Does Lady of the Sea General Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Lady of the Sea General Hospital. In a medical emergency, call 911.

Where is Lady of the Sea General Hospital?

200 West 134th Place, Cut Off, LA 70345, in Lafourche Parish, Louisiana.

What is the phone number of Lady of the Sea General Hospital?

(985) 632-6401, as listed by Medicare (CMS).

What is the Medicare star rating of Lady of the Sea General Hospital?

CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Lady of the Sea General Hospital — Cut Off, LA

Quick answers

Does Lady of the Sea General Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Lady of the Sea General Hospital. In a medical emergency, call 911.
Where is Lady of the Sea General Hospital?: 200 West 134th Place, Cut Off, LA 70345, in Lafourche Parish, Louisiana.
What is the phone number of Lady of the Sea General Hospital?: (985) 632-6401, as listed by Medicare (CMS).
What is the Medicare star rating of Lady of the Sea General Hospital?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Treatments^[5]

Renal dialysis
Outpatient rehabilitative therapy
Home health

Procedures^[4]

Low dose CT lung cancer screening

Programs and centers^[4][5]

Inpatient medical unit
Cardiopulmonary
Laboratory
Radiology
Dining With Diabetes classes
Community pharmacy

Emergency care (hospital website)^[5]

Emergency room	Yes

Visiting and practical information

Visiting	Medical Unit open to visitors 24/7; Emergency Department allows two visitors at a time at the charge nurse's discretion^[6]
Interpreters and languages	Free interpreter services and other-language communication available; call Administration at (985) 632-6401^[6]

Doctors and clinicians (63)

63 doctors and other clinicians list Lady of the Sea General Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 39 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Ochsner St Anne General Hospital23 mi · Raceland, LA · Critical Access Hospital
Leonard J Chabert Medical Center25 mi · Houma, LA · Acute Care Hospital
West Jefferson Medical Center26 mi · Marrero, LA · Acute Care Hospital
Terrebonne General Medical Center - Parish31 mi · Houma, LA · Acute Care Hospital
St Charles Parish Hospital33 mi · Luling, LA · Acute Care Hospital

Other hospitals nearby

Houma - AMG Specialty Hospital26 mi · Houma, LA · Long-Term Acute Care Hospital
Bridgepoint Continuing Care Hospital26 mi · Marrero, LA · Long-Term Acute Care Hospital
Physicians Medical Center28 mi · Houma, LA · Acute Care Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

The Broadway Nursing and Rehabilitation Ctr17 mi · Lockport, LA · 3 of 5 stars

All nursing homes in the state →

Home health agencies

Lady of the Sea Home Health Agency5.3 mi · Cut Off, LA
Ochsner Home Health of Raceland25 mi · Raceland, LA

All home health agencies in the state →

Dialysis facilities

Lady of the Sea Dialysis Ctr5.3 mi · Cut Off, LA · 2 of 5 stars
Raceland Dialysis Ctr25 mi · Raceland, LA

All dialysis facilities in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

Jefferson Community Health Care Centers DBA InclusivCare-RFK Lafitte Medical Clinic22 mi · Lafitte, LA · Community health center
Teche Health @ Houma East23 mi · Houma, LA · Community health center
Jefferson Community Health Care Centers-Grand Isle24 mi · Grand Isle, LA · Community health center

Clinics and urgent care

Lady of the Sea Medical Clinic - Cut Off5.3 mi · Cut Off, LA · Rural health clinic
Total Urgent Care and Occupational Medicine5.3 mi · Cut Off, LA · Urgent care center
Lady of the Sea Medical Clinic - Larose9.7 mi · Larose, LA · Rural health clinic

Pharmacies

Wal-Mart Stores East LP2.7 mi · Galliano, LA · Community/retail pharmacy
Lafourche Parish Hospital Service District No. 15.3 mi · Cut Off, LA · Community/retail pharmacy
Lafourche Parish Hospital Service District No. 19.7 mi · Larose, LA · Community/retail pharmacy

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Lady of the Sea General Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	Not reported to Medicare
Overall rating of the hospital	Not reported to Medicare
Would recommend the hospital	Not reported to Medicare
Nurses communicated well	Not reported to Medicare
Doctors communicated well	Not reported to Medicare
Staff explained medicines	Not reported to Medicare
Information about recovery at home	Not reported to Medicare
Room and bathroom kept clean	Not reported to Medicare
Quiet at night	Not reported to Medicare
Rated the hospital 9 or 10 out of 10	96%National average: 72%
Would definitely recommend the hospital	88%National average: 71%
Nurses “always” communicated well	98%National average: 80%
Doctors “always” communicated well	99%National average: 80%
Staff “always” explained medicines before giving them	90%National average: 62%
Were given information about recovery at home	96%National average: 86%
Room and bathroom “always” clean	92%National average: 74%
Area around the room “always” quiet at night	88%National average: 60%
Completed surveys	46Response rate: 32%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	Not reported to Medicare

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	Not reported to Medicare
Deaths within 30 days: heart failure patients	Too few cases to report
Deaths within 30 days: pneumonia patients	Too few cases to report
Deaths within 30 days: COPD patients	Not reported to Medicare
Deaths within 30 days: stroke patients	Too few cases to report
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	Not reported to Medicare
Complications after hip or knee replacement	Not reported to Medicare

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	Not reported to Medicare
Readmitted within 30 days: heart failure	Too few cases to report
Readmitted within 30 days: pneumonia	Too few cases to report
Readmitted within 30 days: COPD	Too few cases to report
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Not reported to Medicare

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	62 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	Not reported to Medicare

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Louisiana Best hospitals in Louisiana

