITUBULAR L103 MM X W C1713 $607.20PLATE BONE STAINLESS STEEL SEMITUBULAR L119 MM X W C1713 $648.56PLATE BONE STAINLESS STEEL SEMITUBULAR L135 MM X W C1713 $708.40PLATE BONE STAINLESS STEEL SEMITUBULAR L151 MM X W C1713 $791.20PLATE BONE STAINLESS STEEL SEMITUBULAR L167 MM X W C1713 $777.36PLATE BONE STAINLESS STEEL SEMITUBULAR L183 MM X W C1713 $850.96PLATE BONE STAINLESS STEEL SEMITUBULAR L199 MM X W C1713 $878.56

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 ChargePLATE BONE STAINLESS STEEL SEMITUBULAR L39 MM X W1 C1713 $469.20PLATE BONE STAINLESS STEEL SEMITUBULAR L55 MM X W1 C1713 $501.36PLATE BONE STAINLESS STEEL SEMITUBULAR L71 MM X W1 C1713 $542.80PLATE BONE STAINLESS STEEL SEMITUBULAR L87 MM X W1 C1713 $574.96PLATE BONE STAINLESS STEEL SHORT BEND WRIST 8 HOLE C1713 $7,336.96PLATE BONE STAINLESS STEEL SHORT L138 MM OD12.6 MM C1713 $3,877.76PLATE BONE STAINLESS STEEL SMALL X L24 MM X W18 MM C1713 $5,714.40PLATE BONE STAINLESS STEEL STANDARD BEND WRIST 8 H C1713 $7,336.96PLATE BONE STAINLESS STEEL STRAIGHT L100 MM X W3.8 C1713 $1,885.08PLATE BONE STAINLESS STEEL STRAIGHT L100 MM X W5 M C1713 $1,653.79PLATE BONE STAINLESS STEEL STRAIGHT L17 MM X W5 MM C1713 $408.48PLATE BONE STAINLESS STEEL STRAIGHT L17 MM X W6 MM C1713 $2,785.85PLATE BONE STAINLESS STEEL STRAIGHT L23 MM HAND 12 C1713 $1,807.76PLATE BONE STAINLESS STEEL STRAIGHT L23 MM HAND 6 C1713 $1,430.56PLATE BONE STAINLESS STEEL STRAIGHT L23 MM X W5 MM C1713 $450.34PLATE BONE STAINLESS STEEL STRAIGHT L29 MM X W5 MM C1713 $450.80PLATE BONE STAINLESS STEEL STRAIGHT L35 MM X W5 MM C1713 $510.56PLATE BONE STAINLESS STEEL STRAIGHT L71 MM X W5 MM C1713 $2,013.06PLATE BONE STAINLESS STEEL T H1.3 MM HAND 3 HOLE H C1713 $3,263.59PLATE BONE STAINLESS STEEL T L35 MM HAND 4 HOLE HE C1713 $1,724.96PLATE BONE STAINLESS STEEL T L46 MM HAND 3 HOLE HE C1713 $1,656.00PLATE BONE STAINLESS STEEL T L50 MM X W3.8 MM X H. C1713 $1,643.95PLATE BONE STAINLESS STEEL T L50 MM X W5 MM X H1 M C1713 $1,453.60PLATE BONE STAINLESS STEEL T L66 MM X H1.25 MM 3 H C1713 $1,865.40PLATE BONE STAINLESS STEEL UNIVERSAL L131 MM TROCH C1713 $4,457.36PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L10 C1713 $2,700.16PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L11 C1713 $2,810.56PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L13 C1713 $2,920.96PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L14 C1713 $3,072.80PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L15 C1713 $3,247.60PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L16 C1713 $3,413.20PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L18 C1713 $3,560.40PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L19 C1713 $3,739.76PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L20 C1713 $3,905.36PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L23 C1713 $4,070.96PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L26 C1713 $4,218.16PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L39 C1713 $2,194.16PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L52 C1713 $2,295.36PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L65 C1713 $2,396.56

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 ChargePLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L78 C1713 $2,502.40PLATE BONE STAINLESS STEEL WIDE ANGLE STRAIGHT L91 C1713 $2,608.16PLATE BONE STAINLESS STEEL XS X L22 MM X W14 MM FO C1713 $5,803.00PLATE BONE STAINLESS STEEL Y H1.3 MM HAND 3 HOLE H C1713 $3,263.59PLATE BONE STAINLESS STEEL Y L37 MM HAND 3 HOLE HE C1713 $1,771.92PLATE BONE STANDARD L110 MM ELBOW LEFT OLECRANON 7 C1713 $6,181.50PLATE BONE STANDARD L110 MM ELBOW RIGHT OLECRANON C1713 $6,181.50PLATE BONE STANDARD L150 MM ELBOW RIGHT OLECRANON C1713 $6,181.50PLATE BONE STANDARD L65 MM ELBOW RIGHT OLECRANON 3 C1713 $5,447.00PLATE BONE STANDARD L90 MM ELBOW LEFT OLECRANON 5 C1713 $5,447.00PLATE BONE STRAIGHT 11 HOLE MOLD C1713 $390.00PLATE BONE STRAIGHT 13 HOLE MOLD C1713 $390.00PLATE BONE STRAIGHT 4 HOLE COMPRESSION C1713 $2,640.00PLATE BONE STRAIGHT 4 HOLE MOLD C1713 $344.50PLATE BONE STRAIGHT 5 HOLE MOLD C1713 $344.50PLATE BONE STRAIGHT 6 HOLE MOLD C1713 $344.50PLATE BONE STRAIGHT 7 HOLE MOLD C1713 $344.50PLATE BONE STRAIGHT 8 HOLE MOLD C1713 $344.50PLATE BONE STRAIGHT 9 HOLE MOLD C1713 $390.00PLATE BONE SYNPOR TITANIUM POLYETHYLENE POROUS 43. C1713 $11,464.00PLATE BONE SYNPOR TITANIUM POLYETHYLENE POROUS 44. C1713 $11,848.00PLATE BONE SYNPOR UHMWPE POROUS 35 MM RADIUS FAN H C1713 $5,728.00PLATE BONE SYNPOR UHMWPE POROUS L24 MM X H.8 MM OR C1713 $4,496.00PLATE BONE SYNPOR UHMWPE POROUS L24 MM X H1.5 MM O C1713 $4,496.00PLATE BONE SYNPOR UHMWPE POROUS L30 MM X H.8 MM OR C1713 $4,736.00PLATE BONE SYNPOR UHMWPE POROUS L30 MM X H1.5 MM O C1713 $4,784.00PLATE BONE SYNPOR UHMWPE POROUS L35 MM X H.8 MM OR C1713 $5,016.00PLATE BONE SYNPOR UHMWPE POROUS L35 MM X H1.5 MM O C1713 $5,016.00PLATE BONE SYNPOR UHMWPE POROUS SQUARE L50 MM X W5 C1713 $3,480.00PLATE BONE T LEFT OBLIQUE SPINE 2 X 3 HOLE COMPRES C1713 $2,640.00PLATE BONE T LEFT OBLIQUE SPINE 2 X 4 HOLE C1713 $2,640.00PLATE BONE T RIGHT OBLIQUE SPINE 2 X 4 HOLE C1713 $2,640.00PLATE BONE TAPER L78 MM HUMERUS RIGHT DISTAL POSTE C1713 $5,447.00PLATE BONE THREADLOCK TS TITANIUM L H1 MM LEFT 9 H C1713 $2,247.84PLATE BONE THREADLOCK TS TITANIUM L H1 MM RIGHT 9 C1713 $2,247.84PLATE BONE TIGER MEDIUM SPINE OCCIPITAL NONSTERILE C1713 $9,750.00PLATE BONE TIGER SMALL SPINE OCCIPITAL NONSTERILE C1713 $9,750.00PLATE BONE TIMAX 100 D TUBULAR L61 MM X W9.2 MM X C1713 $408.98PLATE BONE TIMAX 100 D TUBULAR L73 MM X W9.2 MM X C1713 $456.30

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 ChargePLATE BONE TIMAX L67 MM HIP SUPRACONDYLAR 2 HOLE C C1713 $1,696.76PLATE BONE TIMAX L97 MM HIP SUPRACONDYLAR 4 HOLE C C1713 $2,478.00PLATE BONE TIMESH TITANIUM STANDARD SMALL SQUARE C C1713 $1,235.00PLATE BONE TIMESH TITANIUM STANDARD STRAIGHT L4 MM C1713 $199.33PLATE BONE TIMESH TITANIUM STANDARD STRAIGHT L8 MM C1713 $299.00PLATE BONE TITANIUM 0 MM MANDIBLE LOCK RECONSTRUCT C1713 $2,148.00PLATE BONE TITANIUM 0 MM PREBENT W27.1 MM X H.9 MM C1713 $2,694.00PLATE BONE TITANIUM 1/3 TUBULAR 2 ROUND HOLE 3.5 M C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR L100 MM 8 ROUND HO C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR L124 MM 10 ROUND H C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR L124 MM 12 ROUND H C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR L41 MM 3 ROUND HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR L53 MM 4 ROUND HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR L65 MM 5 ROUND HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR L77 MM 6 ROUND HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR L89 MM 7 ROUND HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND 2 HOLE 3.5 M C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND L100 MM 8 HO C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND L124 MM 10 H C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND L124 MM 12 H C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND L41 MM 3 HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND L53 MM 4 HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND L65 MM 5 HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND L77 MM 6 HOL C1713 $581.75PLATE BONE TITANIUM 1/3 TUBULAR ROUND L89 MM 7 HOL C1713 $581.75PLATE BONE TITANIUM 1/4 TUBULAR L23 MM X W7 MM X H C1713 $556.56PLATE BONE TITANIUM 1/4 TUBULAR L25 MM 3 ROUND HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR L31 MM X W7 MM X H C1713 $579.60PLATE BONE TITANIUM 1/4 TUBULAR L33 MM 4 ROUND HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR L39 MM X W7 MM X H C1713 $611.76PLATE BONE TITANIUM 1/4 TUBULAR L41 MM 5 ROUND HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR L47 MM X W7 MM X H C1713 $662.40PLATE BONE TITANIUM 1/4 TUBULAR L49 MM 6 ROUND HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR L55 MM X W7 MM X H C1713 $731.36PLATE BONE TITANIUM 1/4 TUBULAR L57 MM 7 ROUND HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR L63 MM X W7 MM X H C1713 $758.96PLATE BONE TITANIUM 1/4 TUBULAR L65 MM 8 ROUND HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR ROUND L25 MM 3 HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR ROUND L33 MM 4 HOL C1713 $646.75

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 ChargePLATE BONE TITANIUM 1/4 TUBULAR ROUND L41 MM 5 HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR ROUND L49 MM 6 HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR ROUND L57 MM 7 HOL C1713 $646.75PLATE BONE TITANIUM 1/4 TUBULAR ROUND L65 MM 8 HOL C1713 $646.75PLATE BONE TITANIUM 10 MM OFFSET CHIN 6 HOLE 2 BEN C1713 $2,208.00PLATE BONE TITANIUM 10 MM OFFSET L23 MM X W15-21 M C1713 $1,953.60PLATE BONE TITANIUM 10 MM OFFSET W12.5-15 MM X H.6 C1713 $2,135.20PLATE BONE TITANIUM 100 D 5 MM SPACE L OBLIQUE LEF C1713 $1,602.00PLATE BONE TITANIUM 100 D 5 MM SPACE L OBLIQUE RIG C1713 $1,224.60PLATE BONE TITANIUM 100 D 9 MM SPACE L OBLIQUE LEF C1713 $1,507.20PLATE BONE TITANIUM 100 D 9 MM SPACE L OBLIQUE RIG C1713 $1,507.20PLATE BONE TITANIUM 100 D L CONTOUR OBLIQUE LEFT L C1713 $1,530.00PLATE BONE TITANIUM 100 D L CONTOUR OBLIQUE RIGHT C1713 $1,530.00PLATE BONE TITANIUM 100 D L OBLIQUE LEFT L22 MM X C1713 $1,770.00PLATE BONE TITANIUM 100 D L OBLIQUE LEFT L27 MM X C1713 $1,854.00PLATE BONE TITANIUM 100 D L OBLIQUE RIGHT L22 MM X C1713 $1,770.00PLATE BONE TITANIUM 100 D L OBLIQUE RIGHT L27 MM X C1713 $1,854.00PLATE BONE TITANIUM 100 D L RIGHT OBLIQUE L25 MM X C1713 $1,761.20PLATE BONE TITANIUM 100 D MICRO LONG L H.6 MM FRON C1713 $1,166.24PLATE BONE TITANIUM 100 D MICRO REGULAR L H.6 MM F C1713 $1,231.36PLATE BONE TITANIUM 11 MM PREBENT W27.1 MM X H.9 M C1713 $2,694.00PLATE BONE TITANIUM 120 D W8 MM X H2.5 MM MANDIBLE C1713 $7,662.00PLATE BONE TITANIUM 13 MM SPACE 2Y L22 MM X W9 MM C1713 $1,590.00PLATE BONE TITANIUM 13 MM SPACE X L18 MM X W18 MM C1713 $1,666.00PLATE BONE TITANIUM 2 ANGLE W6.5 MM X H2 MM MANDIB C1713 $14,328.00PLATE BONE TITANIUM 2 ANGLE W8 MM X H2.5 MM MANDIB C1713 $15,438.00PLATE BONE TITANIUM 2 MM MANDIBLE LOCK RECONSTRUCT C1713 $2,148.00PLATE BONE TITANIUM 2 MM T OFFSET W4.2 MM X H.6 MM C1713 $2,286.00PLATE BONE TITANIUM 2 WIDE MINI W4.8 MM X H1 MM MA C1713 $2,940.00PLATE BONE TITANIUM 2 Y L14 MM X W10 MM X H.5 MM C C1713 $1,863.20PLATE BONE TITANIUM 255 D CRESCENT W8 MM X H2.5 MM C1713 $7,662.00PLATE BONE TITANIUM 2T STERNUM 14 HOLE LOCK NONSTE C1713 $6,060.93PLATE BONE TITANIUM 2Y L18 MM CRANIOFACIAL 6 HOLE C1713 $1,716.00PLATE BONE TITANIUM 2Y L21 MM CRANIOFACIAL 6 HOLE C1713 $1,716.00PLATE BONE TITANIUM 2Y L30 MM X W19 MM X H.9 MM L4 C1713 $1,668.00PLATE BONE TITANIUM 2Y MINI W4.8 MM X H1 MM MANDIB C1713 $1,771.20PLATE BONE TITANIUM 3 MM OFFSET STRAIGHT L15 MM X C1713 $1,590.00PLATE BONE TITANIUM 3 MM PREBENT W27.1 MM X H.9 MM C1713 $2,694.00PLATE BONE TITANIUM 3-5 MM OFFSET L17 MM X W15-21 C1713 $1,974.00

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 ChargePLATE BONE TITANIUM 4 MM MANDIBLE LOCK RECONSTRUCT C1713 $2,148.00PLATE BONE TITANIUM 4 MM OFFSET CHIN 6 HOLE 2 BEND C1713 $2,208.00PLATE BONE TITANIUM 4 MM OFFSET L17 MM X W15-21 MM C1713 $1,974.00PLATE BONE TITANIUM 4 MM T OFFSET W4.2 MM X H.6 MM C1713 $2,286.00PLATE BONE TITANIUM 4.5 MM SPACE L L22 MM X W4 MM C1713 $1,662.00PLATE BONE TITANIUM 4.5 MM SPACE L L24 MM X W4 MM C1713 $1,662.00PLATE BONE TITANIUM 4.5 MM SPACE L L26 MM X W4 MM C1713 $1,662.00PLATE BONE TITANIUM 4.5 MM SPACE T W31 MM X H.9 MM C1713 $1,972.00PLATE BONE TITANIUM 5 HOLE ANCHOR BRACKET NONSTERI C1713 $1,350.00PLATE BONE TITANIUM 5 MM OFFSET STRAIGHT L17 MM X C1713 $1,574.40PLATE BONE TITANIUM 5 MM PREBENT W27.1 MM X H.9 MM C1713 $2,694.00PLATE BONE TITANIUM 5 MM SPACE L100 MM X W4.8 MM X C1713 $3,344.00PLATE BONE TITANIUM 5 MM SPACE L53 MM X W4.8 MM X C1713 $1,856.40PLATE BONE TITANIUM 5 MM SPACE OBLIQUE L L25 MM X C1713 $1,459.20PLATE BONE TITANIUM 5 MM SPACE OBLIQUE LEFT L L31 C1713 $1,849.60PLATE BONE TITANIUM 5 MM SPACE OBLIQUE LEFT L L41 C1713 $2,019.60PLATE BONE TITANIUM 5 MM SPACE OBLIQUE RIGHT L L31 C1713 $1,849.60PLATE BONE TITANIUM 5 MM SPACE OBLIQUE RIGHT L L41 C1713 $2,019.60PLATE BONE TITANIUM 6 MM MANDIBLE LOCK RECONSTRUCT C1713 $2,011.20PLATE BONE TITANIUM 6 MM OFFSET CHIN 6 HOLE 2 BEND C1713 $2,208.00PLATE BONE TITANIUM 6 MM OFFSET L19 MM X W15-21 MM C1713 $1,505.40PLATE BONE TITANIUM 6 MM OFFSET W12.5-15 MM X H.6 C1713 $1,884.00PLATE BONE TITANIUM 6 MM SPACE 2Y L15 MM X W9 MM X C1713 $1,590.00PLATE BONE TITANIUM 6 MM T OFFSET W4.2 MM X H.6 MM C1713 $2,286.00PLATE BONE TITANIUM 6 MM WEDGE H L32 MM X W16 MM M C1713 $4,225.00PLATE BONE TITANIUM 6-8 MM OFFSET L20 MM X W15-21 C1713 $1,852.80PLATE BONE TITANIUM 7 MM PREBENT W27.1 MM X H.9 MM C1713 $2,694.00PLATE BONE TITANIUM 8 MM OFFSET CHIN 6 HOLE 2 BEND C1713 $2,208.00PLATE BONE TITANIUM 8 MM OFFSET L21 MM X W15-21 MM C1713 $2,082.00PLATE BONE TITANIUM 8 MM OFFSET STRAIGHT L20 MM X C1713 $1,758.00PLATE BONE TITANIUM 8 MM OFFSET W12.5-15 MM X H.6 C1713 $1,884.00PLATE BONE TITANIUM 9 MM PREBENT W27.1 MM X H.9 MM C1713 $2,694.00PLATE BONE TITANIUM 9 MM SPACE 2Y L18 MM X W9 MM X C1713 $1,209.00PLATE BONE TITANIUM 90 D L L17 MM X W4.8 MM X H.6 C1713 $1,440.00PLATE BONE TITANIUM 90 D L L19 MM X W4.8 MM X H.6 C1713 $1,440.00PLATE BONE TITANIUM 90 D L L23 MM X W4.8 MM X H.6 C1713 $1,440.00PLATE BONE TITANIUM 90 D L106 MM L30 MM 8 HOLE LIM C1713 $7,162.16PLATE BONE TITANIUM 90 D L106 MM L35 MM 8 HOLE LIM C1713 $7,162.16PLATE BONE TITANIUM 90 D L106 MM L40 MM 8 HOLE LIM C1713 $7,162.16

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 ChargePLATE BONE TITANIUM 90 D L106 MM L45 MM 8 HOLE LIM C1713 $7,162.16PLATE BONE TITANIUM 90 D L112 MM L30 MM 6 HOLE LC C1713 $6,237.60PLATE BONE TITANIUM 90 D L112 MM L40 MM 6 HOLE LC C1713 $6,237.60PLATE BONE TITANIUM 90 D L132 MM L30 MM 10 HOLE LI C1713 $7,590.00PLATE BONE TITANIUM 90 D L132 MM L35 MM 10 HOLE LI C1713 $7,590.00PLATE BONE TITANIUM 90 D L132 MM L40 MM 10 HOLE LI C1713 $7,590.00PLATE BONE TITANIUM 90 D L132 MM L45 MM 10 HOLE LI C1713 $7,590.00PLATE BONE TITANIUM 90 D L148 MM L30 MM 8 HOLE LC C1713 $6,237.60PLATE BONE TITANIUM 90 D L148 MM L40 MM 8 HOLE LC C1713 $6,237.60PLATE BONE TITANIUM 90 D L148 MM L50 MM 8 HOLE LC C1713 $6,237.60PLATE BONE TITANIUM 90 D L148 MM L60 MM 8 HOLE LC C1713 $6,237.60PLATE BONE TITANIUM 90 D L184 MM L30 MM 10 HOLE LC C1713 $8,142.00PLATE BONE TITANIUM 90 D L184 MM L40 MM 10 HOLE LC C1713 $8,142.00PLATE BONE TITANIUM 90 D L184 MM L50 MM 10 HOLE LC C1713 $8,142.00PLATE BONE TITANIUM 90 D L184 MM L60 MM 10 HOLE LC C1713 $8,142.00PLATE BONE TITANIUM 90 D L220 MM L30 MM 12 HOLE LC C1713 $8,142.00PLATE BONE TITANIUM 90 D L220 MM L40 MM 12 HOLE LC C1713 $8,142.00PLATE BONE TITANIUM 90 D L220 MM L50 MM 12 HOLE LC C1713 $8,142.00PLATE BONE TITANIUM 90 D L220 MM L60 MM 12 HOLE LC C1713 $8,142.00PLATE BONE TITANIUM 90 D L256 MM L30 MM 14 HOLE LC C1713 $10,359.20PLATE BONE TITANIUM 90 D L256 MM L40 MM 14 HOLE LC C1713 $10,359.20PLATE BONE TITANIUM 90 D L256 MM L50 MM 14 HOLE LC C1713 $10,359.20PLATE BONE TITANIUM 90 D L256 MM L60 MM 14 HOLE LC C1713 $10,359.20PLATE BONE TITANIUM 90 D L54 MM L30 MM 4 HOLE LIMI C1713 $6,053.60PLATE BONE TITANIUM 90 D L54 MM L35 MM 4 HOLE LIMI C1713 $6,053.60PLATE BONE TITANIUM 90 D L54 MM L40 MM 4 HOLE LIMI C1713 $6,053.60PLATE BONE TITANIUM 90 D L54 MM L45 MM 4 HOLE LIMI C1713 $6,053.60PLATE BONE TITANIUM 90 D L67 MM L30 MM 5 HOLE LIMI C1713 $6,398.56PLATE BONE TITANIUM 90 D L67 MM L35 MM 5 HOLE LIMI C1713 $6,398.56PLATE BONE TITANIUM 90 D L67 MM L40 MM 5 HOLE LIMI C1713 $6,398.56PLATE BONE TITANIUM 90 D L67 MM L45 MM 5 HOLE LIMI C1713 $6,398.56PLATE BONE TITANIUM 90 D L76 MM L30 MM 4 HOLE LC A C1713 $6,237.60PLATE BONE TITANIUM 90 D L76 MM L40 MM 4 HOLE LC A C1713 $6,237.60PLATE BONE TITANIUM 90 D L80 MM L30 MM 6 HOLE LIMI C1713 $6,674.56PLATE BONE TITANIUM 90 D L80 MM L35 MM 6 HOLE LIMI C1713 $6,674.56PLATE BONE TITANIUM 90 D L80 MM L40 MM 6 HOLE LIMI C1713 $6,674.56PLATE BONE TITANIUM 90 D L80 MM L45 MM 6 HOLE LIMI C1713 $6,674.56PLATE BONE TITANIUM 90 D L94 MM L30 MM 5 HOLE LC A C1713 $6,237.60PLATE BONE TITANIUM 90 D L94 MM L40 MM 5 HOLE LC A C1713 $6,237.60

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 ChargePLATE BONE TITANIUM 9-11 MM OFFSET L23 MM X W15-21 C1713 $1,852.80PLATE BONE TITANIUM ANGLE H1.25 MM MANDIBLE 6 HOLE C1713 $3,360.00PLATE BONE TITANIUM ANGLE H1.25 MM MANDIBLE 8 HOLE C1713 $3,618.00PLATE BONE TITANIUM ANGLE L214 MM X W44 MM X H2.4 C1713 $13,344.00PLATE BONE TITANIUM ANGLE L48 MM X W8 MM X H2.5 MM C1713 $26,982.00PLATE BONE TITANIUM ANGLE L56 MM X W8 MM X H2.5 MM C1713 $28,488.00PLATE BONE TITANIUM ANGLE L64 MM X W8 MM X H2.5 MM C1713 $28,008.00PLATE BONE TITANIUM ANGLE STERNUM 12 HOLE LOCK NON C1713 $8,188.05PLATE BONE TITANIUM ANGLE STERNUM 12 HOLE LOCK STE C1713 $9,005.75PLATE BONE TITANIUM ANGLE UNIVERSAL L32 MM X W6.5 C1713 $8,119.20PLATE BONE TITANIUM BROAD CONTOUR CURVE L29 MM X W C1713 $2,898.00PLATE BONE TITANIUM BROAD CONTOUR CURVE L41 MM X W C1713 $2,347.80PLATE BONE TITANIUM BROAD CONTOUR STRAIGHT L29 MM C1713 $2,550.00PLATE BONE TITANIUM BROAD CONTOUR STRAIGHT L42 MM C1713 $2,742.00PLATE BONE TITANIUM BROAD CONTOUR STRAIGHT L55 MM C1713 $2,898.00PLATE BONE TITANIUM BROAD L105 MM 6 HOLE ACTIVE CO C1713 $1,946.75PLATE BONE TITANIUM BROAD L121 MM 7 HOLE ACTIVE CO C1713 $1,946.75PLATE BONE TITANIUM BROAD L137 MM 8 HOLE ACTIVE CO C1713 $1,946.75PLATE BONE TITANIUM BROAD L153 MM 9 HOLE ACTIVE CO C1713 $1,946.75PLATE BONE TITANIUM BROAD L169 MM 10 HOLE ACTIVE C C1713 $1,946.75PLATE BONE TITANIUM BROAD L185 MM 11 HOLE ACTIVE C C1713 $1,946.75PLATE BONE TITANIUM BROAD L201 MM 12 HOLE ACTIVE C C1713 $1,946.75PLATE BONE TITANIUM BROAD L233 MM 14 HOLE ACTIVE C C1713 $1,946.75PLATE BONE TITANIUM CLAVICLE RIGHT ANTERIOR 3 HOLE C1713 $3,896.75PLATE BONE TITANIUM CONTOUR 4 HOLE LOCK ATTACHMENT C1713 $3,399.36PLATE BONE TITANIUM CONTOUR 8 HOLE LOCK ATTACHMENT C1713 $3,716.80PLATE BONE TITANIUM CONTOUR L119 MM X W4.8 MM X H1 C1713 $3,894.00PLATE BONE TITANIUM CRESCENT H1.25 MM MANDIBLE 5 H C1713 $3,018.00PLATE BONE TITANIUM CRESCENT H1.25 MM MANDIBLE 7 H C1713 $3,210.00PLATE BONE TITANIUM CUBOID FOOT LEFT LOCK STERILE C1713 $5,630.40PLATE BONE TITANIUM CUBOID FOOT RIGHT LOCK STERILE C1713 $5,630.40PLATE BONE TITANIUM CURVE L10 MM CRANIOMAXILLOFACI C1713 $2,022.00PLATE BONE TITANIUM CURVE L10 MM X H1.25 MM MAXILL C1713 $2,022.00PLATE BONE TITANIUM CURVE L12 MM X H1.25 MM MAXILL C1713 $2,178.00PLATE BONE TITANIUM CURVE L14 MM X H1.25 MM MAXILL C1713 $2,178.00PLATE BONE TITANIUM CURVE L16 MM X H1.25 MM MAXILL C1713 $2,040.00PLATE BONE TITANIUM CURVE L30 MM X W4.8 MM X H1.25 C1713 $2,304.00PLATE BONE TITANIUM CURVE L38 MM X W4.8 MM X H1.25 C1713 $2,304.00PLATE BONE TITANIUM CURVE L39.2 MM X H.9 MM L13 MM C1713 $3,225.60

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 ChargePLATE BONE TITANIUM CURVE L4 MM X H1.25 MM MAXILLO C1713 $2,178.00PLATE BONE TITANIUM CURVE L6 MM X H1.25 MM MAXILLO C1713 $2,022.00PLATE BONE TITANIUM CURVE L8 MM X H1.25 MM MAXILLO C1713 $2,178.00PLATE BONE TITANIUM FOOT LEFT CUBOID LOCK NONSTERI C1713 $5,660.30PLATE BONE TITANIUM FOOT NAVICULAR LOCK NONSTERILE C1713 $5,437.20PLATE BONE TITANIUM FOOT NAVICULAR LOCK STERILE 2. C1713 $6,182.03PLATE BONE TITANIUM FOOT RIGHT CUBOID LOCK NONSTER C1713 $5,290.00PLATE BONE TITANIUM FOOT TALUS LOCK NONSTERILE 2.4 C1713 $5,230.16PLATE BONE TITANIUM FOOT TALUS LOCK STERILE 2.4/2. C1713 $5,570.56PLATE BONE TITANIUM FOREFOOT MIDFOOT RIGHT FIRST M C1713 $3,978.00PLATE BONE TITANIUM H CRANIOFACIAL 8 HOLE 2 MM SCR C1713 $1,650.00PLATE BONE TITANIUM H L10 MM X W7 MM X H.5 MM MIDF C1713 $1,470.00PLATE BONE TITANIUM H L14 MM X W10 MM X H.5 MM CRA C1713 $1,863.20PLATE BONE TITANIUM H L19 MM X H.5 MM HAND LEFT 8 C1713 $1,845.71PLATE BONE TITANIUM H L19 MM X H.5 MM HAND RIGHT 8 C1713 $1,845.71PLATE BONE TITANIUM H L19 MM X W13 MM X H.5 MM CRA C1713 $1,698.00PLATE BONE TITANIUM H L22 MM X W4.8 MM X H.9 MM L2 C1713 $1,870.00PLATE BONE TITANIUM H L6 MM X W8.2 MM L9 MM 4 HOLE C1713 $1,472.00PLATE BONE TITANIUM H.2 MM ORBITAL FLOOR MESH NONS C1713 $8,022.00PLATE BONE TITANIUM H.3 MM ORBITAL FLOOR MESH NONS C1713 $8,022.00PLATE BONE TITANIUM H.4 MM ORBITAL FLOOR MESH NONS C1713 $8,022.00PLATE BONE TITANIUM H.9 MM MAXILLOFACIAL 8 HOLE SA C1713 $2,622.00PLATE BONE TITANIUM H1 MM HAND CONDYLAR 2 HOLE HEA C1713 $2,998.97PLATE BONE TITANIUM H1 MM MAXILLOFACIAL 2 HOLE MES C1713 $1,787.84PLATE BONE TITANIUM H1.25 MM MANDIBLE 4 HOLE INTER C1713 $2,274.00PLATE BONE TITANIUM H1.25 MM MANDIBLE 5 HOLE INTER C1713 $2,472.00PLATE BONE TITANIUM H1.25 MM MANDIBLE 6 HOLE INTER C1713 $2,664.00PLATE BONE TITANIUM H1.25 MM MANDIBLE 8 HOLE INTER C1713 $3,018.00PLATE BONE TITANIUM H1.5 MM TUBULAR L78 MM H2 MM D C1713 $2,115.75PLATE BONE TITANIUM L BUTTRESS L86 MM LEG LEFT 4 H C1713 $1,946.75PLATE BONE TITANIUM L BUTTRESS L86 MM LEG RIGHT 4 C1713 $1,946.75PLATE BONE TITANIUM L L18 MM X W12 MM X H.5 MM CRA C1713 $1,754.40PLATE BONE TITANIUM L L25 MM X W4.8 MM X H.9 MM L1 C1713 $1,348.80PLATE BONE TITANIUM L L27 MM X W4.8 MM X H.9 MM L1 C1713 $1,434.00PLATE BONE TITANIUM L L29 MM X W4.8 MM X H.9 MM L1 C1713 $1,434.00PLATE BONE TITANIUM L L86 MM LEG LEFT 4 HOLE BUTTR C1713 $1,946.75PLATE BONE TITANIUM L L86 MM LEG RIGHT 4 HOLE BUTT C1713 $1,946.75PLATE BONE TITANIUM L LONG OBLIQUE LEFT L20 MM X W C1713 $1,356.00PLATE BONE TITANIUM L LONG OBLIQUE RIGHT L20 MM X C1713 $1,272.00

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 ChargePLATE BONE TITANIUM L MINI W4.8 MM X H1 MM MANDIBL C1713 $1,746.00PLATE BONE TITANIUM L OBLIQUE LEFT 4 ROUND HOLE 2 C1713 $646.75PLATE BONE TITANIUM L STRAIGHT LEFT 4 ROUND HOLE 2 C1713 $646.75PLATE BONE TITANIUM L STRAIGHT RIGHT 4 ROUND HOLE C1713 $646.75PLATE BONE TITANIUM L100 MM ELBOW RIGHT LATERAL 10 C1713 $5,479.50PLATE BONE TITANIUM L100 MM X H.7 MM MIDFACE 2 X 2 C1713 $4,164.00PLATE BONE TITANIUM L100 MM X W100 MM CRANIOFACIAL C1713 $14,844.00PLATE BONE TITANIUM L100 MM X W100 MM X H.1 MM MID C1713 $7,476.00PLATE BONE TITANIUM L100 MM X W100 MM X H.2 MM CRA C1713 $5,951.40PLATE BONE TITANIUM L100 MM X W100 MM X H.4 MM MID C1713 $14,940.00PLATE BONE TITANIUM L100 MM X W100 MM X H.5 MM MID C1713 $12,786.00PLATE BONE TITANIUM L100 MM X W2.2 MM X H.7 MM CRA C1713 $4,424.00PLATE BONE TITANIUM L100 MM X W50 MM X H.4 MM CRAN C1713 $11,791.20PLATE BONE TITANIUM L101 MM X W14 MM W11 MM CLAVIC C1713 $5,661.50PLATE BONE TITANIUM L102 MM X W11-14 MM X H3.5 MM C1713 $2,427.75PLATE BONE TITANIUM L102 MM X W15 MM X H4.5 MM HUM C1713 $2,898.68PLATE BONE TITANIUM L108 MM CLAVICLE 10 HOLE MULTI C1713 $2,730.00PLATE BONE TITANIUM L108 MM X H2.5 MM OD10 MM CLAV C1713 $2,437.50PLATE BONE TITANIUM L109 MM TIBIA RIGHT ANTEROLATE C1713 $2,632.50PLATE BONE TITANIUM L109 MM X H3.5 MM TIBIAL LEFT C1713 $2,632.50PLATE BONE TITANIUM L12 MM X H1 MM MAXILLOFACIAL 6 C1713 $2,040.00PLATE BONE TITANIUM L121 MM 10 HOLE ACTIVE COMPRES C1713 $809.25PLATE BONE TITANIUM L122 MM FIBULA RIGHT 8 HOLE MU C1713 $2,525.25PLATE BONE TITANIUM L122 MM X W11-14 MM X H3.5 MM C1713 $2,525.25PLATE BONE TITANIUM L130 MM ELBOW MEDIAL 12 HOLE L C1713 $5,479.50PLATE BONE TITANIUM L133 MM 11 HOLE ACTIVE COMPRES C1713 $809.25PLATE BONE TITANIUM L142 MM X W11-14 MM X H3.5 MM C1713 $2,622.75PLATE BONE TITANIUM L145 MM 12 HOLE ACTIVE COMPRES C1713 $809.25PLATE BONE TITANIUM L159 MM MANDIBLE 20 HOLE RECON C1713 $9,928.00PLATE BONE TITANIUM L17 MM 3 ROUND HOLE 2 MM SCREW C1713 $646.75PLATE BONE TITANIUM L193 MM X W4.8 MM X H.9 MM CRA C1713 $3,644.80PLATE BONE TITANIUM L23 MM 4 ROUND HOLE 2 MM SCREW C1713 $646.75PLATE BONE TITANIUM L26 MM X W5 MM X H1.25 MM MAND C1713 $2,556.00PLATE BONE TITANIUM L29 MM 5 ROUND HOLE 2 MM SCREW C1713 $646.75PLATE BONE TITANIUM L33 MM X W2.2 MM X H.5 MM CRAN C1713 $1,944.80PLATE BONE TITANIUM L33 MM X W7 MM X H.7 MM MANDIB C1713 $2,958.00PLATE BONE TITANIUM L35 MM X W3.3 MM X H.5 MM ORBI C1713 $1,224.60PLATE BONE TITANIUM L36 MM X W32 MM X H.5 MM MEDIA C1713 $7,032.00PLATE BONE TITANIUM L36 MM X W32 MM X H.6 MM MEDIA C1713 $6,822.00

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 ChargePLATE BONE TITANIUM L36 MM X W5 MM X H1.25 MM MAND C1713 $2,572.80PLATE BONE TITANIUM L37 MM X W31 MM SACROILIAC 4 H C1713 $1,706.25PLATE BONE TITANIUM L38 MM X W4.8 MM X H.9 MM CRAN C1713 $1,459.20PLATE BONE TITANIUM L38 MM X W4.8 MM X H.9 MM ORBI C1713 $1,666.00PLATE BONE TITANIUM L4 MM X H1 MM MAXILLOFACIAL 6 C1713 $2,178.00PLATE BONE TITANIUM L40 MM X W29 MM X H.5 MM CRANI C1713 $8,280.00PLATE BONE TITANIUM L40 MM X W7 MM X H.7 MM MANDIB C1713 $2,958.00PLATE BONE TITANIUM L41 MM CRANIOMAXILLOFACIAL ORB C1713 $1,886.40PLATE BONE TITANIUM L42 MM X W38 MM X H.4 MM CRANI C1713 $9,900.80PLATE BONE TITANIUM L43 MM X W8 MM X H.5 MM CRANIO C1713 $3,306.00PLATE BONE TITANIUM L45 MM X W38 MM X H.6 MM CRANI C1713 $11,396.80PLATE BONE TITANIUM L49 MM 4 HOLE ACTIVE COMPRESSI C1713 $809.25PLATE BONE TITANIUM L49 MM ORBITAL RIM 12 HOLE NON C1713 $2,448.00PLATE BONE TITANIUM L50 MM X W50 MM X H.4 MM ORBIT C1713 $7,698.00PLATE BONE TITANIUM L53 MM X W38 MM X H.4 MM CRANI C1713 $9,630.00PLATE BONE TITANIUM L57 MM X H1.25 MM CONDYLAR LEF C1713 $2,254.00PLATE BONE TITANIUM L57 MM X H1.25 MM CONDYLAR RIG C1713 $2,254.00PLATE BONE TITANIUM L57 MM X W7 MM X H1.5 MM CONDY C1713 $2,309.20PLATE BONE TITANIUM L58 MM ELBOW LEFT LATERAL 6 HO C1713 $5,479.50PLATE BONE TITANIUM L58 MM ELBOW RIGHT LATERAL 6 H C1713 $5,479.50PLATE BONE TITANIUM L6 MM X H1 MM MAXILLOFACIAL 6 C1713 $2,022.00PLATE BONE TITANIUM L61 MM 5 HOLE ACTIVE COMPRESSI C1713 $809.25PLATE BONE TITANIUM L65 MM X W5.5 MM X H1.25 MM CR C1713 $2,238.00PLATE BONE TITANIUM L68 MM X W11 MM CLAVICLE RIGHT C1713 $6,968.00PLATE BONE TITANIUM L72 MM CLAVICLE 6 HOLE MULTIDI C1713 $2,730.00PLATE BONE TITANIUM L72 MM X H2.5 MM OD10 MM CLAVI C1713 $2,193.75PLATE BONE TITANIUM L73 MM 6 HOLE ACTIVE COMPRESSI C1713 $809.25PLATE BONE TITANIUM L8 MM X H1 MM MAXILLOFACIAL 6 C1713 $2,040.00PLATE BONE TITANIUM L82 MM X W11-14 MM X H3.5 MM F C1713 $2,427.75PLATE BONE TITANIUM L84 MM ELBOW MEDIAL 7 HOLE LOC C1713 $5,479.50PLATE BONE TITANIUM L88 MM ELBOW MEDIAL 8 HOLE LOC C1713 $5,479.50PLATE BONE TITANIUM L90 MM CLAVICLE 8 HOLE MULTIDI C1713 $2,730.00PLATE BONE TITANIUM L90 MM CRANIOFACIAL 20 HOLE AD C1713 $2,712.00PLATE BONE TITANIUM L90 MM X W4 MM X H.6 MM MANDIB C1713 $2,236.80PLATE BONE TITANIUM L95 MM X W3.3 MM X H.5 MM CRAN C1713 $4,020.00PLATE BONE TITANIUM LARGE 2 ANGLE W6.5 MM X H1.5 M C1713 $13,668.00PLATE BONE TITANIUM LARGE ANGLE LEFT W6.5 MM X H1. C1713 $11,796.00PLATE BONE TITANIUM LARGE ANGLE RIGHT W6.5 MM X H1 C1713 $8,958.30PLATE BONE TITANIUM LARGE ANGLE W6.5 MM X H1.5 MM C1713 $6,222.00

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 ChargePLATE BONE TITANIUM LARGE CRESCENT W6.5 MM X H1.5 C1713 $6,222.00PLATE BONE TITANIUM LARGE H MANUBRIUM 8 HOLE LOCK C1713 $6,283.20PLATE BONE TITANIUM LARGE H.3 MM ORBITAL FLOOR NON C1713 $7,698.00PLATE BONE TITANIUM LARGE L96 MM X W10 MM CLAVICLE C1713 $5,661.50PLATE BONE TITANIUM LARGE W6.5 MM X H1.5 MM MANDIB C1713 $4,524.00PLATE BONE TITANIUM LARGE X L36 MM X W20 MM FOOT L C1713 $5,483.20PLATE BONE TITANIUM LEFT 3 HOLE ACTIVE COMPRESSION C1713 $3,896.75PLATE BONE TITANIUM LEFT 4 HOLE ACTIVE COMPRESSION C1713 $4,546.75PLATE BONE TITANIUM LEFT ANGLE L97 MM X W47 MM MAN C1713 $10,941.20PLATE BONE TITANIUM LEFT OBLIQUE SPINE 2 X 4 HOLE C1713 $2,640.00PLATE BONE TITANIUM LONG L OBLIQUE CRANIOMAXILLOFA C1713 $1,578.00PLATE BONE TITANIUM LONG L OBLIQUE H.6 MM CRANIOFA C1713 $1,578.00PLATE BONE TITANIUM LONG L OBLIQUE MIDFACE LEFT 2 C1713 $1,272.00PLATE BONE TITANIUM LONG Z CRANIOMAXILLOFACIAL LEF C1713 $1,713.60PLATE BONE TITANIUM LONG Z CRANIOMAXILLOFACIAL RIG C1713 $1,824.00PLATE BONE TITANIUM LONG Z L25 MM X W4.8 MM X H.6 C1713 $1,444.80PLATE BONE TITANIUM LONG Z MIDFACE LEFT NONSTERILE C1713 $1,536.00PLATE BONE TITANIUM LONG Z MIDFACE RIGHT NONSTERIL C1713 $1,444.80PLATE BONE TITANIUM LOW PROFILE NONSTERILE LAPIDUS C1713 $3,900.00PLATE BONE TITANIUM MANDIBLE B NONSTERILE 1.3 MM S C1713 $6,616.00PLATE BONE TITANIUM MANDIBLE C NONSTERILE 1.3 MM S C1713 $6,616.00PLATE BONE TITANIUM MEDIUM FLAT H L32 MM X W16 MM C1713 $3,900.00PLATE BONE TITANIUM MEDIUM H.3 MM ORBITAL FLOOR NO C1713 $7,698.00PLATE BONE TITANIUM MEDIUM L94 MM X W11 MM CLAVICL C1713 $5,661.50PLATE BONE TITANIUM MEDIUM X L30 MM X W20 MM FOOT C1713 $5,788.27PLATE BONE TITANIUM MICRO CURVE H.6 MM ORBITAL FLO C1713 $1,266.88PLATE BONE TITANIUM MICRO L36 MM X W32 MM X H.5 MM C1713 $8,724.40PLATE BONE TITANIUM MICRO L50 MM X W50 MM X H.4 MM C1713 $10,404.00PLATE BONE TITANIUM MICRO LONG L H.6 MM FRONTAL MA C1713 $1,166.24PLATE BONE TITANIUM MICRO LONG Y H.6 MM FRONTAL MA C1713 $1,208.56PLATE BONE TITANIUM MICRO MEDIUM L H.6 MM FRONTAL C1713 $1,166.24PLATE BONE TITANIUM MICRO REGULAR STRAIGHT H.6 MM C1713 $521.28PLATE BONE TITANIUM MICRO REGULAR T H.6 MM FRONTAL C1713 $1,166.24PLATE BONE TITANIUM MICRO REGULAR X H.6 MM FRONTAL C1713 $1,266.88PLATE BONE TITANIUM MICRO SHORT STRAIGHT H.6 MM MA C1713 $526.88PLATE BONE TITANIUM MICRO STRAIGHT H.6 MM FRONTAL C1713 $1,728.64PLATE BONE TITANIUM MICRO STRAIGHT H.6 MM MAXILLOF C1713 $663.04PLATE BONE TITANIUM MICRO Y H.6 MM FRONTAL MAXILLA C1713 $1,231.36PLATE BONE TITANIUM MINI BOX H1 MM MANDIBLE 4 HOLE C1713 $1,848.00

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 ChargePLATE BONE TITANIUM MINI BROAD CURVE W4.8 MM X H1 C1713 $3,211.20PLATE BONE TITANIUM MINI BROAD W4.8 MM X H1 MM MAN C1713 $3,012.00PLATE BONE TITANIUM MINI CURVE W4.8 MM X H1 MM MAN C1713 $3,618.00PLATE BONE TITANIUM MINI L OBLIQUE RIGHT 4 ROUND H C1713 $646.75PLATE BONE TITANIUM MINI NARROW W4.8 MM X H1 MM MA C1713 $2,198.40PLATE BONE TITANIUM MINI OBLIQUE ROUND L LEFT 4 HO C1713 $646.75PLATE BONE TITANIUM MINI OBLIQUE ROUND L RIGHT 4 H C1713 $646.75PLATE BONE TITANIUM MINI PREBENT H1 MM MANDIBLE LE C1713 $2,572.80PLATE BONE TITANIUM MINI PREBENT H1 MM MANDIBLE RI C1713 $2,748.00PLATE BONE TITANIUM MINI REGULAR H.6 MM MAXILLOFAC C1713 $811.04PLATE BONE TITANIUM MINI ROUND STRAIGHT L LEFT 4 H C1713 $646.75PLATE BONE TITANIUM MINI ROUND STRAIGHT L RIGHT 4 C1713 $646.75PLATE BONE TITANIUM MINI STANDARD LONG H1 MM MAXIL C1713 $592.00PLATE BONE TITANIUM MINI STANDARD REGULAR H1 MM MA C1713 $526.88PLATE BONE TITANIUM MINI W4.8 MM X H1 MM MANDIBLE C1713 $4,176.00PLATE BONE TITANIUM NARROW CONTOUR CURVE L29 MM X C1713 $2,364.00PLATE BONE TITANIUM NARROW CONTOUR CURVE L41 MM X C1713 $2,550.00PLATE BONE TITANIUM NARROW CONTOUR STRAIGHT L29 MM C1713 $1,528.80PLATE BONE TITANIUM NARROW CONTOUR STRAIGHT L42 MM C1713 $2,178.00PLATE BONE TITANIUM NARROW CONTOUR STRAIGHT L55 MM C1713 $2,364.00PLATE BONE TITANIUM NARROW L105 MM 6 HOLE ACTIVE C C1713 $1,621.75PLATE BONE TITANIUM NARROW L121 MM 7 HOLE ACTIVE C C1713 $1,621.75PLATE BONE TITANIUM NARROW L137 MM 8 HOLE ACTIVE C C1713 $1,621.75PLATE BONE TITANIUM NARROW L153 MM 9 HOLE ACTIVE C C1713 $1,621.75PLATE BONE TITANIUM NARROW L169 MM 10 HOLE ACTIVE C1713 $1,946.75PLATE BONE TITANIUM NARROW L185 MM 11 HOLE ACTIVE C1713 $1,946.75PLATE BONE TITANIUM NARROW L201 MM 12 HOLE ACTIVE C1713 $1,946.75PLATE BONE TITANIUM NARROW L73 MM 4 HOLE ACTIVE CO C1713 $1,621.75PLATE BONE TITANIUM NARROW L89 MM 5 HOLE ACTIVE CO C1713 $1,621.75PLATE BONE TITANIUM OBLIQUE L CRANIOMAXILLOFACIAL C1713 $1,716.00PLATE BONE TITANIUM OBLIQUE LEFT L CRANIOFACIAL 3 C1713 $2,053.60PLATE BONE TITANIUM OBLIQUE RIGHT L CRANIOFACIAL 2 C1713 $1,944.80PLATE BONE TITANIUM OBLIQUE RIGHT L CRANIOFACIAL 3 C1713 $2,053.60PLATE BONE TITANIUM OBLONG L102 MM X W11-14 MM X H C1713 $2,427.75PLATE BONE TITANIUM OBLONG L122 MM X W11-14 MM X H C1713 $2,525.25PLATE BONE TITANIUM OBLONG L82 MM X W11-14 MM X H3 C1713 $2,427.75PLATE BONE TITANIUM ORBITAL RIM 8 HOLE 1.5 MM SCRE C1713 $1,902.00PLATE BONE TITANIUM ORTHODONTIC 4 HOLE ANCHOR MESH C1713 $1,350.00PLATE BONE TITANIUM ORTHODONTIC 5 HOLE ANCHOR MESH C1713 $1,350.00

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 ChargePLATE BONE TITANIUM PREBENT L7.7 MM MAXILLOFACIAL C1713 $2,125.50PLATE BONE TITANIUM RECTANGLE L100 MM X W100 MM X C1713 $15,540.00PLATE BONE TITANIUM RECTANGLE L13 MM X W8 MM CRANI C1713 $1,422.00PLATE BONE TITANIUM RECTANGLE L200 MM X W200 MM X C1713 $70,182.80PLATE BONE TITANIUM RECTANGLE L45 MM X W38 MM X H. C1713 $9,165.98PLATE BONE TITANIUM RHOMBUS L20 MM X W13 MM X H1 M C1713 $2,415.36PLATE BONE TITANIUM RIGHT 4 HOLE ACTIVE COMPRESSIO C1713 $4,546.75PLATE BONE TITANIUM RIGHT ANGLE L97 MM X W47 MM MA C1713 $10,941.20PLATE BONE TITANIUM RIGHT OBLIQUE SPINE 2 X 4 HOLE C1713 $2,640.00PLATE BONE TITANIUM ROUND FIRST METACARPOPHALANGEA C1713 $2,418.00PLATE BONE TITANIUM ROUND H.4 MM OD100 MM CRANIOFA C1713 $16,789.20PLATE BONE TITANIUM ROUND H.6 MM OD100 MM CRANIOFA C1713 $14,814.00PLATE BONE TITANIUM ROUND H.6 MM OD30 MM CRANIOFAC C1713 $5,460.00PLATE BONE TITANIUM ROUND H.6 MM OD70 MM CRANIOFAC C1713 $12,811.20PLATE BONE TITANIUM ROUND L17 MM 3 HOLE 2 MM SCREW C1713 $646.75PLATE BONE TITANIUM ROUND L23 MM 4 HOLE 2 MM SCREW C1713 $646.75PLATE BONE TITANIUM ROUND L29 MM 5 HOLE 2 MM SCREW C1713 $646.75PLATE BONE TITANIUM SHORT BEND WRIST 8 HOLE FUSION C1713 $7,336.96PLATE BONE TITANIUM SHORT L OBLIQUE CRANIOMAXILLOF C1713 $1,578.00PLATE BONE TITANIUM SHORT L OBLIQUE H.6 MM CRANIOF C1713 $1,578.00PLATE BONE TITANIUM SHORT L OBLIQUE MIDFACE LEFT 2 C1713 $1,356.00PLATE BONE TITANIUM SHORT L OBLIQUE MIDFACE RIGHT C1713 $1,356.00PLATE BONE TITANIUM SHORT STRAIGHT CRANIOFACIAL 2 C1713 $421.07PLATE BONE TITANIUM SHORT Z CRANIOMAXILLOFACIAL RI C1713 $1,824.00PLATE BONE TITANIUM SHORT Z L19 MM X W4 MM X H.9 M C1713 $1,824.00PLATE BONE TITANIUM SHORT Z L21 MM X W4.8 MM X H.6 C1713 $1,536.00PLATE BONE TITANIUM SHORT Z L21 MM X W4.8 MM X H.9 C1713 $1,536.00PLATE BONE TITANIUM SHORT Z MIDFACE RIGHT NONSTERI C1713 $1,536.00PLATE BONE TITANIUM SMALL H MANUBRIUM 8 HOLE LOCK C1713 $6,283.20PLATE BONE TITANIUM SMALL H.3 MM ORBITAL FLOOR NON C1713 $7,698.00PLATE BONE TITANIUM SMALL HUMERUS 3 HOLE HEAD MOLD C1713 $390.00PLATE BONE TITANIUM SMALL HUMERUS 4 HOLE HEAD MOLD C1713 $455.00PLATE BONE TITANIUM SMALL L109 MM 9 HOLE ACP 3.5 M C1713 $809.25PLATE BONE TITANIUM SMALL L109 MM 9 HOLE ACTIVE CO C1713 $809.25PLATE BONE TITANIUM SMALL L112 MM X W11 MM X H2.5 C1713 $2,437.50PLATE BONE TITANIUM SMALL L121 MM 10 HOLE ACTIVE C C1713 $809.25PLATE BONE TITANIUM SMALL L133 MM 11 HOLE ACTIVE C C1713 $809.25PLATE BONE TITANIUM SMALL L139 MM X W20-11 MM X H2 C1713 $2,827.50PLATE BONE TITANIUM SMALL L145 MM 12 HOLE ACTIVE C C1713 $809.25

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 ChargePLATE BONE TITANIUM SMALL L169 MM X W20-11 MM X H2 C1713 $3,168.75PLATE BONE TITANIUM SMALL L36 MM 4 HOLE ACP 2.7 MM C1713 $1,621.75PLATE BONE TITANIUM SMALL L36 MM 4 HOLE ACTIVE COM C1713 $1,621.75PLATE BONE TITANIUM SMALL L44 MM 5 HOLE ACTIVE COM C1713 $1,621.75PLATE BONE TITANIUM SMALL L49 MM 4 HOLE ACTIVE COM C1713 $809.25PLATE BONE TITANIUM SMALL L52 MM 6 HOLE ACTIVE COM C1713 $1,621.75PLATE BONE TITANIUM SMALL L61 MM 5 HOLE ACTIVE COM C1713 $809.25PLATE BONE TITANIUM SMALL L68 MM 8 HOLE ACTIVE COM C1713 $1,784.25PLATE BONE TITANIUM SMALL L73 MM 6 HOLE ACTIVE COM C1713 $809.25PLATE BONE TITANIUM SMALL L76 MM 9 HOLE ACTIVE COM C1713 $1,784.25PLATE BONE TITANIUM SMALL L84 MM 10 HOLE ACTIVE CO C1713 $1,784.25PLATE BONE TITANIUM SMALL L85 MM 7 HOLE ACP 3.5 MM C1713 $809.25PLATE BONE TITANIUM SMALL L85 MM 7 HOLE ACTIVE COM C1713 $809.25PLATE BONE TITANIUM SMALL L90 MM 7 HOLE ACP 2.7 MM C1713 $1,784.25PLATE BONE TITANIUM SMALL L90 MM 7 HOLE ACTIVE COM C1713 $1,784.25PLATE BONE TITANIUM SMALL L97 MM 8 HOLE ACP 3.5 MM C1713 $809.25PLATE BONE TITANIUM SMALL L97 MM 8 HOLE ACTIVE COM C1713 $809.25PLATE BONE TITANIUM SMALL OBLIQUE ANGLE T L39 MM 3 C1713 $971.75PLATE BONE TITANIUM SMALL STATURE L24 MM X W16 MM C1713 $4,550.00PLATE BONE TITANIUM SMALL T 2 HOLE HEAD 3 HOLE SHA C1713 $646.75PLATE BONE TITANIUM SMALL T L44 MM 3 HOLE HEAD 5 H C1713 $809.25PLATE BONE TITANIUM SMALL X FOREFOOT MIDFOOT 2.4 M C1713 $4,517.50PLATE BONE TITANIUM SMALL X L24 MM X W18 MM FOOT L C1713 $5,340.56PLATE BONE TITANIUM SPOON L100 MM 5 HOLE SHAFT NON C1713 $2,396.56PLATE BONE TITANIUM SPOON L120 MM 6 HOLE SHAFT NON C1713 $2,557.60PLATE BONE TITANIUM SQUARE CRANIOFACIAL LOW PROFIL C1713 $1,311.18PLATE BONE TITANIUM SQUARE L13 MM X W13 MM CRANIOF C1713 $1,422.00PLATE BONE TITANIUM STANDARD BEND WRIST 8 HOLE FUS C1713 $7,336.96PLATE BONE TITANIUM STANDARD CURVE H.8 MM HAND MET C1713 $2,288.00PLATE BONE TITANIUM STANDARD H.8 MM HAND METACARPA C1713 $1,820.00PLATE BONE TITANIUM STANDARD H1.3 MM HAND LEFT MET C1713 $2,632.50PLATE BONE TITANIUM STANDARD H1.3 MM HAND RIGHT ME C1713 $2,632.50PLATE BONE TITANIUM STANDARD OFFSET H.8 MM HAND ME C1713 $2,047.50PLATE BONE TITANIUM STANDARD STRAIGHT H.8 MM HAND C1713 $2,288.00PLATE BONE TITANIUM STANDARD T H.8 MM HAND METACAR C1713 $2,288.00PLATE BONE TITANIUM STANDARD T H1.3 MM HAND METACA C1713 $2,288.00PLATE BONE TITANIUM STAR MANUBRIUM 12 HOLE LOCK NO C1713 $4,410.90PLATE BONE TITANIUM STAR MANUBRIUM 6 HOLE LOCK NON C1713 $5,963.60PLATE BONE TITANIUM STRAIGHT FOOT METATARSAL 4 HOL C1713 $4,517.50

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 ChargePLATE BONE TITANIUM STRAIGHT FOOT METATARSAL 5 HOL C1713 $4,517.50PLATE BONE TITANIUM STRAIGHT FOOT METATARSAL 6 HOL C1713 $4,517.50PLATE BONE TITANIUM STRAIGHT FOOT METATARSAL 7 HOL C1713 $4,517.50PLATE BONE TITANIUM STRAIGHT FOOT TARSOMETATARSAL C1713 $5,200.00PLATE BONE TITANIUM STRAIGHT H.4 MM CRANIOFACIAL 2 C1713 $282.00PLATE BONE TITANIUM STRAIGHT H.4 MM CRANIOFACIAL 4 C1713 $390.00PLATE BONE TITANIUM STRAIGHT L100 MM X W3.8 MM X H C1713 $1,776.80PLATE BONE TITANIUM STRAIGHT L100 MM X W5 MM X H1 C1713 $1,743.36PLATE BONE TITANIUM STRAIGHT L126 MM X W11 MM 11 H C1713 $2,310.75PLATE BONE TITANIUM STRAIGHT L16 MM CRANIOFACIAL 2 C1713 $294.00PLATE BONE TITANIUM STRAIGHT L160 MM X W8 MM X H2. C1713 $8,856.00PLATE BONE TITANIUM STRAIGHT L17 MM X W6 MM X H1.6 C1713 $2,944.00PLATE BONE TITANIUM STRAIGHT L22 MM MANDIBLE 4 HOL C1713 $2,388.00PLATE BONE TITANIUM STRAIGHT L23 MM HAND 6 HOLE LO C1713 $1,162.33PLATE BONE TITANIUM STRAIGHT L24 MM X W4.5 MM X H. C1713 $1,704.00PLATE BONE TITANIUM STRAIGHT L25 MM CRANIOFACIAL 4 C1713 $402.00PLATE BONE TITANIUM STRAIGHT L25 MM MANDIBLE 4 HOL C1713 $2,337.60PLATE BONE TITANIUM STRAIGHT L25 MM X H.9 MM L15 M C1713 $3,492.00PLATE BONE TITANIUM STRAIGHT L30 MM X W4.5 MM X H. C1713 $1,598.40PLATE BONE TITANIUM STRAIGHT L30 MM X W5 MM X H1.2 C1713 $2,304.00PLATE BONE TITANIUM STRAIGHT L35 MM MANDIBLE 6 HOL C1713 $2,652.00PLATE BONE TITANIUM STRAIGHT L47 MM HAND 12 HOLE L C1713 $1,468.81PLATE BONE TITANIUM STRAIGHT L50 MM 5 HOLE MULTIDI C1713 $1,340.63PLATE BONE TITANIUM STRAIGHT L70 MM 7 HOLE MULTIDI C1713 $1,511.25PLATE BONE TITANIUM STRAIGHT L82 MM 4 HOLE MULTIDI C1713 $1,657.50PLATE BONE TITANIUM STRAIGHT L82 MM X W11 MM X H3. C1713 $1,657.50PLATE BONE TITANIUM STRAIGHT L87 MM X W10 MM CLAVI C1713 $5,661.50PLATE BONE TITANIUM STRAIGHT L90 MM 9 HOLE MULTIDI C1713 $1,706.25PLATE BONE TITANIUM STRAIGHT L90 MM X W10 MM X H1. C1713 $1,706.25PLATE BONE TITANIUM STRAIGHT L95 MM X W8 MM X H2.5 C1713 $6,174.00PLATE BONE TITANIUM STRAIGHT L96 MM X W8 MM X H2.5 C1713 $4,867.20PLATE BONE TITANIUM STRAIGHT STERNUM 12 HOLE LOCK C1713 $7,203.30PLATE BONE TITANIUM STRAIGHT STERNUM 13 HOLE LOCK C1713 $7,459.60PLATE BONE TITANIUM STRAIGHT STERNUM 20 HOLE LOCK C1713 $11,779.20PLATE BONE TITANIUM STRAIGHT STERNUM 30 HOLE LOCK C1713 $17,683.20PLATE BONE TITANIUM STRAIGHT STERNUM 8 HOLE LOCK N C1713 $5,834.40PLATE BONE TITANIUM STRAIGHT W6.5 MM X H2 MM MANDI C1713 $7,500.00PLATE BONE TITANIUM STRAIGHT WRIST 9 HOLE FUSION N C1713 $7,336.96PLATE BONE TITANIUM STRUT L30 MM X W6 MM X H.5 MM C1713 $3,563.20

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 ChargePLATE BONE TITANIUM STRUT L42 MM X W6 MM X H.5 MM C1713 $4,005.20PLATE BONE TITANIUM T 4 HOLE 2 MM SCREW MINI FRAGM C1713 $646.75PLATE BONE TITANIUM T BUTTRESS L84 MM 4 HOLE 4.5 M C1713 $1,946.75PLATE BONE TITANIUM T FOOT METATARSAL 4 HOLE LOW P C1713 $4,517.50PLATE BONE TITANIUM T FOOT TARSOMETATARSAL 4 HOLE C1713 $5,200.00PLATE BONE TITANIUM T L116 MM 6 HOLE 4.5 MM SCREW C1713 $1,946.75PLATE BONE TITANIUM T L148 MM 8 HOLE 4.5 MM SCREW C1713 $1,946.75PLATE BONE TITANIUM T L18 MM X W14 MM X H.5 MM CRA C1713 $1,768.00PLATE BONE TITANIUM T L19 MM CRANIOMAXILLOFACIAL 1 C1713 $1,200.00PLATE BONE TITANIUM T L20 MM X W11 MM X H.5 MM CRA C1713 $1,602.00PLATE BONE TITANIUM T L24 MM X W14 MM X H.5 MM CRA C1713 $1,863.20PLATE BONE TITANIUM T L24 MM X W4.5-4.8 MM X H.6 M C1713 $1,734.00PLATE BONE TITANIUM T L25 MM X W4.5-4.8 MM X H.9 M C1713 $1,440.00PLATE BONE TITANIUM T L32 MM HAND 3 HOLE HEAD 8 HO C1713 $1,656.00PLATE BONE TITANIUM T L32 MM HAND 4 HOLE HEAD 8 HO C1713 $1,845.71PLATE BONE TITANIUM T L44 MM 3 HOLE HEAD 3 HOLE SH C1713 $809.25PLATE BONE TITANIUM T L44 MM 4 HOLE HEAD 4 HOLE SH C1713 $809.25PLATE BONE TITANIUM T L44 MM 6 HOLE HEAD 4 HOLE SH C1713 $809.25PLATE BONE TITANIUM T L50 MM X W3.8 MM X H.9 MM 3 C1713 $1,439.76PLATE BONE TITANIUM T L50 MM X W3.8 MM X H.9 MM 4 C1713 $1,573.20PLATE BONE TITANIUM T L50 MM X W5 MM X H1.2 MM 3 H C1713 $1,481.20PLATE BONE TITANIUM T L50 MM X W5 MM X H1.2 MM 4 H C1713 $1,600.80PLATE BONE TITANIUM T L84 MM 4 HOLE 4.5 MM SCREW C1713 $1,946.75PLATE BONE TITANIUM T L84 MM 4 HOLE BUTTRESS 4.5 M C1713 $1,946.75PLATE BONE TITANIUM TUBULAR L78 MM X W10 MM X H2 M C1713 $2,115.75PLATE BONE TITANIUM UNIVERSAL ANGLE L25 MM X W6.5 C1713 $7,520.80PLATE BONE TITANIUM UNIVERSAL L50 MM X W50 MM X H. C1713 $7,698.00PLATE BONE TITANIUM UNIVERSAL STRAIGHT L64 MM X W6 C1713 $4,515.20PLATE BONE TITANIUM UNIVERSAL STRAIGHT L80 MM X W6 C1713 $3,984.00PLATE BONE TITANIUM W5 MM X H1.25 MM MANDIBLE 12 H C1713 $4,494.00PLATE BONE TITANIUM W5 MM X H1.25 MM MANDIBLE 6 HO C1713 $3,954.00PLATE BONE TITANIUM W6.5 MM X H2 MM MANDIBLE LEFT C1713 $12,396.00PLATE BONE TITANIUM W6.5 MM X H2 MM MANDIBLE RIGHT C1713 $12,396.00PLATE BONE TITANIUM WIDE L66 MM X W8 MM X H2 MM UL C1713 $2,208.38PLATE BONE TITANIUM X CRANIOFACIAL 4 HOLE NONSTERI C1713 $1,452.00PLATE BONE TITANIUM X L10 MM X W7 MM X H.5 MM CRAN C1713 $1,577.60PLATE BONE TITANIUM X MIDFACE 4 HOLE LOW PROFILE N C1713 $1,716.00PLATE BONE TITANIUM X MIDFACE 4 HOLE NONSTERILE 1. C1713 $1,944.80PLATE BONE TITANIUM X STERNUM 10 HOLE LOCK NONSTER C1713 $6,575.60

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 ChargePLATE BONE TITANIUM X WIDE STERNUM 10 HOLE LOCK NO C1713 $6,575.60PLATE BONE TITANIUM XLONG L142 MM ELBOW RIGHT LATE C1713 $6,214.00PLATE BONE TITANIUM XS X L22 MM X W14 MM FOOT LOCK C1713 $5,423.36PLATE BONE TITANIUM Y L18 MM X W11 MM X H.5 MM CRA C1713 $1,761.20PLATE BONE TITANIUM Y L20 MM X W10 MM X H.5 MM CRA C1713 $1,337.05PLATE BONE TITANIUM Y L22 MM X W11 MM CRANIOFACIAL C1713 $1,716.00PLATE BONE TITANIUM Y L22 MM X W11 MM X H.9 MM CRA C1713 $1,944.80PLATE BONE TITANIUM Y L24 MM X W12 MM X H.9 MM CRA C1713 $1,788.40PLATE BONE TITANIUM Y L27 MM X W15 MM X H.5 MM CRA C1713 $1,761.20PLATE BONE TITANIUM Y L30 MM X H.9 MM L19 MM CRANI C1713 $1,890.40PLATE BONE TITANIUM Y L32 MM X W19 MM X H.9 MM L4. C1713 $1,829.20PLATE BONE TITANIUM Y L37 MM HAND 3 HOLE HEAD 8 HO C1713 $1,771.92PLATE BONE TITANIUM Y L38 MM X W19 MM X H.5 MM MID C1713 $1,434.00PLATE BONE TK2 TIMAX 130 D STANDARD BARREL L92.6 M C1713 $2,393.04PLATE BONE TK2 TIMAX 135 D SHORT BARREL L92.6 MM X C1713 $2,393.04PLATE BONE TK2 TIMAX 135 D STANDARD BARREL L92.6 M C1713 $2,393.04PLATE BONE TOMOFIX TITANIUM L102 MM TIBIAL LEFT LA C1713 $8,827.36PLATE BONE TOMOFIX TITANIUM L102 MM TIBIAL RIGHT L C1713 $8,827.36PLATE BONE TOMOFIX TITANIUM L115 MM TIBIAL MEDIAL C1713 $8,827.36PLATE BONE TOMOFIX TITANIUM L121 MM FEMUR LEFT DIS C1713 $8,827.36PLATE BONE TOMOFIX TITANIUM L121 MM FEMUR RIGHT DI C1713 $8,827.36PLATE BONE TOMOFIX TITANIUM L141 MM FEMUR LEFT DIS C1713 $8,827.36PLATE BONE TOMOFIX TITANIUM L141 MM FEMUR RIGHT DI C1713 $8,827.36PLATE BONE TRAVERSE L35 MM SPINE FIX NONSTERILE C1713 $15,600.00PLATE BONE UNIVERSAL NEURO 2 CRANIOFACIAL 2 HOLE L C1713 $907.01PLATE BONE UNIVERSAL NEURO II L10 MM X H.3 MM CRAN C1713 $1,758.51PLATE BONE UNIVERSAL NEURO II LARGE CRANIOMAXILLOF C1713 $2,522.52PLATE BONE UNIVERSAL NEURO II QUIKFLAP TITANIUM L1 C1713 $595.79PLATE BONE UNIVERSAL NEURO II QUIKFLAP TITANIUM ST C1713 $948.87PLATE BONE UNIVERSAL NEURO II TITANIUM 2Y L8 MM CR C1713 $1,461.92PLATE BONE UNIVERSAL NEURO II TITANIUM 3D LARGE BO C1713 $1,617.72PLATE BONE UNIVERSAL NEURO II TITANIUM BOX L28 MM C1713 $1,048.13PLATE BONE UNIVERSAL NEURO II TITANIUM L12 MM CRAN C1713 $700.57PLATE BONE UNIVERSAL NEURO II TITANIUM L14 MM X H. C1713 $1,456.33PLATE BONE UNIVERSAL NEURO II TITANIUM L16 MM CRAN C1713 $838.50PLATE BONE UNIVERSAL NEURO II TITANIUM L6 MM CRANI C1713 $700.57PLATE BONE UNIVERSAL NEURO II TITANIUM LARGE BOX L C1713 $1,572.22PLATE BONE UNIVERSAL NEURO II TITANIUM LARGE GAP L C1713 $1,919.78PLATE BONE UNIVERSAL NEURO II TITANIUM LARGE L22 M C1713 $1,919.78

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 ChargePLATE BONE UNIVERSAL NEURO II TITANIUM STRAIGHT CR C1713 $1,677.00PLATE BONE UNIVERSAL NEURO III TITANIUM DOG L12 MM C1713 $743.47PLATE BONE UNIVERSAL NEURO III TITANIUM SMALL ROUN C1713 $5,697.76PLATE BONE UNIVERSAL TUBULAR 7 HOLE NONSTERILE C1713 $2,115.75PLATE BONE VANTAGE TITANIUM L3.5 CM SPINE THORACIC C1713 $14,625.00PLATE BONE VARIAX BROAD CURVE L175 MM 14 HOLE COMP C1713 $3,569.15PLATE BONE VARIAX BROAD STRAIGHT L103 MM 8 HOLE CO C1713 $3,001.05PLATE BONE VARIAX L97 MM CLAVICLE LEFT SUPERIOR 8 C1713 $5,522.40PLATE BONE VARIAX L99 MM CLAVICLE LEFT SUPERIOR 8 C1713 $5,522.40PLATE BONE VARIAX LONG L36 MM FOOT LEFT NAVICULOCU C1713 $7,512.96PLATE BONE VARIAX NARROW STRAIGHT L102 MM 8 HOLE C C1713 $3,001.05PLATE BONE VARIAX SHORT L56 MM RADIAL LEFT DISTAL C1713 $5,525.00PLATE BONE VARIAX SLIM Y 2 HOLE STERILE C1713 $5,229.12PLATE BONE VARIAX SLIM Y 4 HOLE STERILE C1713 $5,229.12PLATE BONE VARIAX SLIM Y 5 HOLE NONSTERILE C1713 $5,229.12PLATE BONE VARIAX TITANIUM 3D FOOT LEFT 6 HOLE POL C1713 $3,737.76PLATE BONE VARIAX TITANIUM L101 MM X W10 MM X H2 M C1713 $3,235.44PLATE BONE VARIAX TITANIUM L104 MM HUMERUS LEFT DI C1713 $5,234.32PLATE BONE VARIAX TITANIUM L109 MM HUMERUS LEFT DI C1713 $5,234.29PLATE BONE VARIAX TITANIUM L109 MM HUMERUS RIGHT D C1713 $5,234.32PLATE BONE VARIAX TITANIUM L113 MM OLECRANON RIGHT C1713 $5,234.29PLATE BONE VARIAX TITANIUM L113 MM X W10 MM X H2 M C1713 $3,357.12PLATE BONE VARIAX TITANIUM L116 MM HUMERUS DISTAL C1713 $5,234.32PLATE BONE VARIAX TITANIUM L125 MM X W10 MM X H2 M C1713 $3,647.28PLATE BONE VARIAX TITANIUM L128 MM HUMERUS RIGHT D C1713 $5,234.32PLATE BONE VARIAX TITANIUM L132 MM HUMERUS RIGHT D C1713 $5,234.32PLATE BONE VARIAX TITANIUM L137 MM OLECRANON RIGHT C1713 $6,676.93PLATE BONE VARIAX TITANIUM L137 MM X W10 MM X H2 M C1713 $3,647.28PLATE BONE VARIAX TITANIUM L139 MM HUMERUS DISTAL C1713 $6,676.93PLATE BONE VARIAX TITANIUM L149 MM X W10 MM X H2 M C1713 $3,647.28PLATE BONE VARIAX TITANIUM L150 MM HUMERUS RIGHT L C1713 $6,676.96PLATE BONE VARIAX TITANIUM L196 MM HUMERUS LEFT LA C1713 $6,676.93PLATE BONE VARIAX TITANIUM L65 MM OLECRANON RIGHT C1713 $4,748.12PLATE BONE VARIAX TITANIUM L72 MM HUMERUS DISTAL M C1713 $4,748.12PLATE BONE VARIAX TITANIUM L77 MM X W10 MM X H2 MM C1713 $3,235.44PLATE BONE VARIAX TITANIUM L80 MM HUMERUS RIGHT LA C1713 $4,748.12PLATE BONE VARIAX TITANIUM L84 MM HUMERUS RIGHT DI C1713 $4,748.12PLATE BONE VARIAX TITANIUM L89 MM OLECRANON RIGHT C1713 $5,234.32PLATE BONE VARIAX TITANIUM L89 MM X W10 MM X H2 MM C1713 $3,235.44

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 ChargePLATE BONE VARIAX TITANIUM L92 MM HUMERUS DISTAL M C1713 $5,234.29PLATE BONE VARIAX TITANIUM LONG NARROW L76 MM X H2 C1713 $5,525.00PLATE BONE VARIAX TITANIUM NARROW L56 MM X H2 MM R C1713 $5,525.00PLATE BONE VARIAX TITANIUM STANDARD L56 MM X H2 MM C1713 $5,525.00PLATE BONE VARIAX TITANIUM STRAIGHT L108 MM X H2 M C1713 $2,208.96PLATE BONE VARIAX TITANIUM STRAIGHT L60 MM X H2 MM C1713 $2,208.96PLATE BONE VARIAX XSHORT NARROW L49 MM RADIAL LEFT C1713 $5,525.00PLATE BONE VARIAX XSHORT NARROW L49 MM RADIAL RIGH C1713 $5,525.00PLATE BONE VERTEX MAX TITANIUM LARGE SPINE OCCIPIT C1713 $12,000.00PLATE BONE VERTEX MAX TITANIUM MEDIUM SPINE OCCIPI C1713 $12,000.00PLATE BONE VERTEX MAX TITANIUM SMALL SPINE OCCIPIT C1713 $12,000.00PLATE BONE VERTEX SELECT TITANIUM L50 MM SPINE OCC C1713 $9,750.00PLATE BONE VHS HIP 10 HOLE C1713 $5,736.64PLATE BONE VHS HIP 2 HOLE C1713 $3,660.80PLATE BONE VHS HIP 8 HOLE C1713 $5,062.72PLATE BONE VHS STAINLESS STEEL FEMUR SUPRACONDYLAR C1713 $3,506.88PLATE BONE VHS STAINLESS STEEL L102.5 MM HIP 6 HOL C1713 $5,582.72PLATE BONE VHS STAINLESS STEEL L120 MM HIP 6 HOLE C1713 $3,506.88PLATE BONE VHS STAINLESS STEEL L126.5 MM HIP 8 HOL C1713 $5,582.72PLATE BONE VHS STAINLESS STEEL L150.5 MM HIP 10 HO C1713 $5,582.72PLATE BONE VHS STAINLESS STEEL L152 MM FEMUR SUPRA C1713 $4,833.92PLATE BONE VHS STAINLESS STEEL L152 MM SUPRACONDYL C1713 $15,758.08PLATE BONE VHS STAINLESS STEEL L184 MM FEMUR SUPRA C1713 $6,036.16PLATE BONE VHS STAINLESS STEEL L248 MM SUPRACONDYL C1713 $20,683.52PLATE BONE VHS STAINLESS STEEL L338 MM SUPRACONDYL C1713 $26,960.96PLATE BONE VHS STAINLESS STEEL L56 MM FEMUR 2 HOLE C1713 $3,506.88PLATE BONE VHS STAINLESS STEEL L66.5 MM HIP 3 HOLE C1713 $5,582.72PLATE BONE VHS STAINLESS STEEL L88 MM FEMUR 4 HOLE C1713 $3,506.88PLATE BONE WIDE 4 HOLE MOLD PILON C1713 $390.00PLATE BONE WIDE 6 HOLE MOLD PILON C1713 $455.00PLATE BONE WIDE 8 HOLE MOLD PILON C1713 $455.00PLATE BONE WIDE HUMERAL 3 HOLE HEAD MOLD C1713 $390.00PLATE BONE WIDE HUMERAL 4 HOLE HEAD MOLD C1713 $455.00PLATE BONE WIDE HUMERUS 3 HOLE HEAD MOLD C1713 $390.00PLATE BONE WIDE HUMERUS 4 HOLE HEAD MOLD C1713 $455.00PLATE BONE X10 CROSSLINK MULTI-SPAN STAINLESS STEE C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L16 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L19 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L2.953 IN 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 ChargePLATE BONE X10 CROSSLINK TITANIUM L22 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L25 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L28 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L28-30 MM SPINE C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L30-34 MM SPINE C1713 $4,000.00PLATE BONE X10 CROSSLINK TITANIUM L31 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L34 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L34-42 MM SPINE C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L37 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L40 MM SPINE 4.5 C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L41-56 MM SPINE C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM L55-84 MM SPINE C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L13 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L16 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L17 MM C1713 $4,000.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L19 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L21 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L22 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L25 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L28 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L29 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L31 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L33 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L34 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L37 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LORDOTIC L40 MM C1713 $4,800.00PLATE BONE X10 CROSSLINK TITANIUM LOW PROFILE L.5 C1713 $4,000.00PLATE BONE XTEND L10 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00PLATE BONE XTEND L101 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND L104 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND L12 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00PLATE BONE XTEND L14 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00PLATE BONE XTEND L16 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00PLATE BONE XTEND L18 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00PLATE BONE XTEND L20 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00PLATE BONE XTEND L22 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00PLATE BONE XTEND L24 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00PLATE BONE XTEND L24 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L26 MM SPINE CERVICAL ANTERIOR 1 C1713 $4,225.00

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 ChargePLATE BONE XTEND L26 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L28 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L30 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L32 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L34 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L36 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L38 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L40 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L42 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L44 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L45 MM SPINE CERVICAL ANTERIOR 3 C1713 $4,875.00PLATE BONE XTEND L46 MM SPINE CERVICAL ANTERIOR 2 C1713 $4,225.00PLATE BONE XTEND L48 MM SPINE CERVICAL ANTERIOR 3 C1713 $4,875.00PLATE BONE XTEND L54 MM SPINE CERVICAL ANTERIOR 3 C1713 $4,875.00PLATE BONE XTEND L57 MM SPINE CERVICAL ANTERIOR 3 C1713 $4,875.00PLATE BONE XTEND L60 MM SPINE CERVICAL ANTERIOR 3 C1713 $4,875.00PLATE BONE XTEND L60 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L63 MM SPINE CERVICAL ANTERIOR 3 C1713 $4,875.00PLATE BONE XTEND L63 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L66 MM SPINE CERVICAL ANTERIOR 3 C1713 $4,875.00PLATE BONE XTEND L66 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L69 MM SPINE CERVICAL ANTERIOR 3 C1713 $4,875.00PLATE BONE XTEND L72 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L75 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L78 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L80 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND L81 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L83 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND L84 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L86 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND L87 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L89 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND L90 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L92 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND L93 MM SPINE CERVICAL ANTERIOR 4 C1713 $4,875.00PLATE BONE XTEND L95 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND L98 MM SPINE CERVICAL ANTERIOR 5 C1713 $5,525.00PLATE BONE XTEND XLORDOTIC L10 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE XTEND XLORDOTIC L12 MM SPINE CERVICAL A C1713 $4,225.00

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 ChargePLATE BONE XTEND XLORDOTIC L14 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE XTEND XLORDOTIC L24 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE XTEND XLORDOTIC L26 MM SPINE CERVICAL A C1713 $4,225.00PLATE BONE XTEND XLORDOTIC L39 MM SPINE CERVICAL A C1713 $4,875.00PLATE BONE ZEVO TITANIUM L15 MM SPINE CERVICAL ANT C1713 $4,550.00PLATE BONE ZEVO TITANIUM L41 MM SPINE CERVICAL ANT C1713 $4,550.00PLATE EXTERNAL FIXATION 3 HOLE CONNECT $602.56PLATE EXTERNAL FIXATION CARBON FIBER 120 D ARCH L1 $6,881.60PLATE EXTERNAL FIXATION CARBON FIBER 120 D ARCH L2 $7,498.00PLATE EXTERNAL FIXATION CARBON FIBER 90 D ARCH L18 $6,660.80PLATE EXTERNAL FIXATION CARBON FIBER 90 D ARCH L24 $7,084.00PLATE EXTERNAL FIXATION CIRCULAR 3 HOLE HALF RING $1,924.24PLATE EXTERNAL FIXATION CIRCULAR 6 HOLE HALF RING $1,924.24PLATE EXTERNAL FIXATION CIRCULAR THICK 4 HOLE HALF $1,924.24PLATE EXTERNAL FIXATION CIRCULAR THICK 5 HOLE HALF $1,640.24PLATE EXTERNAL FIXATION FEMORAL 1 HOLE CONNECT MRI $542.80PLATE EXTERNAL FIXATION FEMORAL 2 HOLE CONNECT MRI $584.16PLATE EXTERNAL FIXATION FEMORAL 4 HOLE CONNECT MRI $685.36PLATE EXTERNAL FIXATION FEMORAL 5 HOLE CONNECT MRI $791.20PLATE EXTERNAL FIXATION FLAT FEMORAL 1 HOLE CONNEC $542.80PLATE EXTERNAL FIXATION ILIZAROV ADAPTER SMALL BON $695.52PLATE EXTERNAL FIXATION ILIZAROV CARBON FIBER EPOX $2,259.12PLATE EXTERNAL FIXATION ILIZAROV L45 MM 2 HOLE TWI $594.72PLATE EXTERNAL FIXATION ILIZAROV LONG L102 MM 7 HO $2,080.80PLATE EXTERNAL FIXATION ILIZAROV LONG L162 MM 11 H $2,318.40PLATE EXTERNAL FIXATION ILIZAROV LONG L72 MM 5 HOL $1,970.64PLATE EXTERNAL FIXATION ILIZAROV LONG L72 MM 9 HOL $2,196.72PLATE EXTERNAL FIXATION ILIZAROV STAINLESS STEEL A $610.32PLATE EXTERNAL FIXATION L20 MM 2 HOLE TWIST CIRCUL $1,924.24PLATE EXTERNAL FIXATION SHORT CIRCULAR L27 MM 2 HO $1,049.04PLATE EXTERNAL FIXATION SHORT CIRCULAR L37 MM 3 HO $1,217.20PLATE EXTERNAL FIXATION SHORT CIRCULAR L47 MM 4 HO $1,298.32PLATE EXTERNAL FIXATION SHORT CIRCULAR L57 MM 5 HO $1,924.24PLATE EXTERNAL FIXATION SPATIAL FRAME ILIZAROV ALU $12,508.48PLATE EXTERNAL FIXATION SPATIAL FRAME U ID105 MM $7,078.80PLATE EXTERNAL FIXATION SPATIAL FRAME U ID80 MM $7,078.80PLATE EXTERNAL FIXATION SPATIAL FRAME U LONG ID130 $7,068.80PLATE EXTERNAL FIXATION THIN CIRCULAR 4 HOLE HALF $1,924.24PLATE EXTERNAL FIXATION THIN CIRCULAR 5 HOLE HALF $1,924.24

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 ChargePLATE EXTERNAL FIXATION TITANIUM 120 D ARCH L180 M $7,452.00PLATE EXTERNAL FIXATION TITANIUM 120 D ARCH L240 M $8,054.56PLATE EXTERNAL FIXATION TITANIUM 90 D ARCH L180 MM $7,254.16PLATE EXTERNAL FIXATION TITANIUM 90 D ARCH L240 MM $7,866.00PLATE GLENOID EQUINOXE STANDARD SHOULDER REVERSE C1776 $7,865.00PLATE TIBIAL COLUMBUS T2 KNEE CEMENTED CRUCIATE RE C1776 $5,850.00PLATE TIBIAL NEXGEN PRECOAT 2 KNEE STEM C1776 $5,850.00PLATE TIBIAL NEXGEN PRECOAT 3 KNEE PEG C1776 $5,850.00PLATE TIBIAL NEXGEN PRECOAT 3 KNEE STEM C1713 $5,850.00PLATE TIBIAL NEXGEN PRECOAT 5 KNEE STEM C1776 $5,850.00PLATE TIBIAL NEXGEN PRECOAT 6 KNEE STEM C1776 $5,850.00PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE 2 L62 MM X C1776 $26,065.00PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE 3 L67 MM X C1776 $26,065.00PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE 4 KNEE ROT C1776 $26,065.00PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE 5 KNEE ROT C1776 $26,065.00PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE 6 KNEE ROT C1776 $26,065.00PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE PRECOAT 1 C1776 $26,065.00PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE PRECOAT 2 C1776 $23,855.00PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE PRECOAT 3 C1713 $26,065.00PLATELET AGGEGATION 85576 $153.00PLATELET COUNT, AUTOMATED TEST 85049 $30.00PLATELET FUNCTION TEST 85597 $96.00PLATELETS PHERESIS PATHOGEN REDUCED OR RAPID BACT P9073 $3,229.00PLATELETS PHERESIS PATHOGEN-REDUCED EACH UNIT P9073 $2,499.00PLATFORM ACCESS GELPOINT GELSEAL ALEXIS MINI OD10 $1,350.00PLATFORM WALKER C300 LB D18 IN STANDARD UNIVERSAL $875.44PLEDGET CARDIOVASCULAR BARD PTFE THK1.65 MM L4 IN C1768 $139.04PLEDGET CARDIOVASCULAR BARD PTFE THK1.65 MM RECTAN C1768 $4.75PLEDGET CARDIOVASCULAR DEKNATEL PTFE THK1/16 IN L4 C1768 $284.25PLEDGET CARDIOVASCULAR PTFE 6 L1/4 IN X W1/2 IN X C1768 $41.11PLEDGET CARDIOVASCULAR TEFLON THK1/16 IN LARGE L3/ C1768 $31.66PLUG ANCHOR COMPRESS 12 MM SHORT HIP 13 HOLE C1713 $8,192.80PLUG ANCHOR COMPRESS 12 MM STANDARD HIP C1776 $8,800.00PLUG ANCHOR COMPRESS 14 MM SHORT HIP 13 HOLE C1713 $8,192.80PLUG ANCHOR COMPRESS 14 MM SHORT HIP 9 HOLE C1713 $8,192.80PLUG ANCHOR COMPRESS OD12 MM HIP STERILE LATEX FRE C1713 $12,980.00PLUG BONE CEMENT BIO-PLUG OD10 MM C1713 $260.00PLUG BONE CEMENT BIO-PLUG OD20 MM C1713 $260.00PLUG BONE CEMENT COONRAD/MORREY OD16/25 MM ELBOW N C1713 $1,300.00

