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 |
|---|---|---|---|---|
| Path clin consltj mod 21-40 CPT 80504 | $337.44 | $912.00 | $125.45 – $352.62 | 34 |
| Path clin consltj prolng svc CPT 80506 | not published | not published | $43.26 – $101.38 | 3 |
| Path clin consltj sf 5-20 CPT 80503 | $107.67 | $291.00 | $50.75 – $109.94 | 34 |
| Patient recorded spirometry CPT 94014 | not published | not published | $131.50 – $821.13 | 33 |
| Patient recorded spirometry CPT 94015 | not published | not published | $73.40 – $640.79 | 33 |
| Pca3/klk3 antigen CPT 81313 | not published | not published | $224.44 – $637.63 | 35 |
| Pcv21 vaccine im CPT 90684 | not published | not published | $400.03 – $819.73 | 6 |
| Pdgfra gene CPT 81314 | not published | not published | $289.97 – $823.78 | 35 |
| Pdt dstr prmlg les phys/qhp CPT 96573 | not published | not published | $191.47 – $503.35 | 33 |
| Ped crit care age 2-5 init CPT 99475 | not published | not published | $1,354.45 – $1,354.45 | 2 |
| Ped crit care age 2-5 subsq CPT 99476 | not published | not published | $822.18 – $822.18 | 2 |
| Ped crit care transport CPT 99466 | not published | not published | $557.25 – $557.25 | 2 |
| Ped crit care transport addl CPT 99467 | not published | not published | $279.20 – $279.20 | 2 |
| Ped critical care initial CPT 99471 | not published | not published | $1,859.83 – $1,859.83 | 2 |
| Ped critical care subsq CPT 99472 | not published | not published | $974.40 – $974.40 | 2 |
| Ped home apnea mntr att only CPT 94775 | not published | not published | $118.48 – $321.95 | 33 |
| Ped home apnea mntr dl&alys CPT 94776 | not published | not published | $150.77 – $562.55 | 33 |
| Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 | $3,784.62 | $10,228.70 | $24.38 – $43.76 | 5 |
| Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 | $168.77 | $456.12 | $199.59 – $409.01 | 7 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | $424.54 | $1,147.39 | $137.74 – $812.50 | 7 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $716.04 | $1,935.25 | $171.54 – $783.00 | 33 |
| Pelvic CT scan (with contrast) CPT 72193 | $670.16 | $1,811.25 | $171.54 – $783.00 | 33 |
| Pelvic CT scan (without contrast) CPT 72192 | $624.28 | $1,687.25 | $102.47 – $783.00 | 33 |
| Pelvic MRI (with and without contrast) CPT 72197 | $590.15 | $1,595.00 | $344.14 – $1,111.00 | 33 |
| Pelvic MRI (with contrast) CPT 72196 | $720.02 | $1,946.00 | $344.14 – $1,111.00 | 33 |
| Pelvic MRI (without contrast) CPT 72195 | $525.86 | $1,421.25 | $232.92 – $1,111.00 | 33 |
| Pelvic Ultrasound (complete) CPT 76856 | $762.76 | $2,061.50 | $102.47 – $235.69 | 33 |
| Pelvic Ultrasound (limited) CPT 76857 | $429.66 | $1,161.25 | $69.58 – $235.69 | 33 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | $170.34 | $460.38 | $72.41 – $126.14 | 5 |
| Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 | $80.08 | $216.43 | $4.60 – $11.54 | 5 |
| Peng benzathine/procaine inj HCPCS J0558 | $13.32 | $36.00 | $21.19 – $26.06 | 4 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $45.25 | $122.29 | $32.92 – $58.74 | 5 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $91.27 | $246.69 | $0.95 – $1.13 | 4 |
| Penile injection CPT 54235 | not published | not published | $234.36 – $500.47 | 31 |
| Penile vascular study CPT 93980 | $291.75 | $788.50 | $102.47 – $1,146.00 | 34 |
| Penile vascular study CPT 93981 | $307.84 | $832.00 | $102.47 – $1,146.00 | 34 |
| Penis study CPT 54240 | not published | not published | $300.08 – $640.79 | 31 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | $287.12 | $776.00 | $51.09 – $143.84 | 7 |
| Peripheral vascular rehab CPT 93668 | not published | not published | $33.88 – $122.22 | 33 |
| Peri-proc device eval icd CPT 93287 | not published | not published | $68.85 – $1,636.00 | 3 |
| Peri-proc device eval pm CPT 93286 | not published | not published | $68.83 – $1,636.00 | 3 |
| Peritoneogram rs&i CPT 74190 | not published | not published | $528.36 – $1,182.67 | 32 |
| Perit-vens shunt pat tst CPT 78291 | $752.49 | $2,033.75 | $387.22 – $884.18 | 33 |
| Perq dev breast 1st mr guide CPT 19287 | not published | not published | $678.00 – $1,447.81 | 31 |
| Perq dev breast 1st strtctc CPT 19283 | not published | not published | $678.00 – $1,447.81 | 31 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | not published | not published | $234.36 – $500.47 | 31 |
| Perq transcath closure each CPT 93592 | not published | not published | $920.80 – $920.80 | 2 |
| Perq transcath closure pda CPT 93582 | not published | not published | $1,650.70 – $1,650.70 | 2 |
| Perq transcath cls aortic CPT 93591 | not published | not published | $2,125.98 – $2,125.98 | 2 |