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 35 common services exactly as Lady of the Sea General Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED-ACUITY LEVEL III	$437.75	$437.75	$76.06 – $404.98
Emergency room visit (moderate): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $306.43 Aetna — Medicare Replacement: $183.86 Aetna Better Health — Medicaid Replacement: $306.43 Amerihealth Caritas of LA — Medicaid Replacement: $306.43 Blue Cross — Medicaid Replacement: $306.43 Blue Cross Blue Shield of LA — HMO: $348.52 Blue Cross Blue Shield of LA — PPO: $404.98 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $183.86 Cigna — Medicare Replacement: $183.86 Healthy Blue — Medicaid Replacement: $306.43
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EP-PHYS-LEVEL III-EXPANDED PROB HX-MOD	$319.30	$319.30	$76.06 – $404.98
Emergency room visit (moderate): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $223.51 Aetna — Medicare Replacement: $134.11 Aetna Better Health — Medicaid Replacement: $223.51 Amerihealth Caritas of LA — Medicaid Replacement: $223.51 Blue Cross — Medicaid Replacement: $223.51 Blue Cross Blue Shield of LA — HMO: $348.52 Blue Cross Blue Shield of LA — PPO: $404.98 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $134.11 Cigna — Medicare Replacement: $134.11 Healthy Blue — Medicaid Replacement: $223.51
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: ED-ACUITY LEVEL III (M),Separately Identifiable E&M Service on Same Day as Procedure or Other Service	$437.75	$437.75	$76.06 – $404.98
Emergency room visit (moderate): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $306.43 Aetna — Medicare Replacement: $183.86 Aetna Better Health — Medicaid Replacement: $306.43 Amerihealth Caritas of LA — Medicaid Replacement: $306.43 Blue Cross — Medicaid Replacement: $306.43 Blue Cross Blue Shield of LA — HMO: $348.52 Blue Cross Blue Shield of LA — PPO: $404.98 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $183.86 Cigna — Medicare Replacement: $183.86 Healthy Blue — Medicaid Replacement: $306.43
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED-ACUITY LEVEL IV	$746.75	$746.75	$118.75 – $704.68
Emergency room visit (moderately high): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $522.73 Aetna — Medicare Replacement: $313.64 Aetna Better Health — Medicaid Replacement: $522.73 Amerihealth Caritas of LA — Medicaid Replacement: $522.73 Blue Cross — Medicaid Replacement: $522.73 Blue Cross Blue Shield of LA — HMO: $606.45 Blue Cross Blue Shield of LA — PPO: $704.68 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $313.64 Cigna — Medicare Replacement: $313.64 Healthy Blue — Medicaid Replacement: $522.73
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EP-PHYS-LEVEL IV-DETAILED HISTORY	$607.70	$607.70	$118.75 – $704.68
Emergency room visit (moderately high): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $425.39 Aetna — Medicare Replacement: $255.23 Aetna Better Health — Medicaid Replacement: $425.39 Amerihealth Caritas of LA — Medicaid Replacement: $425.39 Blue Cross — Medicaid Replacement: $425.39 Blue Cross Blue Shield of LA — HMO: $606.45 Blue Cross Blue Shield of LA — PPO: $704.68 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $255.23 Cigna — Medicare Replacement: $255.23 Healthy Blue — Medicaid Replacement: $425.39
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: ED-ACUITY LEVEL IV M,Separately Identifiable E&M Service on Same Day as Procedure or Other Service	$746.75	$746.75	$118.75 – $704.68
Emergency room visit (moderately high): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $522.73 Aetna — Medicare Replacement: $313.64 Aetna Better Health — Medicaid Replacement: $522.73 Amerihealth Caritas of LA — Medicaid Replacement: $522.73 Blue Cross — Medicaid Replacement: $522.73 Blue Cross Blue Shield of LA — HMO: $606.45 Blue Cross Blue Shield of LA — PPO: $704.68 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $313.64 Cigna — Medicare Replacement: $313.64 Healthy Blue — Medicaid Replacement: $522.73
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED-ACUITY LEVEL V	$875.50	$875.50	$186.15 – $704.68
Emergency room visit (high): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $612.85 Aetna — Medicare Replacement: $367.71 Aetna Better Health — Medicaid Replacement: $612.85 Amerihealth Caritas of LA — Medicaid Replacement: $612.85 Blue Cross — Medicaid Replacement: $612.85 Blue Cross Blue Shield of LA — HMO: $606.45 Blue Cross Blue Shield of LA — PPO: $704.68 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $367.71 Cigna — Medicare Replacement: $367.71 Healthy Blue — Medicaid Replacement: $612.85
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EP-PHYS-LEVEL V-COMPREHENSIVE HISTORY	$896.10	$896.10	$186.15 – $704.68
Emergency room visit (high): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $627.27 Aetna — Medicare Replacement: $376.36 Aetna Better Health — Medicaid Replacement: $627.27 Amerihealth Caritas of LA — Medicaid Replacement: $627.27 Blue Cross — Medicaid Replacement: $627.27 Blue Cross Blue Shield of LA — HMO: $606.45 Blue Cross Blue Shield of LA — PPO: $704.68 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $376.36 Cigna — Medicare Replacement: $376.36 Healthy Blue — Medicaid Replacement: $627.27
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: ED-ACUITY LEVEL V (M),Separately Identifiable E&M Service on Same Day as Procedure or Other Service	$875.50	$875.50	$186.15 – $704.68
Emergency room visit (high): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $612.85 Aetna — Medicare Replacement: $367.71 Aetna Better Health — Medicaid Replacement: $612.85 Amerihealth Caritas of LA — Medicaid Replacement: $612.85 Blue Cross — Medicaid Replacement: $612.85 Blue Cross Blue Shield of LA — HMO: $606.45 Blue Cross Blue Shield of LA — PPO: $704.68 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $367.71 Cigna — Medicare Replacement: $367.71 Healthy Blue — Medicaid Replacement: $612.85