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 ChargePLUG BONE CEMENT SMALL OD12 MM INTRAMEDULLARY CANA C1713 $260.00PLUG CARDIOVASCULAR AMPLATZER NITINOL L10 MM L135 $4,160.00PLUG CARDIOVASCULAR AMPLATZER NITINOL L7 MM L100 C $4,160.00PLUG CARDIOVASCULAR AMPLATZER NITINOL MESH .098 IN $4,160.00PLUG OCCLUSION MVP PTFE L12 MM X W6.5 MM OD5 MM ME $12,025.00PLUG PLATE LCP STAINLESS STEEL OD3.5 MM THREAD STA C1713 $758.96PLUG SPINAL HELICAL FLANGE C1713 $400.00PLUG SPINAL HELICAL FLANGE DEROTATION C1713 $400.00PLUG SPINAL LINEUM HELICAL FLANGE TITANIUM SPINE C C1713 $325.00PLUG SPINAL POLARIS TITANIUM OD5.5 MM DEROTATION H C1713 $400.00PLUG SPINAL POLARIS TITANIUM PEDICLE HELICAL FLANG C1713 $325.00PLUG SPINAL SOLITAIRE LOCK C1713 $400.00PLUG SURGICAL PARIETEX POLYESTER ROUND OD6.5 CM KE C1784 $195.30PLUG SURGICAL PARIETEX POLYESTER ROUND OD8 CM KEYH C1781 $203.62PLUG SURGICAL PERFIX POLYPROPYLENE LARGE TAPER H1. C1781 $893.10PLUG SURGICAL PERFIX POLYPROPYLENE MEDIUM H1.3 IN C1781 $1,060.00PLUG SURGICAL PERFIX POLYPROPYLENE MEDIUM TAPER H1 C1781 $1,006.66PLUG SURGICAL PERFIX POLYPROPYLENE SMALL TAPER H1 C1781 $801.97PLUG SURGICAL PERFIX POLYPROPYLENE XL TAPER H1.6 I C1781 $1,027.65PNEUMOC 13-VALENT CONJUGATE 0.5 ML SYRG 0.5 ML SYR 90670 $688.92PNEUMOCOCCAL VACCINE 25 MCG/0.5 ML SYRG 0.5 ML SYR 90732 $329.12POCT BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND- 82962 $17.00POCT CHLORIDE 82435 $31.00POCT COAGULATION TIME ACTIVATED 85347 $20.00POCT GLUCOSE 82947 $22.00POCT HEMATOCRIT 85014 $14.00POCT IONIZED CALCIUM 82330 $76.00POCT POTASSIUM 84132 $26.00POCT SODIUM 84295 $27.00POCT TCO2 82374 $38.00POLIDOCANOL 1 % FOAM 5 ML BOX $1,787.00POOLING OF PLATELETS OR OTHER BLOOD PRODUCTS 86965 $130.00PORPHYRINS, TOTAL 84311 $412.00PORT ACCESS AIRSEAL L120 MM OD12 MM 2 WALL CANNULA $564.20PORT ENDOSCOPIC SILS OD15 MM FLEXIBLE CANNULA OBTU $2,600.00PORT ENDOSCOPIC SILS OD5 MM 1 INCISION CANNULA OBT $2,275.00PORT HAND ACCESS ALEXIS GELPORT GELSEAL L120 MM AB $2,250.00PORT HAND ACCESS LAP DISC OD5 CM ABDOMEN SLEEVE ST $9,394.97PORT IMPLANTABLE INFUSION MRI CHRONOFLEX SILICONE C1788 $1,105.00

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 ChargePORT IMPLANTABLE INFUSION MRI PLASTIC OD8 FR 1 LUM C1788 $2,307.50PORT IMPLANTABLE INFUSION MRI PLASTIC W32 MM X H13 C1788 $1,215.50PORT IMPLANTABLE INFUSION MRI SILICONE PLASTIC LOW C1788 $1,472.00PORT IMPLANTABLE INFUSION MRI SLIMPORT POLYURETHAN C1788 $1,768.00PORT IMPLANTABLE INFUSION POWERPORT AIRGUARD CHRON C1788 $2,760.00PORT IMPLANTABLE INFUSION POWERPORT CLEARVUE AIRGU C1788 $2,437.50PORT IMPLANTABLE INFUSION POWERPORT CLEARVUE ISP 8 C1788 $2,000.00PORT IMPLANTABLE INFUSION POWERPORT DUO MRI AIRGUA C1788 $2,567.50PORT IMPLANTABLE INFUSION POWERPORT ISP AIRGUARD C C1788 $3,120.00PORT IMPLANTABLE INFUSION POWERPORT ISP MRI AIRGUA C1788 $1,794.00PORT IMPLANTABLE INFUSION POWERPORT MRI AIRGUARD C C1788 $828.00PORT IMPLANTABLE INFUSION POWERPORT MRI SILICONE O C1788 $2,760.00PORT IMPLANTABLE INFUSION POWERPORT SLIM AIRGUARD C1788 $1,794.00PORT IMPLANTABLE INFUSION POWERPORT VUE MRI AIRGUA C1788 $2,360.00PORT IMPLANTABLE INFUSION ROSENBLATT SLIMPORT SILI C1788 $2,800.00PORT IMPLANTABLE INFUSION SLIMPORT CHRONOFLEX PEEL C1788 $2,000.00PORT IMPLANTABLE INFUSION SLIMPORT CHRONOFLEX TITA C1788 $1,760.00PORT IMPLANTABLE INFUSION TITANIUM SILICONE SMALL C1788 $1,472.00PORT IMPLANTABLE INFUSION TITANIUM SILICONE W31.7 C1788 $1,480.00PORT IMPLANTABLE INFUSION VORTEX LP PEELPRO TITANI C1788 $3,400.00PORT IMPLANTABLE INFUSION X-PORT ISP MRI POLYURETH C1788 $1,528.00PORT IMPLANTABLE POWERPORT SLIM AIRGUARD CHRONOFLE C1788 $2,208.00POSITIONER IMPLANT SPINE PIN PLATE HOLD $617.60POST AND CORE IN ADDITION TO CROWN D2952 $738.00POST EXTERNAL FIXATION 3 HOLE 5 HOLE CLAMP $1,347.84POST EXTERNAL FIXATION 30 D OD11 MM OUTRIGGER MR C $901.60POST EXTERNAL FIXATION 30 D SMALL MULTIPLE PIN CLA $968.50POST EXTERNAL FIXATION 90 D OD8 MM OUTRIGGER MR CO $938.40POST EXTERNAL FIXATION BONE SCREW ROD TO ROD TELES $2,922.24POST EXTERNAL FIXATION CIRCULAR 2 HOLE FEMALE SMAL $1,495.36POST EXTERNAL FIXATION CIRCULAR 3 HOLE MALE SMALL $1,495.36POST EXTERNAL FIXATION CIRCULAR 4 HOLE FEMALE SMAL $1,495.36POST EXTERNAL FIXATION CIRCULAR 4 HOLE MALE SMALL $1,495.36POST EXTERNAL FIXATION DYNAFIX VISION 3 HOLE 5 HOL $1,075.20POST EXTERNAL FIXATION HOFFMANN 3 30 D OD11 MM $608.40POST EXTERNAL FIXATION HOFFMANN 3 STRAIGHT OD8 MM $825.60POST EXTERNAL FIXATION HOFFMANN II 30 D OD8 MM COL $633.60POST EXTERNAL FIXATION HOFFMANN II ALUMINUM STAINL $706.56POST EXTERNAL FIXATION HOFFMANN II COMPACT 30 D MR $522.24

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 ChargePOST EXTERNAL FIXATION HOFFMANN II COMPACT ALUMINU $522.24POST EXTERNAL FIXATION HOFFMANN II COMPACT STAINLE $499.20POST EXTERNAL FIXATION HOFFMANN II HYDROGEN 90 D O $975.36POST EXTERNAL FIXATION HOFFMANN II STAINLESS STEEL $706.56POST EXTERNAL FIXATION HOFFMANN II TENXOR STANDARD $2,115.84POST EXTERNAL FIXATION ILIZAROV PEDIATRIC 2 HOLE M $1,495.36POST EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 2 $779.60POST EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 3 $782.40POST EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 4 $870.08POST EXTERNAL FIXATION JET-X 30 D NONSTERILE $1,741.76POST EXTERNAL FIXATION JET-X FREEDOM NONSTERILE $4,756.32POST EXTERNAL FIXATION JET-X STRAIGHT NONSTERILE $1,638.96POST EXTERNAL FIXATION LARGE RIGHT ANGLE MULTIPLE $1,163.50POST EXTERNAL FIXATION LONG STANDARD $1,286.40POST EXTERNAL FIXATION PEDIATRIC CIRCULAR 3 HOLE F $1,495.36POST EXTERNAL FIXATION SHORT $1,128.00POST EXTERNAL FIXATION SHORT WIRE MRI SAFE NONSTER $1,393.76POST EXTERNAL FIXATION STRAIGHT MULTIPLE PIN CLAMP $968.50POST EXTERNAL FIXATION STRAIGHT OD11 MM OUTRIGGER $901.60POST EXTERNAL FIXATION STRAIGHT OD8 MM OUTRIGGER M C1713 $860.16POST EXTERNAL FIXATION TALL WIRE MRI SAFE NONSTERI $1,582.40POST TAPER HEMICAP L15 MM OD9.5 MM METATARSOPHALAN C1776 $2,437.50POST TAPER HEMICAP LARGE L13 MM OD7 MM METATARSOPH C1776 $2,437.50POSTSURGICAL COMPLICATIONS TREATMENT D9930 $1,995.00POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG PWPK 1 $3.36POUCH SPECIMEN RETRIEVAL ENDO CATCH METAL POLYURET $456.43PRACAINAMIDE INFUSION CHALLENGE 93799 $544.00PRASUGREL 10 MG TAB 30 EACH BOTTLE $19.86PREALBUMIN (PROTEIN) LEVEL 84134 $54.00PREDNISOLONE 15 MG/5 ML (3 MG/ML) SOLN 5 ML CUP J7510 $3.40PREFABRICATED POST/CORE IN ADDITION TO CROWN D2954 $593.00PREPARATION & PROVISION OF SINGLE STINGING INSECT 95145 $131.00PREPARATION & PROVISION SINGLE-DOSE VIALS ALLERGEN 95144 $190.00PREPARATION GRAFT SITE TRUNK ARM OR LEG 1ST 100CM 15002 $1,451.00PREPARATION OF GRAFT SITE AT TRUNK, ARMS, OR LEGS 15003 $4,825.00PREPARATION OF TISSUE FOR EXAMINATION BY REMOVING 88311 $71.00PREPARE GRAFT SITE FACE SCALP EYELID MOUTH NECK EA 15004 $1,953.00PREPARE GRAFT SITE OF FACE SCALP EYELID MOUTH NECK 15005 $2,424.00PRESSURE MEASUREMENT OF PANCREATIC OR BILE DUCT US 43263 $10,974.00

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 ChargePRETREATMENT RED BLOOD CELLS FOR USE IN ANTIBODY A 86970 $94.00PRETREATMENT RED BLOOD CELLS FOR USE IN ANTIBODY A 86971 $94.00PRETREATMENT SERUM FOR USE IN RED BLOOD CELL ANTIB 86977 $586.00PRETREATMENT SERUM FOR USE IN RED BLOOD CELL ANTIB 86978 $130.00PRETREATMENT SERUM USE IN RED BLOOD CELL ANTIBODY 86975 $145.00PRETREATMENT SERUM USE IN RED BLOOD CELL ANTIBODY 86976 $94.00PREVENTIVE MEDICINE COUNSELING APPROXIMATELY 30 MI 99402 $78.00PREVENTIVE RETINAL DETACHMENT TREATMENT BY HEAT OR 67145 $1,833.00PRIMIDONE LEVEL 80188 $129.00PROBE ABLATION NEUWAVE CERTUS 140 2.45GHZ L15 CM L C1886 $9,550.00PROBE BREAST BIOPSY ENCOR OD12 GA $1,170.00PROBE CRYOABLATION CRYOICE ALUMINUM L10 CM STERILE C2618 $14,657.50PROBE CRYOABLATION CRYOICE L10 CM MALLEABLE C2618 $14,657.50PROBE CRYOSURGICAL V-PROBE RIGHT ANGLE OD2.4 MM C2618 $8,450.00PROBE DOPPLER SWARTZ 20MHZ STANDARD L17.4 CM FLOW $2,225.00PROBE ELECTRODE LEAD 10 MM SPACE 2 BALL L78 IN L10 $569.40PROBE ELECTROSURGICAL FIAPC L220 CM OD2.3 MM FLEXI $1,059.25PROBE ENDOSCOPIC SERFAS L90 MM OD3.5 MM 90-S ACCEL $1,155.36PROBE ENDOSCOPIC SERFAS OD3.5 MM CONTOUR $913.20PROBE LASER OTOPROBE L2.5 MR SHORT ANGLE STERILE D $1,191.67PROBE LITHOTRIPTER L250 CM OD1.9 FR BILIARY ELECTR $1,974.90PROBE NERVE STIMULATOR BALL TIP NEUROMONITOR $777.40PROBE NERVE STIMULATOR INCREMENT STANDARD PRASS TI $1,278.85PROBE NERVE STIMULATOR NIM-RESPONSE 20 NIM-NEURO 2 $1,278.85PROBE NERVE STIMULATOR NIM-RESPONSE PRASS STANDARD $810.99PROBE NERVE STIMULATOR NIM-RESPONSE STANDARD OD.33 $683.77PROBE PACING CHANDLER V L135 CM OD2.4 FR TRANSLUMI $796.00PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA $1,235.00PROBE VITRECTOMY LEGACY EVEREST ATIOP ANTERIOR $884.65PROBE VITRECTOMY PLASTIC STRAIGHT OD23 GA LASER HA $1,432.00PROBE VITRECTOMY PUREPOINT 40 D L6 MM OD25 GA RETI $1,486.72PROBE VITRECTOMY TOTAL PLUS CONSTELLATION 5000 CPM $4,552.00PROBE VITRECTOMY ULTRAVIT CONSTELLATION 5000 CPM O $1,770.80PROBE VITRECTOMY WIDE ANGLE OD20 GA SHIELDED BULLE $438.88PROBING OF NASAL-TEAR DUCT 68840 $534.00PROCAINAMIDE LEVEL 80192 $130.00PROCALCITONIN (HORMONE) LEVEL 84145 $168.00PROCESSING AND STORAGE OF BLOOD UNIT OR COMPONENT 86890 $253.00PROCESSOR EXTERNAL DUAL COCHLEAR IMPLANT L8692 $71,500.00

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 ChargePROCESSOR SOUND BAHA 4 KIT ABUTMENT COVER MULTIPAC L8691 $18,313.75PROCESSOR SOUND BAHA 5 LED VISUAL INDICATOR NONSTE L8691 $20,411.63PROCESSOR SOUND BAHA 5 LED VISUAL INDICATOR NONSTE $20,411.63PROCESSOR SOUND BAHA CORDELLE II BLACK L8614 $17,267.25PROCESSOR SOUND COCHLEAR BAHA 3 ABUTMENT COVER MUL L8691 $18,313.75PROCESSOR SOUND COCHLEAR BAHA 3 POWER KIT ABUTMENT L8691 $18,313.75PROCESSOR SOUND COCHLEAR BAHA 5 BLUETOOTH BCDRIVE L8691 $20,411.63PROCESSOR SOUND COCHLEAR BAHA 5 KIT ABUTMENT COVER L8691 $20,411.63PROCESSOR SOUND CORDELLE II BAHA 7.5-9.5V 250-6500 L8691 $17,267.25PROCESSOR SOUND HARMONY HIRESOLUTION T-MIC POWERCE L8614 $51,610.00PROCESSOR SOUND NUCLEUS 6 MEDIUM COMPACT COCHLEA E L8614 $58,500.00PROCESSOR SOUND NUCLEUS 7 2 KIT KANSO CP1000 CP950 L8614 $74,750.00PROCESSOR SOUND PHONE CLIP L8691 $0.07PROCESSOR SOUND PONTO 3 RIGHT MOCCA BROWN L8690 $18,673.20PROCESSOR SOUND PONTO 3 SUPERPOWER LEFT CHROMA BEI L8690 $20,229.30PROCESSOR SOUND PONTO PLUS LEFT DIAMOND BLACK L8691 $19,197.75PROCESSOR SOUND PONTO PLUS LEFT MOCCA BROWN L8691 $19,197.75PROCESSOR SOUND PONTO PLUS POWER LEFT CHROMA BEIGE L8691 $20,055.75PROCESSOR SOUND PONTO PLUS POWER LEFT DIAMOND BLAC L8691 $20,055.75PROCESSOR SOUND PONTO PLUS POWER LEFT MOCCA BROWN L8691 $20,055.75PROCESSOR SOUND PONTO PLUS POWER LEFT WHITE SILVER L8691 $20,055.75PROCESSOR SOUND PONTO PLUS POWER RIGHT DIAMOND BLA L8691 $20,055.75PROCESSOR SOUND PONTO PLUS POWER RIGHT WHITE SILVE L8691 $20,055.75PROCESSOR SOUND PONTO PLUS RIGHT DIAMOND BLACK L8691 $19,197.75PROCESSOR SOUND PONTO PLUS RIGHT MOCCA BROWN L8691 $19,197.75PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL 84144 $162.00PROGESTERONE 50 MG/ML OIL 10 ML VIAL J2675 $20.17PROGRAMMED HEART RHYTHM STIMULATION AFTER DRUG INF 93623 $541.00PROGRAMMER NEUROSTIMULATOR ACTIVA PC L3.7 IN X W2. C1787 $6,175.00PROGRAMMER NEUROSTIMULATOR AXIUM LITHIUM ION THK2 C1787 $9,795.50PROGRAMMER NEUROSTIMULATOR EON PATIENT PROGRAMMER C1787 $8,614.13PROGRAMMER NEUROSTIMULATOR INTERSTIM THERMOPLASTIC C1787 $7,208.50PROGRAMMER NEUROSTIMULATOR MYSTIM MRI TECHNOLOGY E C1787 $5,850.00PROGRAMMER NEUROSTIMULATOR PATIENT CONTROLLER C1787 $4,875.00PROGRAMMER NEUROSTIMULATOR PRODIGY MRI BURSTDR THK C1787 $4,875.00PROGRAMMING DEVICE EVALUATION OF HEART MONITORING 93260 $172.00PROINSULIN (PANCREATIC HORMONE) LEVEL 84206 $112.00PROLACTIN (MILK PRODUCING HORMONE) LEVEL 84146 $150.00PROLONGED CHEMOTHERAPY INFUSION INTO ARTERY PORT/I 96425 $1,114.00

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 ChargePROLONGED CHEMOTHERAPY INFUSION INTO VEIN PORT/IMP 96416 $1,114.00PROSTATE NEEDLE BIOPSY, ANY METHOD 88305 $230.00PROSTHESIS OSSICULAR ALTO TITANIUM 3 MM L3-7 MM OD L8613 $2,704.85PROSTHESIS OSSICULAR ALTO TITANIUM L2-5.6 MM OD3.5 L8613 $2,163.85PROSTHESIS OSSICULAR ALTO TITANIUM L3-7 MM OD3 MM L8613 $2,163.85PROSTHESIS OSSICULAR ALTO TITANIUM L3-7 MM OD3.5 M L8613 $2,163.85PROSTHESIS OSSICULAR APPLEBAUM HA LARGE DENSE L2.5 L8613 $2,340.00PROSTHESIS OSSICULAR APPLEBAUM HA SMALL DENSE L2 M L8613 $2,340.00PROSTHESIS OSSICULAR BRACKMANN HA L8613 $2,166.00PROSTHESIS OSSICULAR BRACKMANN PARTIAL L8613 $2,124.00PROSTHESIS OSSICULAR CAUSSE FLEX HA TITANIUM OFFSE L8613 $3,344.00PROSTHESIS OSSICULAR CAUSSE ID.6 MM LOOP PISTON L8613 $606.00PROSTHESIS OSSICULAR CAUSSE POLYCEL PARTIAL L8613 $1,410.00PROSTHESIS OSSICULAR DORNHOFFER PORP TITANIUM HA L L8613 $2,310.23PROSTHESIS OSSICULAR DORNHOFFER TITANIUM HA 4 MM 3 L8613 $2,450.24PROSTHESIS OSSICULAR DORNHOFFER TITANIUM L1.4 MM X $795.54PROSTHESIS OSSICULAR DORNHOFFER TITANIUM L4 MM OD3 L8613 $2,310.23PROSTHESIS OSSICULAR ECLIPSE FLUOROPLASTIC NITINOL L8613 $1,946.36PROSTHESIS OSSICULAR FRISBEE TITANIUM L2 MM OD3 MM L8613 $2,152.80PROSTHESIS OSSICULAR GARCIA-IBANEZ HYDROXYAPATITE L8613 $2,731.82PROSTHESIS OSSICULAR GOLDENBERG PLASTI-PORE HA L5. L8613 $3,006.00PROSTHESIS OSSICULAR GOLDENBERG TORP PLASTI-PORE H L8613 $3,222.00PROSTHESIS OSSICULAR H1 MM OD3 MM EAR FRISBEE L8613 $2,100.22PROSTHESIS OSSICULAR H1.5 MM OD3 MM EAR FRISBEE L8613 $2,100.22PROSTHESIS OSSICULAR H3 MM EAR FRISBEE L8613 $2,100.22PROSTHESIS OSSICULAR HA H1.32 MM OD2 MM ODSEC1.5 M L8613 $598.13PROSTHESIS OSSICULAR HA L1.5 MM OD3 MM FRISBEE L8613 $2,162.62PROSTHESIS OSSICULAR HA TITANIUM OFFSET MUSHROOM L L8613 $24,700.00PROSTHESIS OSSICULAR KRAUS HELIX PISTON L8613 $2,863.90PROSTHESIS OSSICULAR KRAUS HELIX UNIVERSAL ID.6 MM L8613 $795.54PROSTHESIS OSSICULAR KRAUS TITANIUM EAR HELIX IMPL L8613 $2,704.85PROSTHESIS OSSICULAR LESINSKI FLEX H/A TITANIUM OF L8613 $2,776.28PROSTHESIS OSSICULAR MCGEE TORP HA L1.5 MM OD3 MM L8613 $2,712.00PROSTHESIS OSSICULAR NITIBOND TITANIUM NITINOL .94 L8613 $2,658.50PROSTHESIS OSSICULAR NITIBOND TITANIUM NITINOL L3. L8613 $2,658.50PROSTHESIS OSSICULAR NITIBOND TITANIUM NITINOL L5 L8613 $2,658.50PROSTHESIS OSSICULAR NITIBOND TITANIUM NITINOL L5. L8613 $2,658.50PROSTHESIS OSSICULAR NITIBOND TITANIUM NITINOL ROU L8613 $2,658.50PROSTHESIS OSSICULAR PORP ALTO L8613 $2,163.85

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 ChargePROSTHESIS OSSICULAR PORP PLASTI-PORE HA OVAL L6.6 L8613 $3,240.00PROSTHESIS OSSICULAR SHEA HA LARGE L1.5 MM OD3 MM L8613 $2,688.00PROSTHESIS OSSICULAR SHEA PORP PLASTI-PORE HA L5.6 L8613 $2,988.00PROSTHESIS OSSICULAR SHEEHY PEG-TOP POLYCEL OVAL L L8613 $1,184.63PROSTHESIS OSSICULAR SHEEHY POLYCEL ROUND TAPER L4 L8613 $1,145.63PROSTHESIS OSSICULAR SHEEHY TORP PLASTI-PORE L4.7 L8613 $1,408.88PROSTHESIS OSSICULAR SILVERSTEIN HA H1 MM OD2.1 MM L8613 $2,472.00PROSTHESIS OSSICULAR TORP PLASTI-PORE HA L10 MM OD L8613 $3,240.00PROSTHESIS PENILE AMS 700 LGX MS PUMP INHIBIZONE L C1813 $45,734.00PROSTHESIS PENILE AMS 700 MS PUMP INHIBIZONE 100 M C1813 $13,665.60PROSTHESIS PENILE AMS 700 MS PUMP INHIBIZONE 65 ML C1813 $13,665.60PROSTHESIS PENILE AMS 700 MS PUMP INHIBIZONE L18 C C1813 $45,284.72PROSTHESIS PENILE AMS SPECTRA CYLINDER L3 CM OD12 C1813 $0.07PROSTHESIS PENILE TITAN COLOPLAST LOCK-OUT BIOFLEX C1813 $46,800.00PROSTHESIS PENILE TITAN LOCK-OUT 0 D CYLINDER SCRO C1813 $46,800.00PROSTHESIS PENILE TITAN LOCK-OUT BIOFLEX SILICONE C1813 $44,622.50PROSTHESIS TESTICULAR LARGE L4.5 CM X W2.9 CM OD2. L8699 $7,600.00PROSTHESIS TESTICULAR TOROSA SALINE LARGE L4.9 CM $11,700.00PROSTHESIS TESTICULAR TOROSA SALINE MEDIUM SALINE L8699 $11,700.00PROSTHESIS VOICE ADVANTAGE OD20 FR INDWELLING HARD L8509 $1,950.00PROSTHESIS VOICE BLOM-SINGER ADVANTAGE SILICONE SI L8509 $1,950.00PROSTHESIS VOICE BLOM-SINGER ADVANTAGE SILVER OXID L8509 $1,950.00PROSTHESIS VOICE BLOM-SINGER CLASSIC L10 MM OD16 F L8509 $1,275.00PROSTHESIS VOICE BLOM-SINGER CLASSIC L12 MM OD16 F L8509 $1,275.00PROSTHESIS VOICE BLOM-SINGER CLASSIC L14 MM OD16 F L8509 $1,275.00PROSTHESIS VOICE BLOM-SINGER CLASSIC L16 MM OD16 F L8509 $1,275.00PROSTHESIS VOICE BLOM-SINGER CLASSIC L18 MM OD16 F L8509 $1,275.00PROSTHESIS VOICE BLOM-SINGER CLASSIC L20 MM OD16 F L8509 $1,275.00PROSTHESIS VOICE BLOM-SINGER CLASSIC L6 MM OD16 FR L8509 $1,275.00PROSTHESIS VOICE BLOM-SINGER CLASSIC L8 MM OD16 FR L8509 $1,275.00PROSTHESIS VOICE BLOM-SINGER OD16 FR LARYNX PLUG I L8507 $300.00PROSTHESIS VOICE PROVOX 2 SILICONE L10 MM OD22.5 F L8509 $1,852.50PROT ELECTROPHORESIS SERUM 84165 $83.00PROT TOTAL SERUM PLASMA WHOLE BLOOD 84155 $33.00PROTECTIVE RESTORATION D2940 $52.00PROTECTOR CAST AQUASHIELD POLYURETHANE PEDIATRIC H $1,630.20PROTECTOR EXTREMITY FOAM UNIVERSAL ELBOW HEEL STOC E0191 $21.98PROTECTOR NERVE AXOGUARD EXTRACELLULAR MATRIX L40 C1763 $17,560.00PROTECTOR NERVE AXOGUARD PORCINE EXTRACELLULAR MAT C1763 $14,267.50

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 ChargePROTECTOR TISSUE AXOGUARD PORCINE EXTRACELLULAR MA C1763 $14,267.50PROTECTOR TISSUE JURGAN BALL ID.035 IN PIN GUARD 6 C1713 $44.00PROTEIN C ANTIGEN (CLOTTING INHIBITOR) MEASUREMENT 85303 $114.00PROTEIN C, (CLOTTING INHIBITOR) ACTIVITY 85302 $86.00PROTEIN ELECTROPHORESIS SER 84160 $51.00PROTEIN MEASUREMENT 84182 $139.00PROTEIN MEASUREMENT, BODY FLUID 84166 $29.00PROTEIN MEASUREMENT, SERUM 84165 $83.00PROTEIN S (CLOTTING INHIBITOR) LEVEL 85305 $83.00PROTEIN TOTAL URINE 84156 $29.00PROTEIN, TOTAL BODY FLUID 84157 $29.00PROTEINASE-3 ANTIBODY 83520 $86.00PROVISIONAL SPLINTING EXTRACORONAL D4321 $461.00PROVISIONAL SPLINTING INTRACORONAL D4320 $295.00PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT 84153 $143.00PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT 84154 $117.00PSA FREE 84154 $117.00PSYCHIATRIC DIAGNOSTIC EVALUATION 90791 $532.00PSYCHOTHERAPY FOR CRISIS ADDITIONAL 30 MINUTES 90840 $334.00PSYCHOTHERAPY FOR CRISIS, FIRST 60 MINUTES 90839 $496.00PSYCHOTHERAPY, 30 MINUTES 90832 $400.00PSYCHOTHERAPY, 45 MINUTES 90834 $532.00PSYCHOTHERAPY, 60 MINUTES 90837 $532.00PSYLLIUM 6 GRAM PWPK 30 EACH PACKET $3.32PULMONARY EXERCISE GROUP G0239 $1,179.00PULMONARY EXERCISE TESTING 94618 $303.00PULMONARY EXERCISE TESTING 94621 $869.00PULMONARY REHABILITATION G0424 $13,276.00PULMONARY SERVICE OR OPERATION 94799 $298.00PULP CAP DIRECT D3110 $142.00PULP CAP INDIRECT D3120 $111.00PULP VITALITY TESTS D0460 $1,995.00PULPOTOMY D3220 $348.00PUMP BREAST PURELY YOURS CARRY ALL STERILE $764.92PUMP BREAST PURELY YOURS L36 IN 4 OZ ELECTRIC HYGI $610.16PUMP CENTRIFUGAL SARNS XCOATING POLYCABONATE 48 ML $1,170.00PUMP DEFLATION TITAN TOUCH 1 TOUCH RELEASE $24,375.00PUMP INTRATHECAL SYNCHROMED EL TITANIUM SILICONE 1 C1772 $77,000.00PUMP INTRATHECAL SYNCHROMED II H26 MM 40 ML RESERV C1772 $63,700.00

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 ChargePUMP INTRATHECAL SYNCHROMED II SILICONE THK26 MM 4 C1772 $63,700.00PUMP INTRATHECAL SYNCHROMED II TITANIUM .22 UM H1 C1772 $83,200.00PUMP INTRATHECAL SYNCHROMED II TITANIUM THK19.5 MM C1772 $63,700.00PUNCH AORTIC CLEANCUT STAINLESS STEEL LONG L8 IN O $1,164.48PUNCH ARTHROSCOPIC 70 D L13 CM OD3.5 MM FRONTAL SI $5,307.51PUNCH ARTHROSCOPIC STERILE DISPOSABLE 5.5 CORKSCRE $487.50PUNCH ARTHROSCOPIC WISHBONE 15 D UP SHAFT STRAIGHT $7,117.50PUNCH ARTHROSCOPIC WISHBONE TEFLON 15 D UP TIP STA $6,467.50PUNCH ENDOSCOPIC HOSEMANN 70 D L13 CM OD5.5 MM FRO $8,632.26PUNCH ENDOSCOPIC RHINOFORCE II STAMMBERGER L10 CM $3,530.28PUNCH ENDOSCOPIC RHINOFORCE II STAMMBERGER PEDIATR $3,530.28PUNCH ENDOSCOPIC STAMMBERGER FORWARD CUT L10 CM AN $4,642.56PUNCH ENDOSCOPIC STAMMBERGER L10 CM ANTRUM LEFT BA $4,642.56PUNCH ENDOSCOPIC STAMMBERGER L18 CM OD3.5 MM SPHEN $4,509.57PUNCH ENDOSCOPIC STAMMBERGER RHINOFORCE II L10 CM $3,530.28PUNCH SURGICAL HAJEK-KOFLER 3.2 MM X 4 MM L17 CM S $5,037.50PUNCTURE ASPIRATION OF BREAST CYST 19001 $452.00PUNCTURE ASPIRATION OF BREAST CYST 19101 $6,872.00PURE TONE AIR AND BONE CONDUCTION HEARING ASSESSME 92553 $378.00PURE TONE AIR CONDUCTION THRESHOLD HEARING ASSESSM 92552 $174.00PYRAZINAMIDE 80299 $71.00PYRUVATE KINASE (ENZYME) LEVEL 84220 $73.00QUANTITATION OF THERAPEUTIC DRUG 80299 $86.00QUINIDINE LEVEL 80194 $113.00RADIATION THERAPY CONSULTATION 77370 $557.00RADIATION THERAPY CONSULTATION PER WEEK 77336 $557.00RADIATION THERAPY DELIVERY 77385 $2,498.00RADIATION THERAPY DELIVERY 77386 $2,498.00RADIATION THERAPY PLAN 77306 $1,293.00RADIATION THERAPY PLAN 77307 $557.00RADIATION THERAPY PLAN 77316 $557.00RADIATION THERAPY PLAN 77317 $1,547.00RADIATION THERAPY PLAN 77318 $1,547.00RADIATION THERAPY STEREOTACTIC RADIOSURGERY FOR CR 77371 $38,230.00RADIATION THERAPY TOTAL BODY PORT PLAN 77321 $1,547.00RADIATION TREATMENT DELIVERY 77402 $493.00RADIATION TREATMENT DELIVERY 77407 $493.00RADIATION TREATMENT DELIVERY 77412 $951.00RADIATION TREATMENT DELIVERY, SUPERFICIAL 77401 $461.00

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 ChargeRADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTI 77332 $1,060.00RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTI 77333 $502.00RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTI 77334 $1,060.00RADIATION TREATMENT MANAGEMENT, 1 OR 2 TREATMENTS 77431 $548.00RADIATION TREATMENT MANAGEMENT, 5 TREATMENTS 77427 $937.00RADIOACTIVE MATERIAL THERAPY INTO ARTERY 79445 $1,143.00RADIOACTIVE MATERIAL THERAPY INTO BODY SPACE OR CA 79200 $1,454.00RADIOACTIVE MATERIAL THERAPY INTO BONE JOINT 79440 $1,454.00RADIOACTIVE MATERIAL THERAPY INTO TISSUE 79300 $1,143.00RADIOACTIVE MATERIAL THERAPY INTO VEIN 79403 $1,454.00RADIOACTIVE MATERIAL THERAPY INTO VEIN 79101 $1,362.00RADIOFREQUENCY DESTRUCTION OF INSUFFICIENT VEIN OF 36476 $1,076.00RADIOGRAPHIC/SURGICAL IMPLANT INDEX D6190 $2,260.00RADIOLOGICAL S & I IMAGING OF LUNG ARTERY CONTRAST 75746 $3,460.00RADIOLOGICAL SUPERVISION & INTERP DILATION BILIARY 74363 $150.00RADIOLOGICAL SUPERVISION & INTERP DILATION OF KIDN 74485 $5,467.00RADIOLOGICAL SUPERVISION & INTERP IMAGING LIVER VE 75885 $10,728.00RADIOLOGICAL SUPERVISION & INTERP IMAGING LIVER VE 75889 $10,728.00RADIOLOGICAL SUPERVISION & INTERP IMAGING LYMPHATI 75803 $1,557.00RADIOLOGICAL SUPERVISION & INTERP IMAGING OF ARTER 75716 $8,046.00RADIOLOGICAL SUPERVISION & INTERP IMAGING OF ARTER 75733 $10,728.00RADIOLOGICAL SUPERVISION & INTERP IMAGING OF LIVER 75887 $3,460.00RADIOLOGICAL SUPERVISION & INTERP OF DRAWING BLOOD 75893 $10,728.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF AR 75710 $8,046.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF AR 75731 $2,451.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF AR 75743 $10,728.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF LY 75801 $1,557.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF VE 75820 $3,460.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF VE 75822 $3,460.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF VE 75840 $10,728.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF VE 75842 $10,728.00RADIOLOGICAL SUPERVISION & INTERP OF IMAGING OF VE 75860 $3,460.00RADIOLOGICAL SUPERVISION & INTERP OF INSERT CATHET 74328 $456.00RADIOLOGICAL SUPERVISION & INTERP OF INSERT CATHET 74329 $122.00RADIOLOGICAL SUPERVISION & INTERP OF MRI GUIDANCE 77021 $1,110.00RADIOLOGICAL SUPERVISION & INTERP OF OBSTRUCT OF B 75894 $2,807.00RADIOLOGICAL SUPERVISION & INTERP OF OPENING OF DI 74360 $456.00RADIOLOGICAL SUPERVISION & INTERP OF PLACE BLOOD V 75958 $701.00RADIOLOGICAL SUPERVISION & INTERP OF PLACEMENT CAT 74742 $105.00

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 ChargeRADIOLOGICAL SUPERVISION & INTERP OF PLACEMENT CAT 75989 $1,710.00RADIOLOGICAL SUPERVISION & INTERP PLACE (ACCESS TH 74355 $510.00RADIOLOGICAL SUPERVISION & INTERP PLACE BLOOD VESS 75959 $608.00RADIOLOGICAL SUPERVISION & INTERP PLACEMENT LONG S 74340 $379.00RADIOLOGICAL SUPERVISION & INTERP REMOVAL OBSTRUCT 75901 $541.00RADIOLOGICAL SUPERVISION & INTERP REMOVAL OF FOREI 74235 $212.00RADIOLOGICAL SUPERVISION & INTERP X-RAY ABDOMINAL 75630 $8,046.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF BILE AN 74300 $179.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF BRAIN A 70015 $2,453.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF DISC OF 72285 $8,365.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF DISC OF 72295 $8,365.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF KIDNEY 74470 $1,235.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF LOWER A 74190 $1,235.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF LOWER B 70010 $2,453.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF SPINAL 72270 $2,453.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF TEAR DR 70170 $1,235.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF URINARY 74430 $760.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF URINARY 74450 $1,013.00RADIOLOGICAL SUPERVISION & INTERP X-RAY OF URINARY 74455 $832.00RADIOLOGICAL SUPERVISION & INTERPRETATION CHANGE O 75984 $277.00RADIOLOGICAL SUPERVISION & INTERPRETATION IMAGING 75809 $343.00RADIOLOGICAL SUPERVISION & INTERPRETATION IMAGING 75825 $10,728.00RADIOLOGICAL SUPERVISION & INTERPRETATION IMAGING 75833 $10,728.00RADIOLOGICAL SUPERVISION & INTERPRETATION OF CT GU 77012 $258.00RADIOLOGICAL SUPERVISION & INTERPRETATION OF IMAGI 75870 $3,460.00RADIOLOGICAL SUPERVISION & INTERPRETATION REPAIR O 75956 $1,232.00RADIOLOGICAL SUPERVISION & INTERPRETATION REPAIR O 75957 $1,051.00RADIOLOGICAL SUPERVISION & INTERPRETATION X-RAY OF 74740 $1,472.00RADIOLOGICAL SUPERVISION & INTERPRETATION X-RAY OF 75810 $3,932.00RADIOLOGICAL SUPERVISION AND INTERPRETATION IMAGIN 75831 $10,728.00RADIOLOGICAL SUPERVISION AND INTERPRETATION IMAGIN 75741 $10,728.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF BIO 75970 $1,663.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75827 $3,460.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75891 $10,728.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 77053 $1,235.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 77054 $1,235.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75710 $10,728.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75705 $10,728.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75726 $10,728.00

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 ChargeRADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75736 $10,728.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75756 $3,460.00RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMA 75774 $297.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 70390 $1,235.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 72240 $2,453.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 72255 $2,453.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 72265 $1,841.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 72275 $291.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 74425 $840.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 74440 $1,013.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 74445 $458.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 75872 $3,460.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 75880 $3,460.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 70332 $1,444.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73040 $1,444.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73085 $1,444.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73115 $1,444.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73525 $1,444.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73580 $1,444.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 73615 $1,444.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 75600 $10,728.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 75605 $10,728.00RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY 75625 $10,728.00RADIOLOGICAL SUPERVISN & INTERP REMOVE OBSTRUCTIVE 75902 $202.00RAIL EXTERNAL FIXATION 4 MM XS MIDDLE LEVEL SMALL $1,305.60RAIL EXTERNAL FIXATION 6 MM XS BRIDGE FIXATOR $1,526.40RAIL EXTERNAL FIXATION ANGLE RING ADAPTER $1,000.00RAIL EXTERNAL FIXATION CARBON ADULT COMPRESSION DI $2,361.60RAIL EXTERNAL FIXATION CARBON ADULT L350 MM FIX AN $2,800.00RAIL EXTERNAL FIXATION CARBON SMALL L100 MM $13,578.24RAIL EXTERNAL FIXATION CARBON SMALL L150 MM $14,380.80RAIL EXTERNAL FIXATION CARBON SMALL L200 MM $12,333.36RAIL EXTERNAL FIXATION CARBON SMALL L250 MM $15,974.40RAIL EXTERNAL FIXATION DYNAFIX CARBON ADULT L420 M $16,185.60RAIL EXTERNAL FIXATION DYNAFIX CARBON ADULT STANDA $14,572.80RAIL EXTERNAL FIXATION DYNAFIX SMALL COMPRESSION D $2,112.00RAIL EXTERNAL FIXATION DYNAMIZATION SMALL FIXATOR $3,855.36RAIL EXTERNAL FIXATION SMALL L20 CM $6,259.20RAIL EXTERNAL FIXATION SMALL ROTATIONAL SERRATE $9,415.68

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 ChargeRAIL EXTERNAL FIXATION SMALL ROTATIONAL T CLAMP $5,912.40RAIL EXTERNAL FIXATION TITANIUM CARBON FIBER SMALL $5,141.76RAIL EXTERNAL FIXATION UNIVERSAL L100 MM FOOT $3,805.44RAIL EXTERNAL FIXATION UNIVERSAL L125 MM FOOT $4,124.16RAIL EXTERNAL FIXATION UNIVERSAL L150 MM FOOT $4,435.20RAIL EXTERNAL FIXATION UNIVERSAL L75 MM FOOT $3,490.56RAIL EXTERNAL FIXATION XS L10 CM MIDDLE LEVEL MAC $4,468.80RAIL EXTERNAL FIXATION XS L15 CM MIDDLE LEVEL MAC $5,366.40RAIL EXTERNAL FIXATION XS L25 CM MIDDLE LEVEL MAC $5,619.90RAMUCIRUMAB 10 MG/ML SOLN 10 ML VIAL J9308 $5,681.75RAMUCIRUMAB 10 MG/ML SOLN 50 ML VIAL J9308 $28,208.75RANGE OF MOTION TESTING OF ARM, LEG OR EACH SPINE 95851 $24.00RANGE OF MOTION TESTING OF HAND 95852 $20.00RAPID DESENSITIZATION PROCEDURE, EACH HOUR 95180 $1,321.00REACHER REHABILITATION SAMMONS PRESTON ALUMINUM RU $1,616.00REAMER SURGICAL 20 MM CONCAVE $2,948.40REAMER SURGICAL 20 MM CONVEX $2,948.40REAMER SURGICAL ANCHORAGE FOOT ANKLE CROSS PLATE D $2,720.25REAMER SURGICAL CONCAVE OD14 MM METATARSOPHALANGEA $1,313.00REAMER SURGICAL CONCAVE OD16 MM METATARSOPHALANGEA $1,313.00REAMER SURGICAL CONVEX OD14 MM METATARSOPHALANGEAL $1,313.00REAMER SURGICAL CONVEX OD16 MM METATARSOPHALANGEAL $1,313.00REAMER SURGICAL ENCOMPASS OD17 MM $3,022.11REAMER SURGICAL GRAFIX OD10 MM CORING STERILE DISP $1,157.00REAMER SURGICAL GRAFIX OD11 MM CORING BUSHING STER $1,157.00REAMER SURGICAL GRAFIX OD9 MM CORING BUSHING STERI $1,157.00REAMER SURGICAL GRAFTMAX CURVE OD5 MM FEMORAL CORT $2,249.00REAMER SURGICAL L145 MM QUICK COUPLING DRILL 5 MM $2,552.75REAMER SURGICAL L510 MM MODIFIED TRINKLE $2,484.93REAMER SURGICAL LOW PROFILE OD10.5 MM ACL CANNULAT $1,267.50REAMER SURGICAL LOW PROFILE OD5 MM ACL CANNULATED $1,267.50REAMER SURGICAL LOW PROFILE OD5.5 MM ACL CANNULATE $1,267.50REAMER SURGICAL LOW PROFILE OD6 MM ACL CANNULATED $1,267.50REAMER SURGICAL LOW PROFILE OD6.5 MM ACL CANNULATE $1,267.50REAMER SURGICAL LOW PROFILE OD7.5 MM ACL CANNULATE $1,267.50REAMER SURGICAL LOW PROFILE OD9.5 MM ACL CANNULATE $1,267.50REAMER SURGICAL OD8 MM ACL CANNULATED HEAD STERILE $1,397.50REAMER SURGICAL OD8.5 MM PILOT HEAD STERILE $1,332.50REAMER SURGICAL RESTORE FULL FLUTE OD13 MM $3,074.50

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 ChargeREAMER SURGICAL T HANDLE $2,418.00REAMER SURGICAL TK2 BUTTON SPRING DISPOSABLE $2,061.80RECEMENT INLAY/ONLAY RESTORATION D2910 $93.00RECHANNELING OF ARTERY 35372 $13,799.00RECHARGER NEUROSTIMULATOR RESTOREADVANCED SURESCAN $10,400.00RECONSTRUCTION OF FEMALE BLADDER NECK FOR STRESS U 53860 $6,292.00RECONSTRUCTION OF LOWER JAW OR CHEEK BONE WITH INS 21249 $12,096.00RECONSTRUCTION OF NIPPLE OR AREA AROUND NIPPLE 19350 $10,912.00RECORDER CARDIAC CONFIRM RX SMALL SLIM 1 TOUCH PRO C1764 $32,000.00RECORDER CARDIAC REVEAL LINQ LOOP C1764 $23,475.00RECORDING EVALUATE HEIGHT & DURATION HEART BEATS T 93278 $113.00RECOVERY PHASE 1 1ST 15 MINUTES $1,611.00RECOVERY PHASE 1 EACH ADDITIONAL 15 MINUTES $149.00RECOVERY PHASE 2 1ST 15 MINUTES $806.00RECOVERY PHASE 2 EACH ADDITIONAL 15 MINUTES $75.00RED BLOOD CELL ANTIBODY DETECTION TEST 86880 $49.00RED BLOOD CELL ANTIBODY DETECTION TEST 86885 $652.00RED BLOOD CELL ANTIBODY LEVEL 86886 $36.00RED BLOOD CELL ANTIBODY MEASUREMENT 86941 $92.00RED BLOOD CELL ANTIBODY SCREENING TEST 86940 $59.00RED BLOOD CELL CONCENTRATION MEASUREMENT 85014 $17.00RED BLOOD CELL COUNT, AUTOMATED TEST 85041 $21.00RED BLOOD CELL FRAGILITY MEASUREMENT 85555 $33.00RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLA 85651 $26.00RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLA 85652 $19.00RED BLOOD COUNT, MANUAL TEST 85044 $31.00RE-EVALUATION LIMITED D0170 $100.00RE-EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED 97168 $350.00RE-EVALUATION OF PHYSICAL THERAPY TYPICALLY 20 MIN 97164 $325.00REFILLING & MAINTENANCE IMPLANT SPINAL/BRAIN DRUG 95990 $1,191.00REFILLING & MAINTENANCE MD IMPLANT SPINAL/BRAIN DR 95991 $540.00REFILLING & MAINTENANCE OF IMPLANTABLE PUMP OR RES 96522 $854.00REFILLING AND MAINTENANCE OF PORTABLE PUMP 96521 $540.00REGIONAL BLOCK ANESTHESIA D9211 $19.00REIMPLANT/STABILIZATION EVULSED TOOTH D7270 $975.00REINFORCEMENT STAPLE LINE SEAMGUARD BIOABSORBABLE $1,056.79REINSERTION OF OCULAR IMPLANT 65150 $7,025.00RELEASE OF SCAR TISSUE FROM CONJUNCTIVA 68330 $7,484.00RELEASE OF SCAR TISSUE FROM EYELIDS 68340 $6,106.00

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 ChargeRELEASE OF TISSUE AT TEAR DUCT OPENING 68705 $1,035.00RELEASE OF TWISTED BOWEL IN RECTUM AND LARGE BOWEL 45321 $9,263.00RELEASE OF TWISTED LARGE BOWEL USING AN ENDOSCOPE 45337 $2,639.00RELEASE OF WRIST LIGAMENT USING AN ENDOSCOPE 29848 $5,427.00RELOAD STAPLER CONTOUR CURVE L40 MM OD.2 MM REGULA $2,126.09RELOAD STAPLER CONTOUR TITANIUM L40 MM X H4.7 MM H $2,126.09RELOAD STAPLER DA VINCI SI ENDOWRIST D3.5 MM L45 M $1,170.00RELOAD STAPLER DA VINCI SI ENDOWRIST D4.3 MM L45 M $1,170.00RELOAD STAPLER DA VINCI XI ENDOWRIST D3.5 MM L45 M $17,280.00RELOAD STAPLER DA VINCI XI ENDOWRIST D4.3 MM L30 M $16,400.00RELOAD STAPLER DA VINCI XI ENDOWRIST D4.3 MM L45 M $1,440.00RELOAD STAPLER DST SERIES GIA TITANIUM L80 MM X H4 $457.93RELOAD STAPLER DST SERIES TA TITANIUM L45 MM X H3. $338.33RELOAD STAPLER DST SERIES TA TITANIUM L45 MM X H4. $338.33RELOAD STAPLER DST SERIES TA TITANIUM L60 MM THICK $547.95RELOAD STAPLER ECHELON ENDOPATH ECHELON FLEX TITAN $821.19RELOAD STAPLER ECHELON ENDOPATH L45 MM REGULAR THI $821.19RELOAD STAPLER ECHELON ENDOPATH L60 MM REGULAR THI $896.14RELOAD STAPLER ECHELON ENDOPATH L60 MM REGULAR TIS $975.17RELOAD STAPLER ECHELON ENDOPATH L60 MM THICK TISSU $975.17RELOAD STAPLER ECHELON ENDOPATH L60 MM THIN TISSUE $975.17RELOAD STAPLER EEA TITANIUM L25 MM X H4.8 MM THIN $1,706.77RELOAD STAPLER EEA TITANIUM L28 MM X H4.8 MM REGUL $1,851.79RELOAD STAPLER EEA TITANIUM L31 MM X H4.8 MM THICK $1,706.77RELOAD STAPLER ENDO GIA ROTICULATOR TITANIUM PEDIA $2,795.00RELOAD STAPLER ENDO GIA TITANIUM 2 MM 2.5 MM 3 MM $1,059.05RELOAD STAPLER ENDO GIA TITANIUM 2 MM L45 MM MESEN $1,301.95RELOAD STAPLER ENDO GIA TITANIUM 3 MM 3.5 MM 4 MM $1,112.15RELOAD STAPLER ENDO GIA TITANIUM 4 MM 4.5 MM 5 MM $4,246.75RELOAD STAPLER ENDO GIA TITANIUM PEDIATRIC UNIVERS $511.42RELOAD STAPLER ENDOPATH ECHELON TITANIUM L35 MM X $968.57RELOAD STAPLER ENDOPATH ETS L45 MM THIN VASCULAR T $549.57RELOAD STAPLER ENDOPATH ETS TITANIUM L35 MM X H2.5 $611.23RELOAD STAPLER ENDOPATH ETS TITANIUM L35 MM X H3.5 $611.23RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H2 M $750.78RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 $329.74RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H4.1 $714.44RELOAD STAPLER ENDOPATH L45 MM X H3.5 MM H1.5 MM R $1,047.85RELOAD STAPLER ENDOPATH L45 MM X H4.1 MM H2 MM THI $1,289.66

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 ChargeRELOAD STAPLER ETHICON TITANIUM H1.8 MM H2 MM L75 $471.69RELOAD STAPLER GIA 90 PREMIUM STAINLESS STEEL L90 $553.67RELOAD STAPLER GIA TITANIUM L100 MM X H3.8 MM H1.5 $717.15RELOAD STAPLER GIA TITANIUM L100 MM X H4.8 MM H2 M $717.15RELOAD STAPLER GIA TITANIUM L60 MM X H2.5 MM H1 MM $338.85RELOAD STAPLER GIA TITANIUM L80 MM X H3.8 MM H1.5 $457.93RELOAD STAPLER ILA TITANIUM L100 MM X H3.8 MM REGU $610.42RELOAD STAPLER ILA TITANIUM L100 MM X H4.8 MM THIC $610.42RELOAD STAPLER ILAN TITANIUM L100 MM X H3.8 MM REG $630.37RELOAD STAPLER L30 MM MEDIUM THICK TISSUE ARTICULA $1,006.33RELOAD STAPLER L45 MM MESENTERY THIN TISSUE CURVE $1,345.70RELOAD STAPLER L45 MM TISSUE ARTICULATE STERILE LA $1,296.30RELOAD STAPLER L60 MM EXTRA THICK TISSUE ARTICULAT $10,966.80RELOAD STAPLER LDS STAINLESS STEEL ANGLE RIGHT H15 $777.08RELOAD STAPLER MULTIFIRE ENDO GIA TITANIUM H4.8 MM $852.35RELOAD STAPLER MULTIFIRE ENDO GIA TITANIUM L30 MM $568.23RELOAD STAPLER MULTIFIRE ENDO TA TITANIUM L30 MM X $568.23RELOAD STAPLER PI STAINLESS STEEL L15 MM X H3 MM T $765.25RELOAD STAPLER PI STAINLESS STEEL L90 MM X H3.5 MM $860.41RELOAD STAPLER PREMIUM POLYSORB LACTOMER L55 MM X $691.99RELOAD STAPLER PROXIMATE L100 MM OD.2 MM REGULAR T $602.45RELOAD STAPLER PROXIMATE L30 MM VASCULAR TISSUE 3 $530.66RELOAD STAPLER PROXIMATE TITANIUM L100 MM X H4.5 M $602.45RELOAD STAPLER PROXIMATE TITANIUM L55 MM X H4.5 MM $526.26RELOAD STAPLER PROXIMATE TITANIUM L75 MM REGULAR T $307.49RELOAD STAPLER PROXIMATE TITANIUM L75 MM X H4.5 MM $816.40RELOAD STAPLER SIGNIA TITANIUM 2 MM 2.5 MM 3 MM L3 $952.90RELOAD STAPLER SM STAINLESS STEEL OD.51 MM 35 STAP $473.01RELOAD STAPLER SUREFORM 60 BLUE $22,080.00RELOAD STAPLER SUREFORM 60 GREEN $22,080.00RELOAD STAPLER SUREFORM 60 WHITE $22,080.00RELOAD STAPLER TA 90 B TITANIUM L90 MM X H4.8 MM T $1,716.33RELOAD STAPLER TA PREMIUM TITANIUM L90 MM X H3.5 M $332.22RELOAD STAPLER TA PREMIUM TITANIUM L90 MM X H4.8 M $332.22RELOAD STAPLER TA TITANIUM L90 MM X H4.8 MM H2 MM $578.76RELOAD STAPLER TRI-STAPLE 2.0 L30 MM VASCULAR MEDI $1,118.65RELOCATE PATIENT SKIN TO FOREHEAD CHEEK CHIN MOUTH 15240 $4,101.00RELOCATION OF DEFIBRILLATOR DEVICE SKIN POCKET 33223 $5,372.00RELOCATION OF PACEMAKER GENERATOR SKIN POCKET 33222 $4,963.00

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 ChargeRELOCATION OF PATIENT SKIN (20 SQ CENTIMETERS OR L 15200 $6,274.00RELOCATION OF PATIENT SKIN (20 SQ CM OR LESS) TO S 15220 $7,058.00RELOCATION OF SKIN (100 SQ CM OR LESS) FOR TISSUE 15040 $6,196.00RELOCATION OF TISSUE LINING THE MOUTH TO GUM SURFA 41870 $12,096.00RELOCATION PATIENT SKIN TO NOSE EARS EYELID AND/OR 15260 $4,100.00REMOTE EVALUATION SINGLE DUAL OR MULTIPLE LEAD PAC 93294 $1,404.00REMOTE EVALUATIONS DEFIB TRANSM TECHN REV SUPP & D 93296 $164.00REMOTE EVALUATIONS IMPLANT HEART MONITOR SYST W/MD 93297 $88.00REMOTE EVALUATIONS IMPLANT HEART REC SYST TECHN RE 93299 $164.00REMOTE EVALUATIONS OF DEFIBRILLATOR UP TO 90 DAYS 93295 $365.00REMOVAL (2 CM OR GREATER) TISSUE GROWTH BENEATH TH 21012 $6,324.00REMOVAL (2 CM OR GREATER) TISSUE GROWTH BENEATH TH 21013 $3,753.00REMOVAL (3.1 TO 4.0 CM) GROWTH OF FACE EARS EYELID 11444 $5,393.00REMOVAL (5 CENTIMETERS OR GREATER) MUSCLE GROWTH O 21554 $4,076.00REMOVAL (LESS THAN 1.5 CM) TISSUE GROWTH BENEATH T 28043 $4,139.00REMOVAL (LESS THAN 2 CM) TISSUE GROWTH BENEATH THE 21011 $4,212.00REMOVAL (LESS THAN 3 CM) TISSUE GROWTH BENEATH SKI 24075 $4,139.00REMOVAL (LESS THAN 3 CM) TISSUE GROWTH BENEATH THE 21930 $4,139.00REMOVAL (LESS THAN 3 CM) TISSUE GROWTH BENEATH THE 23075 $4,139.00REMOVAL (LESS THAN 3 CM) TISSUE GROWTH BENEATH THE 25075 $4,139.00REMOVAL (LESS THAN 3 CM) TISSUE GROWTH BENEATH THE 27327 $6,128.00REMOVAL (LESS THAN 3 CM) TISSUE GROWTH BENEATH THE 27618 $4,139.00REMOVAL (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH IN 22900 $6,128.00REMOVAL (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH OF 24076 $9,300.00REMOVAL (OVER 4.0 CM) GROWTH OF THE FACE EARS EYEL 11446 $6,128.00REMOVAL AND MICROSCOPIC EXAM GROWTH OF THE HEAD NE 17311 $1,357.00REMOVAL AND MICROSCOPIC EXAM GROWTH OF THE HEAD NE 17312 $1,357.00REMOVAL AND REPLACEMENT MULTIPLE LEAD PERMANENT PA 33229 $37,284.00REMOVAL AND REPLACEMENT OF DEFIBRILLATOR PULSE GEN 33262 $88,443.00REMOVAL AND REPLACEMENT OF DEFIBRILLATOR PULSE GEN 33263 $88,443.00REMOVAL AND REPLACEMENT OF DEFIBRILLATOR PULSE GEN 33264 $123,849.00REMOVAL AND REPLACEMENT OF DUAL LEAD PERMANENT PAC 33228 $30,262.00REMOVAL AND REPLACEMENT OF INDWELLING STENT IN URI 50382 $8,521.00REMOVAL AND REPLACEMENT OF INDWELLING STENT IN URI 50385 $8,521.00REMOVAL AND REPLACEMENT OF SINGLE LEAD PERMANENT P 33227 $31,956.00REMOVAL AND REPLACEMENT OF STENT IN KIDNEY AND URI 50387 $5,364.00REMOVAL AND TYING 2 OR MORE HEMORRHOID GROUP 46946 $6,749.00REMOVAL AND TYING HEMORRHOID GROUP 46945 $6,749.00REMOVAL AND/OR SCRAPING OF LOWER JAW BONE GROWTH O 21040 $6,639.00

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 ChargeREMOVAL BENIGN NONODONTOGENIC CYST TUMOR D7461 $4,494.00REMOVAL BENIGN ODONTOGENIC CYST/TUMOR D7450 $659.00REMOVAL BENIGN ODONTOGENIC CYST/TUMOR D7451 $2,979.00REMOVAL BONE FROM LOWER SPINE FOR DECOMPRESSION OF 0275T $16,778.00REMOVAL BONE FROM UPPER OR MIDDLE SPINE FOR DECOMP 0274T $16,778.00REMOVAL FOREIGN BODY DEEP THIGH/KNEE 27372 $9,514.00REMOVAL FOREIGN BODY OR STENT FROM PANCREATIC OR B 43275 $8,855.00REMOVAL FOREIGN BODY STONE OR STENT FROM BLADDER C 52310 $4,174.00REMOVAL FOREIGN MATERIAL FROM SKIN & TISSUE AT OPE 11010 $1,241.00REMOVAL FOREIGN MATERIAL SKIN TISSUE & MUSCLE AT O 11011 $1,395.00REMOVAL FOREIGN MATERIAL SKIN TISSUE MUSCLE & BONE 11012 $9,300.00REMOVAL GROWTH (0.5 CM OR LESS) OF THE FACE EAR EY 11440 $1,241.00REMOVAL GROWTH (0.5 CM OR LESS) OF THE SCALP NECK 11420 $2,153.00REMOVAL GROWTH (0.6 TO 1.0 CM) OF THE FACE EARS EY 11441 $1,241.00REMOVAL GROWTH (0.6 TO 1.0 M) OF THE SCALP NECK HA 11421 $2,153.00REMOVAL GROWTH (1.1 TO 2.0 CM) OF THE FACE EARS EY 11442 $2,420.00REMOVAL GROWTH (1.1 TO 2.0 CM) OF THE SCALP NECK H 11422 $2,153.00REMOVAL LATERAL EXOSTOSIS MAXILLA/MANDIBLE D7471 $720.00REMOVAL MALIGNANT GROWTH (0.5 CM OR LESS) OF FACE 11640 $1,241.00REMOVAL MALIGNANT GROWTH (0.5 CM OR LESS) SCALP NE 11620 $5,393.00REMOVAL MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) 11601 $1,241.00REMOVAL MALIGNANT GROWTH (0.6 TO 1.0 CM) OF FACE E 11641 $1,241.00REMOVAL MALIGNANT GROWTH (0.6 TO 1.0 CM) OF SCALP 11621 $1,241.00REMOVAL MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) 11602 $1,241.00REMOVAL MALIGNANT GROWTH (1.1 TO 2.0 CM) OF FACE E 11642 $1,241.00REMOVAL MALIGNANT GROWTH (1.1 TO 2.0 CM) OF SCALP 11622 $2,153.00REMOVAL MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) 11603 $2,153.00REMOVAL MALIGNANT GROWTH (2.1 TO 3.0 CM) OF FACE E 11643 $2,153.00REMOVAL MALIGNANT GROWTH (2.1 TO 3.0 CM) OF SCALP 11623 $2,153.00REMOVAL MALIGNANT GROWTH (3.1 TO 4 CENTIMETERS) OF 11604 $2,153.00REMOVAL MALIGNANT GROWTH (3.1 TO 4 CM) OF SCALP NE 11624 $4,139.00REMOVAL MALIGNANT GROWTH (3.1 TO 4.0 CM) OF FACE E 11644 $4,139.00REMOVAL MALIGNANT GROWTH (OVER 4.0 CENTIMETERS) OF 11606 $4,139.00REMOVAL MALIGNANT GROWTH (OVER 4.0 CM) OF SCALP NE 11626 $6,128.00REMOVAL MALIGNANT GROWTH (OVER 4.0 CM) OF THE FACE 11646 $6,128.00REMOVAL MULTIPLE POLYPS OR GROWTHS IN RECTUM & LAR 45315 $3,746.00REMOVAL OF (OVER 1 CENTIMETER) GROWTH OF SCLERA 68115 $6,106.00REMOVAL OF (UP TO 1 CENTIMETER) GROWTH OF SCLERA 68110 $5,051.00REMOVAL OF 1 OR MORE BREAST GROWTH, OPEN PROCEDURE 19120 $6,873.00

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 ChargeREMOVAL OF 2 TO 4 THICKENED SKIN GROWTHS 11056 $264.00REMOVAL OF ABDOMINAL CAVITY CATHETER 49422 $6,209.00REMOVAL OF ABNORMAL TISSUE DIVIDING THE VAGINA 57130 $5,366.00REMOVAL OF ANAL GROWTH 46220 $5,351.00REMOVAL OF ANAL POLYPS OR GROWTHS USING AN ENDOSCO 46610 $4,070.00REMOVAL OF ANTIBODIES FROM SURFACE OF RED BLOOD CE 86860 $130.00REMOVAL OF BILE DUCT STONES USING AN ENDOSCOPE, AC 47554 $9,052.00REMOVAL OF BILIARY DRAINAGE CATHETER ACCESSED THRO 47537 $2,159.00REMOVAL OF BILIARY DUCT OR GALLBLADDER STONE ACCES 47544 $1,004.00REMOVAL OF BLOOD ACCUMULATION BETWEEN NAIL AND NAI 11740 $421.00REMOVAL OF BLOOD CLOT FROM DIALYSIS GRAFT, OPEN PR 36831 $13,839.00REMOVAL OF BLOOD CLOT FROM EYE 65930 $10,987.00REMOVAL OF BLOOD CLOT IN ARTERY 34001 $3,213.00REMOVAL OF BLOOD CLOT IN ARTERY 34201 $17,507.00REMOVAL OF BLOOD CLOT IN HEART ARTERY, ACCESSED TH 92973 $14,983.00REMOVAL OF BLOOD CLOT IN UNDERARM OR UPPER CHEST V 34490 $13,839.00REMOVAL OF BLOOD CLOT IN VENA CAVA, PELVIC OR THIG 34451 $5,427.00REMOVAL OF BLOOD CLOT OF ARTERIAL OR VENOUS GRAFT 35875 $13,839.00REMOVAL OF BLOOD FLOW ASSIST DEVICE IN AORTA, ACCE 33968 $109.00REMOVAL OF BONE IMPLANT 20670 $4,651.00REMOVAL OF BONY GROWTH OF JAW BONE INSIDE MOUTH 21031 $6,639.00REMOVAL OF BONY GROWTH OF UPPER JAW BONE INSIDE MO 21032 $6,639.00REMOVAL OF BREAST GROWTH, OPEN PROCEDURE 19125 $6,872.00REMOVAL OF BRONCHIAL VALVES IN LUNG AIRWAYS USING 31649 $2,818.00REMOVAL OF CATHETER IN ARTERY OR VEINCM 37214 $7,830.00REMOVAL OF CENTRAL VENOUS CATHETER FOR INFUSION 36589 $2,451.00REMOVAL OF CONGENITAL DEFECT OF LYMPH NODES AT UND 38550 $8,125.00REMOVAL OF CRANIAL TONGS OR HALO (STABILIZATION DE 20665 $1,321.00REMOVAL OF CYST OR GROWTH OF COLLAR BONE OR SHOULD 23140 $5,738.00REMOVAL OF DEEP BONE IMPLANT 20680 $6,128.00REMOVAL OF DEEP FOREIGN BODY IN MUSCLE OR TENDON 20525 $6,128.00REMOVAL OF DEFIBRILLATOR ELECTRODE 33272 $11,546.00REMOVAL OF DEFIBRILLATOR ELECTRODES 33244 $7,221.00REMOVAL OF DEFIBRILLATOR PULSE GENERATOR 33241 $6,258.00REMOVAL OF DENTAL BONE 41823 $12,096.00REMOVAL OF DRUG DELIVERY IMPLANT FROM TISSUE 11982 $1,321.00REMOVAL OF ELECTRODE FROM RIGHT HEART 33234 $6,781.00REMOVAL OF ELECTRODES FROM RIGHT HEART 33235 $6,781.00REMOVAL OF EMBEDDED FOREIGN BODY IN EYELID 67938 $646.00

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 ChargeREMOVAL OF EMBEDDED FOREIGN BODY OF MOUTH 40804 $2,974.00REMOVAL OF EMBEDDED FOREIGN BODY OF MOUTH 40805 $1,840.00REMOVAL OF ENGORGED HEMORRHOID 46320 $4,718.00REMOVAL OF ENLARGED MEMBRANE COVERING OF TEETH OR 41828 $6,639.00REMOVAL OF ESOPHAGEAL POLYPS OR GROWTHS USING AN E 43216 $8,336.00REMOVAL OF ESOPHAGEAL POLYPS OR GROWTHS USING AN E 43217 $4,137.00REMOVAL OF EXCESSIVE SKIN AND FAT OF UPPER EYELID 15823 $5,571.00REMOVAL OF EXCESSIVE SKIN OF LOWER EYELID 15820 $5,571.00REMOVAL OF EXCESSIVE SKIN OF LOWER EYELID AND FAT 15821 $5,571.00REMOVAL OF EXCESSIVE SKIN OF UPPER EYELID 15822 $6,260.00REMOVAL OF EXTERNAL FEMALE GENITAL SCAR TISSUE 56441 $6,708.00REMOVAL OF EYE CONTENTS 65091 $10,450.00REMOVAL OF EYELASHES 67825 $1,035.00REMOVAL OF EYELASHES BY FORCEPS 67820 $331.00REMOVAL OF EYELID GROWTH 67800 $1,035.00REMOVAL OF EYELID GROWTH 67840 $2,748.00REMOVAL OF FACIAL BONES 21026 $17,356.00REMOVAL OF FEMALE GENITAL GLAND OR CYST 56740 $5,366.00REMOVAL OF FLUID FROM BETWEEN LUNG AND CHEST CAVIT 32551 $1,521.00REMOVAL OF FLUID FROM CHEST CAVITY 32554 $1,521.00REMOVAL OF FLUID FROM CHEST CAVITY WITH IMAGING GU 32555 $2,407.00REMOVAL OF FLUID FROM CHEST CAVITY WITH INSERT IND 32556 $1,483.00REMOVAL OF FLUID FROM CHEST CAVITY WITH INSERT IND 32557 $1,841.00REMOVAL OF FOREIGN BODIES IN ESOPHAGUS USING AN EN 43215 $4,137.00REMOVAL OF FOREIGN BODIES IN LARGE BOWEL USING AN 45332 $1,550.00REMOVAL OF FOREIGN BODIES IN LARGE BOWEL USING AN 45379 $3,086.00REMOVAL OF FOREIGN BODIES OF ESOPHAGUS STOMACH AND 43247 $3,479.00REMOVAL OF FOREIGN BODIES OF ESOPHAGUS USING AN EN 43194 $3,375.00REMOVAL OF FOREIGN BODY FROM EAR CANAL 69200 $183.00REMOVAL OF FOREIGN BODY FROM EAR CANAL UNDER ANEST 69205 $7,661.00REMOVAL OF FOREIGN BODY FROM THROAT 42809 $183.00REMOVAL OF FOREIGN BODY FROM TISSUE, ACCESSED BENE 10120 $1,257.00REMOVAL OF FOREIGN BODY FROM TISSUE, ACCESSED BENE 10121 $5,502.00REMOVAL OF FOREIGN BODY FROM VOICE BOX USING AN EN 31530 $6,235.00REMOVAL OF FOREIGN BODY IN ANUS USING AN ENDOSCOPE 46608 $3,300.00REMOVAL OF FOREIGN BODY IN EXTERNAL EYE, CONJUNCTI 65205 $332.00REMOVAL OF FOREIGN BODY IN EXTERNAL EYE, CONJUNCTI 65210 $1,321.00REMOVAL OF FOREIGN BODY IN LUNG AIRWAYS USING AN E 31635 $3,674.00REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON 20520 $1,241.00

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 ChargeREMOVAL OF FOREIGN BODY IN NOSE 30300 $183.00REMOVAL OF FOREIGN BODY IN UTERUS USING AN ENDOSCO 58562 $6,045.00REMOVAL OF FOREIGN BODY OF FOOT TISSUE 28192 $4,139.00REMOVAL OF FOREIGN BODY OF FOOT TISSUE 28193 $2,692.00REMOVAL OF FOREIGN BODY OF FOOT TISSUE, ACCESSED B 28190 $2,153.00REMOVAL OF FOREIGN BODY OF FOREARM OR WRIST 25248 $5,738.00REMOVAL OF FOREIGN BODY, EXTERNAL EYE, CORNEA 65220 $331.00REMOVAL OF FOREIGN BODY, EXTERNAL EYE, CORNEA WITH 65222 $331.00REMOVAL OF FORESKIN OF USING CLAMP OR DEVICE 54150 $6,260.00REMOVAL OF FORESKIN, NEONATE (28 DAYS OF AGE OR LE 54160 $6,260.00REMOVAL OF FORESKIN, PATIENT OLDER THAN 28 DAYS OF 54161 $6,260.00REMOVAL OF GALLBLADDER USING AN ENDOSCOPE 47562 $3,807.00REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DU 47563 $8,412.00REMOVAL OF GROWTH (0.5 CENTIMETERS OR LESS) OF THE 11400 $2,318.00REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE 11401 $1,241.00REMOVAL OF GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE 11402 $2,318.00REMOVAL OF GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE 11403 $2,153.00REMOVAL OF GROWTH (2.1 TO 3.0 CM) OF FACE EARS EYE 11443 $2,153.00REMOVAL OF GROWTH (2.1 TO 3.0 CM) OF THE SCALP NEC 11423 $4,139.00REMOVAL OF GROWTH (3.1 TO 4.0 CENTIMETERS) OF THE 11404 $5,502.00REMOVAL OF GROWTH (3.1 TO 4.0 CM) OF THE SCALP NEC 11424 $4,139.00REMOVAL OF GROWTH (4.0 CENTIMETERS) OF THE TRUNK, 11406 $5,502.00REMOVAL OF GROWTH (OVER 4.0 CM) OF THE SCALP NECK 11426 $6,128.00REMOVAL OF GROWTH OF CORNEA 65400 $5,041.00REMOVAL OF GROWTH OF DENTAL BONE WITH REPAIR 41826 $6,639.00REMOVAL OF GROWTH OF FLOOR OF MOUTH 41116 $6,639.00REMOVAL OF GROWTH OF LYMPH NODE 38308 $11,265.00REMOVAL OF GROWTH OF MOUTH 40812 $4,233.00REMOVAL OF GROWTH OF ROOF OF MOUTH 42104 $8,797.00REMOVAL OF GROWTH OF ROOF OF MOUTH 42106 $8,797.00REMOVAL OF GROWTH OF SCLERA 66130 $7,484.00REMOVAL OF GROWTH OF SCLERA 68130 $5,041.00REMOVAL OF GROWTH OF SKIN AND TISSUE ON NOSE 30124 $6,639.00REMOVAL OF GROWTH OF SKIN NERVE OR NERVE LINING 64788 $4,962.00REMOVAL OF GROWTH OF TENDON COVERING OR JOINT CAPS 28090 $5,843.00REMOVAL OF GROWTH OF TENDON COVERING OR JOINT CAPS 28092 $5,843.00REMOVAL OF GROWTH OF TENDON FINGER OR HAND 26160 $4,374.00REMOVAL OF GROWTH OF TISSUE OF MOUTH 40810 $8,797.00REMOVAL OF GROWTH OF TONGUE 41110 $8,797.00

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 ChargeREMOVAL OF GROWTH OF TONGUE 41112 $8,797.00REMOVAL OF HEMORRHOID BY RUBBER BANDING 46221 $2,202.00REMOVAL OF IMPACT EAR WAX, ONE EAR 69210 $183.00REMOVAL OF IMPACTED EAR WAX BY WASHING 69209 $261.00REMOVAL OF IMPACTED STOOL OR FOREIGN BODY UNDER AN 45915 $4,718.00REMOVAL OF IMPLANTABLE CONTRACEPTIVE CAPSULES 11976 $1,241.00REMOVAL OF IMPLANTED EARDRUM TUBE UNDER ANESTHESIA 69424 $5,122.00REMOVAL OF IMPLANTED LENS IN EYE 65920 $6,185.00REMOVAL OF INDWELLING STENT IN URINARY DUCT 50384 $5,050.00REMOVAL OF INDWELLING STENT IN URINARY DUCT (URETE 50386 $2,275.00REMOVAL OF INFLAMED OR INFECTED SKIN 11001 $104.00REMOVAL OF INFLAMED OR INFECTED SKIN, UP TO 10% OF 11000 $773.00REMOVAL OF INTERNAL AND EXTERNAL HEMORRHOIDS 46255 $4,801.00REMOVAL OF INTRA-UTERINE DEVICE (IUD) FOR PREGNANC 58301 $438.00REMOVAL OF KIDNEY DRAINAGE TUBE (URETER) USING FLU 50389 $1,832.00REMOVAL OF LARGE BOWEL POLYPS OR GROWTHS USING AN 44394 $3,086.00REMOVAL OF LARGE BOWEL TISSUE USING AN ENDOSCOPE 45390 $3,746.00REMOVAL OF LOWER HEART CHAMBER BLOOD FLOW ASSIST D 33992 $1,022.00REMOVAL OF LOWER JAW BONE 21025 $12,096.00REMOVAL OF MALIGNANT GROWTH (0.5 CM OR LESS) OF TH 11600 $2,153.00REMOVAL OF MALIGNANT GROWTH OF LOWER JAW BONE 21044 $17,356.00REMOVAL OF MALIGNANT GROWTH OF UPPER JAW OR CHEEK 21034 $12,096.00REMOVAL OF MORE THAN 4 THICKENED SKIN GROWTHS 11057 $395.00REMOVAL OF MULTIPLE ANAL POLYPS OR GROWTHS USING A 46612 $9,263.00REMOVAL OF MULTIPLE EXTERNAL ANAL GROWTHS 46230 $5,090.00REMOVAL OF MULTIPLE GROWTHS OF DIFFERENT EYELIDS 67805 $1,035.00REMOVAL OF MULTIPLE GROWTHS OF SAME EYELID 67801 $2,748.00REMOVAL OF MULTIPLE INTERNAL AND EXTERNAL HEMORRHO 46260 $6,106.00REMOVAL OF NAIL 11750 $1,241.00REMOVAL OF OUTER LAYER OF CORNEA 65435 $2,748.00REMOVAL OF OVERGROWN GUM TISSUE 41820 $6,639.00REMOVAL OF PERIPHERAL VENOUS CATHETER FOR INFUSION 36590 $2,900.00REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR 33233 $7,270.00REMOVAL OF PLAQUE & INSERTION OF STENTS INTO ARTER 37231 $64,082.00REMOVAL OF PLAQUE & INSERTION OF STENTS INTO ARTER 37235 $17,958.00REMOVAL OF PLAQUE AND INSERT STENT IN MAJOR CORONA 92933 $29,531.00REMOVAL OF PLAQUE AND INSERT STENT IN MAJOR CORONA 92934 $29,531.00REMOVAL OF PLAQUE IN ARTERY IN ONE LEG ENDOVASCULA 37229 $38,643.00REMOVAL OF PLAQUE IN ARTERY IN ONE LEG ENDOVASCULA 37233 $17,958.00

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 ChargeREMOVAL OF PLAQUE MAJOR CORONARY ARTERY OR BRANCH 92924 $37,074.00REMOVAL OF PLAQUE MAJOR CORONARY ARTERY OR BRANCH 92925 $37,074.00REMOVAL OF POLYP OR GROWTH OF RECTUM AND LARGE BOW 45308 $87.00REMOVAL OF POLYP OR GROWTH OF RECTUM AND LARGE BOW 45309 $3,746.00REMOVAL OF POLYPS IN NOSE 30110 $4,553.00REMOVAL OF POLYPS OR GROWTHS IN LARGE BOWEL USING 45384 $2,550.00REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS STOMACH 43250 $4,137.00REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS STOMACH 43251 $4,137.00REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING 44392 $3,086.00REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING 45333 $1,550.00REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING 45338 $2,639.00REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING 45385 $2,550.00REMOVAL OF PORTION OF EXTERNAL EAR 69110 $4,139.00REMOVAL OF RECTAL GROWTH 45171 $9,960.00REMOVAL OF RECTAL MUSCLE GROWTH 45172 $7,536.00REMOVAL OF RECURRING CATARACT IN LENS CAPSULE USIN 66821 $1,833.00REMOVAL OF REMAINING OR REGROWN PROSTATE TISSUE WI 52630 $10,098.00REMOVAL OF ROD WITH TENDON GRAFT AT HAND OR FINGER 26418 $4,374.00REMOVAL OF SALIVARY CYST UNDER TONGUE 42408 $6,639.00REMOVAL OF SALIVARY GLAND STONE 42330 $4,233.00REMOVAL OF SCAR TISSUE FOLLOWING PENILE FORESKIN R 54162 $747.00REMOVAL OF SINGLE ANAL POLYP OR GROWTH USING AN EN 46611 $4,070.00REMOVAL OF SINGLE THICKENED SKIN GROWTH 11055 $198.00REMOVAL OF SKIN AND BONE 11047 $1,241.00REMOVAL OF SKIN AND BONE FIRST 20 SQ CM OR LESS 11044 $2,221.00REMOVAL OF SKIN AND TISSUE 11045 $773.00REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS 11042 $773.00REMOVAL OF SKIN AND/OR MUSCLE 11046 $773.00REMOVAL OF SKIN AND/OR MUSCLE FIRST 20 SQ CM OR LE 11043 $773.00REMOVAL OF SKIN DEBRIS AND DRAINAGE OF MASTOID CAV 69220 $264.00REMOVAL OF SKIN OF FINGER OR TOE NAIL 11765 $264.00REMOVAL OF SKIN SUTURE WITH CHANGE OF BLADDER TUBE 51705 $563.00REMOVAL OF SKIN TAGS 11201 $264.00REMOVAL OF SOFT TISSUE GROWTH OF EAR CANAL 69145 $5,007.00REMOVAL OF SPERM DUCT 55250 $6,260.00REMOVAL OF STONE FROM BILE OR PANCREATIC DUCT USIN 43264 $5,783.00REMOVAL OF SUTURE AROUND SKIN SURFACE TUBE WITH CH 51710 $1,962.00REMOVAL OF SUTURES BETWEEN UPPER AND LOWER EYELIDS 67710 $2,271.00REMOVAL OF SUTURES UNDER ANESTHESIA BY OTHER SURGE 15851 $3,834.00

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 ChargeREMOVAL OF SUTURES UNDER ANESTHESIA BY SAME SURGEO 15850 $773.00REMOVAL OF TAILBONE CYST 11770 $6,128.00REMOVAL OF TISSUE AT DENTAL EDGE AND CHEEK 40819 $4,233.00REMOVAL OF TISSUE CONNECTING TONGUE AND FLOOR OF M 41115 $1,840.00REMOVAL OF TISSUE FIBER AT DENTAL BONE 41822 $4,233.00REMOVAL OF TISSUE FROM 1 TO 5 FINGER OR TOE NAILS 11720 $264.00REMOVAL OF TISSUE FROM 6 OR MORE FINGER OR TOE NAI 11721 $264.00REMOVAL OF TISSUE FROM WOUNDS PER SESSION 97597 $395.00REMOVAL OF TISSUE FROM WOUNDS PER SESSION 97598 $395.00REMOVAL OF TISSUE FROM WOUNDS PER SESSION 97602 $794.00REMOVAL OF TISSUE LINING OF ESOPHAGUS STOMACH AND/ 43254 $3,751.00REMOVAL OF TISSUE LINING OF ESOPHAGUS USING AN END 43211 $5,710.00REMOVAL OF TISSUE OVERGROWTH AT TEETH OR TOOTH SOC 41830 $6,639.00REMOVAL OF TUNNELED CATHETER IN LUNG LINING 32552 $1,841.00REMOVAL OF UP TO AND INCLUDING 15 SKIN TAGS 11200 $706.00REMOVAL OF VENA CAVA FILTER BY ENDOVASCULAR APPROA 37193 $9,220.00REMOVAL OR BIVALVING OF FULL ARM OR LEG CAST 29705 $349.00REMOVAL OR BIVALVING OF GAUNTLET, BOOT, OR BODY CA 29700 $349.00REMOVAL OR BIVALVING OF SHOULDER, HIP SPICA, OR JA 29710 $697.00REMOVAL OR CRUSHING KIDNEY STONE (OVER 2 CM) OR IN 50081 $14,557.00REMOVAL OR DESTRUCTION OF CERVIX 57522 $5,366.00REMOVAL OR DESTRUCTION OF THROAT GROWTH 42808 $6,523.00REMOVAL OR RELOCATION OF CORNEAL CONJUNCTIVA 65420 $4,167.00REMOVAL OR RELOCATION OF CORNEAL CONJUNCTIVA 65426 $6,185.00REMOVAL OR REVISION OF NEUROSTIMULATOR PULSE GENER 63688 $11,599.00REMOVAL OR REVISION OF SPINAL NEUROSTIMULATOR ELEC 63661 $6,745.00REMOVAL OR SCRAPING OF UPPER JAW OR CHEEK BONE GRO 21030 $17,356.00REMOVAL RESIDUAL TOOTH ROOTS D7250 $1,995.00REMOVAL SKIN & TISSUE BENEATH THE SKIN OF ANUS/NAV 11471 $6,128.00REMOVAL SKIN & TISSUE BENEATH THE SKIN OF UNDERARM 11451 $9,300.00REMOVAL SPINAL CANAL DRUG INFUSION PUMP OR DEVICE 62365 $18,511.00REMOVAL TISSUE GROWTH BENEATH THE SKIN AT FOREARM 25071 $7,415.00REMOVAL TISSUE GROWTH BENEATH THE SKIN OF NECK OR 21555 $4,139.00REMOVAL TOOTH IMPACTED COMPLETE BONY D7240 $1,995.00REMOVAL TOOTH IMPACTED COMPLETE BONY COMPLICATED D7241 $1,995.00REMOVAL TOOTH IMPACTED PARTIALLY BONY D7230 $1,995.00REMOVAL TOOTH IMPACTED SOFT TISSUE D7220 $1,995.00REMOVAL TOOTH WITH FLAP D7210 $1,995.00REMOVAL TORUS MANDIBULARIS D7473 $6,639.00

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 ChargeREMOVAL TORUS PALATINUS D7472 $6,639.00REMOVAL WITH REINSERTION OF DRUG DELIVERY IMPLANT 11983 $183.00REMOVAL/CRUSHING KIDNEY STONE OR INSERT KIDNEY STE 50080 $11,719.00REMOVE BLOOD CLOT & INJECTIONS TO DISSOLVE BLOOD C 37184 $13,839.00REMOVE BLOOD CLOT & INJECTIONS TO DISSOLVE BLOOD C 37185 $11,141.00REMOVE BLOOD CLOT & INJECTIONS TO DISSOLVE BLOOD C 37186 $12,490.00REMOVE BLOOD CLOT & INJECTIONS TO DISSOLVE BLOOD C 37187 $11,141.00REMOVE BLOOD CLOT & INJECTIONS TO DISSOLVE BLOOD C 37188 $13,839.00REMOVE IMPLANT D6100 $498.00REMOVE PLAQUE & INSERTION OF STENTS INTO ARTERIES 37227 $64,082.00REMOVE PLAQUE IN ARTERIES IN ONE LEG ENDOVASCULAR 37225 $36,042.00RENIN (KIDNEY ENZYME) LEVEL 84244 $170.00REPAIR DUCT OPENING 68760 $855.00REPAIR IMPLANT PROSTHESIS D6090 $428.00REPAIR OF (2.5 CENTIMETER OR LESS) LACERATION TO F 41251 $848.00REPAIR OF 2 ELECTRODES FOR PERMANENT PACEMAKER OR 33220 $6,781.00REPAIR OF ANAL MUSCLE AND ABNORMAL ANAL DRAINAGE T 46280 $6,145.00REPAIR OF BLOOD VESSEL OF ARM 35206 $8,659.00REPAIR OF BLOOD VESSEL OF LEG 35226 $2,605.00REPAIR OF CENTRAL VENOUS CATHETER FOR INFUSION 36575 $1,772.00REPAIR OF CENTRAL VENOUS CATHETER FOR INFUSION 36576 $3,509.00REPAIR OF DETACHED RETINA BY INJECTION OF AIR OR G 67110 $6,437.00REPAIR OF DETACHED RETINA, 1 OR MORE SESSIONS 67101 $6,437.00REPAIR OF DETACHED RETINA, 1 OR MORE SESSIONS 67105 $1,833.00REPAIR OF EARDRUM 69610 $6,639.00REPAIR OF ELECTRODE FOR PERMANENT PACEMAKER OR DEF 33218 $6,781.00REPAIR OF FINGER OR TOE NAIL BED 11760 $1,932.00REPAIR OF FINGER OR TOE NAIL BED WITH GRAFT 11762 $6,196.00REPAIR OF FINGER TENDON 26350 $6,668.00REPAIR OF FINGER TENDON 26356 $8,459.00REPAIR OF FINGER TENDON 26357 $10,495.00REPAIR OF FINGER TENDON 26370 $10,495.00REPAIR OF FINGER TENDON 26433 $10,581.00REPAIR OF FINGER TENDON WITH GRAFT 26420 $10,495.00REPAIR OF FOOT TENDON 28208 $5,843.00REPAIR OF FOREARM AND/OR WRIST TENDON COVERING WIT 25275 $10,495.00REPAIR OF FOREARM AND/OR WRIST TENDON OR MUSCLE 25270 $8,510.00REPAIR OF HAND TENDON 26410 $5,466.00REPAIR OF LACERATED CONJUNCTIVA 65270 $5,047.00

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 ChargeREPAIR OF LACERATION TO FLOOR OF MOUTH AND/OR TONG 41250 $289.00REPAIR OF LACERATION TO FLOOR OF MOUTH AND/OR TONG 41252 $1,840.00REPAIR OF LIGAMENT OF HAND OR FINGER JOINT 26540 $10,581.00REPAIR OF LIP AND BORDER 40650 $1,840.00REPAIR OF LOWER JAW BONE WITH BONE GRAFT 21215 $12,096.00REPAIR OF NASAL OR CHEEK BONE WITH BONE GRAFT 21210 $12,096.00REPAIR OF NON-HEALED FRACTURE OF SHIN BONE 27720 $22,799.00REPAIR OF PROTRUDING EAR 69300 $6,639.00REPAIR OF SEPARATION OF WOUND CLOSURE 12020 $1,451.00REPAIR OF SEPARATION OF WOUND CLOSURE WITH INSERTI 12021 $927.00REPAIR OF SPICA, BODY CAST, OR JACKET 29720 $349.00REPAIR OF TENDON OR MUSCLE OF FOREARM AND/OR WRIST 25260 $8,510.00REPAIR OF TENDON OR MUSCLE OF UPPER ARM OR ELBOW 24341 $15,852.00REPAIR OF TOE TENDON, ACCESSED THROUGH THE SKIN 28010 $5,843.00REPAIR OF TRAUMATIC TEAR IN LUNG AND/OR CONTROL OF 32110 $6,693.00REPAIR OF TURNING-OUTWARD EYELID DEFECT 67916 $6,106.00REPAIR OF VERTICAL LIP WOUND EXTENDING TO HALF OF 40652 $1,792.00REPAIR OF VERTICAL LIP WOUND EXTENDING TO OVER HAL 40654 $1,792.00REPAIR OF WOUND SCALP HAND FOOT OVER 30CM 12007 $445.00REPAIR OF WOUND (1.1 TO 2.5 CENTIMETERS) EYELIDS, 13151 $1,632.00REPAIR OF WOUND (1.1 TO 2.5 CENTIMETERS) OF SCALP, 13120 $1,042.00REPAIR OF WOUND (1.1 TO 2.5 CENTIMETERS) OF TRUNK 13100 $1,451.00REPAIR OF WOUND (2.5 CM OR LESS) OF FACE EARS EYEL 12051 $1,257.00REPAIR OF WOUND (2.6 TO 5.0 CM) OF FACE EARS EYELI 12052 $1,257.00REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) EYELIDS, 13152 $1,451.00REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF NECK H 12042 $1,257.00REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF SCALP, 13121 $1,161.00REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF TRUNK 13101 $1,451.00REPAIR OF WOUND (5.1 TO 7.5 CM) OF FACE EARS EYELI 12053 $1,257.00REPAIR OF WOUND (7.6 TO 12.5 CM) OF FACE EARS EYEL 12054 $1,257.00REPAIR OF WOUND (OVER 30.0 CENTIMETERS) OF NECK HA 12047 $6,196.00REPAIR OF WOUND FACE EAR EYE NOSE LIP 12.6CM TO 2 12016 $445.00REPAIR OF WOUND FACE EAR EYE NOSE LIP 20.1CM TO 3 12017 $1,244.00REPAIR OF WOUND FACE EAR EYE NOSE LIP 7.6CM TO 12 12015 $445.00REPAIR OF WOUND FACE EAR EYE NOSE LIP 5.1CM TO 7.5 12014 $445.00REPAIR OF WOUND FACE EAR EYE NOSE LIP OVER 30CM 12018 $927.00REPAIR OF WOUND FACE EAR EYE NOSE LIP OVER 30CM 12057 $1,257.00REPAIR OF WOUND OF EYELID MARGIN 67935 $4,917.00REPAIR OF WOUND OF EYELIDS, NOSE, EARS, AND/OR LIP 13153 $927.00

