Supplies, drugs & other prices at Our Lady of Lourdes Regional Medical Center

Lafayette, LA · every code in this section with a posted price and a Medicare benchmark.

72 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
2d tte w or w/o fol w/con,fu (C8924) $1,049 $2,098 3.3×
3D cntr simula trgt lvr les (0944T) $265.50 $531 1.2×
Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) $6,284.50 $12,569 3.6×
Abltj perc cryoabltj img gdn uxtr/perph nerve (0440T) $6,284.50 $12,569 3.6×
Adm tocilizu covid-19 1st (M0249) $409.50 $819 1.0×
Adm tocilizu covid-19 2nd (M0250) $409.50 $819 1.0×
Ca screen;pelvic/breast exam (G0101) $82 $164 0.9×
Chemo extend iv infus w/pump (G0498) $490.50 $981 1.6×
Computed tomography, breast, including 3D rendering, when performed, bilateral; with contrast material(s) (0637T) $554.50 $1,109 1.8×
Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s) (0636T) $285.50 $571 1.3×
Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast, followed by contrast… (0638T) $554.50 $1,109 1.8×
Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s) (0634T) $554.50 $1,109 3.5×
Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material (0633T) $285.50 $571 3.0×
Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast… (0635T) $554.50 $1,109 3.5×
Depression screen annual (G0444) $25 $50 0.7×
Diab manage trn per indiv (G0108) $43.50 $87 0.8×
Diab manage trn ind/group (G0109) $28.50 $57 1.8×
Direct refer hospital observ (G0379) $1,193 $2,386 2.2×
Drug test def 1-7 classes (G0480) $200 $400 1.7×
Drug test def 15-21 classes (G0482) $400 $800 2.0×
Drug test def 22+ classes (G0483) $518.50 $1,037 2.1×
Drug test def 8-14 classes (G0481) $296.50 $593 1.9×
Elec stim other than wound (G0283) $77.50 $155 6.1×
Fecal blood scrn immunoassay (G0328) $35.50 $71 2.0×
Hbot, full body chamber, 30m (G0277) $418.50 $837 3.4×
Home sleep test/type 3 porta (G0399) $367 $734 1.9×
Inj for sacroiliac jt anesth (G0260) $2,101.50 $4,203 3.3×
Instill pharm renal pelvis (C9789) $1,519 $3,038 1.4×
Liver dis 10 assays w/nash (0003M) $904.50 $1,809 1.8×
Mra w/cont, abd (C8900) $2,253.50 $4,507 7.1×
Mra w/cont, chest (C8909) $1,458 $2,916 4.6×
Mra w/cont, lwr ext (C8912) $1,271.50 $2,543 4.0×
Mra w/cont, pelvis (C8918) $1,880 $3,760 6.0×
Mra w/o cont, abd (C8901) $1,589.50 $3,179 7.4×
Mra w/o cont, lwr ext (C8913) $882.50 $1,765 4.1×
Mra w/o cont, pelvis (C8919) $1,045 $2,090 4.8×
Mra w/o fol w/cont, abd (C8902) $2,568.50 $5,137 8.1×
Mra w/o fol w/cont, chest (C8911) $1,642.50 $3,285 5.2×
Mra w/o fol w/cont, lwr ext (C8914) $1,280.50 $2,561 4.1×
Mra w/o fol w/cont, pelvis (C8920) $2,297 $4,594 7.3×
Mra, w/dye, upper extremity (C8934) $4,681.50 $9,363 14.8×
Mra, w/o dye, upper extr (C8935) $1,712 $3,424 7.9×
Mra, w/o&w/dye, upper extr (C8936) $7,205.50 $14,411 22.8×
Mri w/cont, breast, bi (C8906) $1,772 $3,544 5.6×
Mri w/o fol w/cont, breast, (C8908) $2,084.50 $4,169 6.6×
Mri w/o fol w/cont, brst, un (C8905) $1,610.50 $3,221 5.1×
Njx pltlt plasma w/img harvest/preparation (0232T) $1,375.50 $2,751 3.4×
Oth resp proc, group (G0239) $81.50 $163 2.4×
Perc d-e cor revasc chro sin (C9607) $20,270.50 $40,541 1.2×
Perc d-e cor revasc t cabg s (C9604) $21,081.50 $42,163 2.0×
Perc d-e cor stent ather s (C9602) $21,081.50 $42,163 1.3×
Perc drug-el cor stent sing (C9600) $21,081.50 $42,163 2.0×
Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0629T) $13,571 $27,142 1.2×
Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T) $13,571 $27,142 1.2×
Prolonged iv inf, req pump (C8957) $378.50 $757 2.0×
Psa screening (G0103) $63.25 $126.50 3.3×
Revasc intra lithotrip-ather (C9766) $13,414.50 $26,829 0.8×
Revasc intra lithotrip-stent (C9765) $13,414.50 $26,829 0.8×
Revasc intravasc lithotripsy (C9764) $7,150.50 $14,301 0.7×
Revasc lith-sten-ath tib/per (C9775) $21,580 $43,160 1.3×
Revasc lithotr-ather tib/per (C9774) $21,580 $43,160 1.3×
Revasc lithotr-stent tib/per (C9773) $21,580 $43,160 1.3×
Revasc lithotrip tibi/perone (C9772) $13,414.50 $26,829 1.3×
Revasc lithotrip-stent-ather (C9767) $21,580 $43,160 1.3×
Therapeutic procd strg endur (G0237) $80 $160 3.1×
Tpmt Nudt15 Gene Analysis Common Variants (0034U) $302.50 $605 0.6×
Trauma respons w/hosp criti (G0390) $1,568.50 $3,137 1.3×
Trim nail(s) (G0127) $79 $158 1.5×
Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) $22,936 $45,872 2.2×
Trluml peripheral atherectomy iliac artery ea (0238T) $23,233.50 $46,467 1.4×
Unsched dialysis esrd pt hos (G0257) $1,203 $2,406 1.9×
Vasc emb/occ w/prs cath (C9797) $19,750 $39,500 1.2×