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: BASIC METABOLIC PANEL	$231.75	$231.75	$4.97 – $162.23
Basic metabolic panel (blood test): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $162.23 Aetna — Medicare Replacement: $97.34 Aetna Better Health — Medicaid Replacement: $8.46 Amerihealth Caritas of LA — Medicaid Replacement: $8.46 Blue Cross — Medicaid Replacement: $8.46 Blue Cross Blue Shield of LA — HMO: $16.90 Blue Cross Blue Shield of LA — PPO: $19.64 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $97.34 Cigna — Medicare Replacement: $97.34 Healthy Blue — Medicaid Replacement: $8.46
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: BASIC METABOLIC PANEL DAILY	$231.75	$231.75	$4.97 – $162.23
Basic metabolic panel (blood test): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $162.23 Aetna — Medicare Replacement: $97.34 Aetna Better Health — Medicaid Replacement: $8.46 Amerihealth Caritas of LA — Medicaid Replacement: $8.46 Blue Cross — Medicaid Replacement: $8.46 Blue Cross Blue Shield of LA — HMO: $16.90 Blue Cross Blue Shield of LA — PPO: $19.64 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $97.34 Cigna — Medicare Replacement: $97.34 Healthy Blue — Medicaid Replacement: $8.46
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: BASIC METABOLIC PANEL ER	$231.75	$231.75	$4.97 – $162.23
Basic metabolic panel (blood test): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $162.23 Aetna — Medicare Replacement: $97.34 Aetna Better Health — Medicaid Replacement: $8.46 Amerihealth Caritas of LA — Medicaid Replacement: $8.46 Blue Cross — Medicaid Replacement: $8.46 Blue Cross Blue Shield of LA — HMO: $16.90 Blue Cross Blue Shield of LA — PPO: $19.64 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $97.34 Cigna — Medicare Replacement: $97.34 Healthy Blue — Medicaid Replacement: $8.46
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL	$309	$309	$6.20 – $216.30
Comprehensive metabolic panel (blood test): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $216.30 Aetna — Medicare Replacement: $129.78 Aetna Better Health — Medicaid Replacement: $10.56 Amerihealth Caritas of LA — Medicaid Replacement: $10.56 Blue Cross — Medicaid Replacement: $10.56 Blue Cross Blue Shield of LA — HMO: $18.42 Blue Cross Blue Shield of LA — PPO: $21.40 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $129.78 Cigna — Medicare Replacement: $129.78 Healthy Blue — Medicaid Replacement: $10.56
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL DAILY	$309	$309	$6.20 – $216.30
Comprehensive metabolic panel (blood test): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $216.30 Aetna — Medicare Replacement: $129.78 Aetna Better Health — Medicaid Replacement: $10.56 Amerihealth Caritas of LA — Medicaid Replacement: $10.56 Blue Cross — Medicaid Replacement: $10.56 Blue Cross Blue Shield of LA — HMO: $18.42 Blue Cross Blue Shield of LA — PPO: $21.40 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $129.78 Cigna — Medicare Replacement: $129.78 Healthy Blue — Medicaid Replacement: $10.56
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Hospital (facility) fee In the file: LIPID PROFILE	$180.25	$180.25	$7.01 – $126.18
Cholesterol panel (lipid panel): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $126.18 Aetna — Medicare Replacement: $75.71 Aetna Better Health — Medicaid Replacement: $13.39 Amerihealth Caritas of LA — Medicaid Replacement: $13.39 Blue Cross — Medicaid Replacement: $13.39 Blue Cross Blue Shield of LA — HMO: $18.76 Blue Cross Blue Shield of LA — PPO: $21.80 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $75.71 Cigna — Medicare Replacement: $75.71 Healthy Blue — Medicaid Replacement: $13.39
Kidney function panel CPT 80069 · Inpatient or outpatient · Hospital (facility) fee In the file: RENAL PROFILE	$180.25	$180.25	$5.09 – $126.18
Kidney function panel: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $126.18 Aetna — Medicare Replacement: $75.71 Aetna Better Health — Medicaid Replacement: $8.68 Amerihealth Caritas of LA — Medicaid Replacement: $8.68 Blue Cross — Medicaid Replacement: $8.68 Blue Cross Blue Shield of LA — HMO: $16.10 Blue Cross Blue Shield of LA — PPO: $18.71 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $75.71 Cigna — Medicare Replacement: $75.71 Healthy Blue — Medicaid Replacement: $8.68
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: LIVER FUNCTION PROFILE	$180.25	$180.25	$4.80 – $126.18
Liver function panel: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $126.18 Aetna — Medicare Replacement: $75.71 Aetna Better Health — Medicaid Replacement: $8.17 Amerihealth Caritas of LA — Medicaid Replacement: $8.17 Blue Cross — Medicaid Replacement: $8.17 Blue Cross Blue Shield of LA — HMO: $11.73 Blue Cross Blue Shield of LA — PPO: $13.63 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $75.71 Cigna — Medicare Replacement: $75.71 Healthy Blue — Medicaid Replacement: $8.17
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: LIVER PANEL PICCOLO	$180.25	$180.25	$4.80 – $126.18
Liver function panel: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $126.18 Aetna — Medicare Replacement: $75.71 Aetna Better Health — Medicaid Replacement: $8.17 Amerihealth Caritas of LA — Medicaid Replacement: $8.17 Blue Cross — Medicaid Replacement: $8.17 Blue Cross Blue Shield of LA — HMO: $11.73 Blue Cross Blue Shield of LA — PPO: $13.63 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $75.71 Cigna — Medicare Replacement: $75.71 Healthy Blue — Medicaid Replacement: $8.17
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: .HEPATIC FUNCTION PROFILE DAILY	$180.25	$180.25	$4.80 – $126.18
Liver function panel: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $126.18 Aetna — Medicare Replacement: $75.71 Aetna Better Health — Medicaid Replacement: $8.17 Amerihealth Caritas of LA — Medicaid Replacement: $8.17 Blue Cross — Medicaid Replacement: $8.17 Blue Cross Blue Shield of LA — HMO: $11.73 Blue Cross Blue Shield of LA — PPO: $13.63 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $75.71 Cigna — Medicare Replacement: $75.71 Healthy Blue — Medicaid Replacement: $8.17
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: URINALYSIS W REFLEX TO CULTURE	$62.83	$62.83	$2.66 – $43.98
Urine test (automated, with microscope): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $43.98 Aetna — Medicare Replacement: $26.39 Aetna Better Health — Medicaid Replacement: $3.17 Amerihealth Caritas of LA — Medicaid Replacement: $3.17 Blue Cross — Medicaid Replacement: $3.17 Blue Cross Blue Shield of LA — HMO: $4.42 Blue Cross Blue Shield of LA — PPO: $5.13 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $26.39 Cigna — Medicare Replacement: $26.39 Healthy Blue — Medicaid Replacement: $3.17
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: URINALYSIS W REFLEX TO MICROSCOPIC	$62.83	$62.83	$2.66 – $43.98
Urine test (automated, with microscope): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $43.98 Aetna — Medicare Replacement: $26.39 Aetna Better Health — Medicaid Replacement: $3.17 Amerihealth Caritas of LA — Medicaid Replacement: $3.17 Blue Cross — Medicaid Replacement: $3.17 Blue Cross Blue Shield of LA — HMO: $4.42 Blue Cross Blue Shield of LA — PPO: $5.13 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $26.39 Cigna — Medicare Replacement: $26.39 Healthy Blue — Medicaid Replacement: $3.17
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: .CLINIC UA DIPSTICK AUTO W MICRO	$51.50	$51.50	$2.66 – $43.98
Urine test (automated, with microscope): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $36.05 Aetna — Medicare Replacement: $21.63 Aetna Better Health — Medicaid Replacement: $3.17 Amerihealth Caritas of LA — Medicaid Replacement: $3.17 Blue Cross — Medicaid Replacement: $3.17 Blue Cross Blue Shield of LA — HMO: $4.42 Blue Cross Blue Shield of LA — PPO: $5.13 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $21.63 Cigna — Medicare Replacement: $21.63 Healthy Blue — Medicaid Replacement: $3.17
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Hospital (facility) fee In the file: .CLINIC UA DIPSTICK NONAUTO WO MICRO	$36.05	$36.05	$2.14 – $27.40
Urine test (manual, without microscope): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $25.24 Aetna — Medicare Replacement: $15.14 Aetna Better Health — Medicaid Replacement: $3.48 Amerihealth Caritas of LA — Medicaid Replacement: $3.48 Blue Cross — Medicaid Replacement: $3.48 Blue Cross Blue Shield of LA — HMO: $3.12 Blue Cross Blue Shield of LA — PPO: $3.63 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $15.14 Cigna — Medicare Replacement: $15.14 Healthy Blue — Medicaid Replacement: $3.48
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Hospital (facility) fee In the file: .CLINITEST	$39.14	$39.14	$2.14 – $27.40
Urine test (manual, without microscope): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $27.40 Aetna — Medicare Replacement: $16.44 Aetna Better Health — Medicaid Replacement: $3.48 Amerihealth Caritas of LA — Medicaid Replacement: $3.48 Blue Cross — Medicaid Replacement: $3.48 Blue Cross Blue Shield of LA — HMO: $3.12 Blue Cross Blue Shield of LA — PPO: $3.63 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $16.44 Cigna — Medicare Replacement: $16.44 Healthy Blue — Medicaid Replacement: $3.48
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Hospital (facility) fee In the file: .HEMASTIX URINE	$39.14	$39.14	$2.14 – $27.40
Urine test (manual, without microscope): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $27.40 Aetna — Medicare Replacement: $16.44 Aetna Better Health — Medicaid Replacement: $3.48 Amerihealth Caritas of LA — Medicaid Replacement: $3.48 Blue Cross — Medicaid Replacement: $3.48 Blue Cross Blue Shield of LA — HMO: $3.12 Blue Cross Blue Shield of LA — PPO: $3.63 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $16.44 Cigna — Medicare Replacement: $16.44 Healthy Blue — Medicaid Replacement: $3.48
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Hospital (facility) fee In the file: URINALYSIS MICROSCOPIC ONLY	$36.05	$36.05	$1.88 – $25.24
Urine test (automated, without microscope): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $25.24 Aetna — Medicare Replacement: $15.14 Aetna Better Health — Medicaid Replacement: $2.25 Amerihealth Caritas of LA — Medicaid Replacement: $2.25 Blue Cross — Medicaid Replacement: $2.25 Blue Cross Blue Shield of LA — HMO: $3.66 Blue Cross Blue Shield of LA — PPO: $4.26 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $15.14 Cigna — Medicare Replacement: $15.14 Healthy Blue — Medicaid Replacement: $2.25
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Hospital (facility) fee In the file: URINALYSIS W REFLEX TO MICROSCOPIC	$36.05	$36.05	$1.88 – $25.24
Urine test (automated, without microscope): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $25.24 Aetna — Medicare Replacement: $15.14 Aetna Better Health — Medicaid Replacement: $2.25 Amerihealth Caritas of LA — Medicaid Replacement: $2.25 Blue Cross — Medicaid Replacement: $2.25 Blue Cross Blue Shield of LA — HMO: $3.66 Blue Cross Blue Shield of LA — PPO: $4.26 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $15.14 Cigna — Medicare Replacement: $15.14 Healthy Blue — Medicaid Replacement: $2.25
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: PSA	$217.33	$217.33	$10.79 – $152.13
PSA (prostate specific antigen) blood test: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $152.13 Aetna — Medicare Replacement: $91.28 Aetna Better Health — Medicaid Replacement: $18.39 Amerihealth Caritas of LA — Medicaid Replacement: $18.39 Blue Cross — Medicaid Replacement: $18.39 Blue Cross Blue Shield of LA — HMO: $29.92 Blue Cross Blue Shield of LA — PPO: $34.77 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $91.28 Cigna — Medicare Replacement: $91.28 Healthy Blue — Medicaid Replacement: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: PSA SCREEN	$217.33	$217.33	$10.79 – $152.13
PSA (prostate specific antigen) blood test: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $152.13 Aetna — Medicare Replacement: $91.28 Aetna Better Health — Medicaid Replacement: $18.39 Amerihealth Caritas of LA — Medicaid Replacement: $18.39 Blue Cross — Medicaid Replacement: $18.39 Blue Cross Blue Shield of LA — HMO: $29.92 Blue Cross Blue Shield of LA — PPO: $34.77 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $91.28 Cigna — Medicare Replacement: $91.28 Healthy Blue — Medicaid Replacement: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: PSA TOTAL LC	$217.33	$217.33	$10.79 – $152.13
PSA (prostate specific antigen) blood test: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $152.13 Aetna — Medicare Replacement: $91.28 Aetna Better Health — Medicaid Replacement: $18.39 Amerihealth Caritas of LA — Medicaid Replacement: $18.39 Blue Cross — Medicaid Replacement: $18.39 Blue Cross Blue Shield of LA — HMO: $29.92 Blue Cross Blue Shield of LA — PPO: $34.77 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $91.28 Cigna — Medicare Replacement: $91.28 Healthy Blue — Medicaid Replacement: $18.39
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: THYROID CASCADE	$187.46	$187.46	$9.86 – $131.22
Thyroid stimulating hormone (TSH) test: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $131.22 Aetna — Medicare Replacement: $78.73 Aetna Better Health — Medicaid Replacement: $16.80 Amerihealth Caritas of LA — Medicaid Replacement: $16.80 Blue Cross — Medicaid Replacement: $16.80 Blue Cross Blue Shield of LA — HMO: $31.10 Blue Cross Blue Shield of LA — PPO: $36.14 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $78.73 Cigna — Medicare Replacement: $78.73 Healthy Blue — Medicaid Replacement: $16.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: THYROID STIMULATING HORMONE	$187.46	$187.46	$9.86 – $131.22
Thyroid stimulating hormone (TSH) test: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $131.22 Aetna — Medicare Replacement: $78.73 Aetna Better Health — Medicaid Replacement: $16.80 Amerihealth Caritas of LA — Medicaid Replacement: $16.80 Blue Cross — Medicaid Replacement: $16.80 Blue Cross Blue Shield of LA — HMO: $31.10 Blue Cross Blue Shield of LA — PPO: $36.14 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $78.73 Cigna — Medicare Replacement: $78.73 Healthy Blue — Medicaid Replacement: $16.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: TSH W REFLEX TO FT4	$187.46	$187.46	$9.86 – $131.22
Thyroid stimulating hormone (TSH) test: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $131.22 Aetna — Medicare Replacement: $78.73 Aetna Better Health — Medicaid Replacement: $16.80 Amerihealth Caritas of LA — Medicaid Replacement: $16.80 Blue Cross — Medicaid Replacement: $16.80 Blue Cross Blue Shield of LA — HMO: $31.10 Blue Cross Blue Shield of LA — PPO: $36.14 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $78.73 Cigna — Medicare Replacement: $78.73 Healthy Blue — Medicaid Replacement: $16.80
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: CBC DAILY	$103	$103	$3.80 – $72.10
Complete blood count (CBC), automated: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $72.10 Aetna — Medicare Replacement: $43.26 Aetna Better Health — Medicaid Replacement: $6.47 Amerihealth Caritas of LA — Medicaid Replacement: $6.47 Blue Cross — Medicaid Replacement: $6.47 Blue Cross Blue Shield of LA — HMO: $10.54 Blue Cross Blue Shield of LA — PPO: $12.24 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $43.26 Cigna — Medicare Replacement: $43.26 Healthy Blue — Medicaid Replacement: $6.47
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: COMPLETE BLOOD COUNT	$103	$103	$3.80 – $72.10
Complete blood count (CBC), automated: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $72.10 Aetna — Medicare Replacement: $43.26 Aetna Better Health — Medicaid Replacement: $6.47 Amerihealth Caritas of LA — Medicaid Replacement: $6.47 Blue Cross — Medicaid Replacement: $6.47 Blue Cross Blue Shield of LA — HMO: $10.54 Blue Cross Blue Shield of LA — PPO: $12.24 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $43.26 Cigna — Medicare Replacement: $43.26 Healthy Blue — Medicaid Replacement: $6.47
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: COMPLETE BLOOD COUNT ER	$103	$103	$3.80 – $72.10
Complete blood count (CBC), automated: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $72.10 Aetna — Medicare Replacement: $43.26 Aetna Better Health — Medicaid Replacement: $6.47 Amerihealth Caritas of LA — Medicaid Replacement: $6.47 Blue Cross — Medicaid Replacement: $6.47 Blue Cross Blue Shield of LA — HMO: $10.54 Blue Cross Blue Shield of LA — PPO: $12.24 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $43.26 Cigna — Medicare Replacement: $43.26 Healthy Blue — Medicaid Replacement: $6.47
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: PROTIME / INR ER	$77.25	$77.25	$3.29 – $54.08
Blood clotting time test (prothrombin time, PT): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $54.08 Aetna — Medicare Replacement: $32.45 Aetna Better Health — Medicaid Replacement: $4.29 Amerihealth Caritas of LA — Medicaid Replacement: $4.29 Blue Cross — Medicaid Replacement: $4.29 Blue Cross Blue Shield of LA — HMO: $6.39 Blue Cross Blue Shield of LA — PPO: $7.43 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $32.45 Cigna — Medicare Replacement: $32.45 Healthy Blue — Medicaid Replacement: $4.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: PT & INR	$77.25	$77.25	$3.29 – $54.08
Blood clotting time test (prothrombin time, PT): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $54.08 Aetna — Medicare Replacement: $32.45 Aetna Better Health — Medicaid Replacement: $4.29 Amerihealth Caritas of LA — Medicaid Replacement: $4.29 Blue Cross — Medicaid Replacement: $4.29 Blue Cross Blue Shield of LA — HMO: $6.39 Blue Cross Blue Shield of LA — PPO: $7.43 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $32.45 Cigna — Medicare Replacement: $32.45 Healthy Blue — Medicaid Replacement: $4.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: PT DAILY	$77.25	$77.25	$3.29 – $54.08
Blood clotting time test (prothrombin time, PT): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $54.08 Aetna — Medicare Replacement: $32.45 Aetna Better Health — Medicaid Replacement: $4.29 Amerihealth Caritas of LA — Medicaid Replacement: $4.29 Blue Cross — Medicaid Replacement: $4.29 Blue Cross Blue Shield of LA — HMO: $6.39 Blue Cross Blue Shield of LA — PPO: $7.43 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $32.45 Cigna — Medicare Replacement: $32.45 Healthy Blue — Medicaid Replacement: $4.29
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: APTT ER	$82.40	$82.40	$3.52 – $77.87
Blood clotting test (partial thromboplastin time, PTT): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $57.68 Aetna — Medicare Replacement: $34.61 Aetna Better Health — Medicaid Replacement: $6.01 Amerihealth Caritas of LA — Medicaid Replacement: $6.01 Blue Cross — Medicaid Replacement: $6.01 Blue Cross Blue Shield of LA — HMO: $10.25 Blue Cross Blue Shield of LA — PPO: $11.91 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $34.61 Cigna — Medicare Replacement: $34.61 Healthy Blue — Medicaid Replacement: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: PTT ACTIVATED	$82.40	$82.40	$3.52 – $77.87
Blood clotting test (partial thromboplastin time, PTT): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $57.68 Aetna — Medicare Replacement: $34.61 Aetna Better Health — Medicaid Replacement: $6.01 Amerihealth Caritas of LA — Medicaid Replacement: $6.01 Blue Cross — Medicaid Replacement: $6.01 Blue Cross Blue Shield of LA — HMO: $10.25 Blue Cross Blue Shield of LA — PPO: $11.91 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $34.61 Cigna — Medicare Replacement: $34.61 Healthy Blue — Medicaid Replacement: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: PTT DAILY	$82.40	$82.40	$3.52 – $77.87
Blood clotting test (partial thromboplastin time, PTT): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $57.68 Aetna — Medicare Replacement: $34.61 Aetna Better Health — Medicaid Replacement: $6.01 Amerihealth Caritas of LA — Medicaid Replacement: $6.01 Blue Cross — Medicaid Replacement: $6.01 Blue Cross Blue Shield of LA — HMO: $10.25 Blue Cross Blue Shield of LA — PPO: $11.91 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $34.61 Cigna — Medicare Replacement: $34.61 Healthy Blue — Medicaid Replacement: $6.01