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 ChargeREPAIR OF WOUND OF SCALP, ARMS, AND/OR LEGS 13122 $508.00REPAIR OF WOUND OF TRUNK 13102 $927.00REPAIR ROOT D3333 $180.00REPAIR TO INCREASE DEPTH OF MOUTH 40844 $12,096.00REPAIR TO INCREASE DEPTH ON ONE SIDE OF THE MOUTH 40842 $12,096.00REPAIR WOUND (1.1 TO 2.5 CM) FACE MOUTH NECK UNDER 13131 $1,042.00REPAIR WOUND (12.6 TO 20.0 CENTIMETERS) OF NECK HA 12045 $1,932.00REPAIR WOUND (12.6 TO 20.0 CM) OF FACE EARS EYELID 12055 $1,257.00REPAIR WOUND (12.6 TO 20.0 CM) OF SCALP NECK UNDER 12005 $445.00REPAIR WOUND (12.6 TO 20.0 CM) OF THE SCALP UNDERA 12035 $1,257.00REPAIR WOUND (2.5 CENTIMETERS OR LESS) OF NECK HAN 12041 $1,257.00REPAIR WOUND (2.5 CM OR LESS) OF FACE EAR EYELID N 12011 $445.00REPAIR WOUND (2.5 CM OR LESS) OF SCALP NECK UNDERA 12001 $396.00REPAIR WOUND (2.5 CM OR LESS) OF THE SCALP UNDERAR 12031 $1,257.00REPAIR WOUND (2.6 TO 5.0 CM) OF FACE EAR EYELID NO 12013 $445.00REPAIR WOUND (2.6 TO 7.5 CM) FACE MOUTH NECK UNDER 13132 $1,632.00REPAIR WOUND (2.6 TO 7.5 CM) OF SCALP NECK UNDERAR 12002 $396.00REPAIR WOUND (2.6 TO 7.5 CM) OF THE SCALP UNDERARM 12032 $1,257.00REPAIR WOUND (20.1 TO 30.0 CENTIMETERS) OF NECK HA 12046 $1,257.00REPAIR WOUND (20.1 TO 30.0 CM) OF FACE EARS EYELID 12056 $1,257.00REPAIR WOUND (20.1 TO 30.0 CM) OF SCALP NECK UNDER 12006 $445.00REPAIR WOUND (20.1 TO 30.0 CM) OF THE SCALP UNDERA 12036 $1,932.00REPAIR WOUND (7.6 TO 12.5 CENTIMETERS) OF NECK HAN 12044 $1,932.00REPAIR WOUND (7.6 TO 12.5 CM) OF SCALP NECK UNDERA 12004 $396.00REPAIR WOUND (7.6 TO 12.5 CM) OF THE SCALP UNDERAR 12034 $1,257.00REPAIR WOUND (OVER 30.0 CM) OF THE SCALP UNDERARM 12037 $6,274.00REPAIR WOUND OF FOREHEAD CHEEK CHIN MOUTH NECK UND 13133 $1,042.00REPAIR/MODIFICATION HEARING AID V5014 $458.00REPLACEMENT ATTACHMENT D6091 $1,304.00REPLACEMENT OF CENTRAL VENOUS CATHETER 36580 $3,259.00REPLACEMENT OF CENTRAL VENOUS CATHETER 36581 $9,971.00REPLACEMENT OF CENTRAL VENOUS CATHETER 36582 $9,945.00REPLACEMENT OF CENTRAL VENOUS CATHETER 36583 $9,945.00REPLACEMENT OF KIDNEY DRAINAGE CATHETER ACCESSED T 50435 $2,346.00REPLACEMENT OF LIVER DUCT DRAINAGE CATHETER ACCESS 47536 $9,736.00REPLACEMENT OF PERIPHERAL VENOUS CATHETER 36584 $2,900.00REPLACEMENT OF PERIPHERAL VENOUS CATHETER 36585 $7,830.00REPLACEMENT OF SMALL BOWEL TUBE 49451 $1,962.00REPLACEMENT OF STENT PANCREATIC OR BILE DUCT USING 43276 $8,724.00

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 ChargeREPLACEMENT OF STOMACH OR LARGE BOWEL TUBE 49450 $1,962.00REPLACEMENT OF STOMACH TO SMALL BOWEL TUBE 49452 $1,580.00REPOSITION LOWER HEART CHAMBER BLOOD FLOW ASSIST D 33993 $1,022.00REPOSITIONING MANEUVERS FOR TREATMENT OF VERTIGO, 95992 $98.00REPOSITIONING OF CENTRAL VENOUS CATHETER USING FLU 36597 $3,509.00REPOSITIONING OF FORESKIN INCLUDING SCAR TISSUE RE 54450 $857.00REPOSITIONING OF IMPLANTED LEFT HEART ELECTRODE 33226 $8,134.00REPOSITIONING OF IMPLANTED PACEMAKER OR DEFIBRILLA 33215 $6,781.00REPOSITIONING OF PREVIOUSLY IMPLANTED DEFIBRILLATO 33273 $11,546.00REPOSITIONING OF STOMACH FEEDING TUBE 43761 $2,783.00REPOSITIONING OF VENA CAVA FILTER BY ENDOVASCULAR 37192 $10,767.00REPROGRAMMING OF PROGRAMMABLE BRAIN AND SPINAL FLU 62252 $285.00RESERVOIR PROSTHETIC TITAN COLOPLAST LOCK-OUT BIOF C1813 $10,887.50RESERVOIR SHUNT BARIUM NEONATE SMALL FLAT DOME L2. $3,815.20RESERVOIR SHUNT CODMAN HOLTER RICKHAM SALMON NYLON $2,728.00RESERVOIR SHUNT DELTA REGULAR OD6 MM CSF BURR HOLE $1,197.95RESERVOIR SHUNT INTEGRA PUDENZ OMMAYA DOME H7.2 MM $2,380.32RESERVOIR SHUNT INTEGRA PUDENZ OMMAYA L2.5 CM OD1. $2,286.08RESERVOIR SHUNT INTEGRA PUDENZ OMMAYA STANDARD L2. $1,934.01RESERVOIR SHUNT NATUS PUDENZ H5 MM OD2.2 CM ODSEC1 $2,380.32RESERVOIR SHUNT NATUS PUDENZ STANDARD H6 MM OD2.2 $1,934.01RESERVOIR SHUNT NEONATE SMALL L4.5 MM CSF BARIUM I $3,663.20RESERVOIR SHUNT NEONATE SMALL W10 MM X H4 MM OD2.1 $2,624.38RESERVOIR SHUNT OMMAYA STANDARD L2.5 CM OD2.5 CM 1 $1,934.01RESHAPING OF BONY CARTILAGE DIVIDING NASAL PASSAGE 30420 $12,096.00RESHAPING OF TOOTH BONE 41874 $6,639.00RESIN 4 OR MORE SURFACES D2335 $531.00RESIN COMPOSITE 4 OR MORE SURFACES D2394 $433.00RESIN COMPOSITE ONE SURFACE D2391 $240.00RESIN COMPOSITE THREE SURFACES D2393 $367.00RESIN COMPOSITE TWO SURFACES D2392 $303.00RESIN ONE SURFACE D2330 $280.00RESIN THREE SURFACES D2332 $424.00RESIN TWO SURFACES D2331 $348.00RESP BLOOD GAS W 02 SAT 82805 $81.00RESP CARBOXYHEMOGLOBIN QUANT 82375 $85.00RESP CHLORIDE 82435 $31.00RESP METHEMOGLOBIN QUANT 83050 $56.00RESP POTASSIUM 84132 $35.00

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 ChargeRESP SODIUM 84295 $37.00RESPIRATORY INHALED AEROSOL TREATMENT TO RELIEVE A 94644 $221.00RESPIRATORY INHALED AEROSOL TREATMENT TO RELIEVE A 94645 $221.00RESPIRATORY INHALED PRESSURE/NONPRESSURE TREATM RE 94640 $157.00RESPIRATORY MOTION MANAGEMENT SIMULATION 77293 $1,755.00RESTORATION OF EYELID BLINKING FUNCTION 67912 $5,672.00RETIC COUNT AUTOMATED 85045 $29.00RETRACTOR LAPAROSCOPIC DEXTRUS LARGE LOW PROFILE F $325.52RETRACTOR LAPAROSCOPIC DEXTRUS MEDIUM LOW PROFILE $325.52RETRACTOR LAPAROSCOPIC DEXTRUS SMALL LOW PROFILE F $357.18RETRACTOR SURGICAL DE LEE UNIVERSAL L9.5 IN L2.75 $856.51RETRIEVAL OF FOREIGN BODY OF BLOOD VESSELS ACCESSE 37197 $9,945.00RETRIEVER SUTURE HEWSON L10.1 IN LIGAMENT DRILL GU $610.00RETRIEVER SUTURE L30 MM OD7 MM TIP CUTTING DISPOSA $1,586.00RETROGRADE FILLING PER ROOT D3430 $474.00REVASCULARIZATION CORONARY DRUG ELUTING STENT C9604 $47,295.00REVASCULARIZATION CORONARY DRUG ELUTING STENT C9606 $47,295.00REVASCULARIZATION CORONARY DRUG ELUTING STENT C9607 $64,082.00REVISION OF DIALYSIS GRAFT, OPEN PROCEDURE 36832 $13,839.00REVISION OF SHUNT FROM JUGULAR VEIN TO ABDOMINAL C 49426 $6,834.00REVISION OF SHUNTS TO BYPASS BLOOD FLOW TO LIVER U 37183 $31,109.00REVISION OF TISSUE CONNECTING TONGUE TO FLOOR OF M 41520 $6,639.00REVISION OR REPAIR OF OPERATIVE WOUND OF EYE 66250 $5,041.00RHEUMATOID FACTOR ANALYSIS 86430 $44.00RHEUMATOID FACTOR LEVEL 86431 $44.00RIFAMPIN 80299 $194.00RING ACETABULAR DURALOC DYNAMIC BANTAM OD40 MM HIP C1776 $1,448.20RING ACETABULAR DURALOC DYNAMIC OD42 MM HIP LOCK S C1776 $1,448.20RING ACETABULAR DURALOC DYNAMIC OD56 MM HIP LOCK S C1776 $1,448.20RING ACETABULAR RINGLOC OD23 MM HIP LOCK C1776 $682.50RING ANASTOMOSIS VALTRAC 1.5 MM OD25 MM BOWEL RADI $1,860.30RING ANASTOMOSIS VALTRAC 1.5 MM OD31 MM BOWEL RADI $1,860.30RING ANASTOMOSIS VALTRAC 2 MM OD25 MM BOWEL RADIOP $1,860.30RING ANASTOMOSIS VALTRAC 2 MM OD28 MM BOWEL RADIOP $1,860.30RING ANASTOMOSIS VALTRAC 2 MM OD31 MM BOWEL RADIOP $1,860.30RING ANASTOMOSIS VALTRAC 2 MM OD34 MM BOWEL RADIOP $1,860.30RING ANNULOPLASTY CARPENTIER-EDWARDS CLASSIC OD26 $8,832.00RING ANNULOPLASTY CARPENTIER-EDWARDS CLASSIC TITAN $8,832.00RING ANNULOPLASTY CARPENTIER-EDWARDS OD28 MM TRICU $8,832.00

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 ChargeRING ANNULOPLASTY CARPENTIER-EDWARDS OD32 MM TRICU $8,832.00RING ANNULOPLASTY CG FUTURE OD24 MM $10,400.00RING ANNULOPLASTY CG FUTURE OD26 MM $10,400.00RING ANNULOPLASTY CG FUTURE OD28 MM MITRAL VALVE B $10,400.00RING ANNULOPLASTY CG FUTURE OD30 MM $10,400.00RING ANNULOPLASTY CG FUTURE OD32 MM $10,400.00RING ANNULOPLASTY CG FUTURE OD34 MM $10,400.00RING ANNULOPLASTY CG FUTURE OD36 MM MITRAL VALVE S $10,400.00RING ANNULOPLASTY CG FUTURE OD38 MM $10,400.00RING ANNULOPLASTY DURAN ANCORE OD23 MM CHORDAL GUI $6,500.00RING ANNULOPLASTY DURAN ANCORE OD25 MM CHORDAL GUI $6,500.00RING ANNULOPLASTY DURAN ANCORE OD27 MM CHORDAL GUI $6,500.00RING ANNULOPLASTY DURAN ANCORE OD29 MM CHORDAL GUI $6,500.00RING ANNULOPLASTY DURAN ANCORE OD31 MM CHORDAL GUI $6,500.00RING ANNULOPLASTY DURAN ANCORE OD33 MM CHORDAL GUI $6,500.00RING ANNULOPLASTY DURAN ANCORE OD35 MM 10 L $6,500.00RING ANNULOPLASTY EDWARDS MC3 TITANIUM SILICONE RU $10,237.50RING ANNULOPLASTY MEMO 3D OD24 MM MITRAL SEMIRIGID $16,000.00RING ANNULOPLASTY MEMO 3D OD28 MM MITRAL SEMI RIGI $21,016.00RING ANNULOPLASTY MEMO 3D OD36 MM MITRAL SEMIRIGID $16,000.00RING ANNULOPLASTY OD28 MM TRIAD $12,350.00RING ANNULOPLASTY SEGUIN POLYETHYLENE POLYESTER OD $6,500.00RING ANNULOPLASTY SJM SEGUIN OD34 MM ODSEC28 MM ID $6,500.00RING ANNULOPLASTY TRI-AD OD26 MM TRICUSPID LOW PRO $12,350.00RING ANNULOPLASTY TRI-AD OD34 MM TRICUSPID LOW PRO $12,350.00RING ANNULOPLASTY TRI-AD OD36 MM TRICUSPID LOW PRO $12,350.00RING ANNULOPLASTY TRI-AD POLYESTER FABRIC OD30 MM $12,350.00RING ANNULOPLASTY TRI-AD POLYESTER FABRIC OD32 MM $12,350.00RING EXTERNAL FIXATION 2/3 ID105 MM TAYLOR SPATIAL $7,527.60RING EXTERNAL FIXATION 2/3 ID155 MM TAYLOR SPATIAL $5,546.00RING EXTERNAL FIXATION 2/3 ID180 MM TAYLOR SPATIAL $5,548.80RING EXTERNAL FIXATION 2/3 ID205 MM TAYLOR SPATIAL $5,548.80RING EXTERNAL FIXATION 2/3 ID230 MM TAYLOR SPATIAL $5,548.80RING EXTERNAL FIXATION 2/3 ID80 MM TAYLOR SPATIAL $8,000.48RING EXTERNAL FIXATION ADAPTER $3,259.60RING EXTERNAL FIXATION ADAPTER FEMALE $3,448.56RING EXTERNAL FIXATION ALUMINUM 1/2 CIRCLE ID180 M $6,116.80RING EXTERNAL FIXATION ALUMINUM 2/3 ID130 MM TAYLO $6,364.80RING EXTERNAL FIXATION ALUMINUM 2/3 ID180 MM TAYLO $6,373.20

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 ChargeRING EXTERNAL FIXATION ALUMINUM 2/3 ID205 MM $6,385.20RING EXTERNAL FIXATION ALUMINUM FULL ID155 MM TAYL $6,364.80RING EXTERNAL FIXATION ALUMINUM FULL ID180 MM TAYL $6,354.40RING EXTERNAL FIXATION ALUMINUM FULL ID205 MM TAYL $6,364.80RING EXTERNAL FIXATION CARBON FIBER 1/2 ID100 MM M $3,233.76RING EXTERNAL FIXATION CARBON FIBER 1/2 ID120 MM M $3,440.80RING EXTERNAL FIXATION CARBON FIBER 1/2 ID140 MM M $3,638.56RING EXTERNAL FIXATION CARBON FIBER 1/2 ID160 MM M $4,029.60RING EXTERNAL FIXATION CARBON FIBER 1/2 ID180 MM M $4,241.20RING EXTERNAL FIXATION CARBON FIBER 1/2 ID200 MM M $4,443.60RING EXTERNAL FIXATION CARBON FIBER 5/8 ID140 MM M $4,241.20RING EXTERNAL FIXATION CARBON FIBER 5/8 ID160 MM M $4,443.60RING EXTERNAL FIXATION CARBON FIBER 5/8 ID180 MM M $4,646.00RING EXTERNAL FIXATION CARBON FIBER 5/8 ID200 MM M $4,843.76RING EXTERNAL FIXATION CARBON FIBER FULL ID160 MM $8,054.56RING EXTERNAL FIXATION CARBON FIBER ID140 MM FULL $7,254.16RING EXTERNAL FIXATION CARBON FIBER ID160 MM FOOT $5,634.96RING EXTERNAL FIXATION CARBON FIBER ID180 MM FULL $8,868.80RING EXTERNAL FIXATION CARBON FIBER ID200 MM FULL $9,664.56RING EXTERNAL FIXATION CARBON FIBER LONG ID100 MM $5,211.76RING EXTERNAL FIXATION CARBON FIBER LONG ID140 MM $5,423.36RING EXTERNAL FIXATION CARBON FIBER LONG ID180 MM $5,842.00RING EXTERNAL FIXATION CARBON FIBER LONG L210 MM F $8,736.00RING EXTERNAL FIXATION CARBON FIBER SHORT ID100 MM $5,211.76RING EXTERNAL FIXATION CARBON FIBER SHORT ID140 MM $5,423.36RING EXTERNAL FIXATION CARBON FIBER SHORT ID160 MM $5,634.96RING EXTERNAL FIXATION CARBON FIBER SHORT ID180 MM $5,842.00RING EXTERNAL FIXATION CARBON FIBER SHORT L210 MM $7,281.60RING EXTERNAL FIXATION CARBON SHORT ID180 MM FOOT $11,947.52RING EXTERNAL FIXATION CIRCLE FULL ID130 MM TAYLO $6,364.80RING EXTERNAL FIXATION CIRCLE HALF ID155 MM TAYLOR $5,956.80RING EXTERNAL FIXATION COMPASS CARBON FIBER EPOXY $4,885.44RING EXTERNAL FIXATION DFS 2/3 ID180 MM HYBRID FIX $3,429.12RING EXTERNAL FIXATION DFS ID130 MM 1/3 RING $2,138.88RING EXTERNAL FIXATION DFS STAINLESS STEEL 1/3 ID1 $2,384.64RING EXTERNAL FIXATION DFS STAINLESS STEEL ID220 M $3,237.12RING EXTERNAL FIXATION DISTRACTION $6,927.36RING EXTERNAL FIXATION FULL ID105 MM FULL RING CIR $6,364.80RING EXTERNAL FIXATION FULL ID115 MM NONSTERILE HY $3,339.60

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 ChargeRING EXTERNAL FIXATION FULL ID165 MM NONSTERILE HY $3,785.76RING EXTERNAL FIXATION FULL ID205 MM NONSTERILE HY $4,416.00RING EXTERNAL FIXATION HEIDELBERG ADAPTER $26,764.80RING EXTERNAL FIXATION HEX-FIX ADAPTER $5,140.80RING EXTERNAL FIXATION HEX-FIX UNIVERSAL ADAPTER $7,670.40RING EXTERNAL FIXATION ID100 MM ROTATE $12,218.88RING EXTERNAL FIXATION ID115 MM 3/4 RING NONSTERIL $2,999.20RING EXTERNAL FIXATION ID130 MM 1/2 RING CIRCULAR $7,178.64RING EXTERNAL FIXATION ID130 MM ROTATE $12,218.88RING EXTERNAL FIXATION ID140 MM 3/4 RING NONSTERIL $3,279.76RING EXTERNAL FIXATION ID150 MM ROTATE $13,440.00RING EXTERNAL FIXATION ID155 MM 2/3 RING CIRCULAR $6,385.20RING EXTERNAL FIXATION ID165 MM 1/4 RING NONSTERIL $2,769.20RING EXTERNAL FIXATION ID165 MM 3/4 RING NONSTERIL $3,440.80RING EXTERNAL FIXATION ID180 MM ROTATE $13,847.04RING EXTERNAL FIXATION ID205 MM 1/2 RING CIRCULAR $7,178.64RING EXTERNAL FIXATION ID205 MM 3/4 RING NONSTERIL $4,075.60RING EXTERNAL FIXATION ID220 MM ROTATE $14,668.80RING EXTERNAL FIXATION ID230 MM 1/2 RING CIRCULAR $7,178.64RING EXTERNAL FIXATION ID230 MM 2/3 RING ADDITIONA $6,385.20RING EXTERNAL FIXATION ID230 MM FULL RING CIRCULAR $6,364.80RING EXTERNAL FIXATION ID80 MM FULL RING CIRCULAR $8,291.44RING EXTERNAL FIXATION ILIZAROV 180 D ID130 MM CIR $7,048.80RING EXTERNAL FIXATION ILIZAROV 180 D ID160 MM CIR $6,873.12RING EXTERNAL FIXATION ILIZAROV 5/8 ID160 MM 5/8 R $5,939.28RING EXTERNAL FIXATION ILIZAROV 5/8 ID180 MM 5/8 R $6,402.16RING EXTERNAL FIXATION ILIZAROV 90 D ID180 MM CIRC $5,228.64RING EXTERNAL FIXATION ILIZAROV 90 D ID200 MM CIRC $5,228.64RING EXTERNAL FIXATION ILIZAROV CARBON FIBER EPOXY $3,999.36RING EXTERNAL FIXATION ILIZAROV COMPASS CARBON FIB $4,869.52RING EXTERNAL FIXATION ILIZAROV ID130 MM 5/8 RING $5,148.88RING EXTERNAL FIXATION ILIZAROV ID150 MM 5/8 RING $5,564.00RING EXTERNAL FIXATION ILIZAROV LARGE ADAPTER BALL $5,385.60RING EXTERNAL FIXATION ILIZAROV STAINLESS STEEL 1/ $4,709.92RING EXTERNAL FIXATION ILIZAROV STAINLESS STEEL AD $6,170.64RING EXTERNAL FIXATION ILIZAROV STAINLESS STEEL ID $6,386.16RING EXTERNAL FIXATION ILIZAROV STAINLESS STEEL OD $7,759.28RING EXTERNAL FIXATION LONG CIRCLE ID155 MM FOOT T $7,491.44RING EXTERNAL FIXATION LONG L180 MM ID180 MM FOOT $7,709.60

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 ChargeRING EXTERNAL FIXATION LONG OD180 MM FOOT TRILOBE $7,281.60RING EXTERNAL FIXATION SHORT ID155 MM FOOT CIRCULA $7,709.60RING EXTERNAL FIXATION SHORT ID180 MM CIRCULAR FOO $9,055.12RING EXTERNAL FIXATION STAINLESS STEEL ID100 MM 1/ $4,764.32RING EXTERNAL FIXATION STAINLESS STEEL ID100 MM 3/ $5,413.44RING EXTERNAL FIXATION STAINLESS STEEL ID110 MM 1/ $4,845.44RING EXTERNAL FIXATION STAINLESS STEEL ID110 MM 3/ $5,413.44RING EXTERNAL FIXATION STAINLESS STEEL ID120 MM 1/ $5,413.44RING EXTERNAL FIXATION STAINLESS STEEL ID120 MM 3/ $5,413.44RING EXTERNAL FIXATION STAINLESS STEEL ID40 MM 1/2 $3,286.32RING EXTERNAL FIXATION STAINLESS STEEL ID40 MM 3/4 $4,306.40RING EXTERNAL FIXATION STAINLESS STEEL ID50 MM 1/2 $3,373.28RING EXTERNAL FIXATION STAINLESS STEEL ID50 MM 3/4 $4,445.52RING EXTERNAL FIXATION STAINLESS STEEL ID60 MM 1/2 $2,410.80RING EXTERNAL FIXATION STAINLESS STEEL ID70 MM 1/2 $3,541.36RING EXTERNAL FIXATION STAINLESS STEEL ID70 MM 3/4 $5,413.44RING EXTERNAL FIXATION STAINLESS STEEL ID80 MM 1/2 $3,541.36RING EXTERNAL FIXATION STAINLESS STEEL ID80 MM 3/4 $5,413.44RING EXTERNAL FIXATION STAINLESS STEEL ID90 MM 1/2 $4,845.44RING EXTERNAL FIXATION STAINLESS STEEL ID90 MM 3/4 $5,413.44RING EXTERNAL FIXATION TITANIUM 5/8 OD130 MM NONST $4,241.20RING EXTERNAL FIXATION TITANIUM 5/8 OD150 MM NONST $4,646.00RING EXTERNAL FIXATION TITANIUM 5/8 OD160 MM NONST $5,036.96RING EXTERNAL FIXATION TITANIUM 5/8 OD180 MM NONST $5,851.20RING EXTERNAL FIXATION TITANIUM 5/8 OD200 MM NONST $6,044.40RING EXTERNAL FIXATION TITANIUM FULL OD140 MM NONS $6,444.56RING EXTERNAL FIXATION TITANIUM FULL OD160 MM NONS $7,493.36RING EXTERNAL FIXATION TITANIUM FULL OD180 MM NONS $8,054.56RING EXTERNAL FIXATION TITANIUM FULL OD200 MM NONS $8,744.56RING EXTERNAL FIXATION TITANIUM HALF OD100 MM NONS $2,842.80RING EXTERNAL FIXATION TITANIUM HALF OD110 MM NONS $2,916.40RING EXTERNAL FIXATION TITANIUM HALF OD120 MM NONS $3,036.00RING EXTERNAL FIXATION TITANIUM HALF OD130 MM NONS $3,114.16RING EXTERNAL FIXATION TITANIUM HALF OD140 MM NONS $3,233.76RING EXTERNAL FIXATION TITANIUM HALF OD150 MM NONS $3,440.80RING EXTERNAL FIXATION TITANIUM HALF OD160 MM MR C $3,753.60RING EXTERNAL FIXATION TITANIUM HALF OD180 MM NONS $4,029.60RING EXTERNAL FIXATION TITANIUM HALF OD200 MM NONS $4,365.36RING EXTERNAL FIXATION TITANIUM HALF OD220 MM NONS $4,646.00

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 ChargeRING EXTERNAL FIXATION TITANIUM HALF OD240 MM NONS $4,843.76RING EXTERNAL FIXATION TITANIUM HALF OD80 MM NONST $2,635.76RING EXTERNAL FIXATION TITANIUM LONG ID180+ MM FOO $7,695.76RING EXTERNAL FIXATION TITANIUM LONG ID200+ MM FOO $7,971.76RING EXTERNAL FIXATION TITANIUM LONG OD100 MM FOOT $6,854.00RING EXTERNAL FIXATION TITANIUM LONG OD140 MM FOOT $7,134.56RING EXTERNAL FIXATION TITANIUM LONG OD160 MM FOOT $7,415.20RING EXTERNAL FIXATION TITANIUM SHORT OD100 MM FOO $6,854.00RING EXTERNAL FIXATION TITANIUM SHORT OD140 MM FOO $7,134.56RING EXTERNAL FIXATION TITANIUM SHORT OD160 MM FOO $7,415.20RING EXTERNAL FIXATION TITANIUM SHORT OD180 MM FOO $7,695.76RING EXTERNAL FIXATION TITANIUM SHORT OD200 MM FOO $7,971.76RING EXTERNAL FIXATION TRILOBE LONG ID150 MM FOOT $7,281.60RING EXTERNAL FIXATION TRILOBE SHORT ID150 MM FOOT $11,947.52RING SPINAL MESA RAIL SMALL STATURE OD4.5 MM BUTTR C1821 $2,000.00RING SPINAL MESA SMALL STATURE OD4.5 MM BUTTRESS N C1821 $2,000.00RING SPINAL TITANIUM OD6 MM FIXATION NONSTERILE C1821 $755.20RING TRACTION HALO GRAPHITE MEDIUM OD21-24 IN SPIN L0859 $11,232.00ROD EXTERNAL FIXATION BLUNT L335 MM OD5 MM ODSEC1. $1,734.20ROD EXTERNAL FIXATION CARBON FIBER 135 D CURVE L49 $5,193.36ROD EXTERNAL FIXATION CARBON FIBER 180 D CURVE L85 $5,607.36ROD EXTERNAL FIXATION CARBON FIBER 45 D CURVE L207 $4,328.56ROD EXTERNAL FIXATION CARBON FIBER 90 D CURVE L117 $1,384.56ROD EXTERNAL FIXATION CARBON FIBER 90 D CURVE L382 $4,760.96ROD EXTERNAL FIXATION CARBON FIBER ANGLE L120 MM X $2,654.16ROD EXTERNAL FIXATION CARBON FIBER ANGLE L50 MM X $2,654.16ROD EXTERNAL FIXATION CARBON FIBER ANGLE L80 MM X $2,654.16ROD EXTERNAL FIXATION CARBON FIBER L100 MM NONSTER $1,600.00ROD EXTERNAL FIXATION CARBON FIBER L100 MM OD11 MM $1,646.80ROD EXTERNAL FIXATION CARBON FIBER L120 MM OD4 MM $2,654.16ROD EXTERNAL FIXATION CARBON FIBER L125 MM OD11 MM $1,646.80ROD EXTERNAL FIXATION CARBON FIBER L150 MM OD11 MM $1,338.03ROD EXTERNAL FIXATION CARBON FIBER L156 MM OD4 MM $1,476.56ROD EXTERNAL FIXATION CARBON FIBER L200 MM OD11 MM $1,646.80ROD EXTERNAL FIXATION CARBON FIBER L200 MM OD8 MM $904.48ROD EXTERNAL FIXATION CARBON FIBER L200 MM RADIAL $20,240.00ROD EXTERNAL FIXATION CARBON FIBER L214 MM OD8 MM $2,801.36ROD EXTERNAL FIXATION CARBON FIBER L220 MM RADIAL $20,240.00ROD EXTERNAL FIXATION CARBON FIBER L250 MM OD11 MM $1,438.91

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 ChargeROD EXTERNAL FIXATION CARBON FIBER L300 MM OD11 MM $1,438.91ROD EXTERNAL FIXATION CARBON FIBER L350 MM OD11 MM C1713 $1,438.91ROD EXTERNAL FIXATION CARBON FIBER L350 MM OD11 MM $1,644.50ROD EXTERNAL FIXATION CARBON FIBER L382 MM OD8 MM $2,801.36ROD EXTERNAL FIXATION CARBON FIBER L400 MM OD11 MM C1713 $1,577.23ROD EXTERNAL FIXATION CARBON FIBER L400 MM OD11 MM $1,813.50ROD EXTERNAL FIXATION CARBON FIBER L450 MM OD11 MM $1,941.20ROD EXTERNAL FIXATION CARBON FIBER L499 MM OD8 MM $2,801.36ROD EXTERNAL FIXATION CARBON FIBER L500 MM OD11 MM $1,941.20ROD EXTERNAL FIXATION CARBON FIBER L540 MM OD8 MM $2,801.36ROD EXTERNAL FIXATION CARBON FIBER L550 MM OD11 MM $2,097.60ROD EXTERNAL FIXATION CARBON FIBER L600 MM OD11 MM $2,097.60ROD EXTERNAL FIXATION CARBON FIBER L650 MM OD11 MM $2,097.60ROD EXTERNAL FIXATION CARBON FIBER L78 MM OD4 MM M $1,292.56ROD EXTERNAL FIXATION CARBON FIBER MEDIUM L160 MM $1,122.40ROD EXTERNAL FIXATION CARBON L600 MM $1,367.04ROD EXTERNAL FIXATION COMPACT HOFFMANN II CARBON F $445.04ROD EXTERNAL FIXATION DYNAFIX VISION ALUMINUM L150 $1,113.60ROD EXTERNAL FIXATION DYNAFIX VISION ALUMINUM L200 $1,113.60ROD EXTERNAL FIXATION DYNAFIX VISION ALUMINUM L250 $1,175.04ROD EXTERNAL FIXATION DYNAFIX VISION ALUMINUM L300 $1,175.04ROD EXTERNAL FIXATION DYNAFIX VISION ALUMINUM L350 $1,240.32ROD EXTERNAL FIXATION DYNAFIX VISION ALUMINUM L400 $1,240.32ROD EXTERNAL FIXATION DYNAFIX VISION CARBON L150 M $1,113.60ROD EXTERNAL FIXATION DYNAFIX VISION CARBON L200 M $1,113.60ROD EXTERNAL FIXATION DYNAFIX VISION CARBON L250 M $1,132.80ROD EXTERNAL FIXATION DYNAFIX VISION CARBON L300 M $1,175.04ROD EXTERNAL FIXATION DYNAFIX VISION CARBON L350 M $1,240.32ROD EXTERNAL FIXATION DYNAFIX VISION L100 MM CONNE $3,532.80ROD EXTERNAL FIXATION DYNAFIX VISION L150 MM CONNE $3,709.44ROD EXTERNAL FIXATION DYNAFIX VISION L50 MM CONNEC $3,356.16ROD EXTERNAL FIXATION HOFFMANN 3 SEMICIRCLE L220 M $2,300.35ROD EXTERNAL FIXATION HOFFMANN 3 VECTRAN CARBON L2 $1,760.98ROD EXTERNAL FIXATION HOFFMANN 3 VECTRAN CARBON L3 $1,808.30ROD EXTERNAL FIXATION HOFFMANN 3 VECTRAN CARBON L4 $2,068.56ROD EXTERNAL FIXATION HOFFMANN II ALUMINUM CURVE S $1,344.00ROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER L15 $1,378.56ROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER L30 $1,497.60ROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER L35 $1,608.96

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 ChargeROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER L40 $2,034.39ROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER L50 $1,839.36ROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER L65 $1,378.56ROD EXTERNAL FIXATION HOFFMANN II CARBON FIBER STR $1,497.60ROD EXTERNAL FIXATION HOFFMANN II CARBON L100 MM O $1,378.56ROD EXTERNAL FIXATION HOFFMANN II CARBON L150 MM O $1,876.19ROD EXTERNAL FIXATION HOFFMANN II CARBON L200 MM O $1,927.68ROD EXTERNAL FIXATION HOFFMANN II CARBON L250 MM O $1,926.82ROD EXTERNAL FIXATION HOFFMANN II CARBON L300 MM O $1,983.77ROD EXTERNAL FIXATION HOFFMANN II CARBON L450 MM O $2,034.39ROD EXTERNAL FIXATION HOFFMANN II CARBON L500 MM O $2,146.56ROD EXTERNAL FIXATION HOFFMANN II CARBON L65 MM OD $1,876.19ROD EXTERNAL FIXATION HOFFMANN II CARBON STRAIGHT $1,839.36ROD EXTERNAL FIXATION HOFFMANN II COMPACT CARBON F $548.72ROD EXTERNAL FIXATION HOFFMANN II COMPACT CARBON L $502.96ROD EXTERNAL FIXATION HOFFMANN II COMPACT L100 MM $803.20ROD EXTERNAL FIXATION HOFFMANN II COMPACT MRI CARB $552.24ROD EXTERNAL FIXATION HOFFMANN II MRI CARBON L100 $1,876.19ROD EXTERNAL FIXATION HOFFMANN II MRI CARBON L174 $1,831.68ROD EXTERNAL FIXATION HOFFMANN II MRI COMPACT CARB $679.68ROD EXTERNAL FIXATION HOFFMANN II STANDARD L40 MM $15,148.80ROD EXTERNAL FIXATION ILIZAROV ADULT LARGE L100 MM $1,108.80ROD EXTERNAL FIXATION ILIZAROV ALUMINUM STAINLESS $6,921.12ROD EXTERNAL FIXATION ILIZAROV LARGE L150 MM TELES $2,466.64ROD EXTERNAL FIXATION ILIZAROV LARGE L200 MM TELES $2,746.16ROD EXTERNAL FIXATION ILIZAROV QUICK CONNECT $11,016.24ROD EXTERNAL FIXATION ILIZAROV STAINLESS STEEL ALU $2,190.88ROD EXTERNAL FIXATION INSERTION $1,033.50ROD EXTERNAL FIXATION L100 MM THREAD SLOT MR SAFE $478.40ROD EXTERNAL FIXATION L120 MM THREAD MR CONDITIONA $478.40ROD EXTERNAL FIXATION L150 MM THREAD MR SAFE NONST $478.40ROD EXTERNAL FIXATION L200 MM THREAD MR SAFE NONST $524.40ROD EXTERNAL FIXATION L250 MM THREAD MR SAFE NONST $524.40ROD EXTERNAL FIXATION L300 MM THREAD MR SAFE NONST $602.56ROD EXTERNAL FIXATION L350 MM THREAD MR SAFE NONST $602.56ROD EXTERNAL FIXATION L400 MM THREAD MR SAFE NONST $791.20ROD EXTERNAL FIXATION L500 MM NONSTERILE MANDIBLE $9,537.60ROD EXTERNAL FIXATION L60 MM THREAD MR CONDITIONAL $478.40ROD EXTERNAL FIXATION L80 MM THREAD SLOT MR CONDIT $478.40

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 ChargeROD EXTERNAL FIXATION MEDIUM L150 MM STRAIGHT $1,285.20ROD EXTERNAL FIXATION MONOTUBE TRIAX CARBON L200 M $1,180.80ROD EXTERNAL FIXATION OFFSET DISTAL RADIUS SYSTEM $2,142.00ROD EXTERNAL FIXATION OPTIROM TARGET $7,800.00ROD EXTERNAL FIXATION SHORT L75 MM STRAIGHT $1,285.20ROD EXTERNAL FIXATION SHORT QUICK CONNECT $8,142.40ROD EXTERNAL FIXATION STAINLESS STEEL L220 MM OD8 $1,113.20ROD EXTERNAL FIXATION STAINLESS STEEL L240 MM OD8 $904.48ROD EXTERNAL FIXATION STAINLESS STEEL L280 MM OD8 $911.95ROD EXTERNAL FIXATION STAINLESS STEEL L360 MM OD8 $1,214.40ROD EXTERNAL FIXATION STAINLESS STEEL L400 MM OD8 $1,214.40ROD EXTERNAL FIXATION STAINLESS STEEL L460 MM OD8 $1,214.40ROD EXTERNAL FIXATION TITANIUM 1/2 PREBENT OD4 MM $3,451.20ROD EXTERNAL FIXATION TITANIUM 3/4 PREBENT OD4 MM $3,782.40ROD EXTERNAL FIXATION TITANIUM FULL PREBENT OD4 MM $4,809.60ROD EXTERNAL FIXATION TITANIUM L500 MM OD4 MM MAND $13,952.00ROD EXTERNAL FIXATION VECTRAN CARBON L150 MM OD5 M $679.68ROD EXTERNAL FIXATION VECTRAN CARBON L200 MM OD5 M $679.68ROD EXTERNAL FIXATION VISION CARBON FIBER L400 MM $1,240.32ROD EXTERNAL FIXATION VISION CARBON L500 MM OD9.5 $1,347.84ROD EXTERNAL FIXATION WRISTFIX WRIST CONNECT $522.24ROD FIXATION TITANIUM L110 MM MAXILLARY NONSTERILE C1713 $2,384.00ROD FIXATION TITANIUM L110 MM MAXILLARY TALL OFFSE C1713 $3,488.00ROD FIXATION TITANIUM L80 MM MAXILLARY NONSTERILE C1713 $2,384.00ROD FIXATION TITANIUM L80 MM MAXILLARY TALL OFFSET C1713 $3,488.00ROD INTRAMEDULLARY FASSIER-DUVAL TELESCOPIC IM SYS C1713 $7,200.00ROD ORTHOPEDIC EASYCLIP OD2 MM FOOT ANKLE POSITION $787.80ROD ORTHOPEDIC L8 MM METATARSOPHALANGEAL STABILIZA C1776 $1,998.75ROD REAMING L650 MM OD2.5 MM BALL TIP EXTENSION ST $685.43ROD REAMING L950 MM OD2.5 MM BALL TIP STERILE $644.67ROD SPINAL 2 HEXAGON STRAIGHT L500 MM OD5.5 MM NON C1713 $1,137.50ROD SPINAL 2 HEXAGON STRAIGHT L500 MM OD5.5 MM STO C1713 $1,400.00ROD SPINAL AVATAR PREBENT L85 MM OD5.5 MM POSTERIO C1713 $1,300.00ROD SPINAL BEACON STRAIGHT L150 MM OD6.35 MM HEXAG C1713 $812.50ROD SPINAL BULLET HEXAGON CONTOUR L45 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CAPITOL CURVE L30 MM OD3.5 MM C1713 $812.50ROD SPINAL CCM PLUS STRAIGHT L90 MM OD4.75 MM PERC C1713 $1,300.00ROD SPINAL CD HORIZON COCRMO CURVE L100 MM OD5.5 M C1713 $1,600.00ROD SPINAL CD HORIZON COCRMO CURVE L110 MM OD5.5 M C1713 $1,137.50

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 ChargeROD SPINAL CD HORIZON COCRMO CURVE L120 MM OD5.5 M C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO CURVE L30 MM OD5.5 MM C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO CURVE L35 MM OD5.5 MM C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO CURVE L40 MM OD5.5 MM C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO CURVE L45 MM OD5.5 MM C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO CURVE L50 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CD HORIZON COCRMO CURVE L55 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CD HORIZON COCRMO CURVE L60 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CD HORIZON COCRMO CURVE L70 MM OD5.5 MM C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO CURVE L80 MM OD5.5 MM C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO CURVE L90 MM OD5.5 MM C1713 $1,400.00ROD SPINAL CD HORIZON COCRMO PLUS STRAIGHT L500 MM C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO STRAIGHT L500 MM OD4. C1713 $1,137.50ROD SPINAL CD HORIZON COCRMO STRAIGHT L500 MM OD5. C1713 $1,600.00ROD SPINAL CD HORIZON LEGACY STAINLESS STEEL L50 C C1713 $1,600.00ROD SPINAL CD HORIZON LEGACY STAINLESS STEEL PREBE C1713 $1,600.00ROD SPINAL CD HORIZON LEGACY TITANIUM PREBENT L60 C1713 $812.50ROD SPINAL CD HORIZON LEGACY TITANIUM PREBENT L70 C1713 $812.50ROD SPINAL CD HORIZON LEGACY TITANIUM PREBENT L90 C1713 $812.50ROD SPINAL CD HORIZON SEXTANT TITANIUM STANDARD CO C1713 $1,625.00ROD SPINAL CD HORIZON SOLERA COCRMO CURVE L90 MM O C1713 $1,137.50ROD SPINAL CD HORIZON TITANIUM CURVE L100 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L110 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L120 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L30 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L35 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L40 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L45 MM OD5.5 C1713 $1,200.00ROD SPINAL CD HORIZON TITANIUM CURVE L50 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L55 MM OD5.5 C1713 $1,000.00ROD SPINAL CD HORIZON TITANIUM CURVE L60 MM OD5.5 C1713 $1,200.00ROD SPINAL CD HORIZON TITANIUM CURVE L70 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L80 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM CURVE L90 MM OD5.5 C1713 $812.50ROD SPINAL CD HORIZON TITANIUM STRAIGHT L500 MM OD C1713 $1,137.50ROD SPINAL CHROMALOY PLUS CHROMALLOY L50 MM OD5.5 C1713 $1,400.00ROD SPINAL CHROMALOY PLUS CURVE L100 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L105 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L110 MM OD5.5 MM C1713 $1,600.00

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 ChargeROD SPINAL CHROMALOY PLUS CURVE L115 MM OD5.5 MM C1713 $1,400.00ROD SPINAL CHROMALOY PLUS CURVE L30 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L35 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L40 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L45 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L55 MM OD5.5 MM C1713 $1,137.50ROD SPINAL CHROMALOY PLUS CURVE L60 MM OD5.5 MM C1713 $1,400.00ROD SPINAL CHROMALOY PLUS CURVE L65 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L70 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L75 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L80 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L85 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L90 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS CURVE L95 MM OD5.5 MM C1713 $1,600.00ROD SPINAL CHROMALOY PLUS STRAIGHT L500 MM OD5.5 M C1713 $1,600.00ROD SPINAL CLICKX PANGEA TITANIUM L15 MM OD6 MM TR C1713 $2,000.00ROD SPINAL COCR 2 HEXAGON STRAIGHT L150 MM OD4.5 M C1713 $1,400.00ROD SPINAL COCR 2 HEXAGON STRAIGHT L300 MM GRAY C1713 $1,400.00ROD SPINAL COCR 2 HEXAGON STRAIGHT L300 MM OD4.5 M C1713 $1,400.00ROD SPINAL COCR 2 HEXAGON STRAIGHT L500 MM OD4.5 M C1713 $1,400.00ROD SPINAL COCR 2 HEXAGON STRAIGHT L500 MM OD6 MM C1713 $1,400.00ROD SPINAL COCR 2 HEXAGON STRAIGHT L600 MM GRAY C1713 $1,400.00ROD SPINAL COCR CONTOUR L100 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L110 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L125 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L30 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L35 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L40 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L45 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L50 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L55 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L60 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L65 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L70 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L75 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L80 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L85 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L90 MM OD4.5 MM C1713 $1,400.00ROD SPINAL COCR CONTOUR L95 MM OD4.5 MM C1713 $1,400.00

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 ChargeROD SPINAL COCR L300 MM OD3.5 MM ODSEC4.5 MM TRANS C1713 $2,400.00ROD SPINAL COCR L300 MM OD3.5-5.5 MM TRANSITIONAL C1713 $2,400.00ROD SPINAL COCR L300 MM OD5.5 MM C1713 $1,137.50ROD SPINAL COCR L500 MM OD3.5 MM ODSEC4.5 MM TRANS C1713 $2,400.00ROD SPINAL COCR L500 MM OD3.5-5.5 MM TRANSITIONAL C1713 $2,400.00ROD SPINAL COCR L500 MM OD4.5 MM ODSEC5.5 MM TRANS C1713 $2,400.00ROD SPINAL COCR STRAIGHT HEXAGON L200 MM OD3.5 MM C1713 $1,400.00ROD SPINAL COCR STRAIGHT HEXAGON L300 MM OD3.5 MM C1713 $1,400.00ROD SPINAL COCR STRAIGHT HEXAGON L400 MM OD3.5 MM C1713 $1,400.00ROD SPINAL CONQUEST STRAIGHT L450 MM OD5.5 MM POST C1713 $1,300.00ROD SPINAL CREO TITANIUM CURVE L100 MM OD5.5 MM NO C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L125 MM OD5.5 MM NO C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L150 MM OD5.5 MM NO C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L30 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L35 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L40 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L45 MM OD5.5 MM C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L50 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L55 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L60 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L65 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L70 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L75 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L80 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L85 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L90 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM CURVE L95 MM OD5.5 MM NON C1713 $812.50ROD SPINAL CREO TITANIUM L200 MM OD5.5 MM HEXAGON C1713 $812.50ROD SPINAL CREO TITANIUM L300 MM OD5.5 MM HEXAGON C1713 $1,137.50ROD SPINAL CREO TITANIUM STRAIGHT L45 MM OD5.5 MM C1713 $812.50ROD SPINAL CROSSBAR MEDIUM OD5.5 MM C1713 $3,250.00ROD SPINAL CROSSLINK STAINLESS STEEL L11 MM OD4.5 C1713 $4,800.00ROD SPINAL CROSSLINK STAINLESS STEEL L12 MM OD4.5 C1713 $4,800.00ROD SPINAL CROSSLINK STAINLESS STEEL L13 MM OD4.5 C1713 $4,800.00ROD SPINAL CROSSLINK STAINLESS STEEL L14 MM OD4.5 C1713 $4,800.00ROD SPINAL CROSSLINK STAINLESS STEEL L15 MM OD4.5 C1713 $4,800.00ROD SPINAL CROSSLINK STAINLESS STEEL L16 MM OD4.5 C1713 $4,800.00ROD SPINAL CROSSLINK STAINLESS STEEL L17 MM OD4.5 C1713 $4,800.00ROD SPINAL CURVE L45 MM HEXAGON END C1713 $1,300.00

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 ChargeROD SPINAL CURVE L50 MM OD5.5 MM CONTOUR GRAY C1713 $812.50ROD SPINAL CURVE L50 MM OD6.35 MM C1713 $812.50ROD SPINAL CURVED CONTOUR L65 MM OD5.5 MM CONTOUR C1713 $1,000.00ROD SPINAL CYPHER CURVE L35 MM OD5.5 MM MIS C1713 $1,300.00ROD SPINAL CYPHER CURVE L50 MM OD5.5 MM MIS C1713 $1,300.00ROD SPINAL DENALI CONTOUR L100 MM OD5.5 MM NONSTER C1713 $812.50ROD SPINAL DENALI CONTOUR L125 MM OD5.5 MM NONSTER C1713 $812.50ROD SPINAL DENALI CONTOUR L375 MM OD5.5 MM NONSTER C1713 $1,137.50ROD SPINAL DENALI CONTOUR L40 MM OD5.5 MM BULLET H C1713 $1,300.00ROD SPINAL DENALI CONTOUR L45 MM OD5.5 MM NONSTERI C1713 $812.50ROD SPINAL DENALI CONTOUR L50 MM OD5.5 MM BULLET H C1713 $1,300.00ROD SPINAL DENALI CONTOUR L500 MM OD5.5 MM NONSTER C1713 $1,137.50ROD SPINAL DENALI CONTOUR L70 MM OD5.5 MM BULLET N C1713 $1,600.00ROD SPINAL DENALI CONTOUR L70 MM OD5.5 MM NONSTERI C1713 $812.50ROD SPINAL DENALI CONTOUR L75 MM OD5.5 MM NONSTERI C1713 $812.50ROD SPINAL DENALI CURVE CONTOUR L50 MM OD5.5 MM NO C1713 $812.50ROD SPINAL DENALI L70 MM OD5.5 MM CONTOUR NONSTERI C1713 $812.50ROD SPINAL DENALI STRAIGHT L500 MM OD5.5 MM HEXAGO C1713 $1,400.00ROD SPINAL DENALI STRAIGHT L600 MM OD5.5 MM HEXAGO C1713 $1,400.00ROD SPINAL DENALI STRAIGHT L90 MM OD5.5 MM SPINE N C1713 $1,000.00ROD SPINAL DENALI TITANIUM CONTOUR L80 MM OD5.5 MM C1713 $812.50ROD SPINAL DENALI TITANIUM CONTOUR L90 MM OD5.5 MM C1713 $812.50ROD SPINAL DENALI TITANIUM CONTOUR L95 MM OD5.5 MM C1713 $812.50ROD SPINAL DIAPASON OSS TITANIUM L120 MM OD6 MM TH C1713 $600.00ROD SPINAL DIAPASON TITANIUM L130 MM OD6 MM THORAC C1713 $600.00ROD SPINAL ELLIPSE L350 MM OD3.5-5.5 MM TAPERED C1713 $3,250.00ROD SPINAL ELLIPSE L500 MM OD3.5-5.5 MM TAPERED C1713 $3,250.00ROD SPINAL ELLIPSE TAPER L350 MM OD3.5-3.7 MM C1713 $3,250.00ROD SPINAL ELLIPSE TITANIUM L350 MM OD3.5-4.5 MM T C1713 $3,250.00ROD SPINAL ELLIPSE TITANIUM L350 MM OD3.5-6.5 MM T C1713 $3,250.00ROD SPINAL ELLIPSE TITANIUM TAPER L350 MM OD3.5-4 C1713 $3,250.00ROD SPINAL ELLIPSE TITANIUM TAPER L350 MM OD3.5-5 C1713 $3,250.00ROD SPINAL ELLIPSE TITANIUM TAPER L350 MM OD3.5-6 C1713 $3,250.00ROD SPINAL ELLIPSE TITANIUM TAPER L350 MM OD3.5-6. C1713 $3,250.00ROD SPINAL ES2 RADIUS TITANIUM HEXAGON L35 MM OD5. C1713 $1,300.00ROD SPINAL ES2 RADIUS TITANIUM HEXAGON L40 MM OD5. C1713 $1,300.00ROD SPINAL EVEREST 2 HEXAGON STRAIGHT L200 MM OD6 C1713 $1,400.00ROD SPINAL EVEREST 2 HEXAGON STRAIGHT L400 MM OD6 C1713 $1,400.00ROD SPINAL EVEREST 2 HEXAGON STRAIGHT L500 MM OD6 C1713 $1,400.00

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 ChargeROD SPINAL EVEREST 2 HEXAGON STRAIGHT L600 MM OD6 C1713 $1,400.00ROD SPINAL EXPEDIUM COCR L120 MM OD4.5 MM HEXAGONA C1713 $1,400.00ROD SPINAL EXPEDIUM COCR L300 MM OD4.5 MM HEXAGONA C1713 $1,400.00ROD SPINAL EXPEDIUM COCR STRAIGHT L450 MM OD4.5 MM C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL 160 KSI L120 M C1713 $1,000.00ROD SPINAL EXPEDIUM STAINLESS STEEL 160 KSI L300 M C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL 160 KSI L480 M C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL 160 KSI L600 M C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL 200 KSI L120 M C1713 $1,000.00ROD SPINAL EXPEDIUM STAINLESS STEEL 200 KSI L300 M C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL 200 KSI L480 M C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL 200 KSI L600 M C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL HEXAGON L300 M C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL L120 MM OD5.5 C1713 $1,000.00ROD SPINAL EXPEDIUM STAINLESS STEEL L480 MM OD5.5 C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL L600 MM OD5.5 C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL OD4.5-5.5 MM 2 C1713 $1,400.00ROD SPINAL EXPEDIUM STAINLESS STEEL OD5-5.5 MM TRA C1713 $4,000.00ROD SPINAL EXPEDIUM STRAIGHT L120 MM OD4.5 MM HEXA C1713 $1,000.00ROD SPINAL EXPEDIUM STRAIGHT L300 MM OD4.5 MM HEXA C1713 $1,400.00ROD SPINAL EXPEDIUM STRAIGHT L450 MM OD4.5 MM HEXA C1713 $1,400.00ROD SPINAL EXPEDIUM STRAIGHT L600 MM OD4.5 MM HEXA C1713 $1,400.00ROD SPINAL EXPEDIUM TITANIUM L120 MM OD4.5 MM NONS C1713 $1,000.00ROD SPINAL EXPEDIUM TITANIUM L120 MM OD5.5 MM NONS C1713 $1,000.00ROD SPINAL EXPEDIUM TITANIUM L300 MM OD5.5 MM HEX C1713 $1,400.00ROD SPINAL EXPEDIUM TITANIUM L300 MM OD5.5 MM NONS C1713 $1,400.00ROD SPINAL EXPEDIUM TITANIUM L480 MM OD5.5 MM C1713 $1,400.00ROD SPINAL EXPEDIUM TITANIUM L480 MM OD5.5 MM NONS C1713 $1,400.00ROD SPINAL EXPEDIUM TITANIUM L600 MM OD5.5 MM C1713 $1,400.00ROD SPINAL EXPEDIUM TITANIUM OD4.5-5.5 MM C1713 $2,000.00ROD SPINAL EXPEDIUM TITANIUM PREBENT L105 MM OD5.5 C1713 $812.50ROD SPINAL EXPEDIUM TITANIUM STRAIGHT HEXAGON L300 C1713 $1,400.00ROD SPINAL EXPEDIUM TITANIUM STRAIGHT HEXAGON L450 C1713 $1,400.00ROD SPINAL EXPEDIUM TITANIUM STRAIGHT HEXAGON L600 C1713 $1,400.00ROD SPINAL EXPEDIUM VIPER 2 STRAIGHT L480 MM MIS C1713 $1,600.00ROD SPINAL L100 MM OD5.5 MM CONTOUR GRAY C1713 $812.50ROD SPINAL L100 MM OD5.5 MM HEXAGONAL END CONTOURE C1713 $1,600.00ROD SPINAL L100 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L100 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00

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 ChargeROD SPINAL L110 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L120 MM OD4.5 MM ULTRA STRENGTH HEXAGON C1713 $1,000.00ROD SPINAL L120 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00ROD SPINAL L125 MM OD5.5 MM CONTOUR GRAY C1713 $812.50ROD SPINAL L125 MM OD5.5 MM HEXAGONAL END CONTOURE C1713 $1,600.00ROD SPINAL L125 MM STRAIGHT C1713 $812.50ROD SPINAL L150 MM HARD C1713 $1,000.00ROD SPINAL L150 MM OD5.5 MM CONTOUR GRAY C1713 $1,000.00ROD SPINAL L150 MM OD5.5 MM HEXAGONAL END CONTOURE C1713 $1,600.00ROD SPINAL L150 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00ROD SPINAL L20 MM OD6.35 MM STRAIGHT HEXAGONAL END C1713 $812.50ROD SPINAL L200 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00ROD SPINAL L225 MM STRAIGHT C1713 $812.50ROD SPINAL L240 MM STRAIGHT C1713 $812.50ROD SPINAL L30 CM OD6.35 MM HEXAGONAL HEAD CEREBRA C1713 $1,137.50ROD SPINAL L30 MM OD5.5 MM CONTOUR GRAY C1713 $1,000.00ROD SPINAL L30 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L30 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00ROD SPINAL L300 MM OD4.5 MM ULTRA STRENGTH HEXAGON C1713 $1,400.00ROD SPINAL L300 MM OD5.5 MM STRAIGHT GRAY C1713 $1,400.00ROD SPINAL L35 MM OD5.5 MM CONTOUR GRAY C1713 $1,000.00ROD SPINAL L35 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L40 MM OD5.5 MM CONTOUR GRAY C1713 $1,000.00ROD SPINAL L40 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,300.00ROD SPINAL L40 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L40 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00ROD SPINAL L400 MM OD5.5 MM STRAIGHT GRAY C1713 $1,400.00ROD SPINAL L45 MM OD5.5 MM CONTOUR GRAY C1713 $812.50ROD SPINAL L45 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L450 MM OD4.5 MM ULTRA STRENGTH HEXAGON C1713 $1,400.00ROD SPINAL L50 MM OD5.5 MM CLOSED MULTIAXIAL SCREW C1713 $4,800.00ROD SPINAL L50 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,300.00ROD SPINAL L50 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00ROD SPINAL L500 MM OD5.5 MM STRAIGHT GRAY C1713 $1,400.00ROD SPINAL L55 MM OD5.5 MM CONTOUR GRAY C1713 $1,000.00ROD SPINAL L55 MM OD5.5 MM CURVED C1713 $812.50ROD SPINAL L55 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00ROD SPINAL L55 MM OD6.35 MM STRAIGHT C1713 $812.50ROD SPINAL L60 MM OD5.5 MM CLOSED MULTIAXIAL SCREW C1713 $5,200.00

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 ChargeROD SPINAL L60 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00ROD SPINAL L60 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L60 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00ROD SPINAL L600 MM OD4.5 MM ULTRA STRENGTH HEXAGON C1713 $1,400.00ROD SPINAL L65 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00ROD SPINAL L70 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L70 MM OD5.5 MM STRAIGHT GRAY C1713 $1,000.00ROD SPINAL L75 MM OD5.5 MM CONTOUR GRAY C1713 $812.50ROD SPINAL L75 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00ROD SPINAL L75 MM STRAIGHT C1713 $1,300.00ROD SPINAL L80 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00ROD SPINAL L80 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L80 MM OD5.5 MM PRECURVED C1713 $1,000.00ROD SPINAL L85 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00ROD SPINAL L90 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00ROD SPINAL L90 MM OD5.5 MM PRECONTOURED C1713 $812.50ROD SPINAL L95 MM OD5.5 MM HEXAGONAL END CONTOURED C1713 $1,600.00ROD SPINAL LEGACY CD HORIZON L20 IN OD4.5 MM ANTER C1713 $1,600.00ROD SPINAL LEGACY CD HORIZON TITANIUM PREBENT L100 C1713 $812.50ROD SPINAL LEGACY CD HORIZON TITANIUM PREBENT L40 C1713 $812.50ROD SPINAL LEGACY CD HORIZON TITANIUM PREBENT L50 C1713 $812.50ROD SPINAL LEGACY CD HORIZON TITANIUM PREBENT L60 C1713 $812.50ROD SPINAL LEGACY CD HORIZON TITANIUM PRECUT PREBE C1713 $812.50ROD SPINAL LINEUM TITANIUM UNIVERSAL L80 MM OD3.5 C1713 $812.50ROD SPINAL LONGITUDE II CCM PLUS STRAIGHT L500 MM C1713 $1,300.00ROD SPINAL LONGITUDE II COCRMO STRAIGHT L500 MM OD C1713 $1,300.00ROD SPINAL LORDOTIC L30 MM OD3.5 MM C1713 $812.50ROD SPINAL LORDOTIC L70 MM OD3.5 MM C1713 $812.50ROD SPINAL LORDOTIC L80 MM OD3.5 MM C1713 $812.50ROD SPINAL MAGEC OFFSET L70 MM OD4.5 MM ACTUATOR S C1713 $140,000.00ROD SPINAL MAGEC OFFSET L70 MM OD5.5 MM ACTUATOR S C1713 $140,000.00ROD SPINAL MAGEC OFFSET L90 MM OD5.5 MM EXTENSION C1713 $140,000.00ROD SPINAL MAGEC STANDARD L70 MM OD4.5 MM STERILE C1713 $140,000.00ROD SPINAL MAGEC STANDARD L90 MM OD4.5 MM SMALL IN C1713 $140,000.00ROD SPINAL MAGEC STANDARD L90 MM OD5.5 MM SMALL IN C1713 $140,000.00ROD SPINAL MALIBU L50 MM OD5.5 MM PRECONTOUR NONST C1713 $812.50ROD SPINAL MALIBU L55 MM OD5.5 MM PRECONTOUR C1713 $812.50ROD SPINAL MALIBU L65 MM OD5.5 MM PRECONTOUR C1713 $812.50ROD SPINAL MALIBU PRECONTOUR L120 MM OD5.5 MM 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 ChargeROD SPINAL MALIBU PRECONTOUR L75 MM OD5.5 MM C1713 $812.50ROD SPINAL MD-MAX CURVE L35 MM PERCUTANEOUS ULIF C1713 $1,300.00ROD SPINAL MD-MAX CURVE L40 MM UNILATERAL LUMBAR I C1713 $1,300.00ROD SPINAL MD-MAX CURVE L50 MM PERCUTANEOUS ULIF C1713 $1,300.00ROD SPINAL MESA COCR L495 MM OD5.5 MM RAIL TRANSIT C1713 $8,000.00ROD SPINAL MESA CONTOUR L375 MM OD5.5 MM NONSTERIL C1713 $8,000.00ROD SPINAL MESA CONTOUR L495 MM OD5.5 MM NONSTERIL C1713 $8,000.00ROD SPINAL MESA RAIL TITANIUM L495 MM OD5.5 MM TRA C1713 $8,000.00ROD SPINAL MESA SMALL STATURE 2 HEXAGON STRAIGHT L C1713 $1,000.00ROD SPINAL MESA SMALL STATURE CONTOUR L150 MM OD4. C1713 $1,000.00ROD SPINAL MESA SMALL STATURE L500 MM OD4.5 MM TRA C1713 $8,000.00ROD SPINAL MESA XL ADJUSTABLE RAIL CONNECTOR TRANS C1713 $4,000.00ROD SPINAL MOSS MIAMI SI TITANIUM CURVE PREBENT L4 C1713 $1,000.00ROD SPINAL MOSS MIAMI SI TITANIUM CURVE PREBENT L5 C1713 $1,000.00ROD SPINAL MOSS MIAMI SI TITANIUM CURVE PREBENT L6 C1713 $1,000.00ROD SPINAL MOSS MIAMI SI TITANIUM L45 MM OD5.5 MM C1713 $1,000.00ROD SPINAL MOSS MIAMI SI TITANIUM L75 MM OD5.5 MM C1713 $1,000.00ROD SPINAL MOSS MIAMI SI TITANIUM L85 MM OD5.5 MM C1713 $1,000.00ROD SPINAL MOSS MIAMI SI TITANIUM L95 MM OD5.5 MM C1713 $1,000.00ROD SPINAL MOSS MIAMI SI TITANIUM PREBENT L30 MM O C1713 $1,000.00ROD SPINAL MOSS MIAMI SI TITANIUM PREBENT L70 MM O C1713 $1,000.00ROD SPINAL MOSS MIAMI TITANIUM L30 MM OD5.5 MM 1 I C1713 $1,000.00ROD SPINAL MOSS MIAMI TITANIUM L35 MM OD5.5 MM 1 I C1713 $1,000.00ROD SPINAL MOSS MIAMI TITANIUM L40 MM OD5.5 MM 1 I C1713 $1,000.00ROD SPINAL MOSS MIAMI TITANIUM L50 MM OD5.5 MM 1 I C1713 $1,000.00ROD SPINAL MOSS MIAMI TITANIUM L55 MM OD5.5 MM 1 I C1713 $1,000.00ROD SPINAL MOSS MIAMI TITANIUM L60 MM OD5.5 MM 1 I C1713 $1,000.00ROD SPINAL MOSS MIAMI TITANIUM L65 MM OD5.5 MM 1 I C1713 $1,000.00ROD SPINAL MOSS MIAMI TITANIUM L70 MM OD5.5 MM 1 I C1713 $1,000.00ROD SPINAL OD5.5 MM CONNECTOR C1713 $1,625.00ROD SPINAL PASS LP COCR L500 MM OD5.5 MM NONSTERIL C1713 $1,400.00ROD SPINAL PASS LP COCR L500 MM OD6 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP L120 MM OD6 MM NONSTERILE C1713 $812.50ROD SPINAL PASS LP L140 MM OD6 MM NONSTERILE C1713 $812.50ROD SPINAL PASS LP L160 MM OD6 MM NONSTERILE C1713 $812.50ROD SPINAL PASS LP L180 MM OD6 MM NONSTERILE C1713 $812.50ROD SPINAL PASS LP L220 MM OD5.5 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP L220 MM OD6 MM NONSTERILE C1713 $1,137.50ROD SPINAL PASS LP L240 MM OD5.5 MM NONSTERILE C1713 $1,400.00

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 ChargeROD SPINAL PASS LP L260 MM OD5.5 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP L280 MM OD5.5 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP L280 MM OD6 MM NONSTERILE C1713 $1,137.50ROD SPINAL PASS LP L300 MM OD5.5 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP L320 MM OD6 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP L360 MM OD6 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP L500 MM OD5.5 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP L500 MM OD6 MM NONSTERILE C1713 $1,400.00ROD SPINAL PASS LP PREBENT L100 MM OD5.5 MM NONSTE C1713 $1,000.00ROD SPINAL PASS LP PREBENT L100 MM OD6 MM NONSTERI C1713 $812.50ROD SPINAL PASS LP PREBENT L60 MM OD6 MM NONSTERIL C1713 $1,000.00ROD SPINAL PASS LP PREBENT L80 MM OD5.5 MM NONSTER C1713 $812.50ROD SPINAL PASS LP PREBENT L80 MM OD6 MM NONSTERIL C1713 $812.50ROD SPINAL PASS LP PREBENT L90 MM OD6 MM NONSTERIL C1713 $812.50ROD SPINAL PEEK-OPTIMA L80 MM OD6.35 MM PEDICLE C1713 $1,137.50ROD SPINAL POLARIS L45 MM CURVED C1713 $1,000.00ROD SPINAL POLARIS L90 MM C1713 $1,000.00ROD SPINAL POLARIS TITANIUM CURVE L30 MM OD5.5 MM C1713 $1,000.00ROD SPINAL POLARIS TITANIUM HEXAGON L510 MM OD5.5 C1713 $1,400.00ROD SPINAL POLARIS TITANIUM L105 MM C1713 $1,000.00ROD SPINAL POLARIS TITANIUM L110 MM C1713 $1,000.00ROD SPINAL POLARIS TITANIUM L120 MM C1713 $1,000.00ROD SPINAL POLARIS TITANIUM L130 MM C1713 $1,000.00ROD SPINAL POLARIS TITANIUM L35 MM CURVED C1713 $1,000.00ROD SPINAL POLARIS TITANIUM L40 MM OD5.5 MM PRECUR C1713 $2,344.00ROD SPINAL POLARIS TITANIUM L50 MM CURVED C1713 $1,000.00ROD SPINAL POLARIS TITANIUM L55 MM CURVED C1713 $1,000.00ROD SPINAL POLARIS TITANIUM L65 MM CURVED C1713 $1,000.00ROD SPINAL POLARIS TITANIUM L75 MM PRECURVED C1713 $1,000.00ROD SPINAL POLARIS TITANIUM PRECURVE L70 MM OD5.5 C1713 $1,000.00ROD SPINAL PREBENT L50 MM C1713 $812.50ROD SPINAL PREBENT L60 MM OD5.5 MM C1713 $812.50ROD SPINAL PREBENT OD3.5 MM C1713 $1,300.00ROD SPINAL PRECEPT TITANIUM PREBENT L50 MM NONSTER C1713 $1,300.00ROD SPINAL PRECEPT TITANIUM PREBENT L55 MM NONSTER C1713 $1,300.00ROD SPINAL PRECEPT TITANIUM PREBENT L85 MM NONSTER C1713 $1,300.00ROD SPINAL REFORM COCRMO STRAIGHT L300 MM OD5.5 MM C1713 $1,137.50ROD SPINAL REFORM TITANIUM STRAIGHT L100 MM OD5.5 C1713 $812.50ROD SPINAL REFORM TITANIUM STRAIGHT L120 MM OD5.5 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 ChargeROD SPINAL REFORM TITANIUM STRAIGHT L200 MM OD5.5 C1713 $812.50ROD SPINAL REFORM TITANIUM STRAIGHT L400 MM OD5.5 C1713 $812.50ROD SPINAL REFORM TITANIUM STRAIGHT L500 MM OD5.5 C1713 $812.50ROD SPINAL REFORM TITANIUM STRAIGHT L80 MM OD5.5 M C1713 $812.50ROD SPINAL REVERE TITANIUM CURVE L125 MM OD5.5 MM C1713 $812.50ROD SPINAL REVOLVE EXTRA LORDOTIC L100 MM OD5.5 MM C1713 $1,137.50ROD SPINAL REVOLVE L100 MM OD5.5 MM C1713 $2,210.00ROD SPINAL REVOLVE L45 MM OD5.5 MM C1713 $1,137.50ROD SPINAL REVOLVE L55 MM OD5.5 MM C1713 $1,137.50ROD SPINAL REVOLVE L90 MM OD5.5 MM C1713 $2,210.00ROD SPINAL SAVANNAH-T TITANIUM ALUMINUM VANADIUM C C1713 $812.50ROD SPINAL SEXTANT CD HORIZON TITANIUM PREBENT L35 C1713 $1,300.00ROD SPINAL SEXTANT CD HORIZON TITANIUM STANDARD PR C1713 $1,300.00ROD SPINAL SIERRA TITANIUM L300 MM OD3.5 MM PRECON C1713 $1,137.50ROD SPINAL SILVERTON TITANIUM CURVE L45 MM OD5.5 M C1713 $812.50ROD SPINAL SILVERTON TITANIUM CURVE L85 MM OD5.5 M C1713 $812.50ROD SPINAL SOLERA CD HORIZON COCRMO CURVE L90 MM O C1713 $4,095.00ROD SPINAL SOLERA CD HORIZON COCRMO STRAIGHT L500 C1713 $1,137.50ROD SPINAL SPINE FIBER OPTIC CORD STABILIZATION C1713 $2,717.00ROD SPINAL STAINLESS STEEL L200 MM OD5 MM HARD NON C1713 $1,400.00ROD SPINAL STAINLESS STEEL L300 MM OD3.5 MM C1713 $1,600.00ROD SPINAL STAINLESS STEEL L300 MM OD5 MM HARD NON C1713 $1,400.00ROD SPINAL STAINLESS STEEL L400 MM OD5 MM HARD NON C1713 $1,400.00ROD SPINAL STAINLESS STEEL L500 MM OD3.5 MM C1713 $1,400.00ROD SPINAL STAINLESS STEEL L500 MM OD5 MM HARD NON C1713 $1,400.00ROD SPINAL STAINLESS STEEL L510 MM OD5.5 MM HEXAGO C1713 $1,400.00ROD SPINAL STAINLESS STEEL MEDIUM L510 MM OD5.5 MM C1713 $1,400.00ROD SPINAL STAINLESS STEEL STRAIGHT L400 MM L65 MM C1713 $1,400.00ROD SPINAL STRAIGHT L400 MM OD5.5 MM PRECUT C1713 $1,137.50ROD SPINAL STRAIGHT L80 MM OD5.5 MM CONTOUR GRAY C1713 $1,000.00ROD SPINAL SYNAPSE TITANIUM CURVE PREBENT L50 MM O C1713 $1,000.00ROD SPINAL TIGER 100 D OD3.5 MM OCCIPITAL NONSTERI C1713 $1,300.00ROD SPINAL TIGER PREBENT L40 MM OD5.5 MM LINE NONS C1713 $812.50ROD SPINAL TIGER PREBENT L40 MM OD5.5 MM NONSTERIL C1713 $1,300.00ROD SPINAL TIGER PREBENT L45 MM OD5.5 MM LINE NONS C1713 $812.50ROD SPINAL TIGER PREBENT L45 MM OD5.5 MM NONSTERIL C1713 $1,300.00ROD SPINAL TIGER PREBENT L50 MM OD5.5 MM LINE NONS C1713 $812.50ROD SPINAL TIGER PREBENT L55 MM OD5.5 MM LINE NONS C1713 $812.50ROD SPINAL TIGER PREBENT L65 MM OD5.5 MM LINE NONS 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 ChargeROD SPINAL TIGER PREBENT L75 MM OD5.5 MM LINE NONS C1713 $812.50ROD SPINAL TIGER PREBENT L85 MM OD5.5 MM LINE NONS C1713 $812.50ROD SPINAL TIGER PREBENT L95 MM OD5.5 MM LINE NONS C1713 $812.50ROD SPINAL TIGER STRAIGHT L120 MM OD3.5 MM LINE NO C1713 $812.50ROD SPINAL TIGER STRAIGHT L150 MM OD5.5 MM LINE NO C1713 $812.50ROD SPINAL TIGER STRAIGHT L200 MM OD5.5 MM LINE NO C1713 $812.50ROD SPINAL TIGER STRAIGHT L240 MM OD3.5 MM LINE NO C1713 $1,137.50ROD SPINAL TIGER STRAIGHT L40 MM OD3.5 MM LINE NON C1713 $812.50ROD SPINAL TIGER STRAIGHT L40 MM OD3.5 MM NONSTERI C1713 $812.50ROD SPINAL TIGER STRAIGHT L450 MM OD5.5 MM LINE NO C1713 $1,137.50ROD SPINAL TIGER STRAIGHT L80 MM OD3.5 MM LINE NON C1713 $812.50ROD SPINAL TITANIUM 2 HEXAGON STRAIGHT L150 MM OD4 C1713 $1,000.00ROD SPINAL TITANIUM 2 HEXAGON STRAIGHT L300 MM OD4 C1713 $1,400.00ROD SPINAL TITANIUM 2 HEXAGON STRAIGHT L400 MM OD6 C1713 $1,400.00ROD SPINAL TITANIUM 2 HEXAGON STRAIGHT L500 MM OD4 C1713 $1,400.00ROD SPINAL TITANIUM ALLOY L500 MM HEXAGONAL END C1713 $1,400.00ROD SPINAL TITANIUM CONTOUR L100 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L110 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L125 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L30 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L35 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L40 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L45 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L50 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L55 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L60 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L65 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L70 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L75 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L80 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L85 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L90 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CONTOUR L95 MM OD4.5 MM C1713 $1,000.00ROD SPINAL TITANIUM CURVE L100 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM CURVE L40 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM CURVE L50 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM CURVE L60 MM OD4 MM NONSTERILE C1713 $1,000.00ROD SPINAL TITANIUM CURVE L90 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM L100 MM CURVED C1713 $1,000.00

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 ChargeROD SPINAL TITANIUM L140 MM OD6.35 MM STRAIGHT C1713 $812.50ROD SPINAL TITANIUM L150 MM STRAIGHT DEFORMITY HEX C1713 $1,000.00ROD SPINAL TITANIUM L200 MM OD6 MM HARD NONSTERILE C1713 $1,000.00ROD SPINAL TITANIUM L200 MM STRAIGHT DEFORMITY HEX C1713 $1,000.00ROD SPINAL TITANIUM L250 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM L30 MM CURVED C1713 $812.50ROD SPINAL TITANIUM L300 MM OD3.5 MM C1713 $1,600.00ROD SPINAL TITANIUM L300 MM OD4.5 MM ODSEC3.5 MM T C1713 $2,400.00ROD SPINAL TITANIUM L300 MM STRAIGHT DEFORMITY HEX C1713 $1,400.00ROD SPINAL TITANIUM L500 MM OD4.5 MM ODSEC3.5 MM T C1713 $2,400.00ROD SPINAL TITANIUM L500 MM OD5.5 MM ODSEC4.5 MM T C1713 $2,400.00ROD SPINAL TITANIUM L500 MM OD5.5 MM STRAIGHT HEXA C1713 $1,400.00ROD SPINAL TITANIUM L500 MM OD6 MM HEXAGONAL END H C1713 $1,400.00ROD SPINAL TITANIUM L510 MM OD5.5 MM HEXAGON CP C1713 $1,400.00ROD SPINAL TITANIUM L60 MM CURVED C1713 $1,000.00ROD SPINAL TITANIUM L600 MM OD5.5 MM STRAIGHT HEXA C1713 $1,400.00ROD SPINAL TITANIUM L600 MM OD5.5 MM STRAIGHT ROTA C1713 $1,400.00ROD SPINAL TITANIUM L65 MM CURVED C1713 $812.50ROD SPINAL TITANIUM L70 MM CURVED C1713 $812.50ROD SPINAL TITANIUM L75 MM CURVED C1713 $812.50ROD SPINAL TITANIUM L80 MM OD3.5 MM PRECONTOURED C1713 $812.50ROD SPINAL TITANIUM L80 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM L80 MM OD5.5 MM PRECUT C1713 $812.50ROD SPINAL TITANIUM L90 MM OD5.5 MM CONTOUR C1713 $812.50ROD SPINAL TITANIUM L95 MM OD5.5 MM CONTOUR C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L100 MM OD5.5 MM NONS C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L110 MM OD5.5 MM NONS C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L120 MM OD5.5 MM NONS C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L35 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L40 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L45 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L50 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L500 MM OD3.5 MM C1713 $1,600.00ROD SPINAL TITANIUM LORDOTIC L55 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L60 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L65 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L70 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L75 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM LORDOTIC L80 MM OD5.5 MM NONST 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 ChargeROD SPINAL TITANIUM LORDOTIC L90 MM OD5.5 MM NONST C1713 $812.50ROD SPINAL TITANIUM PREBENT L110 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM PREBENT L50 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM PREBENT L55 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM PREBENT L60 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM PREBENT L65 MM OD5.5 MM C1713 $812.50ROD SPINAL TITANIUM PRECURVE L100 MM OD3.2 MM OCCI C1713 $2,000.00ROD SPINAL TITANIUM STRAIGHT 2 HEXAGON L150 MM OD5 C1713 $1,000.00ROD SPINAL TITANIUM STRAIGHT 2 HEXAGON L200 MM OD5 C1713 $1,000.00ROD SPINAL TITANIUM STRAIGHT 2 HEXAGON L300 MM OD5 C1713 $1,400.00ROD SPINAL TITANIUM STRAIGHT HEXAGON L500 MM OD5.5 C1713 $1,400.00ROD SPINAL TITANIUM STRAIGHT L400 MM L65 MM OD6 MM C1713 $1,400.00ROD SPINAL TITANIUM STRAIGHT L500 MM OD4.75 MM NON C1713 $1,600.00ROD SPINAL UNID COCR L120+ MM OD6 MM C1713 $12,000.00ROD SPINAL UNID PASS TITANIUM 04 OD6 MM NONSTERILE C1713 $9,750.00ROD SPINAL UNID PASS TITANIUM 08 OD6 MM NONSTERILE C1713 $9,750.00ROD SPINAL UNID TITANIUM L120+ MM OD5.5 MM C1713 $9,750.00ROD SPINAL UNID TITANIUM L120+ MM OD6 MM C1713 $9,750.00ROD SPINAL UNIVERSAL INSERTION TEMPLATE C1713 $253.50ROD SPINAL USS TITANIUM L300 MM OD6 MM HARD NONSTE C1713 $1,400.00ROD SPINAL USS TITANIUM L400 MM OD6 MM HARD NONSTE C1713 $1,400.00ROD SPINAL USS TITANIUM L500 MM OD6 MM HARD NONSTE C1713 $1,400.00ROD SPINAL VAIL TITANIUM STRAIGHT L500 MM OD3.5-5. C1713 $1,950.00ROD SPINAL VEPTR II TITANIUM 45 D L400 MM OD6 MM L C1713 $3,443.20ROD SPINAL VEPTR II TITANIUM 45 D L400 MM OD6 MM R C1713 $3,443.20ROD SPINAL VERTEX L240 MM OD3.5 MM STERILE C1713 $1,137.50ROD SPINAL VERTEX MAX TITANIUM L360 MM OD4.5 MM TH C1713 $1,600.00ROD SPINAL VERTEX MAX TITANIUM L360 MM OD5.5 MM OC C1713 $1,400.00ROD SPINAL VERTEX MAX TITANIUM PRECURVE L100 MM OD C1713 $2,000.00ROD SPINAL VERTEX MAX TITANIUM SHORT L240 MM OD3.2 C1713 $1,600.00ROD SPINAL VIPER 2 COCR STRAIGHT L120 MM MIS C1713 $1,600.00ROD SPINAL VIPER 2 COCR STRAIGHT L300 MM MIS C1713 $1,600.00ROD SPINAL VIPER 2 COCR STRAIGHT L600 MM MIS C1713 $1,600.00ROD SPINAL VIRAGE TITANIUM CURVE L100 MM OD3.5 MM C1713 $812.50ROD SPINAL VIRAGE TITANIUM CURVE L50 MM OD3.5 MM N C1713 $812.50ROD SPINAL VIRAGE TITANIUM CURVE L70 MM OD3.5 MM N C1713 $812.50ROD SPINAL VIRAGE TITANIUM CURVE L80 MM OD3.5 MM B C1713 $812.50ROD SPINAL VIRAGE TITANIUM CURVE L90 MM OD3.5 MM O C1713 $812.50ROD SPINAL VIRAGE TITANIUM STRAIGHT L30 MM OD3.5 M 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 ChargeROD SPINAL VITALITY CURVE L65 MM OD5.5 MM THORACOL C1713 $812.50ROD SPINAL VITALITY TITANIUM CURVE L100 MM OD5.5 M C1713 $812.50ROD SPINAL VITALITY TITANIUM CURVE L105 MM OD5.5 M C1713 $812.50ROD SPINAL VUEPOINT II L60 MM OD3.5 MM NONSTERILE C1713 $812.50ROD SPINAL XIA STAINLESS STEEL STANDARD L480 MM OD C1713 $1,400.00ROD SPINAL XIA TITANIUM L200 MM OD4.5 MM NONSTERIL C1713 $1,000.00ROD SPINAL XIA TITANIUM LONG L480 MM OD4.5 MM 1.2 C1713 $1,400.00ROD SPINAL XIA VITALLIUM L600 MM OD4.5 MM C1713 $1,400.00ROD SPINAL YUKON CONTOUR L75 MM OD3.5 MM NONSTERIL C1713 $812.50ROD SPINAL YUKON CONTOUR L75 MM OD3.5 MM OCCIPITOC C1713 $812.50ROOM & BOARD INTENSIVE CARE UNIT $5,217.00ROOM & BOARD INTENSIVE CARE UNIT BURN CARE $5,085.00ROOM & BOARD INTENSIVE CARE UNIT SURGICAL $5,217.00ROOM & BOARD MED/SURG GENERAL PRIVATE $1,916.00ROOM & BOARD PSYCHIATRIC PRIVATE $2,129.00ROOM & BOARD PSYCHIATRIC SEMI PRIVATE $2,129.00ROOM & BOARD TELEMETRY $3,088.00ROPIVACAINE (PF) IN 0.9 % NACL 0.2 % 400 ML ELPH 1 J2795 $1,237.50ROTAVIRUS VACCINE LIVE 2 ML SOLN 2 ML TUBE 90680 $332.91ROUTER SURGICAL FLUTE L12.8 MM OD1.4 MM NONSTERILE $608.40ROUTER SURGICAL SPIRAL L16 MM OD2.3 MM BLUE RED $717.60ROUTER SURGICAL TAPER L10 MM OD1.5 MM LATEX FREE $811.72ROUTER SURGICAL TAPER OD2.3 MM BLUE RED $717.60ROUTINE EKG USING AT LEAST 12 LEADS INCLUDING INTE 93000 $458.00ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING 93005 $129.00RPR, BLOOD QUANT 86593 $34.00RT CALCIUM IONIZED 82330 $133.00RUBBER BANDING OF LARGE BOWEL USING AN ENDOSCOPE 45350 $3,746.00RUBELLA ANTIBODY, IGG 86762 $112.00RUBEOLA ANTIBODY, IGG 86765 $100.00RUSSELL VIPER VENOM DILUTED 85613 $68.00SALICYLIC ACID 20 % SOLN 60 ML BOTTLE $137.60SALICYLIC ACID 30 % SOLN 60 ML BOTTLE $157.40SCALPEL SURGICAL L.063 IN KIT PERFECT MIS $1,024.40SCISSORS LAPAROSCOPIC ENDO SCIZ STAINLESS STEEL L3 $359.91SCISSORS LAPAROSCOPIC HOT SHEARS DA VINCI S/SI END $1,600.00SCRAPING OF CORNEA FOR DIAGNOSIS 65430 $331.00SCRAPING OF SKIN 15783 $773.00SCRAPING OF SKIN OF FACE 15780 $6,128.00

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 ChargeSCRAPING OF THE CERVIX USING AN ENDOSCOPE 57456 $863.00SCRAPING OF TISSUE OF CERVIX 57505 $1,838.00SCREENING ABDOMINAL AORTA WITH IMAGE DOCUMENTATION 76706 $458.00SCREENING CT SCAN OF LARGE BOWEL 74263 $435.00SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS 77063 $278.00SCREENING TEST FOR COMPATIBLE BLOOD UNIT 86902 $36.00SCREENING TEST FOR COMPATIBLE BLOOD UNIT 86904 $68.00SCREENING TEST FOR MONONUCLEOSIS (MONO) 86308 $40.00SCREENING TEST FOR PATHOGENIC ORGANISMS 87081 $51.00SCREENING TEST FOR PRESENCE OF ANTIBODY 86403 $79.00SCREENING TEST FOR RED BLOOD CELL ANTIBODIES 86850 $86.00SCREW ACETABULAR TRIDENT TITANIUM HEMISPHERE L25 M C1713 $162.50SCREW ACETABULAR TRIDENT TITANIUM HEMISPHERE L30 M C1713 $162.50SCREW ACETABULAR TRILOGY L20 MM OD6.5 MM HIP SELF C1713 $162.50SCREW ACETABULAR TRILOGY L25 MM OD6.5 MM HIP SELF C1713 $162.50SCREW BONE 3.5 MM L38 MM OD5 MM HIP CORTICAL HEX D C1713 $939.12SCREW BONE 4 MM L100 MM L30 MM CORTICAL SELF DRILL C1713 $916.48SCREW BONE 4 MM L120 MM L40 MM CORTICAL SELF DRILL C1713 $916.48SCREW BONE 4 MM L90 MM L30 MM OD3 MM OD2.5 MM CORT C1713 $957.44SCREW BONE 4 MM TAPER L70 MM L20 MM OD3 MM ODSEC2. C1713 $957.44SCREW BONE 4 MM TAPER L80 MM L20 MM OD3 MM ODSEC2. C1713 $957.44SCREW BONE 4 MM TAPER L80 MM L35 MM OD3 MM ODSEC2. C1713 $957.44SCREW BONE 4 MM TAPER L90 MM L40 MM OD3 MM OD2.5 M C1713 $957.44SCREW BONE 4 MM TAPER L90 MM L40 MM OD3 MM ODSEC2. C1713 $957.44SCREW BONE 4.5 MM FULL THREAD L80 MM OD7 MM CANNUL C1713 $2,216.56SCREW BONE 6 MM L100 MM L30 MM OD6/5 MM CORTICAL T C1713 $957.44SCREW BONE 6 MM L100 MM L40 MM OD6/5 MM CORTICAL T C1713 $957.44SCREW BONE 6 MM L150 MM L50 MM OD3.8 MM CORTICAL S C1713 $872.00SCREW BONE 6 MM L150 MM L50 MM OD4.8 MM CORTICAL S C1713 $916.48SCREW BONE 6 MM L180 MM L60 MM CORTICAL SELF DRILL C1713 $916.48SCREW BONE 6 MM L90 MM L30 MM OD6/5 MM CORTICAL TA C1713 $957.44SCREW BONE 6 MM SHANK L100 MM L30 MM OD6 MM OD5 MM C1713 $957.44SCREW BONE 6 MM SHANK L140 MM L90 MM OD6 MM OD5 MM C1713 $957.44SCREW BONE 6 MM SHANK L160 MM L40 MM OD6/5 MM CORT C1713 $957.44SCREW BONE 6 MM SHANK L180 MM L30 MM OD6 MM OD5 MM C1713 $957.44SCREW BONE 6 MM SHANK L220 MM L30 MM OD6 MM OD5 MM C1713 $957.44SCREW BONE 6 MM SHANK L220 MM L40 MM OD6 MM OD5 MM C1713 $957.44SCREW BONE 6 MM SHANK L220 MM L60 MM OD6 MM ODSEC5 C1713 $957.44SCREW BONE 6 MM SHANK L250 MM L100 MM OD6 MM ODSEC C1713 $957.44

