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 |
|---|---|---|---|---|
| Upgrade pm system CPT 33214 | not published | not published | $17,570.00 – $17,570.00 | 1 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $622.25 | $1,681.75 | $344.14 – $1,111.00 | 33 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $590.15 | $1,595.00 | $344.14 – $1,111.00 | 33 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $558.05 | $1,508.25 | $232.92 – $1,111.00 | 33 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | not published | not published | $903.46 – $5,618.00 | 32 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | not published | not published | $903.46 – $5,618.00 | 32 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $903.46 – $5,618.00 | 32 |
| Urea nitrogen CPT 84520 | $10.55 | $28.50 | $3.48 – $9.88 | 35 |
| Urea nitrogen 24 hour urine CPT 84540 | $42.00 | $113.50 | $4.89 – $13.90 | 35 |
| Urea nitrogen clearance CPT 84545 | $13.97 | $37.75 | $6.34 – $18.00 | 35 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $4.52 – $12.83 | 35 |
| Ureteral reflux study CPT 78740 | not published | not published | $387.22 – $884.18 | 33 |
| Ureter endoscopy CPT 50970 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $5,618.00 – $5,618.00 | 1 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | not published | not published | $232.92 – $525.31 | 32 |
| Urethrocystography void s&i CPT 74455 | not published | not published | $232.92 – $525.31 | 33 |
| Uric acid blood CPT 84550 | $50.14 | $135.50 | $3.98 – $11.30 | 35 |
| Uric acid urine CPT 84560 | $27.20 | $73.50 | $4.47 – $12.70 | 35 |
| Urinalysis glass test CPT 81020 | not published | not published | $4.14 – $11.75 | 35 |
| Urinalysis microscopic only CPT 81015 | $6.57 | $17.75 | $2.68 – $7.63 | 35 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $1.91 – $5.43 | 35 |
| Urinalysis (with microscopy) CPT 81001 | $22.20 | $60.00 | $2.79 – $7.93 | 35 |
| Urinalysis (without microscopy) CPT 81003 | $10.45 | $28.25 | $1.98 – $5.63 | 35 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $201.55 – $201.55 | 1 |
| Urinary reflex study CPT 51792 | not published | not published | $57.24 – $122.22 | 31 |
| Urine Culture Test CPT 87086 | $80.01 | $216.25 | $7.10 – $20.18 | 35 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $124.21 – $265.25 | 31 |
| Urine pregnancy test CPT 81025 | $75.94 | $205.25 | $7.58 – $21.53 | 35 |
| Urine screen for bacteria CPT 81007 | not published | not published | $26.38 – $74.95 | 35 |
| Urography, antegrade CPT 74425 | $588.49 | $1,590.50 | $304.65 – $824.45 | 33 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $171.54 – $393.89 | 33 |
| Use 1st target lesion CPT 76982 | not published | not published | $102.47 – $235.69 | 33 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $1,005.47 | $2,717.49 | $15.63 – $27.94 | 5 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | not published | not published | $197.21 – $404.13 | 6 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | not published | not published | $179.41 – $367.65 | 6 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | not published | not published | $190.20 – $389.75 | 6 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | not published | not published | $107.09 – $219.45 | 6 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | not published | not published | $79.97 – $163.88 | 6 |
| Vaccine dtap < 7 years im CPT 90700 | $48.14 | $130.10 | $43.55 – $75.98 | 6 |
| Vaccine dtap-hep b-ipv im CPT 90723 | not published | not published | $150.78 – $282.35 | 6 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $100.18 | $270.75 | $102.62 – $189.15 | 6 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $263.12 – $456.51 | 6 |
| Vaccine dtap-ipv/hib im CPT 90698 | $187.87 | $507.75 | $164.69 – $328.33 | 6 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $48.14 | $130.10 | $44.58 – $81.93 | 6 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | not published | not published | $19.26 – $33.85 | 6 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $92.87 | $251.00 | $88.04 – $179.02 | 6 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | $108.78 | $294.00 | $162.35 – $332.15 | 6 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $80.75 | $218.25 | $51.63 – $98.98 | 6 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | $49.21 | $133.00 | $35.51 – $85.85 | 3 