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Hospital (facility) fee In the file: CT HEAD WO CONTRAST	$1,442	$1,442	$37.46 – $1,009.40
CT scan of the head or brain, without contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $1,009.40 Aetna — Medicare Replacement: $605.64 Aetna Better Health — Medicaid Replacement: $1,009.40 Amerihealth Caritas of LA — Medicaid Replacement: $1,009.40 Blue Cross — Medicaid Replacement: $1,009.40 Blue Cross Blue Shield of LA — HMO: $258.88 Blue Cross Blue Shield of LA — PPO: $300.81 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $605.64 Cigna — Medicare Replacement: $605.64 Healthy Blue — Medicaid Replacement: $1,009.40
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR CT HEAD WO CONTRAST,Professional Component	$211.15	$211.15	$37.46 – $1,009.40
CT scan of the head or brain, without contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $147.81 Aetna — Medicare Replacement: $88.68 Aetna Better Health — Medicaid Replacement: $147.81 Amerihealth Caritas of LA — Medicaid Replacement: $147.81 Blue Cross — Medicaid Replacement: $147.81 Blue Cross Blue Shield of LA — HMO: $258.88 Blue Cross Blue Shield of LA — PPO: $300.81 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $88.68 Cigna — Medicare Replacement: $88.68 Healthy Blue — Medicaid Replacement: $147.81
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Hospital (facility) fee In the file: MRI BRAIN W AND WO CONTRAST	$2,584.27	$2,584.27	$103.65 – $1,808.99
MRI of the brain, before and after contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $1,808.99 Aetna — Medicare Replacement: $1,085.39 Aetna Better Health — Medicaid Replacement: $1,808.99 Amerihealth Caritas of LA — Medicaid Replacement: $1,808.99 Blue Cross — Medicaid Replacement: $1,808.99 Blue Cross Blue Shield of LA — HMO: $927.43 Blue Cross Blue Shield of LA — PPO: $1,077.65 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $1,085.39 Cigna — Medicare Replacement: $1,085.39 Healthy Blue — Medicaid Replacement: $1,808.99
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR MRI BRAIN W AND WO CONTRAST,Professional Component	$507.79	$507.79	$103.65 – $1,808.99
MRI of the brain, before and after contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $355.45 Aetna — Medicare Replacement: $213.27 Aetna Better Health — Medicaid Replacement: $355.45 Amerihealth Caritas of LA — Medicaid Replacement: $355.45 Blue Cross — Medicaid Replacement: $355.45 Blue Cross Blue Shield of LA — HMO: $927.43 Blue Cross Blue Shield of LA — PPO: $1,077.65 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $213.27 Cigna — Medicare Replacement: $213.27 Healthy Blue — Medicaid Replacement: $355.45
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Hospital (facility) fee In the file: CHEST 2 VIEWS	$166.86	$166.86	$9.91 – $216.73
Chest X-ray, 2 views: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $116.80 Aetna — Medicare Replacement: $70.08 Aetna Better Health — Medicaid Replacement: $116.80 Amerihealth Caritas of LA — Medicaid Replacement: $116.80 Blue Cross — Medicaid Replacement: $116.80 Blue Cross Blue Shield of LA — HMO: $33.11 Blue Cross Blue Shield of LA — PPO: $38.48 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $70.08 Cigna — Medicare Replacement: $70.08 Healthy Blue — Medicaid Replacement: $116.80
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Hospital (facility) fee In the file: CHEST DECUBITUS 2 VIEW	$166.86	$166.86	$9.91 – $216.73
Chest X-ray, 2 views: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $116.80 Aetna — Medicare Replacement: $70.08 Aetna Better Health — Medicaid Replacement: $116.80 Amerihealth Caritas of LA — Medicaid Replacement: $116.80 Blue Cross — Medicaid Replacement: $116.80 Blue Cross Blue Shield of LA — HMO: $33.11 Blue Cross Blue Shield of LA — PPO: $38.48 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $70.08 Cigna — Medicare Replacement: $70.08 Healthy Blue — Medicaid Replacement: $116.80
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Hospital (facility) fee In the file: CHEST OBLIQUES ONLY 2 VIEWS	$166.86	$166.86	$9.91 – $216.73
Chest X-ray, 2 views: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $116.80 Aetna — Medicare Replacement: $70.08 Aetna Better Health — Medicaid Replacement: $116.80 Amerihealth Caritas of LA — Medicaid Replacement: $116.80 Blue Cross — Medicaid Replacement: $116.80 Blue Cross Blue Shield of LA — HMO: $33.11 Blue Cross Blue Shield of LA — PPO: $38.48 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $70.08 Cigna — Medicare Replacement: $70.08 Healthy Blue — Medicaid Replacement: $116.80
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Hospital (facility) fee In the file: L SPINE MINIMUM 4 VIEWS	$268.83	$268.83	$13.42 – $188.18
X-ray of the lower spine, at least 4 views: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $188.18 Aetna — Medicare Replacement: $112.91 Aetna Better Health — Medicaid Replacement: $188.18 Amerihealth Caritas of LA — Medicaid Replacement: $188.18 Blue Cross — Medicaid Replacement: $188.18 Blue Cross Blue Shield of LA — HMO: $62.51 Blue Cross Blue Shield of LA — PPO: $72.63 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $112.91 Cigna — Medicare Replacement: $112.91 Healthy Blue — Medicaid Replacement: $188.18
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR L SPINE MIN 4 VIEWS,Professional Component	$66.95	$66.95	$13.42 – $188.18
X-ray of the lower spine, at least 4 views: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $46.87 Aetna — Medicare Replacement: $28.12 Aetna Better Health — Medicaid Replacement: $46.87 Amerihealth Caritas of LA — Medicaid Replacement: $46.87 Blue Cross — Medicaid Replacement: $46.87 Blue Cross Blue Shield of LA — HMO: $62.51 Blue Cross Blue Shield of LA — PPO: $72.63 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $28.12 Cigna — Medicare Replacement: $28.12 Healthy Blue — Medicaid Replacement: $46.87
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Hospital (facility) fee In the file: MRI L SPINE WO CONTRAST	$1,755.12	$1,755.12	$65.31 – $1,228.58
MRI of the lower back (lumbar spine), without contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $1,228.58 Aetna — Medicare Replacement: $737.15 Aetna Better Health — Medicaid Replacement: $1,228.58 Amerihealth Caritas of LA — Medicaid Replacement: $1,228.58 Blue Cross — Medicaid Replacement: $1,228.58 Blue Cross Blue Shield of LA — HMO: $605.35 Blue Cross Blue Shield of LA — PPO: $703.40 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $737.15 Cigna — Medicare Replacement: $737.15 Healthy Blue — Medicaid Replacement: $1,228.58
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR MRI L SPINE WO CONTRAST,Professional Component	$320.33	$320.33	$65.31 – $1,228.58
MRI of the lower back (lumbar spine), without contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $224.23 Aetna — Medicare Replacement: $134.54 Aetna Better Health — Medicaid Replacement: $224.23 Amerihealth Caritas of LA — Medicaid Replacement: $224.23 Blue Cross — Medicaid Replacement: $224.23 Blue Cross Blue Shield of LA — HMO: $605.35 Blue Cross Blue Shield of LA — PPO: $703.40 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $134.54 Cigna — Medicare Replacement: $134.54 Healthy Blue — Medicaid Replacement: $224.23
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Hospital (facility) fee In the file: CT PELVIS W CONTRAST	$1,957	$1,957	$50.87 – $1,369.90
CT scan of the pelvis, with contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $1,369.90 Aetna — Medicare Replacement: $821.94 Aetna Better Health — Medicaid Replacement: $1,369.90 Amerihealth Caritas of LA — Medicaid Replacement: $1,369.90 Blue Cross — Medicaid Replacement: $1,369.90 Blue Cross Blue Shield of LA — HMO: $394.59 Blue Cross Blue Shield of LA — PPO: $458.50 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $821.94 Cigna — Medicare Replacement: $821.94 Healthy Blue — Medicaid Replacement: $1,369.90
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR CT PELVIS W CONTRAST,Professional Component	$266.77	$266.77	$50.87 – $1,369.90
CT scan of the pelvis, with contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $186.74 Aetna — Medicare Replacement: $112.04 Aetna Better Health — Medicaid Replacement: $186.74 Amerihealth Caritas of LA — Medicaid Replacement: $186.74 Blue Cross — Medicaid Replacement: $186.74 Blue Cross Blue Shield of LA — HMO: $394.59 Blue Cross Blue Shield of LA — PPO: $458.50 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $112.04 Cigna — Medicare Replacement: $112.04 Healthy Blue — Medicaid Replacement: $186.74
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Hospital (facility) fee In the file: MRI LOWER LT EXT JNT ANKLE WO CONTRAS	$1,985.84	$1,985.84	$59.21 – $1,390.09
MRI of a leg joint (such as the knee), without contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $1,390.09 Aetna — Medicare Replacement: $834.05 Aetna Better Health — Medicaid Replacement: $1,390.09 Amerihealth Caritas of LA — Medicaid Replacement: $1,390.09 Blue Cross — Medicaid Replacement: $1,390.09 Blue Cross Blue Shield of LA — HMO: $605.35 Blue Cross Blue Shield of LA — PPO: $703.40 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $834.05 Cigna — Medicare Replacement: $834.05 Healthy Blue — Medicaid Replacement: $1,390.09
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Hospital (facility) fee In the file: MRI LOWER LT EXT JNT HIP WO CONTRAS	$1,985.84	$1,985.84	$59.21 – $1,390.09
MRI of a leg joint (such as the knee), without contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $1,390.09 Aetna — Medicare Replacement: $834.05 Aetna Better Health — Medicaid Replacement: $1,390.09 Amerihealth Caritas of LA — Medicaid Replacement: $1,390.09 Blue Cross — Medicaid Replacement: $1,390.09 Blue Cross Blue Shield of LA — HMO: $605.35 Blue Cross Blue Shield of LA — PPO: $703.40 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $834.05 Cigna — Medicare Replacement: $834.05 Healthy Blue — Medicaid Replacement: $1,390.09
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Hospital (facility) fee In the file: MRI LOWER LT EXT JNT KNEE WO CONTRAS	$1,985.84	$1,985.84	$59.21 – $1,390.09
MRI of a leg joint (such as the knee), without contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $1,390.09 Aetna — Medicare Replacement: $834.05 Aetna Better Health — Medicaid Replacement: $1,390.09 Amerihealth Caritas of LA — Medicaid Replacement: $1,390.09 Blue Cross — Medicaid Replacement: $1,390.09 Blue Cross Blue Shield of LA — HMO: $605.35 Blue Cross Blue Shield of LA — PPO: $703.40 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $834.05 Cigna — Medicare Replacement: $834.05 Healthy Blue — Medicaid Replacement: $1,390.09