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 ChargeSCREW BONE 6 MM SHANK L250 MM L30 MM OD6 MM ODSEC5 C1713 $957.44SCREW BONE 6 MM SHANK L250 MM L40 MM OD6/5 MM CORT C1713 $957.44SCREW BONE 6 MM SHANK L250 MM L50 MM OD6 MM ODSEC5 C1713 $957.44SCREW BONE 6 MM SHANK L250 MM L60 MM OD6 MM ODSEC5 C1713 $957.44SCREW BONE 6 MM SHANK L300 MM L60 MM OD6 MM OD5 MM C1713 $957.44SCREW BONE 6 MM SHANK L900 MM L40 MM OD6 MM OD5 MM C1713 $957.44SCREW BONE 6 MM TAPER L150 MM L40 MM OD6/5 MM CORT C1713 $957.44SCREW BONE 6 MM TAPER L150 MM L50 MM OD6/5 MM CORT C1713 $957.44SCREW BONE ACCESS TAPER L220 MM L60 MM OD6-5 MM PE C1713 $957.44SCREW BONE ACCUFIT TITANIUM L40 MM OD5.5 MM SPINE C1713 $1,300.00SCREW BONE ACCUFIT TITANIUM L45 MM OD5.5 MM SPINE C1713 $1,300.00SCREW BONE ACUMED L30 MM OD2.7 MM NONLOCK HEXALOBE C1713 $422.50SCREW BONE ACUTRAK 2 TITANIUM 3 MM FULL THREAD L50 C1713 $2,619.50SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD FLUTE L4 C1713 $2,652.00SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L45 MM O C1713 $2,574.00SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM O C1713 $2,574.00SCREW BONE ACUTRAK 2 TITANIUM MICRO FULL THREAD L1 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MICRO FULL THREAD L2 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MICRO FULL THREAD L3 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MICRO FULL THREAD L8 C1713 $2,880.00SCREW BONE ACUTRAK 2 TITANIUM MICRO FULL THREAD L9 C1713 $2,880.00SCREW BONE ACUTRAK 2 TITANIUM MINI FULL THREAD L16 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MINI FULL THREAD L18 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MINI FULL THREAD L20 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MINI FULL THREAD L22 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MINI FULL THREAD L24 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MINI FULL THREAD L26 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MINI FULL THREAD L28 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM MINI FULL THREAD L30 C1713 $2,340.00SCREW BONE ACUTRAK 2 TITANIUM STANDARD FULL THREAD C1713 $2,340.00SCREW BONE ACUTRAK TITANIUM FULL THREAD L25 MM OD4 C1713 $2,360.00SCREW BONE ACUTRAK TITANIUM FULL THREAD L30 MM OD4 C1713 $2,360.00SCREW BONE ACUTRAK TITANIUM FULL THREAD L35 MM OD4 C1713 $2,360.00SCREW BONE ACUTRAK TITANIUM FULL THREAD L40 MM OD4 C1713 $2,360.00SCREW BONE ACUTRAK TITANIUM FULL THREAD L45 MM OD4 C1713 $2,360.00SCREW BONE ACUTRAK TITANIUM FULL THREAD L50 MM OD4 C1713 $2,360.00SCREW BONE AFFIXUS 3.5 MM HEXAGON L34 MM OD5 MM HI C1713 $939.12SCREW BONE AFFIXUS 3.5 MM L32 MM OD5 MM HIP FEMUR C1713 $939.12SCREW BONE AFFIXUS 3.5 MM L36 MM OD5 MM HIP CORTIC C1713 $939.12

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 ChargeSCREW BONE AFFIXUS 3.5 MM L40 MM OD5 MM HIP CORTIC C1713 $939.12SCREW BONE AFFIXUS 3.5 MM L42 MM OD5 MM HIP CORTIC C1713 $939.12SCREW BONE AFFIXUS 3.5 MM L46 MM OD5 MM HIP CORTIC C1713 $939.12SCREW BONE AFFIXUS 3.5 MM L48 MM OD5 MM HIP CORTIC C1713 $939.12SCREW BONE AFFIXUS 3.5 MM L56 MM OD5 MM HIP FEMUR C1713 $939.12SCREW BONE AFFIXUS 3.6 MM HEXAGON L80 MM OD5 MM OD C1713 $1,313.52SCREW BONE AFFIXUS 3.6 MM L70 MM OD5 MM ID3 MM HIP C1713 $1,313.52SCREW BONE AFFIXUS 3.6 MM L70 MM OD5 MM ODSEC3 MM C1713 $1,313.52SCREW BONE AFFIXUS 3.6 MM L75 MM HIP FEMUR CORTICA C1713 $1,313.52SCREW BONE AFFIXUS 6.5 MM L100 MM OD10.5 MM HIP LA C1713 $3,272.88SCREW BONE AFFIXUS 6.5 MM L110 MM OD10.5 MM HIP LA C1713 $3,211.65SCREW BONE AFFIXUS 6.5 MM L120 MM OD10.5 MM HIP LA C1713 $3,272.88SCREW BONE AFFIXUS 6.5 MM L80 MM OD10.5 MM HIP FEM C1713 $3,272.88SCREW BONE AFFIXUS 6.5 MM L80 MM OD10.5 MM HIP LAG C1713 $3,272.88SCREW BONE AFFIXUS 6.5 MM L85 MM OD10.5 MM HIP LAG C1713 $3,272.88SCREW BONE AFFIXUS 6.5 MM L95 MM OD10.5 MM HIP LAG C1713 $3,264.30SCREW BONE AFFIXUS L50 MM OD5 MM ODSEC3.5 MM HIP F C1713 $939.12SCREW BONE AIM ART TK2 VERSANAIL TIMAX FULL THREAD C1713 $209.56SCREW BONE AIM TIMAX L90 MM L23 MM OD6.5 MM FEMUR C1713 $1,659.84SCREW BONE AIRVANCE SPINE C1713 $11,700.00SCREW BONE AIRVANCE SPINE $11,700.00SCREW BONE ALPS PARTIAL THREAD L18 MM OD4 MM TIBIA C1713 $256.88SCREW BONE ALPS PARTIAL THREAD L35 MM OD4 MM TIBIA C1713 $256.88SCREW BONE ALPS T15 L40 MM OD3.5 MM TIBIA CORTICAL C1713 $679.38SCREW BONE ALPS T15 L54 MM OD3.5 MM TIBIA CORTICAL C1713 $679.38SCREW BONE ALPS TIMAX FULL THREAD L12 MM OD4 MM FI C1713 $256.88SCREW BONE ALPS TIMAX FULL THREAD L16 MM OD4 MM FI C1713 $256.88SCREW BONE ALPS TIMAX FULL THREAD L18 MM OD4 MM FI C1713 $241.80SCREW BONE ALPS TIMAX FULL THREAD L20 MM OD4 MM FI C1713 $241.80SCREW BONE ALPS TIMAX FULL THREAD L24 MM OD3.5 MM C1713 $175.50SCREW BONE ALPS TIMAX FULL THREAD L34 MM OD3.5 MM C1713 $256.88SCREW BONE ALPS TIMAX L65 MM OD3.5 MM CORTICAL NON C1713 $256.88SCREW BONE ALTEON L25 MM OD6.5 MM ACETABULAR CANCE C1713 $162.50SCREW BONE AMBI CHS IMHS PARTIAL THREAD L90 MM L21 C1713 $1,681.20SCREW BONE AMBI CHS STAINLESS STEEL L105 MM L21 MM C1713 $1,681.20SCREW BONE AMBI CLASSIC IMHS STANDARD L120 MM L21 C1713 $1,681.20SCREW BONE AMBI CLASSIC IMHS STANDARD L125 MM L21 C1713 $1,681.20SCREW BONE AMBI CLASSIC L65 MM L21 MM OD9/16 IN OD C1713 $1,796.16SCREW BONE AMBI CLASSIC STAINLESS STEEL L36 MM OD4 C1713 $126.88

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 ChargeSCREW BONE AMBI CLASSIC STAINLESS STEEL L38 MM OD4 C1713 $126.88SCREW BONE AMBI CLASSIC STAINLESS STEEL L42 MM OD4 C1713 $126.88SCREW BONE AMBI CLASSIC STAINLESS STEEL STANDARD L C1713 $1,681.20SCREW BONE AMBI IMHS CLASSIC CHS STAINLESS STEEL S C1713 $1,681.20SCREW BONE AMBI IMHS CLASSIC STAINLESS STEEL STAND C1713 $1,681.20SCREW BONE ANCHORAGE T8 L28 MM OD3.6 MM LAG CROSS C1713 $1,533.35SCREW BONE ANODYNE L12 MM OD4 MM SPINE CERVICAL SE C1713 $487.50SCREW BONE ANODYNE L12 MM OD4.5 MM SPINE CERVICAL C1713 $487.50SCREW BONE ANODYNE L14 MM OD4 MM SPINE CERVICAL SE C1713 $487.50SCREW BONE ANODYNE L14 MM OD4.5 MM SPINE CERVICAL C1713 $487.50SCREW BONE ANODYNE L16 MM OD4 MM SPINE CERVICAL SE C1713 $487.50SCREW BONE ANODYNE L16 MM OD4.5 MM SPINE CERVICAL C1713 $487.50SCREW BONE ANODYNE L18 MM OD4 MM SPINE CERVICAL SE C1713 $487.50SCREW BONE ANODYNE L20 MM OD4 MM SPINE CERVICAL SE C1713 $487.50SCREW BONE APTUS TITANIUM 7 L18 MM OD2.5 MM WRIST C1713 $341.64SCREW BONE APTUS TRILOCK TITANIUM 7 L14 MM OD2.5 M C1713 $587.47SCREW BONE APTUS TRILOCK TITANIUM 7 L16 MM OD2.5 M C1713 $587.47SCREW BONE APTUS TRILOCK TITANIUM 7 L18 MM OD2.5 M C1713 $587.47SCREW BONE APTUS TRILOCK TITANIUM 7 L20 MM OD2.5 M C1713 $537.49SCREW BONE APTUS TRILOCK TITANIUM 7 L22 MM OD2.5 M C1713 $537.49SCREW BONE APTUS TRILOCK TITANIUM 7 L28 MM OD2.5 M C1713 $587.47SCREW BONE APTUS TRILOCK TITANIUM 7 L30 MM OD2.5 M C1713 $587.47SCREW BONE ARMADA L30 MM OD5 MM SPINE POLYAXIAL NO C1713 $3,900.00SCREW BONE ARMADA L30 MM OD6.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE ARMADA L35 MM OD7.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE ARMADA L45 MM OD4.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE ARMADA TITANIUM L45 MM OD7.5 MM SPINE P C1713 $3,900.00SCREW BONE ARMADA TITANIUM L50 MM OD7.5 MM SPINE P C1713 $3,900.00SCREW BONE ARMADA TITANIUM L50 MM OD8.5 MM SPINE P C1713 $3,900.00SCREW BONE ARMADA TITANIUM L55 MM OD7.5 MM SPINE P C1713 $3,900.00SCREW BONE ART TK2 TIMAX FULL THREAD L24 MM OD4.5 C1713 $209.56SCREW BONE ASLS TITANIUM NIOBIUM ALUMINUM T25 FULL C1713 $1,174.49SCREW BONE ASLS TITANIUM T25 FULL THREAD L48 MM OD C1713 $1,174.49SCREW BONE ASNIS III STAINLESS STEEL FULL THREAD L C1713 $1,470.95SCREW BONE ASNIS III STAINLESS STEEL L75 MM L20 MM C1713 $1,470.95SCREW BONE ASNIS III STAINLESS STEEL L85 MM L20 MM C1713 $1,470.95SCREW BONE ASNIS III STAINLESS STEEL L90 MM L20 MM C1713 $1,470.95SCREW BONE ASNIS III STAINLESS STEEL L95 MM L20 MM C1713 $1,470.95SCREW BONE ASNIS III STAINLESS STEEL THREAD L100 M C1713 $1,470.95

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 ChargeSCREW BONE ASNIS III TITANIUM 1/3 THREAD REVERSE C C1713 $910.00SCREW BONE ASNIS III TITANIUM FULL THREAD L85 MM L C1713 $1,448.05SCREW BONE ASNIS III TITANIUM FULL THREAD L95 MM L C1713 $1,448.07SCREW BONE ASNIS III TITANIUM L100 MM L20 MM OD6.5 C1713 $1,448.07SCREW BONE ASNIS III TITANIUM L110 MM L20 MM OD6.5 C1713 $723.06SCREW BONE ASNIS III TITANIUM L65 MM OD5 MM CANNUL C1713 $975.00SCREW BONE ASNIS III TITANIUM L65 MM OD6.5 MM FULL C1713 $1,474.20SCREW BONE ASNIS III TITANIUM L70 MM OD5 MM CANNUL C1713 $975.00SCREW BONE ASNIS III TITANIUM L70 MM OD6.5 MM ORTH C1713 $1,474.20SCREW BONE ASNIS III TITANIUM PARTIAL THREAD L75 M C1713 $1,448.07SCREW BONE ASNIS III TITANIUM PARTIAL THREAD L90 M C1713 $1,461.72SCREW BONE ASNIS III TITANIUM PARTIAL THREAD REVER C1713 $1,448.07SCREW BONE ASNIS PARTIAL THREAD MICRO L11 MM L5 MM C1713 $1,204.32SCREW BONE ASNIS STAINLESS STEEL L105 MM L20 MM OD C1713 $1,470.95SCREW BONE ASNIS STAINLESS STEEL L110 MM L20 MM OD C1713 $1,470.95SCREW BONE ASNIS STAINLESS STEEL L115 MM L20 MM OD C1713 $1,470.95SCREW BONE ASNIS STAINLESS STEEL L80 MM L20 MM OD6 C1713 $1,470.95SCREW BONE ASNIS STAINLESS STEEL PARTIAL THREAD L7 C1713 $1,470.95SCREW BONE ASNIS TITANIUM MICRO L11 MM L4 MM OD3 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L12 MM L4 MM OD3 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L13 MM L4 MM OD3 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L15 MM L4 MM OD3 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L15 MM L6 MM OD2 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L16 MM L4 MM OD3 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L17 MM L4 MM OD3 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L20 MM L5 MM OD3 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L22 MM L5 MM OD2 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L24 MM L6 MM OD3 M C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO L8 MM L4 MM OD2 MM C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L10 C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L12 C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L14 C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L16 C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L18 C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L20 C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L38 C1713 $1,204.32SCREW BONE ASNIS TITANIUM MICRO REVERSE CUT FLUTE C1713 $1,204.32SCREW BONE ASSURE L18 MM OD4 MM SPINE SELF TAPPING C1713 $390.00SCREW BONE ASSURE TITANIUM L10 MM OD4 MM SPINE CER C1713 $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 ChargeSCREW BONE ASSURE TITANIUM L10 MM OD4.5 MM SPINE C C1713 $390.00SCREW BONE ASSURE TITANIUM L12 MM OD4 MM SPINE CER C1713 $390.00SCREW BONE ASSURE TITANIUM L12 MM OD4.5 MM SPINE C C1713 $390.00SCREW BONE ASSURE TITANIUM L14 MM OD4 MM SPINE CER C1713 $390.00SCREW BONE ASSURE TITANIUM L14 MM OD4.5 MM SPINE C C1713 $390.00SCREW BONE ASSURE TITANIUM L16 MM OD4 MM SPINE CER C1713 $390.00SCREW BONE ASSURE TITANIUM L16 MM OD4.5 MM SPINE C C1713 $390.00SCREW BONE ASSURE TITANIUM L18 MM OD4.5 MM SPINE S C1713 $390.00SCREW BONE ASSURE TITANIUM L20 MM OD4 MM SPINE CER C1713 $390.00SCREW BONE ASSURE TITANIUM L20 MM OD4.5 MM SPINE C C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L10 MM OD4 MM C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L10 MM OD4.5 M C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L12 MM OD4 MM C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L12 MM OD4.5 M C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L14 MM OD4.5 M C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L16 MM OD4 MM C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L16 MM OD4.5 M C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L18 MM OD4 MM C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L18 MM OD4.5 M C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L20 MM OD4 MM C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L20 MM OD4.5 M C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L6 MM OD4.5 MM C1713 $390.00SCREW BONE ASSURE TITANIUM STANDARD L8 MM OD4.5 MM C1713 $390.00SCREW BONE ATLANTIS TITANIUM L13 MM OD4 MM SPINE C C1713 $600.00SCREW BONE ATLANTIS TITANIUM L14 MM OD4 MM SPINE C C1713 $600.00SCREW BONE ATLANTIS TITANIUM L15 MM OD4.5 MM SPINE C1713 $600.00SCREW BONE ATN TIMAX L100 MM OD10.5 MM TROCHANTERI C1713 $3,773.60SCREW BONE ATOLL L10 MM OD4 MM SPINE OCCIPITAL SEL C1713 $812.50SCREW BONE AUTOFIX STAINLESS STEEL L25 MM OD2 MM F C1713 $1,750.32SCREW BONE AUTOFIX STAINLESS STEEL L28 MM OD2 MM F C1713 $1,750.32SCREW BONE AUTOFIX STAINLESS STEEL T7 L18 MM OD2 M C1713 $1,750.32SCREW BONE AUTOFIX STAINLESS STEEL T7 L20 MM OD2 M C1713 $1,750.32SCREW BONE AUTOFIX STAINLESS STEEL T7 L22 MM OD2.5 C1713 $1,750.32SCREW BONE AUTOFIX STAINLESS STEEL T7 L25 MM OD2.5 C1713 $1,750.32SCREW BONE AUTOFIX STAINLESS STEEL T7 L28 MM OD2.5 C1713 $1,750.32SCREW BONE AUTOFIX STAINLESS STEEL T7 L30 MM OD2.5 C1713 $1,750.32SCREW BONE AVATAR L30 MM OD7.5 MM SPINE EXTEND TAB C1713 $6,500.00SCREW BONE AVATAR L40 MM OD5.5 MM SPINAL NONSTERIL C1713 $6,500.00SCREW BONE AVATAR L40 MM OD7.5 MM SPINAL NONSTERIL C1713 $6,500.00

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 ChargeSCREW BONE AVATAR L45 MM OD7.5 MM SPINAL NONSTERIL C1713 $6,500.00SCREW BONE AVATAR L50 MM OD5.5 MM SPINE EXTEND TAB C1713 $6,500.00SCREW BONE AVATAR L50 MM OD6.5 MM SPINAL NONSTERIL C1713 $6,500.00SCREW BONE AVATAR L50 MM OD7.5 MM SPINE EXTEND TAB C1713 $6,500.00SCREW BONE AVATAR SPINE NONSTERILE MINIMALLY INVAS C1713 $325.00SCREW BONE AXON TITANIUM L12 MM OD3.5 MM SPINE CAN C1713 $4,800.00SCREW BONE AXON TITANIUM L8 MM OD3.5 MM SPINE CANC C1713 $4,800.00SCREW BONE AXSOS 3 TITANIUM FULL THREAD L16 MM OD4 C1713 $216.58SCREW BONE AXSOS 3 TITANIUM FULL THREAD L44 MM OD4 C1713 $216.58SCREW BONE AXSOS 3 TITANIUM L14 MM OD4 MM LOCK SEL C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L18 MM OD3.5 MM CORTIC C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L24 MM OD3.5 MM CORTEX C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L26 MM OD3.5 MM CORTEX C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L30 MM OD3.5 MM CORTEX C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L32 MM OD4 MM CORTEX S C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L36 MM OD3.5 MM CORTEX C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L38 MM OD4 MM CORTEX S C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L42 MM OD3.5 MM CORTEX C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L42 MM OD4 MM CORTEX S C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L48 MM OD4 MM LOCK SEL C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L55 MM OD3.5 MM CORTIC C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L65 MM OD3.5 MM CORTEX C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L65 MM OD4 MM CORTEX S C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L65 MM OD4 MM LOCK SEL C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L70 MM OD4 MM CORTEX S C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L75 MM OD3.5 MM CORTEX C1713 $158.34SCREW BONE AXSOS 3 TITANIUM L75 MM OD4 MM CORTEX S C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L80 MM OD4 MM CORTEX S C1713 $965.06SCREW BONE AXSOS 3 TITANIUM L85 MM OD4 MM CORTEX S C1713 $965.06SCREW BONE AXSOS STAINLESS STEEL 2.5 MM FULL THREA C1713 $130.35SCREW BONE AXSOS STAINLESS STEEL 2.5 MM PARTIAL TH C1713 $116.94SCREW BONE AXSOS STAINLESS STEEL FULL THREAD L32 M C1713 $130.33SCREW BONE AXSOS STAINLESS STEEL L65 MM OD4 MM FEM C1713 $524.55SCREW BONE AXSOS STAINLESS STEEL T15 L80 MM OD4 MM C1713 $524.55SCREW BONE AXSOS STAINLESS STEEL T15 L85 MM OD4 MM C1713 $524.55SCREW BONE AXSOS STAINLESS STEEL T20 L28 MM OD5 MM C1713 $583.05SCREW BONE AXSOS STAINLESS STEEL T20 L30 MM OD5 MM C1713 $583.05SCREW BONE AXSOS STAINLESS STEEL T20 L34 MM OD5 MM C1713 $583.05SCREW BONE AXSOS STAINLESS STEEL T20 L36 MM OD5 MM C1713 $583.05

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 ChargeSCREW BONE AXSOS STAINLESS STEEL T20 L44 MM OD5 MM C1713 $583.05SCREW BONE AXSOS STAINLESS STEEL T20 L70 MM OD5 MM C1713 $583.05SCREW BONE BEACON L30 MM OD7.5 MM SPINE REDUCTION C1713 $3,575.00SCREW BONE BIASED ANGLE L14 MM OD3.5 MM CEPHELAD C C1713 $3,900.00SCREW BONE BIOMET DFS HA L6 MM TAPER L180 MM L30 M C1713 $1,105.92SCREW BONE BIOMET DFS HA TAPER L150 MM L20 MM OD6- C1713 $1,105.92SCREW BONE BRIGADE COROENT L25 MM OD4.5 MM SPINE N C1713 $1,300.00SCREW BONE BRIGADE COROENT L27.5 MM OD4.5 MM SPINE C1713 $1,300.00SCREW BONE CABO L14 MM OD4.3 MM SPINE SELF TAP VAR C1713 $487.50SCREW BONE CABO L16 MM OD4 MM SPINE SELF DRILL FIX C1713 $487.50SCREW BONE CAPSURE PS3 TITANIUM L50 MM OD6.5 MM SP C1713 $4,225.00SCREW BONE CD HORIZON COCR L35 MM OD6 MM SPINAL MU C1713 $5,200.00SCREW BONE CD HORIZON HA L35 MM OD6.5 MM SPINE MUL C1713 $3,900.00SCREW BONE CD HORIZON HA L40 MM OD6.5 MM SPINE MUL C1713 $3,900.00SCREW BONE CD HORIZON HA L45 MM OD6.5 MM SPINE MUL C1713 $3,900.00SCREW BONE CD HORIZON HA L50 MM OD6.5 MM SPINE MUL C1713 $3,900.00SCREW BONE CD HORIZON LEGACY PEEK L45 MM OD5.5 MM C1713 $3,900.00SCREW BONE CD HORIZON LEGACY PEEK L45 MM OD6.5 MM C1713 $3,900.00SCREW BONE CD HORIZON LEGACY PEEK L50 MM OD6.5 MM C1713 $3,900.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL FLUTE C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL KNURL C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L20 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L25 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L30 M C1713 $4,800.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L35 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L40 M C1713 $3,900.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L45 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L50 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L55 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L60 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L65 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY STAINLESS STEEL L70 M C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM ANGLE REVERS C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L20 MM C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L25 MM C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L30 MM C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L35 MM C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L40 MM C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L45 MM C1713 $3,900.00

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 ChargeSCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L50 MM C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L55 MM C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM FLUTE L60 MM C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L20 MM OD6.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L30 MM OD4.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L35 MM OD6.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L40 MM OD6.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L40 MM OD7.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L45 MM OD6.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L45 MM OD7.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L45 MM OD8.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L50 MM OD6.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L50 MM OD7.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L60 MM OD5.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L65 MM OD6.5 C1713 $4,800.00SCREW BONE CD HORIZON LEGACY TITANIUM L65 MM OD8.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L70 MM OD7.5 C1713 $5,200.00SCREW BONE CD HORIZON LEGACY TITANIUM L80 MM OD7.5 C1713 $3,900.00SCREW BONE CD HORIZON M8 STAINLESS STEEL L30 MM OD C1713 $3,200.00SCREW BONE CD HORIZON M8 STAINLESS STEEL L35 MM OD C1713 $3,200.00SCREW BONE CD HORIZON M8 STAINLESS STEEL L40 MM OD C1713 $3,200.00SCREW BONE CD HORIZON M8 STAINLESS STEEL L45 MM OD C1713 $3,200.00SCREW BONE CD HORIZON PEEK HA L40 MM OD5.5 MM SPIN C1713 $3,900.00SCREW BONE CD HORIZON PEEK HA L40 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE CD HORIZON PEEK HA L45 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE CD HORIZON PEEK HA L45 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE CD HORIZON PEEK HA L50 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE CD HORIZON PEEK HA L50 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE CD HORIZON PEEK L40 MM OD7.5 MM SPINE P C1713 $3,900.00SCREW BONE CD HORIZON PEEK L45 MM OD7.5 MM SPINE P C1713 $3,900.00SCREW BONE CD HORIZON PEEK L50 MM OD7.5 MM SPINE P C1713 $3,900.00SCREW BONE CD HORIZON SOLERA COCR HA L40 MM OD6.5 C1713 $3,900.00SCREW BONE CD HORIZON SOLERA COCR HA L45 MM OD6.5 C1713 $3,900.00SCREW BONE CD HORIZON STAINLESS STEEL L35 MM OD4.5 C1713 $3,200.00SCREW BONE CD HORIZON STAINLESS STEEL L40 MM OD4.5 C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L20 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L20 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L20 MM OD5 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L20 MM OD5.5 MM SPI C1713 $5,200.00

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 ChargeSCREW BONE CD HORIZON TITANIUM L20 MM OD6.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L25 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L25 MM OD4.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L25 MM OD5 MM SPINE C1713 $4,800.00SCREW BONE CD HORIZON TITANIUM L25 MM OD5.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L25 MM OD6 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L25 MM OD6.5 MM SPI C1713 $4,800.00SCREW BONE CD HORIZON TITANIUM L25 MM OD7.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L25 MM OD8.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L30 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L30 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L30 MM OD5 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L30 MM OD5.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L30 MM OD6 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L30 MM OD6.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L30 MM OD7.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L30 MM OD8.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L35 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L35 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L35 MM OD5 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L35 MM OD5.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L35 MM OD6 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L35 MM OD6.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L35 MM OD7.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L35 MM OD8.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L40 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L40 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L40 MM OD5 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L40 MM OD5.5 MM SPI C1713 $2,275.00SCREW BONE CD HORIZON TITANIUM L40 MM OD6 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L40 MM OD6.5 MM SPI C1713 $2,800.00SCREW BONE CD HORIZON TITANIUM L40 MM OD7.5 MM SPI C1713 $2,275.00SCREW BONE CD HORIZON TITANIUM L40 MM OD8.5 MM SPI C1713 $4,800.00SCREW BONE CD HORIZON TITANIUM L45 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L45 MM OD4.5 MM SPI C1713 $4,800.00SCREW BONE CD HORIZON TITANIUM L45 MM OD5 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L45 MM OD5.5 MM SPI C1713 $2,800.00SCREW BONE CD HORIZON TITANIUM L45 MM OD6 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L45 MM OD6.5 MM SPI C1713 $3,200.00

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 ChargeSCREW BONE CD HORIZON TITANIUM L45 MM OD7.5 MM SPI C1713 $3,900.00SCREW BONE CD HORIZON TITANIUM L45 MM OD8.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L50 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L50 MM OD4.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L50 MM OD5 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L50 MM OD5.5 MM SPI C1713 $4,800.00SCREW BONE CD HORIZON TITANIUM L50 MM OD6 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L50 MM OD6.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L50 MM OD7.5 MM SPI C1713 $2,275.00SCREW BONE CD HORIZON TITANIUM L50 MM OD8.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L55 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L55 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L55 MM OD5 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L55 MM OD5.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L55 MM OD6 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L55 MM OD6.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L55 MM OD7.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L55 MM OD8.5 MM SPI C1713 $4,800.00SCREW BONE CD HORIZON TITANIUM L60 MM OD5.5 MM SPI C1713 $2,800.00SCREW BONE CD HORIZON TITANIUM L60 MM OD6 MM SPINE C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L60 MM OD6.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L60 MM OD7.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L60 MM OD8.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L65 MM OD6.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L65 MM OD7.5 MM SPI C1713 $3,200.00SCREW BONE CD HORIZON TITANIUM L65 MM OD8.5 MM SPI C1713 $5,200.00SCREW BONE CD HORIZON TITANIUM L70 MM OD7.5 MM SPI C1713 $5,200.00SCREW BONE CFX STANDARD L10 MM OD1.2 MM MIDFACE NO C1713 $424.00SCREW BONE CFX STANDARD L12 MM OD1.2 MM MIDFACE NO C1713 $424.00SCREW BONE CFX STANDARD L4 MM OD1.2 MM MIDFACE NON C1713 $424.00SCREW BONE CFX STANDARD L6 MM OD1.2 MM MIDFACE NON C1713 $424.00SCREW BONE CFX STANDARD L8 MM OD1.2 MM MIDFACE NON C1713 $424.00SCREW BONE CHARLOTTE STAINLESS STEEL L22 MM OD3 MM C1713 $975.00SCREW BONE CHARLOTTE STAINLESS STEEL L24 MM OD3 MM C1713 $1,150.50SCREW BONE CHECKMATE TITANIUM L10 MM OD3 MM FIRST C1713 $650.00SCREW BONE CHECKMATE TITANIUM L12 MM OD3 MM FIRST C1713 $650.00SCREW BONE CHECKMATE TITANIUM L14 MM OD3 MM FIRST C1713 $650.00SCREW BONE CHECKMATE TITANIUM L16 MM OD3 MM FIRST C1713 $650.00SCREW BONE CHECKMATE TITANIUM L18 MM OD3 MM FIRST C1713 $650.00

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 ChargeSCREW BONE CHESAPEAKE L20 MM OD5.5 MM SPINE SELF T C1713 $1,300.00SCREW BONE CHESAPEAKE L25 MM OD5.5 MM SPINE SELF T C1713 $1,300.00SCREW BONE CHLOROUS ACID L100 MM PERITROCHANTERIC C1713 $3,350.88SCREW BONE CHS STAINLESS STEEL L55 MM HIP INTERMED C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL L60 MM HIP INTERMED C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL L65 MM HIP INTERMED C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL L75 MM HIP INTERMED C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL L80 MM HIP INTERMED C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL L85 MM HIP INTERMED C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL L90 MM HIP INTERMED C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL L95 MM HIP INTERMED C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL PEDIATRIC L22 MM HI C1713 $3,398.24SCREW BONE CHS STAINLESS STEEL PEDIATRIC L25 MM HI C1713 $3,398.24SCREW BONE CHS STAINLESS STEEL PEDIATRIC L28 MM HI C1713 $3,398.24SCREW BONE CHS STAINLESS STEEL PEDIATRIC L31 MM HI C1713 $3,398.24SCREW BONE CHS STAINLESS STEEL PEDIATRIC L34 MM HI C1713 $3,398.24SCREW BONE CHS STAINLESS STEEL PEDIATRIC L35 MM HI C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL PEDIATRIC L37 MM HI C1713 $3,398.24SCREW BONE CHS STAINLESS STEEL PEDIATRIC L40 MM HI C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL PEDIATRIC L45 MM HI C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL PEDIATRIC L50 MM HI C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL PEDIATRIC L70 MM HI C1713 $3,125.20SCREW BONE CHS STAINLESS STEEL PEDIATRIC OD2.5 MM C1713 $510.08SCREW BONE CITADEL L30 MM OD6.5 MM SPINE SELF TAP C1713 $1,300.00SCREW BONE CITADEL L51 MM OD6.5 MM SPINE SELF TAP C1713 $1,300.00SCREW BONE CITADEL L54 MM OD6.5 MM SPINE SELF TAP C1713 $1,300.00SCREW BONE CLASSIC AMBI IMHS STANDARD L70 MM OD9 M C1713 $1,681.20SCREW BONE COALITION L14 MM OD3.6 MM SPINE SELF TA C1713 $390.00SCREW BONE COALITION L16 MM OD3.6 MM SPINE SELF TA C1713 $390.00SCREW BONE COALITION L18 MM OD3.6 MM SPINE SELF TA C1713 $390.00SCREW BONE COALITION L20 MM OD3.6 MM SPINE SELF DR C1713 $390.00SCREW BONE COALITION L20 MM OD3.6 MM SPINE SELF TA C1713 $390.00SCREW BONE COCR L20 MM OD4 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L20 MM OD4.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L20 MM OD5 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L20 MM OD5.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L20 MM OD6.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L25 MM OD4 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L25 MM OD4.5 MM SPINE SAGITTAL ADJ C1713 $5,200.00

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 ChargeSCREW BONE COCR L25 MM OD5.5 MM SPINE MULTIAXIAL R C1713 $5,200.00SCREW BONE COCR L25 MM OD6 MM SPINE MULTIAXIAL 5.5 C1713 $4,800.00SCREW BONE COCR L25 MM OD8.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L25 MM OD9.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L30 MM OD6 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L30 MM OD6.5 MM SPINE MULTIAXIAL R C1713 $4,800.00SCREW BONE COCR L30 MM OD6.5 MM SPINE SAGITTAL ADJ C1713 $5,200.00SCREW BONE COCR L30 MM OD8.5 MM SPINE MULTIAXIAL 5 C1713 $4,800.00SCREW BONE COCR L30 MM OD9.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L35 MM OD5.5 MM SPINE REDUCTION MU C1713 $5,200.00SCREW BONE COCR L35 MM OD6.5 MM SPINE MULTIAXIAL R C1713 $5,200.00SCREW BONE COCR L35 MM OD6.5 MM SPINE REDUCTION MU C1713 $5,200.00SCREW BONE COCR L35 MM OD7.5 MM SPINE SAGITTAL ADJ C1713 $5,200.00SCREW BONE COCR L35 MM OD8.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L35 MM OD9.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L40 MM OD5.5 MM SPINE REDUCTION MU C1713 $5,200.00SCREW BONE COCR L40 MM OD6 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L40 MM OD6.5 MM SPINE REDUCTION MU C1713 $5,200.00SCREW BONE COCR L40 MM OD7.5 MM SPINE REDUCTION MU C1713 $5,200.00SCREW BONE COCR L40 MM OD7.5 MM SPINE SAGITTAL ADJ C1713 $5,200.00SCREW BONE COCR L40 MM OD9.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L45 MM OD6 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L45 MM OD7.5 MM SPINE SAGITTAL ADJ C1713 $5,200.00SCREW BONE COCR L45 MM OD9.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L50 MM OD4 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L50 MM OD5.5 MM SPINE REDUCTION MU C1713 $5,200.00SCREW BONE COCR L50 MM OD5.5 MM SPINE SAGITTAL ADJ C1713 $5,200.00SCREW BONE COCR L50 MM OD9.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L55 MM OD4 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L55 MM OD4.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L55 MM OD5 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L55 MM OD6 MM SPINE MULTIAXIAL 5.5 C1713 $5,200.00SCREW BONE COCR L55 MM OD6.5 MM SPINE SAGITTAL ADJ C1713 $5,200.00SCREW BONE COCR L55 MM OD7.5 MM SPINE SAGITTAL ADJ C1713 $5,200.00SCREW BONE COCR L55 MM OD9.5 MM SPINE MULTIAXIAL 5 C1713 $5,200.00SCREW BONE COCR L80 MM OD7.5 MM SPINE MULTIAXIAL 5 C1713 $3,900.00SCREW BONE COCR L80 MM OD7.5 MM SPINE REDUCTION MU C1713 $3,900.00SCREW BONE COCR L80 MM OD8.5 MM SPINE MULTIAXIAL 5 C1713 $3,900.00SCREW BONE COCR L80 MM OD8.5 MM SPINE REDUCTION MU C1713 $3,900.00

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 ChargeSCREW BONE COCR L80 MM OD9.5 MM SPINE MULTIAXIAL 5 C1713 $3,900.00SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L15 MM OD C1713 $325.00SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L20 MM OD C1713 $325.00SCREW BONE COMPRESSION APS C1713 $227.50SCREW BONE COMPRESSION FT TITANIUM 1.5 MM MICRO FU C1713 $1,917.50SCREW BONE COMPRESSION FT TITANIUM MINI FULL THREA C1713 $1,917.50SCREW BONE COMPRESSION FT TITANIUM STANDARD FULL T C1713 $1,917.50SCREW BONE CONQUEST L45 MM OD8.5 MM SPINE NONSTERI C1713 $5,200.00SCREW BONE CONQUEST L55 MM OD5.5 MM SPINE NONSTERI C1713 $5,200.00SCREW BONE CORRIDOR L30 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORRIDOR L30 MM OD4 MM SPINE CANNULATED C1713 $2,925.00SCREW BONE CORRIDOR L32 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORRIDOR L32 MM OD4 MM SPINE CANNULATED C1713 $2,925.00SCREW BONE CORRIDOR L34 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORRIDOR L34 MM OD4 MM SPINE CANNULATED C1713 $2,925.00SCREW BONE CORRIDOR L36 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORRIDOR L36 MM OD4 MM SPINE CANNULATED C1713 $2,925.00SCREW BONE CORRIDOR L38 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORRIDOR L38 MM OD4 MM SPINE CANNULATED C1713 $2,925.00SCREW BONE CORRIDOR L40 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORRIDOR L42 MM OD3.5 MM SPINE CANNULAT C1713 $2,600.00SCREW BONE CORRIDOR L44 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORRIDOR L46 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORRIDOR L48 MM OD3.5 MM SPINE CANNULAT C1713 $2,925.00SCREW BONE CORTICAL C1713 $552.63SCREW BONE CORTICAL 2 LEAD C1713 $1,071.36SCREW BONE CREO AMP OD5.5 MM SPINE POLYAXIAL TULIP C1713 $1,787.50SCREW BONE CREO CREO AMP L35 MM OD6.5 MM SPINE MOD C1713 $1,787.50SCREW BONE CREO CREO AMP L40 MM OD6.5 MM SPINE MOD C1713 $1,787.50SCREW BONE CREO CREO AMP L45 MM OD6.5 MM SPINE MOD C1713 $1,787.50SCREW BONE CREO CREO AMP OD5.5 MM SPINE POLYAXIAL C1713 $1,787.50SCREW BONE CREO L30 MM OD5.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L30 MM OD6.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L35 MM OD5.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L35 MM OD6.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L40 MM OD5.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L40 MM OD6.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L40 MM OD7.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L40 MM OD7.5-6 MM SPINE 2 OUTER DI C1713 $3,575.00

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 ChargeSCREW BONE CREO L40 MM OD8.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L45 MM OD5.5 MM SPINE MULTIAXIAL C1713 $3,575.00SCREW BONE CREO L45 MM OD5.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L45 MM OD6.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L45 MM OD6.5-5 MM SPINE 2 OUTER DI C1713 $3,575.00SCREW BONE CREO L45 MM OD7.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L50 MM OD5.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L50 MM OD6.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L50 MM OD6.5-5 MM SPINE 2 OUTER DI C1713 $3,575.00SCREW BONE CREO L50 MM OD8-6.5 MM SPINE 2 OUTER DI C1713 $3,575.00SCREW BONE CREO L55 MM OD5.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L55 MM OD6.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L55 MM OD7.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L60 MM OD6.5 MM SPINE PREASSEMBLE C1713 $3,575.00SCREW BONE CREO L60 MM OD7.5-6 MM SPINE 2 OUTER DI C1713 $3,575.00SCREW BONE CREO L70 MM OD8.5-7 MM SPINE 2 OUTER DI C1713 $3,575.00SCREW BONE CREO L70 MM OD8-6.5 MM SPINE PREASSEMBL C1713 $3,575.00SCREW BONE CROSSLINK TITANIUM SET C1713 $400.00SCREW BONE CSLP QUICK LOCK TITANIUM L12 MM OD4 MM C1713 $487.50SCREW BONE CSLP QUICK LOCK TITANIUM L16 MM OD4 MM C1713 $487.50SCREW BONE CSLP TITANIUM L12 MM OD4 MM SPINE CERVI C1713 $487.50SCREW BONE CSLP TITANIUM L12 MM OD4.5 MM SPINE CER C1713 $487.50SCREW BONE CSLP TITANIUM L14 MM OD4 MM SPINE CERVI C1713 $487.50SCREW BONE CSLP TITANIUM L14 MM OD4.5 MM SPINE CER C1713 $487.50SCREW BONE CYLINDRICAL L12 MM OD2 MM FOOT ANKLE CA C1713 $585.00SCREW BONE DART-FIRE TITANIUM PARTIAL THREAD L36 M C1713 $812.50SCREW BONE DCP STAINLESS STEEL L36 MM OD2 MM CORTI C1713 $223.04SCREW BONE DCP STAINLESS STEEL L42 MM OD2 MM CORTI C1713 $223.04SCREW BONE DELTA SYSTEM PGLA L6 MM OD2.2 MM CRANIO C1713 $881.04SCREW BONE DELTA SYSTEM PLLA D-LACTIDE GLYCOLIDE L C1713 $1,683.04SCREW BONE DELTA TITANIUM L4 MM OD2.2 MM MAXILLOFA C1713 $881.04SCREW BONE DELTA XTEND METAGLENE L18 MM OD4.5 MM S C1713 $487.50SCREW BONE DELTA XTEND METAGLENE L24 MM OD4.5 MM S C1713 $487.50SCREW BONE DELTA XTEND METAGLENE L30 MM OD4.5 MM S C1713 $487.50SCREW BONE DELTA XTEND METAGLENE L36 MM OD4.5 MM S C1713 $487.50SCREW BONE DENALI L20 MM OD4.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L20 MM OD5.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L20 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L20 MM OD7.5 MM SPINE MONOAXIAL 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 ChargeSCREW BONE DENALI L20 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L25 MM OD4.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L25 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L25 MM OD5.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L25 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L25 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L25 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L25 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L25 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L25 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L25 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L30 MM OD4.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L30 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L30 MM OD5.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L30 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L30 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L30 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L30 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L30 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L30 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L30 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L35 MM OD4.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L35 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L35 MM OD5.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L35 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L35 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L35 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L35 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L35 MM OD7.5 MM SPINE POLYAXIAL C1713 $6,400.00SCREW BONE DENALI L35 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L35 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L40 MM OD4.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L40 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L40 MM OD5.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L40 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L40 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L40 MM OD6.5 MM SPINE POLYAXIAL C1713 $6,400.00SCREW BONE DENALI L40 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L40 MM OD7.5 MM SPINE POLYAXIAL 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 ChargeSCREW BONE DENALI L40 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L40 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L45 MM OD4.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L45 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L45 MM OD5.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L45 MM OD5.5 MM SPINE POLYAXIAL C1713 $6,400.00SCREW BONE DENALI L45 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L45 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L45 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L45 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L45 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L45 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L50 MM OD4.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L50 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L50 MM OD5.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L50 MM OD5.5 MM SPINE POLYAXIAL C1713 $6,400.00SCREW BONE DENALI L50 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L50 MM OD6.5 MM SPINE PEDICLE PO C1713 $4,800.00SCREW BONE DENALI L50 MM OD6.5 MM SPINE POLYAXIAL C1713 $6,400.00SCREW BONE DENALI L50 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L50 MM OD7.5 MM SPINE POLYAXIAL C1713 $6,400.00SCREW BONE DENALI L50 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L50 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L55 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L55 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L55 MM OD6.5 MM SPINE POLYAXIAL C1713 $6,400.00SCREW BONE DENALI L55 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L55 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L55 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L55 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L60 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L60 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L60 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L60 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L60 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L60 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L60 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L65 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L65 MM OD6.5 MM SPINE MONOAXIAL 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 ChargeSCREW BONE DENALI L65 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L65 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L65 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L65 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L65 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L70 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L70 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L70 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L70 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L70 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L70 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L75 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L75 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L75 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L75 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L75 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L75 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L80 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L80 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L80 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L80 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L80 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L80 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L85 MM OD6.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L85 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L85 MM OD7.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L85 MM OD7.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DENALI L85 MM OD8.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE DENALI L85 MM OD8.5 MM SPINE POLYAXIAL C1713 $4,800.00SCREW BONE DFS 4 MM TAPER L80 MM L35 MM OD3.3 MM O C1713 $957.44SCREW BONE DFS 6 MM TAPER L90 MM L40 MM OD3 MM OD2 C1713 $957.44SCREW BONE DFS DYNAFIX BIOMET HA TAPER L200 MM L40 C1713 $1,105.92SCREW BONE DFS HA TAPER L200 MM L90 MM OD6-5 MM CA C1713 $1,105.92SCREW BONE DFS L6 MM TAPER L150 MM L50 MM OD6-5 MM C1713 $1,105.92SCREW BONE DFS L6 MM TAPER L170 MM L80 MM OD6 MM O C1713 $957.44SCREW BONE DFS L6 MM TAPER L200 MM L90 MM OD6 MM O C1713 $957.44SCREW BONE DFS MINI L70 MM L30 MM CORTICAL TAPERED C1713 $844.80SCREW BONE DFS TAPER L120 MM L60 MM OD6-5 MM ODSEC C1713 $912.00SCREW BONE DFS TAPER L140 MM L50 MM OD6-5 MM ODSEC C1713 $1,564.16

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 ChargeSCREW BONE DFS TAPER L150 MM L40 MM OD6-5 MM ODSEC C1713 $957.44SCREW BONE DFS TAPER L160 MM L90 MM OD5-6 MM CANCE C1713 $957.44SCREW BONE DFS TAPER L80 MM L20 MM OD3.3-3 MM ODSE C1713 $957.44SCREW BONE DHHS STAINLESS STEEL L90 MM OD2.4 MM HI C1713 $648.56SCREW BONE DHS DCS STAINLESS STEEL L100 MM L22 MM C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L105 MM L22 MM C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L110 MM L22 MM C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L115 MM L22 MM C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L120 MM L22 MM C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L125 MM L22 MM C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L130 MM L22 MM C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L135 MM L22 MM C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L140 MM L22 MM C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L140 MM OD12.7 C1713 $2,957.24SCREW BONE DHS DCS STAINLESS STEEL L145 MM L22 MM C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L36 MM OD12.7 M C1713 $250.38SCREW BONE DHS DCS STAINLESS STEEL L50 MM L22 MM O C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L55 MM L22 MM O C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L55 MM OD14 MM C1713 $3,022.16SCREW BONE DHS DCS STAINLESS STEEL L60 MM L22 MM O C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L60 MM OD12.7 M C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L65 MM L22 MM O C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L65 MM OD12.7 M C1713 $2,718.56SCREW BONE DHS DCS STAINLESS STEEL L70 MM L22 MM O C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L75 MM L22 MM O C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L80 MM L22 MM O C1713 $2,378.16SCREW BONE DHS DCS STAINLESS STEEL L85 MM L22 MM O C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L90 MM L22 MM O C1713 $1,932.26SCREW BONE DHS DCS STAINLESS STEEL L95 MM L22 MM O C1713 $2,378.16SCREW BONE DIVERGENCE TITANIUM L13 MM OD3.5 MM SPI C1713 $487.50SCREW BONE DIVERGENCE TITANIUM L15 MM OD3.5 MM SPI C1713 $487.50SCREW BONE DRILL-FREE MAXDRIVE STAINLESS STEEL L12 C1713 $615.68SCREW BONE DRILL-FREE MAXDRIVE TITANIUM MICRO L7 M C1713 $384.80SCREW BONE DURANGO TITANIUM L20 MM OD5 MM SPINE LA C1713 $1,300.00SCREW BONE DURANGO TITANIUM L25 MM OD5 MM SPINE LA C1713 $1,300.00SCREW BONE DVR L14 MM OD2.7 MM CORTICAL LOCK NONST C1713 $503.62SCREW BONE DVR L18 MM OD2.7 MM HAND CORTICAL LOW P C1713 $253.50SCREW BONE DVR L18 MM OD2.7 MM RADIUS DISTAL VOLAR C1713 $503.62SCREW BONE DVR L20 MM OD2.7 MM RADIUS DISTAL VOLAR C1713 $503.62

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 ChargeSCREW BONE DVR L24 MM OD2.7 MM RADIUS DISTAL VOLAR C1713 $503.62SCREW BONE DVR SQUARE L16 MM OD2.7 MM RADIUS DISTA C1713 $503.62SCREW BONE DYNAFIX L110 MM L50 MM OD6/5 MM CANCELL C1713 $1,564.16SCREW BONE DYNAFIX L130 MM L40 MM OD6/5 MM CANCELL C1713 $957.44SCREW BONE DYNAFIX STAINLESS STEEL L180 MM L100 MM C1713 $957.44SCREW BONE DYNAFIX STAINLESS STEEL L90 MM L30 MM O C1713 $957.44SCREW BONE DYNAFIX VS DFS TITANIUM L30 MM OD6 MM O C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L36 MM OD6 MM C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L40 MM OD6 MM R C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L42 MM OD6 MM C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L45 MM OD6 MM C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L50 MM OD6 MM C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L60 MM OD6 MM N C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L65 MM OD6 MM N C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L70 MM OD6 MM O C1713 $906.88SCREW BONE DYNAFIX VS DFS TITANIUM L75 MM OD6 MM O C1713 $906.88SCREW BONE DYNAFIX VS L38 MM OD6 MM NONSTERILE OST C1713 $906.88SCREW BONE DYNAFIX WRISTFIX STAINLESS STEEL 4 MM S C1713 $957.44SCREW BONE ELLIPSE TITANIUM L10 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L12 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L14 MM OD3.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L14 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L16 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L18 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L20 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L22 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L24 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L26 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L28 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L32 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L34 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L36 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L38 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L40 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L42 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L44 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L46 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L48 MM OD4.5 MM SPINE C1713 $3,575.00SCREW BONE ELLIPSE TITANIUM L50 MM OD4.5 MM SPINE C1713 $3,575.00

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 ChargeSCREW BONE ENCORE TITANIUM L15 MM OD6.5 MM CANCELL C1713 $162.50SCREW BONE ENCORE TITANIUM L20 MM OD6.5 MM CANCELL C1713 $162.50SCREW BONE ENCORE TITANIUM L25 MM OD6.5 MM CANCELL C1713 $162.50SCREW BONE ENCORE TITANIUM L30 MM OD6.5 MM CANCELL C1713 $162.50SCREW BONE ENCORE TITANIUM L35 MM OD6.5 MM CANCELL C1713 $162.50SCREW BONE ENCORE TITANIUM L40 MM OD6.5 MM CANCELL C1713 $162.50SCREW BONE ENDOSKELETON TAS TITANIUM L25 MM OD5.5 C1713 $1,462.50SCREW BONE ENDOSKELETON TAS TITANIUM L30 MM OD5.5 C1713 $1,462.50SCREW BONE ENDOSKELETON TAS TITANIUM L30 MM OD6.5 C1713 $1,462.50SCREW BONE EQUINOXE L18 MM OD4.5 MM SHOULDER KIT C C1713 $325.00SCREW BONE EQUINOXE L22 MM OD4.5 MM SHOULDER KIT C C1713 $325.00SCREW BONE EQUINOXE L26 MM OD4.5 MM SHOULDER KIT C C1713 $325.00SCREW BONE EQUINOXE L30 MM OD4.5 MM SHOULDER KIT C C1713 $325.00SCREW BONE EQUINOXE L34 MM OD4.5 MM SHOULDER KIT C C1713 $325.00SCREW BONE EQUINOXE L38 MM OD4.5 MM SHOULDER KIT C C1713 $325.00SCREW BONE EQUINOXE L42 MM OD4.5 MM SHOULDER KIT C C1713 $325.00SCREW BONE EQUINOXE L46 MM OD4.5 MM SHOULDER KIT C C1713 $325.00SCREW BONE EQUINOXE SHOULDER GLENOSPHERE LOCK REVE C1713 $325.00SCREW BONE ES2 LITE XIA 3 LONG BLADE L40 MM L15 MM C1713 $5,200.00SCREW BONE ES2 LITE XIA 3 SHORT BLADE L40 MM L15 M C1713 $5,200.00SCREW BONE EVEREST L30 MM OD5.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EVEREST L30 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE EVEREST L35 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE EVEREST L40 MM OD5.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE EVEREST L40 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE EVEREST L40 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE EVEREST L45 MM OD5.5 MM SPINE CANNULATE C1713 $5,200.00SCREW BONE EVEREST L45 MM OD5.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EVEREST L45 MM OD6.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EVEREST L50 MM OD5.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EVEREST L50 MM OD6.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EVEREST L50 MM OD8.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EVEREST L55 MM OD8.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EVEREST L70 MM OD8.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EVEREST L80 MM OD8.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE EXPEDIUM L25 MM OD4.35 MM SPINE UNIPLAN C1713 $4,800.00SCREW BONE EXPEDIUM L25 MM OD5 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L30 MM OD4.35 MM SPINE UNIPLAN C1713 $4,800.00SCREW BONE EXPEDIUM L30 MM OD5 MM SPINE UNIPLANAR 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 ChargeSCREW BONE EXPEDIUM L30 MM OD5.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L30 MM OD6 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L30 MM OD7 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L35 MM OD4.35 MM SPINE UNIPLAN C1713 $4,800.00SCREW BONE EXPEDIUM L35 MM OD5 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L35 MM OD5.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L35 MM OD6 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L35 MM OD6.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L35 MM OD7 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L40 MM OD4.35 MM SPINE UNIPLAN C1713 $4,800.00SCREW BONE EXPEDIUM L40 MM OD5 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L40 MM OD5.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L40 MM OD6 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L40 MM OD6.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L40 MM OD7 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L45 MM OD5 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L45 MM OD5.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L45 MM OD6 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L45 MM OD7 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L50 MM OD5.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L50 MM OD6 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L50 MM OD7 MM SPINE UNIPLANAR C1713 $4,800.00SCREW BONE EXPEDIUM L55 MM OD6.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L60 MM OD6.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM L80 MM OD6.5 MM SPINE POLYAXIA C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L100 MM OD4.35 C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L100 MM OD6 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L100 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L100 MM OD7.5 C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L20 MM OD4.35 C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L20 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L20 MM OD5.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L20 MM OD6 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L22.5 MM OD4 M C1713 $2,400.00SCREW BONE EXPEDIUM STAINLESS STEEL L25 MM OD4 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L25 MM OD4.35 C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L25 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L25 MM OD5.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L25 MM OD6 MM 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 ChargeSCREW BONE EXPEDIUM STAINLESS STEEL L25 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L27.5 MM OD4 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L27.5 MM OD4.3 C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD4 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD4.35 C1713 $2,400.00SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD5.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD6 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD6.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L30 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD4 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD4.35 C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD5 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD5.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD6 MM C1713 $2,400.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD8 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L35 MM OD9 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD10 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD4 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD4.35 C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD5.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD6 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD7 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD8 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L40 MM OD9 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD4.35 C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD5.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD6 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD6.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD8 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L45 MM OD9 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD10 MM 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 ChargeSCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD4.35 C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD6 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD6.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD8 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L50 MM OD9 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L55 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L55 MM OD6 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L55 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L55 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L55 MM OD8 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L60 MM OD5 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L60 MM OD6 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L60 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L60 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L60 MM OD8 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD10 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD6 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD6.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD8 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L65 MM OD9 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L70 MM OD5 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L70 MM OD6 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L70 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L70 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L75 MM OD5 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L75 MM OD6 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L75 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L80 MM OD10 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L80 MM OD6 MM C1713 $2,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L80 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L80 MM OD7.5 M C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L80 MM OD8 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L80 MM OD9 MM 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 ChargeSCREW BONE EXPEDIUM STAINLESS STEEL L90 MM OD6 MM C1713 $4,800.00SCREW BONE EXPEDIUM STAINLESS STEEL L90 MM OD7 MM C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L100 MM OD10 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L100 MM OD7 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L100 MM OD7.5 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L100 MM OD8 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L100 MM OD9 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L20 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L20 MM OD5 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L20 MM OD6 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L20 MM OD7 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L22.5 MM OD4 MM SPINE C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD4 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD4 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD4 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD4 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD5 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD5 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD6 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L25 MM OD7 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L27 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L27.5 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L27.5 MM OD4.35 MM SP C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD10 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD4 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD4 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD4 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD4 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD5 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD5 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD5 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD5 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD6 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 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 ChargeSCREW BONE EXPEDIUM TITANIUM L30 MM OD7 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L30 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD4 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD4 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD4 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD4 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD5 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD5 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD5 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD5 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD6 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD6 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD6 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD7 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L35 MM OD8 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD10 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD4 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD4 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD4 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD4.35 MM SPIN C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD5 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD5 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD5 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD5 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD6 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD6 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD7 MM SPINE P 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 ChargeSCREW BONE EXPEDIUM TITANIUM L40 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD8 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L40 MM OD9 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD10 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD5 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD5 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD5 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD6 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD6 MM SPINE C C1713 $5,200.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD6 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD7 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD8 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD8 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L45 MM OD9 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD10 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD5 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD5 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD6 MM SPINE 1 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD6 MM SPINE C C1713 $2,400.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD6 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD6 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD7 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD8 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD8 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L50 MM OD9 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD10 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 ChargeSCREW BONE EXPEDIUM TITANIUM L55 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD5 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD6 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD7 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD8 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L55 MM OD9 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD5 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD5 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD7 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L60 MM OD8 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD10 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD5 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD5 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD6 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD6 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD6 MM SPINE T C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD7 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD7 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD8 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L65 MM OD9 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD4.35 MM SPIN C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD5 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD5 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD6 MM SPINE 2 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 ChargeSCREW BONE EXPEDIUM TITANIUM L70 MM OD6 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD7 MM SPINE 2 C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD7 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L70 MM OD8 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L75 MM OD5 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L75 MM OD5 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L75 MM OD6 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L75 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L75 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L75 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD10 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD6 MM SPINE M C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD6 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD6 MM SPINE U C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD7 MM SPINE P C1713 $2,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD7 MM SPINE T C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD8 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L80 MM OD9 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L90 MM OD7 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L90 MM OD8 MM SPINE P C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L95 MM OD10 MM SPINE C1713 $4,800.00SCREW BONE EXPEDIUM TITANIUM L95 MM OD9 MM SPINE P C1713 $4,800.00SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUN C1713 $1,719.20SCREW BONE FIXOS L50 MM OD7 MM COMPRESSION HEADLES C1713 $3,485.04SCREW BONE FIXOS SHORT L75 MM OD7 MM COMPRESSION H C1713 $3,485.04SCREW BONE FIXOS TITANIUM L34 MM OD4 MM MIDFOOT RE C1713 $2,062.32SCREW BONE FIXOS TITANIUM SHORT THREAD L45 MM OD7 C1713 $3,485.04SCREW BONE FIXOS TITANIUM SHORT THREAD L65 MM OD7 C1713 $3,485.04SCREW BONE FIXOS TWIST-OFF SNAP-OFF L14 MM OD2.7 M C1713 $2,096.64SCREW BONE FIXOS TWIST-OFF TITANIUM L12 MM OD2 MM C1713 $2,096.64SCREW BONE FIXOS TWIST-OFF TITANIUM LARGE L11 MM O C1713 $2,580.48SCREW BONE FREEDOM TITANIUM L17.5 MM OD4.5 MM WRIS C1713 $1,492.40SCREW BONE FREEDOM TITANIUM L35 MM OD4.5 MM WRIST C1713 $1,492.40SCREW BONE FULL THREAD HEXAGON L30 MM OD4.5 MM COR C1713 $131.96SCREW BONE FULL THREAD HEXAGON L36 MM OD4.5 MM COR C1713 $131.96

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 ChargeSCREW BONE FULL THREAD HEXAGON L38 MM OD4.5 MM COR C1713 $131.96SCREW BONE FULL THREAD L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L10 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L12 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L12 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L14 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L14 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L16 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L16 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L18 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L18 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L20 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L20 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L20 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L22 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L22 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L22 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L24 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L24 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L24 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L26 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L26 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L26 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L28 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L28 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L28 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L30 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L30 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L30 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L32 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L32 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L32 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L34 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L34 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L34 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L36 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L36 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L36 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L36 MM OD4.8 MM CANCELLOUS C1713 $648.96

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 ChargeSCREW BONE FULL THREAD L38 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L38 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L38 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L40 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L40 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L40 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L42 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L42 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L42 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L44 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L44 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L44 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L46 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L46 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L46 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L48 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L48 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L48 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L50 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L50 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE FULL THREAD L50 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L52 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L54 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L54 MM OD5 MM FEMORAL CORTI C1713 $939.12SCREW BONE FULL THREAD L56 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L56 MM OD4.8 MM ODSEC7 MM H C1713 $648.96SCREW BONE FULL THREAD L60 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L64 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L68 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE FULL THREAD L72 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE G7 DOME L15 MM OD6.5 MM HIP ACETABULAR C1713 $162.50SCREW BONE G7 DOME L20 MM OD6.5 MM HIP ACETABULAR C1713 $162.50SCREW BONE G7 DOME L25 MM OD6.5 MM HIP ACETABULAR C1713 $162.50SCREW BONE G7 DOME L30 MM OD6.5 MM HIP ACETABULAR C1713 $162.50SCREW BONE G7 DOME L35 MM OD6.5 MM HIP ACETABULAR C1713 $162.50SCREW BONE G7 DOME L40 MM OD6.5 MM HIP ACETABULAR C1713 $162.50SCREW BONE G7 DOME L45 MM OD6.5 MM HIP ACETABULAR C1713 $162.50SCREW BONE G7 DOME L60 MM OD6.5 MM HIP ACETABULAR C1713 $162.50SCREW BONE GAMMA3 TITANIUM L100 MM OD10.5 MM LAG S C1713 $2,660.19

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 ChargeSCREW BONE GAMMA3 TITANIUM L105 MM OD10.5 MM LAG S C1713 $2,660.19SCREW BONE GAMMA3 TITANIUM L110 MM OD10.5 MM LAG S C1713 $2,660.19SCREW BONE GAMMA3 TITANIUM L115 MM OD10.5 MM LAG S C1713 $2,660.19SCREW BONE GAMMA3 TITANIUM L75 MM OD10.5 MM HIP TR C1713 $2,660.19SCREW BONE GAMMA3 TITANIUM L80 MM OD10.5 MM LAG ST C1713 $2,660.19SCREW BONE GAMMA3 TITANIUM L85 MM OD10.5 MM LAG ST C1713 $2,660.19SCREW BONE GAMMA3 TITANIUM L90 MM OD10.5 MM LAG ST C1713 $2,660.19SCREW BONE GAMMA3 TITANIUM L95 MM OD10.5 MM HIP TR C1713 $2,660.19SCREW BONE HA 6 MM TAPER L250 MM L40 MM OD6/5 MM C C1713 $1,105.92SCREW BONE HELIX R L11 MM OD4 MM SPINE SELF DRILL C1713 $487.50SCREW BONE HELIX WIRE TITANIUM L46 IN OD4 MM CANCE C1713 $659.04SCREW BONE HELIX WIRE TITANIUM L48 IN OD4 MM CANCE C1713 $673.14SCREW BONE HEXAGON L16 MM OD3.5 MM DISTAL CORTICAL C1713 $112.96SCREW BONE HEXALOBE L110 MM OD4.3 MM PELVIS COLUMN C1713 $435.50SCREW BONE HEXALOBE L115 MM OD4.3 MM PELVIS NONSTE C1713 $435.50SCREW BONE HYDROXYAPATITE L100 MM L30 MM OD6/5 MM C1713 $1,029.12SCREW BONE HYDROXYAPATITE L110 MM L50 MM OD6/5 MM C1713 $1,029.12SCREW BONE HYDROXYAPATITE L120 MM L60 MM OD6/5 MM C1713 $1,029.12SCREW BONE HYDROXYAPATITE L130 MM L50 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L130 MM L60 MM OD6/5 MM C1713 $1,029.12SCREW BONE HYDROXYAPATITE L150 MM L30 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L150 MM L60 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L160 MM L70 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L200 MM L30 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L200 MM L80 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L220 MM L50 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L220 MM L60 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L250 MM L30 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L250 MM L50 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L250 MM L60 MM OD6/5 MM C1713 $1,105.92SCREW BONE HYDROXYAPATITE L300 MM L60 MM OD6/5 MM C1713 $1,105.92SCREW BONE IMHS STAINLESS STEEL L115 MM L21 MM OD1 C1713 $1,681.20SCREW BONE IMHS STAINLESS STEEL STANDARD L110 MM L C1713 $1,681.20SCREW BONE IMHS STAINLESS STEEL STANDARD L60 MM L2 C1713 $1,681.20SCREW BONE IMSC STAINLESS STEEL L25 MM L16 MM OD6. C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L105 MM C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L110 MM C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L115 MM C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L120 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 ChargeSCREW BONE IMSC STAINLESS STEEL UNIVERSAL L30 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L35 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L40 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L45 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L50 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L55 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L60 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L65 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L70 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L75 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L85 MM L C1713 $1,566.24SCREW BONE IMSC STAINLESS STEEL UNIVERSAL L95 MM L C1713 $1,566.24SCREW BONE INDEPENDENCE HA L20 MM OD5.5 MM SPINE V C1713 $1,300.00SCREW BONE INDEPENDENCE HA L25 MM OD5.5 MM SPINE V C1713 $1,300.00SCREW BONE INDEPENDENCE L12 MM OD5.5 MM SPINE FIX C1713 $1,300.00SCREW BONE INDEPENDENCE L20 MM OD5.5 MM SPINE VARI C1713 $1,300.00SCREW BONE INDEPENDENCE L25 MM OD5.5 MM SPINE VARI C1713 $1,300.00SCREW BONE INDEPENDENCE L40 MM OD5.5 MM SPINE FIX C1713 $1,300.00SCREW BONE L10 MM L4 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L10 MM L4 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L10 MM L5 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L10 MM OD1.2 MM LAG NONSTERILE C1713 $560.00SCREW BONE L10 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L10 MM OD3 MM CORTICAL RIGHT STABILIZAT C1713 $438.75SCREW BONE L10 MM OD3.2 MM CORTICAL HEXAGONAL ANKL C1713 $435.50SCREW BONE L10 MM OD3.5 MM ELBOW LOCKING HEXALOBE C1713 $676.00SCREW BONE L10 MM OD4 MM SPINE VARIABLE ANGLE NONS C1713 $1,300.00SCREW BONE L100 MM HIP LAG C1713 $3,927.04SCREW BONE L100 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L100 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L100 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L100 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L100 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L105 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L105 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L105 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L105 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L11 MM OD2.7 MM RADIUS DISTAL NONLOCK L C1713 $253.50SCREW BONE L110 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75

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 ChargeSCREW BONE L110 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L110 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L110 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L115 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L115 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L115 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L115 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L115 MM SOLID SLIDING LAP C1713 $2,680.08SCREW BONE L12 MM L4 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L12 MM L4 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L12 MM L5 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L12 MM OD1.2 MM LAG NONSTERILE C1713 $560.00SCREW BONE L12 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L12 MM OD2.7 MM ELBOW NONLOCKING HEXALO C1713 $422.50SCREW BONE L12 MM OD3.2 MM CORTEX HEXAGONAL NONSTE C1713 $435.50SCREW BONE L12 MM OD3.5 MM CORTICAL C1713 $152.30SCREW BONE L12 MM OD3.5 MM SPINE C1713 $3,900.00SCREW BONE L12 MM OD3.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE L12 MM OD3.6 MM SPINE FIX ANGLE SELF DR C1713 $390.00SCREW BONE L12 MM OD3.6 MM SPINE FIX ANGLE SELF TA C1713 $390.00SCREW BONE L12 MM OD3.6 MM SPINE SELF TAP VARIABLE C1713 $390.00SCREW BONE L12 MM OD4 MM SPINE SELF DRILL VARIABLE C1713 $487.50SCREW BONE L12 MM SPINE SELF DRILL C1713 $325.00SCREW BONE L12 MM SPINE SELF TAP C1713 $390.00SCREW BONE L120 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L120 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L120 MM L30 MM CORTICAL SELF DRILLING S C1713 $916.48SCREW BONE L120 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L125 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L125 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L130 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L130 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L14 MM CORTICAL C1713 $152.30SCREW BONE L14 MM L4 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L14 MM L5 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L14 MM L5 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L14 MM L6 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L14 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L14 MM OD2.7 MM FULLY THREADED C1713 $1,144.00

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 ChargeSCREW BONE L14 MM OD2.7 MM RADIUS DISTAL NONLOCK L C1713 $253.50SCREW BONE L14 MM OD3.2 MM CORTEX HEXAGONAL NONSTE C1713 $435.50SCREW BONE L14 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L14 MM OD3.5 MM DISTAL CORTICAL VOLAR R C1713 $112.96SCREW BONE L14 MM OD3.5 MM SPINE CERVICAL C1713 $3,900.00SCREW BONE L14 MM OD3.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE L14 MM OD3.6 MM SPINE FIX ANGLE SELF DR C1713 $390.00SCREW BONE L14 MM OD4 MM CERVICAL SPINE C1713 $3,900.00SCREW BONE L14 MM OD4 MM SPINE SELF DRILL FIX C1713 $325.00SCREW BONE L14 MM OD4 MM SPINE SELF DRILL FIX ANGL C1713 $487.50SCREW BONE L14 MM OD4 MM SPINE SELF DRILL VARIABLE C1713 $487.50SCREW BONE L14 MM OD4.35 MM SPINE SELF TAP C1713 $325.00SCREW BONE L14 MM OD4.35 MM SPINE SELF TAP MAGENTA C1713 $487.50SCREW BONE L14 MM SPINE SELF DRILL C1713 $325.00SCREW BONE L15 MM OD2.4 MM ODSEC3.5 MM CORTEX SELF C1713 $460.19SCREW BONE L15 MM OD2.7 MM RADIUS DISTAL NONLOCK L C1713 $253.50SCREW BONE L16 MM CORTICAL C1713 $152.30SCREW BONE L16 MM L4 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L16 MM L5 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L16 MM L7 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L16 MM L7 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L16 MM OD2.5 MM FOOT ANKLE SELF TAP THR C1713 $585.00SCREW BONE L16 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L16 MM OD2.7 MM ELBOW NONLOCKING HEXALO C1713 $422.50SCREW BONE L16 MM OD2.7 MM LOW PROFILE NONSTERILE C1713 $253.50SCREW BONE L16 MM OD3.2 MM CORTICAL HEXAGONAL ANKL C1713 $435.50SCREW BONE L16 MM OD3.5 MM CERVICAL SPINE C1713 $3,900.00SCREW BONE L16 MM OD3.5 MM CORTICAL VARIABLE ANGLE C1713 $253.76SCREW BONE L16 MM OD3.5 MM ELBOW NONLOCKING HEXALO C1713 $422.50SCREW BONE L16 MM OD3.6 MM SPINE FIX ANGLE SELF DR C1713 $390.00SCREW BONE L16 MM OD3.6 MM SPINE SELF DRILL VARIAB C1713 $390.00SCREW BONE L16 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE L16 MM OD4 MM SPINE SELF TAP C1713 $325.00SCREW BONE L16 MM OD4.35 MM SPINE SELF TAP C1713 $325.00SCREW BONE L16 MM SPINE SELF DRILL C1713 $325.00SCREW BONE L160 MM L30 MM OD6.5 MM CORTICAL TAPERE C1713 $957.44SCREW BONE L160 MM L50 MM OD6.5 MM CORTICAL TAPERE C1713 $957.44SCREW BONE L170 MM L60 MM OD6.5 MM CORTICAL TAPERE C1713 $957.44SCREW BONE L18 MM CORTICAL C1713 $152.30

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 ChargeSCREW BONE L18 MM L5 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L18 MM L6 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L18 MM L7 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L18 MM L8 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L18 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L18 MM OD2.7 MM ELBOW NONLOCKING HEXALO C1713 $422.50SCREW BONE L18 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L18 MM OD3.6 MM SPINE FIX ANGLE SELF DR C1713 $390.00SCREW BONE L18 MM OD3.6 MM SPINE FIX ANGLE SELF TA C1713 $390.00SCREW BONE L18 MM OD3.6 MM SPINE SELF DRILL VARIAB C1713 $390.00SCREW BONE L18 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE L180 MM L50 MM CORTICAL SELF DRILLING C1713 $916.48SCREW BONE L19 MM OD3 MM STERILE C1713 $1,204.32SCREW BONE L20 MM CORTICAL C1713 $162.96SCREW BONE L20 MM L5 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L20 MM L6 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L20 MM L7 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L20 MM L7 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L20 MM L8 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L20 MM L9 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L20 MM OD2 MM FOOT ANKLE SELF TAP THREA C1713 $585.00SCREW BONE L20 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L20 MM OD2.7 MM FULLY THREADED C1713 $1,144.00SCREW BONE L20 MM OD2.7 MM LOCK HEXALOBE HEAD NONS C1713 $617.50SCREW BONE L20 MM OD2.7 MM MULTIDIRECTIONAL NONSTE C1713 $841.62SCREW BONE L20 MM OD3.6 MM SPINE FIX ANGLE SELF DR C1713 $1,300.00SCREW BONE L20 MM OD3.6 MM SPINE FIX ANGLE SELF TA C1713 $1,300.00SCREW BONE L20 MM OD3.6 MM SPINE SELF TAP VARIABLE C1713 $1,300.00SCREW BONE L20 MM OD3.6 MM SPINE VARIABLE ANGLE SE C1713 $1,300.00SCREW BONE L20 MM OD4 MM ORTHOPEDIC 2 THREAD C1713 $1,585.92SCREW BONE L20 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE L20 MM OD4 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L20 MM OD4.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L20 MM OD4.75 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L20 MM OD5.5 MM FIX C1713 $2,800.00SCREW BONE L20 MM OD5.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L200 MM L70 MM CORTICAL SELF TAPPING SE C1713 $916.48SCREW BONE L200 MM L80 MM CORTICAL SELF TAPPING SE C1713 $916.48SCREW BONE L22 MM L10 MM OD2.7 MM CANNULATED C1713 $780.00

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 ChargeSCREW BONE L22 MM L5 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L22 MM L7 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L22 MM L9 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L22 MM OD2.5 MM FOOT ANKLE SELF TAP THR C1713 $585.00SCREW BONE L22 MM OD2.7 MM CORTICAL LOCK NONSTERIL C1713 $503.62SCREW BONE L22 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L22 MM OD2.7 MM ELBOW LOCKING HEXALOBE C1713 $617.50SCREW BONE L22 MM OD2.7 MM FULLY THREADED C1713 $1,144.00SCREW BONE L22 MM OD3.2 MM CORTICAL HEXAGONAL HEAD C1713 $435.50SCREW BONE L22 MM OD3.5 MM C1713 $253.76SCREW BONE L22 MM OD3.5 MM CORTICAL C1713 $162.96SCREW BONE L22.5 MM OD4 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L22.5 MM OD4.5 MM SPINE POLYAXIAL DEFOR C1713 $5,200.00SCREW BONE L24 MM L10 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L24 MM L10 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L24 MM L6 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L24 MM L8 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L24 MM L8 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L24 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L24 MM OD2.7 MM FULLY THREADED C1713 $1,144.00SCREW BONE L24 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L24 MM OD4 MM FEMUR PILOT TIPPED C1713 $1,585.92SCREW BONE L24 MM SPINE HUMP GROWTH CONTROL C1713 $728.00SCREW BONE L25 MM OD4 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L25 MM OD4 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L25 MM OD4.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L25 MM OD4.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L25 MM OD4.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L25 MM OD4.75 MM FIX C1713 $2,800.00SCREW BONE L25 MM OD4.75 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L25 MM OD5 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L25 MM OD5 MM SPINE POSTERIOR UNIPLANAR C1713 $5,200.00SCREW BONE L25 MM OD5 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L25 MM OD5.5 MM FIX C1713 $2,800.00SCREW BONE L25 MM OD5.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L25 MM OD5.5 MM SPINE POLYAXIAL REVOLVE C1713 $4,550.00SCREW BONE L25 MM OD5.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L25 MM OD5.5 MM VARIABLE ANGLE C1713 $4,800.00SCREW BONE L250 MM L50 MM CORTICAL SELF DRILLING S C1713 $916.48

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 ChargeSCREW BONE L250 MM L80 MM CORTICAL SELF DRILLING S C1713 $916.48SCREW BONE L250 MM L80 MM OD6.5 MM CORTICAL TAPERE C1713 $957.44SCREW BONE L26 MM L12 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L26 MM L12 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L26 MM L6 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L26 MM L8 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L26 MM L9 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L26 MM OD2.5 MM FOOT ANKLE SELF TAP THR C1713 $585.00SCREW BONE L26 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L26 MM OD2.7 MM ELBOW HEXALOBE NONSTERI C1713 $422.50SCREW BONE L26 MM OD2.7 MM FULLY THREADED C1713 $1,144.00SCREW BONE L26 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L26 MM OD4.5 MM CORTICAL C1713 $234.00SCREW BONE L26 MM OD5 MM ODSEC3.5 MM HIP CORTICAL C1713 $939.12SCREW BONE L27.5 MM OD4 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L27.5 MM OD4 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L27.5 MM OD4.5 MM SPINE POLYAXIAL DEFOR C1713 $5,200.00SCREW BONE L27.5 MM OD4.5 MM SPINE UNIPLANAR DEFOR C1713 $5,200.00SCREW BONE L28 MM L12 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L28 MM L14 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L28 MM L6 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L28 MM L9 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L28 MM L9 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L28 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L28 MM OD2.7 MM FULLY THREADED C1713 $1,144.00SCREW BONE L28 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L28 MM OD3.5 MM ELBOW NONLOCKING HEXALO C1713 $435.50SCREW BONE L28 MM OD3.5 MM NONLOCK HEXALOBE HEAD N C1713 $435.50SCREW BONE L28 MM OD3.5 MM SPINE C1713 $3,900.00SCREW BONE L28 MM OD4 MM ORTHOPEDIC PILOT TIPPED C1713 $1,585.92SCREW BONE L28 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE L3 MM OD1.5 MM CRANIOMAXILLOFACIAL CORT C1713 $780.00SCREW BONE L30 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L30 MM L10 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L30 MM L14 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L30 MM L14 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L30 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L30 MM L6 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L30 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00

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 ChargeSCREW BONE L30 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L30 MM OD3.5 MM ELBOW LOCKING HEXALOBE C1713 $676.00SCREW BONE L30 MM OD4 MM CORTICAL 2 LEAD C1713 $1,071.36SCREW BONE L30 MM OD4 MM FIX ANGLE C1713 $2,800.00SCREW BONE L30 MM OD4 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L30 MM OD4 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L30 MM OD4.5 MM CORTICAL C1713 $234.00SCREW BONE L30 MM OD4.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L30 MM OD4.5 MM SPINE POLYAXIAL NONSTER C1713 $4,225.00SCREW BONE L30 MM OD4.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L30 MM OD4.75 MM FIX C1713 $2,800.00SCREW BONE L30 MM OD4.75 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L30 MM OD5 MM SPINE POSTERIOR UNIPLANAR C1713 $5,200.00SCREW BONE L30 MM OD5 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L30 MM OD5.5 MM FIX C1713 $2,800.00SCREW BONE L30 MM OD5.5 MM POLYAXIAL NONSTERILE DE C1713 $5,200.00SCREW BONE L30 MM OD5.5 MM POLYAXIAL NONSTERILE ME C1713 $5,200.00SCREW BONE L30 MM OD5.5 MM SPINE MULTIAXIAL REDUCT C1713 $5,200.00SCREW BONE L30 MM OD5.5 MM SPINE POLYAXIAL REVOLVE C1713 $4,550.00SCREW BONE L30 MM OD5.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L30 MM OD5.5 MM VARIABLE C1713 $4,800.00SCREW BONE L30 MM OD6.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L30 MM OD6.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L30 MM OD6.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L30 MM OD7.5 MM FIX C1713 $2,800.00SCREW BONE L30 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L30 MM OD8.5 MM FIX C1713 $2,800.00SCREW BONE L30 MM WRIST C1713 $1,287.33SCREW BONE L32 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L32 MM L14 MM OD2.7 MM CANNULATED C1713 $780.00SCREW BONE L32 MM L15 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L32 MM OD2.4 MM ODSEC3.5 MM CORTEX SELF C1713 $430.08SCREW BONE L32 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L32 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L32 MM OD3.5 MM ELBOW LOCKING HEXALOBE C1713 $676.00SCREW BONE L32 MM OD3.5 MM ELBOW NONLOCKING HEXALO C1713 $435.50SCREW BONE L32 MM OD3.5 MM NONLOCK HEXALOBE HEAD N C1713 $435.50SCREW BONE L32 MM OD3.5 MM SPINE C1713 $3,900.00SCREW BONE L32 MM OD4 MM COMPRESSION HEADLESS C1713 $2,062.32

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 ChargeSCREW BONE L32 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE L32 MM OD6 MM TIBIA C1713 $906.88SCREW BONE L34 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L34 MM L11 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L34 MM L15 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L34 MM OD2.4 MM ODSEC3.5 MM CORTEX SELF C1713 $430.08SCREW BONE L34 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L34 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L34 MM OD3.5 MM ELBOW NONLOCKING HEXALO C1713 $435.50SCREW BONE L34 MM OD3.5 MM NONLOCK HEXALOBE HEAD N C1713 $435.50SCREW BONE L34 MM OD6 MM TIBIA CORTICAL OSTEOTOMY C1713 $906.88SCREW BONE L35 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L35 MM OD4 MM FIX ANGLE C1713 $2,800.00SCREW BONE L35 MM OD4 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L35 MM OD4 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L35 MM OD4.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L35 MM OD4.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L35 MM OD4.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L35 MM OD4.75 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L35 MM OD5 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L35 MM OD5 MM SPINE POSTERIOR UNIPLANAR C1713 $5,200.00SCREW BONE L35 MM OD5 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L35 MM OD5.5 MM CORTICAL NONSTERILE LAT C1713 $868.66SCREW BONE L35 MM OD5.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L35 MM OD5.5 MM POLYAXIAL NONSTERILE ME C1713 $5,200.00SCREW BONE L35 MM OD5.5 MM SPINE POLYAXIAL REVOLVE C1713 $4,550.00SCREW BONE L35 MM OD5.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L35 MM OD6.5 MM FIX C1713 $2,800.00SCREW BONE L35 MM OD6.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L35 MM OD6.5 MM POLYAXIAL NONSTERILE DE C1713 $5,200.00SCREW BONE L35 MM OD6.5 MM POLYAXIAL NONSTERILE ME C1713 $5,200.00SCREW BONE L35 MM OD6.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L35 MM OD7.5 MM FIX C1713 $2,800.00SCREW BONE L35 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L35 MM OD8.5 MM FIX C1713 $2,800.00SCREW BONE L35 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE L350 MM OD4 MM TRANSFIXING DRILLING TIP C1713 $878.40SCREW BONE L350 MM OD5 MM ANKLE TRANSFIXING C1713 $955.20SCREW BONE L36 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00

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 ChargeSCREW BONE L36 MM L15 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L36 MM OD2.4 MM ODSEC3.5 MM CORTEX SELF C1713 $430.08SCREW BONE L36 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L36 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L36 MM OD3.5 MM NONLOCK HEXALOBE HEAD N C1713 $435.50SCREW BONE L36 MM OD3.5 MM SPINE C1713 $3,900.00SCREW BONE L36 MM OD4 MM CORTICAL 2 LEAD C1713 $1,071.36SCREW BONE L36 MM OD4 MM ORTHOPEDIC 2 THREAD C1713 $1,585.92SCREW BONE L36 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE L38 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L38 MM L13 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L38 MM L16 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L38 MM OD2.4 MM ODSEC3.5 MM CORTEX SELF C1713 $430.08SCREW BONE L38 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L38 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L38 MM OD3.5 MM ELBOW CALCANEAL NONLOCK C1713 $435.50SCREW BONE L38 MM OD3.5 MM ELBOW LOCK HEXALOBE NON C1713 $676.00SCREW BONE L38 MM OD3.5 MM ELBOW LOCKING HEXALOBE C1713 $676.00SCREW BONE L38 MM OD3.5 MM ELBOW NONLOCKING HEXALO C1713 $435.50SCREW BONE L38 MM OD4 MM CORTICAL 2 LEAD C1713 $1,071.36SCREW BONE L38 MM OD4 MM ORTHOPEDIC PILOT TIPPED C1713 $1,585.92SCREW BONE L39 MM OD5.5 MM SPINAL VERTEBRAL TRUSS C1713 $1,300.00SCREW BONE L4 MM OD1.5 MM CORTICAL CRANIOMAXILLOFA C1713 $780.00SCREW BONE L4 MM OD2 MM CRANIOMAXILLOFACIAL CORTIC C1713 $780.00SCREW BONE L4 MM OD2.5 MM CORTICAL CRANIOMAXILLOFA C1713 $780.00SCREW BONE L40 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L40 MM L13 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L40 MM L16 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L40 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L40 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L40 MM OD2.4 MM OD3.5 MM CORTEX SELF TA C1713 $430.08SCREW BONE L40 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L40 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L40 MM OD3.5 MM NONLOCK HEXALOBE HEAD N C1713 $435.50SCREW BONE L40 MM OD4 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L40 MM OD4 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L40 MM OD4.2 MM CANCELLOUS MULTIDIRECTI C1713 $705.06SCREW BONE L40 MM OD4.5 MM ODSEC8 MM HIP CORTICAL C1713 $126.88SCREW BONE L40 MM OD4.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00

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 ChargeSCREW BONE L40 MM OD4.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L40 MM OD4.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L40 MM OD4.75 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L40 MM OD5 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L40 MM OD5 MM SPINE POSTERIOR UNIPLANAR C1713 $5,200.00SCREW BONE L40 MM OD5 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L40 MM OD5.5 MM FIX C1713 $2,800.00SCREW BONE L40 MM OD5.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L40 MM OD5.5 MM POLYAXIAL NONSTERILE DE C1713 $5,200.00SCREW BONE L40 MM OD5.5 MM POLYAXIAL NONSTERILE ME C1713 $5,200.00SCREW BONE L40 MM OD5.5 MM SPINE FIX C1713 $2,800.00SCREW BONE L40 MM OD5.5 MM SPINE POLYAXIAL REVOLVE C1713 $4,550.00SCREW BONE L40 MM OD5.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L40 MM OD6.5 MM FIX C1713 $2,800.00SCREW BONE L40 MM OD6.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L40 MM OD6.5 MM POLYAXIAL NONSTERILE DE C1713 $5,200.00SCREW BONE L40 MM OD6.5 MM POLYAXIAL NONSTERILE ME C1713 $5,200.00SCREW BONE L40 MM OD6.5 MM SPINE FIX C1713 $2,800.00SCREW BONE L40 MM OD6.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L40 MM OD7.5 MM FIX C1713 $2,800.00SCREW BONE L40 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L40 MM OD8.5 MM FIX C1713 $2,800.00SCREW BONE L40 MM OD8.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L40 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE L42 MM 2 LEAD THREAD C1713 $1,071.36SCREW BONE L42 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L42 MM L14 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L42 MM L16 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L42 MM OD2.4 MM OD3.5 MM CORTEX SELF TA C1713 $430.08SCREW BONE L42 MM OD5.5 MM SPINAL VERTEBRAL TRUSS C1713 $1,300.00SCREW BONE L44 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L44 MM L17 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L44 MM OD2.4 MM OD3.5 MM CORTEX SELF TA C1713 $430.08SCREW BONE L44 MM OD6 MM CORTICAL C1713 $906.88SCREW BONE L45 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L45 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L45 MM OD3.5 MM ELBOW LOCKING HEXALOBE C1713 $676.00SCREW BONE L45 MM OD3.5 MM LOCK HEXALOBE HEAD NONS C1713 $676.00SCREW BONE L45 MM OD3.5 MM NONLOCK HEXALOBE HEAD N C1713 $435.50

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 ChargeSCREW BONE L45 MM OD4 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L45 MM OD4.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L45 MM OD4.75 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L45 MM OD5 MM SPINE POLYAXIAL DEFORMITY C1713 $5,200.00SCREW BONE L45 MM OD5 MM SPINE POSTERIOR UNIPLANAR C1713 $5,200.00SCREW BONE L45 MM OD5 MM SPINE UNIPLANAR DEFORMITY C1713 $5,200.00SCREW BONE L45 MM OD5.5 MM FIX C1713 $2,800.00SCREW BONE L45 MM OD5.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L45 MM OD5.5 MM SPINAL VERTEBRAL TRUSS C1713 $1,300.00SCREW BONE L45 MM OD5.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L45 MM OD5.5 MM SPINE POLYAXIAL REVOLVE C1713 $4,550.00SCREW BONE L45 MM OD5.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L45 MM OD5.5 MM SPINE UNIPLANAR NONSTER C1713 $5,200.00SCREW BONE L45 MM OD6.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L45 MM OD6.5 MM SPINE CANNULATED SHANK C1713 $2,600.00SCREW BONE L45 MM OD6.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L45 MM OD6.5 MM SPINE REVOLVING C1713 $4,550.00SCREW BONE L45 MM OD6.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L45 MM OD7.5 MM FIX C1713 $2,800.00SCREW BONE L45 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L45 MM OD8.5 MM FIX C1713 $2,800.00SCREW BONE L45 MM OD8.5 MM POLYAXIAL NONSTERILE ME C1713 $5,200.00SCREW BONE L45 MM OD8.5 MM SPINE FOUNDATION NONSTE C1713 $5,200.00SCREW BONE L46 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L46 MM L15 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L46 MM L17 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L46 MM L9 MM OD4 MM CANCELLOUS CANNULAT C1713 $659.04SCREW BONE L46 MM OD2.4 MM OD3.5 MM CORTEX SELF TA C1713 $460.19SCREW BONE L48 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L48 MM L16 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L48 MM L18 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L48 MM OD2.3 MM ODSEC3.5 MM CORTICAL SE C1713 $460.19SCREW BONE L5 MM OD1.5 MM CRANIOMAXILLOFACIAL CORT C1713 $780.00SCREW BONE L5 MM OD1.5 MM CRANIOMAXILLOFACIAL CROS C1713 $408.20SCREW BONE L50 MM L10 MM OD3.5 MM CANNULATED C1713 $780.00SCREW BONE L50 MM L16 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L50 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L50 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L50 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75

