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 |
|---|---|---|---|---|
| Lumbar diskogram s&i CPT 72295 | not published | not published | $187.12 – $4,139.17 | 2 |
| Lung function test (mbc/mvv) CPT 94200 | $93.98 | $254.00 | $28.55 – $122.22 | 33 |
| Lung Function Test (Spirometry) CPT 94010 | $233.56 | $631.25 | $44.50 – $321.95 | 33 |
| Lung perfusion imaging CPT 78580 | $1,550.95 | $4,191.75 | $387.22 – $884.18 | 33 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $791.73 | $2,139.81 | $250.15 – $448.73 | 5 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $52.47 | $141.80 | $50.31 – $90.40 | 5 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $23.60 – $50.39 | 31 |
| Lymphatics/lymph node imaging CPT 78195 | $1,550.95 | $4,191.75 | $518.69 – $1,158.73 | 33 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $32.17 – $91.40 | 35 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $43.15 – $122.58 | 35 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $166.77 – $473.78 | 35 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $595.78 – $1,346.74 | 32 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $3,433.34 – $3,433.34 | 1 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $6,833.27 – $6,833.27 | 1 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $6,833.27 – $6,833.27 | 1 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $490.72 – $1,047.90 | 31 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $6.15 – $17.15 | 4 |
| Macroscopic exam arthropod CPT 87168 | $25.25 | $68.25 | $3.76 – $10.68 | 35 |
| Macroscopic exam parasite CPT 87169 | not published | not published | $3.79 – $10.78 | 35 |
| Magnesium CPT 83735 | $40.05 | $108.25 | $5.90 – $16.75 | 35 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $50.14 | $135.50 | $0.60 – $0.74 | 4 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $232.92 – $667.03 | 33 |
| Malaria antibody CPT 86750 | not published | not published | $11.61 – $32.98 | 35 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $97.59 | $263.75 | $89.03 – $265.25 | 33 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $95.83 | $259.00 | $58.63 – $265.25 | 33 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $231.16 – $493.62 | 31 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $51.96 | $140.43 | $2.76 – $3.81 | 4 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $4.46 – $12.68 | 35 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | $760.63 | $2,055.75 | $254.75 – $254.75 | 2 |
| Map tachycard site(s) CPT 93609 | not published | not published | $4,669.75 – $24,882.00 | 3 |
| Mastoids complete CPT 70130 | $217.19 | $587.00 | $102.47 – $235.69 | 33 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $4,371.37 | $11,814.50 | $26.23 – $53.74 | 6 |
| M.avium-intra dna amp prob CPT 87561 | not published | not published | $30.88 – $87.73 | 35 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $24.02 – $68.23 | 35 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $15.54 | $42.00 | $12.73 – $36.15 | 35 |
| Mayo aathr protein s free CPT 85306 | $43.48 | $117.50 | $13.48 – $38.30 | 35 |
| Mayo activated protein c resistance assay CPT 85307 | $35.71 | $96.50 | $13.48 – $38.30 | 35 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $57.08 | $154.28 | $33.94 – $96.43 | 35 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | not published | not published | $33.68 – $33.68 | 2 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $62.16 | $168.00 | $56.25 – $56.25 | 2 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $5.55 | $15.00 | $13.01 – $36.95 | 35 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $25.90 | $70.00 | $56.25 – $56.25 | 2 |
| Mayo alpha 1 antitrypsin CPT 82103 | $15.73 | $42.50 | $11.83 – $33.60 | 35 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $80.38 | $217.25 | $13.27 – $37.70 | 35 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | not published | not published | $32.50 – $32.50 | 2 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | not published | not published | $56.25 – $56.25 | 2 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $172.05 | $465.00 | $107.03 – $304.08 | 35 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $96.57 | $261.00 | $80.66 – $229.15 | 35 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $202.76 | $548.00 | $120.56 – $342.50 | 35 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | not published | not published | $1,020.80 – $2,900.00 | 4 |
| Mayo androstenedione CPT 82157 | not published | not published | $25.77 – $73.20 | 35 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $4.81 | $13.00 | $12.85 – $36.50 | 35 |