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Hospital (facility) fee In the file: CT ABD AND PELVIS W	$3,296	$3,296	$83.51 – $2,307.20
CT scan of the abdomen and pelvis, with contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $2,307.20 Aetna — Medicare Replacement: $1,384.32 Aetna Better Health — Medicaid Replacement: $2,307.20 Amerihealth Caritas of LA — Medicaid Replacement: $2,307.20 Blue Cross — Medicaid Replacement: $2,307.20 Blue Cross Blue Shield of LA — HMO: $645.67 Blue Cross Blue Shield of LA — PPO: $750.26 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $1,384.32 Cigna — Medicare Replacement: $1,384.32 Healthy Blue — Medicaid Replacement: $2,307.20
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR CT ABD AND PELVIS W,Professional Component	$541.78	$541.78	$83.51 – $2,307.20
CT scan of the abdomen and pelvis, with contrast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $379.25 Aetna — Medicare Replacement: $227.55 Aetna Better Health — Medicaid Replacement: $379.25 Amerihealth Caritas of LA — Medicaid Replacement: $379.25 Blue Cross — Medicaid Replacement: $379.25 Blue Cross Blue Shield of LA — HMO: $645.67 Blue Cross Blue Shield of LA — PPO: $750.26 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $227.55 Cigna — Medicare Replacement: $227.55 Healthy Blue — Medicaid Replacement: $379.25
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Hospital (facility) fee In the file: US ABDOMEN COMPLETE	$540.75	$540.75	$35.86 – $378.53
Ultrasound of the abdomen, complete: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $378.53 Aetna — Medicare Replacement: $227.12 Aetna Better Health — Medicaid Replacement: $378.53 Amerihealth Caritas of LA — Medicaid Replacement: $378.53 Blue Cross — Medicaid Replacement: $378.53 Blue Cross Blue Shield of LA — HMO: $158.81 Blue Cross Blue Shield of LA — PPO: $184.54 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $227.12 Cigna — Medicare Replacement: $227.12 Healthy Blue — Medicaid Replacement: $378.53
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR US ABDOMEN COMPLETE,Professional Component	$166.86	$166.86	$35.86 – $378.53
Ultrasound of the abdomen, complete: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $116.80 Aetna — Medicare Replacement: $70.08 Aetna Better Health — Medicaid Replacement: $116.80 Amerihealth Caritas of LA — Medicaid Replacement: $116.80 Blue Cross — Medicaid Replacement: $116.80 Blue Cross Blue Shield of LA — HMO: $158.81 Blue Cross Blue Shield of LA — PPO: $184.54 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $70.08 Cigna — Medicare Replacement: $70.08 Healthy Blue — Medicaid Replacement: $116.80
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Hospital (facility) fee In the file: US OB >1ST TRI SGL OR 1ST GEST	$566.50	$566.50	$43.79 – $396.55
Pregnancy ultrasound (after the first trimester): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $396.55 Aetna — Medicare Replacement: $237.93 Aetna Better Health — Medicaid Replacement: $396.55 Amerihealth Caritas of LA — Medicaid Replacement: $396.55 Blue Cross — Medicaid Replacement: $396.55 Blue Cross Blue Shield of LA — HMO: $159.44 Blue Cross Blue Shield of LA — PPO: $185.26 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $237.93 Cigna — Medicare Replacement: $237.93 Healthy Blue — Medicaid Replacement: $396.55
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR US OB>1ST TRI SGL OR 1ST GEST,Professional Component	$174.07	$174.07	$43.79 – $396.55
Pregnancy ultrasound (after the first trimester): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $121.85 Aetna — Medicare Replacement: $73.11 Aetna Better Health — Medicaid Replacement: $121.85 Amerihealth Caritas of LA — Medicaid Replacement: $121.85 Blue Cross — Medicaid Replacement: $121.85 Blue Cross Blue Shield of LA — HMO: $159.44 Blue Cross Blue Shield of LA — PPO: $185.26 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $73.11 Cigna — Medicare Replacement: $73.11 Healthy Blue — Medicaid Replacement: $121.85
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Hospital (facility) fee In the file: US PELVIC TRANSVAGINAL	$618	$618	$30.40 – $432.60
Transvaginal ultrasound: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $432.60 Aetna — Medicare Replacement: $259.56 Aetna Better Health — Medicaid Replacement: $432.60 Amerihealth Caritas of LA — Medicaid Replacement: $432.60 Blue Cross — Medicaid Replacement: $432.60 Blue Cross Blue Shield of LA — HMO: $142.57 Blue Cross Blue Shield of LA — PPO: $165.66 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $259.56 Cigna — Medicare Replacement: $259.56 Healthy Blue — Medicaid Replacement: $432.60
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR US PELVIC TRANSVAGINAL,Professional Component	$147.29	$147.29	$30.40 – $432.60
Transvaginal ultrasound: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $103.10 Aetna — Medicare Replacement: $61.86 Aetna Better Health — Medicaid Replacement: $103.10 Amerihealth Caritas of LA — Medicaid Replacement: $103.10 Blue Cross — Medicaid Replacement: $103.10 Blue Cross Blue Shield of LA — HMO: $142.57 Blue Cross Blue Shield of LA — PPO: $165.66 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $61.86 Cigna — Medicare Replacement: $61.86 Healthy Blue — Medicaid Replacement: $103.10
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR MAMMOGRAM UNILATERAL LT,Professional Component	$83.43	$83.43	$35.04 – $162.23
Diagnostic mammogram, one breast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $58.40 Aetna — Medicare Replacement: $35.04 Aetna Better Health — Medicaid Replacement: $58.40 Amerihealth Caritas of LA — Medicaid Replacement: $58.40 Blue Cross — Medicaid Replacement: $58.40 Blue Cross Blue Shield of LA — HMO: $95.62 Blue Cross Blue Shield of LA — PPO: $111.11 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $35.04 Cigna — Medicare Replacement: $35.04 Healthy Blue — Medicaid Replacement: $58.40
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR MAMMOGRAM UNILATERAL RT,Professional Component	$83.43	$83.43	$35.04 – $162.23
Diagnostic mammogram, one breast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $58.40 Aetna — Medicare Replacement: $35.04 Aetna Better Health — Medicaid Replacement: $58.40 Amerihealth Caritas of LA — Medicaid Replacement: $58.40 Blue Cross — Medicaid Replacement: $58.40 Blue Cross Blue Shield of LA — HMO: $95.62 Blue Cross Blue Shield of LA — PPO: $111.11 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $35.04 Cigna — Medicare Replacement: $35.04 Healthy Blue — Medicaid Replacement: $58.40
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Hospital (facility) fee · modifier LT In the file: MAMMO 3D UNILATERAL LEFT DX W ICAD,Left Side	$231.75	$231.75	$35.04 – $162.23
Diagnostic mammogram, one breast: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $162.23 Aetna — Medicare Replacement: $97.34 Aetna Better Health — Medicaid Replacement: $162.23 Amerihealth Caritas of LA — Medicaid Replacement: $162.23 Blue Cross — Medicaid Replacement: $162.23 Blue Cross Blue Shield of LA — HMO: $95.62 Blue Cross Blue Shield of LA — PPO: $111.11 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $97.34 Cigna — Medicare Replacement: $97.34 Healthy Blue — Medicaid Replacement: $162.23
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Hospital (facility) fee In the file: MAMMO 3D BILATERAL DX W ICAD	$437.75	$437.75	$44.28 – $306.43
Diagnostic mammogram, both breasts: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $306.43 Aetna — Medicare Replacement: $183.86 Aetna Better Health — Medicaid Replacement: $306.43 Amerihealth Caritas of LA — Medicaid Replacement: $306.43 Blue Cross — Medicaid Replacement: $306.43 Blue Cross Blue Shield of LA — HMO: $120.02 Blue Cross Blue Shield of LA — PPO: $139.46 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $183.86 Cigna — Medicare Replacement: $183.86 Healthy Blue — Medicaid Replacement: $306.43
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR MAMMOGRAM BILATERAL,Professional Component	$106.09	$106.09	$44.28 – $306.43
Diagnostic mammogram, both breasts: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $74.26 Aetna — Medicare Replacement: $44.56 Aetna Better Health — Medicaid Replacement: $74.26 Amerihealth Caritas of LA — Medicaid Replacement: $74.26 Blue Cross — Medicaid Replacement: $74.26 Blue Cross Blue Shield of LA — HMO: $120.02 Blue Cross Blue Shield of LA — PPO: $139.46 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $44.56 Cigna — Medicare Replacement: $44.56 Healthy Blue — Medicaid Replacement: $74.26
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Hospital (facility) fee In the file: MAMMO 3D BILATERAL SCREENING W ICAD	$412	$412	$33.64 – $288.40
Screening mammogram, both breasts: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $288.40 Aetna — Medicare Replacement: $173.04 Aetna Better Health — Medicaid Replacement: $288.40 Amerihealth Caritas of LA — Medicaid Replacement: $288.40 Blue Cross — Medicaid Replacement: $288.40 Blue Cross Blue Shield of LA — HMO: $88.75 Blue Cross Blue Shield of LA — PPO: $103.13 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $173.04 Cigna — Medicare Replacement: $173.04 Healthy Blue — Medicaid Replacement: $288.40
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR MAMMO DIGITAL SCREENING BILATERAL,Professional Component	$108.15	$108.15	$33.64 – $288.40
Screening mammogram, both breasts: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $75.71 Aetna — Medicare Replacement: $45.42 Aetna Better Health — Medicaid Replacement: $75.71 Amerihealth Caritas of LA — Medicaid Replacement: $75.71 Blue Cross — Medicaid Replacement: $75.71 Blue Cross Blue Shield of LA — HMO: $88.75 Blue Cross Blue Shield of LA — PPO: $103.13 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $45.42 Cigna — Medicare Replacement: $45.42 Healthy Blue — Medicaid Replacement: $75.71
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Hospital (facility) fee · modifier 52 In the file: MAMMO 3D UNILATERAL LT SCREENING W ICAD,Reduced Services	$412	$412	$33.64 – $288.40
Screening mammogram, both breasts: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $288.40 Aetna — Medicare Replacement: $173.04 Aetna Better Health — Medicaid Replacement: $288.40 Amerihealth Caritas of LA — Medicaid Replacement: $288.40 Blue Cross — Medicaid Replacement: $288.40 Blue Cross Blue Shield of LA — HMO: $88.75 Blue Cross Blue Shield of LA — PPO: $103.13 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $173.04 Cigna — Medicare Replacement: $173.04 Healthy Blue — Medicaid Replacement: $288.40