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | $48.14 | $130.09 | $91.68 – $187.86 | 6 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $67.71 | $183.00 | $85.86 – $175.94 | 6 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | not published | not published | $216.62 – $420.75 | 6 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $67.34 | $182.00 | $38.64 – $76.93 | 6 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $655.27 | $1,771.00 | $450.16 – $765.65 | 6 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | not published | not published | $128.26 – $456.13 | 6 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $156.05 | $421.75 | $101.86 – $208.73 | 6 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | not published | not published | $101.86 – $208.73 | 6 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | $48.29 | $130.50 | $26.67 – $54.65 | 6 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $48.29 | $130.50 | $27.27 – $55.88 | 6 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | $158.27 | $427.75 | $30.98 – $213.88 | 6 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | not published | not published | $114.21 – $193.40 | 5 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | $108.41 | $293.00 | $32.10 – $146.50 | 6 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $79.37 | $214.50 | $33.15 – $107.25 | 6 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | not published | not published | $15.50 – $26.10 | 5 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | not published | not published | $37.08 – $69.48 | 6 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | not published | not published | $108.38 – $183.50 | 5 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $45.79 | $123.75 | $44.96 – $92.13 | 6 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | $9.25 | $25.00 | $13.33 – $27.33 | 6 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $163.54 | $442.00 | $313.76 – $515.83 | 6 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | $354.55 | $958.25 | $303.33 – $319.64 | 6 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | not published | not published | $251.58 – $288.92 | 4 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $247.62 | $669.25 | $226.37 – $410.58 | 6 |
| Vaccine mmr live subcutaneous CPT 90707 | $52.17 | $141.00 | $138.82 – $247.78 | 6 |
| Vaccine mmrv live subcutaneous CPT 90710 | $202.11 | $546.25 | $406.49 – $773.83 | 6 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $150.13 | $405.75 | $162.83 – $333.68 | 6 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | $306.27 | $827.75 | $314.75 – $644.97 | 6 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | not published | not published | $318.60 – $633.90 | 6 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $506.16 | $1,368.00 | $381.74 – $745.09 | 6 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | not published | not published | $65.31 – $115.50 | 6 |
| Vaccine rabies im CPT 90675 | $482.70 | $1,304.59 | $304.96 – $819.44 | 37 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | $628.72 | $1,699.25 | $449.16 – $752.25 | 6 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | not published | not published | $873.18 – $1,628.36 | 6 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | not published | not published | $814.18 – $1,268.45 | 6 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | not published | not published | $430.42 – $714.00 | 6 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | not published | not published | $143.37 – $372.48 | 6 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | $210.35 | $568.50 | $144.48 – $257.58 | 6 |
| Vaccine tdap >=7 years im CPT 90715 | $48.15 | $130.13 | $47.67 – $96.57 | 6 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $177.60 | $480.00 | $41.43 – $83.71 | 6 |
| Vaccine typhoid vicps im CPT 90691 | not published | not published | $144.14 – $309.20 | 6 |
| Vaccine varicella live subcutaneous CPT 90716 | $136.16 | $368.00 | $267.73 – $455.63 | 6 |
| Vaccine yellow fever live subcutaneous CPT 90717 | not published | not published | $215.43 – $376.28 | 6 |
| Vaccinia vrs vac 0.3 ml perq CPT 90622 | not published | not published | $0.01 – $0.02 | 35 |
| Vacuum drain bottle/tube kit HCPCS A7048 | $322.92 | $872.75 | $148.60 – $148.60 | 2 |
| Vaginal bx CPT 58999 | not published | not published | $193.85 – $413.96 | 31 |
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.