Ascension St. Vincent's Southside (St. Luke's-St. Vincent's HealthCare, Inc.)
4201 Belfort Rd, Jacksonville, FL · Ascension · · NPI 1396926747
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $5.32 – $15.13 | 35 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $10.45 | $28.25 | $2.89 – $8.20 | 35 |
| Glucose blood quantitative CPT 82947 | $6.85 | $18.50 | $3.46 – $9.83 | 35 |
| Glucose body fluid CPT 82945 | $43.01 | $116.25 | $3.46 – $9.83 | 35 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $57.24 – $152.23 | 33 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $79.27 | $214.25 | $11.32 – $32.18 | 35 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $10.92 | $29.50 | $3.45 – $9.80 | 35 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $41.71 | $112.72 | $13.14 – $23.08 | 5 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $55.59 | $150.25 | $16.35 – $46.45 | 35 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $49.30 | $133.25 | $16.30 – $46.30 | 35 |
| Gonioscopy CPT 92020 | not published | not published | $63.80 – $265.25 | 33 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $1,478.45 | $3,995.80 | $860.27 – $1,539.70 | 5 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $2,874.90 | $7,770.00 | $37.04 – $75.91 | 6 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $9,693.72 | $26,199.25 | $77.62 – $159.05 | 6 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $20,559.61 | $55,566.50 | $77.78 – $77.78 | 2 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $3,735.34 | $10,095.50 | $79.80 – $163.51 | 6 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $12,026.39 | $32,503.75 | $128.66 – $263.66 | 6 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $6,329.68 | $17,107.25 | $166.37 – $340.92 | 6 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $5,920.37 | $16,001.00 | $45.75 – $205.28 | 6 |
| Great toe with reduction 28495 CPT 28495 | not published | not published | $231.16 – $493.62 | 31 |
| Growth hormone antibody CPT 86277 | $51.06 | $138.00 | $13.85 – $39.35 | 35 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $66.53 – $189.00 | 35 |
| G-tube reposition CPT 43761 | not published | not published | $234.36 – $500.47 | 31 |
| Gu dilat ureter/urethra s&i CPT 74485 | not published | not published | $211.85 – $4,366.49 | 2 |
| Guided cath fluid drainage 10030 CPT 10030 | not published | not published | $678.00 – $1,447.81 | 31 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $589.86 – $1,259.60 | 31 |
| Hair trnspl 1-15 punch grfts CPT 15775 | not published | not published | $385.00 – $822.13 | 31 |
| Hair trnspl >15 punch grafts CPT 15776 | not published | not published | $385.00 – $822.13 | 31 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $48.04 | $129.85 | $0.95 – $1.82 | 4 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | $10.54 | $28.48 | $5.77 – $12.83 | 3 |
| Hand X-ray CPT 73130 | $248.92 | $672.75 | $75.77 – $194.81 | 33 |
| Haptoglobin quantitative CPT 83010 | $21.09 | $57.00 | $11.07 – $31.45 | 35 |
| Harvest stem cell concentrte CPT 38215 | not published | not published | $421.28 – $899.60 | 31 |
| Hast w/i&r phys/qhp CPT 94452 | $236.80 | $640.00 | $84.05 – $265.25 | 33 |
| Hast w/oxygen titrate CPT 94453 | $231.16 | $624.75 | $112.58 – $265.25 | 33 |
| Hba1/hba2 full gene sequence CPT 81259 | not published | not published | $528.00 – $1,500.00 | 35 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | not published | not published | $178.11 – $506.00 | 35 |
| Hba1/hba2 gene fam vrnt CPT 81258 | not published | not published | $330.22 – $938.13 | 35 |
| Hbb full gene sequence CPT 81364 | not published | not published | $285.63 – $811.45 | 35 |
| Hbb gene com variants CPT 81361 | not published | not published | $153.83 – $437.03 | 35 |
| Hbb gene dup/del variants CPT 81363 | not published | not published | $178.11 – $506.00 | 35 |
| Hbb gene known fam variant CPT 81362 | not published | not published | $330.22 – $938.13 | 35 |
| Hbot, full body chamber, 30m HCPCS G0277 | $897.99 | $2,427.00 | $401.55 – $401.55 | 2 |
| Hc ea ha check monaural CPT 92594 | not published | not published | $52.05 – $52.05 | 2 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | not published | not published | $171.54 – $521.16 | 33 |
| Hcg free betachain test CPT 84704 | not published | not published | $13.46 – $38.23 | 35 |
| Hcg qualitative CPT 84703 | $59.85 | $161.75 | $6.62 – $18.80 | 35 |
| Hcg quantitative CPT 84702 | $77.70 | $210.00 | $13.24 – $37.63 | 35 |
| Hc hearing aid chck binaurl CPT 92593 | not published | not published | $88.58 – $88.58 | 2 |
| Hc hearing aid chck monarl CPT 92592 | not published | not published | $54.80 – $54.80 | 2 |
| Hc hearing aid exam both ears CPT 92591 | not published | not published | $173.28 – $173.28 | 2 |