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CLINIC EKG W/INTERP AND READING	$82.40	$82.40	$25.75 – $151.92
Electrocardiogram (ECG/EKG) with reading: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $57.68 Aetna — Medicare Replacement: $34.61 Aetna Better Health — Medicaid Replacement: $57.68 Amerihealth Caritas of LA — Medicaid Replacement: $57.68 Blue Cross — Medicaid Replacement: $57.68 Blue Cross Blue Shield of LA — HMO: $130.74 Blue Cross Blue Shield of LA — PPO: $151.92 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $34.61 Cigna — Medicare Replacement: $34.61 Healthy Blue — Medicaid Replacement: $57.68
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · Hospital (facility) fee In the file: EKG W INTERP AND READING	$180.25	$180.25	$25.75 – $151.92
Electrocardiogram (ECG/EKG) with reading: 10 of 18 insurance plan rates Aetna — All Commercial Plans: $126.18 Aetna — Medicare Replacement: $75.71 Aetna Better Health — Medicaid Replacement: $126.18 Amerihealth Caritas of LA — Medicaid Replacement: $126.18 Blue Cross — Medicaid Replacement: $126.18 Blue Cross Blue Shield of LA — HMO: $130.74 Blue Cross Blue Shield of LA — PPO: $151.92 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $75.71 Cigna — Medicare Replacement: $75.71 Healthy Blue — Medicaid Replacement: $126.18