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 ChargeSCREW BONE L50 MM L18 MM OD4 MM CANNULATED C1713 $780.00SCREW BONE L50 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L50 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L50 MM OD2.4 MM OD3.5 MM CORTEX SELF TA C1713 $430.08SCREW BONE L50 MM OD3 MM ELBOW LOCKING HEXALOBE NO C1713 $617.50SCREW BONE L50 MM OD3.5 MM CORTICAL C1713 $253.76SCREW BONE L50 MM OD3.5 MM CORTICAL LOW PROFILE NO C1713 $297.44SCREW BONE L50 MM OD3.5 MM LOCK HEXALOBE HEAD NONS C1713 $812.50SCREW BONE L50 MM OD4.75 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L50 MM OD4.75 MM SPINE MULTI AXIAL C1713 $4,800.00SCREW BONE L50 MM OD5.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L50 MM OD5.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L50 MM OD5.5 MM SPINE POLYAXIAL REVOLVE C1713 $4,550.00SCREW BONE L50 MM OD5.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L50 MM OD6.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L50 MM OD6.5 MM SPINE CONSTRUCTION C1713 $5,200.00SCREW BONE L50 MM OD6.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L50 MM OD6.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L50 MM OD7.5 MM FIX C1713 $2,800.00SCREW BONE L50 MM OD7.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L50 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L50 MM OD8.5 MM FIX C1713 $2,800.00SCREW BONE L50 MM OD8.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L50 MM ORTHOPEDIC LAG C1713 $3,927.04SCREW BONE L51 MM OD5.5 MM SPINAL VERTEBRAL TRUSS C1713 $1,300.00SCREW BONE L52 MM L17 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L52 MM OD4.5 MM CORTICAL C1713 $243.75SCREW BONE L54 MM L18 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L54 MM OD2.4 MM OD3.5 MM CORTEX SELF TA C1713 $430.08SCREW BONE L54 MM OD5.5 MM SPINAL VERTEBRAL TRUSS C1713 $1,300.00SCREW BONE L55 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L55 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L55 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L55 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L55 MM OD3.5 MM ELBOW HEXALOBE NONSTERI C1713 $565.50SCREW BONE L55 MM OD3.5 MM ELBOW LOCKING HEXALOBE C1713 $812.50SCREW BONE L55 MM OD5.5 MM FIX C1713 $2,800.00SCREW BONE L55 MM OD5.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L55 MM OD5.5 MM SPINE POLYAXIAL REVOLVE C1713 $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 ChargeSCREW BONE L55 MM OD6.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L55 MM OD6.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L55 MM OD7.5 MM FIX C1713 $2,800.00SCREW BONE L55 MM OD7.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L55 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L55 MM OD8.5 MM FIX C1713 $2,800.00SCREW BONE L55 MM OD8.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE L56 MM L19 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L56 MM OD2.4 MM OD3.5 MM CORTEX SELF TA C1713 $430.08SCREW BONE L56 MM OD4.5 MM CORTICAL C1713 $248.63SCREW BONE L58 MM OD2.4 MM OD3.5 MM CORTEX SELF TA C1713 $430.08SCREW BONE L6 MM OD1.2 MM LAG NONSTERILE C1713 $560.00SCREW BONE L6 MM OD1.5 MM CRANIOMAXILLOFACIAL CORT C1713 $780.00SCREW BONE L6 MM OD2 MM CRANIOMAXILLOFACIAL CORTIC C1713 $780.00SCREW BONE L6 MM OD2.5 MM CRANIOMAXILLOFACIAL CORT C1713 $549.60SCREW BONE L6 MM OD2.7 MM HEXALOBE C1713 $390.00SCREW BONE L60 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L60 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L60 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L60 MM L20 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L60 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L60 MM L32 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L60 MM OD5.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L60 MM OD6.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L60 MM OD6.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L60 MM OD6.5 MM VARIABLE C1713 $4,800.00SCREW BONE L60 MM OD7.5 MM MULTI AXIAL C1713 $4,800.00SCREW BONE L60 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L60 MM OD7.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L60 MM OD8.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L64 MM L21 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L65 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L65 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L65 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L65 MM LAG FIXED SOLID C1713 $2,680.08SCREW BONE L65 MM LAG SLIDING SOLID C1713 $2,680.08SCREW BONE L65 MM LAG TELESCOPING KEYLESS C1713 $3,350.88SCREW BONE L65 MM OD3.5 MM ELBOW HEXALOBE NONSTERI C1713 $565.50SCREW BONE L65 MM OD5.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00

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 ChargeSCREW BONE L65 MM OD6.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L65 MM OD6.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L65 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L65 MM OD7.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L69 MM L23 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L7 MM OD2.3 MM OD3.5 MM CORTICAL HEAD S C1713 $430.08SCREW BONE L70 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L70 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L70 MM L20 MM CORTICAL SELF DRILLING C1713 $916.48SCREW BONE L70 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L70 MM OD7.5 MM MULTI AXIAL C1713 $4,800.00SCREW BONE L70 MM OD8.5 MM SPINE ILIAC POLYAXIAL O C1713 $3,900.00SCREW BONE L70 MM OD8.5 MM SPINE POLYAXIAL DARK BL C1713 $3,900.00SCREW BONE L72 MM L24 MM OD4.5 MM CANNULATED C1713 $809.25SCREW BONE L75 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L75 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L75 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L75 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L75 MM LAG C1713 $3,927.04SCREW BONE L75 MM OD5.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L75 MM OD6.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L75 MM OD6.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L75 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L75 MM OD7.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L8 MM OD1.5 MM CORTICAL CRANIOMAXILLOFA C1713 $780.00SCREW BONE L8 MM OD1.5 MM CRANIOMAXILLOFACIAL CORT C1713 $780.00SCREW BONE L8 MM OD2 MM CRANIOMAXILLOFACIAL CORTIC C1713 $780.00SCREW BONE L8 MM OD2.5 MM CORTICAL CRANIOMAXILLOFA C1713 $549.60SCREW BONE L8 MM OD2.7 MM CORTICAL SELF TAP C1713 $156.00SCREW BONE L80 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L80 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L80 MM L20 MM CORTICAL SELF DRILLING C1713 $1,514.24SCREW BONE L80 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L80 MM L35 MM OD3 MM CORTICAL SELF DRIL C1713 $916.48SCREW BONE L80 MM LAG C1713 $3,927.04SCREW BONE L80 MM OD8.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L80 MM OD8.5 MM SPINE POLYAXIAL GREEN C1713 $3,900.00SCREW BONE L85 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L85 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75

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 ChargeSCREW BONE L85 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L85 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L85 MM LAG C1713 $3,927.04SCREW BONE L85 MM OD5.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L85 MM OD6 MM C1713 $906.88SCREW BONE L85 MM OD6.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L85 MM OD6.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L85 MM OD7.5 MM SPINE POLYAXIAL DEFORMI C1713 $5,200.00SCREW BONE L85 MM OD7.5 MM SPINE UNIPLANAR DEFORMI C1713 $5,200.00SCREW BONE L85 MM ORTHOPEDIC LAG TELESCOPING ASSEM C1713 $3,350.88SCREW BONE L9 MM OD2.4 MM ODSEC3.5 MM CORTEX SELF C1713 $460.19SCREW BONE L90 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L90 MM L16 MM OD6.5 MM CANNULATED C1713 $971.75SCREW BONE L90 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L90 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE L90 MM LAG C1713 $3,927.04SCREW BONE L90 MM OD6 MM C1713 $906.88SCREW BONE L90 MM OD6.5 MM METAPHYSEAL CANNULATED C1713 $1,566.24SCREW BONE L90 MM OD8.5 MM MULTIAXIAL C1713 $4,800.00SCREW BONE L90 MM OD8.5 MM SPINE ILIAC MULTIAXIAL C1713 $3,900.00SCREW BONE L95 MM HIP LAG C1713 $3,927.04SCREW BONE L95 MM L16 MM OD5.8 MM CANNULATED C1713 $890.50SCREW BONE L95 MM L16 MM OD7.5 MM CANNULATED C1713 $1,036.75SCREW BONE L95 MM L22 MM LAG SELF TAP APS C1713 $1,105.00SCREW BONE LC-DCP TITANIUM FULL THREAD HEXAGON L32 C1713 $145.92SCREW BONE LC-DCP TITANIUM FULL THREAD L100 MM OD4 C1713 $156.40SCREW BONE LC-DCP TITANIUM FULL THREAD L30 MM OD6. C1713 $264.48SCREW BONE LC-DCP TITANIUM FULL THREAD L65 MM OD4 C1713 $156.40SCREW BONE LC-DCP TITANIUM FULL THREAD L75 MM OD4 C1713 $156.40SCREW BONE LC-DCP TITANIUM FULL THREAD L85 MM OD4 C1713 $156.40SCREW BONE LC-DCP TITANIUM FULL THREAD L95 MM OD4 C1713 $156.40SCREW BONE LC-DCP TITANIUM HEXAGON SPHERE L45 MM O C1713 $154.08SCREW BONE LC-DCP TITANIUM HEXAGON SPHERE L50 MM O C1713 $154.08SCREW BONE LC-DCP TITANIUM L115 MM L16 MM OD6.5 MM C1713 $358.80SCREW BONE LC-DCP TITANIUM L120 MM L16 MM OD6.5 MM C1713 $358.80SCREW BONE LC-DCP TITANIUM L60 MM OD4 MM TIBIA CAN C1713 $138.32SCREW BONE LC-DCP TITANIUM L65 MM OD4 MM TIBIA CAN C1713 $153.52SCREW BONE LC-DCP TITANIUM L75 MM OD4 MM TIBIA CAN C1713 $153.52SCREW BONE LC-DCP TITANIUM L85 MM OD4 MM TIBIA CAN C1713 $153.52

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 ChargeSCREW BONE LC-DCP TITANIUM L95 MM OD4 MM TIBIA CAN C1713 $153.52SCREW BONE LC-DCP TITANIUM PARTIAL THREAD HEXAGON C1713 $138.32SCREW BONE LC-DCP TITANIUM STANDARD L36 MM OD4.5 M C1713 $131.04SCREW BONE LCP DHHS STAINLESS STEEL L90 MM OD2.4 M C1713 $308.16SCREW BONE LCP STARDRIVE TITANIUM ALLOY L14 MM OD1 C1713 $248.50SCREW BONE LCP STARDRIVE TITANIUM L30 MM OD2.7 MM C1713 $804.96SCREW BONE LCP STARDRIVE TITANIUM L40 MM OD2.7 MM C1713 $804.96SCREW BONE LCP TITANIUM 1/3 THREAD HEXAGON L40 MM C1713 $1,402.96SCREW BONE LCP TITANIUM 1/3 THREAD HEXAGON L42 MM C1713 $1,402.96SCREW BONE LCP TITANIUM ALLOY L15 MM OD1.5 MM CORT C1713 $248.50SCREW BONE LCP TITANIUM ALLOY L16 MM OD1.5 MM CORT C1713 $248.50SCREW BONE LCP TITANIUM ALLOY L18 MM OD1.5 MM CORT C1713 $248.50SCREW BONE LCP TITANIUM ALLOY L20 MM OD1.5 MM CORT C1713 $248.50SCREW BONE LCP TITANIUM ALLOY L22 MM OD1.5 MM CORT C1713 $248.50SCREW BONE LCP TITANIUM ALLOY L24 MM OD1.5 MM CORT C1713 $248.50SCREW BONE LCP TITANIUM FULL THREAD L70 MM OD4 MM C1713 $156.40SCREW BONE LCP TITANIUM FULL THREAD L8 MM OD2.7 MM C1713 $246.08SCREW BONE LCP TITANIUM FULL THREAD L80 MM OD4 MM C1713 $156.40SCREW BONE LCP TITANIUM FULL THREAD L90 MM OD4 MM C1713 $156.40SCREW BONE LCP TITANIUM L10 MM OD2 MM SMALL BONE C C1713 $635.38SCREW BONE LCP TITANIUM L10 MM OD5 MM ORTHOPEDIC S C1713 $1,780.16SCREW BONE LCP TITANIUM L11 MM OD2 MM HAND FOOT WR C1713 $635.38SCREW BONE LCP TITANIUM L12 MM OD2 MM SMALL BONE C C1713 $635.38SCREW BONE LCP TITANIUM L12 MM OD5 MM ORTHOPEDIC S C1713 $1,780.16SCREW BONE LCP TITANIUM L13 MM OD2 MM ORTHOPEDIC S C1713 $635.38SCREW BONE LCP TITANIUM L14 MM OD2 MM SMALL BONE C C1713 $635.38SCREW BONE LCP TITANIUM L16 MM OD2 MM ORTHOPEDIC S C1713 $635.38SCREW BONE LCP TITANIUM L18 MM OD2 MM ORTHOPEDIC S C1713 $635.38SCREW BONE LCP TITANIUM L22 MM OD2 MM ORTHOPEDIC S C1713 $635.38SCREW BONE LCP TITANIUM L24 MM OD2 MM ORTHOPEDIC S C1713 $635.38SCREW BONE LCP TITANIUM L26 MM OD2 MM ORTHOPEDIC S C1713 $635.38SCREW BONE LCP TITANIUM L26 MM OD2.7 MM HUMERUS DI C1713 $804.96SCREW BONE LCP TITANIUM L28 MM OD2 MM ORTHOPEDIC S C1713 $635.38SCREW BONE LCP TITANIUM L28 MM OD2.7 MM HUMERUS DI C1713 $804.96SCREW BONE LCP TITANIUM L30 MM OD2 MM CORTICAL T6 C1713 $679.85SCREW BONE LCP TITANIUM L32 MM OD2.7 MM HUMERUS DI C1713 $804.96SCREW BONE LCP TITANIUM L34 MM OD2.7 MM HUMERUS DI C1713 $804.96SCREW BONE LCP TITANIUM L38 MM OD2.7 MM SELF TAPPI C1713 $804.96SCREW BONE LCP TITANIUM L40 MM OD2.7 MM ODSEC5 MM C1713 $221.44

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 ChargeSCREW BONE LCP TITANIUM L42 MM OD2.7 MM CORTICAL S C1713 $221.44SCREW BONE LCP TITANIUM L42 MM OD2.7 MM HUMERUS DI C1713 $804.96SCREW BONE LCP TITANIUM L44 MM OD2.7 MM CORTICAL S C1713 $221.44SCREW BONE LCP TITANIUM L44 MM OD2.7 MM SELF TAPPI C1713 $804.96SCREW BONE LCP TITANIUM L46 MM OD2.7 MM SELF TAPPI C1713 $804.96SCREW BONE LCP TITANIUM L48 MM OD2.7 MM HUMERUS DI C1713 $804.96SCREW BONE LCP TITANIUM L50 MM OD2 MM CORTICAL T6 C1713 $804.96SCREW BONE LCP TITANIUM L50 MM OD2.7 MM CORTICAL S C1713 $221.44SCREW BONE LCP TITANIUM L54 MM OD3.5 MM FIBULA HUM C1713 $695.18SCREW BONE LCP TITANIUM L55 MM OD2.7 MM CORTICAL S C1713 $221.44SCREW BONE LCP TITANIUM L55 MM OD2.7 MM HUMERUS DI C1713 $804.96SCREW BONE LCP TITANIUM L56 MM OD3.5 MM FIBULA HUM C1713 $695.18SCREW BONE LCP TITANIUM L58 MM OD3.5 MM FIBULA HUM C1713 $695.18SCREW BONE LCP TITANIUM L6 MM OD2 MM ORTHOPEDIC SE C1713 $635.38SCREW BONE LCP TITANIUM L60 MM OD2 MM CORTICAL T6 C1713 $804.96SCREW BONE LCP TITANIUM L60 MM OD2.7 MM CORTICAL S C1713 $221.44SCREW BONE LCP TITANIUM L65 MM OD3.5 MM TIBIA PROX C1713 $695.18SCREW BONE LCP TITANIUM L7 MM OD2 MM ORTHOPEDIC SE C1713 $635.38SCREW BONE LCP TITANIUM L8 MM OD2 MM CORTICAL SELF C1713 $635.38SCREW BONE LCP TITANIUM L8 MM OD2.7 MM SELF TAPPIN C1713 $804.96SCREW BONE LCP TITANIUM L8 MM OD5 MM ORTHOPEDIC SE C1713 $1,780.16SCREW BONE LCP TITANIUM L85 MM OD3.5 MM TIBIA PROX C1713 $695.18SCREW BONE LCP TITANIUM L9 MM OD2 MM ORTHOPEDIC SE C1713 $679.85SCREW BONE LCP TITANIUM L90 MM OD3.5 MM MEDIAL LAT C1713 $695.18SCREW BONE LCP TITANIUM L95 MM OD3.5 MM TIBIA MEDI C1713 $695.18SCREW BONE LCP TITANIUM PARTIAL THREAD CONICAL L75 C1713 $933.76SCREW BONE LCP TITANIUM PARTIAL THREAD L100 MM OD4 C1713 $153.52SCREW BONE LCP TITANIUM PARTIAL THREAD L40 MM L12 C1713 $154.08SCREW BONE LCP TITANIUM PARTIAL THREAD L70 MM OD4 C1713 $153.52SCREW BONE LCP TITANIUM PARTIAL THREAD L80 MM OD4 C1713 $153.52SCREW BONE LCP TITANIUM PARTIAL THREAD L90 MM OD4 C1713 $153.52SCREW BONE LCP TITANIUM T15 FULL THREAD L35 MM OD3 C1713 $695.18SCREW BONE LCP TITANIUM T15 FULL THREAD L44 MM OD3 C1713 $695.18SCREW BONE LCP TITANIUM T15 FULL THREAD L46 MM OD3 C1713 $695.18SCREW BONE LCP TITANIUM T15 FULL THREAD L48 MM OD3 C1713 $695.18SCREW BONE LCP TITANIUM T15 FULL THREAD L52 MM OD3 C1713 $695.18SCREW BONE LCP TITANIUM T15 FULL THREAD L75 MM OD3 C1713 $695.18SCREW BONE LCP TITANIUM T6 L20 MM OD2 MM CORTICAL C1713 $635.38SCREW BONE LCP TITANIUM T8 L10 MM OD2.4 MM ODSEC4 C1713 $323.36

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 ChargeSCREW BONE LCP TITANIUM T8 L20 MM OD2.4 MM ODSEC4 C1713 $323.36SCREW BONE LCP TITANIUM T8 L22 MM OD2.4 MM ODSEC4 C1713 $323.36SCREW BONE LCP TITANIUM T8 L24 MM OD2.4 MM ODSEC4 C1713 $323.36SCREW BONE LCP TITANIUM T8 L28 MM OD2.4 MM ODSEC4 C1713 $323.36SCREW BONE LCP TITANIUM T8 L30 MM OD2.4 MM ODSEC4 C1713 $323.36SCREW BONE LCP TITANIUM T8 L46 MM OD2.7 MM RADIUS C1713 $221.44SCREW BONE LCP TITANIUM T8 L48 MM OD2.7 MM RADIUS C1713 $221.44SCREW BONE LCP TITANIUM T8 L6 MM OD2.4 MM ODSEC4 M C1713 $323.36SCREW BONE LCP TITANIUM T8 L8 MM OD2.4 MM ODSEC4 M C1713 $323.36SCREW BONE LEGACY CD HORIZON L40 MM OD5.5 MM SPINE C1713 $5,200.00SCREW BONE LEGACY CD HORIZON L40 MM OD7.5 MM SPINE C1713 $5,200.00SCREW BONE LEGACY CD HORIZON L45 MM OD7.5 MM SPINE C1713 $5,200.00SCREW BONE LEGACY CD HORIZON L50 MM OD6.5 MM SPINE C1713 $5,200.00SCREW BONE LEGACY CD HORIZON L50 MM OD7.5 MM SPINE C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK HA L40 MM OD5.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK HA L40 MM OD7.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK HA L45 MM OD7.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK HA L50 MM OD6.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK HA L50 MM OD7.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK L40 MM OD5.5 MM C1713 $3,900.00SCREW BONE LEGACY CD HORIZON PEEK L40 MM OD7.5 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK L45 MM OD7.5 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK L50 MM OD6.5 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON PEEK L50 MM OD7.5 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL 10 D C1713 $2,275.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL 20 D C1713 $3,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L100 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L110 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L20 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L25 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L27.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L30 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L32.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L35 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L37.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L40 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L45 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L50 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L55 M C1713 $3,200.00

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 ChargeSCREW BONE LEGACY CD HORIZON STAINLESS STEEL L60 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L65 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L70 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L75 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L80 M C1713 $3,900.00SCREW BONE LEGACY CD HORIZON STAINLESS STEEL L90 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L100 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L35 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L40 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L45 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L50 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L55 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L60 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L70 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L80 MM C1713 $2,275.00SCREW BONE LEGACY CD HORIZON TITANIUM 10 D L90 MM C1713 $2,800.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L100 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L35 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L40 MM C1713 $2,275.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L45 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L50 MM C1713 $2,275.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L55 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L60 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L70 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L80 MM C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM 20 D L90 MM C1713 $2,800.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L20 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L25 MM C1713 $4,800.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L30 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L35 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L40 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L45 MM C1713 $4,800.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L50 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L55 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L60 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L65 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L70 MM C1713 $4,800.00SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L75 MM C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L100 MM OD10 C1713 $5,200.00

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 ChargeSCREW BONE LEGACY CD HORIZON TITANIUM L100 MM OD5. C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L100 MM OD6. C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L100 MM OD7. C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L100 MM OD8. C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L100 MM OD9. C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L110 MM OD10 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L110 MM OD9. C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L20 MM OD4 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L20 MM OD4.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L20 MM OD5 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L20 MM OD5.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L25 MM OD4 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L25 MM OD4.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L25 MM OD5 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L25 MM OD5.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L25 MM OD6 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L25 MM OD6.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L25 MM OD7.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L25 MM OD8.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L30 MM OD4 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L30 MM OD4.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L30 MM OD5 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L30 MM OD5.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L30 MM OD6 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L30 MM OD6.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L30 MM OD7.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L30 MM OD8.5 C1713 $4,800.00SCREW BONE LEGACY CD HORIZON TITANIUM L35 MM OD4 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L35 MM OD4.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L35 MM OD5 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L35 MM OD5.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L35 MM OD6 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L35 MM OD6.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L35 MM OD7.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L35 MM OD8.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD4 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD4.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD5 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD5.5 C1713 $3,900.00

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 ChargeSCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD6 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD6.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD7.5 C1713 $3,900.00SCREW BONE LEGACY CD HORIZON TITANIUM L40 MM OD8.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD4 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD4.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD5 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD5.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD6 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD6.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD7.5 C1713 $3,900.00SCREW BONE LEGACY CD HORIZON TITANIUM L45 MM OD8.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD4 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD4.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD5 M C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD5.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD6 M C1713 $4,800.00SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD6.5 C1713 $2,275.00SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD7.5 C1713 $3,900.00SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD8.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD4 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD4.5 C1713 $2,800.00SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD5 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD5.5 C1713 $2,800.00SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD6 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD6.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD7.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L55 MM OD8.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L60 MM OD5.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L60 MM OD6 M C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L60 MM OD6.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L60 MM OD7.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L60 MM OD8.5 C1713 $4,800.00SCREW BONE LEGACY CD HORIZON TITANIUM L65 MM OD6.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L65 MM OD7.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L65 MM OD8.5 C1713 $4,800.00SCREW BONE LEGACY CD HORIZON TITANIUM L70 MM OD5.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L70 MM OD6.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L70 MM OD7.5 C1713 $3,200.00

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 ChargeSCREW BONE LEGACY CD HORIZON TITANIUM L70 MM OD8.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L75 MM OD6.5 C1713 $4,800.00SCREW BONE LEGACY CD HORIZON TITANIUM L75 MM OD7.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L75 MM OD8.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L80 MM OD10. C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L80 MM OD5.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L80 MM OD6.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L80 MM OD7.5 C1713 $2,275.00SCREW BONE LEGACY CD HORIZON TITANIUM L80 MM OD8.5 C1713 $2,275.00SCREW BONE LEGACY CD HORIZON TITANIUM L80 MM OD9.5 C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L90 MM OD10. C1713 $5,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L90 MM OD5.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L90 MM OD6.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L90 MM OD7.5 C1713 $3,200.00SCREW BONE LEGACY CD HORIZON TITANIUM L90 MM OD8.5 C1713 $3,200.00SCREW BONE LEGACY L10 MM OD3.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L10 MM OD4 MM SPINE FIX ANGLE 3. C1713 $3,200.00SCREW BONE LEGACY L15 MM OD3.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L15 MM OD4 MM SPINE FIX ANGLE 3. C1713 $2,800.00SCREW BONE LEGACY L15 MM OD4.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L20 MM OD3.5 MM SPINE FIX ANGLE C1713 $2,800.00SCREW BONE LEGACY L20 MM OD4 MM SPINE FIX ANGLE 3. C1713 $3,200.00SCREW BONE LEGACY L20 MM OD4.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L20 MM OD5.5 MM SPINE FIX ANGLE C1713 $2,800.00SCREW BONE LEGACY L25 MM OD3.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L25 MM OD4 MM SPINE FIX ANGLE 3. C1713 $3,200.00SCREW BONE LEGACY L25 MM OD4.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L25 MM OD5.5 MM SPINE FIX ANGLE C1713 $2,800.00SCREW BONE LEGACY L30 MM OD3.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L30 MM OD4 MM SPINE FIX ANGLE 3. C1713 $3,200.00SCREW BONE LEGACY L30 MM OD4.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L30 MM OD5.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L35 MM OD4 MM SPINE FIX ANGLE 3. C1713 $3,200.00SCREW BONE LEGACY L35 MM OD4.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L35 MM OD5.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L40 MM OD4 MM SPINE FIX ANGLE 3. C1713 $2,800.00SCREW BONE LEGACY L40 MM OD4.5 MM SPINE FIX ANGLE C1713 $2,800.00SCREW BONE LEGACY L40 MM OD5.5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE LEGACY L45 MM OD5.5 MM SPINE FIX ANGLE C1713 $3,200.00

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 ChargeSCREW BONE LEGACY TITANIUM 20 D L60 MM OD7.5 MM IL C1713 $2,800.00SCREW BONE LEIBINGER TITANIUM L12 MM OD2.3 MM MAXI C1713 $482.08SCREW BONE LEIBINGER UNIVERSAL 2 MMF TITANIUM L8 M C1713 $717.15SCREW BONE LEIBINGER UNIVERSAL 2 SMARTLOCK TITANIU C1713 $1,008.00SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L10 MM O C1713 $502.40SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L12 MM O C1713 $767.20SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L14 MM O C1713 $767.20SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L16 MM O C1713 $767.20SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L18 MM O C1713 $767.20SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L20 MM O C1713 $665.36SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L3 MM OD C1713 $434.56SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L4 MM OD C1713 $366.64SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L5 MM OD C1713 $420.96SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L6 MM OD C1713 $448.08SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L7 MM OD C1713 $454.88SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L8 MM OD C1713 $448.08SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L9 MM OD C1713 $475.28SCREW BONE LEIBINGER UNIVERSAL TITANIUM L20 MM OD2 C1713 $441.36SCREW BONE LEVEL ONE MAXDRIVE DRILL-FREE TITANIUM C1713 $615.68SCREW BONE LEVEL ONE MAXDRIVE TI-6AL-4V L13 MM OD2 C1713 $757.76SCREW BONE LEVEL ONE MAXDRIVE TI6AL4V L16 MM L12 M C1713 $615.68SCREW BONE LEVEL ONE MAXDRIVE TI-6AL-4V MICRO L4 M C1713 $384.80SCREW BONE LEVEL ONE MAXDRIVE TI-6AL-4V MICRO L5 M C1713 $384.80SCREW BONE LEVEL ONE MAXDRIVE TI-6AL-4V MINI L7 MM C1713 $367.04SCREW BONE LEVEL ONE MAXDRIVE TITANIUM ALUMINUM VA C1713 $367.04SCREW BONE LEVEL ONE MAXDRIVE TITANIUM L11 MM OD2 C1713 $757.76SCREW BONE LEVEL ONE TI-6AL-4V MICRO L4 MM OD1.5 M C1713 $318.80SCREW BONE LEVEL ONE TITANIUM L11 MM OD2.7 MM CRAN C1713 $917.60SCREW BONE LEVEL ONE TITANIUM L7 MM OD2.3 MM CRANI C1713 $834.72SCREW BONE LEVEL ONE TITANIUM L9 MM OD2.3 MM CRANI C1713 $834.72SCREW BONE LEVEL ONE TITANIUM MICRO L3.5 MM OD1.5 C1713 $318.80SCREW BONE LINEUM TITANIUM L14 MM OD3.5 MM OCCIPIT C1713 $3,900.00SCREW BONE LINEUM TITANIUM L30 MM OD4 MM OCCIPITOC C1713 $3,900.00SCREW BONE LINEUM TITANIUM L34 MM OD4 MM OCCIPITOC C1713 $3,900.00SCREW BONE LINEUM TITANIUM STANDARD HELIX L12 MM O C1713 $3,900.00SCREW BONE LINEUM TITANIUM STANDARD HELIX L14 MM O C1713 $3,900.00SCREW BONE LINEUM TITANIUM STANDARD L22 MM OD3.5 M C1713 $3,900.00SCREW BONE LISS TITANIUM L40 MM OD5 MM SELF DRILL C1713 $1,476.56SCREW BONE LISS TITANIUM L45 MM OD5 MM SELF DRILL C1713 $1,476.56

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 ChargeSCREW BONE LISS TITANIUM L50 MM OD5 MM SELF DRILL C1713 $1,476.56SCREW BONE LISS TITANIUM L51 MM OD5 MM SELF DRILL C1713 $1,476.56SCREW BONE LISS TITANIUM L52 MM OD5 MM SELF DRILL C1713 $1,476.56SCREW BONE LISS TITANIUM L53 MM OD5 MM SELF DRILL C1713 $1,476.56SCREW BONE LISS TITANIUM L54 MM OD5 MM SELF DRILL C1713 $1,476.56SCREW BONE LISS TITANIUM L55 MM OD5 MM FEMUR DISTA C1713 $1,476.56SCREW BONE LISS TITANIUM L55 MM OD5 MM SELF DRILL C1713 $1,476.56SCREW BONE LISS TITANIUM L56 MM OD5 MM SELF DRILL C1713 $1,476.56SCREW BONE LISS TITANIUM L60 MM OD5 MM FEMUR DISTA C1713 $1,476.56SCREW BONE LISS TITANIUM L65 MM OD5 MM FEMUR DISTA C1713 $1,476.56SCREW BONE LISS TITANIUM L70 MM OD5 MM FEMUR DISTA C1713 $1,476.56SCREW BONE LISS TITANIUM L75 MM OD5 MM FEMUR DISTA C1713 $1,476.56SCREW BONE LISS TITANIUM L8 MM OD5 MM SELF TAPPING C1713 $1,439.76SCREW BONE LISS TITANIUM L80 MM OD5 MM FEMUR DISTA C1713 $1,476.56SCREW BONE LISS TITANIUM L85 MM OD5 MM FEMUR DISTA C1713 $1,476.56SCREW BONE LISS TITANIUM L90 MM OD5 MM FEMUR DISTA C1713 $1,476.56SCREW BONE LONG L28 MM SPINE C1713 $3,900.00SCREW BONE LONG THREAD L10 MM L4 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L11 MM L5 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L12 MM L5 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L13 MM L6 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L14 MM L6 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L15 MM L6 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L16 MM L6 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L17 MM L8 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L18 MM L8 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L19 MM L9 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L20 MM L9 MM OD2 MM CANNULA C1713 $549.25SCREW BONE LONG THREAD L22 MM L10 MM OD2 MM CANNUL C1713 $549.25SCREW BONE LONG THREAD L24 MM L10 MM OD2 MM CANNUL C1713 $549.25SCREW BONE LONG THREAD L8 MM L4 MM OD2 MM CANNULAT C1713 $549.25SCREW BONE LOTUS L14 MM OD4 MM SPINE POLYAXIAL NON C1713 $3,900.00SCREW BONE LOTUS L16 MM OD4 MM SPINE POLYAXIAL NON C1713 $3,900.00SCREW BONE LOTUS L18 MM OD4 MM SPINE POLYAXIAL NON C1713 $3,900.00SCREW BONE LOW PROFILE SCREW STAINLESS STEEL T15 F C1713 $227.50SCREW BONE LOW PROFILE SCREW TITANIUM 2.5 MM PARTI C1713 $780.00SCREW BONE LOW PROFILE SCREW TITANIUM T10 FULL THR C1713 $715.00SCREW BONE LOW PROFILE SCREW TITANIUM T15 FULL THR C1713 $390.00SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T10 C1713 $747.50

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 ChargeSCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 C1713 $227.50SCREW BONE LOW PROFILE SCREWS TITANIUM 1.5 MM PART C1713 $747.50SCREW BONE LOW PROFILE SCREWS TITANIUM 2.5 MM PART C1713 $780.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L40 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L45 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L55 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L60 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L65 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L70 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L75 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L80 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L90 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L95 C1713 $1,625.00SCREW BONE LOW PROFILE SCREWS TITANIUM L10 MM OD3 C1713 $910.00SCREW BONE LOW PROFILE SCREWS TITANIUM L12 MM OD3 C1713 $910.00SCREW BONE LOW PROFILE SCREWS TITANIUM L14 MM OD3 C1713 $910.00SCREW BONE LOW PROFILE SCREWS TITANIUM L16 MM OD3 C1713 $910.00SCREW BONE LOW PROFILE SCREWS TITANIUM L18 MM OD3 C1713 $910.00SCREW BONE LOW PROFILE SCREWS TITANIUM L24 MM OD3 C1713 $910.00SCREW BONE LOW PROFILE SCREWS TITANIUM L45 MM OD4. C1713 $1,267.50SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD4. C1713 $1,267.50SCREW BONE LOW PROFILE SCREWS TITANIUM PARTIAL THR C1713 $1,137.50SCREW BONE LOW PROFILE SCREWS TITANIUM T10 FULL TH C1713 $715.00SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL TH C1713 $390.00SCREW BONE LOW PROFILE SCREWS TITANIUM T8 FULL THR C1713 $812.50SCREW BONE M3-X TITANIUM L12 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L14 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L16 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L18 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L20 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L22 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L24 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L26 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L28 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L30 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L32 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L34 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE M3-X TITANIUM L36 MM OD3 MM HAND CANNUL C1713 $600.00SCREW BONE MAGNUM+ L20 MM OD5.5 MM SPINE NONSTERIL C1713 $1,300.00

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 ChargeSCREW BONE MAGNUM+ L25 MM OD5.5 MM SPINE NONSTERIL C1713 $1,300.00SCREW BONE MAGNUM+ L30 MM OD5.5 MM SPINE NONSTERIL C1713 $1,300.00SCREW BONE MALIBU L45 MM OD6.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE MALIBU L50 MM OD5.5 MM SPINE PEDICLE PO C1713 $3,900.00SCREW BONE MALIBU L50 MM OD6.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE MALIBU TITANIUM L55 MM OD6.5 MM SPINE T C1713 $3,900.00SCREW BONE MARINER L30 MM OD5.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L35 MM OD4.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L35 MM OD5.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L35 MM OD6.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L35 MM OD7.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L40 MM OD4.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L40 MM OD5.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L40 MM OD6.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L40 MM OD7.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L45 MM OD5.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L45 MM OD6.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L45 MM OD7.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L45 MM OD8.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L50 MM OD5.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L50 MM OD6.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L50 MM OD7.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L50 MM OD8.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L55 MM OD6.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L60 MM OD6.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER L80 MM OD8.5 MM SPINE SOLID NON C1713 $1,300.00SCREW BONE MARINER SPINE POLYAXIAL SEAT EXTEND NON C1713 $2,600.00SCREW BONE MARINER SPINE POLYAXIAL SEAT NONSTERILE C1713 $2,600.00SCREW BONE MATRIXMANDIBLE TITANIUM L10 MM OD2 MM M C1713 $360.75SCREW BONE MATRIXMANDIBLE TITANIUM L10 MM OD2.4 MM C1713 $678.00SCREW BONE MATRIXMANDIBLE TITANIUM L10 MM OD2.7 MM C1713 $738.00SCREW BONE MATRIXMANDIBLE TITANIUM L10 MM OD2.9 MM C1713 $1,248.00SCREW BONE MATRIXMANDIBLE TITANIUM L12 MM OD2 MM M C1713 $474.00SCREW BONE MATRIXMANDIBLE TITANIUM L12 MM OD2.4 MM C1713 $638.40SCREW BONE MATRIXMANDIBLE TITANIUM L12 MM OD2.7 MM C1713 $738.00SCREW BONE MATRIXMANDIBLE TITANIUM L12 MM OD2.9 MM C1713 $1,248.00SCREW BONE MATRIXMANDIBLE TITANIUM L14 MM OD2 MM M C1713 $444.00SCREW BONE MATRIXMANDIBLE TITANIUM L14 MM OD2.4 MM C1713 $678.00SCREW BONE MATRIXMANDIBLE TITANIUM L14 MM OD2.7 MM C1713 $738.00

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 ChargeSCREW BONE MATRIXMANDIBLE TITANIUM L14 MM OD2.9 MM C1713 $1,248.00SCREW BONE MATRIXMANDIBLE TITANIUM L16 MM OD2 MM M C1713 $360.75SCREW BONE MATRIXMANDIBLE TITANIUM L16 MM OD2.4 MM C1713 $638.40SCREW BONE MATRIXMANDIBLE TITANIUM L16 MM OD2.7 MM C1713 $738.00SCREW BONE MATRIXMANDIBLE TITANIUM L16 MM OD2.9 MM C1713 $1,248.00SCREW BONE MATRIXMANDIBLE TITANIUM L18 MM OD2 MM M C1713 $474.00SCREW BONE MATRIXMANDIBLE TITANIUM L18 MM OD2.4 MM C1713 $678.00SCREW BONE MATRIXMANDIBLE TITANIUM L18 MM OD2.7 MM C1713 $738.00SCREW BONE MATRIXMANDIBLE TITANIUM L18 MM OD2.9 MM C1713 $1,248.00SCREW BONE MATRIXMANDIBLE TITANIUM L5 MM OD2 MM MA C1713 $474.00SCREW BONE MATRIXMANDIBLE TITANIUM L5 MM OD2.4 MM C1713 $678.00SCREW BONE MATRIXMANDIBLE TITANIUM L5 MM OD2.7 MM C1713 $738.00SCREW BONE MATRIXMANDIBLE TITANIUM L6 MM OD2 MM MA C1713 $360.75SCREW BONE MATRIXMANDIBLE TITANIUM L6 MM OD2.4 MM C1713 $518.70SCREW BONE MATRIXMANDIBLE TITANIUM L6 MM OD2.7 MM C1713 $691.20SCREW BONE MATRIXMANDIBLE TITANIUM L8 MM OD2 MM MA C1713 $360.75SCREW BONE MATRIXMANDIBLE TITANIUM L8 MM OD2.4 MM C1713 $638.40SCREW BONE MATRIXMANDIBLE TITANIUM L8 MM OD2.7 MM C1713 $738.00SCREW BONE MATRIXMANDIBLE TITANIUM L8 MM OD2.9 MM C1713 $1,248.00SCREW BONE MATRIXMIDFACE TITANIUM L10 MM OD1.55 MM C1713 $588.00SCREW BONE MATRIXMIDFACE TITANIUM L10 MM OD1.85 MM C1713 $606.00SCREW BONE MATRIXMIDFACE TITANIUM L12 MM OD1.55 MM C1713 $588.00SCREW BONE MATRIXMIDFACE TITANIUM L12 MM OD1.85 MM C1713 $576.00SCREW BONE MATRIXMIDFACE TITANIUM L14 MM OD1.55 MM C1713 $588.00SCREW BONE MATRIXMIDFACE TITANIUM L14 MM OD1.85 MM C1713 $606.00SCREW BONE MATRIXMIDFACE TITANIUM L16 MM OD1.55 MM C1713 $588.00SCREW BONE MATRIXMIDFACE TITANIUM L16 MM OD1.85 MM C1713 $606.00SCREW BONE MATRIXMIDFACE TITANIUM L18 MM OD1.55 MM C1713 $588.00SCREW BONE MATRIXMIDFACE TITANIUM L18 MM OD1.85 MM C1713 $606.00SCREW BONE MATRIXMIDFACE TITANIUM L3 MM OD1.55 MM C1713 $588.00SCREW BONE MATRIXMIDFACE TITANIUM L3 MM OD1.85 MM C1713 $606.00SCREW BONE MATRIXMIDFACE TITANIUM L4 MM OD1.55 MM C1713 $556.80SCREW BONE MATRIXMIDFACE TITANIUM L4 MM OD1.85 MM C1713 $606.00SCREW BONE MATRIXMIDFACE TITANIUM L5 MM OD1.55 MM C1713 $556.80SCREW BONE MATRIXMIDFACE TITANIUM L5 MM OD1.85 MM C1713 $606.00SCREW BONE MATRIXMIDFACE TITANIUM L6 MM OD1.55 MM C1713 $588.00SCREW BONE MATRIXMIDFACE TITANIUM L6 MM OD1.85 MM C1713 $606.00SCREW BONE MATRIXMIDFACE TITANIUM L8 MM OD1.55 MM C1713 $556.80SCREW BONE MATRIXMIDFACE TITANIUM L8 MM OD1.85 MM 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 ChargeSCREW BONE MATRIXNEURO TITANIUM L3 MM OD1.5 MM CRA C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L3 MM OD1.5 MM ODS C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L3 MM OD1.8 MM ODS C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L3 MM OD2.55 MM OD C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L4 MM OD1.5 MM CRA C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L4 MM OD1.5 MM ODS C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L4 MM OD1.8 MM ODS C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L4 MM OD2.55 MM OD C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L5 MM OD1.5 MM CRA C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L5 MM OD1.5 MM ODS C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L5 MM OD1.55 MM ID C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L5 MM OD1.8 MM ODS C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L5 MM OD1.85 MM ID C1713 $565.60SCREW BONE MATRIXNEURO TITANIUM L5 MM OD2.55 MM OD C1713 $285.60SCREW BONE MATRIXORTHOGNATHIC TITANIUM L10 MM OD1. C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L10 MM OD2. C1713 $618.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L12 MM OD1. C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L12 MM OD2. C1713 $618.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L14 MM OD1. C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L14 MM OD2. C1713 $618.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L16 MM OD1. C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L16 MM OD2. C1713 $580.80SCREW BONE MATRIXORTHOGNATHIC TITANIUM L18 MM OD1. C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L18 MM OD2. C1713 $618.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L4 MM OD1.8 C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L4 MM OD2.1 C1713 $618.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L5 MM OD1.8 C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L5 MM OD2.1 C1713 $618.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L6 MM OD1.8 C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L6 MM OD2.1 C1713 $580.80SCREW BONE MATRIXORTHOGNATHIC TITANIUM L8 MM OD1.8 C1713 $588.00SCREW BONE MATRIXORTHOGNATHIC TITANIUM L8 MM OD2.1 C1713 $618.00SCREW BONE MATRIXRIB TITANIUM L10 MM OD2.9 MM RIB C1713 $1,428.00SCREW BONE MATRIXRIB TITANIUM L12 MM OD2.9 MM RIB C1713 $1,428.00SCREW BONE MATRIXRIB TITANIUM L14 MM OD2.9 MM RIB C1713 $1,428.00SCREW BONE MATRIXRIB TITANIUM L6 MM OD2.9 MM RIB S C1713 $1,428.00SCREW BONE MATRIXRIB TITANIUM L8 MM OD2.9 MM RIB S C1713 $1,428.00SCREW BONE MAXAN L12 MM OD4 MM SPINE VARIABLE ANGL C1713 $487.50SCREW BONE MAXAN L14 MM OD4 MM SPINE FIX ANGLE 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 ChargeSCREW BONE MAXAN L14 MM OD4 MM SPINE VARIABLE ANGL C1713 $487.50SCREW BONE MAXAN L14 MM OD4.5 MM SPINE VARIABLE AN C1713 $487.50SCREW BONE MAXAN L16 MM OD4.5 MM SPINE VARIABLE AN C1713 $487.50SCREW BONE MAXDRIVE THREADLOCK TS TITANIUM TAPER L C1713 $834.72SCREW BONE MAXDRIVE TITANIUM L17 MM OD2.3 MM MANDI C1713 $426.24SCREW BONE MAXDRIVE TITANIUM L9 MM OD2.3 MM ORALMA C1713 $426.24SCREW BONE MAXDRIVE TITANIUM L9 MM OD2.5 MM ORALMA C1713 $444.00SCREW BONE MAXDRIVE TITANIUM STANDARD L11 MM OD2.3 C1713 $426.24SCREW BONE MAXDRIVE TITANIUM STANDARD L13 MM OD2.3 C1713 $426.24SCREW BONE MAXDRIVE TITANIUM STANDARD L15 MM OD2.3 C1713 $426.24SCREW BONE MAXDRIVE TITANIUM STANDARD L7 MM OD2.3 C1713 $426.24SCREW BONE MAXDRIVE TITANIUM STANDARD L9 MM OD2.3 C1713 $426.24SCREW BONE MAXDRIVE TITANIUM STANDARD MICRO L9 MM C1713 $337.44SCREW BONE MAXDRIVE TITANIUM STANDARD MINI L17 MM C1713 $337.44SCREW BONE MAXDRIVE TITANIUM STANDARD MINI L19 MM C1713 $337.44SCREW BONE MEDIUM SPINE LOCK CAP C1713 $162.50SCREW BONE MESA 2 L100 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L100 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L110 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L110 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L20 MM OD4 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L25 MM OD4 MM SPINE POLYAXIAL NO C1713 $4,225.00SCREW BONE MESA 2 L25 MM OD4 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L25 MM OD4.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L25 MM OD4.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L25 MM OD5 MM SPINE POLYAXIAL NO C1713 $5,200.00SCREW BONE MESA 2 L25 MM OD5 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L25 MM OD5.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L25 MM OD5.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L25 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD4 MM SPINE POLYAXIAL NO C1713 $4,225.00SCREW BONE MESA 2 L30 MM OD4 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L30 MM OD4.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD5 MM SPINE POLYAXIAL NO C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD5 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD5.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD5.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00

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 ChargeSCREW BONE MESA 2 L30 MM OD6.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD7.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L30 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD4 MM SPINE POLYAXIAL NO C1713 $4,225.00SCREW BONE MESA 2 L35 MM OD4 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L35 MM OD4.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD5 MM SPINE POLYAXIAL NO C1713 $4,225.00SCREW BONE MESA 2 L35 MM OD5 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD5.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD5.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L35 MM OD6.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD7.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L35 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD4 MM SPINE POLYAXIAL NO C1713 $4,225.00SCREW BONE MESA 2 L40 MM OD4 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD4.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L40 MM OD4.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD5 MM SPINE POLYAXIAL NO C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD5 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L40 MM OD5.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L40 MM OD6.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD7.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L40 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L45 MM OD4.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L45 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L45 MM OD5.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L45 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L45 MM OD6.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L45 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L45 MM OD7.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L45 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L45 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00

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 ChargeSCREW BONE MESA 2 L50 MM OD4.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L50 MM OD5.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L50 MM OD5.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L50 MM OD6.5 MM SPINE POLYAXIAL C1713 $4,225.00SCREW BONE MESA 2 L50 MM OD6.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L50 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L50 MM OD7.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L50 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L50 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L55 MM OD5.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L55 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L55 MM OD6.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L55 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L55 MM OD7.5 MM SPINE UNIPLANAR C1713 $5,200.00SCREW BONE MESA 2 L55 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L55 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L60 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L60 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L60 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L60 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L70 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L70 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L70 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L70 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L80 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L80 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L80 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L80 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L90 MM OD7.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L90 MM OD8.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA 2 L90 MM OD9.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE MESA COCR STRAIGHT L495 MM OD5.5 MM RAI C1713 $8,000.00SCREW BONE MESA COCR STRAIGHT L500 MM OD5.5 MM RAI C1713 $8,000.00SCREW BONE MESA L100 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L100 MM OD7.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L100 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L100 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L110 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L110 MM OD7.5 MM SPINE FOUNDATION C1713 $5,200.00

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 ChargeSCREW BONE MESA L110 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L110 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L20 MM OD4 MM SPINE POSTERIOR UNIP C1713 $5,200.00SCREW BONE MESA L20 MM OD4.5 MM SPINE POLYAXIAL NO C1713 $5,200.00SCREW BONE MESA L20 MM OD4.5 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA L20 MM OD5 MM SPINE UNIPLANAR NONS C1713 $5,200.00SCREW BONE MESA L20 MM OD5.5 MM SPINE POLYAXIAL NO C1713 $5,200.00SCREW BONE MESA L20 MM OD5.5 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA L20 MM OD6.5 MM SPINE UNIPLANAR NO C1713 $5,200.00SCREW BONE MESA L25 MM OD4 MM SPINE POSTERIOR UNIP C1713 $5,200.00SCREW BONE MESA L25 MM OD4.5 MM SPINE FOUNDATION N C1713 $5,200.00SCREW BONE MESA L25 MM OD5 MM SPINE POLYAXIAL NONS C1713 $5,200.00SCREW BONE MESA L25 MM OD5.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L25 MM OD5.5 MM SPINE POLYAXIAL AS C1713 $5,200.00SCREW BONE MESA L30 MM OD4 MM SPINE POSTERIOR UNIP C1713 $5,200.00SCREW BONE MESA L30 MM OD4.5 MM SPINE NONSTERILE C1713 $5,200.00SCREW BONE MESA L30 MM OD5 MM SPINE POLYAXIAL NONS C1713 $5,200.00SCREW BONE MESA L30 MM OD5.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L30 MM OD6.5 MM SPINE POSTERIOR UN C1713 $5,200.00SCREW BONE MESA L30 MM OD7.5 MM SPINE PEDICLE POST C1713 $5,200.00SCREW BONE MESA L35 MM OD4 MM SPINE POSTERIOR UNIP C1713 $5,200.00SCREW BONE MESA L35 MM OD4.5 MM SPINE FOUNDATION N C1713 $5,200.00SCREW BONE MESA L35 MM OD5 MM SPINE POLYAXIAL NONS C1713 $5,200.00SCREW BONE MESA L35 MM OD5.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L35 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L35 MM OD7.5 MM SACRUM FOUNDATION C1713 $5,200.00SCREW BONE MESA L35 MM OD7.5 MM SPINE ASSEMBLY POL C1713 $5,200.00SCREW BONE MESA L35 MM OD7.5 MM SPINE PEDICLE POST C1713 $5,200.00SCREW BONE MESA L35 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L35 MM OD8.5 MM SPINE PEDICLE POST C1713 $5,200.00SCREW BONE MESA L40 MM OD4 MM SPINE POSTERIOR UNIP C1713 $5,200.00SCREW BONE MESA L40 MM OD4.5 MM SPINE FOUNDATION N C1713 $5,200.00SCREW BONE MESA L40 MM OD5 MM SPINE POLYAXIAL NONS C1713 $5,200.00SCREW BONE MESA L40 MM OD5.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L40 MM OD5.5 MM SPINE POLYAXIAL NO C1713 $4,225.00SCREW BONE MESA L40 MM OD6.5 MM SPINE NONSTERILE C1713 $5,200.00SCREW BONE MESA L40 MM OD6.5 MM SPINE POLYAXIAL LI C1713 $5,200.00SCREW BONE MESA L40 MM OD7.5 MM FOUNDATION POSTERI C1713 $5,200.00SCREW BONE MESA L40 MM OD7.5 MM SPINE ASSEMBLY POL C1713 $5,200.00

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 ChargeSCREW BONE MESA L40 MM OD7.5 MM SPINE POLYAXIAL NO C1713 $5,200.00SCREW BONE MESA L40 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L40 MM OD8.5 MM SPINE PEDICLE POST C1713 $5,200.00SCREW BONE MESA L40 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L45 MM OD5.5 MM SPINE NONSTERILE C1713 $5,200.00SCREW BONE MESA L45 MM OD5.5 MM SPINE POLYAXIAL GO C1713 $5,200.00SCREW BONE MESA L45 MM OD5.5 MM SPINE POLYAXIAL NO C1713 $4,225.00SCREW BONE MESA L45 MM OD6.5 MM SPINE NONSTERILE C1713 $5,200.00SCREW BONE MESA L45 MM OD6.5 MM SPINE PEDICLE UNIP C1713 $5,200.00SCREW BONE MESA L45 MM OD6.5 MM SPINE POLYAXIAL GO C1713 $5,200.00SCREW BONE MESA L45 MM OD7.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L45 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L50 MM OD5.5 MM SPINE UNIPLANAR BR C1713 $5,200.00SCREW BONE MESA L50 MM OD6.5 MM SACRUM SPINE FOUND C1713 $5,200.00SCREW BONE MESA L50 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L50 MM OD8.5 MM SPINE PEDICLE UNIP C1713 $5,200.00SCREW BONE MESA L50 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L55 MM OD5.5 MM SPINE POLYAXIAL AS C1713 $5,200.00SCREW BONE MESA L55 MM OD5.5 MM SPINE POSTERIOR UN C1713 $5,200.00SCREW BONE MESA L55 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L55 MM OD7.5 MM SPINE C1713 $5,200.00SCREW BONE MESA L55 MM OD7.5+ MM SPINE PEDICLE UNI C1713 $5,200.00SCREW BONE MESA L55 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L60 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L60 MM OD7.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L60 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L65 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L65 MM OD7.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L65 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L65 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L70 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L70 MM OD7.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L70 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L70 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L75 MM OD6.5 MM SPINE FOUNDATION N C1713 $5,200.00SCREW BONE MESA L80 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L80 MM OD7.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L80 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L80 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00

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 ChargeSCREW BONE MESA L90 MM OD6.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L90 MM OD7.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L90 MM OD8.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA L90 MM OD9.5 MM SPINE FOUNDATION C1713 $5,200.00SCREW BONE MESA MINI LONG L30 MM OD6.5 MM SPINE SH C1713 $5,200.00SCREW BONE MESA RAIL COCR L500 MM OD4.5 MM SPINE T C1713 $8,000.00SCREW BONE MESA RAIL COCR STRAIGHT L500 MM OD4.5 M C1713 $8,000.00SCREW BONE MESA RAIL TITANIUM STRAIGHT L500 MM OD4 C1713 $8,000.00SCREW BONE MESA SMALL STATURE L20 MM OD4 MM SPINE C1713 $5,200.00SCREW BONE MESA SMALL STATURE L20 MM OD4.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L20 MM OD5 MM SPINE C1713 $5,200.00SCREW BONE MESA SMALL STATURE L22.5 MM OD4 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L22.5 MM OD4.5 MM SP C1713 $5,200.00SCREW BONE MESA SMALL STATURE L25 MM OD5.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L25 MM OD6.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L25 MM OD7.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L25 MM OD8.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L30 MM OD5 MM SPINE C1713 $5,200.00SCREW BONE MESA SMALL STATURE L30 MM OD8.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L35 MM OD8.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L40 MM OD8.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L45 MM OD4.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L45 MM OD8.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L50 MM OD4.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L50 MM OD5 MM SPINE C1713 $5,200.00SCREW BONE MESA SMALL STATURE L50 MM OD8.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L55 MM OD5.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L55 MM OD6.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L55 MM OD8.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L60 MM OD5.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L60 MM OD8.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L65 MM OD5.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L70 MM OD7.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L75 MM OD5.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L80 MM OD7.5 MM SPIN C1713 $5,200.00SCREW BONE MESA SMALL STATURE L85 MM OD5.5 MM SPIN C1713 $5,200.00SCREW BONE MESA TITANIUM FUNNEL L25 MM OD6.5 MM SA C1713 $5,200.00SCREW BONE MESA TITANIUM FUNNEL L25 MM OD7.5 MM SA C1713 $5,200.00SCREW BONE MESA TITANIUM FUNNEL L25 MM OD8.5 MM SA C1713 $5,200.00

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 ChargeSCREW BONE MESA TITANIUM FUNNEL L30 MM OD7.5 MM SA C1713 $5,200.00SCREW BONE MESA TITANIUM FUNNEL L30 MM OD8.5 MM SA C1713 $5,200.00SCREW BONE MESA TITANIUM L25 MM OD4.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L30 MM OD4.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L30 MM OD4.5 MM SPINE UNI C1713 $5,200.00SCREW BONE MESA TITANIUM L35 MM OD4.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L35 MM OD6.5 MM SPINE UNI C1713 $5,200.00SCREW BONE MESA TITANIUM L40 MM OD4.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L40 MM OD7.5 MM SPINE C1713 $5,200.00SCREW BONE MESA TITANIUM L45 MM OD4.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L45 MM OD7.5 MM SPINE C1713 $5,200.00SCREW BONE MESA TITANIUM L45 MM OD7.5 MM SPINE PED C1713 $5,200.00SCREW BONE MESA TITANIUM L45 MM OD8.5 MM SPINE PED C1713 $5,200.00SCREW BONE MESA TITANIUM L50 MM OD4.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L50 MM OD5.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L50 MM OD6.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L50 MM OD7.5 MM SPINE PED C1713 $5,200.00SCREW BONE MESA TITANIUM L50 MM OD7.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L50 MM OD8.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L55 MM OD6.5 MM SPINE PED C1713 $5,200.00SCREW BONE MESA TITANIUM L55 MM OD7.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L55 MM OD8.5 MM SPINE PED C1713 $5,200.00SCREW BONE MESA TITANIUM L55 MM OD8.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L60 MM OD5.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L60 MM OD6.5 MM SPINE C1713 $5,200.00SCREW BONE MESA TITANIUM L60 MM OD7.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L60 MM OD8.5 MM SPINE PED C1713 $5,200.00SCREW BONE MESA TITANIUM L60 MM OD8.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L65 MM OD5.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L65 MM OD6.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L65 MM OD7.5 MM SPINE POL C1713 $5,200.00SCREW BONE MESA TITANIUM L65 MM OD8.5 MM SPINE POL C1713 $5,200.00SCREW BONE MFX TITANIUM MINI STANDARD L8 MM OD2 MM C1713 $492.00SCREW BONE MFX TITANIUM STANDARD MINI L10 MM OD2 M C1713 $344.00SCREW BONE MFX TITANIUM STANDARD MINI L12 MM OD2 M C1713 $344.00SCREW BONE MFX TITANIUM STANDARD MINI L14 MM OD2 M C1713 $344.00SCREW BONE MFX TITANIUM STANDARD MINI L16 MM OD2 M C1713 $492.00SCREW BONE MFX TITANIUM STANDARD MINI L18 MM OD2 M C1713 $376.00SCREW BONE MFX TITANIUM STANDARD MINI L20 MM OD2 M C1713 $344.00

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 ChargeSCREW BONE MFX TITANIUM STANDARD MINI L22 MM OD2 M C1713 $344.00SCREW BONE MINI L16 MM OD2.5 MM HEAD NONSTERILE C1713 $1,204.32SCREW BONE MINI L18 MM OD2.5 MM HEAD NONSTERILE C1713 $1,204.32SCREW BONE MINI L50 MM L18 MM OD3 MM CORTICAL TAPE C1713 $844.80SCREW BONE MINI L60 MM L25 MM CORTICAL C1713 $844.80SCREW BONE MOUNTAINEER OD3.5 MM SPINE OCCIPITOCERV C1713 $400.00SCREW BONE MPACT L20 MM OD6.5 MM CANCELLOUS HIP FL C1713 $162.50SCREW BONE MPACT L25 MM OD6.5 MM CANCELLOUS HIP FL C1713 $162.50SCREW BONE MPACT L30 MM OD6.5 MM HIP CANCELLOUS FL C1713 $162.50SCREW BONE MPACT L35 MM OD6.5 MM CANCELLOUS HIP FL C1713 $162.50SCREW BONE MPACT L40 MM OD6.5 MM HIP CANCELLOUS FL C1713 $162.50SCREW BONE MPACT L45 MM OD6.5 MM CANCELLOUS FLAT H C1713 $162.50SCREW BONE MULTILOC TITANIUM 3.8 MM FULL THREAD L2 C1713 $1,630.20SCREW BONE MULTILOC TITANIUM 3.8 MM FULL THREAD L4 C1713 $1,630.20SCREW BONE MULTILOC TITANIUM 3.8 MM FULL THREAD L5 C1713 $1,356.03SCREW BONE MULTILOC TITANIUM 3.8 MM FULL THREAD L6 C1713 $1,356.03SCREW BONE MULTILOC TITANIUM ALUMINUM NIOBIUM FULL C1713 $1,630.20SCREW BONE MULTILOC TITANIUM ALUMINUM NIOBIUM SD15 C1713 $971.75SCREW BONE MULTILOC TITANIUM NIOBIUM ALUMINUM 3.8 C1713 $1,630.20SCREW BONE MULTILOC TITANIUM NIOBIUM ALUMINUM FULL C1713 $1,356.03SCREW BONE NAIL-EX TITANIUM L100 MM OD5 MM FEMUR T C1713 $1,550.40SCREW BONE NAIL-EX TITANIUM L22 MM OD4 MM HUMERUS C1713 $1,550.40SCREW BONE NAIL-EX TITANIUM TROCAR FULL THREAD L72 C1713 $1,212.96SCREW BONE NAIL-EX TITANIUM TROCAR L60 MM OD4 MM O C1713 $1,212.96SCREW BONE NAIL-EX TITANIUM TROCAR L62 MM OD4 MM O C1713 $1,550.40SCREW BONE NAIL-EX TITANIUM TROCAR L80 MM OD4 MM O C1713 $1,212.96SCREW BONE NAUTILUS L40 MM OD6.5 MM SPINE POLYAXIA C1713 $5,200.00SCREW BONE NAUTILUS L45 MM OD6.5 MM SPINE POLYAXIA C1713 $5,200.00SCREW BONE NAUTILUS L50 MM OD6.5 MM SPINE POLYAXIA C1713 $5,200.00SCREW BONE NCB PROTASUL-64 3.5 MM L32 MM OD5 MM OD C1713 $190.13SCREW BONE NCB PROTASUL-64 3.5 MM L38 MM OD5 MM OD C1713 $760.50SCREW BONE NCB PROTASUL-64 3.5 MM L40 MM OD5 MM OD C1713 $190.13SCREW BONE NCB PROTASUL-64 3.5 MM L44 MM OD5 MM OD C1713 $760.50SCREW BONE NCB PROTASUL-64 3.5 MM L46 MM OD5 MM OD C1713 $760.50SCREW BONE NCB PROTASUL-64 3.5 MM L50 MM OD5 MM OD C1713 $760.50SCREW BONE NCB PROTASUL-64 3.5 MM L75 MM OD5 MM OD C1713 $190.13SCREW BONE NCB PROTASUL-64 3.5 MM PARTIAL THREAD L C1713 $642.20SCREW BONE NCB PROTASUL-64 L80 MM OD5 MM ODSEC3.5 C1713 $760.50SCREW BONE NCB PROTASUL-64 L85 MM OD5 MM ODSEC3.5 C1713 $760.50

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 ChargeSCREW BONE NCB TI6AL4V PARTIAL THREAD HEXAGON L70 C1713 $642.20SCREW BONE OD4 MM RADIUS DISTAL COVER FIXATOR C1713 $26.16SCREW BONE OD4 MM SPINE OCCIPITAL C1713 $390.00SCREW BONE OD4 MM SPINE OCCIPITAL RIDGE C1713 $390.00SCREW BONE OD4.5 MM SPINE SELF TAPPING RIGID C1713 $390.00SCREW BONE OD6/5 MM CANCELLOUS AUXILIARY C1713 $9,246.19SCREW BONE OMEGA PLUS STAINLESS STEEL L25 MM HIP C C1713 $386.40SCREW BONE OMEGA STAINLESS STEEL L32.3 MM OD3 MM H C1713 $348.08SCREW BONE OMEGA3 STAINLESS STEEL STANDARD L85 MM C1713 $1,392.30SCREW BONE OMEGA3 STAINLESS STEEL STANDARD L95 MM C1713 $1,392.30SCREW BONE OMNI TALON L14 MM OD4 MM SPINE CERVICAL C1713 $487.50SCREW BONE OMNI VBR TITANIUM SPINE THORACOLUMBAR L C1713 $325.00SCREW BONE OPTETRAK OD7 MM TIBIAL KNEE EXTENSION E C1713 $162.50SCREW BONE OPTILOCK L12 MM OD3.5 MM LOCK UPPER EXT C1713 $679.38SCREW BONE OPTILOCK L14 MM OD3.5 MM LOCK UPPER EXT C1713 $679.38SCREW BONE OPTILOCK L65 MM OD5.5 MM LAG CANNULATED C1713 $439.40SCREW BONE OPTIO-C L14 MM SPINE SELF DRILL VARIABL C1713 $487.50SCREW BONE ORTHOLOC TITANIUM NITRIDE L10 MM OD2 MM C1713 $416.00SCREW BONE ORTHOLOC TITANIUM NITRIDE L12 MM OD2 MM C1713 $344.50SCREW BONE OSS SMALL THREAD FEMUR LOCK LARGE HEAD C1713 $1,980.00SCREW BONE OSTEOGRIP TSRH THINLINE TITANIUM L45 MM C1713 $2,600.00SCREW BONE OSTEOGRIP TSRH THINLINE TITANIUM LONG L C1713 $2,600.00SCREW BONE OSTEOGRIP TSRH THINLINE TITANIUM SHORT C1713 $2,600.00SCREW BONE OVERWATCH DUALFIX STANDARD L35 MM OD5.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L40 MM OD5.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L40 MM OD6.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L40 MM OD7.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L40 MM OD8.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L45 MM OD5.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L45 MM OD6.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L45 MM OD7.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L50 MM OD6.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L50 MM OD7.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L55 MM OD6.5 C1713 $3,900.00SCREW BONE OVERWATCH DUALFIX STANDARD L60 MM OD8.5 C1713 $3,900.00SCREW BONE OVERWATCH STANDARD L45 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE OVERWATCH STANDARD L50 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE PANGEA TITANIUM L28 MM OD4 MM SPINE PED C1713 $2,800.00SCREW BONE PANGEA TITANIUM L32 MM OD4 MM SPINE PED 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 ChargeSCREW BONE PANGEA TITANIUM T25 L20 MM L11.5 MM OD4 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L20 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L25 MM L11.5 MM OD4 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L25 MM L11.5 MM OD5 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L25 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L25 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L25 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L25 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L28 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM L11.5 MM OD4 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM L11.5 MM OD5 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM OD5 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM OD6 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM OD7 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L30 MM OD8 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L32 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM L11.5 MM OD4 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM L11.5 MM OD5 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM OD5 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM OD6 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM OD7 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L35 MM OD8 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L38 MM L11.5 MM OD4 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L38 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM L11.5 MM OD4 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM L11.5 MM OD5 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM OD5 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 ChargeSCREW BONE PANGEA TITANIUM T25 L40 MM OD6 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM OD7 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L40 MM OD8 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM L11.5 MM OD4 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM L11.5 MM OD5 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM OD4 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM OD5 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM OD6 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM OD7 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L45 MM OD8 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L50 MM L11.5 MM OD5 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L50 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L50 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L50 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L50 MM OD5 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L50 MM OD6 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L50 MM OD7 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L50 MM OD8 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L55 MM L11.5 MM OD5 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L55 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L55 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L55 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L55 MM OD6 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L55 MM OD7 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L55 MM OD8 MM SPINE C1713 $4,800.00SCREW BONE PANGEA TITANIUM T25 L60 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L60 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L60 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L65 MM L11.5 MM OD6 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L65 MM L11.5 MM OD7 C1713 $2,800.00SCREW BONE PANGEA TITANIUM T25 L65 MM L11.5 MM OD8 C1713 $2,800.00SCREW BONE PASS LP L25 MM OD4.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L25 MM OD5.5 MM SPINE PEDICLE P C1713 $4,800.00SCREW BONE PASS LP L30 MM OD4.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L30 MM OD5.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L30 MM OD6.5 MM SPINE PEDICLE P 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 ChargeSCREW BONE PASS LP L30 MM OD6.5 MM SPINE SACRAL NO C1713 $4,800.00SCREW BONE PASS LP L35 MM OD4.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L35 MM OD5.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L35 MM OD6.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L35 MM OD7.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L40 MM OD4.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L40 MM OD5.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L40 MM OD6.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L40 MM OD7.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L40 MM OD8.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L45 MM OD4.5 MM SPINE PEDICLE P C1713 $4,800.00SCREW BONE PASS LP L45 MM OD5.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L45 MM OD6.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L45 MM OD6.5 MM SPINE SACRAL NO C1713 $4,800.00SCREW BONE PASS LP L45 MM OD7.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L45 MM OD8 MM SPINE PEDICLE POL C1713 $4,800.00SCREW BONE PASS LP L45 MM OD8.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L50 MM OD5.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L50 MM OD6.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L50 MM OD6.5 MM SPINE SACRAL NO C1713 $4,800.00SCREW BONE PASS LP L50 MM OD7.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L50 MM OD8.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L55 MM OD5.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L55 MM OD6.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L55 MM OD7.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L55 MM OD8.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L60 MM OD6.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L60 MM OD7.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS LP L60 MM OD8.5 MM SPINE PEDICLE P C1713 $3,900.00SCREW BONE PASS TL L50 MM OD6.5 MM SPINE PEDICLE N C1713 $3,900.00SCREW BONE PASS TULIP L100 MM OD8.5 MM SPINE ILIAC C1713 $3,900.00SCREW BONE PASS TULIP L55 MM OD6.5 MM SPINE PEDICL C1713 $3,900.00SCREW BONE PASS TULIP L60 MM OD8.5 MM SPINE PEDICL C1713 $3,900.00SCREW BONE PASS TULIP L70 MM OD8.5 MM SPINE ILIAC C1713 $3,900.00SCREW BONE PASS TULIP L80 MM OD7.5 MM SPINE ILIAC C1713 $3,900.00SCREW BONE PASS TULIP L80 MM OD8.5 MM SPINE ILIAC C1713 $3,900.00SCREW BONE PASS TULIP L90 MM OD8.5 MM SPINE ILIAC C1713 $3,900.00SCREW BONE PCM L14 MM SPINAL DISTRACTION C1713 $162.50SCREW BONE PEANUT TITANIUM BUTTRESS TAPER L40 MM O C1713 $728.00

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 ChargeSCREW BONE PEANUT TITANIUM L32 MM OD4.5 MM SOLID C1713 $728.00SCREW BONE PEANUT TITANIUM L40 MM OD4.5 MM FEMUR T C1713 $728.00SCREW BONE PEANUT TITANIUM PEDIATRIC L16 MM OD4.5 C1713 $728.00SCREW BONE PEANUT TITANIUM PEDIATRIC L24 MM OD4.5 C1713 $728.00SCREW BONE PEANUT TITANIUM PEDIATRIC TAPER L16 MM C1713 $728.00SCREW BONE PEANUT TITANIUM PEDIATRIC TAPER L32 MM C1713 $728.00SCREW BONE PEDIATRIC L19 MM OD8 MM HIP OSTEOTOMY O C1713 $2,102.80SCREW BONE PEDIATRIC L22 MM OD8 MM HIP OSTEOTOMY O C1713 $2,102.80SCREW BONE PEDIATRIC L25 MM OD8 MM HIP HIP SYSTEM C1713 $2,102.80SCREW BONE PEDIATRIC L28 MM OD8 MM HIP OSTEOTOMY O C1713 $1,974.00SCREW BONE PEDIATRIC L32 MM OD8 MM HIP OSTEOTOMY C1713 $1,974.00SCREW BONE PEDIATRIC L35 MM OD8 MM HIP OSTEOTOMY C1713 $1,974.00SCREW BONE PEDIATRIC L38 MM OD8 MM HIP OSTEOTOMY C1713 $1,974.00SCREW BONE PEDIATRIC L41 MM OD8 MM HIP OSTEOTOMY O C1713 $2,102.80SCREW BONE PEDIATRIC L44 MM OD8 MM HIP OSTEOTOMY C1713 $1,974.00SCREW BONE PEDIATRIC L47 MM OD8 MM HIP OSTEOTOMY C1713 $1,974.00SCREW BONE PEDIATRIC L50 MM OD8 MM HIP OSTEOTOMY O C1713 $1,974.00SCREW BONE PEDILOC L14 MM OD3.5 MM FEMUR CORTICAL C1713 $448.00SCREW BONE PEDILOC L20 MM OD3.5 MM FEMUR CORTICAL C1713 $448.00SCREW BONE PEDILOC L22 MM OD3.5 MM FEMUR CORTICAL C1713 $1,672.00SCREW BONE PEDIPLATES STAINLESS STEEL PEDIATRIC FU C1713 $1,720.00SCREW BONE PERI-LOC STAINLESS STEEL 2.5 MM FLUTE L C1713 $1,178.24SCREW BONE PHOENIX L100 MM OD6 MM RECONSTRUCTION C C1713 $1,850.88SCREW BONE PHOENIX L105 MM OD6 MM RECONSTRUCTION C C1713 $1,850.88SCREW BONE PHOENIX L110 MM OD6 MM RECONSTRUCTION C C1713 $1,850.88SCREW BONE PHOENIX L115 MM OD6 MM PARTIALLY THREAD C1713 $1,850.88SCREW BONE PHOENIX L120 MM OD6 MM PARTIALLY THREAD C1713 $1,850.88SCREW BONE PHOENIX L125 MM OD6 MM PARTIALLY THREAD C1713 $1,850.88SCREW BONE PHOENIX L130 MM OD6 MM PARTIALLY THREAD C1713 $1,850.88SCREW BONE PHOENIX L32 MM OD2.7 MM LOCK C1713 $598.26SCREW BONE PHOENIX L32 MM OD3.5 MM PERIARTICULAR L C1713 $655.72SCREW BONE PHOENIX L50 MM OD6 MM CANNULATED PARTIA C1713 $1,850.88SCREW BONE PHOENIX L55 MM OD6 MM PARTIALLY THREADE C1713 $1,850.88SCREW BONE PHOENIX L60 MM OD6 MM PARTIALLY THREADE C1713 $1,850.88SCREW BONE PHOENIX L65 MM OD6 MM PARTIALLY THREADE C1713 $1,850.88SCREW BONE PHOENIX L70 MM OD6 MM PARTIALLY THREADE C1713 $1,850.88SCREW BONE PHOENIX L75 MM OD6 MM PARTIALLY THREADE C1713 $1,850.88SCREW BONE PHOENIX L80 MM OD6 MM RECONSTRUCTION CA C1713 $1,850.88SCREW BONE PHOENIX L95 MM OD6 MM RECONSTRUCTION CA C1713 $1,850.88

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 ChargeSCREW BONE PHOENIX PARTIAL THREAD L85 MM OD6 MM CA C1713 $2,053.12SCREW BONE PHOENIX PARTIAL THREAD L90 MM OD6 MM CA C1713 $1,850.88SCREW BONE PHOENIX THREADED L20 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L22 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L24 MM OD4 MM 2 LEAD C1713 $1,182.72SCREW BONE PHOENIX THREADED L26 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L40 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L46 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L48 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L50 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L52 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L54 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L56 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX THREADED L58 MM OD4 MM 2 LEAD C1713 $1,071.36SCREW BONE PHOENIX TITANIUM L100 MM OD5 MM CORTICA C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L105 MM OD5 MM CORTICA C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L110 MM OD5 MM CORTICA C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L20 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L22 MM OD5 MM CORTICAL C1713 $1,024.00SCREW BONE PHOENIX TITANIUM L24 MM OD5 MM CORTICAL C1713 $1,038.96SCREW BONE PHOENIX TITANIUM L26 MM OD5 MM CORTICAL C1713 $924.00SCREW BONE PHOENIX TITANIUM L28 MM OD5 MM CORTICAL C1713 $924.00SCREW BONE PHOENIX TITANIUM L30 MM OD5 MM CORTEX S C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L32 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L34 MM OD5 MM CORTICAL C1713 $832.00SCREW BONE PHOENIX TITANIUM L36 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L38 MM OD5 MM CORTICAL C1713 $1,038.96SCREW BONE PHOENIX TITANIUM L40 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L42 MM OD5 MM CORTICAL C1713 $924.00SCREW BONE PHOENIX TITANIUM L44 MM OD5 MM CORTICAL C1713 $1,038.96SCREW BONE PHOENIX TITANIUM L46 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L48 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L50 MM OD5 MM CORTICAL C1713 $750.75SCREW BONE PHOENIX TITANIUM L54 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L56 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L58 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L60 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L65 MM OD5 MM CORTICAL C1713 $832.00SCREW BONE PHOENIX TITANIUM L70 MM OD5 MM CORTICAL C1713 $1,038.96

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 ChargeSCREW BONE PHOENIX TITANIUM L75 MM OD5 MM CORTICAL C1713 $1,038.96SCREW BONE PHOENIX TITANIUM L80 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L85 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L90 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PHOENIX TITANIUM L95 MM OD5 MM CORTICAL C1713 $1,278.72SCREW BONE PINNACLE L15 MM OD6.5 MM ACETABULAR CAN C1713 $162.50SCREW BONE PINNACLE L20 MM OD6.5 MM ACETABULAR CAN C1713 $162.50SCREW BONE PINNACLE L25 MM OD6.5 MM ACETABULAR CAN C1713 $162.50SCREW BONE PINNACLE L30 MM OD6.5 MM ACETABULAR CAN C1713 $162.50SCREW BONE PINNACLE L35 MM OD6.5 MM ACETABULAR CAN C1713 $162.50SCREW BONE PINNACLE L40 MM OD6.5 MM ACETABULAR CAN C1713 $162.50SCREW BONE PINNACLE L45 MM OD6.5 MM ACETABULAR CAN C1713 $162.50SCREW BONE PINNACLE L55 MM OD6.5 MM ACETABULAR CAN C1776 $162.50SCREW BONE POLARIS STAINLESS STEEL L20 MM OD4 MM S C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L20 MM OD4.75 M C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L25 MM OD4 MM S C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L30 MM OD4 MM S C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L30 MM OD6.5 MM C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L35 MM OD4 MM S C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L35 MM OD4.75 M C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L35 MM OD5.5 MM C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L40 MM OD4 MM S C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L40 MM OD4.75 M C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L40 MM OD5.5 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L45 MM OD4.75 M C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L45 MM OD6.5 MM C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L50 MM OD5.5 MM C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L50 MM OD6.5 MM C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L55 MM OD5.5 MM C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L55 MM OD6.5 MM C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL L60 MM OD7.5 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L70 MM OD6.5 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L70 MM OD7.5 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L70 MM OD8.5 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L80 MM OD6.5 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L80 MM OD7.5 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL L90 MM OD7.5 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL STANDARD L30 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL STANDARD L35 MM 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 ChargeSCREW BONE POLARIS STAINLESS STEEL STANDARD L40 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL STANDARD L45 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL STANDARD L55 MM C1713 $4,800.00SCREW BONE POLARIS STAINLESS STEEL UNIVERSAL L25 M C1713 $2,800.00SCREW BONE POLARIS STAINLESS STEEL UNIVERSAL L45 M C1713 $4,800.00SCREW BONE POLARIS TITANIUM ADULT L25 MM OD4.7 MM C1713 $2,800.00SCREW BONE POLARIS TITANIUM L20 MM OD4.75 MM SPINE C1713 $2,800.00SCREW BONE POLARIS TITANIUM L25 MM OD4 MM ILIAC SP C1713 $4,800.00SCREW BONE POLARIS TITANIUM L25 MM OD4.75 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L30 MM OD4.75 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L30 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L30 MM OD6.5 MM SPINAL C1713 $4,800.00SCREW BONE POLARIS TITANIUM L30 MM OD6.5 MM SPINE C1713 $2,800.00SCREW BONE POLARIS TITANIUM L30 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L30 MM OD8.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L35 MM OD4.75 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L35 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L35 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L35 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L35 MM OD8.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L40 MM OD4.75 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L40 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L40 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L40 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L40 MM OD8.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L45 MM OD4.75 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L45 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L45 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L45 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L45 MM OD8.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L50 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L50 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L50 MM OD7 MM SPINE MU C1713 $3,900.00SCREW BONE POLARIS TITANIUM L50 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L55 MM OD5.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L55 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L55 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L55 MM OD8.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L60 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 ChargeSCREW BONE POLARIS TITANIUM L70 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L70 MM OD8.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L80 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L80 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L90 MM OD6.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L90 MM OD7.5 MM SPINE C1713 $4,800.00SCREW BONE POLARIS TITANIUM L90 MM OD8.5 MM ILIAC C1713 $4,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L20 MM OD4 M C1713 $4,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L25 MM OD4 M C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L30 MM OD7.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L30 MM OD8.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L35 MM OD7.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L35 MM OD8.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L40 MM OD7.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L40 MM OD8.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L45 MM OD4 M C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L45 MM OD7.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L45 MM OD8.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L50 MM OD7.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L50 MM OD8.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L55 MM OD7.5 C1713 $2,800.00SCREW BONE POLARIS TITANIUM UNIVERSAL L55 MM OD8.5 C1713 $2,800.00SCREW BONE POLARUS 3 HEXALOBE LOW PROFILE L34 MM O C1713 $695.50SCREW BONE POLARUS 3 HEXALOBE LOW PROFILE L40 MM O C1713 $695.50SCREW BONE POLARUS 3 HEXALOBE LOW PROFILE L42 MM O C1713 $695.50SCREW BONE POLARUS 3 L26 MM OD4.3 MM HUMERUS LOCK C1713 $695.50SCREW BONE POLARUS 3 L28 MM OD4.3 MM HUMERUS LOCK C1713 $695.50SCREW BONE PRECEPT L40 MM OD5.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE PRECEPT L45 MM OD5.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE PRECEPT L45 MM OD6.5 MM SPINE POLYAXIAL C1713 $5,200.00SCREW BONE PROLOCK TITANIUM 15 D L14 MM OD2.4 MM U C1713 $449.48SCREW BONE PROLOK TITANIUM 15 D L16 MM OD2.4 MM FO C1713 $449.48SCREW BONE PROLOK TITANIUM 15 D L18 MM OD2.4 MM FO C1713 $449.48SCREW BONE PROLOK TITANIUM 15 D L20 MM OD2.4 MM FO C1713 $449.48SCREW BONE PROLOK TITANIUM 15 D L22 MM OD2.4 MM FO C1713 $449.48SCREW BONE PROLOK TITANIUM 15 D L24 MM OD2.4 MM FO C1713 $449.48SCREW BONE PROPELLER HEAD TITANIUM SMALL L14 MM OD C1713 $1,144.00SCREW BONE PROTASUL-64WF FULL THREAD L50 MM OD6.5 C1713 $162.50SCREW BONE PROTEX CT STANDARD L6 MM OD4 MM SPINE S C1713 $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 ChargeSCREW BONE PYRENEES L14 MM OD4.35 MM SPINE SELF TA C1713 $487.50SCREW BONE QUICKFIX TITANIUM FULL THREAD L10 MM OD C1713 $1,560.00SCREW BONE QUICKFIX TITANIUM FULL THREAD L11 MM OD C1713 $1,560.00SCREW BONE QUICKFIX TITANIUM FULL THREAD L12 MM OD C1713 $1,560.00SCREW BONE QUICKFIX TITANIUM FULL THREAD L13 MM OD C1713 $1,560.00SCREW BONE QUICKFIX TITANIUM FULL THREAD L14 MM OD C1713 $1,560.00SCREW BONE QUICKFIX TITANIUM SHORT PARTIAL THREAD C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD HE C1713 $975.00SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD L1 C1713 $975.00SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD L2 C1713 $975.00SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD L3 C1713 $975.00SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD L4 C1713 $975.00SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD L5 C1713 $975.00SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L14 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L16 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L18 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L24 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L26 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L30 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L32 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L34 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L36 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L38 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L44 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L46 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L48 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L50 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L52 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L54 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L60 C1713 $1,072.50SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD HEX C1713 $942.50SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD L12 C1713 $910.00SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD L14 C1713 $910.00SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD L16 C1713 $910.00SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD L18 C1713 $942.50SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD L20 C1713 $942.50SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD L8 C1713 $942.50SCREW BONE RAIL TITANIUM STRAIGHT L495 MM OD5.5 MM C1713 $8,000.00SCREW BONE RAIL TITANIUM STRAIGHT L500 MM OD5.5 MM C1713 $8,000.00

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 ChargeSCREW BONE RANGE OD5.5 MM SPINE TAP SYSTEM C1713 $1,449.60SCREW BONE RANGE OD6.5 MM SPINE TAP SYSTEM C1713 $1,449.60SCREW BONE RANGE OD7.5 MM SPINE TAP SYSTEM C1713 $1,449.60SCREW BONE RANGE OD8.5 MM SPINE TAP SYSTEM C1713 $1,481.60SCREW BONE RAPIDSORB L3 MM OD1.5 MM CRANIOMAXILLOF C1713 $547.44SCREW BONE RAPIDSORB L4 MM OD1.5 MM CRANIOMAXILLOF C1713 $780.00SCREW BONE RAPIDSORB L4 MM OD2 MM CRANIOMAXILLOFAC C1713 $780.00SCREW BONE RAPIDSORB L5 MM OD1.5 MM CRANIOMAXILLOF C1713 $780.00SCREW BONE RAPIDSORB L6 MM OD1.5 MM CRANIOMAXILLOF C1713 $780.00SCREW BONE REFORM 30 D L35 MM OD6.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L35 MM OD7.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L40 MM OD5.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L40 MM OD6.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L45 MM OD5.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L45 MM OD6.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L45 MM OD7.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L50 MM OD5.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L50 MM OD6.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L50 MM OD7.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L50 MM OD8.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L55 MM OD6.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L55 MM OD7.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L55 MM OD8.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L70 MM OD8.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM 30 D L80 MM OD8.5 MM SPINE PEDIC C1713 $3,900.00SCREW BONE REFORM L30 MM OD5.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L30 MM OD6.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L35 MM OD4.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L35 MM OD5.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L35 MM OD6.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L35 MM OD7.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L35 MM OD7.5 MM SPINE PEDICLE UN C1713 $3,900.00SCREW BONE REFORM L40 MM OD5.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L40 MM OD6.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L40 MM OD7.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L45 MM OD5.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L45 MM OD6.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L45 MM OD7.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L45 MM OD8.5 MM SPINE PEDICLE MO C1713 $2,080.00

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 ChargeSCREW BONE REFORM L50 MM OD5.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L50 MM OD6.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L50 MM OD7.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L50 MM OD8.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L55 MM OD6.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L55 MM OD7.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L55 MM OD8.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L60 MM OD6.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L60 MM OD8.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L60 MM OD9.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L70 MM OD8.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L70 MM OD9.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM L80 MM OD8.5 MM SPINE PEDICLE MO C1713 $2,080.00SCREW BONE REFORM NARROW PARALLEL DOMINO SPINE PED C1713 $1,625.00SCREW BONE REUNION L16 MM OD4.5 MM PERIPHERAL STER C1713 $487.50SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STER C1713 $487.50SCREW BONE REUNION L24 MM OD4.5 MM PERIPHERAL STER C1713 $487.50SCREW BONE REUNION L32 MM OD4.5 MM PERIPHERAL STER C1713 $487.50SCREW BONE REUNION L32 MM OD6.5 MM PERIPHERAL CENT C1713 $487.50SCREW BONE REUNION L44 MM L6.5 MM OD7 MM FOOT ANKL C1713 $487.50SCREW BONE REUNITE LACTOSORB L10 MM OD3.5 MM ORTHO C1713 $1,291.16SCREW BONE REVERE L25 MM OD5 MM SPINE PEDICLE 6.35 C1713 $3,575.00SCREW BONE REVERE L35 MM OD5 MM SPINE PEDICLE 6.35 C1713 $3,575.00SCREW BONE REVERE L45 MM OD6.5 MM SPINE NONSTERILE C1713 $3,575.00SCREW BONE REVERE L45 MM OD7.5 MM SPINE NONSTERILE C1713 $3,575.00SCREW BONE REVERE L90 MM OD9 MM SPINE PEDICLE 6.35 C1713 $3,575.00SCREW BONE REVERE STAINLESS STEEL L30 MM OD6.5 MM C1713 $3,575.00SCREW BONE REVERE STAINLESS STEEL L30 MM OD7.5 MM C1713 $3,575.00SCREW BONE REVERE STAINLESS STEEL L45 MM OD7.5 MM C1713 $3,575.00SCREW BONE REVERE TITANIUM L25 MM OD4.5 MM SPINE P C1713 $3,575.00SCREW BONE REVERE TITANIUM L30 MM OD4.5 MM SPINE P C1713 $3,575.00SCREW BONE REVERE TITANIUM L55 MM OD8.5 MM SPINE P C1713 $3,575.00SCREW BONE REVERE TITANIUM L70 MM OD7.5 MM SPINE P C1713 $3,575.00SCREW BONE REVERE TITANIUM L70 MM OD8.5 MM SPINE P C1713 $3,575.00SCREW BONE REVERE TITANIUM L75 MM OD7.5 MM SPINE P C1713 $3,575.00SCREW BONE REVERE TITANIUM L90 MM OD7.5 MM SPINE P C1713 $3,575.00SCREW BONE RSP L14 MM OD5 MM SHOULDER LOCK GLENOID C1713 $455.00SCREW BONE RSP L18 MM OD5 MM SHOULDER LOCK GLENOID C1713 $455.00SCREW BONE RSP L22 MM OD5 MM SHOULDER LOCK GLENOID C1713 $455.00