| Hc hearing aid exam one ear CPT 92590 | not published | not published | $135.98 – $135.98 | 2 |
| Hc i-131 sodium iodide cap dx per mci HCPCS A9528 | $476.28 | $1,287.25 | $115.23 – $250.45 | 6 |
| Hc mohs micrographic h/n/h/f/g 1st stage 5 blocks CPT 17311 | not published | not published | $589.86 – $1,259.60 | 31 |
| Hc mohs trunk/arm/leg 1st stage 5 blocks CPT 17313 | not published | not published | $589.86 – $1,259.60 | 31 |
| Hc nm cardiac blood pool planar 1 stdy wal motn eject fract CPT 78481 | not published | not published | $378.83 – $1,158.73 | 33 |
| Hc nm fusion spect CT unlisted CPT 78999 | not published | not published | $387.22 – $884.18 | 32 |
| Hc nm kidney imaging with flow CPT 78701 | not published | not published | $387.22 – $884.18 | 33 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | not published | not published | $518.69 – $1,158.73 | 33 |
| Hc pet myocardial imaging metabolic eval single study CPT 78459 | not published | not published | $3,044.09 – $5,025.00 | 2 |
| Hdr rdncl ntrstl/icav brchtx CPT 77770 | not published | not published | $668.57 – $1,427.68 | 32 |
| Hdr rdncl ntrstl/icav brchtx CPT 77771 | not published | not published | $668.57 – $1,427.68 | 32 |
| Hdr rdncl ntrstl/icav brchtx CPT 77772 | not published | not published | $668.57 – $1,810.70 | 32 |
| Hdr rdncl skn surf brachytx CPT 77767 | not published | not published | $253.41 – $541.14 | 32 |
| Hdr rdncl skn surf brachytx CPT 77768 | not published | not published | $253.41 – $832.94 | 32 |
| Head CT scan (with and without contrast) CPT 70470 | $768.31 | $2,076.50 | $171.54 – $783.00 | 33 |
| Head CT scan (with contrast) CPT 70460 | $722.43 | $1,952.50 | $171.54 – $783.00 | 33 |
| Head CT scan (without contrast) CPT 70450 | $676.55 | $1,828.50 | $102.47 – $783.00 | 33 |
| Heart first pass add-on CPT 78496 | not published | not published | $56.17 – $56.17 | 1 |
| Heart first pass multiple CPT 78483 | not published | not published | $502.56 – $1,158.73 | 33 |
| Heart image spect CPT 78494 | $1,550.95 | $4,191.75 | $387.22 – $884.18 | 33 |
| Heart infarct image CPT 78466 | not published | not published | $387.22 – $884.18 | 33 |
| Heart infarct image (ef) CPT 78468 | not published | not published | $457.14 – $1,158.73 | 33 |
| Heinz bodies direct CPT 85441 | not published | not published | $3.70 – $10.50 | 35 |
| Helicobacter pylori antibody igm CPT 86677 | $7.86 | $21.25 | $14.83 – $42.13 | 35 |
| Hemagglutination inhibition CPT 86280 | not published | not published | $7.21 – $20.48 | 35 |
| Hematocrit CPT 85014 | $18.50 | $50.00 | $2.09 – $5.93 | 35 |
| Hematopoietic nuclear tx CPT 79403 | not published | not published | $215.98 – $533.34 | 33 |
| Hemodialysis one evaluation CPT 90935 | $181.58 | $490.75 | $170.23 – $1,439.84 | 33 |
| Hemoglobin CPT 85018 | $15.91 | $43.00 | $2.09 – $5.93 | 35 |
| Hemoglobin copper sulfate CPT 83026 | not published | not published | $3.53 – $10.03 | 35 |
| Hemoglobin fetal qualitative CPT 83033 | not published | not published | $7.04 – $20.00 | 35 |
| Hemoglobin f (fetal) chemical CPT 83030 | $13.23 | $35.75 | $9.45 – $26.85 | 35 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $10.64 | $28.75 | $7.22 – $20.50 | 35 |
| Hemoglobin-oxygen affinity CPT 82820 | not published | not published | $11.74 – $33.35 | 35 |
| Hemoglobin plasma CPT 83051 | $5.92 | $16.00 | $6.43 – $18.28 | 35 |
| Hemoglobin urine CPT 83069 | not published | not published | $3.48 – $9.88 | 35 |
| Hemolysin acid CPT 85475 | not published | not published | $7.80 – $22.18 | 35 |
| Hemolysins/agglutinins auto CPT 86940 | $41.07 | $111.00 | $7.72 – $21.93 | 35 |
| Hemolysins and agglutinins incubated CPT 86941 | $41.53 | $112.25 | $10.66 – $30.28 | 35 |
| Hemophilus influenza antibdy CPT 86684 | not published | not published | $13.94 – $39.60 | 35 |
| Hemorrhoidectomy intrnl lig rbbr band ligations CPT 46221 | not published | not published | $878.55 – $1,876.08 | 31 |
| Heparin assay CPT 85520 | $33.76 | $91.25 | $11.52 – $32.73 | 35 |
| Heparin bolus from bag HCPCS J1644 | $243.09 | $657.00 | $0.27 – $0.30 | 4 |
| Heparin neutralization CPT 85525 | not published | not published | $10.42 – $29.60 | 35 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $66.16 | $178.82 | $0.02 – $0.03 | 4 |
| Hepatitis a antibody igm CPT 86709 | $35.71 | $96.50 | $9.91 – $28.15 | 35 |
| Hepatitis b core antibody igm CPT 86705 | $34.60 | $93.50 | $10.36 – $29.43 | 35 |
| Hepatitis b core antibody total CPT 86704 | $42.74 | $115.50 | $10.60 – $30.13 | 35 |
| Hepatitis b immune globulin greater than 1,560 units/5 ml im solution CPT 90371 | $66.23 | $179.00 | $137.49 – $365.78 | 37 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.