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee · modifier GO In the file: OT THERAPEUTIC EXERCISES 15 MIN,Service was delivered under an outpatient Occupational Pathology plan of care	$82.40	$82.40	$11 – $57.68
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $57.68 Aetna — Medicare Replacement: $34.61 Aetna Better Health — Medicaid Replacement: $11 Amerihealth Caritas of LA — Medicaid Replacement: $11 Blue Cross — Medicaid Replacement: $11 Blue Cross Blue Shield of LA — HMO: $39.39 Blue Cross Blue Shield of LA — PPO: $45.77 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $34.61 Cigna — Medicare Replacement: $34.61 Healthy Blue — Medicaid Replacement: $11
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee · modifier GP In the file: PT THER EXER 15 MIN,Service was delivered under an outpatient Physical Pathology plan of care	$82.40	$82.40	$11 – $57.68
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $57.68 Aetna — Medicare Replacement: $34.61 Aetna Better Health — Medicaid Replacement: $11 Amerihealth Caritas of LA — Medicaid Replacement: $11 Blue Cross — Medicaid Replacement: $11 Blue Cross Blue Shield of LA — HMO: $39.39 Blue Cross Blue Shield of LA — PPO: $45.77 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $34.61 Cigna — Medicare Replacement: $34.61 Healthy Blue — Medicaid Replacement: $11
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Hospital (facility) fee · modifier GP In the file: PT EVAL LOW COMPLEX,Service was delivered under an outpatient Physical Pathology plan of care	$216.30	$216.30	$58.94 – $151.41
Physical therapy evaluation (low complexity): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $151.41 Aetna — Medicare Replacement: $90.85 Aetna Better Health — Medicaid Replacement: $58.94 Amerihealth Caritas of LA — Medicaid Replacement: $58.94 Blue Cross — Medicaid Replacement: $58.94 Blue Cross Blue Shield of LA — HMO: $97.94 Blue Cross Blue Shield of LA — PPO: $113.80 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $90.85 Cigna — Medicare Replacement: $90.85 Healthy Blue — Medicaid Replacement: $58.94
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Hospital (facility) fee · modifier GP In the file: PT EVAL MOD COMPLEX,Service was delivered under an outpatient Physical Pathology plan of care	$236.90	$236.90	$58.94 – $165.83
Physical therapy evaluation (moderate complexity): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $165.83 Aetna — Medicare Replacement: $99.50 Aetna Better Health — Medicaid Replacement: $58.94 Amerihealth Caritas of LA — Medicaid Replacement: $58.94 Blue Cross — Medicaid Replacement: $58.94 Blue Cross Blue Shield of LA — HMO: $97.94 Blue Cross Blue Shield of LA — PPO: $113.80 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $99.50 Cigna — Medicare Replacement: $99.50 Healthy Blue — Medicaid Replacement: $58.94
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Hospital (facility) fee · modifier GP In the file: PT EVAL HIGH COMPLEX,Service was delivered under an outpatient Physical Pathology plan of care	$278.10	$278.10	$58.94 – $194.67
Physical therapy evaluation (high complexity): 10 of 18 insurance plan rates Aetna — All Commercial Plans: $194.67 Aetna — Medicare Replacement: $116.80 Aetna Better Health — Medicaid Replacement: $58.94 Amerihealth Caritas of LA — Medicaid Replacement: $58.94 Blue Cross — Medicaid Replacement: $58.94 Blue Cross Blue Shield of LA — HMO: $97.94 Blue Cross Blue Shield of LA — PPO: $113.80 Blue Cross Blue Shield of LA MCR Adv — Medicare Replacement: $116.80 Cigna — Medicare Replacement: $116.80 Healthy Blue — Medicaid Replacement: $58.94

