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 |
|---|---|---|---|---|
| Laryngoscopy w/exc of tumor CPT 31540 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Laryngoscopy w/fb & op scope CPT 31531 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Laryngoscopy w/fb removal CPT 31530 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Laryngoscopy with biopsy CPT 31576 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Laryngoscopy with biopsy 31510 CPT 31510 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Laryngoscopy w/w/o tracheoscopy aspiration CPT 31515 | not published | not published | $374.19 – $5,618.00 | 32 |
| Larynscop remve cart + scop CPT 31561 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Larynscop w/tumr exc + scope CPT 31541 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Laser surgery eye strands CPT 67031 | not published | not published | $528.64 – $1,128.87 | 31 |
| Lavage cannulation maxillary sinus CPT 31000 | not published | not published | $223.78 – $477.85 | 31 |
| Lead capillary CPT 83655 | $39.96 | $108.00 | $10.66 – $30.28 | 35 |
| Legion pneumo dna dir prob CPT 87540 | not published | not published | $17.64 – $50.13 | 35 |
| Legion pneumo dna quant CPT 87542 | not published | not published | $36.75 – $104.40 | 35 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,088.26 | $2,941.25 | $232.92 – $1,146.00 | 34 |
| Leishmania antibody CPT 86717 | not published | not published | $10.78 – $30.63 | 35 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $9.58 | $25.89 | $4.28 – $6.24 | 4 |
| Leukacyte transfusion CPT 86950 | not published | not published | $124.68 – $352.62 | 34 |
| Leukocyte phagocytosis CPT 86344 | not published | not published | $9.14 – $25.98 | 35 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $2,050.48 | $5,541.85 | $210.19 – $395.93 | 5 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $1,440.90 | $3,894.33 | $2,037.77 – $3,650.25 | 5 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $27.06 | $73.13 | $0.06 – $0.08 | 4 |
| Levetiracetam therapeutic drug level CPT 80177 | $19.61 | $53.00 | $11.66 – $33.13 | 35 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $77.82 | $210.32 | $1.26 – $2.84 | 4 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $21.31 | $57.60 | $8.09 – $8.09 | 3 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | not published | not published | $610.45 – $610.45 | 2 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $48.29 | $130.50 | $0.02 – $0.07 | 4 |
| Lidocaine therapeutic drug level CPT 80176 | $9.62 | $26.00 | $12.93 – $36.73 | 35 |
| Limb exercise test CPT 95875 | not published | not published | $143.35 – $321.95 | 33 |
| Limited autopsy CPT 88036 | not published | not published | $103.58 – $238.68 | 3 |
| Limited autopsy CPT 88037 | not published | not published | $92.03 – $212.08 | 3 |
| Limited visual field xm CPT 92081 | not published | not published | $40.73 – $122.22 | 33 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $49.15 | $132.83 | $4.23 – $4.47 | 4 |
| Lipase CPT 83690 | $66.79 | $180.50 | $6.06 – $17.23 | 35 |
| Lipoprotein blood high res frac & quant CPT 83701 | not published | not published | $29.80 – $84.65 | 35 |
| Lipoprotein blood quant CPT 83704 | $29.69 | $80.25 | $30.09 – $85.48 | 35 |
| Lipoprotein direct measurement hdl CPT 83718 | $45.88 | $124.00 | $7.21 – $20.48 | 35 |
| Lipoprotein direct measurement ldl CPT 83721 | $21.37 | $57.75 | $9.24 – $26.25 | 35 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $30.09 – $85.48 | 35 |
| Lip surgery procedure CPT 40799 | not published | not published | $223.78 – $477.85 | 31 |
| Listeria monocytogenes CPT 86723 | not published | not published | $11.61 – $32.98 | 35 |
| Lithium therapeutic drug level CPT 80178 | $80.38 | $217.25 | $5.82 – $16.53 | 35 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $2,496.21 | $6,746.50 | $353.98 – $353.98 | 2 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $169.14 – $440.48 | 34 |
| Liver elastography 91200 CPT 91200 | not published | not published | $46.05 – $321.95 | 33 |
| Liver Function Test CPT 80076 | $50.14 | $135.50 | $7.19 – $20.43 | 35 |
| Liver imaging CPT 78201 | not published | not published | $503.55 – $1,158.73 | 33 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $518.69 – $1,158.73 | 33 |
| Liver/spleen imag static only CPT 78215 | $1,550.95 | $4,191.75 | $387.22 – $884.18 | 33 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $303.51 – $884.18 | 33 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $173.45 – $173.45 | 2 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $38.99 | $105.39 | $1.92 – $2.03 | 4 |
| Loudness balance test CPT 92562 | not published | not published | $113.68 – $640.79 | 33 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $693.10 | $1,873.25 | $171.54 – $783.00 | 33 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $647.32 | $1,749.50 | $344.14 – $824.45 | 33 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $601.44 | $1,625.50 | $102.47 – $783.00 | 33 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $654.35 | $1,768.50 | $344.14 – $1,111.00 | 33 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $622.25 | $1,681.75 | $344.14 – $1,111.00 | 33 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,136.27 | $3,071.00 | $232.92 – $1,111.00 | 33 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $327.27 | $884.50 | $77.83 – $235.69 | 33 |
| Low frequency non-thermal Ultrasound CPT 97610 | $352.89 | $953.75 | $191.47 – $935.83 | 33 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $19.35 – $54.98 | 35 |
| 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 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $17.64 – $50.13 | 35 |
| 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 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $41.88 – $118.98 | 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 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $37.70 – $107.10 | 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 |
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.