| Perq transcath cls mitral CPT 93590 | not published | not published | $2,561.30 – $2,561.30 | 2 |
| Perq transcath septal reduxn CPT 93583 | not published | not published | $1,849.53 – $1,849.53 | 2 |
| Pertussis ag if CPT 87265 | not published | not published | $10.54 – $29.95 | 35 |
| Pertuzumab 30 mg/ml desensitization HCPCS J9306 | $13.57 | $36.67 | $19.80 – $35.46 | 5 |
| Pessary 3.5 in 7 vag sil rng fold HCPCS A4562 | $97.22 | $262.75 | $178.83 – $178.83 | 2 |
| Pet CT skull-mid thgh initial CPT 78815 | $1,998.00 | $5,400.00 | $3,353.85 – $5,025.00 | 2 |
| Pet CT whole body initial CPT 78816 | $2,016.50 | $5,450.00 | $3,353.85 – $5,025.00 | 2 |
| Pet fdg brain metoblic eval sb CPT 78608 | not published | not published | $3,353.85 – $5,025.00 | 2 |
| Pet image full body CPT 78813 | not published | not published | $3,353.85 – $5,025.00 | 2 |
| Pet image ltd area CPT 78811 | not published | not published | $3,044.09 – $5,025.00 | 2 |
| Pet image skull-thigh CPT 78812 | not published | not published | $3,353.85 – $5,025.00 | 2 |
| Pet image w/ct lmtd CPT 78814 | $1,979.50 | $5,350.00 | $3,353.85 – $5,025.00 | 2 |
| Pet scan brain perf study CPT 78609 | not published | not published | $235.47 – $235.47 | 1 |
| Ph1 assmt&mgmt nqhp 11-20 CPT 98967 | not published | not published | $22.86 – $59.53 | 33 |
| Ph1 assmt&mgmt nqhp 21-30 CPT 98968 | not published | not published | $31.50 – $82.03 | 33 |
| Ph1 assmt&mgmt nqhp 5-10 CPT 98966 | not published | not published | $12.31 – $32.05 | 33 |
| Pharmacologic management w/psytx CPT 90863 | not published | not published | $60.63 – $60.63 | 2 |
| Ph body fluid CPT 83986 | $36.08 | $97.50 | $3.15 – $8.95 | 35 |
| Phencyclidine (pcp) CPT 83992 | $42.37 | $114.50 | $43.31 – $83.63 | 3 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $282.14 | $762.55 | $46.14 – $46.14 | 3 |
| Phenobarbital therapeutic drug level CPT 80184 | $45.05 | $121.75 | $13.47 – $38.25 | 35 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $45.87 | $123.97 | $0.01 – $0.02 | 4 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | $24.14 | $65.25 | $0.71 – $0.71 | 3 |
| Phenytoin total therapeutic drug level CPT 80185 | $52.63 | $142.25 | $11.66 – $33.13 | 35 |
| Phlebotomy therapeutic CPT 99195 | $217.01 | $586.50 | $124.21 – $265.25 | 33 |
| Phone e/m phys/qhp 11-20 min CPT 99442 | not published | not published | $223.20 – $223.20 | 2 |
| Phone e/m phys/qhp 21-30 min CPT 99443 | not published | not published | $316.90 – $316.90 | 2 |
| Phone e/m phys/qhp 5-10 min CPT 99441 | not published | not published | $137.90 – $137.90 | 2 |
| Phosphorus CPT 84100 | $42.37 | $114.50 | $4.17 – $11.85 | 35 |
| Phosphorus 24 hour urine CPT 84105 | $23.68 | $64.00 | $5.09 – $14.45 | 35 |
| Photchmtx tar&uvb/ptrltm&uvb CPT 96910 | not published | not published | $57.24 – $267.65 | 33 |
| Photochemotherapy puva CPT 96912 | not published | not published | $57.24 – $227.38 | 33 |
| Photochemotherapy uv-a or b CPT 96913 | not published | not published | $344.88 – $822.13 | 33 |
| Photodynamic tx addl 15 min CPT 96571 | not published | not published | $60.63 – $5,618.00 | 3 |
| Photodynmc tx 30 min add-on CPT 96570 | not published | not published | $134.55 – $5,618.00 | 3 |
| Photo patch test CPT 95052 | not published | not published | $13.35 – $122.22 | 33 |
| Photosensitivity tests CPT 95056 | not published | not published | $121.73 – $265.25 | 33 |
| Phys blood bank serv authrj CPT 86079 | $107.67 | $291.00 | $45.89 – $125.60 | 35 |
| Phys blood bank serv reactj CPT 86078 | $337.44 | $912.00 | $46.19 – $352.62 | 35 |
| Phys blood bank serv xmatch CPT 86077 | $53.65 | $145.00 | $22.99 – $126.38 | 35 |
| Physician standby services CPT 99360 | not published | not published | $139.88 – $139.88 | 2 |
| Phys review of motion tests CPT 96004 | not published | not published | $258.18 – $258.18 | 2 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $48.28 | $130.48 | $2.99 – $3.32 | 4 |
| Pik3ca gene trgt seq alys CPT 81309 | not published | not published | $241.85 – $687.08 | 35 |
| Pinch graft 1/mlt c> sm ulcer tip/oth area 2cm 15050 CPT 15050 | not published | not published | $589.86 – $1,259.60 | 31 |
| Pinworm exam CPT 87172 | $9.44 | $25.50 | $3.76 – $10.68 | 35 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $58.22 | $157.35 | $1.37 – $1.71 | 4 |
| Pituitary evaluation panel CPT 80418 | not published | not published | $509.94 – $1,448.70 | 35 |
| Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 | not published | not published | $678.00 – $1,447.81 | 31 |
| Placental lactogen CPT 83632 | not published | not published | $17.80 – $50.55 | 35 |
| Plasma volume multiple CPT 78111 | not published | not published | $191.19 – $3,044.09 | 2 |
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.