Source: Lady of the Sea General Hospital’s standard charges file (losgh.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on September 15, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Critical Access Hospital
Address	200 West 134th Place, Cut Off, LA 70345
Parish	Lafourche Parish
State	Louisiana
Phone	(985) 632‑6401
Emergency services	Yes
Ownership	Government - Hospital District or Authority
Medicare overall rating	Not rated by CMS
CMS Certification Number	191325
Name in Medicare records	LADY OF THE SEA GENERAL HOSPITAL
Profile level	Medicare data + hospital website
Official website	losgh.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Lady of the Sea General Hospital — losgh.org
Services — losgh.org
Patients & Visitors — losgh.org

Lady of the Sea General Hospital

Summary

Profile from official sources

At a glance

Quick answers

Treatments^[5]

Procedures^[4]

Programs and centers^[4][5]

Emergency care (hospital website)^[5]

Visiting and practical information

Doctors and clinicians (63)

Main specialties

Doctors with a page on this site (63)

Other emergency rooms nearby

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Home health agencies

Dialysis facilities

Community care nearby

Community health centers

Clinics and urgent care

Pharmacies

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Heart tests and sleep study

Physical therapy and mental health

Hospital information

Sources

From the hospital’s website

Lady of the Sea General Hospital

Summary

Profile from official sources

At a glance

Quick answers

Treatments[5]

Procedures[4]

Programs and centers[4][5]

Emergency care (hospital website)[5]

Visiting and practical information

Doctors and clinicians (63)

Main specialties

Doctors with a page on this site (63)

Other emergency rooms nearby

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Home health agencies

Dialysis facilities

Community care nearby

Community health centers

Clinics and urgent care

Pharmacies

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Heart tests and sleep study

Physical therapy and mental health

Hospital information

Sources

From the hospital’s website

Treatments^[5]

Procedures^[4]

Programs and centers^[4][5]

Emergency care (hospital website)^[5]