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 ChargeSCREW BONE RSP L26 MM OD5 MM SHOULDER LOCK GLENOID C1713 $455.00SCREW BONE RSP L30 MM OD5 MM SHOULDER LOCK GLENOID C1713 $455.00SCREW BONE RSP L34 MM OD5 MM SHOULDER LOCK GLENOID C1713 $455.00SCREW BONE RSP L38 MM OD5 MM SHOULDER LOCK GLENOID C1713 $455.00SCREW BONE SCHANZ HYDROXYAPATITE L175 MM OD5 MM OR C1713 $1,743.36SCREW BONE SCHANZ HYDROXYAPATITE L200 MM OD5 MM OR C1713 $1,743.36SCREW BONE SCHANZ HYDROXYAPATITE L80 MM OD4/3 MM O C1713 $1,540.96SCREW BONE SCHANZ STAINLESS STEEL L100 MM OD3 MM S C1713 $223.44SCREW BONE SCHANZ STAINLESS STEEL L130 MM OD4 MM S C1713 $231.80SCREW BONE SCHANZ STAINLESS STEEL L150 MM OD5 MM S C1713 $228.00SCREW BONE SCHANZ TITANIUM L100 MM L30 MM OD4 MM S C1713 $1,274.16SCREW BONE SCHANZ TITANIUM L100 MM L30 MM OD6 MM O C1713 $1,564.00SCREW BONE SCHANZ TITANIUM L150 MM L60 MM OD6 MM O C1713 $1,564.00SCREW BONE SCHANZ TITANIUM L200 MM L80 MM OD6 MM O C1713 $1,270.75SCREW BONE SCHANZ TITANIUM L22 MM OD2.5 MM ODSEC4 C1713 $3,416.00SCREW BONE SCHANZ TITANIUM L50 MM OD2.5 MM ODSEC4 C1713 $2,792.00SCREW BONE SCHANZ TITANIUM L60 MM L20 MM OD4 MM OR C1713 $1,274.16SCREW BONE SCHANZ TITANIUM L60 MM OD2.5 MM ODSEC4 C1713 $2,792.00SCREW BONE SCHANZ TITANIUM L70 MM OD2.5 MM ODSEC4 C1713 $1,996.80SCREW BONE SCHANZ TITANIUM L80 MM L20 MM OD4 MM SE C1713 $1,274.16SCREW BONE SECUR-FIT X-TRA TITANIUM T15 L18 MM OD3 C1713 $297.44SCREW BONE SECUR-FIT X-TRA TITANIUM T15 L22 MM OD3 C1713 $297.44SCREW BONE SECUR-FIT X-TRA TITANIUM T15 L24 MM OD3 C1713 $297.44SCREW BONE SECUR-FIT X-TRA TITANIUM T15 L28 MM OD3 C1713 $297.44SCREW BONE SHORT THREAD L17 MM L5 MM OD2 MM CANNUL C1713 $549.25SCREW BONE SHORT THREAD L18 MM L5 MM OD2 MM CANNUL C1713 $549.25SCREW BONE SHORT THREAD L19 MM L5 MM OD2 MM CANNUL C1713 $549.25SCREW BONE SHORT THREAD L20 MM L5 MM OD2 MM CANNUL C1713 $549.25SCREW BONE SHORT THREAD L22 MM L5 MM OD2 MM CANNUL C1713 $549.25SCREW BONE SHORT THREAD L24 MM L6 MM OD2 MM CANNUL C1713 $549.25SCREW BONE SIERRA L12 MM OD3.5 MM SPINE OCCIPITOCE C1713 $3,900.00SCREW BONE SIERRA L12 MM OD4 MM SPINE EXTEND TAB C1713 $3,900.00SCREW BONE SIERRA L14 MM OD3.5 MM SPINE OCCIPITOCE C1713 $3,900.00SCREW BONE SIERRA TITANIUM L24 MM OD4 MM OCCIPITOC C1713 $3,900.00SCREW BONE SILVERTON L100 MM OD8.5 MM SPINE PEDICL C1713 $3,900.00SCREW BONE SILVERTON L50 MM OD8.5 MM SPINE PEDICLE C1713 $3,900.00SCREW BONE SILVERTON L80 MM OD6.5 MM SPINE PEDICLE C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L100 MM OD6.5 MM SPI C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L100 MM OD7.5 MM SPI C1713 $3,900.00

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 ChargeSCREW BONE SILVERTON TITANIUM L20 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L20 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L25 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L25 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L30 MM OD5.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L30 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L30 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L35 MM OD5.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L35 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L35 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L40 MM OD5.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L40 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L40 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L45 MM OD5.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L45 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L45 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L50 MM OD5.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L50 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L50 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L50 MM OD8.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L55 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L55 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L60 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L60 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L65 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L65 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L70 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L70 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L75 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L75 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L80 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L80 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L80 MM OD8.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L85 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L85 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L90 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L90 MM OD7.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L95 MM OD6.5 MM SPIN C1713 $3,900.00SCREW BONE SILVERTON TITANIUM L95 MM OD7.5 MM SPIN C1713 $3,900.00

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 ChargeSCREW BONE SKYLINE TITANIUM L16 MM OD4 MM SPINE CE C1713 $600.00SCREW BONE SMALL L18 MM OLECRANON CONICAL EXTRACTI C1713 $1,933.44SCREW BONE SOLERA CD HORIZON COCR L25 MM OD4.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L25 MM OD5 MM SP C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L25 MM OD5.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L25 MM OD6.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L25 MM OD7.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L30 MM OD4 MM SP C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L30 MM OD4.5 MM C1713 $4,800.00SCREW BONE SOLERA CD HORIZON COCR L30 MM OD5 MM SP C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L30 MM OD5.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L30 MM OD6.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L30 MM OD7.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L35 MM OD4.5 MM C1713 $4,800.00SCREW BONE SOLERA CD HORIZON COCR L35 MM OD5 MM SP C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L35 MM OD5.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L35 MM OD6 MM SP C1713 $4,800.00SCREW BONE SOLERA CD HORIZON COCR L35 MM OD6.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L35 MM OD7.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L40 MM OD4 MM SP C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L40 MM OD4.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L40 MM OD5 MM SP C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L40 MM OD5.5 MM C1713 $4,800.00SCREW BONE SOLERA CD HORIZON COCR L40 MM OD6.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L40 MM OD7.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L40 MM OD8.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L45 MM OD4 MM SP C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L45 MM OD4.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L45 MM OD5 MM SP C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L45 MM OD5.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L45 MM OD6.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L45 MM OD7.5 MM C1713 $4,800.00SCREW BONE SOLERA CD HORIZON COCR L45 MM OD8.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L50 MM OD4.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L50 MM OD5 MM SP C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L50 MM OD5.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L50 MM OD6.5 MM C1713 $4,800.00SCREW BONE SOLERA CD HORIZON COCR L50 MM OD7.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L55 MM OD5.5 MM 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 ChargeSCREW BONE SOLERA CD HORIZON COCR L55 MM OD6.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L55 MM OD7.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L55 MM OD8.5 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L60 MM OD5.5 MM C1713 $4,800.00SCREW BONE SOLERA CD HORIZON COCR L60 MM OD6 MM SP C1713 $5,200.00SCREW BONE SOLERA CD HORIZON COCR L60 MM OD6.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L60 MM OD7.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON COCR L90 MM OD9.5 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON LEGACY STAINLESS STEE C1713 $5,200.00SCREW BONE SOLERA CD HORIZON LEGACY TITANIUM L50 M C1713 $3,900.00SCREW BONE SOLERA CD HORIZON LEGACY TITANIUM L60 M C1713 $5,200.00SCREW BONE SOLERA CD HORIZON LEGACY TITANIUM L70 M C1713 $5,200.00SCREW BONE SOLERA CD HORIZON LEGACY TITANIUM L80 M C1713 $3,900.00SCREW BONE SOLERA CD HORIZON LEGACY TITANIUM L90 M C1713 $4,800.00SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM CO C1713 $3,900.00SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM SM C1713 $3,200.00SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM T2 C1713 $3,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L20 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L25 MM C1713 $4,800.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L30 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L35 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L40 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L45 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L50 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L55 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L60 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L65 MM C1713 $5,200.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L70 MM C1713 $3,900.00SCREW BONE SOLERA CD HORIZON TITANIUM COCR L90 MM C1713 $3,900.00SCREW BONE SOLERA COCR L35 MM OD4 MM SPINE MULTIAX C1713 $5,200.00SCREW BONE SOLERA COCR L55 MM OD7.5 MM SPINE REDUC C1713 $5,200.00SCREW BONE SPHERX II L35 MM OD6.5 MM SPINE DLS C1713 $3,900.00SCREW BONE SPHERX II L40 MM OD6.5 MM SPINE 2 LOCKI C1713 $3,900.00SCREW BONE SPHERX II L45 MM OD6.5 MM SPINE 2 C1713 $3,900.00SCREW BONE SPHERX II L50 MM OD6.5 MM SPINE 2 LOCKI C1713 $3,900.00SCREW BONE SPS TITANIUM FULL THREAD L16 MM OD4 MM C1713 $100.50SCREW BONE SPS TITANIUM FULL THREAD L18 MM OD4 MM C1713 $100.49SCREW BONE SPS TITANIUM FULL THREAD L20 MM OD4 MM C1713 $100.50SCREW BONE SPS TITANIUM PARTIAL THREAD L40 MM OD4 C1713 $100.50

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 ChargeSCREW BONE STAINLESS STEEL 1/2 THREAD REVERSE CUT C1713 $1,402.96SCREW BONE STAINLESS STEEL 1/3 THREAD REVERSE CUT C1713 $1,139.91SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L10 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L100 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L105 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L110 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L115 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 C1713 $113.95SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L120 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L125 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L130 C1713 $630.16SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L135 C1713 $630.16SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 C1713 $113.95SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L140 C1713 $630.16SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L145 C1713 $630.16SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L150 C1713 $630.16SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 C1713 $113.95SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 C1713 $113.95SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 C1713 $135.46SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 C1713 $52.59SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 C1713 $113.95SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 C1713 $113.95SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 C1713 $135.46SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L35 C1713 $113.95SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 C1713 $135.46SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L42 C1713 $135.46SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L44 C1713 $135.46SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L46 C1713 $135.46SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L48 C1713 $135.46SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 C1713 $140.24SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 M C1713 $199.94SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L60 C1713 $140.24

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 ChargeSCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L65 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L70 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L75 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 M C1713 $199.94SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L80 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L85 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L90 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L95 C1713 $205.84SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD REVE C1713 $1,380.00SCREW BONE STAINLESS STEEL 2.5 MM L34 MM OD3.5 MM C1713 $855.60SCREW BONE STAINLESS STEEL 2.5 MM L36 MM OD3.5 MM C1713 $855.60SCREW BONE STAINLESS STEEL 2.5 MM L38 MM OD3.5 MM C1713 $855.60SCREW BONE STAINLESS STEEL 2.5 MM L40 MM OD3.5 MM C1713 $855.60SCREW BONE STAINLESS STEEL 2.5 MM L45 MM OD3.5 MM C1713 $1,807.52SCREW BONE STAINLESS STEEL 2.5 MM L50 MM OD3.5 MM C1713 $855.60SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L C1713 $112.39SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD R C1713 $1,329.36SCREW BONE STAINLESS STEEL 2.5 MM STANDARD FULL TH C1713 $236.88SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L20 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L25 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L30 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L35 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L40 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L45 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L50 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L55 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L60 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L65 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L70 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L75 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L80 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L85 MM OD5 C1713 $1,395.94SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L100 C1713 $285.76SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L105 C1713 $285.76SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L110 C1713 $285.76SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L115 C1713 $358.80SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L120 C1713 $358.80SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L125 C1713 $358.80SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L130 C1713 $358.80

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 ChargeSCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L135 C1713 $358.80SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L140 C1713 $358.80SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L145 C1713 $358.80SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L150 C1713 $358.80SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L20 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L22 C1713 $136.50SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L24 C1713 $136.50SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L25 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L26 C1713 $136.50SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L28 C1713 $136.50SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L30 C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L35 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L40 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L45 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L46 C1713 $136.50SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L50 C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L55 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L60 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L65 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L70 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L75 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L76 C1713 $1,196.00SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L77 C1713 $1,196.00SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L80 C1713 $264.48SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L85 C1713 $285.76SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L90 C1713 $285.76SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD L95 C1713 $285.76SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD REVE C1713 $1,927.36SCREW BONE STAINLESS STEEL 3.5 MM FULL THREAD STAN C1713 $1,927.36SCREW BONE STAINLESS STEEL 3.5 MM L100 MM L16 MM O C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L100 MM L32 MM O C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L100 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L105 MM L16 MM O C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L105 MM L32 MM O C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L105 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L110 MM L16 MM O C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L110 MM L32 MM O C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L110 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L115 MM L16 MM O C1713 $291.53

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 ChargeSCREW BONE STAINLESS STEEL 3.5 MM L115 MM L32 MM O C1713 $291.53SCREW BONE STAINLESS STEEL 3.5 MM L115 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L120 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L125 MM L16 MM O C1713 $291.53SCREW BONE STAINLESS STEEL 3.5 MM L125 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L130 MM L16 MM O C1713 $291.53SCREW BONE STAINLESS STEEL 3.5 MM L130 MM L32 MM O C1713 $291.53SCREW BONE STAINLESS STEEL 3.5 MM L130 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L135 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L140 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L145 MM OD4.5 MM C1713 $285.76SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L28 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L30 MM L16 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L32 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L34 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L35 MM L16 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L36 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L38 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L40 MM L16 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L40 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L42 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L44 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L45 MM L16 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L45 MM L32 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L46 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L50 MM L24 MM OD C1713 $246.08SCREW BONE STAINLESS STEEL 3.5 MM L50 MM L32 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L52 MM OD2.4 MM C1713 $460.19SCREW BONE STAINLESS STEEL 3.5 MM L52 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L54 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L55 MM L32 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM C1713 $132.67

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 ChargeSCREW BONE STAINLESS STEEL 3.5 MM L60 MM L16 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L60 MM L32 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L65 MM L16 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L65 MM L32 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L70 MM L16 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L70 MM L32 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L72 MM OD4.5 MM C1713 $132.67SCREW BONE STAINLESS STEEL 3.5 MM L75 MM L32 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L76 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L80 MM L16 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L80 MM L32 MM OD C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM L80 MM L38 MM OD C1713 $246.08SCREW BONE STAINLESS STEEL 3.5 MM L80 MM OD4.5 MM C1713 $285.76SCREW BONE STAINLESS STEEL 3.5 MM L85 MM L16 MM OD C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L85 MM L32 MM OD C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L85 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L90 MM L16 MM OD C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L90 MM L32 MM OD C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L90 MM OD4.5 MM C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L95 MM L16 MM OD C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM L95 MM L32 MM OD C1713 $232.18SCREW BONE STAINLESS STEEL 3.5 MM PARTIAL THREAD L C1713 $214.89SCREW BONE STAINLESS STEEL 3.5 MM REVERSE CUT FLUT C1713 $1,521.13SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L100 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L105 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L110 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L115 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L120 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L125 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L130 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L135 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L140 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L145 M C1713 $1,117.48SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L20 MM C1713 $1,607.13SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L25 MM C1713 $1,080.11

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 ChargeSCREW BONE STAINLESS STEEL 4 MM FULL THREAD L30 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L35 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L40 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L45 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L50 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L55 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L60 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L65 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L70 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L75 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L80 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L85 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L90 MM C1713 $1,080.11SCREW BONE STAINLESS STEEL 4 MM FULL THREAD L95 MM C1713 $1,329.36SCREW BONE STAINLESS STEEL 4 MM L14 MM OD4 MM ID3. C1713 $975.20SCREW BONE STAINLESS STEEL 4 MM L155 MM L16 MM OD7 C1713 $1,532.38SCREW BONE STAINLESS STEEL 4 MM L155 MM L32 MM OD7 C1713 $1,808.95SCREW BONE STAINLESS STEEL 4 MM L160 MM L16 MM OD7 C1713 $1,532.38SCREW BONE STAINLESS STEEL 4 MM L160 MM L32 MM OD7 C1713 $1,808.95SCREW BONE STAINLESS STEEL 4 MM L165 MM L16 MM OD7 C1713 $1,532.38SCREW BONE STAINLESS STEEL 4 MM L165 MM L32 MM OD7 C1713 $1,808.95SCREW BONE STAINLESS STEEL 4 MM L170 MM L16 MM OD7 C1713 $1,532.38SCREW BONE STAINLESS STEEL 4 MM L170 MM L32 MM OD7 C1713 $1,808.95SCREW BONE STAINLESS STEEL 4 MM L175 MM L16 MM OD7 C1713 $1,532.38SCREW BONE STAINLESS STEEL 4 MM L175 MM L32 MM OD7 C1713 $1,808.95SCREW BONE STAINLESS STEEL 4 MM L180 MM L16 MM OD7 C1713 $1,532.38SCREW BONE STAINLESS STEEL 4 MM L180 MM L32 MM OD7 C1713 $1,532.38SCREW BONE STAINLESS STEEL 4 MM L22 MM OD4 MM ID3. C1713 $975.20SCREW BONE STAINLESS STEEL 4 MM L26 MM OD4 MM ID3. C1713 $792.35SCREW BONE STAINLESS STEEL 4 MM L34 MM OD4 MM ID3. C1713 $975.20SCREW BONE STAINLESS STEEL 4 MM L38 MM OD4 MM ID3. C1713 $792.35SCREW BONE STAINLESS STEEL 4 MM L46 MM OD4 MM ID3. C1713 $975.20SCREW BONE STAINLESS STEEL 4 MM L50 MM OD4 MM ID3. C1713 $975.20SCREW BONE STAINLESS STEEL 4 MM L54 MM OD4 MM ID3. C1713 $975.20SCREW BONE STAINLESS STEEL 4 MM L58 MM OD4 MM ID3. C1713 $975.20SCREW BONE STAINLESS STEEL 4 MM L62 MM OD4 MM ID3. C1713 $975.20SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L40 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L45 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L50 C1713 $956.80

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 ChargeSCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L55 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L60 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L65 C1713 $1,177.60SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L70 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L75 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L80 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L85 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L90 C1713 $956.80SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L95 C1713 $1,177.60SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L16 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L18 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L20 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L22 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L24 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L26 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L28 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L30 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L32 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L34 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L36 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L40 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L42 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L44 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L46 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L48 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L50 C1713 $157.52SCREW BONE STAINLESS STEEL 5 MM PARTIAL THREAD L52 C1713 $157.52SCREW BONE STAINLESS STEEL BUTTRESS L12 MM OD2 MM C1713 $804.00SCREW BONE STAINLESS STEEL BUTTRESS L30 MM OD2 MM C1713 $782.00SCREW BONE STAINLESS STEEL BUTTRESS L8 MM OD2 MM M C1713 $804.00SCREW BONE STAINLESS STEEL BUTTRESS L8 MM OD2 MM R C1713 $804.00SCREW BONE STAINLESS STEEL FULL THREAD L10 MM OD2. C1713 $199.94SCREW BONE STAINLESS STEEL FULL THREAD L100 MM OD3 C1713 $135.46SCREW BONE STAINLESS STEEL FULL THREAD L110 MM OD3 C1713 $135.46SCREW BONE STAINLESS STEEL FULL THREAD L115 MM OD6 C1713 $993.60SCREW BONE STAINLESS STEEL FULL THREAD L120 MM OD6 C1713 $993.60SCREW BONE STAINLESS STEEL FULL THREAD L125 MM OD6 C1713 $993.60SCREW BONE STAINLESS STEEL FULL THREAD L130 MM OD6 C1713 $993.60SCREW BONE STAINLESS STEEL FULL THREAD L14 MM OD4 C1713 $196.64

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 ChargeSCREW BONE STAINLESS STEEL FULL THREAD L16 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L18 MM OD3. C1713 $1,380.00SCREW BONE STAINLESS STEEL FULL THREAD L18 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L20 MM OD4 C1713 $113.95SCREW BONE STAINLESS STEEL FULL THREAD L22 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L24 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L26 MM W2.5 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L28 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L30 MM OD2. C1713 $199.94SCREW BONE STAINLESS STEEL FULL THREAD L30 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L32 MM OD2. C1713 $199.94SCREW BONE STAINLESS STEEL FULL THREAD L32 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L34 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L36 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L38 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L40 MM OD2. C1713 $199.94SCREW BONE STAINLESS STEEL FULL THREAD L40 MM OD3. C1713 $956.80SCREW BONE STAINLESS STEEL FULL THREAD L40 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L42 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L44 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L45 MM OD3. C1713 $956.80SCREW BONE STAINLESS STEEL FULL THREAD L46 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L48 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L50 MM OD2. C1713 $199.94SCREW BONE STAINLESS STEEL FULL THREAD L50 MM OD3. C1713 $956.80SCREW BONE STAINLESS STEEL FULL THREAD L50 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L52 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L54 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L55 MM OD3. C1713 $956.80SCREW BONE STAINLESS STEEL FULL THREAD L56 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L58 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L60 MM OD3. C1713 $956.80SCREW BONE STAINLESS STEEL FULL THREAD L60 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L65 MM OD4 C1713 $196.64SCREW BONE STAINLESS STEEL FULL THREAD L75 MM W2.5 C1713 $349.60SCREW BONE STAINLESS STEEL FULL THREAD L85 MM OD4 C1713 $349.60SCREW BONE STAINLESS STEEL FULL THREAD L95 MM OD4 C1713 $349.60SCREW BONE STAINLESS STEEL FULL THREAD REVERSE CUT C1713 $1,196.00SCREW BONE STAINLESS STEEL L10 MM OD1 MM ODSEC1.6 C1713 $536.46

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 ChargeSCREW BONE STAINLESS STEEL L10 MM OD1.3 MM ODSEC2. C1713 $524.40SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 C1713 $260.82SCREW BONE STAINLESS STEEL L10 MM OD2 MM MAXILLARY C1713 $312.00SCREW BONE STAINLESS STEEL L10 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L10 MM OD2.4 MM MAXILLA C1713 $282.00SCREW BONE STAINLESS STEEL L10 MM OD2.4 MM ODSEC3. C1713 $430.08SCREW BONE STAINLESS STEEL L10 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L10 MM OD2.7 MM CORTICA C1713 $552.50SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L10 MM OD4 MM SPINE FIX C1713 $3,200.00SCREW BONE STAINLESS STEEL L10 MM OD5 MM SELF TAP C1713 $1,439.76SCREW BONE STAINLESS STEEL L100 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L100 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L100 MM OD15 MM ORTHOPE C1713 $2,504.32SCREW BONE STAINLESS STEEL L100 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L100 MM OD5 MM ODSEC3.5 C1713 $1,687.40SCREW BONE STAINLESS STEEL L100 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L105 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L105 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L105 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L105 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L105 MM OD5 MM ODSEC3.5 C1713 $1,687.40SCREW BONE STAINLESS STEEL L105 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L11 MM OD1 MM ODSEC1.6 C1713 $501.36SCREW BONE STAINLESS STEEL L11 MM OD1.3 MM ODSEC2. C1713 $561.11SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L11 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L11 MM OD2.4 MM ODSEC3. C1713 $430.08SCREW BONE STAINLESS STEEL L11 MM OD2.4 MM ODSEC4. C1713 $342.64SCREW BONE STAINLESS STEEL L110 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L110 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L110 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L110 MM OD5 MM ODSEC3.5 C1713 $1,687.40SCREW BONE STAINLESS STEEL L110 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L115 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L115 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L12 MM OD1 MM ODSEC1.6 C1713 $536.46SCREW BONE STAINLESS STEEL L12 MM OD1.3 MM ODSEC2. 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 ChargeSCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L12 MM OD2 MM MAXILLARY C1713 $312.00SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 C1713 $260.82SCREW BONE STAINLESS STEEL L12 MM OD2.4 MM MAXILLA C1713 $211.44SCREW BONE STAINLESS STEEL L12 MM OD2.4 MM ODSEC3. C1713 $331.20SCREW BONE STAINLESS STEEL L12 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L12 MM OD2.7 MM CORTICA C1713 $552.50SCREW BONE STAINLESS STEEL L12 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L12 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L12 MM OD5 MM SELF TAP C1713 $1,439.76SCREW BONE STAINLESS STEEL L120 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L120 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L125 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L125 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L13 MM OD1 MM ODSEC1.6 C1713 $501.36SCREW BONE STAINLESS STEEL L13 MM OD1.3 MM ODSEC2. C1713 $524.40SCREW BONE STAINLESS STEEL L13 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L13 MM OD2 MM ODSEC3.5 C1713 $260.82SCREW BONE STAINLESS STEEL L13 MM OD2.4 MM ODSEC3. C1713 $430.08SCREW BONE STAINLESS STEEL L13 MM OD2.4 MM ODSEC4. C1713 $342.64SCREW BONE STAINLESS STEEL L130 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L130 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L135 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L135 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L14 MM OD1 MM ODSEC1.6 C1713 $501.36SCREW BONE STAINLESS STEEL L14 MM OD1.3 MM ODSEC2. C1713 $524.40SCREW BONE STAINLESS STEEL L14 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L14 MM OD2 MM MAXILLARY C1713 $370.00SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 C1713 $198.06SCREW BONE STAINLESS STEEL L14 MM OD2.4 MM MAXILLA C1713 $199.20SCREW BONE STAINLESS STEEL L14 MM OD2.4 MM ODSEC3. C1713 $331.20SCREW BONE STAINLESS STEEL L14 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L14 MM OD2.7 MM CORTICA C1713 $552.50SCREW BONE STAINLESS STEEL L14 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM CORTEX C1713 $143.64SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L14 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L14 MM OD5 MM SELF TAP C1713 $1,462.80SCREW BONE STAINLESS STEEL L140 MM L16 MM OD6.5 MM C1713 $2,470.16

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 ChargeSCREW BONE STAINLESS STEEL L140 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L145 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L145 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L15 MM OD3.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L15 MM OD4 MM SPINE FIX C1713 $3,200.00SCREW BONE STAINLESS STEEL L15 MM OD4.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L150 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L150 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L150 MM L35 MM OD4 MM S C1713 $1,170.00SCREW BONE STAINLESS STEEL L150 MM L40 MM OD5 MM S C1713 $1,170.00SCREW BONE STAINLESS STEEL L150 MM L40 MM OD5 MM T C1713 $1,170.00SCREW BONE STAINLESS STEEL L155 MM L16 MM X W4 MM C1713 $1,808.95SCREW BONE STAINLESS STEEL L16 MM OD1.3 MM ODSEC2. C1713 $524.40SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L16 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L16 MM OD2.4 MM ODSEC3. C1713 $331.20SCREW BONE STAINLESS STEEL L16 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L16 MM OD2.7 MM CORTICA C1713 $552.50SCREW BONE STAINLESS STEEL L16 MM OD2.7 MM OLECRAN C1713 $700.00SCREW BONE STAINLESS STEEL L16 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L16 MM OD4 MM ID3.4 MM C1713 $975.20SCREW BONE STAINLESS STEEL L160 MM L16 MM X W4 MM C1713 $1,808.95SCREW BONE STAINLESS STEEL L160 MM L32 MM OD6.5 MM C1713 $1,495.00SCREW BONE STAINLESS STEEL L165 MM L16 MM X W4 MM C1713 $1,808.95SCREW BONE STAINLESS STEEL L170 MM L16 MM X W4 MM C1713 $1,808.95SCREW BONE STAINLESS STEEL L175 MM L16 MM X W4 MM C1713 $1,808.95SCREW BONE STAINLESS STEEL L18 MM OD1.3 MM ODSEC2. C1713 $524.40SCREW BONE STAINLESS STEEL L18 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L18 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L18 MM OD2.4 MM ODSEC3. C1713 $331.20SCREW BONE STAINLESS STEEL L18 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L18 MM OD2.7 MM OLECRAN C1713 $700.00SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC5 C1713 $855.60SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L18 MM OD4 MM ID3.4 MM C1713 $975.20SCREW BONE STAINLESS STEEL L18 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L18 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L18 MM OD5 MM SELF TAP C1713 $1,462.80

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 ChargeSCREW BONE STAINLESS STEEL L180 MM L16 MM X W4 MM C1713 $1,808.95SCREW BONE STAINLESS STEEL L180 MM L32 MM OD6.5 MM C1713 $1,495.00SCREW BONE STAINLESS STEEL L20 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L20 MM OD2.4 MM ODSEC3. C1713 $331.20SCREW BONE STAINLESS STEEL L20 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L20 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC5 C1713 $855.60SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L20 MM OD4 MM PERIARTIC C1713 $975.20SCREW BONE STAINLESS STEEL L20 MM OD4 MM SPINE FIX C1713 $2,800.00SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX C1713 $132.67SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L20 MM OD5.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L200 MM L40 MM OD5 MM S C1713 $1,170.00SCREW BONE STAINLESS STEEL L200 MM L40 MM OD5 MM T C1713 $1,170.00SCREW BONE STAINLESS STEEL L200 MM L60 MM OD5 MM S C1713 $1,170.00SCREW BONE STAINLESS STEEL L200 MM L60 MM OD5 MM T C1713 $1,170.00SCREW BONE STAINLESS STEEL L200 MM L80 MM OD5 MM S C1713 $1,170.00SCREW BONE STAINLESS STEEL L22 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L22 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L22 MM OD2.4 MM ODSEC3. C1713 $331.20SCREW BONE STAINLESS STEEL L22 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L22 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L22 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L22 MM OD3.5 MM ODSEC5 C1713 $855.60SCREW BONE STAINLESS STEEL L22 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L22 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L24 MM OD1.5 MM ODSEC3 C1713 $243.76SCREW BONE STAINLESS STEEL L24 MM OD2 MM ODSEC3.5 C1713 $260.82SCREW BONE STAINLESS STEEL L24 MM OD2.4 MM ODSEC3. C1713 $331.20SCREW BONE STAINLESS STEEL L24 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L24 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L24 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L24 MM OD3.5 MM ODSEC5 C1713 $855.60SCREW BONE STAINLESS STEEL L24 MM OD4 MM PERIARTIC C1713 $975.20SCREW BONE STAINLESS STEEL L25 MM OD3.5 MM SPINE F C1713 $2,800.00SCREW BONE STAINLESS STEEL L25 MM OD4 MM SPINE FIX C1713 $3,200.00

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 ChargeSCREW BONE STAINLESS STEEL L25 MM OD4.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L25 MM OD5.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L26 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L26 MM OD2.4 MM ODSEC3. C1713 $331.20SCREW BONE STAINLESS STEEL L26 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L26 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC5 C1713 $855.60SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L26 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L26 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L28 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L28 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L28 MM OD2.4 MM RADIUS C1713 $331.20SCREW BONE STAINLESS STEEL L28 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC5 C1713 $855.60SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L28 MM OD4 MM CORTICAL C1713 $975.20SCREW BONE STAINLESS STEEL L28 MM OD4.5 MM FEMORAL C1713 $2,144.00SCREW BONE STAINLESS STEEL L30 MM HIP COMPRESSION C1713 $648.56SCREW BONE STAINLESS STEEL L30 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L30 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L30 MM OD2.4 MM ODSEC3. C1713 $354.38SCREW BONE STAINLESS STEEL L30 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L30 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC5 C1713 $855.60SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L30 MM OD4 MM ID3.4 MM C1713 $975.20SCREW BONE STAINLESS STEEL L30 MM OD4 MM SPINE FIX C1713 $3,200.00SCREW BONE STAINLESS STEEL L30 MM OD4.5 MM CORTEX C1713 $132.67SCREW BONE STAINLESS STEEL L30 MM OD4.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L30 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L30 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L30 MM OD5.5 MM SPINE F C1713 $2,800.00SCREW BONE STAINLESS STEEL L32 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L32 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L32 MM OD2.7 MM OLECRAN C1713 $700.00

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 ChargeSCREW BONE STAINLESS STEEL L32 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC5 C1713 $855.60SCREW BONE STAINLESS STEEL L32 MM OD4 MM CORTICAL C1713 $975.20SCREW BONE STAINLESS STEEL L34 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L34 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L34 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L34 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L35 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L35 MM OD4 MM SPINE FIX C1713 $2,800.00SCREW BONE STAINLESS STEEL L35 MM OD4.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L35 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L35 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L35 MM OD5.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L36 MM OD2 MM ODSEC3.5 C1713 $260.82SCREW BONE STAINLESS STEEL L36 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L36 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L36 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L36 MM OD4 MM CORTICAL C1713 $792.35SCREW BONE STAINLESS STEEL L38 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L38 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L38 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L38 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L4 MM OD2 MM MAXILLARY C1713 $370.00SCREW BONE STAINLESS STEEL L40 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L40 MM OD2 MM ODSEC3.5 C1713 $243.76SCREW BONE STAINLESS STEEL L40 MM OD2.4 MM ODSEC4. C1713 $331.20SCREW BONE STAINLESS STEEL L40 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L40 MM OD4 MM CORTICAL C1713 $975.20SCREW BONE STAINLESS STEEL L40 MM OD4 MM SPINE FIX C1713 $3,200.00SCREW BONE STAINLESS STEEL L40 MM OD4.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L40 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L40 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L40 MM OD5.5 MM SPINE F C1713 $3,200.00SCREW BONE STAINLESS STEEL L42 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L42 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L42 MM OD3.5 MM ODSEC2. C1713 $130.33SCREW BONE STAINLESS STEEL L42 MM OD4 MM ID3.4 MM C1713 $975.20

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 ChargeSCREW BONE STAINLESS STEEL L44 MM OD2 MM CORTICAL C1713 $223.04SCREW BONE STAINLESS STEEL L44 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L44 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L44 MM OD4 MM CORTICAL C1713 $975.20SCREW BONE STAINLESS STEEL L45 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L45 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L45 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L45 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L45 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L45 MM OD5.5 MM SPINE F C1713 $2,800.00SCREW BONE STAINLESS STEEL L46 MM OD2 MM CORTICAL C1713 $223.04SCREW BONE STAINLESS STEEL L46 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L46 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L48 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L48 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L48 MM OD4 MM CORTICAL C1713 $975.20SCREW BONE STAINLESS STEEL L48 MM OD4.5 MM CORTEX C1713 $132.67SCREW BONE STAINLESS STEEL L50 MM L16 MM OD6.5 MM C1713 $2,007.01SCREW BONE STAINLESS STEEL L50 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L50 MM OD2.7 MM OLECRAN C1713 $679.44SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L50 MM OD4.5 MM CORTEX C1713 $132.67SCREW BONE STAINLESS STEEL L50 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L50 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L51 MM OD5 MM SELF DRIL C1713 $1,476.56SCREW BONE STAINLESS STEEL L52 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L52 MM OD4 MM CORTICAL C1713 $975.20SCREW BONE STAINLESS STEEL L54 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L55 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L55 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L55 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L55 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L55 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L56 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L56 MM OD4 MM CORTICAL C1713 $975.20SCREW BONE STAINLESS STEEL L58 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L6 MM OD1 MM ODSEC1.6 M C1713 $501.36SCREW BONE STAINLESS STEEL L6 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 ChargeSCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 M C1713 $243.76SCREW BONE STAINLESS STEEL L6 MM OD2 MM MAXILLARY C1713 $370.00SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 M C1713 $260.82SCREW BONE STAINLESS STEEL L6 MM OD2.4 MM MAXILLAR C1713 $282.00SCREW BONE STAINLESS STEEL L6 MM OD2.4 MM ODSEC3.5 C1713 $460.19SCREW BONE STAINLESS STEEL L6 MM OD2.4 MM ODSEC4.5 C1713 $342.64SCREW BONE STAINLESS STEEL L60 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L60 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L60 MM OD2.4 MM ODSEC3. C1713 $430.08SCREW BONE STAINLESS STEEL L60 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L60 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L60 MM OD4 MM CORTICAL C1713 $975.20SCREW BONE STAINLESS STEEL L60 MM OD4.5 MM CORTEX C1713 $132.67SCREW BONE STAINLESS STEEL L60 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L60 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L60 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L62 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L64 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L65 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L65 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L65 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L65 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L65 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L65 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L66 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L68 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L7 MM OD1 MM ODSEC1.6 M C1713 $501.36SCREW BONE STAINLESS STEEL L7 MM OD1.3 MM ODSEC2.4 C1713 $561.11SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 M C1713 $260.82SCREW BONE STAINLESS STEEL L7 MM OD2 MM ODSEC3.5 M C1713 $243.76SCREW BONE STAINLESS STEEL L7 MM OD2.4 MM ODSEC4.5 C1713 $342.64SCREW BONE STAINLESS STEEL L70 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L70 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L70 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX C1713 $132.67SCREW BONE STAINLESS STEEL L70 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L70 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L70 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L75 MM L16 MM OD6.5 MM C1713 $2,470.16

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 ChargeSCREW BONE STAINLESS STEEL L75 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L75 MM OD15 MM ORTHOPED C1713 $2,504.32SCREW BONE STAINLESS STEEL L75 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L75 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L75 MM OD4.5 MM CORTEX C1713 $246.08SCREW BONE STAINLESS STEEL L75 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L75 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L75 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L8 MM OD1 MM ODSEC1.6 M C1713 $501.36SCREW BONE STAINLESS STEEL L8 MM OD1.3 MM ODSEC2.4 C1713 $524.40SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 M C1713 $243.76SCREW BONE STAINLESS STEEL L8 MM OD2 MM MAXILLARY C1713 $312.00SCREW BONE STAINLESS STEEL L8 MM OD2 MM ODSEC3.5 M C1713 $243.76SCREW BONE STAINLESS STEEL L8 MM OD2.4 MM MAXILLAR C1713 $282.00SCREW BONE STAINLESS STEEL L8 MM OD2.4 MM ODSEC3.5 C1713 $430.08SCREW BONE STAINLESS STEEL L8 MM OD2.4 MM ODSEC4.5 C1713 $331.20SCREW BONE STAINLESS STEEL L8 MM OD5 MM SELF TAP L C1713 $1,439.76SCREW BONE STAINLESS STEEL L80 MM L16 MM OD6.5 MM C1713 $2,007.01SCREW BONE STAINLESS STEEL L80 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L80 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L80 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L80 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L80 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L85 MM L16 MM OD6.5 MM C1713 $2,007.01SCREW BONE STAINLESS STEEL L85 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L85 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L85 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L85 MM OD5 MM SELF DRIL C1713 $1,453.60SCREW BONE STAINLESS STEEL L85 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L9 MM OD1 MM ODSEC1.6 M C1713 $501.36SCREW BONE STAINLESS STEEL L9 MM OD1.3 MM ODSEC2.4 C1713 $524.40SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 M C1713 $243.76SCREW BONE STAINLESS STEEL L9 MM OD2 MM ODSEC3.5 M C1713 $243.76SCREW BONE STAINLESS STEEL L9 MM OD2.4 MM ODSEC4.5 C1713 $342.64SCREW BONE STAINLESS STEEL L90 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L90 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L90 MM OD3.5 MM CORTEX C1713 $201.31SCREW BONE STAINLESS STEEL L90 MM OD5 MM FEMUR DIS C1713 $1,476.56SCREW BONE STAINLESS STEEL L90 MM OD5 MM SELF DRIL C1713 $1,453.60

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 ChargeSCREW BONE STAINLESS STEEL L90 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL L95 MM L16 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L95 MM L32 MM OD6.5 MM C1713 $2,470.16SCREW BONE STAINLESS STEEL L95 MM OD3.5 MM CORTEX C1713 $311.22SCREW BONE STAINLESS STEEL L95 MM OD3.5 MM ODSEC6 C1713 $135.46SCREW BONE STAINLESS STEEL L95 MM OD4.5 MM CORTEX C1713 $232.18SCREW BONE STAINLESS STEEL L95 MM OD5 MM ODSEC3.5 C1713 $1,687.40SCREW BONE STAINLESS STEEL L95 MM OD6.5 MM ODSEC8 C1713 $993.60SCREW BONE STAINLESS STEEL LONG THREAD L105 MM OD4 C1713 $2,792.27SCREW BONE STAINLESS STEEL LONG THREAD L110 MM OD4 C1713 $2,792.27SCREW BONE STAINLESS STEEL LONG THREAD L14 MM OD3 C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L15 MM L7 M C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L16 MM OD3 C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L17 MM L8 M C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L18 MM L8 M C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L19 MM L9 M C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L20 MM L8 M C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L21 MM L9 M C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L22 MM L10 C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L23 MM L10 C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L24 MM L10 C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L25 MM L10 C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L26 MM L12 C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L27 MM L12 C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L28 MM L12 C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L29 MM L12 C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L30 MM L8 M C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L32 MM L14 C1713 $1,173.58SCREW BONE STAINLESS STEEL LONG THREAD L34 MM L16 C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L36 MM L16 C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L38 MM L18 C1713 $1,444.40SCREW BONE STAINLESS STEEL LONG THREAD L40 MM L18 C1713 $1,444.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L100 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L105 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L110 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L115 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L120 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L125 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L130 MM C1713 $1,876.80

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 ChargeSCREW BONE STAINLESS STEEL PARTIAL THREAD L135 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L140 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L145 MM C1713 $1,876.80SCREW BONE STAINLESS STEEL PARTIAL THREAD L40 MM O C1713 $777.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L45 MM O C1713 $777.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L50 MM O C1713 $1,766.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L55 MM O C1713 $1,766.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L60 MM O C1713 $1,766.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L65 MM O C1713 $1,766.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L70 MM O C1713 $1,435.20SCREW BONE STAINLESS STEEL PARTIAL THREAD L75 MM O C1713 $1,435.20SCREW BONE STAINLESS STEEL PARTIAL THREAD L80 MM L C1713 $1,566.24SCREW BONE STAINLESS STEEL PARTIAL THREAD L80 MM O C1713 $1,766.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L85 MM O C1713 $1,766.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L90 MM O C1713 $1,766.40SCREW BONE STAINLESS STEEL PARTIAL THREAD L95 MM O C1713 $1,435.20SCREW BONE STAINLESS STEEL PARTIAL THREAD REVERSE C1713 $1,483.76SCREW BONE STAINLESS STEEL PEDIATRIC T8 L12 MM OD2 C1713 $181.55SCREW BONE STAINLESS STEEL PEDIATRIC T8 L14 MM OD2 C1713 $181.55SCREW BONE STAINLESS STEEL PEDIATRIC T8 L16 MM OD2 C1713 $181.55SCREW BONE STAINLESS STEEL PEDIATRIC T8 L18 MM OD2 C1713 $181.55SCREW BONE STAINLESS STEEL PEDIATRIC T8 L20 MM OD2 C1713 $181.55SCREW BONE STAINLESS STEEL PEDIATRIC T8 L22 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L24 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L26 MM OD2 C1713 $181.55SCREW BONE STAINLESS STEEL PEDIATRIC T8 L28 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L30 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L32 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L34 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L36 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L38 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L40 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L42 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L44 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L46 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L48 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L50 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L55 MM OD2 C1713 $223.44SCREW BONE STAINLESS STEEL PEDIATRIC T8 L60 MM OD2 C1713 $223.44

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 ChargeSCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L100 C1713 $1,826.16SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L105 C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L110 C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L115 C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L120 C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L125 C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L130 C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L135 C1713 $1,495.00SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L140 C1713 $1,495.00SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L145 C1713 $1,495.00SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L150 C1713 $1,495.00SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L170 C1713 $1,495.00SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L30 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L35 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L40 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L45 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L50 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L55 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L60 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L65 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L70 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L75 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L80 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L85 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L90 M C1713 $1,483.76SCREW BONE STAINLESS STEEL REVERSE CUT FLUTE L95 M C1713 $1,483.76SCREW BONE STAINLESS STEEL SHORT THREAD L10 MM L4 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L105 MM L2 C1713 $2,792.27SCREW BONE STAINLESS STEEL SHORT THREAD L11 MM L4 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L110 MM L2 C1713 $2,792.27SCREW BONE STAINLESS STEEL SHORT THREAD L12 MM L4 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L13 MM OD3 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L14 MM L4 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L15 MM L4 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L16 MM L4 C1713 $2,447.20SCREW BONE STAINLESS STEEL SHORT THREAD L17 MM L4 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L18 MM L5 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L19 MM L5 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L20 MM L4 C1713 $1,173.58

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 ChargeSCREW BONE STAINLESS STEEL SHORT THREAD L21 MM L5 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L22 MM L5 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L23 MM L5 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L24 MM L6 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L25 MM L6 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L26 MM L6 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L27 MM L6 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L28 MM L6 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L29 MM L6 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L30 MM L4 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L32 MM L6 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L34 MM L7 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L36 MM L7 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L38 MM L8 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L40 MM L4 C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L48 MM OD4 C1713 $1,139.91SCREW BONE STAINLESS STEEL SHORT THREAD L8 MM L4 M C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD L9 MM L4 M C1713 $1,173.58SCREW BONE STAINLESS STEEL SHORT THREAD REVERSE CU C1713 $1,744.60SCREW BONE STAINLESS STEEL STANDARD FULL THREAD L1 C1713 $236.88SCREW BONE STAINLESS STEEL STANDARD FULL THREAD L2 C1713 $236.88SCREW BONE STAINLESS STEEL STANDARD FULL THREAD L3 C1713 $236.88SCREW BONE STAINLESS STEEL STANDARD FULL THREAD L4 C1713 $236.88SCREW BONE STAINLESS STEEL STANDARD FULL THREAD L5 C1713 $226.48SCREW BONE STAINLESS STEEL STANDARD FULL THREAD L6 C1713 $236.88SCREW BONE STAINLESS STEEL STANDARD FULL THREAD L8 C1713 $236.88SCREW BONE STAINLESS STEEL STANDARD L10 MM OD1.5 M C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L10 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L10 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L100 MM OD3.5 C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L100 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L105 MM OD3.5 C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L105 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L11 MM OD1.5 M C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L110 MM OD3.5 C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L110 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L115 MM OD3.5 C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L115 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L12 MM OD2 MM C1713 $223.04

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 ChargeSCREW BONE STAINLESS STEEL STANDARD L12 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L120 MM OD3.5 C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L120 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L125 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L130 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L135 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L14 MM OD1.5 M C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L14 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L14 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L14 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L140 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L145 MM OD4.5 C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L150 MM OD4.5 C1713 $313.12SCREW BONE STAINLESS STEEL STANDARD L155 MM OD4.5 C1713 $313.12SCREW BONE STAINLESS STEEL STANDARD L16 MM OD1.5 M C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L16 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L16 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L16 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L160 MM OD4.5 C1713 $313.12SCREW BONE STAINLESS STEEL STANDARD L18 MM OD1.5 M C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L18 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L18 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L18 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L20 MM OD1.5 M C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L20 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L20 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L20 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L22 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L22 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L22 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L24 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L24 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L24 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L26 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L26 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L26 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L28 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L28 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L28 MM OD4.5 M 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 ChargeSCREW BONE STAINLESS STEEL STANDARD L30 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L30 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L30 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L32 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L32 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L32 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L34 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L34 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L34 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L36 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L36 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L38 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L38 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L40 MM OD2 MM C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L40 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L40 MM OD4.5 M C1713 $106.47SCREW BONE STAINLESS STEEL STANDARD L42 MM OD4.5 M C1713 $106.47SCREW BONE STAINLESS STEEL STANDARD L44 MM OD4.5 M C1713 $106.47SCREW BONE STAINLESS STEEL STANDARD L45 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L46 MM OD4.5 M C1713 $106.47SCREW BONE STAINLESS STEEL STANDARD L48 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L50 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L50 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L52 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L54 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L55 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L56 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L58 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L6 MM OD1.5 MM C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L60 MM OD3.5 M C1713 $127.68SCREW BONE STAINLESS STEEL STANDARD L60 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L62 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L64 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L65 MM OD3.5 M C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L66 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L68 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L7 MM OD1.5 MM C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L70 MM OD3.5 M C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L70 MM OD4.5 M 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 ChargeSCREW BONE STAINLESS STEEL STANDARD L72 MM OD4.5 M C1713 $131.04SCREW BONE STAINLESS STEEL STANDARD L75 MM OD3.5 M C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L76 MM OD4.5 M C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L8 MM OD1.5 MM C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L8 MM OD2 MM O C1713 $223.04SCREW BONE STAINLESS STEEL STANDARD L80 MM OD3.5 M C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L80 MM OD4.5 M C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L85 MM OD3.5 M C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L85 MM OD4.5 M C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L9 MM OD1.5 MM C1713 $228.80SCREW BONE STAINLESS STEEL STANDARD L90 MM OD3.5 M C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L90 MM OD4.5 M C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD L95 MM OD3.5 M C1713 $198.88SCREW BONE STAINLESS STEEL STANDARD L95 MM OD4.5 M C1713 $218.88SCREW BONE STAINLESS STEEL STANDARD PARTIAL THREAD C1713 $129.92SCREW BONE STAINLESS STEEL T10 FULL THREAD L10 MM C1713 $747.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L12 MM C1713 $747.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L14 MM C1713 $227.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L16 MM C1713 $747.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L18 MM C1713 $227.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L20 MM C1713 $747.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L22 MM C1713 $747.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L24 MM C1713 $747.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L26 MM C1713 $227.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L28 MM C1713 $227.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L30 MM C1713 $227.50SCREW BONE STAINLESS STEEL T10 FULL THREAD L8 MM O C1713 $747.50SCREW BONE STAINLESS STEEL T15 FULL THREAD L10 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L100 MM C1713 $215.04SCREW BONE STAINLESS STEEL T15 FULL THREAD L105 MM C1713 $215.04SCREW BONE STAINLESS STEEL T15 FULL THREAD L110 MM C1713 $215.04SCREW BONE STAINLESS STEEL T15 FULL THREAD L115 MM C1713 $215.04SCREW BONE STAINLESS STEEL T15 FULL THREAD L12 MM C1713 $140.14SCREW BONE STAINLESS STEEL T15 FULL THREAD L120 MM C1713 $215.04SCREW BONE STAINLESS STEEL T15 FULL THREAD L125 MM C1713 $215.04SCREW BONE STAINLESS STEEL T15 FULL THREAD L130 MM C1713 $694.56SCREW BONE STAINLESS STEEL T15 FULL THREAD L135 MM C1713 $694.56SCREW BONE STAINLESS STEEL T15 FULL THREAD L14 MM C1713 $140.14SCREW BONE STAINLESS STEEL T15 FULL THREAD L140 MM C1713 $694.56

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 ChargeSCREW BONE STAINLESS STEEL T15 FULL THREAD L145 MM C1713 $694.56SCREW BONE STAINLESS STEEL T15 FULL THREAD L150 MM C1713 $694.56SCREW BONE STAINLESS STEEL T15 FULL THREAD L16 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L18 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L20 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L22 MM C1713 $140.14SCREW BONE STAINLESS STEEL T15 FULL THREAD L24 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L26 MM C1713 $140.14SCREW BONE STAINLESS STEEL T15 FULL THREAD L28 MM C1713 $140.14SCREW BONE STAINLESS STEEL T15 FULL THREAD L30 MM C1713 $140.14SCREW BONE STAINLESS STEEL T15 FULL THREAD L32 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L34 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L35 MM C1713 $695.18SCREW BONE STAINLESS STEEL T15 FULL THREAD L36 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L38 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L40 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L42 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L44 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L45 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L46 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L48 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L50 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L52 MM C1713 $1,297.20SCREW BONE STAINLESS STEEL T15 FULL THREAD L54 MM C1713 $695.18SCREW BONE STAINLESS STEEL T15 FULL THREAD L55 MM C1713 $140.14SCREW BONE STAINLESS STEEL T15 FULL THREAD L56 MM C1713 $695.18SCREW BONE STAINLESS STEEL T15 FULL THREAD L58 MM C1713 $695.18SCREW BONE STAINLESS STEEL T15 FULL THREAD L60 MM C1713 $140.14SCREW BONE STAINLESS STEEL T15 FULL THREAD L65 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L70 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L75 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L8 MM O C1713 $747.50SCREW BONE STAINLESS STEEL T15 FULL THREAD L80 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L85 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L90 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 FULL THREAD L95 MM C1713 $172.48SCREW BONE STAINLESS STEEL T15 L10 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L10 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L100 MM OD3.5 MM CO C1713 $317.40

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 ChargeSCREW BONE STAINLESS STEEL T15 L105 MM OD3.5 MM CO C1713 $317.40SCREW BONE STAINLESS STEEL T15 L110 MM OD3.5 MM CO C1713 $317.40SCREW BONE STAINLESS STEEL T15 L12 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L12 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L14 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L14 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L16 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L16 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L18 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L18 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L20 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L20 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L22 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L22 MM OD3.5 MM FEM C1713 $448.00SCREW BONE STAINLESS STEEL T15 L22 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L22 MM OD4 MM SELF C1713 $524.55SCREW BONE STAINLESS STEEL T15 L24 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L24 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L24 MM OD4 MM SELF C1713 $524.55SCREW BONE STAINLESS STEEL T15 L26 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L26 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L28 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L28 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L28 MM OD4 MM SELF C1713 $524.55SCREW BONE STAINLESS STEEL T15 L30 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L30 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L30 MM OD4 MM SELF C1713 $524.55SCREW BONE STAINLESS STEEL T15 L32 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L32 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L34 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L34 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L36 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L36 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L36 MM OD4 MM SELF C1713 $524.55SCREW BONE STAINLESS STEEL T15 L38 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L38 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L40 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L40 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L42 MM OD3.5 MM COR C1713 $203.26

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 ChargeSCREW BONE STAINLESS STEEL T15 L42 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L44 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L44 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L45 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L46 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L46 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L48 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L48 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L48 MM OD4 MM SELF C1713 $524.55SCREW BONE STAINLESS STEEL T15 L50 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L50 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L52 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L52 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L54 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L54 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L55 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L56 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L56 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L58 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L58 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L60 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L60 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L62 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L64 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L65 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L65 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L66 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L68 MM OD3.5 MM COR C1713 $203.26SCREW BONE STAINLESS STEEL T15 L70 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L70 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L75 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L75 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L80 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L80 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L85 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L85 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L90 MM OD3.5 MM COR C1713 $317.40SCREW BONE STAINLESS STEEL T15 L90 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 L95 MM OD3.5 MM COR C1713 $203.26

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 ChargeSCREW BONE STAINLESS STEEL T15 L95 MM OD3.5 MM SEL C1713 $855.21SCREW BONE STAINLESS STEEL T15 LONG THREAD L100 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L30 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L32 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L34 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L36 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L38 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L40 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L42 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L44 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L46 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L48 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L50 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L52 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L54 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L56 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L58 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L60 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L65 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L70 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L75 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L80 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L85 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L90 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 LONG THREAD L95 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 OD4.5 MM 2 PART CON C1713 $1,099.36SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L10 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L12 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L14 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L16 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L18 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L20 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L22 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L24 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L26 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L28 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L30 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L32 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L34 C1713 $1,136.16

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 ChargeSCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L36 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L38 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L40 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L42 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L44 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L46 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L48 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L50 C1713 $923.13SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L52 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L54 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L56 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L58 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L60 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L65 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L70 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L75 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L80 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L85 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L90 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 PARTIAL THREAD L95 C1713 $1,136.16SCREW BONE STAINLESS STEEL T15 SHORT THREAD L100 M C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L20 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L22 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L24 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L26 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L28 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L30 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L32 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L34 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L36 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L38 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L40 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L42 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L44 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L46 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L48 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L50 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L52 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L54 MM C1713 $1,999.53

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 ChargeSCREW BONE STAINLESS STEEL T15 SHORT THREAD L56 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L58 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L60 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L65 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L70 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L75 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L80 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L85 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L90 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T15 SHORT THREAD L95 MM C1713 $1,999.53SCREW BONE STAINLESS STEEL T25 FULL THREAD L10 MM C1713 $1,446.38SCREW BONE STAINLESS STEEL T25 FULL THREAD L14 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L16 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L18 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L20 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L22 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L24 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L26 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L28 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L30 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L32 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L34 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L36 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L38 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L40 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L42 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L44 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L46 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L48 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L50 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L52 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L54 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L55 MM C1713 $807.30SCREW BONE STAINLESS STEEL T25 FULL THREAD L56 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L58 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L60 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L62 MM C1713 $792.35SCREW BONE STAINLESS STEEL T25 FULL THREAD L65 MM C1713 $807.30SCREW BONE STAINLESS STEEL T25 FULL THREAD L70 MM C1713 $807.30

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 ChargeSCREW BONE STAINLESS STEEL T25 FULL THREAD L75 MM C1713 $807.30SCREW BONE STAINLESS STEEL T25 FULL THREAD L8 MM O C1713 $1,780.16SCREW BONE STAINLESS STEEL T25 FULL THREAD L80 MM C1713 $807.30SCREW BONE STAINLESS STEEL T25 FULL THREAD L85 MM C1713 $807.30SCREW BONE STAINLESS STEEL T25 FULL THREAD L90 MM C1713 $807.30SCREW BONE STAINLESS STEEL T25 L10 MM OD5 MM ID4.4 C1713 $1,439.76SCREW BONE STAINLESS STEEL T25 L12 MM OD5 MM ID4.4 C1713 $1,439.76SCREW BONE STAINLESS STEEL T25 L12 MM OD5 MM SELF C1713 $1,729.59SCREW BONE STAINLESS STEEL T25 L14 MM OD5 MM SELF C1713 $1,729.59SCREW BONE STAINLESS STEEL T25 L16 MM OD5 MM SELF C1713 $1,729.59SCREW BONE STAINLESS STEEL T25 L18 MM OD5 MM SELF C1713 $1,729.59SCREW BONE STAINLESS STEEL T25 L22 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L24 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L28 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L30 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L32 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L34 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L36 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L38 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L40 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L42 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L44 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L48 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L50 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L55 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L60 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L65 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L75 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T25 L8 MM OD5 MM ID4.4 C1713 $1,439.76SCREW BONE STAINLESS STEEL T25 L90 MM OD5 MM SELF C1713 $1,031.62SCREW BONE STAINLESS STEEL T4 L10 MM OD1.5 MM CORT C1713 $327.25SCREW BONE STAINLESS STEEL T4 L10 MM OD1.5 MM SELF C1713 $612.95SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORT C1713 $248.50SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM SELF C1713 $612.95SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM CORT C1713 $248.50SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF C1713 $754.40SCREW BONE STAINLESS STEEL T4 L13 MM OD1.5 MM CORT C1713 $305.84SCREW BONE STAINLESS STEEL T4 L13 MM OD1.5 MM SELF C1713 $612.95SCREW BONE STAINLESS STEEL T4 L14 MM OD1.5 MM CORT C1713 $327.25

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 ChargeSCREW BONE STAINLESS STEEL T4 L14 MM OD1.5 MM SELF C1713 $612.95SCREW BONE STAINLESS STEEL T4 L15 MM OD1.5 MM CORT C1713 $327.25SCREW BONE STAINLESS STEEL T4 L15 MM OD1.5 MM SELF C1713 $754.40SCREW BONE STAINLESS STEEL T4 L16 MM L5 MM OD1.5 M C1713 $1,532.38SCREW BONE STAINLESS STEEL T4 L16 MM OD1.5 MM CORT C1713 $305.84SCREW BONE STAINLESS STEEL T4 L16 MM OD1.5 MM SELF C1713 $612.95SCREW BONE STAINLESS STEEL T4 L18 MM OD1.5 MM CORT C1713 $327.25SCREW BONE STAINLESS STEEL T4 L18 MM OD1.5 MM SELF C1713 $754.40SCREW BONE STAINLESS STEEL T4 L20 MM L6 MM OD1.5 M C1713 $1,532.38SCREW BONE STAINLESS STEEL T4 L20 MM OD1.5 MM CORT C1713 $305.84SCREW BONE STAINLESS STEEL T4 L20 MM OD1.5 MM SELF C1713 $754.40SCREW BONE STAINLESS STEEL T4 L22 MM OD1.5 MM CORT C1713 $305.84SCREW BONE STAINLESS STEEL T4 L22 MM OD1.5 MM SELF C1713 $754.40SCREW BONE STAINLESS STEEL T4 L24 MM OD1.5 MM CORT C1713 $305.84SCREW BONE STAINLESS STEEL T4 L24 MM OD1.5 MM SELF C1713 $807.21SCREW BONE STAINLESS STEEL T4 L6 MM OD1.5 MM CORTE C1713 $265.89SCREW BONE STAINLESS STEEL T4 L6 MM OD1.5 MM SELF C1713 $754.40SCREW BONE STAINLESS STEEL T4 L7 MM OD1.5 MM CORTE C1713 $265.89SCREW BONE STAINLESS STEEL T4 L7 MM OD1.5 MM SELF C1713 $612.95SCREW BONE STAINLESS STEEL T4 L8 MM OD1.5 MM CORTE C1713 $305.84SCREW BONE STAINLESS STEEL T4 L8 MM OD1.5 MM SELF C1713 $612.95SCREW BONE STAINLESS STEEL T4 L9 MM OD1.5 MM CORTE C1713 $305.84SCREW BONE STAINLESS STEEL T4 L9 MM OD1.5 MM SELF C1713 $612.95SCREW BONE STAINLESS STEEL T6 L10 MM OD2 MM CORTEX C1713 $296.00SCREW BONE STAINLESS STEEL T6 L10 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L11 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L11 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L12 MM OD2 MM CORTEX C1713 $240.50SCREW BONE STAINLESS STEEL T6 L12 MM OD2 MM SELF T C1713 $836.74SCREW BONE STAINLESS STEEL T6 L13 MM OD2 MM CORTEX C1713 $224.77SCREW BONE STAINLESS STEEL T6 L13 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L14 MM OD2 MM CORTEX C1713 $224.77SCREW BONE STAINLESS STEEL T6 L14 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L15 MM OD2 MM CORTEX C1713 $237.32SCREW BONE STAINLESS STEEL T6 L16 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L16 MM OD2 MM SELF T C1713 $836.74SCREW BONE STAINLESS STEEL T6 L18 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L18 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L20 MM OD2 MM CORTEX C1713 $276.64

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 ChargeSCREW BONE STAINLESS STEEL T6 L20 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L22 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L22 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L24 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L24 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L26 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L26 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L28 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L28 MM OD2 MM SELF T C1713 $782.00SCREW BONE STAINLESS STEEL T6 L30 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L32 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L34 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L36 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L38 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L40 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L6 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L6 MM OD2 MM SELF TA C1713 $782.00SCREW BONE STAINLESS STEEL T6 L7 MM OD2 MM CORTEX C1713 $296.00SCREW BONE STAINLESS STEEL T6 L7 MM OD2 MM SELF TA C1713 $836.74SCREW BONE STAINLESS STEEL T6 L8 MM OD2 MM CORTEX C1713 $240.50SCREW BONE STAINLESS STEEL T6 L8 MM OD2 MM SELF TA C1713 $836.74SCREW BONE STAINLESS STEEL T6 L9 MM OD2 MM CORTEX C1713 $276.64SCREW BONE STAINLESS STEEL T6 L9 MM OD2 MM SELF TA C1713 $782.00SCREW BONE STAINLESS STEEL T8 FULL THREAD L10 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L11 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L12 MM O C1713 $551.01SCREW BONE STAINLESS STEEL T8 FULL THREAD L13 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L14 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L16 MM O C1713 $725.63SCREW BONE STAINLESS STEEL T8 FULL THREAD L18 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L20 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L22 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L24 MM O C1713 $551.01SCREW BONE STAINLESS STEEL T8 FULL THREAD L26 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L28 MM O C1713 $725.63SCREW BONE STAINLESS STEEL T8 FULL THREAD L30 MM O C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L6 MM OD C1713 $678.16SCREW BONE STAINLESS STEEL T8 FULL THREAD L7 MM OD C1713 $725.63SCREW BONE STAINLESS STEEL T8 FULL THREAD L8 MM OD C1713 $725.63

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 ChargeSCREW BONE STAINLESS STEEL T8 FULL THREAD L9 MM OD C1713 $678.16SCREW BONE STAINLESS STEEL T8 L10 MM OD2.4 MM CORT C1713 $264.36SCREW BONE STAINLESS STEEL T8 L10 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L10 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L10 MM OD2.7 MM ID2. C1713 $654.03SCREW BONE STAINLESS STEEL T8 L10 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L11 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L11 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L11 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L12 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L12 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L12 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L12 MM OD2.7 MM ID2. C1713 $654.03SCREW BONE STAINLESS STEEL T8 L12 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L13 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L13 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L13 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L14 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L14 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L14 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L14 MM OD2.7 MM ID2. C1713 $654.03SCREW BONE STAINLESS STEEL T8 L14 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L16 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L16 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L16 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L16 MM OD2.7 MM ID2. C1713 $654.03SCREW BONE STAINLESS STEEL T8 L16 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L18 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L18 MM OD2.4 MM SELF C1713 $824.79SCREW BONE STAINLESS STEEL T8 L18 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L18 MM OD2.7 MM ID2. C1713 $654.03SCREW BONE STAINLESS STEEL T8 L18 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L20 MM OD2.4 MM DIST C1713 $770.84SCREW BONE STAINLESS STEEL T8 L20 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L20 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L20 MM OD2.7 MM ID2. C1713 $654.03SCREW BONE STAINLESS STEEL T8 L20 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L22 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L22 MM OD2.4 MM SELF C1713 $770.84

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 ChargeSCREW BONE STAINLESS STEEL T8 L22 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L22 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L22 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L24 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L24 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L24 MM OD2.7 MM ID2. C1713 $654.03SCREW BONE STAINLESS STEEL T8 L24 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L26 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L26 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L26 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L26 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L26 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L28 MM OD2.4 MM ODSE C1713 $325.36SCREW BONE STAINLESS STEEL T8 L28 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L28 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L28 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L28 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L30 MM OD2.4 MM CORT C1713 $264.36SCREW BONE STAINLESS STEEL T8 L30 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L30 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L30 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L30 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L32 MM OD2.4 MM ODSE C1713 $282.86SCREW BONE STAINLESS STEEL T8 L32 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L32 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L32 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L32 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L34 MM OD2.4 MM ODSE C1713 $282.86SCREW BONE STAINLESS STEEL T8 L34 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L34 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L34 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L36 MM OD2.4 MM ODSE C1713 $348.14SCREW BONE STAINLESS STEEL T8 L36 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L36 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L36 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L36 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L38 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L38 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L38 MM OD2.7 MM ELBO C1713 $258.83

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 ChargeSCREW BONE STAINLESS STEEL T8 L38 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L38 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L40 MM OD2.4 MM ODSE C1713 $264.36SCREW BONE STAINLESS STEEL T8 L40 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L40 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L40 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L40 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L42 MM OD2.4 MM ODSE C1713 $316.36SCREW BONE STAINLESS STEEL T8 L42 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L42 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L42 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L42 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L44 MM OD2.4 MM ODSE C1713 $316.36SCREW BONE STAINLESS STEEL T8 L44 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L44 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L44 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L44 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L46 MM OD2.4 MM ODSE C1713 $316.36SCREW BONE STAINLESS STEEL T8 L46 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L46 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L46 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L46 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L48 MM OD2.4 MM ODSE C1713 $316.36SCREW BONE STAINLESS STEEL T8 L48 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L48 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L48 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L48 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L50 MM OD2.4 MM ODSE C1713 $316.36SCREW BONE STAINLESS STEEL T8 L50 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L50 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L50 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L50 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L52 MM OD2.4 MM ODSE C1713 $316.36SCREW BONE STAINLESS STEEL T8 L52 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L52 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L52 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L54 MM OD2.4 MM ODSE C1713 $316.36SCREW BONE STAINLESS STEEL T8 L54 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L54 MM OD2.7 MM ELBO C1713 $258.83

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 ChargeSCREW BONE STAINLESS STEEL T8 L54 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L55 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L56 MM OD2.4 MM ODSE C1713 $338.50SCREW BONE STAINLESS STEEL T8 L56 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L56 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L56 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L58 MM OD2.4 MM CORT C1713 $316.36SCREW BONE STAINLESS STEEL T8 L58 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L58 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L58 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L6 MM OD2.4 MM ODSEC C1713 $325.36SCREW BONE STAINLESS STEEL T8 L60 MM OD2.4 MM CORT C1713 $316.36SCREW BONE STAINLESS STEEL T8 L60 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L60 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L60 MM OD2.7 MM ID2. C1713 $804.96SCREW BONE STAINLESS STEEL T8 L60 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L62 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L64 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L66 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L68 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L7 MM OD2.4 MM ODSEC C1713 $348.14SCREW BONE STAINLESS STEEL T8 L7 MM OD2.4 MM SELF C1713 $824.79SCREW BONE STAINLESS STEEL T8 L70 MM OD2.7 MM ELBO C1713 $258.83SCREW BONE STAINLESS STEEL T8 L8 MM OD2.4 MM ODSEC C1713 $325.36SCREW BONE STAINLESS STEEL T8 L8 MM OD2.4 MM SELF C1713 $770.84SCREW BONE STAINLESS STEEL T8 L8 MM OD2.7 MM ID2.1 C1713 $804.96SCREW BONE STAINLESS STEEL T8 L8 MM OD2.7 MM METAP C1713 $258.83SCREW BONE STAINLESS STEEL T8 L8 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 L9 MM OD2.4 MM ODSEC C1713 $264.36SCREW BONE STAINLESS STEEL T8 L9 MM OD2.4 MM RADIU C1713 $770.84SCREW BONE STAINLESS STEEL T8 L9 MM OD2.7 MM SELF C1713 $805.35SCREW BONE STAINLESS STEEL T8 LONG THREAD FLUTE L1 C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD FLUTE L2 C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD FLUTE L3 C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD FLUTE L4 C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD L18 MM L C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD L20 MM L C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD L22 MM L C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD L26 MM L C1713 $1,984.58

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 ChargeSCREW BONE STAINLESS STEEL T8 LONG THREAD L28 MM L C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD L30 MM L C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD L38 MM L C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 LONG THREAD REVERSE C1713 $1,231.73SCREW BONE STAINLESS STEEL T8 SHORT THREAD FLUTE L C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 SHORT THREAD L10 MM C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 SHORT THREAD L12 MM C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 SHORT THREAD L18 MM C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 SHORT THREAD L22 MM C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 SHORT THREAD L24 MM C1713 $1,984.58SCREW BONE STAINLESS STEEL T8 SHORT THREAD REVERSE C1713 $1,151.15SCREW BONE STANDARD L12 MM OD3.6 MM SPINE VARIABLE C1713 $390.00SCREW BONE STANDARD L14 MM OD3.6 MM SPINE VARIABLE C1713 $390.00SCREW BONE STARDRIVE LCP TITANIUM ALLOY L11 MM OD1 C1713 $248.50SCREW BONE STARDRIVE LCP TITANIUM ALLOY L12 MM OD1 C1713 $248.50SCREW BONE STARDRIVE LCP TITANIUM ALLOY L13 MM OD1 C1713 $248.50SCREW BONE STARDRIVE LCP TITANIUM ALLOY L6 MM OD1. C1713 $248.50SCREW BONE STARDRIVE LCP TITANIUM ALLOY L7 MM OD1. C1713 $248.50SCREW BONE STARDRIVE LCP TITANIUM ALLOY L9 MM OD1. C1713 $248.50SCREW BONE SURELOK MD-MAX L50 MM OD6.5 MM SPINE 3 C1713 $5,200.00SCREW BONE SYNAPSE TITANIUM 50 D T15 L14 MM OD3.5 C1713 $4,800.00SCREW BONE SYNAPSE TITANIUM L8 MM OD4.5 MM SPINE L C1713 $400.00SCREW BONE SYNAPSE TITANIUM SPINE LOCK NONSTERILE C1713 $400.00SCREW BONE SYNERGY TITANIUM L60 MM OD8 MM ILIAC SP C1713 $1,142.40SCREW BONE T10 FULL THREAD L10 MM OD2.7 MM STARDRI C1713 $585.00SCREW BONE T10 FULL THREAD L12 MM OD2.7 MM STARDRI C1713 $585.00SCREW BONE T10 FULL THREAD L14 MM OD2.7 MM STARDRI C1713 $585.00SCREW BONE T10 FULL THREAD L16 MM OD2.7 MM LOCK ST C1713 $1,040.00SCREW BONE T10 FULL THREAD L16 MM OD2.7 MM STARDRI C1713 $585.00SCREW BONE T10 FULL THREAD L18 MM OD2.7 MM LOCK ST C1713 $1,040.00SCREW BONE T10 FULL THREAD L18 MM OD2.7 MM STARDRI C1713 $585.00SCREW BONE T10 FULL THREAD L26 MM OD2.7 MM LOCK ST C1713 $1,040.00SCREW BONE T10 FULL THREAD L28 MM OD3.5 MM LOCK ST C1713 $1,035.45SCREW BONE T10 FULL THREAD L32 MM OD3.5 MM LOCK ST C1713 $1,035.45SCREW BONE T10 FULL THREAD L32 MM OD3.5 MM STARDRI C1713 $533.00SCREW BONE T10 FULL THREAD L34 MM OD3.5 MM LOCK ST C1713 $1,035.45SCREW BONE T10 FULL THREAD L34 MM OD3.5 MM STARDRI C1713 $533.00SCREW BONE T10 FULL THREAD L36 MM OD2.7 MM STARDRI C1713 $585.00SCREW BONE T10 FULL THREAD L36 MM OD3.5 MM LOCK ST C1713 $1,035.45

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 ChargeSCREW BONE T10 FULL THREAD L38 MM OD2.7 MM STARDRI C1713 $585.00SCREW BONE T10 FULL THREAD L40 MM OD3.5 MM STARDRI C1713 $533.00SCREW BONE T10 FULL THREAD L44 MM OD3.5 MM STARDRI C1713 $533.00SCREW BONE T10 FULL THREAD L46 MM OD3.5 MM LOCK ST C1713 $1,035.45SCREW BONE T10 FULL THREAD L46 MM OD3.5 MM STARDRI C1713 $533.00SCREW BONE T10 FULL THREAD L48 MM OD3.5 MM STARDRI C1713 $533.00SCREW BONE T10 FULL THREAD L50 MM OD3.5 MM LOCK ST C1713 $1,035.45SCREW BONE T10 FULL THREAD L50 MM OD3.5 MM STARDRI C1713 $533.00SCREW BONE T10 FULL THREAD L55 MM OD3.5 MM LOCK ST C1713 $1,035.45SCREW BONE T10 FULL THREAD L55 MM OD3.5 MM STARDRI C1713 $533.00SCREW BONE T10 FULL THREAD L60 MM OD3.5 MM LOCK ST C1713 $1,035.45SCREW BONE T10 L60 MM OD2.7 MM LOCK C1713 $686.40SCREW BONE T15 L20 MM OD3.5 MM LOW PROFILE NONLOCK C1713 $280.54SCREW BONE T15 L22 MM OD3.5 MM LOW PROFILE NONLOCK C1713 $280.54SCREW BONE T15 L24 MM OD3.5 MM LOW PROFILE NONLOCK C1713 $280.54SCREW BONE T15 L26 MM OD3.5 MM LOCK MULTIDIRECTION C1713 $939.64SCREW BONE T15 L26 MM OD3.5 MM LOW PROFILE NONLOCK C1713 $280.54SCREW BONE T15 L28 MM OD3.5 MM LOW PROFILE NONLOCK C1713 $280.54SCREW BONE T15 L30 MM OD3.5 MM LOW PROFILE NONLOCK C1713 $280.54SCREW BONE T15 L32 MM OD3.5 MM LOW PROFILE NONLOCK C1713 $280.54SCREW BONE T2 TITANIUM FULL THREAD L32.5 MM OD5 MM C1713 $932.88SCREW BONE T2 TITANIUM FULL THREAD L37.5 MM OD5 MM C1713 $932.88SCREW BONE T2 TITANIUM FULL THREAD L50 MM OD4 MM F C1713 $953.16SCREW BONE T2 TITANIUM FULL THREAD L75 MM OD5 MM L C1713 $1,024.14SCREW BONE T2 TITANIUM OD6 MM HUMERUS ADVANCE COMP C1713 $892.32SCREW BONE T2 TITANIUM PARTIAL THREAD L80 MM OD5 M C1713 $1,024.14SCREW BONE T8 FULL THREAD L10 MM OD2.4 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L10 MM OD2.7 MM LOCK STA C1713 $1,040.00SCREW BONE T8 FULL THREAD L12 MM OD2.4 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L12 MM OD2.7 MM LOCK STA C1713 $1,040.00SCREW BONE T8 FULL THREAD L12 MM OD2.7 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L14 MM OD2.4 MM LOCK STA C1713 $1,040.00SCREW BONE T8 FULL THREAD L14 MM OD2.4 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L16 MM OD2.4 MM LOCK STA C1713 $1,040.00SCREW BONE T8 FULL THREAD L16 MM OD2.7 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L18 MM OD2.4 MM LOCK STA C1713 $1,040.00SCREW BONE T8 FULL THREAD L18 MM OD2.7 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L20 MM OD2.4 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L20 MM OD2.7 MM STARDRIV C1713 $585.00

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 ChargeSCREW BONE T8 FULL THREAD L22 MM OD2.7 MM LOCK STA C1713 $1,040.00SCREW BONE T8 FULL THREAD L22 MM OD2.7 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L24 MM OD2.4 MM LOCK STA C1713 $1,040.00SCREW BONE T8 FULL THREAD L24 MM OD2.7 MM LOCK STA C1713 $1,040.00SCREW BONE T8 FULL THREAD L24 MM OD2.7 MM STARDRIV C1713 $585.00SCREW BONE T8 FULL THREAD L28 MM OD2.4 MM LOCK STA C1713 $1,040.00SCREW BONE T8 L24 MM OD3.6 MM FOOT ANKLE LAG CROSS C1713 $1,533.35SCREW BONE T8 L34 MM OD2.4 MM SELF TAP VARIABLE AN C1713 $770.84SCREW BONE TAPER L250 MM L80 MM OD4.8 MM TIBIA COR C1713 $916.48SCREW BONE TAPER L60 MM L20 MM OD3.5-3.2 MM ODSEC6 C1713 $957.44SCREW BONE TAPER L70 MM L20 MM OD3.5-3.2 MM ODSEC6 C1713 $957.44SCREW BONE TAPER L80 MM L30 MM OD3.5-3.2 MM ODSEC6 C1713 $957.44SCREW BONE TAPER L90 MM L40 MM OD3.5-3.2 MM ODSEC6 C1713 $957.44SCREW BONE TC-100 L18 MM OD2.7 MM CORTICAL SELF TA C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L10 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L10 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L12 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L12 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L14 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L16 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L18 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L20 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L20 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L22 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L22 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L24 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L24 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L26 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L26 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L28 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L28 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L30 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L30 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L32 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L32 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L34 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L34 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L36 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L36 MM OD3.5 MM C1713 $112.96

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 ChargeSCREW BONE TC-100 STAINLESS STEEL L38 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L38 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L40 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L40 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L45 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L45 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L50 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L50 MM OD3.5 MM C1713 $112.96SCREW BONE TC-100 STAINLESS STEEL L55 MM OD2.7 MM C1713 $106.16SCREW BONE TC-100 STAINLESS STEEL L55 MM OD3.5 MM C1713 $138.64SCREW BONE TC-100 STAINLESS STEEL L60 MM OD3.5 MM C1713 $138.64SCREW BONE TC-100 STAINLESS STEEL L65 MM OD3.5 MM C1713 $138.64SCREW BONE TC-100 STAINLESS STEEL L70 MM OD3.5 MM C1713 $138.64SCREW BONE TC-100 STAINLESS STEEL L75 MM OD3.5 MM C1713 $138.64SCREW BONE TC-100 STAINLESS STEEL L80 MM OD3.5 MM C1713 $138.64SCREW BONE TC-100 STAINLESS STEEL L85 MM OD3.5 MM C1713 $138.64SCREW BONE TC-100 STAINLESS STEEL L90 MM OD3.5 MM C1713 $138.64SCREW BONE TC-100 STAINLESS STEEL L95 MM OD3.5 MM C1713 $138.64SCREW BONE TFN-ADVANCED TITANIUM 3.5 MM FULL THREA C1713 $1,259.70SCREW BONE TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM C1713 $3,488.16SCREW BONE TFN-ADVANCED TITANIUM L100 MM OD10.35 M C1713 $3,488.16SCREW BONE TFN-ADVANCED TITANIUM L90 MM OD10.35 MM C1713 $3,488.16SCREW BONE TFN-ADVANCED TITANIUM L95 MM OD10.35 MM C1713 $3,488.16SCREW BONE TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM C1713 $3,488.16SCREW BONE THREADED L28 MM OD4 MM 2 LEAD C1713 $1,182.72SCREW BONE THREADED L32 MM OD4 MM TIBIA CORTICAL 2 C1713 $1,071.36SCREW BONE THREADED L34 MM OD4 MM TIBIA CORTICAL 2 C1713 $1,071.36SCREW BONE THREADLOCK TS LEVEL ONE MAXDRIVE TITANI C1713 $834.72SCREW BONE THREADLOCK TS MAXDRIVE TITANIUM TAPER L C1713 $834.72SCREW BONE THREADLOCK TS TITANIUM L10 MM OD2.7 MM C1713 $663.04SCREW BONE THREADLOCK TS TITANIUM L12 MM OD2.7 MM C1713 $663.04SCREW BONE THREADLOCK TS TITANIUM L12 MM OD3.2 MM C1713 $734.08SCREW BONE THREADLOCK TS TITANIUM L13 MM OD2.7 MM C1713 $917.60SCREW BONE THREADLOCK TS TITANIUM L14 MM OD2.7 MM C1713 $663.04SCREW BONE THREADLOCK TS TITANIUM L17 MM OD2.7 MM C1713 $917.60SCREW BONE THREADLOCK TS TITANIUM L19 MM OD2.7 MM C1713 $917.60SCREW BONE THREADLOCK TS TITANIUM L7 MM OD2.7 MM M C1713 $917.60SCREW BONE THREADLOCK TS TITANIUM L9 MM OD2.7 MM M C1713 $917.60SCREW BONE TIAL6V4 ELI L10 MM OD3 MM CANCELLOUS LO C1713 $438.75

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 ChargeSCREW BONE TIAL6V4 ELI L24 MM OD3.5 MM CORTICAL MU C1713 $162.96SCREW BONE TIAL6V4 ELI L30 MM OD4 MM CANCELLOUS CA C1713 $630.63SCREW BONE TIAL6V4 ELI L32 MM OD4 MM CANCELLOUS CA C1713 $630.63SCREW BONE TIAL6V4 ELI L34 MM OD4 MM CANCELLOUS CA C1713 $630.63SCREW BONE TIAL6V4 ELI L36 MM OD4 MM CANCELLOUS CA C1713 $630.63SCREW BONE TIAL6V4 ELI L44 MM OD4 MM CANCELLOUS CA C1713 $659.04SCREW BONE TIAL6V4 ELI L46 MM OD3.5 MM CORTICAL NO C1713 $233.81SCREW BONE TIAL6V4 ELI L50 MM OD4 MM CANCELLOUS CA C1713 $673.14SCREW BONE TIAL6V4 ELI L55 MM OD4 MM CANCELLOUS CA C1713 $673.14SCREW BONE TIAL6V4 ELI L60 MM OD4 MM CANCELLOUS CA C1713 $673.14SCREW BONE TIAL6V4 L26 MM OD3.5 MM CORTICAL NONSTE C1713 $162.96SCREW BONE TIAL6V4 L28 MM OD3.5 MM CORTICAL NONSTE C1713 $191.30SCREW BONE TIAL6V4 L36 MM OD3.5 MM CORTICAL NONSTE C1713 $191.30SCREW BONE TIAL6V4 L42 MM OD3.5 MM ACETABULAR CORT C1713 $191.30SCREW BONE TIAL6V4 L44 MM OD3.5 MM CORTICAL NONSTE C1713 $233.81SCREW BONE TIALV L12 MM OD2.7 MM CORTICAL C1713 $146.25SCREW BONE TIALV L14 MM OD3 MM CANCELLOUS LOCK C1713 $438.75SCREW BONE TIALV L18 MM OD3 MM CANCELLOUS RIGHT ST C1713 $438.75SCREW BONE TIALV L20 MM OD3 MM CANCELLOUS DISTAL 2 C1713 $438.75SCREW BONE TIALV L20 MM OD3 MM CANCELLOUS RIGHT ST C1713 $438.75SCREW BONE TIALV L22 MM OD2.7 MM CORTICAL C1713 $146.25SCREW BONE TIALV L22 MM OD3 MM CANCELLOUS DISTAL 2 C1713 $438.75SCREW BONE TIALV L22 MM OD3 MM CANCELLOUS RIGHT ST C1713 $438.75SCREW BONE TIGER BIASED ANGLE L10 MM OD3.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L12 MM OD3.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L12 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L14 MM OD3.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L14 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L14 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L16 MM OD3.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L16 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L18 MM OD3.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L18 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L20 MM OD3.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L20 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L20 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L22 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L22 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L24 MM OD3.5 MM SPIN C1713 $3,900.00

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 ChargeSCREW BONE TIGER BIASED ANGLE L24 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L24 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L26 MM OD3.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L26 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L26 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L28 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L28 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L30 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L32 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER BIASED ANGLE L34 MM OD4.5 MM SPIN C1713 $3,900.00SCREW BONE TIGER L10 MM OD4 MM SPINE OCCIPITAL NON C1713 $812.50SCREW BONE TIGER L100 MM OD7.5 MM SPINE PEDICLE PO C1713 $1,950.00SCREW BONE TIGER L12 MM OD4 MM SPINE OCCIPITAL NON C1713 $812.50SCREW BONE TIGER L14 MM OD4 MM SPINE OCCIPITAL NON C1713 $812.50SCREW BONE TIGER L14 MM OD4 MM SPINE POLYAXIAL NON C1713 $3,900.00SCREW BONE TIGER L24 MM OD4 MM SPINE POLYAXIAL NON C1713 $3,900.00SCREW BONE TIGER L28 MM OD3.5 MM SPINE LONG SHANK C1713 $3,900.00SCREW BONE TIGER L28 MM OD3.5 MM SPINE POLYAXIAL N C1713 $3,900.00SCREW BONE TIGER L30 MM OD3.5 MM SPINE LONG SHANK C1713 $3,900.00SCREW BONE TIGER L30 MM OD3.5 MM SPINE POLYAXIAL N C1713 $3,900.00SCREW BONE TIGER L30 MM OD4 MM SPINE POLYAXIAL NON C1713 $3,900.00SCREW BONE TIGER L32 MM OD3.5 MM SPINE POLYAXIAL N C1713 $3,900.00SCREW BONE TIGER L32 MM OD4 MM SPINE LONG SHANK NO C1713 $3,900.00SCREW BONE TIGER L32 MM OD4 MM SPINE POLYAXIAL NON C1713 $3,900.00SCREW BONE TIGER L34 MM OD3.5 MM SPINE LONG SHANK C1713 $3,900.00SCREW BONE TIGER L34 MM OD3.5 MM SPINE POLYAXIAL N C1713 $3,900.00SCREW BONE TIGER L36 MM OD3.5 MM SPINE POLYAXIAL N C1713 $3,900.00SCREW BONE TIGER L36 MM OD4 MM SPINE LONG SHANK NO C1713 $3,900.00SCREW BONE TIGER L40 MM OD5.5 MM SPINE PEDICLE MON C1713 $2,275.00SCREW BONE TIGER L40 MM OD5.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L40 MM OD6.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L40 MM OD7.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L45 MM OD5.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L45 MM OD6.5 MM SPINE CANNULATED C1713 $5,200.00SCREW BONE TIGER L45 MM OD6.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L45 MM OD7.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L50 MM OD6.5 MM SPINE CANNULATED C1713 $5,200.00SCREW BONE TIGER L50 MM OD6.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L50 MM OD7.5 MM SPINE PEDICLE NON C1713 $3,900.00

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 ChargeSCREW BONE TIGER L55 MM OD6.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L6 MM OD4 MM SPINE OCCIPITAL NONS C1713 $812.50SCREW BONE TIGER L60 MM OD6.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L60 MM OD7.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIGER L8 MM OD4 MM SPINE OCCIPITAL NONS C1713 $812.50SCREW BONE TIGER L8 MM OD5 MM SPINE OCCIPITAL NONS C1713 $812.50SCREW BONE TIGER L80 MM OD7.5 MM SPINE PEDICLE NON C1713 $3,900.00SCREW BONE TIMAX 4 CUT FLUTE L100 MM L22 MM OD6.5 C1713 $1,399.32SCREW BONE TIMAX FULL THREAD L14 MM OD3.5 MM CORTE C1713 $175.50SCREW BONE TIMAX FULL THREAD L14 MM OD4 MM FIBULA C1713 $256.88SCREW BONE TIMAX FULL THREAD L16 MM OD3.5 MM CORTE C1713 $175.50SCREW BONE TIMAX FULL THREAD L18 MM OD3.5 MM CORTE C1713 $175.50SCREW BONE TIMAX FULL THREAD L20 MM OD3.5 MM ELBOW C1713 $175.50SCREW BONE TIMAX FULL THREAD L22 MM OD3.5 MM CORTI C1713 $175.50SCREW BONE TIMAX FULL THREAD L32 MM OD3.5 MM CORTE C1713 $256.88SCREW BONE TIMAX FULL THREAD L36 MM OD3.5 MM CORTE C1713 $256.88SCREW BONE TIMAX FULL THREAD L40 MM OD3.5 MM CORTE C1713 $256.88SCREW BONE TIMAX FULL THREAD L55 MM OD3.5 MM CORTE C1713 $256.88SCREW BONE TIMAX LARGE 4 CUT FLUTE L85 MM L22 MM O C1713 $1,399.32SCREW BONE TIMAX OBLIQUE FULL THREAD L40 MM OD4.5 C1713 $209.56SCREW BONE TIMAX T15 L10 MM OD3.5 MM CORTICAL LOCK C1713 $679.38SCREW BONE TIMAX T15 L16 MM OD3.5 MM CORTEX SELF T C1713 $679.38SCREW BONE TIMAX T15 L18 MM OD3.5 MM CORTICAL SELF C1713 $679.38SCREW BONE TIMAX T15 L20 MM OD3.5 MM CORTEX SELF T C1713 $679.38SCREW BONE TIMAX T15 L24 MM OD3.5 MM CORTICAL SELF C1713 $679.38SCREW BONE TIMAX T15 L26 MM OD3.5 MM CORTEX SELF T C1713 $679.38SCREW BONE TIMAX T15 L28 MM OD3.5 MM CORTICAL SELF C1713 $679.38SCREW BONE TIMAX T15 L30 MM OD3.5 MM CORTEX SELF T C1713 $679.38SCREW BONE TIMAX T15 L34 MM OD3.5 MM CORTICAL SELF C1713 $679.38SCREW BONE TITANIUM .062 IN 3.5 MM 1/3 FULL THREAD C1713 $1,137.50SCREW BONE TITANIUM 1.3 MM L18 MM OD2.5 MM SELF TA C1713 $435.24SCREW BONE TITANIUM 1.3 MM L24 MM OD2.5 MM SELF TA C1713 $435.24SCREW BONE TITANIUM 1.3 MM L26 MM OD2.5 MM SELF TA C1713 $439.40SCREW BONE TITANIUM 1/2 THREAD L16 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L18 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L20 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L22 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L24 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L26 MM OD4 MM ODSEC C1713 $1,402.96