| Mayo antithrombin iii antigen CPT 85301 | $18.50 | $50.00 | $9.51 – $27.03 | 35 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $22.27 | $60.20 | $13.24 – $37.63 | 35 |
| Mayo avwpr vw factor activity CPT 85397 | $74.00 | $200.00 | $27.16 – $77.15 | 35 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | not published | not published | $33.69 – $87.73 | 34 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $38.11 | $103.00 | $56.25 – $56.25 | 2 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $4.44 | $12.00 | $8.96 – $25.45 | 35 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | not published | not published | $127.46 – $362.10 | 35 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | not published | not published | $188.87 – $536.55 | 35 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $4.63 | $12.50 | $11.35 – $32.25 | 35 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | not published | not published | $56.25 – $56.25 | 2 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $6.94 | $18.75 | $11.61 – $32.98 | 35 |
| Mayo brcmg brucella antibody igm CPT 86622 | not published | not published | $7.86 – $22.33 | 35 |
| Mayo c1 esterase inhibitor CPT 83883 | $45.88 | $124.00 | $11.97 – $34.00 | 35 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | not published | not published | $56.25 – $56.25 | 2 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $9.44 | $25.50 | $14.84 – $42.18 | 35 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | not published | not published | $23.57 – $66.95 | 35 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | not published | not published | $107.56 – $305.55 | 35 |
| Mayo ceruloplasmin CPT 82390 | not published | not published | $9.45 – $26.85 | 35 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $24.24 | $65.50 | $12.43 – $35.30 | 35 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $37.00 | $100.00 | $11.33 – $32.20 | 35 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | not published | not published | $10.40 – $29.55 | 35 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | not published | not published | $11.16 – $31.70 | 35 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $71.04 | $192.00 | $102.51 – $291.23 | 35 |
| Mayo chromium CPT 82495 | $36.63 | $99.00 | $17.85 – $50.70 | 35 |
| Mayo cocaine definitive assay confirmation urine CPT 80353 | not published | not published | $56.25 – $56.25 | 2 |
| Mayo coccidioides antibody CPT 86635 | $5.18 | $14.00 | $10.09 – $28.68 | 35 |
| Mayo cocou cortisone urine CPT 82542 | $35.65 | $96.36 | $21.20 – $60.23 | 35 |
| Mayo cortisol free CPT 82530 | $28.21 | $76.25 | $14.70 – $41.78 | 35 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $32.19 | $87.00 | $40.44 – $105.33 | 34 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $26.64 | $72.00 | $10.67 – $30.30 | 35 |
| Mayo csmpu benzodiazepines definitive assay >=13 urine CPT 80347 | not published | not published | $57.60 – $57.60 | 2 |
| Mayo csmpu opiod/analogs definitive assay >=5 urine CPT 80364 | not published | not published | $39.83 – $39.83 | 2 |
| Mayo cyanide CPT 82600 | $12.58 | $34.00 | $17.07 – $48.50 | 35 |
| Mayo cytopathology in situ hybridization urinary tract 3-5 probes each specimen manual CPT 88120 | $166.50 | $450.00 | $143.50 – $1,147.58 | 35 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $4.81 | $13.00 | $11.66 – $33.13 | 35 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | not published | not published | $22.24 – $63.18 | 35 |
| Mayo dihydrotestosterone CPT 82642 | $43.33 | $117.12 | $25.77 – $73.20 | 35 |
| Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid CPT 83518 | not published | not published | $8.48 – $24.10 | 35 |
| Mayo efpo chloride stool CPT 82438 | $22.57 | $61.00 | $4.40 – $12.50 | 35 |
| Mayo estriol CPT 82677 | $35.79 | $96.72 | $21.28 – $60.45 | 35 |
| Mayo estrone CPT 82679 | $36.93 | $99.80 | $21.96 – $62.38 | 35 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | not published | not published | $14.38 – $40.85 | 35 |
| Mayo everolimus therapeutic drug level CPT 80169 | $35.52 | $96.00 | $12.08 – $34.33 | 35 |
| Mayo factor ii CPT 85210 | $70.30 | $190.00 | $11.42 – $32.45 | 35 |
| Mayo factor v CPT 85220 | $42.37 | $114.50 | $15.53 – $44.13 | 35 |
| Mayo factor vii CPT 85230 | $38.11 | $103.00 | $15.75 – $44.75 | 35 |
| Mayo factor viii vw factor antigen CPT 85246 | $60.59 | $163.75 | $20.19 – $57.35 | 35 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $20.35 | $55.00 | $20.19 – $57.35 | 35 |
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.