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 ChargeSCREW BONE TITANIUM 1/2 THREAD L28 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L30 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L32 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L34 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L36 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L42 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L44 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L46 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L48 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L50 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L52 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/2 THREAD L54 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/2 THREAD L56 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/2 THREAD L58 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/2 THREAD L60 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/2 THREAD L64 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/2 THREAD L68 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/2 THREAD L72 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/3 THREAD L10 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L12 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L14 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L16 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L18 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L20 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L22 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L22 MM OD4.5 MM ODS C1713 $1,166.10SCREW BONE TITANIUM 1/3 THREAD L24 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L24 MM OD4.5 MM ODS C1713 $1,166.10SCREW BONE TITANIUM 1/3 THREAD L26 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L26 MM OD4.5 MM ODS C1713 $1,166.10SCREW BONE TITANIUM 1/3 THREAD L28 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L28 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 1/3 THREAD L30 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L32 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L32 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 1/3 THREAD L34 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L34 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 1/3 THREAD L36 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L38 MM OD4 MM ODSEC C1713 $1,402.96

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 ChargeSCREW BONE TITANIUM 1/3 THREAD L38 MM OD4.5 MM ODS C1713 $1,166.10SCREW BONE TITANIUM 1/3 THREAD L42 MM OD4.5 MM ODS C1713 $1,166.10SCREW BONE TITANIUM 1/3 THREAD L44 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L44 MM OD4.5 MM ODS C1713 $1,166.10SCREW BONE TITANIUM 1/3 THREAD L46 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L46 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 1/3 THREAD L48 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L48 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 1/3 THREAD L50 MM OD4 MM ODSEC C1713 $1,402.96SCREW BONE TITANIUM 1/3 THREAD L52 MM OD4 MM ODSEC C1713 $1,139.91SCREW BONE TITANIUM 1/3 THREAD L52 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 1/3 THREAD L54 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/3 THREAD L54 MM OD4.5 MM ODS C1713 $1,166.10SCREW BONE TITANIUM 1/3 THREAD L56 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/3 THREAD L56 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 1/3 THREAD L58 MM OD4 MM ODSEC C1713 $1,173.58SCREW BONE TITANIUM 1/3 THREAD L60 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/3 THREAD L64 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/3 THREAD L64 MM OD4.5 MM ODS C1713 $1,166.10SCREW BONE TITANIUM 1/3 THREAD L68 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/3 THREAD L68 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 1/3 THREAD L72 MM OD4 MM ODSEC C1713 $1,444.40SCREW BONE TITANIUM 1/3 THREAD L72 MM OD4.5 MM ODS C1713 $1,435.20SCREW BONE TITANIUM 2 MM INCREMENT L10 MM OD2.4 MM C1713 $468.00SCREW BONE TITANIUM 2 MM INCREMENT L12 MM OD2.4 MM C1713 $468.00SCREW BONE TITANIUM 2 MM INCREMENT L14 MM OD2.4 MM C1713 $468.00SCREW BONE TITANIUM 2 MM INCREMENT L16 MM OD2.4 MM C1713 $468.00SCREW BONE TITANIUM 2 MM INCREMENT L5 MM OD2.4 MM C1713 $468.00SCREW BONE TITANIUM 2 MM INCREMENT L6 MM OD2.4 MM C1713 $468.00SCREW BONE TITANIUM 2 MM INCREMENT L8 MM OD2.4 MM C1713 $468.00SCREW BONE TITANIUM 2.5 MM FULL THREAD L10 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L10 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L10 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L12 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L12 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L12 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L14 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L14 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L14 MM OD4 C1713 $140.24

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 ChargeSCREW BONE TITANIUM 2.5 MM FULL THREAD L16 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L16 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L16 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L18 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L18 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L18 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L20 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L20 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L20 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L22 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L22 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L22 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L24 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L24 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L24 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L26 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L26 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L26 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L30 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L30 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L30 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L32 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L32 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L34 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L34 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L35 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L36 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L36 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L38 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L38 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L40 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L40 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L40 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L45 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L45 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L45 MM OD4 C1713 $140.24

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 ChargeSCREW BONE TITANIUM 2.5 MM FULL THREAD L50 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L50 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L50 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L55 MM OD2. C1713 $246.08SCREW BONE TITANIUM 2.5 MM FULL THREAD L55 MM OD3. C1713 $166.72SCREW BONE TITANIUM 2.5 MM FULL THREAD L55 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM FULL THREAD L60 MM OD4 C1713 $140.24SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L10 MM L C1713 $138.32SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L10 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L12 MM L C1713 $138.32SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L12 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L14 MM L C1713 $138.32SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L14 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L16 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L16 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L18 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L18 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L20 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L20 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L22 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L22 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L24 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L24 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L26 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L26 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L28 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L28 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L30 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L32 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L32 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L34 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L35 MM L C1713 $138.32SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L36 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L38 MM L C1713 $154.08SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L38 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L40 MM L C1713 $138.32SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L40 MM O C1713 $780.00SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L45 MM L C1713 $138.32SCREW BONE TITANIUM 2.5 MM PARTIAL THREAD L50 MM L C1713 $138.32

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 ChargeSCREW BONE TITANIUM 2.5 MM STANDARD FULL THREAD L1 C1713 $236.88SCREW BONE TITANIUM 2.5 MM STANDARD FULL THREAD L2 C1713 $236.88SCREW BONE TITANIUM 2.5 MM STANDARD FULL THREAD L3 C1713 $127.68SCREW BONE TITANIUM 2.5 MM STANDARD FULL THREAD L4 C1713 $127.68SCREW BONE TITANIUM 2.5 MM STANDARD FULL THREAD L5 C1713 $127.68SCREW BONE TITANIUM 2.5 MM STANDARD L55 MM OD3.5 M C1713 $127.68SCREW BONE TITANIUM 2.5 MM STANDARD L60 MM OD3.5 M C1713 $127.68SCREW BONE TITANIUM 2.5MM STANDARD SMALL HEXAGON S C1713 $236.88SCREW BONE TITANIUM 3.5 MM FULL THREAD L100 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L18 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L24 MM OD4 C1713 $1,550.40SCREW BONE TITANIUM 3.5 MM FULL THREAD L26 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L26 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L28 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L28 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L30 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L30 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L32 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L32 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L34 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L34 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L36 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L36 MM OD5 C1713 $985.53SCREW BONE TITANIUM 3.5 MM FULL THREAD L38 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L38 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L40 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L40 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L42 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L42 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L44 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L44 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L46 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L46 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L48 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L48 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L50 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L50 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L50 MM OD6 C1713 $1,336.08SCREW BONE TITANIUM 3.5 MM FULL THREAD L52 MM OD4 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 ChargeSCREW BONE TITANIUM 3.5 MM FULL THREAD L52 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L54 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L54 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L56 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L56 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L58 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L58 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L60 MM OD4 C1713 $1,550.40SCREW BONE TITANIUM 3.5 MM FULL THREAD L60 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L62 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L64 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L64 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L65 MM OD6 C1713 $1,336.08SCREW BONE TITANIUM 3.5 MM FULL THREAD L66 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L68 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L68 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L70 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L72 MM OD4 C1713 $1,550.40SCREW BONE TITANIUM 3.5 MM FULL THREAD L72 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L74 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L76 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L76 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L78 MM OD4 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L80 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L80 MM OD6 C1713 $1,336.08SCREW BONE TITANIUM 3.5 MM FULL THREAD L85 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L90 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM FULL THREAD L95 MM OD5 C1713 $1,212.96SCREW BONE TITANIUM 3.5 MM L14 MM OD5 MM ID4.4 MM C1713 $1,518.00SCREW BONE TITANIUM 3.5 MM L18 MM OD5 MM ID4.4 MM C1713 $1,467.36SCREW BONE TITANIUM 3.5 MM L26 MM OD5 MM ID4.4 MM C1713 $1,467.36SCREW BONE TITANIUM 3.5 MM L40 MM OD5 MM ID4.4 MM C1713 $1,467.36SCREW BONE TITANIUM 3.5 MM L50 MM L32 MM OD6.5 MM C1713 $264.48SCREW BONE TITANIUM 3.5 MM L55 MM OD5 MM ID4.4 MM C1713 $1,494.96SCREW BONE TITANIUM 3.5 MM L55 MM OD6 MM ODSEC8 MM C1713 $1,336.08SCREW BONE TITANIUM 3.5 MM L60 MM L16 MM OD6.5 MM C1713 $264.48SCREW BONE TITANIUM 3.5 MM L65 MM L16 MM OD6.5 MM C1713 $264.48SCREW BONE TITANIUM 3.5 MM L65 MM L32 MM OD6.5 MM C1713 $264.48SCREW BONE TITANIUM 3.5 MM L65 MM OD5 MM ID4.4 MM C1713 $1,494.96

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 ChargeSCREW BONE TITANIUM 3.5 MM L70 MM L32 MM OD6.5 MM C1713 $264.48SCREW BONE TITANIUM 3.5 MM L75 MM L32 MM OD6.5 MM C1713 $264.48SCREW BONE TITANIUM 3.5 MM L75 MM OD5 MM ID4.4 MM C1713 $1,494.96SCREW BONE TITANIUM 3.5 MM L85 MM OD5 MM ID4.4 MM C1713 $1,214.66SCREW BONE TITANIUM 3.5 MM STANDARD L100 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L105 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L110 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L115 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L120 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L125 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L130 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L135 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L14 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L140 MM OD4.5 C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L16 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L18 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L20 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L22 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L24 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L26 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L28 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L30 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L32 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L34 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L38 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L40 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L42 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L44 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L46 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L48 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L50 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L52 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L54 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L56 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L58 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L60 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L62 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L64 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L66 MM OD4.5 M 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 ChargeSCREW BONE TITANIUM 3.5 MM STANDARD L68 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L70 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L72 MM OD4.5 M C1713 $131.04SCREW BONE TITANIUM 3.5 MM STANDARD L76 MM OD4.5 M C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L80 MM OD4.5 M C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L85 MM OD4.5 M C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L90 MM OD4.5 M C1713 $218.88SCREW BONE TITANIUM 3.5 MM STANDARD L95 MM OD4.5 M C1713 $218.88SCREW BONE TITANIUM ALUMINUM VANADIUM L12 MM OD3 M C1713 $438.75SCREW BONE TITANIUM ALUMINUM VANADIUM L14 MM OD3.5 C1713 $552.63SCREW BONE TITANIUM ALUMINUM VANADIUM L34 MM OD3.5 C1713 $191.30SCREW BONE TITANIUM ALUMINUM VANADIUM L42 MM OD4 M C1713 $659.04SCREW BONE TITANIUM COCR L20 MM OD4.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L20 MM OD5 MM SPINE FIX A C1713 $3,200.00SCREW BONE TITANIUM COCR L25 MM OD4.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L25 MM OD5 MM SPINE FIX A C1713 $3,200.00SCREW BONE TITANIUM COCR L30 MM OD4.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L30 MM OD5 MM SPINE FIX A C1713 $3,200.00SCREW BONE TITANIUM COCR L30 MM OD5.5 MM SPINE FIX C1713 $2,800.00SCREW BONE TITANIUM COCR L30 MM OD6.5 MM SPINE FIX C1713 $2,800.00SCREW BONE TITANIUM COCR L35 MM OD4.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L35 MM OD5 MM SPINE FIX A C1713 $3,200.00SCREW BONE TITANIUM COCR L35 MM OD5.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L35 MM OD6.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L35 MM OD7.5 MM SPINE FIX C1713 $2,800.00SCREW BONE TITANIUM COCR L40 MM OD4.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L40 MM OD5 MM SPINE FIX A C1713 $3,200.00SCREW BONE TITANIUM COCR L40 MM OD7.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L45 MM OD4.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L45 MM OD5 MM SPINE FIX A C1713 $3,200.00SCREW BONE TITANIUM COCR L45 MM OD5.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L45 MM OD7.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L50 MM OD5.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L50 MM OD6.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L50 MM OD7.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L55 MM OD6.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM COCR L55 MM OD7.5 MM SPINE FIX C1713 $3,200.00SCREW BONE TITANIUM CONDYLE NONSTERILE LRP C1713 $918.00SCREW BONE TITANIUM CONDYLE SLOT NONSTERILE C1713 $1,074.00

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 ChargeSCREW BONE TITANIUM CONTOUR L30 MM OD3.5 MM HUMERU C1713 $581.04SCREW BONE TITANIUM CRUCIFORM L10 MM OD2.1 MM HAND C1713 $195.00SCREW BONE TITANIUM CRUCIFORM L12 MM OD2.1 MM HAND C1713 $195.00SCREW BONE TITANIUM DOME L15 MM OD6.5 MM HIP ACETA C1713 $162.50SCREW BONE TITANIUM DOME L20 MM OD6.5 MM HIP ACETA C1713 $162.50SCREW BONE TITANIUM DOME L25 MM OD6.5 MM HIP ACETA C1713 $162.50SCREW BONE TITANIUM DOME L30 MM OD6.5 MM HIP ACETA C1713 $162.50SCREW BONE TITANIUM DOME L35 MM OD6.5 MM HIP ACETA C1713 $162.50SCREW BONE TITANIUM DOME L40 MM OD6.5 MM HIP ACETA C1713 $162.50SCREW BONE TITANIUM FLUTE CRUCIFORM L3 MM OD1.3 MM C1713 $518.40SCREW BONE TITANIUM FLUTE L16 MM OD1.3 MM MAXILLOF C1713 $518.40SCREW BONE TITANIUM FLUTE L18 MM OD1.3 MM MAXILLOF C1713 $548.96SCREW BONE TITANIUM FLUTE L3 MM OD1.7 MM CRANIOFAC C1713 $537.60SCREW BONE TITANIUM FLUTE L4 MM OD1.7 MM CRANIOFAC C1713 $537.60SCREW BONE TITANIUM FLUTE L5 MM OD1.7 MM CRANIOFAC C1713 $537.60SCREW BONE TITANIUM FLUTE L6 MM OD1.3 MM ODSEC2.4 C1713 $518.40SCREW BONE TITANIUM FLUTE L6 MM OD1.7 MM CRANIOFAC C1713 $537.60SCREW BONE TITANIUM FLUTE L9 MM OD1.2 MM CRANIOMAX C1713 $600.00SCREW BONE TITANIUM FULL THREAD L10 MM OD2.3 MM CO C1713 $487.50SCREW BONE TITANIUM FULL THREAD L10 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L10 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L100 MM OD6.5 MM C C1713 $256.75SCREW BONE TITANIUM FULL THREAD L100 MM OD6.5 MM O C1713 $993.60SCREW BONE TITANIUM FULL THREAD L100 MM OD7.3 MM O C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L105 MM OD6.5 MM C C1713 $256.75SCREW BONE TITANIUM FULL THREAD L105 MM OD6.5 MM O C1713 $993.60SCREW BONE TITANIUM FULL THREAD L105 MM OD7.3 MM O C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L110 MM OD6.5 MM C C1713 $256.75SCREW BONE TITANIUM FULL THREAD L110 MM OD6.5 MM O C1713 $993.60SCREW BONE TITANIUM FULL THREAD L110 MM OD7.3 MM O C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L115 MM OD6.5 MM O C1713 $1,840.00SCREW BONE TITANIUM FULL THREAD L115 MM OD7.3 MM O C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L12 MM OD2.3 MM CO C1713 $487.50SCREW BONE TITANIUM FULL THREAD L12 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L120 MM OD6.5 MM F C1713 $1,840.00SCREW BONE TITANIUM FULL THREAD L120 MM OD6.5 MM O C1713 $993.60SCREW BONE TITANIUM FULL THREAD L120 MM OD7.3 MM O C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L125 MM OD6.5 MM O C1713 $1,840.00SCREW BONE TITANIUM FULL THREAD L125 MM OD7.3 MM O C1713 $1,826.16

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 ChargeSCREW BONE TITANIUM FULL THREAD L130 MM OD6.5 MM O C1713 $1,840.00SCREW BONE TITANIUM FULL THREAD L130 MM OD7.3 MM O C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L14 MM OD2.3 MM CO C1713 $487.50SCREW BONE TITANIUM FULL THREAD L14 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L14 MM OD4.5 MM OD C1713 $163.28SCREW BONE TITANIUM FULL THREAD L150 MM OD6.5 MM O C1713 $1,890.56SCREW BONE TITANIUM FULL THREAD L16 MM OD2.3 MM CO C1713 $487.50SCREW BONE TITANIUM FULL THREAD L16 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L16 MM OD4.5 MM OD C1713 $163.28SCREW BONE TITANIUM FULL THREAD L160 MM OD6.5 MM O C1713 $1,890.56SCREW BONE TITANIUM FULL THREAD L170 MM OD6.5 MM O C1713 $1,890.56SCREW BONE TITANIUM FULL THREAD L18 MM OD2.3 MM CO C1713 $487.50SCREW BONE TITANIUM FULL THREAD L18 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L18 MM OD4.5 MM OD C1713 $163.28SCREW BONE TITANIUM FULL THREAD L180 MM OD6.5 MM O C1713 $1,890.56SCREW BONE TITANIUM FULL THREAD L20 MM OD2.3 MM CO C1713 $487.50SCREW BONE TITANIUM FULL THREAD L20 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L20 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L20 MM OD7.3 MM FE C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L22 MM OD2.3 MM CO C1713 $487.50SCREW BONE TITANIUM FULL THREAD L22 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L22 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L24 MM OD2.3 MM CO C1713 $487.50SCREW BONE TITANIUM FULL THREAD L24 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L24 MM OD4 MM LOCK C1713 $945.56SCREW BONE TITANIUM FULL THREAD L24 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L25 MM OD4 MM LOCK C1713 $953.16SCREW BONE TITANIUM FULL THREAD L25 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L25 MM OD6.5 MM OD C1713 $264.48SCREW BONE TITANIUM FULL THREAD L25 MM OD7.3 MM OR C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L26 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L26 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L28 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L28 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L30 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L30 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L30 MM OD4 MM LOCK C1713 $953.16SCREW BONE TITANIUM FULL THREAD L30 MM OD4.5 MM ID C1713 $1,356.03SCREW BONE TITANIUM FULL THREAD L30 MM OD4.5 MM OD C1713 $1,472.00

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 ChargeSCREW BONE TITANIUM FULL THREAD L30 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L30 MM OD5 MM ODSE C1713 $939.12SCREW BONE TITANIUM FULL THREAD L30 MM OD7.3 MM FE C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L32 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L32 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L32 MM W2.5 MM OD2 C1713 $221.44SCREW BONE TITANIUM FULL THREAD L34 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L34 MM OD3.75 MM S C1713 $1,300.00SCREW BONE TITANIUM FULL THREAD L34 MM OD4 MM LOCK C1713 $953.16SCREW BONE TITANIUM FULL THREAD L34 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L35 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L35 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L35 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L35 MM OD6.5 MM OD C1713 $264.48SCREW BONE TITANIUM FULL THREAD L35 MM OD7.3 MM OR C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L36 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L36 MM OD3.75 MM S C1713 $1,300.00SCREW BONE TITANIUM FULL THREAD L36 MM OD4.5 MM ID C1713 $1,356.03SCREW BONE TITANIUM FULL THREAD L36 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L38 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L38 MM OD4.5 MM ID C1713 $1,356.03SCREW BONE TITANIUM FULL THREAD L38 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L40 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L40 MM OD3.5 MM TI C1713 $956.80SCREW BONE TITANIUM FULL THREAD L40 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L40 MM OD4 MM LOCK C1713 $965.06SCREW BONE TITANIUM FULL THREAD L40 MM OD4.5 MM ID C1713 $1,356.03SCREW BONE TITANIUM FULL THREAD L40 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L40 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L40 MM OD5.5 MM TI C1713 $868.66SCREW BONE TITANIUM FULL THREAD L40 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L40 MM OD6.5 MM OD C1713 $264.48SCREW BONE TITANIUM FULL THREAD L40 MM OD7.3 MM FE C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L42 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L42 MM OD4.5 MM ID C1713 $1,356.03SCREW BONE TITANIUM FULL THREAD L42 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L42.5 MM OD5 MM LO C1713 $932.88SCREW BONE TITANIUM FULL THREAD L44 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L44 MM OD4.5 MM ID C1713 $1,356.03

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 ChargeSCREW BONE TITANIUM FULL THREAD L44 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L45 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L45 MM OD3.5 MM TI C1713 $956.80SCREW BONE TITANIUM FULL THREAD L45 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L45 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L45 MM OD5.5 MM TI C1713 $868.66SCREW BONE TITANIUM FULL THREAD L45 MM OD6 MM SELF C1713 $1,336.08SCREW BONE TITANIUM FULL THREAD L45 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L45 MM OD6.5 MM OD C1713 $264.48SCREW BONE TITANIUM FULL THREAD L45 MM OD7.3 MM OR C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L46 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L46 MM OD4.5 MM ID C1713 $1,356.03SCREW BONE TITANIUM FULL THREAD L46 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L47.5 MM OD5 MM LO C1713 $932.88SCREW BONE TITANIUM FULL THREAD L48 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L48 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L50 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L50 MM OD3.5 MM TI C1713 $956.80SCREW BONE TITANIUM FULL THREAD L50 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L50 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L50 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L50 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L50 MM OD6.5 MM OD C1713 $264.48SCREW BONE TITANIUM FULL THREAD L50 MM OD7.3 MM FE C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L52 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L52.5 MM OD5 MM LO C1713 $932.88SCREW BONE TITANIUM FULL THREAD L54 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L55 MM OD3.5 MM CO C1713 $172.48SCREW BONE TITANIUM FULL THREAD L55 MM OD3.5 MM TI C1713 $956.80SCREW BONE TITANIUM FULL THREAD L55 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L55 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L55 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L55 MM OD6.5 MM OD C1713 $264.48SCREW BONE TITANIUM FULL THREAD L55 MM OD7.3 MM OR C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L56 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L57.5 MM OD5 MM LO C1713 $932.88SCREW BONE TITANIUM FULL THREAD L58 MM OD4.5 MM OD C1713 $163.28SCREW BONE TITANIUM FULL THREAD L6 MM OD2.7 MM ODS C1713 $246.08SCREW BONE TITANIUM FULL THREAD L60 MM OD3.5 MM CO C1713 $172.48

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 ChargeSCREW BONE TITANIUM FULL THREAD L60 MM OD3.5 MM TI C1713 $956.80SCREW BONE TITANIUM FULL THREAD L60 MM OD4 MM CANC C1713 $94.25SCREW BONE TITANIUM FULL THREAD L60 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L60 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L60 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L60 MM OD6.5 MM OD C1713 $993.60SCREW BONE TITANIUM FULL THREAD L60 MM OD7.3 MM FE C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L62 MM OD4.5 MM OD C1713 $163.28SCREW BONE TITANIUM FULL THREAD L64 MM OD4.5 MM OD C1713 $1,196.00SCREW BONE TITANIUM FULL THREAD L65 MM OD3.5 MM TI C1713 $956.80SCREW BONE TITANIUM FULL THREAD L65 MM OD4 MM CANC C1713 $216.58SCREW BONE TITANIUM FULL THREAD L65 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L65 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L65 MM OD6.5 MM OD C1713 $993.60SCREW BONE TITANIUM FULL THREAD L65 MM OD7.3 MM OR C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L66 MM OD4.5 MM OD C1713 $163.28SCREW BONE TITANIUM FULL THREAD L68 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L70 MM OD3.5 MM TI C1713 $956.80SCREW BONE TITANIUM FULL THREAD L70 MM OD4.5 MM OD C1713 $163.28SCREW BONE TITANIUM FULL THREAD L70 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L70 MM OD5.5 MM CO C1713 $868.66SCREW BONE TITANIUM FULL THREAD L70 MM OD6.5 MM CA C1713 $224.25SCREW BONE TITANIUM FULL THREAD L70 MM OD6.5 MM OD C1713 $993.60SCREW BONE TITANIUM FULL THREAD L70 MM OD7.3 MM FE C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L72 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L75 MM OD3.5 MM TI C1713 $956.80SCREW BONE TITANIUM FULL THREAD L75 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L75 MM OD6.5 MM CA C1713 $256.75SCREW BONE TITANIUM FULL THREAD L75 MM OD6.5 MM OD C1713 $993.60SCREW BONE TITANIUM FULL THREAD L75 MM OD7.3 MM OD C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L76 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L77 MM OD4.5 MM OD C1713 $1,472.00SCREW BONE TITANIUM FULL THREAD L80 MM OD3.5 MM TI C1713 $933.76SCREW BONE TITANIUM FULL THREAD L80 MM OD4.5 MM OD C1713 $276.00SCREW BONE TITANIUM FULL THREAD L80 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L80 MM OD6.5 MM CA C1713 $256.75SCREW BONE TITANIUM FULL THREAD L80 MM OD6.5 MM OD C1713 $993.60SCREW BONE TITANIUM FULL THREAD L80 MM OD7.3 MM OD C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L85 MM OD3.5 MM TI C1713 $933.76

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 ChargeSCREW BONE TITANIUM FULL THREAD L85 MM OD4.5 MM OD C1713 $276.00SCREW BONE TITANIUM FULL THREAD L85 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L85 MM OD6.5 MM CA C1713 $256.75SCREW BONE TITANIUM FULL THREAD L85 MM OD6.5 MM OD C1713 $993.60SCREW BONE TITANIUM FULL THREAD L85 MM OD7.3 MM OR C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L90 MM OD3.5 MM TI C1713 $933.76SCREW BONE TITANIUM FULL THREAD L90 MM OD4.5 MM OD C1713 $276.00SCREW BONE TITANIUM FULL THREAD L90 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L90 MM OD6 MM ODSE C1713 $970.32SCREW BONE TITANIUM FULL THREAD L90 MM OD6.5 MM CA C1713 $256.75SCREW BONE TITANIUM FULL THREAD L90 MM OD6.5 MM OD C1713 $993.60SCREW BONE TITANIUM FULL THREAD L90 MM OD7.3 MM OD C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD L95 MM OD3.5 MM TI C1713 $933.76SCREW BONE TITANIUM FULL THREAD L95 MM OD4.5 MM OD C1713 $276.00SCREW BONE TITANIUM FULL THREAD L95 MM OD5 MM LOCK C1713 $932.88SCREW BONE TITANIUM FULL THREAD L95 MM OD6.5 MM CA C1713 $256.75SCREW BONE TITANIUM FULL THREAD L95 MM OD6.5 MM OD C1713 $993.60SCREW BONE TITANIUM FULL THREAD L95 MM OD7.3 MM OD C1713 $1,826.16SCREW BONE TITANIUM FULL THREAD REVERSE CUT FLUTE C1713 $1,840.00SCREW BONE TITANIUM L10 MM L4 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L10 MM L5 MM OD4 MM CANCELLOUS C1713 $94.25SCREW BONE TITANIUM L10 MM OD1 MM ODSEC1.6 MM CORT C1713 $407.36SCREW BONE TITANIUM L10 MM OD1 MM ODSEC1.6 MM CRAN C1713 $576.00SCREW BONE TITANIUM L10 MM OD1.2 MM ODSEC1.6 MM CR C1713 $600.00SCREW BONE TITANIUM L10 MM OD1.3 MM CRANIOFACIAL S C1713 $518.40SCREW BONE TITANIUM L10 MM OD1.3 MM ODSEC2.4 MM CO C1713 $426.08SCREW BONE TITANIUM L10 MM OD1.3 MM ODSEC2.4 MM CR C1713 $554.96SCREW BONE TITANIUM L10 MM OD1.5 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L10 MM OD1.5 MM CRANIOMAXILLOF C1713 $402.00SCREW BONE TITANIUM L10 MM OD1.5 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L10 MM OD1.5 MM ODSEC3 MM CORT C1713 $198.06SCREW BONE TITANIUM L10 MM OD1.7 MM MANDIBLE EMERG C1713 $576.00SCREW BONE TITANIUM L10 MM OD1.7 MM ODSEC2.4 MM CR C1713 $570.00SCREW BONE TITANIUM L10 MM OD2 MM CORTICAL MINI FR C1713 $110.50SCREW BONE TITANIUM L10 MM OD2 MM CRANIOMAXILLOFAC C1713 $398.40SCREW BONE TITANIUM L10 MM OD2 MM MANDIBLE CORTICA C1713 $486.40SCREW BONE TITANIUM L10 MM OD2 MM ODSEC3 MM CRANIO C1713 $414.00SCREW BONE TITANIUM L10 MM OD2 MM ODSEC3.3 MM CRAN C1713 $444.00SCREW BONE TITANIUM L10 MM OD2 MM ODSEC3.3 MM MAND C1713 $643.50

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 ChargeSCREW BONE TITANIUM L10 MM OD2 MM ODSEC3.5 MM CORT C1713 $199.94SCREW BONE TITANIUM L10 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L10 MM OD2 MM ODSEC3.5 MM MAND C1713 $429.60SCREW BONE TITANIUM L10 MM OD2 MM ODSEC3.5 MM MAXI C1713 $304.20SCREW BONE TITANIUM L10 MM OD2.3 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L10 MM OD2.3 MM MAXILLOFACIAL C1713 $482.08SCREW BONE TITANIUM L10 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L10 MM OD2.4 MM MANDIBLE EMERG C1713 $414.00SCREW BONE TITANIUM L10 MM OD2.4 MM MAXILLOFACIAL C1713 $424.00SCREW BONE TITANIUM L10 MM OD2.4 MM ODSEC3.3 MM CR C1713 $468.00SCREW BONE TITANIUM L10 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L10 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96SCREW BONE TITANIUM L10 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L10 MM OD2.7 MM CORTICAL CRUCI C1713 $195.00SCREW BONE TITANIUM L10 MM OD2.7 MM MANDIBLE EMERG C1713 $708.00SCREW BONE TITANIUM L10 MM OD3 MM LOCK HEXALOBE NO C1713 $617.50SCREW BONE TITANIUM L10 MM OD3 MM RADIUS CANCELLOU C1713 $438.75SCREW BONE TITANIUM L10 MM OD3 MM STERNAL SELF DRI C1713 $1,346.40SCREW BONE TITANIUM L10 MM OD3 MM STERNUM SELF TAP C1713 $1,332.80SCREW BONE TITANIUM L10 MM OD3.5 MM CORTEX HEXALOB C1713 $422.50SCREW BONE TITANIUM L10 MM OD3.5 MM CORTEX LOCK HE C1713 $559.00SCREW BONE TITANIUM L10 MM OD3.5 MM CORTEX NONSTER C1713 $439.40SCREW BONE TITANIUM L10 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L10 MM OD3.5 MM SPINE C1713 $400.00SCREW BONE TITANIUM L10 MM OD4 MM SPINE CERVICAL A C1713 $1,300.00SCREW BONE TITANIUM L10 MM OD4 MM SPINE FIX ANGLE C1713 $390.00SCREW BONE TITANIUM L10 MM OD5 MM SELF TAPPING LOC C1713 $1,439.76SCREW BONE TITANIUM L100 MM L16 MM OD5 MM FEMUR SE C1713 $1,635.20SCREW BONE TITANIUM L100 MM L16 MM OD5 MM ODSEC8 M C1713 $1,971.20SCREW BONE TITANIUM L100 MM L16 MM OD6.5 MM CANCEL C1713 $191.75SCREW BONE TITANIUM L100 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L100 MM L32 MM OD6.5 MM CANCEL C1713 $224.25SCREW BONE TITANIUM L100 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L100 MM OD11 MM FEMUR TROCHANT C1713 $2,818.92SCREW BONE TITANIUM L100 MM OD4.5 MM CORTICAL SELF C1713 $256.75SCREW BONE TITANIUM L100 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L100 MM OD5.5 MM SPINE PROXIMA C1713 $3,200.00SCREW BONE TITANIUM L100 MM OD6 MM DISTAL FEMUR LO C1713 $1,336.08SCREW BONE TITANIUM L100 MM OD6.5 MM FEMUR LAG CAN C1713 $1,201.59

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 ChargeSCREW BONE TITANIUM L100 MM OD6.5 MM SPINE PROXIMA C1713 $2,800.00SCREW BONE TITANIUM L105 MM L16 MM OD5 MM ODSEC8 M C1713 $1,635.20SCREW BONE TITANIUM L105 MM L16 MM OD6.5 MM CANCEL C1713 $191.75SCREW BONE TITANIUM L105 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L105 MM L32 MM OD6.5 MM CANCEL C1713 $224.25SCREW BONE TITANIUM L105 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L105 MM OD4.5 MM CORTICAL SELF C1713 $256.75SCREW BONE TITANIUM L105 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L105 MM OD6.5 MM FEMUR LAG CAN C1713 $1,201.59SCREW BONE TITANIUM L105 MM ORTHOPEDIC LAG ASSEMBL C1713 $3,350.88SCREW BONE TITANIUM L11 MM L4 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L11 MM OD1 MM ODSEC1.6 MM CORT C1713 $501.36SCREW BONE TITANIUM L11 MM OD1 MM ODSEC1.6 MM CRAN C1713 $576.00SCREW BONE TITANIUM L11 MM OD1.2 MM ODSEC1.6 MM CR C1713 $600.00SCREW BONE TITANIUM L11 MM OD1.3 MM ODSEC2.4 MM CO C1713 $524.40SCREW BONE TITANIUM L11 MM OD1.3 MM ODSEC2.4 MM CR C1713 $518.40SCREW BONE TITANIUM L11 MM OD1.5 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L11 MM OD1.5 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L11 MM OD1.5 MM ODSEC3 MM CORT C1713 $211.92SCREW BONE TITANIUM L11 MM OD1.7 MM CRANIOFACIAL E C1713 $537.60SCREW BONE TITANIUM L11 MM OD1.7 MM ODSEC2.4 MM CR C1713 $570.00SCREW BONE TITANIUM L11 MM OD2 MM CORTICAL CRANIOF C1713 $456.00SCREW BONE TITANIUM L11 MM OD2 MM ODSEC3 MM CRANIO C1713 $414.00SCREW BONE TITANIUM L11 MM OD2 MM ODSEC3.5 MM CORT C1713 $199.94SCREW BONE TITANIUM L11 MM OD2 MM ODSEC3.5 MM CRAN C1713 $456.00SCREW BONE TITANIUM L11 MM OD2 MM ODSEC3.5 MM MAXI C1713 $396.00SCREW BONE TITANIUM L11 MM OD2.4 MM MANDIBLE EMERG C1713 $414.00SCREW BONE TITANIUM L11 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96SCREW BONE TITANIUM L110 MM L13 MM OD5 MM ODSEC8 M C1713 $1,971.20SCREW BONE TITANIUM L110 MM L16 MM OD5 MM FEMUR SE C1713 $1,635.20SCREW BONE TITANIUM L110 MM L16 MM OD6.5 MM CANCEL C1713 $191.75SCREW BONE TITANIUM L110 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L110 MM L32 MM OD6.5 MM CANCEL C1713 $224.25SCREW BONE TITANIUM L110 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L110 MM OD4.5 MM CORTICAL SELF C1713 $256.75SCREW BONE TITANIUM L110 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L110 MM PERITROCHANTERIC LAG K C1713 $3,350.88SCREW BONE TITANIUM L110 MM PERITROCHANTERIC LAG S C1713 $2,680.08SCREW BONE TITANIUM L115 MM L16 MM OD5 MM ODSEC8 M C1713 $1,635.20

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 ChargeSCREW BONE TITANIUM L115 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L115 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L115 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L12 MM L5 MM OD4 MM CANCELLOUS C1713 $94.25SCREW BONE TITANIUM L12 MM OD1 MM ODSEC1.6 MM CORT C1713 $536.46SCREW BONE TITANIUM L12 MM OD1 MM ODSEC1.6 MM CRAN C1713 $576.00SCREW BONE TITANIUM L12 MM OD1.2 MM CRANIOMAXILLOF C1713 $600.00SCREW BONE TITANIUM L12 MM OD1.2 MM ODSEC1.6 MM CR C1713 $600.00SCREW BONE TITANIUM L12 MM OD1.3 MM CORTICAL CRANI C1713 $518.40SCREW BONE TITANIUM L12 MM OD1.3 MM ODSEC2.4 MM CO C1713 $426.08SCREW BONE TITANIUM L12 MM OD1.3 MM ODSEC2.4 MM CR C1713 $548.99SCREW BONE TITANIUM L12 MM OD1.5 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L12 MM OD1.5 MM CRANIOMAXILLOF C1713 $228.80SCREW BONE TITANIUM L12 MM OD1.5 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L12 MM OD1.5 MM ODSEC3 MM CORT C1713 $211.92SCREW BONE TITANIUM L12 MM OD1.7 MM MANDIBLE EMERG C1713 $576.00SCREW BONE TITANIUM L12 MM OD1.7 MM ODSEC2.4 MM CR C1713 $570.00SCREW BONE TITANIUM L12 MM OD2 MM CORTICAL MINI FR C1713 $110.50SCREW BONE TITANIUM L12 MM OD2 MM CRANIOMAXILLOFAC C1713 $422.96SCREW BONE TITANIUM L12 MM OD2 MM MANDIBLE CORTEX C1713 $349.05SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3 MM CRANIO C1713 $414.00SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.3 MM CRAN C1713 $444.00SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.3 MM MAND C1713 $846.00SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.5 MM CORT C1713 $199.94SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.5 MM HAND C1713 $260.82SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.5 MM MAND C1713 $456.00SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.5 MM MAXI C1713 $396.00SCREW BONE TITANIUM L12 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L12 MM OD2.4 MM MANDIBLE EMERG C1713 $414.00SCREW BONE TITANIUM L12 MM OD2.4 MM MAXILLOFACIAL C1713 $524.80SCREW BONE TITANIUM L12 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L12 MM OD2.4 MM ODSEC3.5 MM CR C1713 $439.20SCREW BONE TITANIUM L12 MM OD2.4 MM ODSEC3.5 MM MA C1713 $414.00SCREW BONE TITANIUM L12 MM OD2.4 MM ODSEC4 MM MAND C1713 $491.40SCREW BONE TITANIUM L12 MM OD2.4 MM ODSEC4.5 MM CO C1713 $467.16SCREW BONE TITANIUM L12 MM OD2.7 MM CORTEX HEXAGON C1713 $357.50SCREW BONE TITANIUM L12 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L12 MM OD2.7 MM CORTICAL CRUCI C1713 $195.00SCREW BONE TITANIUM L12 MM OD2.7 MM MANDIBLE EMERG C1713 $708.00

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 ChargeSCREW BONE TITANIUM L12 MM OD3 MM LOCK HEXALOBE NO C1713 $617.50SCREW BONE TITANIUM L12 MM OD3 MM STERNAL SELF DRI C1713 $1,346.40SCREW BONE TITANIUM L12 MM OD3.5 MM CORTEX HEXAGON C1713 $383.50SCREW BONE TITANIUM L12 MM OD3.5 MM CORTEX HEXALOB C1713 $422.50SCREW BONE TITANIUM L12 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00SCREW BONE TITANIUM L12 MM OD3.5 MM CORTEX NONSTER C1713 $439.40SCREW BONE TITANIUM L12 MM OD3.5 MM CORTICAL NONLO C1713 $481.00SCREW BONE TITANIUM L12 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L12 MM OD5 MM PERIARTICULAR SE C1713 $1,439.76SCREW BONE TITANIUM L120 MM L16 MM OD5 MM FEMUR SE C1713 $1,635.20SCREW BONE TITANIUM L120 MM L16 MM OD5 MM ODSEC8 M C1713 $1,971.20SCREW BONE TITANIUM L120 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L120 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L120 MM OD11 MM HIP LAG TELESC C1713 $3,350.88SCREW BONE TITANIUM L120 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L125 MM L16 MM OD5 MM ODSEC8 M C1713 $1,635.20SCREW BONE TITANIUM L125 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L125 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L125 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L13 MM L4 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L13 MM OD1 MM ODSEC1.6 MM CORT C1713 $501.36SCREW BONE TITANIUM L13 MM OD1.3 MM ODSEC2.4 MM CO C1713 $524.40SCREW BONE TITANIUM L13 MM OD1.5 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L13 MM OD1.5 MM ODSEC3 MM CORT C1713 $201.83SCREW BONE TITANIUM L13 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L13 MM OD2.4 MM ODSEC4.5 MM CO C1713 $499.86SCREW BONE TITANIUM L13 MM OD3.5 MM CORTEX NONSTER C1713 $439.40SCREW BONE TITANIUM L130 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L130 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L130 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L135 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L135 MM L16 MM OD6.5 MM ODSEC7 C1713 $1,840.00SCREW BONE TITANIUM L135 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L135 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L14 MM L5 MM OD4 MM CANCELLOUS C1713 $94.25SCREW BONE TITANIUM L14 MM L6 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L14 MM OD1 MM ODSEC1.6 MM CORT C1713 $501.36SCREW BONE TITANIUM L14 MM OD1 MM ODSEC1.6 MM CRAN C1713 $542.40SCREW BONE TITANIUM L14 MM OD1.2 MM EMERGENCY FLUT C1713 $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 ChargeSCREW BONE TITANIUM L14 MM OD1.2 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L14 MM OD1.2 MM ODSEC1.6 MM CR C1713 $600.00SCREW BONE TITANIUM L14 MM OD1.2 MM SELF TAP FLUTE C1713 $570.00SCREW BONE TITANIUM L14 MM OD1.3 MM ODSEC2.4 MM CO C1713 $561.11SCREW BONE TITANIUM L14 MM OD1.3 MM ODSEC2.4 MM CR C1713 $518.40SCREW BONE TITANIUM L14 MM OD1.5 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L14 MM OD1.5 MM CRANIOFACIAL S C1713 $414.00SCREW BONE TITANIUM L14 MM OD1.5 MM CRANIOMAXILLOF C1713 $402.00SCREW BONE TITANIUM L14 MM OD1.5 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L14 MM OD1.5 MM ODSEC3 MM CORT C1713 $198.06SCREW BONE TITANIUM L14 MM OD1.7 MM MANDIBLE EMERG C1713 $576.00SCREW BONE TITANIUM L14 MM OD1.7 MM ODSEC2.4 MM CR C1713 $570.00SCREW BONE TITANIUM L14 MM OD2 MM CORTICAL MINI FR C1713 $110.50SCREW BONE TITANIUM L14 MM OD2 MM CRANIOMAXILLOFAC C1713 $422.96SCREW BONE TITANIUM L14 MM OD2 MM MANDIBLE CORTEX C1713 $456.00SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3 MM CRANIO C1713 $414.00SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3.3 MM CRAN C1713 $444.00SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3.3 MM MAND C1713 $846.00SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3.5 MM MAND C1713 $456.00SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3.5 MM MAXI C1713 $374.40SCREW BONE TITANIUM L14 MM OD2.3 MM CORTEX NONTOGG C1713 $455.00SCREW BONE TITANIUM L14 MM OD2.3 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L14 MM OD2.3 MM MAXILLOFACIAL C1713 $482.08SCREW BONE TITANIUM L14 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L14 MM OD2.4 MM MANDIBLE EMERG C1713 $388.80SCREW BONE TITANIUM L14 MM OD2.4 MM MAXILLOFACIAL C1713 $524.80SCREW BONE TITANIUM L14 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L14 MM OD2.4 MM ODSEC3.5 MM CR C1713 $468.00SCREW BONE TITANIUM L14 MM OD2.4 MM ODSEC3.5 MM MA C1713 $388.80SCREW BONE TITANIUM L14 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L14 MM OD2.4 MM ODSEC4.5 MM CO C1713 $467.16SCREW BONE TITANIUM L14 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L14 MM OD2.7 MM MANDIBLE EMERG C1713 $708.00SCREW BONE TITANIUM L14 MM OD2.7 MM RADIUS CORTICA C1713 $146.25SCREW BONE TITANIUM L14 MM OD3 MM CORTICAL RIGHT S C1713 $438.75SCREW BONE TITANIUM L14 MM OD3 MM STERNAL SELF DRI C1713 $1,346.40SCREW BONE TITANIUM L14 MM OD3 MM STERNUM SELF TAP C1713 $1,099.20

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 ChargeSCREW BONE TITANIUM L14 MM OD3.5 MM CORTEX HEXAGON C1713 $383.50SCREW BONE TITANIUM L14 MM OD3.5 MM CORTEX HEXALOB C1713 $422.50SCREW BONE TITANIUM L14 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00SCREW BONE TITANIUM L14 MM OD3.5 MM CORTEX NONSTER C1713 $439.40SCREW BONE TITANIUM L14 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L14 MM OD4 MM SPINE SELF TAP C1713 $325.00SCREW BONE TITANIUM L14 MM OD4.2 MM HUMERUS CANCEL C1713 $581.04SCREW BONE TITANIUM L14 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L14 MM OD5 MM PERIARTICULAR SE C1713 $1,439.76SCREW BONE TITANIUM L140 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L140 MM L16 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L140 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L140 MM L32 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L140 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L140 MM OD6.5 MM ORTHOPEDIC CA C1713 $1,890.56SCREW BONE TITANIUM L145 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L145 MM L16 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L145 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L145 MM OD4.5 MM ODSEC8 MM COR C1713 $276.00SCREW BONE TITANIUM L15 MM L4 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L15 MM OD1.4 MM MIDFACE SELF D C1713 $763.20SCREW BONE TITANIUM L15 MM OD3.5 MM CORTEX NONSTER C1713 $439.40SCREW BONE TITANIUM L150 MM L16 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L150 MM L16 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L150 MM L32 MM OD6.5 MM COMPRE C1713 $2,470.16SCREW BONE TITANIUM L150 MM L32 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L150 MM L35 MM OD4 MM SELF DRI C1713 $1,170.00SCREW BONE TITANIUM L150 MM L40 MM OD5 MM SELF DRI C1713 $1,170.00SCREW BONE TITANIUM L150 MM L40 MM OD5 MM TROCAR T C1713 $1,170.00SCREW BONE TITANIUM L16 MM L4 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L16 MM L6 MM OD4 MM CANCELLOUS C1713 $94.25SCREW BONE TITANIUM L16 MM L7 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L16 MM OD1.2 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L16 MM OD1.3 MM CORTICAL SELF C1713 $548.99SCREW BONE TITANIUM L16 MM OD1.3 MM ODSEC2.4 MM CO C1713 $524.40SCREW BONE TITANIUM L16 MM OD1.3 MM ODSEC2.4 MM CR C1713 $554.96SCREW BONE TITANIUM L16 MM OD1.5 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L16 MM OD1.5 MM CRANIOFACIAL S C1713 $367.20SCREW BONE TITANIUM L16 MM OD1.5 MM CRANIOMAXILLOF C1713 $402.00

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 ChargeSCREW BONE TITANIUM L16 MM OD1.5 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L16 MM OD1.5 MM ODSEC3 MM CORT C1713 $198.06SCREW BONE TITANIUM L16 MM OD1.7 MM MANDIBLE EMERG C1713 $576.00SCREW BONE TITANIUM L16 MM OD1.7 MM ODSEC2.4 MM CR C1713 $537.60SCREW BONE TITANIUM L16 MM OD2 MM CORTICAL MINI FR C1713 $110.50SCREW BONE TITANIUM L16 MM OD2 MM CRANIOMAXILLOFAC C1713 $422.96SCREW BONE TITANIUM L16 MM OD2 MM MANDIBLE CORTEX C1713 $456.00SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3 MM CRANIO C1713 $414.00SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3.3 MM CRAN C1713 $415.20SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3.3 MM MAND C1713 $792.00SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3.5 MM CORT C1713 $199.94SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3.5 MM HAND C1713 $260.82SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3.5 MM MAND C1713 $429.60SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3.5 MM MAXI C1713 $396.00SCREW BONE TITANIUM L16 MM OD2.3 MM CORTEX NONTOGG C1713 $455.00SCREW BONE TITANIUM L16 MM OD2.3 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L16 MM OD2.3 MM MAXILLOFACIAL C1713 $557.12SCREW BONE TITANIUM L16 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L16 MM OD2.4 MM MANDIBLE EMERG C1713 $388.80SCREW BONE TITANIUM L16 MM OD2.4 MM MANDIBLE SELF C1713 $1,022.40SCREW BONE TITANIUM L16 MM OD2.4 MM MAXILLOFACIAL C1713 $424.00SCREW BONE TITANIUM L16 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L16 MM OD2.4 MM ODSEC3.5 MM CR C1713 $468.00SCREW BONE TITANIUM L16 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L16 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96SCREW BONE TITANIUM L16 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L16 MM OD2.7 MM LOCK HEXALOBE C1713 $617.50SCREW BONE TITANIUM L16 MM OD2.7 MM MANDIBLE EMERG C1713 $708.00SCREW BONE TITANIUM L16 MM OD2.7 MM RADIUS CORTICA C1713 $146.25SCREW BONE TITANIUM L16 MM OD3 MM CORTICAL RIGHT S C1713 $438.75SCREW BONE TITANIUM L16 MM OD3 MM RADIUS CANCELLOU C1713 $438.75SCREW BONE TITANIUM L16 MM OD3 MM STERNAL SELF DRI C1713 $1,346.40SCREW BONE TITANIUM L16 MM OD3 MM STERNUM SELF TAP C1713 $1,332.80SCREW BONE TITANIUM L16 MM OD3.5 MM CORTEX HEXALOB C1713 $422.50SCREW BONE TITANIUM L16 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00SCREW BONE TITANIUM L16 MM OD3.5 MM CORTEX NONSTER C1713 $439.40SCREW BONE TITANIUM L16 MM OD3.5 MM CORTICAL LOCK C1713 $552.63SCREW BONE TITANIUM L16 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L16 MM OD4.2 MM SPINE SELF TAP 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 ChargeSCREW BONE TITANIUM L16 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L160 MM L16 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L160 MM L32 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L17 MM L4 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L17 MM L8 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L170 MM L16 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L170 MM L32 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L18 MM L5 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L18 MM L7 MM OD4 MM CANCELLOUS C1713 $94.25SCREW BONE TITANIUM L18 MM OD1.3 MM ODSEC2.4 MM CO C1713 $561.11SCREW BONE TITANIUM L18 MM OD1.3 MM ODSEC2.4 MM CR C1713 $548.99SCREW BONE TITANIUM L18 MM OD1.5 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L18 MM OD1.5 MM CRANIOMAXILLOF C1713 $228.80SCREW BONE TITANIUM L18 MM OD1.5 MM LOCK MULTI VAR C1713 $422.50SCREW BONE TITANIUM L18 MM OD1.5 MM ODSEC3 MM CORT C1713 $198.06SCREW BONE TITANIUM L18 MM OD1.7 MM MANDIBLE EMERG C1713 $576.00SCREW BONE TITANIUM L18 MM OD1.7 MM ODSEC2.4 MM CR C1713 $570.00SCREW BONE TITANIUM L18 MM OD2 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L18 MM OD2 MM CRANIOMAXILLOFAC C1713 $422.96SCREW BONE TITANIUM L18 MM OD2 MM MANDIBLE CORTEX C1713 $456.00SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3 MM CRANIO C1713 $414.00SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3.3 MM CRAN C1713 $444.00SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3.3 MM MAND C1713 $846.00SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3.5 MM CORT C1713 $199.94SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3.5 MM MAND C1713 $643.50SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3.5 MM MAXI C1713 $396.00SCREW BONE TITANIUM L18 MM OD2.3 MM CORTEX NONTOGG C1713 $455.00SCREW BONE TITANIUM L18 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L18 MM OD2.4 MM MANDIBLE EMERG C1713 $414.00SCREW BONE TITANIUM L18 MM OD2.4 MM MAXILLOFACIAL C1713 $424.00SCREW BONE TITANIUM L18 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L18 MM OD2.4 MM ODSEC3.5 MM CR C1713 $468.00SCREW BONE TITANIUM L18 MM OD2.4 MM ODSEC3.5 MM MA C1713 $468.00SCREW BONE TITANIUM L18 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L18 MM OD2.4 MM ODSEC4.5 MM CO C1713 $615.21SCREW BONE TITANIUM L18 MM OD2.7 MM CORTEX LOCK HE C1713 $617.50SCREW BONE TITANIUM L18 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L18 MM OD2.7 MM CORTICAL DISTA C1713 $146.25

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 ChargeSCREW BONE TITANIUM L18 MM OD2.7 MM MANDIBLE EMERG C1713 $708.00SCREW BONE TITANIUM L18 MM OD3 MM CORTICAL RIGHT S C1713 $438.75SCREW BONE TITANIUM L18 MM OD3 MM LOCK HEXALOBE NO C1713 $617.50SCREW BONE TITANIUM L18 MM OD3 MM RADIUS CANCELLOU C1713 $438.75SCREW BONE TITANIUM L18 MM OD3 MM STERNAL SELF DRI C1713 $1,093.95SCREW BONE TITANIUM L18 MM OD3 MM STERNUM SELF TAP C1713 $1,332.80SCREW BONE TITANIUM L18 MM OD3.5 MM CORTEX HEXALOB C1713 $435.50SCREW BONE TITANIUM L18 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00SCREW BONE TITANIUM L18 MM OD3.5 MM CORTEX NONSTER C1713 $439.40SCREW BONE TITANIUM L18 MM OD3.5 MM CORTICAL LOCK C1713 $552.63SCREW BONE TITANIUM L18 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L18 MM OD4 MM HUMERUS LOCK STE C1713 $1,550.40SCREW BONE TITANIUM L18 MM OD4 MM SPINE CERVICAL A C1713 $1,300.00SCREW BONE TITANIUM L18 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L18 MM OD5 MM PERIARTICULAR SE C1713 $1,439.76SCREW BONE TITANIUM L180 MM L16 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L180 MM L32 MM OD6.5 MM ORTHOP C1713 $1,840.00SCREW BONE TITANIUM L19 MM L5 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L19 MM L9 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L2 MM OD1 MM ODSEC1.6 MM CRANI C1713 $576.00SCREW BONE TITANIUM L2 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $600.00SCREW BONE TITANIUM L20 MM L5 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L20 MM L8 MM OD4 MM CANCELLOUS C1713 $94.25SCREW BONE TITANIUM L20 MM OD1.5 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L20 MM OD1.5 MM ODSEC3 MM CORT C1713 $198.06SCREW BONE TITANIUM L20 MM OD2 MM CORTICAL CRANIOF C1713 $396.00SCREW BONE TITANIUM L20 MM OD2 MM CORTICAL MINI FR C1713 $110.50SCREW BONE TITANIUM L20 MM OD2 MM MANDIBLE CORTICA C1713 $456.00SCREW BONE TITANIUM L20 MM OD2 MM ODSEC3.3 MM CRAN C1713 $444.00SCREW BONE TITANIUM L20 MM OD2 MM ODSEC3.5 MM CORT C1713 $199.94SCREW BONE TITANIUM L20 MM OD2 MM ODSEC3.5 MM CRAN C1713 $473.60SCREW BONE TITANIUM L20 MM OD2.3 MM CORTEX NONTOGG C1713 $455.00SCREW BONE TITANIUM L20 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L20 MM OD2.4 MM MANDIBLE CORTI C1713 $604.80SCREW BONE TITANIUM L20 MM OD2.4 MM MAXILLOFACIAL C1713 $424.00SCREW BONE TITANIUM L20 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L20 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L20 MM OD2.4 MM ODSEC4.5 MM CO C1713 $467.16SCREW BONE TITANIUM L20 MM OD2.5 MM FOOT ANKLE CAN C1713 $585.00

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 ChargeSCREW BONE TITANIUM L20 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L20 MM OD2.7 MM CORTICAL DISTA C1713 $146.25SCREW BONE TITANIUM L20 MM OD3 MM CORTICAL STABILI C1713 $438.75SCREW BONE TITANIUM L20 MM OD3 MM STERNAL SELF DRI C1713 $1,346.40SCREW BONE TITANIUM L20 MM OD3 MM STERNUM LOCK NON C1713 $1,099.20SCREW BONE TITANIUM L20 MM OD3 MM STERNUM LOCKING C1713 $1,296.00SCREW BONE TITANIUM L20 MM OD3.5 MM CORTEX HEXALOB C1713 $435.50SCREW BONE TITANIUM L20 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00SCREW BONE TITANIUM L20 MM OD3.5 MM CORTEX NONSTER C1713 $439.40SCREW BONE TITANIUM L20 MM OD3.5 MM CORTICAL NONST C1713 $158.34SCREW BONE TITANIUM L20 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L20 MM OD4 MM HUMERUS LOCK STE C1713 $1,550.40SCREW BONE TITANIUM L20 MM OD4 MM ODSEC3.5 MM HUME C1713 $1,212.96SCREW BONE TITANIUM L20 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L20 MM OD4 MM SPINE FIX ANGLE C1713 $2,800.00SCREW BONE TITANIUM L20 MM OD4 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L20 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L20 MM OD4.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L20 MM OD5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L20 MM OD5.5 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L20 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L20 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L200 MM L40 MM OD5 MM SELF DRI C1713 $1,170.00SCREW BONE TITANIUM L200 MM L40 MM OD5 MM TROCAR T C1713 $1,170.00SCREW BONE TITANIUM L200 MM L60 MM OD5 MM SELF DRI C1713 $1,170.00SCREW BONE TITANIUM L200 MM L60 MM OD5 MM TROCAR T C1713 $1,170.00SCREW BONE TITANIUM L200 MM L80 MM OD5 MM SELF DRI C1713 $1,170.00SCREW BONE TITANIUM L200 MM L80 MM OD5 MM TROCAR T C1713 $1,170.00SCREW BONE TITANIUM L21 MM L5 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L21 MM L9 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L21 MM OD1.4 MM MIDFACE SELF D C1713 $1,072.00SCREW BONE TITANIUM L22 MM L10 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L22 MM L5 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L22 MM L9 MM OD4 MM CANCELLOUS C1713 $94.25SCREW BONE TITANIUM L22 MM OD1.5 MM CRANIOMAXILLOF C1713 $228.80SCREW BONE TITANIUM L22 MM OD1.5 MM ODSEC3 MM CORT C1713 $198.06SCREW BONE TITANIUM L22 MM OD2 MM CORTICAL CRANIOF C1713 $396.00SCREW BONE TITANIUM L22 MM OD2 MM CORTICAL MINI FR C1713 $110.50SCREW BONE TITANIUM L22 MM OD2 MM MANDIBLE CORTICA C1713 $444.00

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 ChargeSCREW BONE TITANIUM L22 MM OD2 MM ODSEC3.3 MM CRAN C1713 $444.00SCREW BONE TITANIUM L22 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L22 MM OD2 MM ODSEC3.5 MM CRAN C1713 $396.00SCREW BONE TITANIUM L22 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L22 MM OD2 MM ODSEC3.5 MM MAND C1713 $243.76SCREW BONE TITANIUM L22 MM OD2.3 MM CORTEX NONTOGG C1713 $455.00SCREW BONE TITANIUM L22 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L22 MM OD2.4 MM MAXILLOFACIAL C1713 $424.00SCREW BONE TITANIUM L22 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L22 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L22 MM OD2.4 MM ODSEC4.5 MM CO C1713 $499.86SCREW BONE TITANIUM L22 MM OD2.7 MM CORTEX LOCK HE C1713 $617.50SCREW BONE TITANIUM L22 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L22 MM OD2.7 MM HEXALOBE NONST C1713 $422.50SCREW BONE TITANIUM L22 MM OD3 MM CORTICAL STABILI C1713 $438.75SCREW BONE TITANIUM L22 MM OD3 MM STERNUM LOCK NON C1713 $1,332.80SCREW BONE TITANIUM L22 MM OD3.5 MM CORTEX HEXALOB C1713 $435.50SCREW BONE TITANIUM L22 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00SCREW BONE TITANIUM L22 MM OD3.5 MM CORTICAL LOCK C1713 $552.63SCREW BONE TITANIUM L22 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L22 MM OD4 MM 2 THREAD PILOT C1713 $1,585.92SCREW BONE TITANIUM L22 MM OD4 MM ODSEC3.5 MM HUME C1713 $1,212.96SCREW BONE TITANIUM L22 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L23 MM L10 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L23 MM L5 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L24 MM L10 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L24 MM L10 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L24 MM OD1.5 MM CRANIOMAXILLOF C1713 $228.80SCREW BONE TITANIUM L24 MM OD1.5 MM ODSEC3 MM CORT C1713 $198.06SCREW BONE TITANIUM L24 MM OD2 MM CORTICAL CRANIOF C1713 $374.40SCREW BONE TITANIUM L24 MM OD2 MM CORTICAL MINI FR C1713 $110.50SCREW BONE TITANIUM L24 MM OD2 MM MANDIBLE CORTICA C1713 $456.00SCREW BONE TITANIUM L24 MM OD2 MM ODSEC3.3 MM CRAN C1713 $444.00SCREW BONE TITANIUM L24 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L24 MM OD2 MM ODSEC3.5 MM CRAN C1713 $396.00SCREW BONE TITANIUM L24 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L24 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L24 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L24 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00

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 ChargeSCREW BONE TITANIUM L24 MM OD2.4 MM ODSEC4.5 MM CO C1713 $467.16SCREW BONE TITANIUM L24 MM OD2.7 MM CORTEX LOCK HE C1713 $617.50SCREW BONE TITANIUM L24 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L24 MM OD3 MM CANCELLOUS DISTA C1713 $438.75SCREW BONE TITANIUM L24 MM OD3 MM STERNUM LOCK NON C1713 $1,332.80SCREW BONE TITANIUM L24 MM OD3.5 MM CORTEX HEXALOB C1713 $435.50SCREW BONE TITANIUM L24 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00SCREW BONE TITANIUM L24 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L24 MM OD4 MM ODSEC3.3 MM HUME C1713 $1,212.96SCREW BONE TITANIUM L24 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L24 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L25 MM L10 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L25 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L25 MM L6 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L25 MM OD4 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L25 MM OD4 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L25 MM OD4.35 MM SPINE 1 INNIE C1713 $4,800.00SCREW BONE TITANIUM L25 MM OD4.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L25 MM OD4.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L25 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L25 MM OD5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L25 MM OD5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L25 MM OD5.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L25 MM OD5.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L25 MM OD6 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L25 MM OD6 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L25 MM OD6.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L25 MM OD6.5 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L25 MM OD7.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L25 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L25 MM OD8.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L26 MM L12 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L26 MM L12 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L26 MM L6 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L26 MM OD2 MM CORTICAL MINI FR C1713 $110.50SCREW BONE TITANIUM L26 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L26 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L26 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L26 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00

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 ChargeSCREW BONE TITANIUM L26 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L26 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96SCREW BONE TITANIUM L26 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L26 MM OD2.7 MM CORTICAL NONST C1713 $236.88SCREW BONE TITANIUM L26 MM OD3 MM CANCELLOUS DISTA C1713 $438.75SCREW BONE TITANIUM L26 MM OD3.5 MM CORTEX HEXALOB C1713 $435.50SCREW BONE TITANIUM L26 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00SCREW BONE TITANIUM L26 MM OD3.5 MM CORTICAL LOCK C1713 $581.04SCREW BONE TITANIUM L26 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L26 MM OD4 MM 2 THREAD PILOT C1713 $1,585.92SCREW BONE TITANIUM L26 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L26 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L27 MM L12 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L27 MM L6 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L27 MM MAXILLOFACIAL SELF DRIL C1713 $1,072.00SCREW BONE TITANIUM L27.5 MM OD4.5 MM SPINE FIX AN C1713 $3,200.00SCREW BONE TITANIUM L27.5 MM OD5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L27.5 MM OD5.5 MM SPINE FIX AN C1713 $2,800.00SCREW BONE TITANIUM L27.5 MM OD6 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L27.5 MM OD6.5 MM SPINE FIX AN C1713 $3,200.00SCREW BONE TITANIUM L27.5 MM OD7.5 MM SPINE FIX AN C1713 $3,200.00SCREW BONE TITANIUM L28 MM L12 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L28 MM L14 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L28 MM L6 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L28 MM OD2 MM CORTICAL MINI FR C1713 $136.50SCREW BONE TITANIUM L28 MM OD2 MM ODSEC3.5 MM CORT C1713 $263.31SCREW BONE TITANIUM L28 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L28 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L28 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L28 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L28 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96SCREW BONE TITANIUM L28 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L28 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L28 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L28 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L29 MM L12 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L29 MM L6 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L3 MM OD1 MM CORTEX CRANIOFACI C1713 $612.00SCREW BONE TITANIUM L3 MM OD1 MM ODSEC1.6 MM CRANI 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 ChargeSCREW BONE TITANIUM L3 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $600.00SCREW BONE TITANIUM L3 MM OD1.3 MM ODSEC2.4 MM CRA C1713 $548.99SCREW BONE TITANIUM L3 MM OD1.5 MM ODSEC3 MM CRANI C1713 $512.40SCREW BONE TITANIUM L3 MM OD1.6 MM ODSEC2.9 MM CRA C1713 $268.72SCREW BONE TITANIUM L3 MM OD1.7 MM ODSEC2.4 MM CRA C1713 $570.00SCREW BONE TITANIUM L3 MM OD1.9 MM ODSEC2.9 MM CRA C1713 $268.72SCREW BONE TITANIUM L30 MM L14 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L30 MM L14 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L30 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L30 MM L16 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L30 MM L16 MM OD6.5 MM THREADE C1713 $2,810.56SCREW BONE TITANIUM L30 MM L6 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L30 MM OD2 MM CORTICAL MINI FR C1713 $136.50SCREW BONE TITANIUM L30 MM OD2 MM ODSEC3.5 MM CORT C1713 $263.31SCREW BONE TITANIUM L30 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L30 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L30 MM OD2.4 MM MANDIBLE CORTE C1713 $642.00SCREW BONE TITANIUM L30 MM OD2.4 MM ODSEC3.5 MM CO C1713 $460.00SCREW BONE TITANIUM L30 MM OD2.4 MM ODSEC4 MM MAND C1713 $684.80SCREW BONE TITANIUM L30 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96SCREW BONE TITANIUM L30 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L30 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L30 MM OD3.5 MM HEXALOBE NONST C1713 $435.50SCREW BONE TITANIUM L30 MM OD4 MM FEMUR PILOT TIP C1713 $1,585.92SCREW BONE TITANIUM L30 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L30 MM OD4 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L30 MM OD4 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD4.35 MM SPINE 1 INNIE C1713 $4,800.00SCREW BONE TITANIUM L30 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L30 MM OD4.5 MM SPINE C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD4.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L30 MM OD4.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L30 MM OD5 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L30 MM OD5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L30 MM OD5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD5.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L30 MM OD5.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD6 MM SPINE 1 INNIE PO 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 ChargeSCREW BONE TITANIUM L30 MM OD6 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L30 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD6.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L30 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD7 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L30 MM OD7.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L30 MM OD7.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L30 MM OD8.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L32 MM L14 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L32 MM L6 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L32 MM OD2 MM CORTICAL MINI FR C1713 $136.50SCREW BONE TITANIUM L32 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L32 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L32 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L32 MM OD2.4 MM MANDIBLE CORTE C1713 $642.00SCREW BONE TITANIUM L32 MM OD2.4 MM MANDIBLE CORTI C1713 $604.80SCREW BONE TITANIUM L32 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96SCREW BONE TITANIUM L32 MM OD2.7 MM CORTICAL C1713 $156.00SCREW BONE TITANIUM L32 MM OD3.5 MM CORTICAL LOCK C1713 $158.34SCREW BONE TITANIUM L32 MM OD3.5 MM CORTICAL NONST C1713 $191.30SCREW BONE TITANIUM L32 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L32 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L32.5 MM OD4.5 MM SPINE FIX AN C1713 $3,200.00SCREW BONE TITANIUM L32.5 MM OD5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L32.5 MM OD5.5 MM SPINE FIX AN C1713 $3,200.00SCREW BONE TITANIUM L32.5 MM OD6 MM SPINE FIX ANGL C1713 $2,800.00SCREW BONE TITANIUM L32.5 MM OD6.5 MM SPINE FIX AN C1713 $3,200.00SCREW BONE TITANIUM L32.5 MM OD7.5 MM SPINE FIX AN C1713 $2,800.00SCREW BONE TITANIUM L34 MM L16 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L34 MM L7 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L34 MM OD2 MM CORTICAL MINI FR C1713 $136.50SCREW BONE TITANIUM L34 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L34 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L34 MM OD2.4 MM MANDIBLE CORTE C1713 $642.00SCREW BONE TITANIUM L34 MM OD2.4 MM ODSEC4.5 MM HA C1713 $574.96SCREW BONE TITANIUM L34 MM OD2.7 MM CORTICAL C1713 $156.00SCREW BONE TITANIUM L34 MM OD2.7 MM CORTICAL NONST C1713 $236.88SCREW BONE TITANIUM L34 MM OD3.5 MM CORTICAL NONST C1713 $158.34

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 ChargeSCREW BONE TITANIUM L34 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L34 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L34 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L35 MM L14 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L35 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L35 MM L16 MM OD6.5 MM COMPRES C1713 $2,810.56SCREW BONE TITANIUM L35 MM L16 MM OD6.5 MM ODSEC7. C1713 $2,470.16SCREW BONE TITANIUM L35 MM OD4 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L35 MM OD4 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L35 MM OD4.35 MM SPINE 1 INNIE C1713 $4,800.00SCREW BONE TITANIUM L35 MM OD4.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L35 MM OD4.5 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L35 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L35 MM OD5 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L35 MM OD5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L35 MM OD5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L35 MM OD5.5 MM SPINE FIX ANGL C1713 $2,800.00SCREW BONE TITANIUM L35 MM OD5.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L35 MM OD6 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L35 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L35 MM OD6.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L35 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L35 MM OD7 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L35 MM OD7.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L35 MM OD7.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L35 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L35 MM OD8.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L35 MM OD8.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L36 MM L16 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L36 MM L7 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L36 MM OD2 MM CORTICAL MINI FR C1713 $224.25SCREW BONE TITANIUM L36 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L36 MM OD2 MM ODSEC3.5 MM HAND C1713 $243.76SCREW BONE TITANIUM L36 MM OD2.4 MM MANDIBLE CORTE C1713 $642.00SCREW BONE TITANIUM L36 MM OD2.4 MM MANDIBLE CORTI C1713 $642.00SCREW BONE TITANIUM L36 MM OD2.4 MM ODSEC4.5 MM CO C1713 $574.96SCREW BONE TITANIUM L36 MM OD2.7 MM CORTICAL C1713 $156.00SCREW BONE TITANIUM L36 MM OD2.7 MM CORTICAL NONST C1713 $236.88SCREW BONE TITANIUM L36 MM OD3.5 MM CORTEX LOCK HE C1713 $676.00

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 ChargeSCREW BONE TITANIUM L36 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L36 MM OD3.5 MM CORTICAL SHOUL C1713 $581.04SCREW BONE TITANIUM L36 MM OD4 MM 2 THREAD PILOT C1713 $1,585.92SCREW BONE TITANIUM L36 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L36 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L37.5 MM OD4.5 MM SPINE FIX AN C1713 $3,200.00SCREW BONE TITANIUM L37.5 MM OD5 MM SPINE FIX ANGL C1713 $2,800.00SCREW BONE TITANIUM L37.5 MM OD5.5 MM SPINE FIX AN C1713 $2,800.00SCREW BONE TITANIUM L37.5 MM OD6 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L37.5 MM OD6.5 MM SPINE FIX AN C1713 $3,200.00SCREW BONE TITANIUM L37.5 MM OD7.5 MM SPINE FIX AN C1713 $2,800.00SCREW BONE TITANIUM L38 MM L18 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L38 MM L8 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L38 MM OD2 MM CORTICAL MINI FR C1713 $224.25SCREW BONE TITANIUM L38 MM OD2 MM ODSEC3.5 MM CORT C1713 $246.08SCREW BONE TITANIUM L38 MM OD2 MM ODSEC3.5 MM HAND C1713 $260.82SCREW BONE TITANIUM L38 MM OD2.4 MM MANDIBLE CORTE C1713 $642.00SCREW BONE TITANIUM L38 MM OD2.4 MM MANDIBLE CORTI C1713 $642.00SCREW BONE TITANIUM L38 MM OD2.4 MM ODSEC4.5 MM HA C1713 $574.96SCREW BONE TITANIUM L38 MM OD2.5 MM CORTICAL NONST C1713 $236.88SCREW BONE TITANIUM L38 MM OD2.7 MM CORTICAL C1713 $156.00SCREW BONE TITANIUM L38 MM OD3.5 MM CORTICAL NONST C1713 $191.30SCREW BONE TITANIUM L38 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L38 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L38 MM OD4.5 MM ODSEC8 MM CORT C1713 $163.28SCREW BONE TITANIUM L4 MM MAXILLOFACIAL SELF DRILL C1713 $612.00SCREW BONE TITANIUM L4 MM OD1 MM ODSEC1.6 MM CRANI C1713 $576.00SCREW BONE TITANIUM L4 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $566.40SCREW BONE TITANIUM L4 MM OD1.3 MM ODSEC2.4 MM CRA C1713 $548.96SCREW BONE TITANIUM L4 MM OD1.5 MM CRANIOMAXILLOFA C1713 $512.40SCREW BONE TITANIUM L4 MM OD1.5 MM ODSEC3 MM CORTE C1713 $390.00SCREW BONE TITANIUM L4 MM OD1.5 MM ODSEC3 MM CRANI C1713 $512.40SCREW BONE TITANIUM L4 MM OD1.6 MM ODSEC2.9 MM CRA C1713 $268.72SCREW BONE TITANIUM L4 MM OD1.7 MM MAXILLOFACIAL E C1713 $334.88SCREW BONE TITANIUM L4 MM OD1.7 MM ODSEC2.4 MM CRA C1713 $570.00SCREW BONE TITANIUM L4 MM OD1.9 MM ODSEC2.9 MM CRA C1713 $268.72SCREW BONE TITANIUM L4 MM OD2 MM CRANIOMAXILLOFACI C1713 $444.00SCREW BONE TITANIUM L4 MM OD2 MM MANDIBLE CORTEX S C1713 $349.05SCREW BONE TITANIUM L4 MM OD2 MM MANDIBLE SELF TAP C1713 $534.00

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 ChargeSCREW BONE TITANIUM L4 MM OD2 MM ODSEC3 MM CRANIOF C1713 $414.00SCREW BONE TITANIUM L4 MM OD2 MM ODSEC3.3 MM CRANI C1713 $444.00SCREW BONE TITANIUM L4 MM OD2 MM ODSEC3.3 MM MANDI C1713 $444.00SCREW BONE TITANIUM L4 MM OD2 MM ODSEC3.5 MM MANDI C1713 $456.00SCREW BONE TITANIUM L4 MM OD2 MM ODSEC3.5 MM MAXIL C1713 $396.00SCREW BONE TITANIUM L40 MM L15 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L40 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L40 MM L16 MM OD6.5 MM ODSEC7. C1713 $2,470.16SCREW BONE TITANIUM L40 MM L16 MM OD6.5 MM THREADE C1713 $2,810.56SCREW BONE TITANIUM L40 MM L18 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L40 MM L8 MM OD3 MM ODSEC4 MM C1713 $1,444.40SCREW BONE TITANIUM L40 MM OD2 MM CORTICAL MINI FR C1713 $224.25SCREW BONE TITANIUM L40 MM OD2.4 MM ODSEC4 MM MAND C1713 $642.00SCREW BONE TITANIUM L40 MM OD2.4 MM ODSEC4.5 MM HA C1713 $574.96SCREW BONE TITANIUM L40 MM OD2.7 MM CORTICAL C1713 $156.00SCREW BONE TITANIUM L40 MM OD2.7 MM CORTICAL NONST C1713 $236.88SCREW BONE TITANIUM L40 MM OD3.5 MM CORTICAL NONST C1713 $158.34SCREW BONE TITANIUM L40 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L40 MM OD4 MM 2 THREAD PILOT T C1713 $1,585.92SCREW BONE TITANIUM L40 MM OD4 MM CANCELLOUS CANNU C1713 $630.63SCREW BONE TITANIUM L40 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L40 MM OD4 MM SPINE FIX ANGLE C1713 $2,800.00SCREW BONE TITANIUM L40 MM OD4 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L40 MM OD4.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L40 MM OD4.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L40 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L40 MM OD5 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L40 MM OD5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L40 MM OD5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD5.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L40 MM OD5.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD6 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L40 MM OD6 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L40 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD6.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L40 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD7 MM SPINE 1 INNIE PO 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 ChargeSCREW BONE TITANIUM L40 MM OD7.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L40 MM OD7.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD8.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L40 MM OD8.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L42 MM OD4 MM 2 THREAD PILOT C1713 $1,585.92SCREW BONE TITANIUM L42 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L44 MM OD3.5 MM CORTICAL NONST C1713 $158.34SCREW BONE TITANIUM L44 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L44 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L45 MM L15 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L45 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L45 MM L16 MM OD6.5 MM CANNULA C1713 $971.75SCREW BONE TITANIUM L45 MM L16 MM OD6.5 MM COMPRES C1713 $2,810.56SCREW BONE TITANIUM L45 MM L16 MM OD6.5 MM ODSEC7. C1713 $2,470.16SCREW BONE TITANIUM L45 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L45 MM OD1.5 MM CRANIOMAXILLOF C1713 $480.00SCREW BONE TITANIUM L45 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L45 MM OD4 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L45 MM OD4.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L45 MM OD4.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L45 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L45 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L45 MM OD5 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L45 MM OD5 MM SPINE FIX ANGLE C1713 $2,800.00SCREW BONE TITANIUM L45 MM OD5 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L45 MM OD5.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L45 MM OD5.5 MM SPINE REDUCTIO C1713 $3,900.00SCREW BONE TITANIUM L45 MM OD5.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L45 MM OD6 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L45 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L45 MM OD6.5 MM SPINE C1713 $5,200.00SCREW BONE TITANIUM L45 MM OD6.5 MM SPINE FIX ANGL C1713 $2,800.00SCREW BONE TITANIUM L45 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L45 MM OD7 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L45 MM OD7.5 MM SPINE C1713 $5,200.00SCREW BONE TITANIUM L45 MM OD7.5 MM SPINE FIX ANGL C1713 $2,800.00SCREW BONE TITANIUM L45 MM OD7.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L45 MM OD7.5 MM SPINE UNIAXIAL 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 ChargeSCREW BONE TITANIUM L45 MM OD8.5 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L46 MM OD3.5 MM CORTICAL NONST C1713 $158.34SCREW BONE TITANIUM L46 MM OD4 MM FEMUR 2 THREAD P C1713 $1,585.92SCREW BONE TITANIUM L46 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L46 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L48 MM OD3.5 MM CORTICAL NONST C1713 $233.81SCREW BONE TITANIUM L48 MM OD4 MM 2 THREAD PILOT T C1713 $1,585.92SCREW BONE TITANIUM L48 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L5 MM OD1 MM ODSEC1.6 MM CRANI C1713 $576.00SCREW BONE TITANIUM L5 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $600.00SCREW BONE TITANIUM L5 MM OD1.3 MM CRANIOMAXILLOFA C1713 $425.10SCREW BONE TITANIUM L5 MM OD1.3 MM ODSEC2.4 MM CRA C1713 $548.96SCREW BONE TITANIUM L5 MM OD1.5 MM CRANIOMAXILLOFA C1713 $512.40SCREW BONE TITANIUM L5 MM OD1.5 MM ODSEC3 MM CORTE C1713 $367.20SCREW BONE TITANIUM L5 MM OD1.5 MM ODSEC3 MM CRANI C1713 $512.40SCREW BONE TITANIUM L5 MM OD1.6 MM ODSEC2.9 MM CRA C1713 $268.72SCREW BONE TITANIUM L5 MM OD1.7 MM ODSEC2.4 MM CRA C1713 $537.60SCREW BONE TITANIUM L5 MM OD1.8 MM SPINE LOCK C1713 $162.50SCREW BONE TITANIUM L5 MM OD1.9 MM ODSEC2.9 MM CRA C1713 $512.40SCREW BONE TITANIUM L5 MM OD2 MM CRANIOMAXILLOFACI C1713 $398.40SCREW BONE TITANIUM L5 MM OD2 MM MANDIBLE CORTEX S C1713 $456.00SCREW BONE TITANIUM L5 MM OD2 MM MANDIBLE CORTICAL C1713 $444.00SCREW BONE TITANIUM L5 MM OD2 MM ODSEC3 MM CRANIOF C1713 $414.00SCREW BONE TITANIUM L5 MM OD2 MM ODSEC3.3 MM CRANI C1713 $474.00SCREW BONE TITANIUM L5 MM OD2 MM ODSEC3.3 MM MANDI C1713 $846.00SCREW BONE TITANIUM L5 MM OD2 MM ODSEC3.5 MM MAXIL C1713 $396.00SCREW BONE TITANIUM L5 MM OD2.4 MM MANDIBLE EMERGE C1713 $414.00SCREW BONE TITANIUM L5 MM OD2.4 MM ODSEC3.3 MM CRA C1713 $468.00SCREW BONE TITANIUM L50 MM L15 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L50 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L50 MM L16 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L50 MM L32 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L50 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L50 MM OD3.5 MM CORTEX HEXALOB C1713 $565.50SCREW BONE TITANIUM L50 MM OD3.5 MM CORTICAL C1713 $233.81SCREW BONE TITANIUM L50 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L50 MM OD4 MM SELF TAP LOCK NO C1713 $965.06SCREW BONE TITANIUM L50 MM OD4 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD4.5 MM CORTICAL SELF C1713 $159.25

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 ChargeSCREW BONE TITANIUM L50 MM OD4.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD4.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L50 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L50 MM OD5 MM SPINE 1 INNIE PO C1713 $4,800.00SCREW BONE TITANIUM L50 MM OD5 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD5 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L50 MM OD5.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD5.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD5.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD5.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD6 MM SPINE FIX ANGLE C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD6.5 MM SPINE CANNULAT C1713 $2,600.00SCREW BONE TITANIUM L50 MM OD6.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD6.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD6.5 MM SPINE REDUCTIO C1713 $3,900.00SCREW BONE TITANIUM L50 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD7.5 MM SPINE C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD7.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD7.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD7.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L50 MM OD8.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L50 MM OD8.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L52 MM OD4 MM 2 THREAD PILOT C1713 $1,585.92SCREW BONE TITANIUM L52 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L54 MM OD4.5 MM CORTICAL SELF C1713 $159.25SCREW BONE TITANIUM L55 MM L15 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L55 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L55 MM L16 MM OD6.5 MM CANNULA C1713 $971.75SCREW BONE TITANIUM L55 MM L16 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L55 MM L32 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L55 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L55 MM OD3.5 MM CORTICAL NONST C1713 $233.81SCREW BONE TITANIUM L55 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L55 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L55 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L55 MM OD5.5 MM SPINE PROXIMAL C1713 $3,200.00

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 ChargeSCREW BONE TITANIUM L55 MM OD5.5 MM SPINE REDUCTIO C1713 $3,900.00SCREW BONE TITANIUM L55 MM OD5.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L55 MM OD6 MM SPINE C1713 $906.88SCREW BONE TITANIUM L55 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L55 MM OD6.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L55 MM OD6.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L55 MM OD6.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L55 MM OD6.5 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L55 MM OD7.5 MM SPINE FIX ANGL C1713 $3,200.00SCREW BONE TITANIUM L55 MM OD7.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L55 MM OD7.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L55 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L55 MM OD8.5 MM SPINE C1713 $5,200.00SCREW BONE TITANIUM L55 MM OD8.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L55 MM OD8.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L56 MM OD4 MM 2 THREAD PILOT C1713 $1,585.92SCREW BONE TITANIUM L56 MM OD4.5 MM CORTICAL SELF C1713 $191.75SCREW BONE TITANIUM L58 MM OD4.5 MM CORTICAL SELF C1713 $191.75SCREW BONE TITANIUM L6 MM CONNECT STARDRIVE NONSTE C1713 $1,099.36SCREW BONE TITANIUM L6 MM CONNECT STARDRIVE STERIL C1713 $1,439.76SCREW BONE TITANIUM L6 MM MAXILLOFACIAL SELF DRILL C1713 $612.00SCREW BONE TITANIUM L6 MM OD1 MM ODSEC1.6 MM CORTE C1713 $501.36SCREW BONE TITANIUM L6 MM OD1 MM ODSEC1.6 MM CRANI C1713 $576.00SCREW BONE TITANIUM L6 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $600.00SCREW BONE TITANIUM L6 MM OD1.3 MM ODSEC2.4 MM COR C1713 $426.08SCREW BONE TITANIUM L6 MM OD1.3 MM ODSEC2.4 MM CRA C1713 $548.99SCREW BONE TITANIUM L6 MM OD1.5 MM CRANIOMAXILLOFA C1713 $228.80SCREW BONE TITANIUM L6 MM OD1.5 MM LOCK MULTI VARI C1713 $422.50SCREW BONE TITANIUM L6 MM OD1.5 MM NEURO SELF TAP C1713 $366.73SCREW BONE TITANIUM L6 MM OD1.5 MM ODSEC3 MM CORTE C1713 $198.06SCREW BONE TITANIUM L6 MM OD1.6 MM ODSEC2.9 MM CRA C1713 $268.72SCREW BONE TITANIUM L6 MM OD1.7 MM ODSEC2.4 MM CRA C1713 $570.00SCREW BONE TITANIUM L6 MM OD1.9 MM ODSEC2.9 MM CRA C1713 $268.72SCREW BONE TITANIUM L6 MM OD2 MM CORTICAL MINI FRA C1713 $110.50SCREW BONE TITANIUM L6 MM OD2 MM CRANIOMAXILLOFACI C1713 $504.00SCREW BONE TITANIUM L6 MM OD2 MM MANDIBLE CORTEX S C1713 $349.05SCREW BONE TITANIUM L6 MM OD2 MM MANDIBLE CORTICAL C1713 $912.00SCREW BONE TITANIUM L6 MM OD2 MM MANDIBLE SELF TAP C1713 $534.00SCREW BONE TITANIUM L6 MM OD2 MM ODSEC3 MM CRANIOF C1713 $414.00

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 ChargeSCREW BONE TITANIUM L6 MM OD2 MM ODSEC3.3 MM CRANI C1713 $444.00SCREW BONE TITANIUM L6 MM OD2 MM ODSEC3.3 MM MANDI C1713 $792.00SCREW BONE TITANIUM L6 MM OD2 MM ODSEC3.5 MM CORTE C1713 $246.08SCREW BONE TITANIUM L6 MM OD2 MM ODSEC3.5 MM HAND C1713 $260.82SCREW BONE TITANIUM L6 MM OD2 MM ODSEC3.5 MM MANDI C1713 $456.00SCREW BONE TITANIUM L6 MM OD2 MM ODSEC3.5 MM MAXIL C1713 $396.00SCREW BONE TITANIUM L6 MM OD2.1 MM HAND CRUCIFORM C1713 $195.00SCREW BONE TITANIUM L6 MM OD2.3 MM MAXILLOFACIAL S C1713 $482.08SCREW BONE TITANIUM L6 MM OD2.4 MM MANDIBLE EMERGE C1713 $414.00SCREW BONE TITANIUM L6 MM OD2.4 MM ODSEC3.3 MM CRA C1713 $468.00SCREW BONE TITANIUM L6 MM OD2.4 MM ODSEC4 MM MANDI C1713 $642.00SCREW BONE TITANIUM L6 MM OD2.4 MM ODSEC4.5 MM COR C1713 $574.96SCREW BONE TITANIUM L6 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L6 MM OD2.7 MM CORTICAL CRUCIF C1713 $195.00SCREW BONE TITANIUM L60 MM L15 MM OD4 MM CANCELLOU C1713 $94.25SCREW BONE TITANIUM L60 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L60 MM L16 MM OD6.5 MM COMPRES C1713 $2,810.56SCREW BONE TITANIUM L60 MM L16 MM OD6.5 MM ODSEC7. C1713 $2,470.16SCREW BONE TITANIUM L60 MM L32 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L60 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L60 MM OD3.5 MM CORTICAL NONST C1713 $233.81SCREW BONE TITANIUM L60 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L60 MM OD4 MM 2 THREAD C1713 $1,585.92SCREW BONE TITANIUM L60 MM OD4.5 MM CORTICAL SELF C1713 $191.75SCREW BONE TITANIUM L60 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L60 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L60 MM OD5.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L60 MM OD5.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L60 MM OD6 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L60 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L60 MM OD7.5 MM SPINE POSTERIO C1713 $5,200.00SCREW BONE TITANIUM L60 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L60 MM OD8.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L60 MM OD8.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L62 MM OD4.5 MM CORTICAL SELF C1713 $191.75SCREW BONE TITANIUM L64 MM OD4 MM 2 THREAD PILOT C1713 $1,585.92SCREW BONE TITANIUM L64 MM OD4.5 MM CORTICAL SELF C1713 $191.75SCREW BONE TITANIUM L65 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L65 MM L16 MM OD6.5 MM CANNULA C1713 $971.75

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 ChargeSCREW BONE TITANIUM L65 MM L16 MM OD6.5 MM COMPRES C1713 $2,810.56SCREW BONE TITANIUM L65 MM L16 MM OD6.5 MM ODSEC7. C1713 $2,470.16SCREW BONE TITANIUM L65 MM L32 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L65 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L65 MM OD3.5 MM CORTICAL NONST C1713 $233.81SCREW BONE TITANIUM L65 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L65 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L65 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L65 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L65 MM OD6.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L65 MM OD7.5 MM SPINE UNIAXIAL C1713 $4,800.00SCREW BONE TITANIUM L65 MM OD8.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L66 MM OD4.5 MM CORTICAL SELF C1713 $191.75SCREW BONE TITANIUM L68 MM OD4 MM 2 THREAD PILOT C1713 $1,585.92SCREW BONE TITANIUM L68 MM OD4.5 MM CORTICAL SELF C1713 $191.75SCREW BONE TITANIUM L7 MM OD1 MM ODSEC1.6 MM CORTE C1713 $501.36SCREW BONE TITANIUM L7 MM OD1 MM ODSEC1.6 MM CRANI C1713 $576.00SCREW BONE TITANIUM L7 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $600.00SCREW BONE TITANIUM L7 MM OD1.3 MM CRANIOFACIAL SE C1713 $518.40SCREW BONE TITANIUM L7 MM OD1.3 MM ODSEC2.4 MM COR C1713 $524.40SCREW BONE TITANIUM L7 MM OD1.3 MM ODSEC2.4 MM CRA C1713 $548.99SCREW BONE TITANIUM L7 MM OD1.5 MM CRANIOMAXILLOFA C1713 $228.80SCREW BONE TITANIUM L7 MM OD1.5 MM LOCK MULTI VARI C1713 $422.50SCREW BONE TITANIUM L7 MM OD1.5 MM ODSEC3 MM CORTE C1713 $198.06SCREW BONE TITANIUM L7 MM OD1.7 MM ODSEC2.4 MM CRA C1713 $570.00SCREW BONE TITANIUM L7 MM OD2 MM CORTICAL CRANIOFA C1713 $456.00SCREW BONE TITANIUM L7 MM OD2 MM CRANIOMAXILLOFACI C1713 $422.99SCREW BONE TITANIUM L7 MM OD2 MM MANDIBLE CORTICAL C1713 $912.00SCREW BONE TITANIUM L7 MM OD2 MM ODSEC3 MM CRANIOF C1713 $414.00SCREW BONE TITANIUM L7 MM OD2 MM ODSEC3.3 MM CRANI C1713 $474.00SCREW BONE TITANIUM L7 MM OD2 MM ODSEC3.5 MM CORTE C1713 $199.94SCREW BONE TITANIUM L7 MM OD2 MM ODSEC3.5 MM CRANI C1713 $456.00SCREW BONE TITANIUM L7 MM OD2 MM ODSEC3.5 MM MAXIL C1713 $396.00SCREW BONE TITANIUM L7 MM OD2.4 MM MANDIBLE EMERGE C1713 $414.00SCREW BONE TITANIUM L7 MM OD2.4 MM ODSEC4.5 MM COR C1713 $615.21SCREW BONE TITANIUM L70 MM L16 MM OD5 MM FEMUR SEL C1713 $1,635.20SCREW BONE TITANIUM L70 MM L16 MM OD5 MM ODSEC8 MM C1713 $1,971.20SCREW BONE TITANIUM L70 MM L16 MM OD6.5 MM CANCELL C1713 $159.25SCREW BONE TITANIUM L70 MM L16 MM OD6.5 MM CANNULA C1713 $971.75

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 ChargeSCREW BONE TITANIUM L70 MM L16 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L70 MM L16 MM OD7.3 MM ODSEC8. C1713 $1,826.16SCREW BONE TITANIUM L70 MM L32 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L70 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L70 MM OD3.5 MM CORTICAL SELF C1713 $94.25SCREW BONE TITANIUM L70 MM OD4.5 MM CORTICAL SELF C1713 $224.25SCREW BONE TITANIUM L70 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L70 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L70 MM OD5.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L70 MM OD6 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L70 MM OD7.5 MM SPINE UNIAXIAL C1713 $5,200.00SCREW BONE TITANIUM L72 MM OD4.5 MM CORTICAL SELF C1713 $224.25SCREW BONE TITANIUM L74 MM OD4.5 MM CORTICAL SELF C1713 $224.25SCREW BONE TITANIUM L75 MM L16 MM OD5 MM ODSEC8 MM C1713 $1,635.20SCREW BONE TITANIUM L75 MM L16 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L75 MM L16 MM OD6.5 MM COMPRES C1713 $2,810.56SCREW BONE TITANIUM L75 MM L16 MM OD6.5 MM ODSEC7. C1713 $2,470.16SCREW BONE TITANIUM L75 MM L32 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L75 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L75 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L75 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L76 MM OD4.5 MM CORTICAL SELF C1713 $224.25SCREW BONE TITANIUM L78 MM OD4.5 MM CORTICAL SELF C1713 $224.25SCREW BONE TITANIUM L8 MM L4 MM OD3 MM ODSEC4 MM I C1713 $1,444.40SCREW BONE TITANIUM L8 MM MAXILLOFACIAL SELF DRILL C1713 $612.00SCREW BONE TITANIUM L8 MM OD1 MM CORTICAL SELF TAP C1713 $633.60SCREW BONE TITANIUM L8 MM OD1 MM ODSEC1.6 MM CORTE C1713 $407.36SCREW BONE TITANIUM L8 MM OD1 MM ODSEC1.6 MM CRANI C1713 $576.00SCREW BONE TITANIUM L8 MM OD1.2 MM CRANIOFACIAL EM C1713 $600.00SCREW BONE TITANIUM L8 MM OD1.2 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L8 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $600.00SCREW BONE TITANIUM L8 MM OD1.3 MM CRANIOFACIAL SE C1713 $518.40SCREW BONE TITANIUM L8 MM OD1.3 MM ODSEC2.4 MM COR C1713 $426.08SCREW BONE TITANIUM L8 MM OD1.3 MM ODSEC2.4 MM CRA C1713 $548.99SCREW BONE TITANIUM L8 MM OD1.5 MM CRANIOMAXILLOFA C1713 $402.00SCREW BONE TITANIUM L8 MM OD1.5 MM LOCK MULTI VARI C1713 $422.50SCREW BONE TITANIUM L8 MM OD1.5 MM ODSEC3 MM CORTE C1713 $211.92SCREW BONE TITANIUM L8 MM OD1.7 MM EMERGENCY FLUTE C1713 $537.60SCREW BONE TITANIUM L8 MM OD1.7 MM ODSEC2.4 MM CRA C1713 $570.00

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 ChargeSCREW BONE TITANIUM L8 MM OD2 MM CORTEX SELF TAP C1713 $534.00SCREW BONE TITANIUM L8 MM OD2 MM CORTICAL MINI FRA C1713 $110.50SCREW BONE TITANIUM L8 MM OD2 MM CRANIOMAXILLOFACI C1713 $504.00SCREW BONE TITANIUM L8 MM OD2 MM MANDIBLE CORTEX S C1713 $349.05SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3 MM CRANIOF C1713 $414.00SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3.3 MM CRANI C1713 $444.00SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3.3 MM MANDI C1713 $846.00SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3.5 MM CORTE C1713 $246.08SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3.5 MM HAND C1713 $260.82SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3.5 MM MANDI C1713 $456.00SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3.5 MM MAXIL C1713 $396.00SCREW BONE TITANIUM L8 MM OD2.3 MM MAXILLOFACIAL S C1713 $482.08SCREW BONE TITANIUM L8 MM OD2.4 MM CORTEX SELF TAP C1713 $642.00SCREW BONE TITANIUM L8 MM OD2.4 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM L8 MM OD2.4 MM MANDIBLE EMERGE C1713 $414.00SCREW BONE TITANIUM L8 MM OD2.4 MM MAXILLOFACIAL S C1713 $424.00SCREW BONE TITANIUM L8 MM OD2.4 MM ODSEC3.3 MM CRA C1713 $468.00SCREW BONE TITANIUM L8 MM OD2.4 MM ODSEC4 MM MANDI C1713 $642.00SCREW BONE TITANIUM L8 MM OD2.4 MM ODSEC4.5 MM COR C1713 $574.96SCREW BONE TITANIUM L8 MM OD2.7 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L8 MM OD2.7 MM CORTICAL CRUCIF C1713 $195.00SCREW BONE TITANIUM L8 MM OD2.7 MM MANDIBLE EMERGE C1713 $667.20SCREW BONE TITANIUM L8 MM OD2.7 MM ODSEC4 MM MANDI C1713 $708.00SCREW BONE TITANIUM L8 MM OD3.5 MM CORTEX LOCK HEX C1713 $676.00SCREW BONE TITANIUM L8 MM SELF DRILL ANCHOR C1713 $768.00SCREW BONE TITANIUM L80 MM L16 MM OD5 MM FEMUR SEL C1713 $1,635.20SCREW BONE TITANIUM L80 MM L16 MM OD5 MM ODSEC8 MM C1713 $1,971.20SCREW BONE TITANIUM L80 MM L16 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L80 MM L16 MM OD6.5 MM CANNULA C1713 $971.75SCREW BONE TITANIUM L80 MM L16 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L80 MM L32 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L80 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L80 MM OD11 MM HIP LAG TELESCO C1713 $3,350.88SCREW BONE TITANIUM L80 MM OD3.5 MM CORTICAL NONST C1713 $158.34SCREW BONE TITANIUM L80 MM OD4.5 MM CORTICAL SELF C1713 $224.25SCREW BONE TITANIUM L80 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L80 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L80 MM OD5.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L80 MM OD6 MM LOCK STERILE AQU C1713 $1,673.52

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 ChargeSCREW BONE TITANIUM L80 MM OD6.5 MM SPINE PROXIMAL C1713 $2,800.00SCREW BONE TITANIUM L85 MM L16 MM OD5 MM ODSEC8 MM C1713 $1,635.20SCREW BONE TITANIUM L85 MM L16 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L85 MM L16 MM OD6.5 MM COMPRES C1713 $2,810.56SCREW BONE TITANIUM L85 MM L16 MM OD6.5 MM ODSEC7. C1713 $2,470.16SCREW BONE TITANIUM L85 MM L32 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L85 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L85 MM OD4.5 MM CORTICAL SELF C1713 $224.25SCREW BONE TITANIUM L85 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L85 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L85 MM PERITROCHANTERIC LAG SO C1713 $2,680.08SCREW BONE TITANIUM L9 MM L4 MM OD3 MM ODSEC4 MM I C1713 $1,444.40SCREW BONE TITANIUM L9 MM OD1 MM ODSEC1.6 MM CORTE C1713 $407.36SCREW BONE TITANIUM L9 MM OD1 MM ODSEC1.6 MM CRANI C1713 $576.00SCREW BONE TITANIUM L9 MM OD1.2 MM ODSEC1.6 MM CRA C1713 $566.40SCREW BONE TITANIUM L9 MM OD1.3 MM ODSEC2.4 MM COR C1713 $426.08SCREW BONE TITANIUM L9 MM OD1.3 MM ODSEC2.4 MM CRA C1713 $548.96SCREW BONE TITANIUM L9 MM OD1.5 MM CORTICAL C1713 $110.50SCREW BONE TITANIUM L9 MM OD1.5 MM CRANIOFACIAL SE C1713 $367.20SCREW BONE TITANIUM L9 MM OD1.5 MM LOCK MULTI VARI C1713 $422.50SCREW BONE TITANIUM L9 MM OD1.5 MM ODSEC3 MM CORTE C1713 $211.92SCREW BONE TITANIUM L9 MM OD1.7 MM CRANIOFACIAL EM C1713 $537.60SCREW BONE TITANIUM L9 MM OD1.7 MM ODSEC2.4 MM CRA C1713 $570.00SCREW BONE TITANIUM L9 MM OD2 MM CORTICAL CRANIOFA C1713 $429.60SCREW BONE TITANIUM L9 MM OD2 MM ODSEC3 MM CRANIOF C1713 $414.00SCREW BONE TITANIUM L9 MM OD2 MM ODSEC3.5 MM CORTE C1713 $246.08SCREW BONE TITANIUM L9 MM OD2 MM ODSEC3.5 MM CRANI C1713 $456.00SCREW BONE TITANIUM L9 MM OD2 MM ODSEC3.5 MM MAXIL C1713 $396.00SCREW BONE TITANIUM L9 MM OD2.4 MM MANDIBLE EMERGE C1713 $414.00SCREW BONE TITANIUM L9 MM OD2.4 MM ODSEC3.5 MM MAN C1713 $414.00SCREW BONE TITANIUM L9 MM OD2.4 MM ODSEC4.5 MM COR C1713 $574.96SCREW BONE TITANIUM L90 MM L16 MM OD5 MM FEMUR SEL C1713 $1,635.20SCREW BONE TITANIUM L90 MM L16 MM OD5 MM ODSEC8 MM C1713 $1,971.20SCREW BONE TITANIUM L90 MM L16 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L90 MM L16 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L90 MM L32 MM OD6.5 MM CANCELL C1713 $224.25SCREW BONE TITANIUM L90 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L90 MM OD4.5 MM CORTICAL SELF C1713 $224.25SCREW BONE TITANIUM L90 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60

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 ChargeSCREW BONE TITANIUM L90 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L90 MM OD5.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L90 MM OD6 MM DISTAL FEMUR LOC C1713 $1,336.08SCREW BONE TITANIUM L90 MM OD6.5 MM FEMUR LAG CANN C1713 $1,201.59SCREW BONE TITANIUM L90 MM OD6.5 MM SPINE PROXIMAL C1713 $3,200.00SCREW BONE TITANIUM L95 MM L16 MM OD5 MM ODSEC8 MM C1713 $1,635.20SCREW BONE TITANIUM L95 MM L16 MM OD6.5 MM CANCELL C1713 $191.75SCREW BONE TITANIUM L95 MM L16 MM OD6.5 MM CANNULA C1713 $971.75SCREW BONE TITANIUM L95 MM L16 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L95 MM L32 MM OD6.5 MM CANCELL C1713 $224.25SCREW BONE TITANIUM L95 MM L32 MM OD6.5 MM COMPRES C1713 $2,470.16SCREW BONE TITANIUM L95 MM OD11 MM FEMUR TROCHANTE C1713 $2,818.92SCREW BONE TITANIUM L95 MM OD4.5 MM CORTICAL SELF C1713 $256.75SCREW BONE TITANIUM L95 MM OD5 MM PERIARTICULAR CA C1713 $1,177.60SCREW BONE TITANIUM L95 MM OD5 MM PERIARTICULAR LO C1713 $1,329.36SCREW BONE TITANIUM L95 MM OD6 MM DISTAL FEMUR LOC C1713 $1,336.08SCREW BONE TITANIUM L95 MM OD6.5 MM FEMUR LAG CANN C1713 $1,201.59SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L105 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L110 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L115 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L120 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L125 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L130 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L135 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L140 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L145 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L150 C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L30 M C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L35 M C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L40 M C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L45 M C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L50 M C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L55 M C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L60 M C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L65 M C1713 $1,826.16SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L70 M C1713 $1,826.16SCREW BONE TITANIUM LARGE L45 MM OD6.5 MM SPINE FI C1713 $2,275.00SCREW BONE TITANIUM LARGE L50 MM OD6.5 MM SPINE FI C1713 $2,275.00SCREW BONE TITANIUM LONG THREAD L100 MM L40 MM OD4 C1713 $2,460.96

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 ChargeSCREW BONE TITANIUM LONG THREAD L15 MM OD3 MM CANN C1713 $1,444.40SCREW BONE TITANIUM LONG THREAD L16 MM L5 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L17 MM L6 MM OD2.4 C1713 $2,447.20SCREW BONE TITANIUM LONG THREAD L17 MM L6 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L18 MM L6 MM OD2.4 C1713 $2,447.20SCREW BONE TITANIUM LONG THREAD L18 MM L6 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L18 MM L8 MM OD3 M C1713 $1,444.40SCREW BONE TITANIUM LONG THREAD L19 MM L7 MM OD2.4 C1713 $2,447.20SCREW BONE TITANIUM LONG THREAD L19 MM L7 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L20 MM L7 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L20 MM L9 MM OD3 M C1713 $1,444.40SCREW BONE TITANIUM LONG THREAD L21 MM L8 MM OD2.4 C1713 $2,447.20SCREW BONE TITANIUM LONG THREAD L21 MM L8 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L22 MM L8 MM OD2.4 C1713 $2,618.50SCREW BONE TITANIUM LONG THREAD L23 MM L8 MM OD2.4 C1713 $2,618.50SCREW BONE TITANIUM LONG THREAD L23 MM L8 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L24 MM L8 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L25 MM L8 MM OD2.4 C1713 $2,447.20SCREW BONE TITANIUM LONG THREAD L25 MM L8 MM OD3 M C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L27 MM L10 MM OD2. C1713 $2,447.20SCREW BONE TITANIUM LONG THREAD L27 MM L10 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L28 MM L10 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L29 MM L10 MM OD2. C1713 $2,447.20SCREW BONE TITANIUM LONG THREAD L29 MM L10 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L30 MM L12 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L30 MM L12 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L32 MM L12 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L32 MM L12 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L34 MM L12 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L34 MM L14 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L36 MM L14 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L36 MM L14 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L38 MM L14 MM OD4. C1713 $2,801.36SCREW BONE TITANIUM LONG THREAD L38 MM L16 MM OD2. C1713 $2,447.20SCREW BONE TITANIUM LONG THREAD L38 MM L16 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L40 MM L16 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM LONG THREAD L40 MM L16 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L42 MM L16 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L44 MM L18 MM OD4. C1713 $2,801.36

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 ChargeSCREW BONE TITANIUM LONG THREAD L46 MM L18 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L48 MM L18 MM OD4. C1713 $2,801.36SCREW BONE TITANIUM LONG THREAD L50 MM L20 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L52 MM L20 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L54 MM L22 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L56 MM L22 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L58 MM L22 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L60 MM L24 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L65 MM L26 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L70 MM L28 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L75 MM L30 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L80 MM L32 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L85 MM L34 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L90 MM L36 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM LONG THREAD L95 MM L38 MM OD4. C1713 $2,801.36SCREW BONE TITANIUM LONG THREAD REVERSE CUT FLUTE C1713 $1,402.96SCREW BONE TITANIUM LOW PROFILE L100 MM L18 MM OD6 C1713 $1,625.00SCREW BONE TITANIUM LOW PROFILE L105 MM L18 MM OD6 C1713 $1,625.00SCREW BONE TITANIUM LOW PROFILE L115 MM L18 MM OD6 C1713 $1,625.00SCREW BONE TITANIUM LOW PROFILE L120 MM L18 MM OD6 C1713 $1,625.00SCREW BONE TITANIUM MICRO L7 MM OD1.2 MM ODSEC1.6 C1713 $566.40SCREW BONE TITANIUM MINI L10 MM OD2 MM HAND LAG HP C1713 $560.00SCREW BONE TITANIUM MINI L12 MM OD2 MM HAND LAG HP C1713 $560.00SCREW BONE TITANIUM MINI L14 MM OD2 MM HAND LAG HP C1713 $560.00SCREW BONE TITANIUM MINI L16 MM OD2 MM HAND LAG HP C1713 $560.00SCREW BONE TITANIUM MINI L18 MM OD2 MM HAND LAG HP C1713 $560.00SCREW BONE TITANIUM MINI L20 MM OD2 MM HAND LAG HP C1713 $560.00SCREW BONE TITANIUM MINI L22 MM OD2 MM HAND LAG HP C1713 $560.00SCREW BONE TITANIUM MINI L8 MM OD2 MM HAND LAG HPS C1713 $560.00SCREW BONE TITANIUM NIOBIUM ALUMINUM T25 PARTIAL T C1713 $1,196.00SCREW BONE TITANIUM OD2 MM CORTICAL COARSE PITCH S C1713 $456.00SCREW BONE TITANIUM OD2.7 MM CRANIOMAXILLOFACIAL M C1713 $2,008.00SCREW BONE TITANIUM OD3 MM CRANIAL LOW PROFILE NON C1713 $672.00SCREW BONE TITANIUM PARTIAL THREAD L100 MM L16 MM C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L100 MM L26 MM C1713 $172.48SCREW BONE TITANIUM PARTIAL THREAD L100 MM L32 MM C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L105 MM L16 MM C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L105 MM L26 MM C1713 $180.88SCREW BONE TITANIUM PARTIAL THREAD L105 MM L32 MM C1713 $285.76

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 ChargeSCREW BONE TITANIUM PARTIAL THREAD L11 MM OD1.5 MM C1713 $455.00SCREW BONE TITANIUM PARTIAL THREAD L110 MM L16 MM C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L110 MM L26 MM C1713 $172.48SCREW BONE TITANIUM PARTIAL THREAD L110 MM L32 MM C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L115 MM L32 MM C1713 $358.80SCREW BONE TITANIUM PARTIAL THREAD L12 MM OD2.3 MM C1713 $455.00SCREW BONE TITANIUM PARTIAL THREAD L120 MM L32 MM C1713 $358.80SCREW BONE TITANIUM PARTIAL THREAD L125 MM L32 MM C1713 $358.80SCREW BONE TITANIUM PARTIAL THREAD L130 MM L32 MM C1713 $358.80SCREW BONE TITANIUM PARTIAL THREAD L135 MM L32 MM C1713 $358.80SCREW BONE TITANIUM PARTIAL THREAD L14 MM OD1.5 MM C1713 $455.00SCREW BONE TITANIUM PARTIAL THREAD L14 MM OD2.3 MM C1713 $455.00SCREW BONE TITANIUM PARTIAL THREAD L140 MM L32 MM C1713 $358.80SCREW BONE TITANIUM PARTIAL THREAD L145 MM L32 MM C1713 $358.80SCREW BONE TITANIUM PARTIAL THREAD L150 MM L32 MM C1713 $358.80SCREW BONE TITANIUM PARTIAL THREAD L20 MM OD2.3 MM C1713 $455.00SCREW BONE TITANIUM PARTIAL THREAD L20 MM OD4.5 MM C1713 $1,166.10SCREW BONE TITANIUM PARTIAL THREAD L22 MM L12 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L24 CM L12 MM O C1713 $136.80SCREW BONE TITANIUM PARTIAL THREAD L26 MM L13 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L26 MM OD3.75 M C1713 $1,300.00SCREW BONE TITANIUM PARTIAL THREAD L28 MM L13 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L30 MM L13 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L30 MM L16 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L30 MM OD4.5 MM C1713 $1,435.20SCREW BONE TITANIUM PARTIAL THREAD L32 MM L13 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L34 MM L13 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L35 MM L16 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L36 MM L13 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L36 MM OD4.5 MM C1713 $1,166.10SCREW BONE TITANIUM PARTIAL THREAD L38 MM L13 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L40 MM L13 MM O C1713 $129.92SCREW BONE TITANIUM PARTIAL THREAD L40 MM L16 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L40 MM OD3.5 MM C1713 $956.80SCREW BONE TITANIUM PARTIAL THREAD L40 MM OD4.5 MM C1713 $1,435.20SCREW BONE TITANIUM PARTIAL THREAD L40 MM OD5.5 MM C1713 $5,167.50SCREW BONE TITANIUM PARTIAL THREAD L42 MM L13 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L44 MM L13 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L45 MM L16 MM O C1713 $264.48

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 ChargeSCREW BONE TITANIUM PARTIAL THREAD L45 MM L32 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L45 MM OD3.5 MM C1713 $956.80SCREW BONE TITANIUM PARTIAL THREAD L45 MM OD4.5 MM C1713 $1,137.50SCREW BONE TITANIUM PARTIAL THREAD L45 MM OD5.5 MM C1713 $5,167.50SCREW BONE TITANIUM PARTIAL THREAD L46 MM L13 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L48 MM L13 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L50 MM L13 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L50 MM L16 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L50 MM OD3.5 MM C1713 $956.80SCREW BONE TITANIUM PARTIAL THREAD L50 MM OD4.5 MM C1713 $1,435.20SCREW BONE TITANIUM PARTIAL THREAD L50 MM OD5.5 MM C1713 $5,167.50SCREW BONE TITANIUM PARTIAL THREAD L52 MM L16 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L54 MM L16 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L55 MM L16 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L55 MM L32 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L55 MM OD3.5 MM C1713 $956.80SCREW BONE TITANIUM PARTIAL THREAD L55 MM OD4.5 MM C1713 $5,167.50SCREW BONE TITANIUM PARTIAL THREAD L55 MM OD5.5 MM C1713 $5,167.50SCREW BONE TITANIUM PARTIAL THREAD L56 MM L16 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L58 MM L16 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L60 MM L16 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L60 MM L32 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L60 MM OD3.5 MM C1713 $956.80SCREW BONE TITANIUM PARTIAL THREAD L60 MM OD4.5 MM C1713 $1,435.20SCREW BONE TITANIUM PARTIAL THREAD L64 MM L20 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L65 MM OD3.5 MM C1713 $933.76SCREW BONE TITANIUM PARTIAL THREAD L68 MM L20 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L70 MM L16 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L72 MM L20 MM O C1713 $148.96SCREW BONE TITANIUM PARTIAL THREAD L75 MM L16 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L76 MM L20 MM O C1713 $172.48SCREW BONE TITANIUM PARTIAL THREAD L76 MM OD4.5 MM C1713 $1,472.00SCREW BONE TITANIUM PARTIAL THREAD L80 MM L16 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L80 MM L20 MM O C1713 $172.48SCREW BONE TITANIUM PARTIAL THREAD L80 MM L32 MM O C1713 $264.48SCREW BONE TITANIUM PARTIAL THREAD L80 MM OD3.5 MM C1713 $933.76SCREW BONE TITANIUM PARTIAL THREAD L80 MM OD4.5 MM C1713 $1,472.00SCREW BONE TITANIUM PARTIAL THREAD L85 MM L16 MM O C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L85 MM L23 MM O C1713 $172.48

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 ChargeSCREW BONE TITANIUM PARTIAL THREAD L85 MM L32 MM O C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L85 MM OD3.5 MM C1713 $933.76SCREW BONE TITANIUM PARTIAL THREAD L9 MM OD1.5 MM C1713 $455.00SCREW BONE TITANIUM PARTIAL THREAD L90 MM L16 MM O C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L90 MM L23 MM O C1713 $172.48SCREW BONE TITANIUM PARTIAL THREAD L90 MM L32 MM O C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L90 MM OD3.5 MM C1713 $933.76SCREW BONE TITANIUM PARTIAL THREAD L95 MM L16 MM O C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L95 MM L26 MM O C1713 $172.48SCREW BONE TITANIUM PARTIAL THREAD L95 MM L32 MM O C1713 $285.76SCREW BONE TITANIUM PARTIAL THREAD L95 MM OD3.5 MM C1713 $933.76SCREW BONE TITANIUM PARTIAL THREAD LOW PROFILE L22 C1713 $1,137.50SCREW BONE TITANIUM PARTIAL THREAD LOW PROFILE L26 C1713 $1,137.50SCREW BONE TITANIUM PARTIAL THREAD REVERSE CUT FLU C1713 $1,840.00SCREW BONE TITANIUM PEDIATRIC L32 MM OD4 MM PROXIM C1713 $1,585.92SCREW BONE TITANIUM PEDIATRIC L44 MM OD4 MM INTRAM C1713 $1,585.92SCREW BONE TITANIUM PEDIATRIC T25 PARTIAL THREAD L C1713 $1,536.40SCREW BONE TITANIUM PEDIATRIC T8 L10 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L12 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L14 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L16 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L18 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L20 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L22 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L24 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L28 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L30 MM OD2.7 MM O C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L34 MM W2.5 MM OD C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L36 MM W2.5 MM OD C1713 $221.44SCREW BONE TITANIUM PEDIATRIC T8 L38 MM W2.5 MM OD C1713 $221.44SCREW BONE TITANIUM REVERSE CUT FLUTE L100 MM L16 C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L100 MM L32 C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L105 MM L16 C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L120 MM L32 C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L45 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L50 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L55 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L60 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L65 MM L16 M C1713 $1,826.16

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 ChargeSCREW BONE TITANIUM REVERSE CUT FLUTE L75 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L75 MM L32 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L80 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L80 MM L32 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L85 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L85 MM L32 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L90 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L90 MM L32 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L95 MM L16 M C1713 $1,826.16SCREW BONE TITANIUM REVERSE CUT FLUTE L95 MM L32 M C1713 $1,826.16SCREW BONE TITANIUM ROUND BARREL L100 MM OD6 MM OD C1713 $1,673.52SCREW BONE TITANIUM ROUND BARREL L30 MM OD6 MM FEM C1713 $1,673.52SCREW BONE TITANIUM ROUND BARREL L30 MM OD6 MM ODS C1713 $1,336.08SCREW BONE TITANIUM ROUND BARREL L35 MM OD6 MM FEM C1713 $1,719.20SCREW BONE TITANIUM ROUND BARREL L35 MM OD6 MM ODS C1713 $1,336.08SCREW BONE TITANIUM ROUND BARREL L40 MM OD6 MM FEM C1713 $1,673.52SCREW BONE TITANIUM ROUND BARREL L40 MM OD6 MM ODS C1713 $1,336.08SCREW BONE TITANIUM ROUND BARREL L45 MM OD6 MM FEM C1713 $1,673.52SCREW BONE TITANIUM ROUND BARREL L50 MM OD6 MM FEM C1713 $1,673.52SCREW BONE TITANIUM ROUND BARREL L60 MM OD6 MM FEM C1713 $1,336.08SCREW BONE TITANIUM ROUND BARREL L65 MM OD6 MM FEM C1713 $1,673.52SCREW BONE TITANIUM ROUND BARREL L75 MM OD6 MM ODS C1713 $1,673.52SCREW BONE TITANIUM ROUND BARREL L85 MM OD6 MM ODS C1713 $1,673.52SCREW BONE TITANIUM ROUND BARREL L90 MM OD6 MM ODS C1713 $1,673.52SCREW BONE TITANIUM SHORT THREAD L10 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L100 MM L20 MM OD C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L11 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L12 MM L4 MM OD3 C1713 $1,444.40SCREW BONE TITANIUM SHORT THREAD L13 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L14 MM L4 MM OD3 C1713 $1,444.40SCREW BONE TITANIUM SHORT THREAD L15 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L16 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L16 MM OD4.2 MM P C1713 $581.04SCREW BONE TITANIUM SHORT THREAD L17 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L18 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L18 MM OD4.2 MM C C1713 $581.04SCREW BONE TITANIUM SHORT THREAD L19 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L20 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L20 MM L7 MM OD4. C1713 $2,460.96

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 ChargeSCREW BONE TITANIUM SHORT THREAD L20 MM OD4.2 MM C C1713 $581.04SCREW BONE TITANIUM SHORT THREAD L21 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L22 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L22 MM L7 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L22 MM OD4.2 MM C C1713 $581.04SCREW BONE TITANIUM SHORT THREAD L23 MM L4 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L24 MM L5 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L24 MM L6 MM OD3 C1713 $1,444.40SCREW BONE TITANIUM SHORT THREAD L24 MM L7 MM OD4. C1713 $2,801.36SCREW BONE TITANIUM SHORT THREAD L25 MM L5 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L26 MM L5 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L26 MM L7 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L26 MM OD4.2 MM C C1713 $581.04SCREW BONE TITANIUM SHORT THREAD L27 MM L6 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L28 MM L6 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L28 MM L7 MM OD4. C1713 $2,801.36SCREW BONE TITANIUM SHORT THREAD L28 MM OD3.5 MM P C1713 $552.63SCREW BONE TITANIUM SHORT THREAD L29 MM L6 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L30 MM L7 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L30 MM L7 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L30 MM OD4.2 MM C C1713 $581.04SCREW BONE TITANIUM SHORT THREAD L32 MM L7 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L32 MM L7 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L32 MM OD4.2 MM C C1713 $705.06SCREW BONE TITANIUM SHORT THREAD L34 MM L7 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L34 MM L8 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L34 MM OD4.2 MM C C1713 $705.06SCREW BONE TITANIUM SHORT THREAD L36 MM L7 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L36 MM L9 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L36 MM OD4.2 MM C C1713 $705.06SCREW BONE TITANIUM SHORT THREAD L38 MM L7 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L38 MM L9 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L38 MM OD4.2 MM C C1713 $705.06SCREW BONE TITANIUM SHORT THREAD L40 MM L10 MM OD3 C1713 $2,442.56SCREW BONE TITANIUM SHORT THREAD L40 MM L8 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L42 MM L8 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L42 MM OD4.2 MM C C1713 $705.06SCREW BONE TITANIUM SHORT THREAD L44 MM L9 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L44 MM OD4.2 MM C C1713 $705.06

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 ChargeSCREW BONE TITANIUM SHORT THREAD L46 MM L9 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L46 MM OD4.2 MM C C1713 $705.06SCREW BONE TITANIUM SHORT THREAD L48 MM L9 MM OD4. C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L50 MM L10 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L52 MM L10 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L54 MM L11 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L56 MM L11 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L58 MM L11 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L60 MM L12 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L65 MM L13 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L70 MM L14 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L75 MM L15 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L80 MM L16 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L85 MM L17 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L90 MM L18 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SHORT THREAD L95 MM L19 MM OD4 C1713 $2,460.96SCREW BONE TITANIUM SMALL L14 MM OD2 MM FOOT ANKLE C1713 $585.00SCREW BONE TITANIUM STANDARD FULL THREAD L30 MM OD C1713 $1,917.50SCREW BONE TITANIUM STANDARD FULL THREAD L34 MM OD C1713 $1,917.50SCREW BONE TITANIUM STANDARD FULL THREAD L38 MM OD C1713 $1,917.50SCREW BONE TITANIUM STANDARD FULL THREAD L40 MM OD C1713 $1,917.50SCREW BONE TITANIUM STANDARD L10 MM OD1.5 MM ODSEC C1713 $228.80SCREW BONE TITANIUM STANDARD L10 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L10 MM W2.5 MM OD2.7 C1713 $236.88SCREW BONE TITANIUM STANDARD L11 MM OD1.5 MM ODSEC C1713 $228.80SCREW BONE TITANIUM STANDARD L12 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L12 MM W2.5 MM OD2.7 C1713 $236.88SCREW BONE TITANIUM STANDARD L14 MM OD1.5 MM ODSEC C1713 $228.80SCREW BONE TITANIUM STANDARD L16 MM OD1.5 MM ODSEC C1713 $228.80SCREW BONE TITANIUM STANDARD L16 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L18 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L20 MM OD1.5 MM ODSEC C1713 $228.80SCREW BONE TITANIUM STANDARD L20 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L20 MM W2.5 MM OD2.7 C1713 $236.88SCREW BONE TITANIUM STANDARD L22 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L24 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L24 MM OD3.5 MM ODSEC C1713 $127.68SCREW BONE TITANIUM STANDARD L26 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L28 MM OD2 MM ODSEC3. C1713 $223.04

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 ChargeSCREW BONE TITANIUM STANDARD L28 MM OD2.7 MM ODSEC C1713 $236.88SCREW BONE TITANIUM STANDARD L30 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L30 MM OD2.7 MM ODSEC C1713 $236.88SCREW BONE TITANIUM STANDARD L32 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L32 MM OD2.7 MM ODSEC C1713 $236.88SCREW BONE TITANIUM STANDARD L34 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L36 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L38 MM OD2 MM ODSEC3. C1713 $223.04SCREW BONE TITANIUM STANDARD L38 MM OD3.5 MM ODSEC C1713 $127.68SCREW BONE TITANIUM STANDARD L6 MM OD2 MM ODSEC3.5 C1713 $223.04SCREW BONE TITANIUM STANDARD L8 MM OD1.5 MM ODSEC3 C1713 $228.80SCREW BONE TITANIUM STANDARD L8 MM OD2 MM ODSEC3.5 C1713 $223.04SCREW BONE TITANIUM STANDARD L8 MM OD2.7 MM ODSEC5 C1713 $236.88SCREW BONE TITANIUM STANDARD L9 MM OD1.5 MM ODSEC3 C1713 $228.80SCREW BONE TITANIUM STANDARD T8 L10 MM OD3 MM TORX C1713 $715.00SCREW BONE TITANIUM STANDARD T8 L12 MM OD3 MM TORX C1713 $715.00SCREW BONE TITANIUM STANDARD T8 L14 MM OD3 MM TORX C1713 $715.00SCREW BONE TITANIUM STANDARD T8 L18 MM OD3 MM TORX C1713 $715.00SCREW BONE TITANIUM STANDARD T8 L22 MM OD3 MM TORX C1713 $715.00SCREW BONE TITANIUM STANDARD T8 L22 MM OD3.5 MM TO C1713 $550.00SCREW BONE TITANIUM STANDARD T8 L24 MM OD3 MM TORX C1713 $715.00SCREW BONE TITANIUM STANDARD T8 L26 MM OD3 MM TORX C1713 $715.00SCREW BONE TITANIUM STANDARD T8 L28 MM OD3 MM TORX C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L10 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L12 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L14 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L16 MM OD3.5 M C1713 $791.70SCREW BONE TITANIUM T10 FULL THREAD L18 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L20 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L22 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L24 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L24 MM OD3.5 M C1713 $400.40SCREW BONE TITANIUM T10 FULL THREAD L26 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L28 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L30 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L34 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L36 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L40 MM OD3 MM C1713 $715.00SCREW BONE TITANIUM T10 FULL THREAD L42 MM OD3.5 M C1713 $400.40

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 ChargeSCREW BONE TITANIUM T10 L12 MM OD3.5 MM ODSEC5 MM C1713 $353.93SCREW BONE TITANIUM T10 L16 MM OD2.7 MM ODSEC5 MM C1713 $353.93SCREW BONE TITANIUM T10 L18 MM OD2.7 MM ODSEC5 MM C1713 $353.93SCREW BONE TITANIUM T10 L20 MM OD2.7 MM ODSEC5 MM C1713 $686.40SCREW BONE TITANIUM T10 L20 MM OD3.5 MM ODSEC5 MM C1713 $686.40SCREW BONE TITANIUM T10 L22 MM OD2.7 MM ODSEC5 MM C1713 $353.93SCREW BONE TITANIUM T10 L28 MM OD3.5 MM ODSEC5 MM C1713 $686.40SCREW BONE TITANIUM T10 L55 MM OD3.5 MM ODSEC5 MM C1713 $353.93SCREW BONE TITANIUM T10 L60 MM OD3.5 MM ODSEC5 MM C1713 $353.93SCREW BONE TITANIUM T15 FULL THREAD HEXALOBE L42 M C1713 $552.50SCREW BONE TITANIUM T15 FULL THREAD L10 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L12 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L14 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L16 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L18 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L20 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L22 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L24 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L26 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L28 MM OD3.5 M C1713 $172.48SCREW BONE TITANIUM T15 FULL THREAD L30 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L32 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L34 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L36 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L38 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L40 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L42 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L45 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L50 MM OD3.5 M C1713 $855.60SCREW BONE TITANIUM T15 FULL THREAD L55 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L60 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L70 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 FULL THREAD L80 MM OD3.5 M C1713 $695.18SCREW BONE TITANIUM T15 LONG THREAD L38 MM L14 MM C1713 $2,460.96SCREW BONE TITANIUM T15 LONG THREAD L44 MM L18 MM C1713 $2,460.96SCREW BONE TITANIUM T15 LONG THREAD L48 MM L18 MM C1713 $2,460.96SCREW BONE TITANIUM T15 PARTIAL THREAD L70 MM OD3. C1713 $933.76SCREW BONE TITANIUM T15 SHORT THREAD L24 MM L7 MM C1713 $2,460.96SCREW BONE TITANIUM T15 SHORT THREAD L28 MM L7 MM C1713 $2,460.96

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 ChargeSCREW BONE TITANIUM T25 FULL THREAD L100 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L100 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L105 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L110 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L115 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L120 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L125 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L14 MM OD4 MM C1713 $975.20SCREW BONE TITANIUM T25 FULL THREAD L14 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L16 MM OD4 MM C1713 $975.20SCREW BONE TITANIUM T25 FULL THREAD L16 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L18 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L18 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L20 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L20 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L22 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L22 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L24 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L24 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L26 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L26 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L26 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L28 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L28 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L28 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L30 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L30 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L30 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L32 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L32 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L32 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L34 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L34 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L34 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L35 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L36 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L36 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L36 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L38 MM OD4 MM C1713 $959.60

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 ChargeSCREW BONE TITANIUM T25 FULL THREAD L38 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L38 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L40 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L40 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L40 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L42 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L42 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L42 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L44 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L44 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L44 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L45 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L46 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L46 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L46 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L48 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L48 MM OD5 MM C1713 $993.60SCREW BONE TITANIUM T25 FULL THREAD L48 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L50 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L50 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L50 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L52 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L52 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L52 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L54 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L54 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L54 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L55 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L56 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L56 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L56 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L58 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L58 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L58 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L60 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L60 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L60 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L62 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L62 MM OD5 MM C1713 $959.60

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 ChargeSCREW BONE TITANIUM T25 FULL THREAD L64 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L64 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L64 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L65 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L66 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L66 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L68 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L68 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L68 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L70 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L70 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L72 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L72 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L72 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L74 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L74 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L75 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L76 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L76 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L76 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L78 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L78 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L80 MM OD4 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L80 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L80 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L85 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L85 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L90 MM OD5 MM C1713 $1,340.64SCREW BONE TITANIUM T25 FULL THREAD L90 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L95 MM OD5 MM C1713 $959.60SCREW BONE TITANIUM T25 FULL THREAD L95 MM OD6 MM C1713 $959.60SCREW BONE TITANIUM T25 L100 MM OD6.5 MM FEMORAL L C1713 $1,000.35SCREW BONE TITANIUM T25 L100 MM OD6.5 MM SELF TAP C1713 $1,274.52SCREW BONE TITANIUM T25 L105 MM OD6.5 MM FEMORAL L C1713 $1,000.35SCREW BONE TITANIUM T25 L105 MM OD6.5 MM SELF TAP C1713 $1,274.52SCREW BONE TITANIUM T25 L110 MM OD6.5 MM FEMORAL L C1713 $1,000.35SCREW BONE TITANIUM T25 L115 MM OD6.5 MM FEMORAL L C1713 $1,000.35SCREW BONE TITANIUM T25 L120 MM OD6.5 MM FEMORAL L C1713 $1,000.35SCREW BONE TITANIUM T25 L125 MM OD6.5 MM FEMORAL L C1713 $1,000.35

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 ChargeSCREW BONE TITANIUM T25 L130 MM OD6.5 MM FEMORAL L C1713 $1,274.52SCREW BONE TITANIUM T25 L60 MM OD6.5 MM FEMORAL LA C1713 $1,000.35SCREW BONE TITANIUM T25 L65 MM OD6.5 MM FEMORAL LA C1713 $1,000.35SCREW BONE TITANIUM T25 L70 MM OD6.5 MM FEMORAL LA C1713 $1,000.35SCREW BONE TITANIUM T25 L75 MM OD6.5 MM FEMORAL LA C1713 $1,000.35SCREW BONE TITANIUM T25 L80 MM OD6.5 MM FEMORAL LA C1713 $1,000.35SCREW BONE TITANIUM T25 L80 MM OD6.5 MM SELF TAP S C1713 $1,274.52SCREW BONE TITANIUM T25 L85 MM OD6.5 MM FEMORAL LA C1713 $1,000.35SCREW BONE TITANIUM T25 L85 MM OD6.5 MM SELF TAP S C1713 $1,274.52SCREW BONE TITANIUM T25 L90 MM OD6.5 MM FEMORAL LA C1713 $1,000.35SCREW BONE TITANIUM T25 L90 MM OD6.5 MM SELF TAP S C1713 $1,274.52SCREW BONE TITANIUM T25 L95 MM OD6.5 MM FEMORAL LA C1713 $1,000.35SCREW BONE TITANIUM T25 L95 MM OD6.5 MM SELF TAP S C1713 $1,274.52SCREW BONE TITANIUM T4 L10 MM OD1.5 MM CORTEX SELF C1713 $265.89SCREW BONE TITANIUM T4 L10 MM OD1.5 MM HAND SELF T C1713 $651.95SCREW BONE TITANIUM T4 L8 MM OD1.5 MM CORTEX SELF C1713 $248.50SCREW BONE TITANIUM T6 L10 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L11 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L12 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L13 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L14 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L16 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L18 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L20 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L22 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L24 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L26 MM OD2 MM CORTEX SELF T C1713 $240.50SCREW BONE TITANIUM T6 L28 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L30 MM OD2 MM CORTEX SELF T C1713 $240.50SCREW BONE TITANIUM T6 L32 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L34 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L36 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L38 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L40 MM OD2 MM CORTEX SELF T C1713 $224.77SCREW BONE TITANIUM T6 L6 MM OD2 MM CORTEX SELF TA C1713 $224.77SCREW BONE TITANIUM T6 L7 MM OD2 MM CORTEX SELF TA C1713 $224.77SCREW BONE TITANIUM T6 L8 MM OD2 MM CORTEX SELF TA C1713 $224.77SCREW BONE TITANIUM T6 L9 MM OD2 MM CORTEX SELF TA C1713 $224.77SCREW BONE TITANIUM T7 FULL THREAD L14 MM OD2.7 MM C1713 $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 ChargeSCREW BONE TITANIUM T8 FULL THREAD HEXALOBE L34 MM C1713 $812.50SCREW BONE TITANIUM T8 FULL THREAD HEXALOBE L36 MM C1713 $812.50SCREW BONE TITANIUM T8 FULL THREAD L10 MM OD2.4 MM C1713 $812.50SCREW BONE TITANIUM T8 FULL THREAD L12 MM OD2.4 MM C1713 $812.50SCREW BONE TITANIUM T8 FULL THREAD L14 MM OD2.4 MM C1713 $812.50SCREW BONE TITANIUM T8 FULL THREAD L16 MM OD2.4 MM C1713 $715.00SCREW BONE TITANIUM T8 FULL THREAD L18 MM OD2.4 MM C1713 $715.00SCREW BONE TITANIUM T8 FULL THREAD L20 MM OD2.4 MM C1713 $812.50SCREW BONE TITANIUM T8 FULL THREAD L26 MM OD2.4 MM C1713 $715.00SCREW BONE TITANIUM T8 L10 MM OD2.4 MM LOCK VARIAB C1713 $948.72SCREW BONE TITANIUM T8 L10 MM OD2.4 MM ODSEC1.9 MM C1713 $678.16SCREW BONE TITANIUM T8 L10 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L10 MM OD3 MM LOCK STARDRIV C1713 $1,066.78SCREW BONE TITANIUM T8 L11 MM OD2.4 MM CORTEX SELF C1713 $346.00SCREW BONE TITANIUM T8 L11 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L12 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L12 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L12 MM OD2.4 MM VARIABLE AN C1713 $948.72SCREW BONE TITANIUM T8 L12 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L12 MM OD3 MM LOCK STARDRIV C1713 $1,066.78SCREW BONE TITANIUM T8 L13 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L13 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L14 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L14 MM OD2.4 MM LOCK VARIAB C1713 $948.72SCREW BONE TITANIUM T8 L14 MM OD2.4 MM ODSEC4 MM C C1713 $323.36SCREW BONE TITANIUM T8 L14 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L14 MM OD3 MM LOCK STARDRIV C1713 $1,066.78SCREW BONE TITANIUM T8 L14 MM OD3.5 MM LOCK STARDR C1713 $820.60SCREW BONE TITANIUM T8 L16 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L16 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L16 MM OD2.4 MM LOCK VARIAB C1713 $948.72SCREW BONE TITANIUM T8 L16 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L16 MM OD3 MM LOCK STARDRIV C1713 $1,066.78SCREW BONE TITANIUM T8 L16 MM OD3.5 MM LOCK STARDR C1713 $820.60SCREW BONE TITANIUM T8 L18 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L18 MM OD2.4 MM ODSEC4 MM C C1713 $323.36SCREW BONE TITANIUM T8 L18 MM OD2.4 MM VARIABLE AN C1713 $948.72SCREW BONE TITANIUM T8 L18 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L18 MM OD3 MM LOCK STARDRIV C1713 $1,066.78

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 ChargeSCREW BONE TITANIUM T8 L18 MM OD3.5 MM LOCK STARDR C1713 $1,066.78SCREW BONE TITANIUM T8 L20 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L20 MM OD2.4 MM VARIABLE AN C1713 $948.72SCREW BONE TITANIUM T8 L20 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L20 MM OD3 MM LOCK STARDRIV C1713 $1,066.78SCREW BONE TITANIUM T8 L20 MM OD3.5 MM LOCK STARDR C1713 $1,066.78SCREW BONE TITANIUM T8 L22 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L22 MM OD2.4 MM LOCK VARIAB C1713 $1,015.13SCREW BONE TITANIUM T8 L22 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L22 MM OD3.5 MM LOCK STARDR C1713 $1,046.76SCREW BONE TITANIUM T8 L24 MM OD2.4 MM ID1.9 MM SE C1713 $678.16SCREW BONE TITANIUM T8 L24 MM OD2.4 MM LOCK VARIAB C1713 $948.72SCREW BONE TITANIUM T8 L24 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L24 MM OD3.5 MM LOCK STARDR C1713 $1,046.76SCREW BONE TITANIUM T8 L26 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L26 MM OD2.4 MM LOCK VARIAB C1713 $948.72SCREW BONE TITANIUM T8 L26 MM OD2.4 MM ODSEC1.9 MM C1713 $678.16SCREW BONE TITANIUM T8 L28 MM OD2.4 MM LOCK VARIAB C1713 $948.72SCREW BONE TITANIUM T8 L28 MM OD2.4 MM ODSEC1.9 MM C1713 $678.16SCREW BONE TITANIUM T8 L30 MM OD2.4 MM LOCK VARIAB C1713 $948.72SCREW BONE TITANIUM T8 L30 MM OD2.4 MM ODSEC1.9 MM C1713 $678.16SCREW BONE TITANIUM T8 L32 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L34 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L36 MM OD2.4 MM ODSEC4 MM C C1713 $323.36SCREW BONE TITANIUM T8 L36 MM OD2.7 MM ID2.1 MM SE C1713 $804.96SCREW BONE TITANIUM T8 L38 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L40 MM OD2.4 MM CORTEX SELF C1713 $346.00SCREW BONE TITANIUM T8 L6 MM OD2.4 MM ODSEC1.9 MM C1713 $678.16SCREW BONE TITANIUM T8 L7 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L7 MM OD2.4 MM ID1.9 MM SEL C1713 $678.16SCREW BONE TITANIUM T8 L8 MM OD2.4 MM LOCK VARIABL C1713 $948.72SCREW BONE TITANIUM T8 L8 MM OD2.4 MM ODSEC1.9 MM C1713 $678.16SCREW BONE TITANIUM T8 L9 MM OD2.4 MM CORTEX SELF C1713 $323.36SCREW BONE TITANIUM T8 L9 MM OD2.4 MM ID1.9 MM SEL C1713 $678.16SCREW BONE TITANIUM T8 LONG THREAD FLUTE L20 MM L7 C1713 $2,618.50SCREW BONE TITANIUM T8 LONG THREAD FLUTE L22 MM L8 C1713 $2,442.56SCREW BONE TITANIUM T8 LONG THREAD FLUTE L24 MM L8 C1713 $2,447.20SCREW BONE TITANIUM T8 LONG THREAD FLUTE L26 MM L1 C1713 $2,442.56SCREW BONE TITANIUM T8 LONG THREAD FLUTE L28 MM L1 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 ChargeSCREW BONE TITANIUM T8 LONG THREAD FLUTE L30 MM L1 C1713 $2,447.20SCREW BONE TITANIUM T8 LONG THREAD FLUTE L32 MM L1 C1713 $2,447.20SCREW BONE TITANIUM T8 LONG THREAD FLUTE L34 MM L1 C1713 $2,618.50SCREW BONE TITANIUM T8 LONG THREAD FLUTE L36 MM L1 C1713 $2,447.20SCREW BONE TITANIUM T8 LONG THREAD FLUTE L40 MM L1 C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD FLUTE L10 MM L C1713 $2,618.50SCREW BONE TITANIUM T8 SHORT THREAD FLUTE L14 MM L C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD FLUTE L16 MM L C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD FLUTE L19 MM L C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD FLUTE L20 MM L C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L11 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L12 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L13 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L15 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L17 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L18 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L21 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L22 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L23 MM L4 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L24 MM L5 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L25 MM L5 MM O C1713 $2,618.50SCREW BONE TITANIUM T8 SHORT THREAD L26 MM L5 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L27 MM L6 MM O C1713 $2,618.50SCREW BONE TITANIUM T8 SHORT THREAD L28 MM L6 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L29 MM L6 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L30 MM L7 MM O C1713 $2,618.50SCREW BONE TITANIUM T8 SHORT THREAD L32 MM L7 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L34 MM L8 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L36 MM L9 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L38 MM L9 MM O C1713 $2,447.20SCREW BONE TITANIUM T8 SHORT THREAD L40 MM L10 MM C1713 $2,618.50SCREW BONE TITANIUM T8 SHORT THREAD L9 MM L4 MM OD C1713 $2,618.50SCREW BONE TK2 TIMAX FULL THREAD L28 MM OD4.5 MM C C1713 $209.56SCREW BONE TK2 TIMAX LARGE 4 CUT FLUTE L70 MM L22 C1713 $1,280.89SCREW BONE TK2 TIMAX LARGE 4 CUT FLUTE L80 MM L22 C1713 $1,399.32SCREW BONE TK2 TIMAX LONG HIP CAPTURE COMPRESSION C1713 $287.30SCREW BONE TK2 TIMAX OBLIQUE FULL THREAD L32 MM OD C1713 $209.56SCREW BONE TK2 TIMAX OBLIQUE FULL THREAD L34 MM OD C1713 $166.40SCREW BONE TK2 TIMAX OBLIQUE FULL THREAD L36 MM OD C1713 $209.56

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 ChargeSCREW BONE TK2 TIMAX OBLIQUE FULL THREAD L38 MM OD C1713 $209.56SCREW BONE TK2 TIMAX SHORT HIP CAPTURE COMPRESSION C1713 $287.30SCREW BONE TK2 TIMAX STANDARD L100 MM OD13 MM ID9 C1713 $1,548.04SCREW BONE TK2 TIMAX STANDARD L105 MM OD13 MM ID9 C1713 $1,548.04SCREW BONE TK2 TIMAX STANDARD L85 MM OD13 MM ID9 M C1713 $1,467.05SCREW BONE TK2 TIMAX STANDARD L90 MM OD13 MM ID9 M C1713 $1,491.10SCREW BONE TK2 TIMAX STANDARD L95 MM OD13 MM ID9 M C1713 $1,467.05SCREW BONE TOMOFIX TITANIUM L14 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L18 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L22 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L24 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L26 MM OD5 MM FEMUR SE C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L26 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L28 MM OD5 MM FEMUR SE C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L30 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L30 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L32 MM OD5 MM FEMUR SE C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L34 MM OD5 MM FEMUR SE C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L35 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L36 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L38 MM OD5 MM FEMUR SE C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L40 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L40 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L42 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L44 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L45 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L46 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L48 MM OD5 MM FEMUR SE C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L50 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L50 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L55 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L55 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L60 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L60 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L65 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L65 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L70 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L70 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L75 MM OD5 MM SELF DRI C1713 $1,453.60

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 ChargeSCREW BONE TOMOFIX TITANIUM L75 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L80 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L80 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L85 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L85 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L90 MM OD5 MM SELF DRI C1713 $1,453.60SCREW BONE TOMOFIX TITANIUM L90 MM OD5 MM SELF TAP C1713 $1,453.60SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELL C1713 $597.87SCREW BONE TRANSFIX L350 MM OD6 MM CALCANEUS DRILL C1713 $1,051.20SCREW BONE TRAVERSE L45 MM OD5.5 MM SPINE NONSTERI C1713 $1,300.00SCREW BONE TRIDENT II L15 MM OD6.5 MM LOW PROFILE C1713 $162.50SCREW BONE TRIDENT II L20 MM OD6.5 MM LOW PROFILE C1713 $162.50SCREW BONE TRIDENT II L25 MM OD6.5 MM LOW PROFILE C1713 $162.50SCREW BONE TRIDENT II L30 MM OD6.5 MM LOW PROFILE C1713 $162.50SCREW BONE TRIDENT II L40 MM OD6.5 MM LOW PROFILE C1713 $162.50SCREW BONE TRIDENT TITANIUM HEMISPHERE L16 MM OD6. C1713 $162.50SCREW BONE TRIDENT TITANIUM HEMISPHERE L20 MM OD6. C1713 $162.50SCREW BONE TRIDENT TITANIUM HEMISPHERE L35 MM OD6. C1713 $162.50SCREW BONE TRIDENT TITANIUM HEMISPHERE L40 MM OD6. C1713 $162.50SCREW BONE TRIDENT TITANIUM HEMISPHERE L45 MM OD6. C1713 $162.50SCREW BONE TRIDENT TITANIUM HEMISPHERE L50 MM OD6. C1713 $162.50SCREW BONE TRILOGY L30 MM OD6.5 MM ACETABULAR CORT C1713 $162.50SCREW BONE TRILOGY TIVANIUM L15 MM OD6.5 MM HIP AC C1713 $866.13SCREW BONE TRILOGY TIVANIUM L35 MM OD6.5 MM HIP AC C1713 $162.50SCREW BONE TRILOGY TIVANIUM L40 MM OD6.5 MM HIP AC C1713 $162.50SCREW BONE TRILOGY TIVANIUM L50 MM OD6.5 MM HIP AC C1713 $162.50SCREW BONE TRILOGY TIVANIUM L60 MM OD6.5 MM HIP AC C1713 $162.50SCREW BONE TRINICA L14 MM OD4.2 MM SPINE SELF DRIL C1713 $487.50SCREW BONE TRUSS L57 MM OD5.5 MM SPINE VARIABLE AN C1713 $1,300.00SCREW BONE TRUSS SPINE CLAMP C1713 $325.00

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 ChargeSCREW BONE TSRH OSTEOGRIP THINLINE L40 MM OD7.5 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L20 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L30 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L35 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L40 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L45 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L50 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L55 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L60 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM LONG L C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM SHORT C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP TITANIUM L35 MM OD7.5 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP TITANIUM L45 MM OD7.5 MM C1713 $2,600.00SCREW BONE TSRH OSTEOGRIP TITANIUM L55 MM OD6.5 MM C1713 $2,600.00SCREW BONE TSRH THINLINE OSTEOGRIP L45 MM OD5.5 MM C1713 $2,600.00SCREW BONE TSRH TITANIUM SHORT POST L45 MM OD8.5 M C1713 $2,400.00SCREW BONE TWINFIX TITANIUM L18 MM OD3.2 MM HAND W C1713 $2,361.60SCREW BONE TWINFIX TITANIUM L22 MM OD3.2 MM HAND W C1713 $2,361.60SCREW BONE UCSS TITANIUM L34 MM OD4 MM SPINE CORTI C1713 $2,925.00SCREW BONE UNIFY L12 MM OD4.2 MM SPINE FIX ANGLE S C1713 $390.00SCREW BONE UNIFY L12 MM OD4.2 MM SPINE VARIABLE AN C1713 $390.00SCREW BONE UNIFY L14 MM OD4.2 MM SPINE FIX ANGLE S C1713 $390.00SCREW BONE UNIFY L14 MM OD4.2 MM SPINE SELF TAP VA C1713 $390.00SCREW BONE UNIFY L14 MM OD4.2 MM SPINE VARIABLE AN C1713 $390.00SCREW BONE UNIFY L14 MM OD4.6 MM SPINE VARIABLE AN C1713 $390.00SCREW BONE UNIFY L16 MM OD4.2 MM SPINE FIX ANGLE S C1713 $390.00SCREW BONE UNIFY L16 MM OD4.2 MM SPINE VARIABLE AN C1713 $390.00SCREW BONE UNIFY L16 MM OD4.6 MM SPINE VARIABLE AN C1713 $390.00SCREW BONE UNILOCK TITANIUM L10 MM OD2.4 MM MANDIB C1713 $1,086.00SCREW BONE UNILOCK TITANIUM L10 MM OD3 MM MANDIBLE C1713 $1,260.00SCREW BONE UNILOCK TITANIUM L10 MM OD3 MM STERNAL C1713 $1,332.80SCREW BONE UNILOCK TITANIUM L12 MM OD2.4 MM MANDIB C1713 $830.70SCREW BONE UNILOCK TITANIUM L12 MM OD3 MM MANDIBLE C1713 $1,260.00SCREW BONE UNILOCK TITANIUM L12 MM OD3 MM STERNAL C1713 $1,332.80SCREW BONE UNILOCK TITANIUM L14 MM OD2.4 MM MANDIB C1713 $1,086.00SCREW BONE UNILOCK TITANIUM L14 MM OD3 MM MANDIBLE C1713 $1,260.00SCREW BONE UNILOCK TITANIUM L14 MM OD3 MM STERNAL C1713 $1,332.80SCREW BONE UNILOCK TITANIUM L16 MM OD2.4 MM MANDIB C1713 $1,086.00SCREW BONE UNILOCK TITANIUM L16 MM OD3 MM MANDIBLE C1713 $1,260.00

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 ChargeSCREW BONE UNILOCK TITANIUM L16 MM OD3 MM STERNAL C1713 $1,332.80SCREW BONE UNILOCK TITANIUM L18 MM OD2.4 MM MANDIB C1713 $1,086.00SCREW BONE UNILOCK TITANIUM L18 MM OD3 MM MANDIBLE C1713 $1,260.00SCREW BONE UNILOCK TITANIUM L18 MM OD3 MM STERNAL C1713 $1,332.80SCREW BONE UNILOCK TITANIUM L20 MM OD2.4 MM MANDIB C1713 $1,086.00SCREW BONE UNILOCK TITANIUM L20 MM OD3 MM MANDIBLE C1713 $1,260.00SCREW BONE UNILOCK TITANIUM L22 MM OD2.4 MM MANDIB C1713 $1,086.00SCREW BONE UNILOCK TITANIUM L22 MM OD3 MM MANDIBLE C1713 $1,260.00SCREW BONE UNILOCK TITANIUM L22 MM OD3 MM STERNUM C1713 $1,100.16SCREW BONE UNILOCK TITANIUM L24 MM OD2.4 MM MANDIB C1713 $1,086.00SCREW BONE UNILOCK TITANIUM L24 MM OD3 MM MANDIBLE C1713 $1,260.00SCREW BONE UNILOCK TITANIUM L8 MM OD2.4 MM MANDIBL C1713 $1,086.00SCREW BONE UNILOCK TITANIUM L8 MM OD3 MM MANDIBLE C1713 $1,260.00SCREW BONE UNILOCK TITANIUM L8 MM OD3 MM STERNAL S C1713 $1,332.80SCREW BONE UNILOCK TITANIUM L8 MM OD3 MM STERNUM L C1713 $1,332.80SCREW BONE UNILOCK TITANIUM OD2.4 MM MANDIBLE SELF C1713 $300.00SCREW BONE UNIVERS REVERS 18 D L24 MM OD4.5 MM SHO C1713 $780.00SCREW BONE UNIVERS REVERS 18 D L30 MM OD4.5 MM SHO C1713 $780.00SCREW BONE UNIVERS REVERS 18 D L36 MM OD4.5 MM SHO C1713 $780.00SCREW BONE UNIVERS REVERS 18 D L42 MM OD4.5 MM SHO C1713 $780.00SCREW BONE UNIVERS REVERS 18 D L48 MM OD4.5 MM SHO C1713 $780.00SCREW BONE UNIVERS REVERS L20 MM OD6.5 MM SHOULDER C1713 $1,105.00SCREW BONE UNIVERSAL NEURO 2 L4 MM OD1.7 MM CRANIO C1713 $488.88SCREW BONE UNIVERSAL NEURO 2 QUIKFLAP TITANIUM L4 C1713 $451.36SCREW BONE UNIVERSAL NEURO III L4 MM OD1.5 MM CRAN C1713 $563.92SCREW BONE UNIVERSAL NEURO III TITANIUM L3 MM OD1. C1713 $563.92SCREW BONE USS STAINLESS STEEL SMALL STATURE L25 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L28 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L30 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L32 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L35 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L38 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L40 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L45 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L50 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L55 M C1713 $2,800.00SCREW BONE USS STAINLESS STEEL SMALL STATURE L60 M C1713 $2,800.00SCREW BONE VAIL TITANIUM L10 MM OD4.5 MM SPINE OCC C1713 $812.50SCREW BONE VAIL TITANIUM L10 MM OD5.3 MM SPINE OCC 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 ChargeSCREW BONE VAIL TITANIUM L12 MM OD4.5 MM SPINE OCC C1713 $812.50SCREW BONE VAIL TITANIUM L14 MM OD4.5 MM SPINE PED C1713 $3,900.00SCREW BONE VAIL TITANIUM L28 MM OD4.5 MM SPINE PED C1713 $3,900.00SCREW BONE VAIL TITANIUM L32 MM OD4.5 MM SPINE PED C1713 $3,900.00SCREW BONE VAIL TITANIUM L6 MM OD4.5 MM SPINE OCCI C1713 $812.50SCREW BONE VARIAX SMARTLOCK TITANIUM L14 MM OD2.7 C1713 $422.50SCREW BONE VARIAX T10 FULL THREAD L10 MM OD3.5 MM C1713 $1,035.45SCREW BONE VARIAX T10 FULL THREAD L12 MM OD3.5 MM C1713 $1,035.45SCREW BONE VARIAX T10 FULL THREAD L14 MM OD3.5 MM C1713 $1,035.45SCREW BONE VARIAX T10 FULL THREAD L16 MM OD3.5 MM C1713 $533.00SCREW BONE VARIAX T10 FULL THREAD L18 MM OD3.5 MM C1713 $533.00SCREW BONE VARIAX T10 FULL THREAD L20 MM OD2.7 MM C1713 $1,040.00SCREW BONE VARIAX T10 FULL THREAD L20 MM OD3.5 MM C1713 $533.00SCREW BONE VARIAX T10 FULL THREAD L22 MM OD3.5 MM C1713 $533.00SCREW BONE VARIAX T10 FULL THREAD L24 MM OD3.5 MM C1713 $533.00SCREW BONE VARIAX T10 FULL THREAD L26 MM OD3.5 MM C1713 $1,035.45SCREW BONE VARIAX T10 FULL THREAD L28 MM OD3.5 MM C1713 $533.00SCREW BONE VARIAX T10 FULL THREAD L30 MM OD3.5 MM C1713 $1,035.45SCREW BONE VARIAX T8 FULL THREAD L14 MM OD2.7 MM F C1713 $1,040.00SCREW BONE VARIAX T8 FULL THREAD L16 MM OD2.7 MM F C1713 $1,040.00SCREW BONE VARIAX T8 FULL THREAD L18 MM OD2.7 MM F C1713 $1,040.00SCREW BONE VARIAX T8 FULL THREAD L20 MM OD2.7 MM F C1713 $1,040.00SCREW BONE VARIAX TITANIUM L10 MM OD2.7 MM ELBOW L C1713 $686.40SCREW BONE VARIAX TITANIUM L12 MM OD2.7 MM DISTAL C1713 $458.64SCREW BONE VARIAX TITANIUM L12 MM OD2.7 MM ELBOW L C1713 $686.40SCREW BONE VARIAX TITANIUM L14 MM OD2.7 MM DISTAL C1713 $458.64SCREW BONE VARIAX TITANIUM L14 MM OD2.7 MM ELBOW L C1713 $686.40SCREW BONE VARIAX TITANIUM L14 MM OD3.5 MM ELBOW S C1713 $686.40SCREW BONE VARIAX TITANIUM L16 MM OD2.7 MM ELBOW S C1713 $686.40SCREW BONE VARIAX TITANIUM L16 MM OD3.5 MM ELBOW S C1713 $686.40SCREW BONE VARIAX TITANIUM L18 MM OD2.7 MM ELBOW S C1713 $686.40SCREW BONE VARIAX TITANIUM L18 MM OD3.5 MM ELBOW S C1713 $353.93SCREW BONE VARIAX TITANIUM L20 MM OD2.7 MM DISTAL C1713 $602.16SCREW BONE VARIAX TITANIUM L20 MM OD3.5 MM ELBOW S C1713 $353.93SCREW BONE VARIAX TITANIUM L22 MM OD2.7 MM ELBOW S C1713 $686.40SCREW BONE VARIAX TITANIUM L22 MM OD3.5 MM ELBOW S C1713 $686.40SCREW BONE VARIAX TITANIUM L24 MM OD2.7 MM ELBOW L C1713 $686.40SCREW BONE VARIAX TITANIUM L26 MM OD3.5 MM ELBOW S C1713 $686.40SCREW BONE VARIAX TITANIUM L28 MM OD2.7 MM ELBOW L C1713 $686.40

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 ChargeSCREW BONE VARIAX TITANIUM L30 MM OD2.7 MM ELBOW L C1713 $686.40SCREW BONE VARIAX TITANIUM L42 MM OD2.7 MM ELBOW L C1713 $686.40SCREW BONE VARIAX TITANIUM T10 FULL THREAD L10 MM C1713 $791.70SCREW BONE VARIAX TITANIUM T10 FULL THREAD L12 MM C1713 $791.70SCREW BONE VARIAX TITANIUM T10 FULL THREAD L14 MM C1713 $400.40SCREW BONE VARIAX TITANIUM T10 FULL THREAD L16 MM C1713 $400.40SCREW BONE VARIAX TITANIUM T10 FULL THREAD L46 MM C1713 $400.40SCREW BONE VARIAX TITANIUM T10 FULL THREAD L55 MM C1713 $400.40SCREW BONE VARIAX TITANIUM T7 FULL THREAD L12 MM O C1713 $711.75SCREW BONE VARIAX TITANIUM T7 FULL THREAD L14 MM O C1713 $711.75SCREW BONE VARIAX TITANIUM T7 FULL THREAD L16 MM O C1713 $533.00SCREW BONE VARIAX TITANIUM T7 FULL THREAD L18 MM O C1713 $711.75SCREW BONE VARIAX TITANIUM T7 FULL THREAD L20 MM O C1713 $533.00SCREW BONE VARIAX TITANIUM T7 FULL THREAD L22 MM O C1713 $711.75SCREW BONE VARIAX TITANIUM T7 FULL THREAD L26 MM O C1713 $711.75SCREW BONE VERSANAIL FULL THREAD L32 MM OD4.8 MM H C1713 $648.96SCREW BONE VERSANAIL FULL THREAD L40 MM OD4.8 MM O C1713 $648.96SCREW BONE VERTEX MAX TITANIUM 0-45 D L12 MM OD4 M C1713 $2,800.00SCREW BONE VERTEX MAX TITANIUM 0-45 D L6 MM OD4.5 C1713 $3,200.00SCREW BONE VERTEX MAX TITANIUM L10 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE VERTEX MAX TITANIUM L10 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE VERTEX MAX TITANIUM L12 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE VERTEX MAX TITANIUM L14 MM OD3.5 MM SPI C1713 $3,900.00SCREW BONE VERTEX MAX TITANIUM L14 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE VERTEX MAX TITANIUM L14 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE VERTEX MAX TITANIUM L16 MM OD3.5 MM SPI C1713 $3,900.00SCREW BONE VERTEX MAX TITANIUM L16 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE VERTEX MAX TITANIUM L16 MM OD4.5 MM SPI C1713 $2,800.00SCREW BONE VERTEX MAX TITANIUM L18 MM OD4 MM SPINE C1713 $2,800.00SCREW BONE VERTEX MAX TITANIUM L18 MM OD4.5 MM SPI C1713 $3,200.00SCREW BONE VERTEX MAX TITANIUM L30 MM OD3.5 MM SPI C1713 $3,900.00SCREW BONE VERTEX MAX TITANIUM L34 MM OD3.5 MM SPI C1713 $3,900.00SCREW BONE VERTEX MAX TITANIUM L34 MM OD4 MM SPINE C1713 $3,900.00SCREW BONE VERTEX MAX TITANIUM L5 MM OD3.5 MM SPIN C1713 $400.00SCREW BONE VERTEX MAX TITANIUM L6 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE VERTEX MAX TITANIUM L8 MM OD4 MM SPINE C1713 $3,200.00SCREW BONE VERTEX MAX TITANIUM L8 MM OD4.5 MM SPIN C1713 $2,800.00SCREW BONE VERTEX TITANIUM L10 MM OD4.5 MM SPINE C C1713 $812.50SCREW BONE VHS L115 MM OD12.7 MM HIP LAG 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 ChargeSCREW BONE VHS L130 MM OD12.7 MM LAG COMPRESSION C1713 $2,071.68SCREW BONE VHS L45 MM LAG C1713 $3,927.04SCREW BONE VHS L45 MM OD3.5 MM CORTICAL HIP INTERM C1713 $253.76SCREW BONE VHS L55 MM LAG C1713 $3,927.04SCREW BONE VHS L55 MM OD12.7 MM HIP LAG COMPRESSIO C1713 $2,071.68SCREW BONE VHS L60 MM HIP LAG C1713 $3,927.04SCREW BONE VHS L70 MM LAG C1713 $3,927.04SCREW BONE VHS L80 MM OD15 MM HIP COMPRESSION LAG C1713 $2,504.32SCREW BONE VHS L85 MM OD15 MM HIP LAG C1713 $2,504.32SCREW BONE VHS L90 MM OD12.7 MM HIP LAG COMPRESSIO C1713 $2,071.68SCREW BONE VHS L90 MM OD15 MM HIP COMPRESSION LAG C1713 $2,504.32SCREW BONE VHS L95 MM OD15 MM HIP COMPRESSION LAG C1713 $2,504.32SCREW BONE VHS PEDIATRIC L35 MM LAG C1713 $3,927.04SCREW BONE VHS PEDIATRIC L40 MM LAG C1713 $3,927.04SCREW BONE VHS PEDIATRIC L65 MM LAG C1713 $3,927.04SCREW BONE VHS STAINLESS STEEL L100 MM OD12.7 MM H C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L105 MM OD12.7 MM H C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L110 MM OD12.7 MM H C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L120 MM OD12.7 MM H C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L125 MM OD12.7 MM H C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L20 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L22 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L24 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L26 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L28 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L30 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L32 MM OD4.5 MM HIP C1713 $213.20SCREW BONE VHS STAINLESS STEEL L34 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L35 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L36 MM OD4.5 MM HIP C1713 $213.20SCREW BONE VHS STAINLESS STEEL L38 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L40 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L40 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L42 MM OD4.5 MM HIP C1713 $213.20SCREW BONE VHS STAINLESS STEEL L44 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L45 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L46 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L50 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L50 MM OD12.7 MM HI 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 ChargeSCREW BONE VHS STAINLESS STEEL L50 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L52 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L54 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L55 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L56 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L58 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L60 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L60 MM OD12.7 MM HI C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L60 MM OD4.5 MM COR C1713 $213.20SCREW BONE VHS STAINLESS STEEL L65 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L65 MM OD12.7 MM HI C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L70 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L70 MM OD12.7 MM HI C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L75 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L75 MM OD12.7 MM HI C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L80 MM L16 MM OD6.5 C1713 $416.00SCREW BONE VHS STAINLESS STEEL L80 MM OD12.7 MM HI C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L85 MM OD12.7 MM HI C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL L95 MM OD12.7 MM HI C1713 $2,071.68SCREW BONE VHS STAINLESS STEEL VARIABLE ANGLE L48 C1713 $213.20SCREW BONE VIP L12 MM OD4.6 MM SPINE CERVICAL ANTE C1713 $390.00SCREW BONE VIP L12 MM OD5.1 MM SPINE SELF DRILL FI C1713 $390.00SCREW BONE VIP L12 MM OD5.1 MM SPINE SELF DRILL VA C1713 $390.00SCREW BONE VIP L12 MM OD5.1 MM SPINE SELF TAP FIX C1713 $390.00SCREW BONE VIP L12 MM OD5.1 MM SPINE SELF TAP VARI C1713 $390.00SCREW BONE VIP L14 MM OD4.6 MM SPINE CERVICAL ANTE C1713 $390.00SCREW BONE VIP L14 MM OD4.6 MM SPINE SELF DRILL VA C1713 $390.00SCREW BONE VIP L14 MM OD5.1 MM SPINE CERVICAL ANTE C1713 $390.00SCREW BONE VIP L14 MM OD5.1 MM SPINE SELF DRILL VA C1713 $390.00SCREW BONE VIP L14 MM OD5.1 MM SPINE SELF TAP VARI C1713 $390.00SCREW BONE VIP L16 MM OD4.6 MM SPINE SELF DRILL VA C1713 $390.00SCREW BONE VIP L16 MM OD4.6 MM SPINE SELF TAP VARI C1713 $390.00SCREW BONE VIP L16 MM OD5.1 MM SPINE SELF DRILL FI C1713 $390.00SCREW BONE VIP L16 MM OD5.1 MM SPINE SELF DRILL VA C1713 $390.00SCREW BONE VIP L16 MM OD5.1 MM SPINE SELF TAP FIX C1713 $390.00SCREW BONE VIP L16 MM OD5.1 MM SPINE SELF TAP VARI C1713 $390.00SCREW BONE VIP L18 MM OD5.1 MM SPINE CERVICAL ANTE C1713 $390.00SCREW BONE VIP L20 MM OD5.1 MM SPINE CERVICAL ANTE C1713 $390.00SCREW BONE VIP L22 MM OD5.1 MM SPINE CERVICAL ANTE C1713 $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 ChargeSCREW BONE VIP L24 MM OD5.1 MM SPINE CERVICAL ANTE C1713 $390.00SCREW BONE VIP L26 MM OD5.1 MM SPINE CERVICAL ANTE C1713 $390.00SCREW BONE VIRAGE L10 MM OD3.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE VIRAGE L12 MM OD3.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE VIRAGE L14 MM OD3.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE VIRAGE L16 MM OD3.5 MM SPINE POLYAXIAL C1713 $3,900.00SCREW BONE VIRAGE TITANIUM L20 MM OD4.5 MM SPINE S C1713 $3,900.00SCREW BONE VIRAGE TITANIUM L25 MM OD4.5 MM SPINE S C1713 $3,900.00SCREW BONE VIRAGE TITANIUM L30 MM OD4.5 MM SPINE S C1713 $3,900.00SCREW BONE VIRAGE TITANIUM L75 MM OD3.5 MM LORDOSE C1713 $812.50SCREW BONE VISIDISK OD1 MM LAG M3X C1713 $826.56SCREW BONE VISION 6 MM SHANK L170 MM L40 MM OD6/5 C1713 $957.44SCREW BONE VISION 6 MM SHANK L180 MM L40 MM OD6/5 C1713 $957.44SCREW BONE VISION DFS HA TAPER L180 MM L60 MM OD6- C1713 $1,105.92SCREW BONE VISION DYNAFIX 2 MM 6 MM TAPER L70 MM L C1713 $957.44SCREW BONE VISION DYNAFIX 3.2 MM 6 MM TAPER L120 M C1713 $957.44SCREW BONE VISION DYNAFIX 3.2 MM 6 MM TAPER L130 M C1713 $957.44SCREW BONE VISION DYNAFIX DFS HA TAPER L120 MM L40 C1713 $1,029.12SCREW BONE VISION DYNAFIX HA 3.2 MM TAPER L110 MM C1713 $957.44SCREW BONE VISION DYNAFIX HA 3.2 MM TAPER L130 MM C1713 $1,029.12SCREW BONE VISION DYNAFIX HA 3.2 MM TAPER L140 MM C1713 $1,029.12SCREW BONE VISION DYNAFIX HA 3.2 MM TAPER L150 MM C1713 $1,029.12SCREW BONE VISION DYNAFIX HA 4.8 MM 6 MM TAPER L11 C1713 $1,105.92SCREW BONE VISION DYNAFIX HA 4.8 MM 6 MM TAPER L12 C1713 $1,105.92SCREW BONE VISION DYNAFIX HA 4.8 MM 6 MM TAPER L13 C1713 $1,105.92SCREW BONE VISION DYNAFIX HA 4.8 MM 6 MM TAPER L15 C1713 $1,105.92SCREW BONE VISION DYNAFIX HA 4.8 MM 6 MM TAPER L20 C1713 $1,105.92SCREW BONE VISION DYNAFIX STAINLESS STEEL 4 MM TAP C1713 $957.44SCREW BONE VISION HA TAPER L200 MM L80 MM OD6-5 MM C1713 $1,105.92SCREW BONE VISION L140 MM L40 MM OD4 MM CORTICAL S C1713 $916.48SCREW BONE VISION XFIX DYNAFIX 4 MM TAPER L80 MM L C1713 $957.44SCREW BONE VISION XFIX DYNAFIX 6 MM TAPER L220 MM C1713 $957.44SCREW BONE VISION XFIX DYNAFIX HA 6 MM TAPER L180 C1713 $1,105.92SCREW BONE VISION XFIX DYNAFIX HA TAPER L160 MM L9 C1713 $1,105.92SCREW BONE VISION XFIX DYNAFIX HA TAPER L170 MM L8 C1713 $1,105.92SCREW BONE VITALITY T27 FULL THREAD L35 MM OD6.5 M C1713 $3,900.00SCREW BONE VITALITY T27 FULL THREAD L40 MM OD6.5 M C1713 $3,900.00SCREW BONE VITALITY T27 FULL THREAD L50 MM OD6.5 M C1713 $3,900.00SCREW BONE VITALITY T27 FULL THREAD L60 MM OD6.5 M C1713 $3,900.00

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 ChargeSCREW BONE VITALITY TITANIUM T27 L45 MM OD6.5 MM S C1713 $3,900.00SCREW BONE VUEPOINT II L14 MM OD3.5 MM SPINE MULTI C1713 $3,900.00SCREW BONE VUEPOINT TITANIUM L10 MM OD3.5 MM SPINE C1713 $3,900.00SCREW BONE VUEPOINT TITANIUM L20 MM OD4 MM SPINE C C1713 $3,900.00SCREW BONE WRISTFIX DYNAFIX STAINLESS STEEL 6 MM T C1713 $957.44SCREW BONE X-CORE MINI TITANIUM OD14 MM SPINE LOCK C1713 $325.00SCREW BONE XIA II TITANIUM L40 MM OD5.5 MM SPINE T C1713 $2,800.00SCREW BONE XIA L45 MM OD5.5 MM SPINE MONOAXIAL C1713 $2,800.00SCREW BONE XIA STAINLESS STEEL L25 MM OD4.5 MM SPI C1713 $2,800.00SCREW BONE XIA STAINLESS STEEL L30 MM OD4.5 MM SPI C1713 $2,800.00SCREW BONE XIA STAINLESS STEEL L30 MM OD5.5 MM SPI C1713 $2,800.00SCREW BONE XIA STAINLESS STEEL L35 MM OD4.5 MM SPI C1713 $2,800.00SCREW BONE XIA STAINLESS STEEL L35 MM OD5.5 MM SPI C1713 $2,800.00SCREW BONE XIA STAINLESS STEEL L40 MM OD4.5 MM SPI C1713 $2,800.00SCREW BONE XIA STAINLESS STEEL L40 MM OD5.5 MM SPI C1713 $2,800.00SCREW BONE XIA TITANIUM 3D L40 MM OD4.5 MM SPINE T C1713 $2,800.00SCREW BONE XIA TITANIUM CURVE L30 MM OD5 MM SPINE C1713 $2,800.00SCREW BONE XIA TITANIUM L12 MM OD4.5 MM SPINE THOR C1713 $2,000.00SCREW BONE XIA TITANIUM L14 MM OD4.5 MM SPINE THOR C1713 $2,000.00SCREW BONE XIA TITANIUM L16 MM OD4.5 MM SPINE THOR C1713 $2,000.00SCREW BONE XIA TITANIUM L17 MM OD4.5 MM SPINE THOR C1713 $2,000.00SCREW BONE XIA TITANIUM L18 MM OD4.5 MM SPINE THOR C1713 $2,000.00SCREW BONE XIA TITANIUM L20 MM OD4 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L21 MM OD4.5 MM SPINE THOR C1713 $2,000.00SCREW BONE XIA TITANIUM L23 MM OD4.5 MM SPINE THOR C1713 $2,000.00SCREW BONE XIA TITANIUM L24 MM OD4.5 MM SPINE THOR C1713 $2,000.00SCREW BONE XIA TITANIUM L25 MM OD4 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L25 MM OD4.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L25 MM OD5 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L25 MM OD5.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L30 MM OD4 MM SPINE THORAC C1713 $4,800.00SCREW BONE XIA TITANIUM L30 MM OD4.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L30 MM OD5 MM SPINE THORAC C1713 $4,800.00SCREW BONE XIA TITANIUM L30 MM OD5.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L30 MM OD6.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L35 MM OD4 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L35 MM OD4.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L35 MM OD5 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L35 MM OD5.5 MM SPINE THOR 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 ChargeSCREW BONE XIA TITANIUM L35 MM OD6.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L40 MM OD4 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L40 MM OD4.5 MM SPINE THOR C1713 $4,800.00SCREW BONE XIA TITANIUM L40 MM OD5 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L40 MM OD5.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L40 MM OD6.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L45 MM OD4.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L45 MM OD5 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L45 MM OD5.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L45 MM OD6.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L50 MM OD5 MM SPINE THORAC C1713 $2,800.00SCREW BONE XIA TITANIUM L50 MM OD5.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L50 MM OD6.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L55 MM OD5.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L55 MM OD6.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L60 MM OD4.5 MM SPINE THOR C1713 $4,800.00SCREW BONE XIA TITANIUM L60 MM OD5 MM SPINE THORAC C1713 $4,800.00SCREW BONE XIA TITANIUM L60 MM OD5.5 MM SPINE THOR C1713 $4,800.00SCREW BONE XIA TITANIUM L60 MM OD6.5 MM SPINE THOR C1713 $2,800.00SCREW BONE XIA TITANIUM L70 MM OD4.5 MM SPINE THOR C1713 $4,800.00SCREW BONE XIA TITANIUM L70 MM OD5 MM SPINE THORAC C1713 $4,800.00SCREW BONE XIA TITANIUM L70 MM OD5.5 MM SPINE THOR C1713 $4,800.00SCREW BONE XIA TITANIUM L70 MM OD6.5 MM SPINE THOR C1713 $4,800.00SCREW BONE XIA TITANIUM LARGE L30 MM OD4 MM SPINE C1713 $2,800.00SCREW BONE XIA TITANIUM MEDIUM L13 MM OD4.5 MM SPI C1713 $2,000.00SCREW BONE XIA TITANIUM STANDARD CURVE L25 MM OD5 C1713 $4,800.00SCREW BONE XSHORT TIBIA LIGAMENT WASHER C1713 $1,628.00SCREW BONE XTEND L12 MM OD4.2 MM SPINE FIX ANGLE S C1713 $390.00SCREW BONE XTEND L12 MM OD4.2 MM SPINE SELF DRILL C1713 $390.00SCREW BONE XTEND L14 MM OD4.2 MM SPINE FIX ANGLE S C1713 $390.00SCREW BONE XTEND L14 MM OD4.2 MM SPINE SELF TAP VA C1713 $390.00SCREW BONE XTEND L14 MM OD4.2 MM SPINE VARIABLE AN C1713 $390.00SCREW BONE XTEND L16 MM OD4.2 MM SPINE FIX ANGLE S C1713 $390.00SCREW BONE XTEND L16 MM OD4.2 MM SPINE SELF DRILL C1713 $390.00SCREW BONE YUKON L14 MM OD3.5 MM SPINE OCCIPITOCER C1713 $3,900.00SCREW BONE YUKON OCT SPINE SET NONSTERILE C1713 $325.00SCREW BONE ZAVATION L14 MM OD4 MM SPINE SELF DRILL C1713 $487.50SCREW BONE ZEVO TITANIUM L13 MM OD3.5 MM SPINE CER C1713 $487.50SCREW BONE ZEVO TITANIUM L15 MM OD3.5 MM SPINE CER 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 ChargeSCREW BONE ZEVO TITANIUM L15 MM OD4 MM SPINE CERVI C1713 $487.50SCREW BONE ZIMMER CONTINUUM TRILOGY TRABECULAR MET C1713 $162.50SCREW COVER BAHA CONE STERILE C1713 $968.05SCREW DISTRACTION CASPAR L12 MM CERVICAL PIN STERI C1713 $162.50SCREW DISTRACTION CASPAR L14 MM CERVICAL PIN STERI C1713 $162.50SCREW DISTRACTION L20 MM MINI JOINT $1,137.50SCREW EXTERNAL DISTRACTOR STAINLESS STEEL OD3.5 MM $936.00SCREW EXTERNAL DISTRACTOR TITANIUM MIDFACIAL EXTER $1,128.00SCREW EXTERNAL FIXATION BIOMET VISION DFS HA TAPER $1,029.12SCREW EXTERNAL FIXATION DFS 6 MM L150 MM L30 MM OD $957.44SCREW EXTERNAL FIXATION DFS HA TAPER L200 MM L50 M $1,029.12SCREW EXTERNAL FIXATION DFS TAPER L120 MM L40 MM O $957.44SCREW EXTERNAL FIXATION DFS TAPER L130 MM L40 MM O $969.28SCREW EXTERNAL FIXATION DFS TAPER L130 MM L50 MM O $957.44SCREW EXTERNAL FIXATION DFS TAPER L140 MM L80 MM O $957.44SCREW EXTERNAL FIXATION DFS TAPER L180 MM L50 MM O $957.44SCREW EXTERNAL FIXATION DFS TAPER L180 MM L90 MM O $957.44SCREW EXTERNAL FIXATION DFS TAPER L200 MM L80 MM O $957.44SCREW EXTERNAL FIXATION DFS VISION TAPER L100 MM L C1713 $957.44SCREW EXTERNAL FIXATION DFS VISION TAPER L200 MM L $957.44SCREW EXTERNAL FIXATION DYNAFIX VS L34 MM OD6 MM C $906.88SCREW EXTERNAL FIXATION HA TAPER L160 MM L30 MM OD $1,029.12SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL HA $961.36SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL HA C1713 $1,147.38SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L10 $588.80SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L10 C1713 $1,140.80SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L12 C1713 $926.90SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L12 $1,288.00SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L13 $648.56SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L15 $588.80SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L15 C1713 $926.90SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L16 $671.60SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L17 C1713 $926.90SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L17 $1,046.50SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L19 $671.60SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L20 $1,046.50SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L25 $1,288.00SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L60 $588.80SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L65 $1,012.00