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Ascension St. Vincent's Southside (St. Luke's-St. Vincent's HealthCare, Inc.)

4201 Belfort Rd, Jacksonville, FL · Ascension · · NPI 1396926747

Source: hospital's published price file ↗ · Published Jan 1, 2026 · Ingested Sep 7, 2026

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
X-ray foot 2 views (both sides) CPT 73620 $194.90 $526.75 $58.23 – $194.81 33
X-ray forearm 2 views (both sides) CPT 73090 $231.71 $626.25 $59.26 – $194.81 33
X-ray hand 2 views (both sides) CPT 73120 $189.53 $512.25 $63.39 – $235.69 33
X-ray head for orthodontia CPT 70350 not published not published $24.19 – $194.81 33
X-ray heel/calcaneus > 2 views (both sides) CPT 73650 $226.44 $612.00 $58.23 – $194.81 33
X-ray hip uni w/wo pelvis min 4 views CPT 73503 $239.39 $647.00 $102.47 – $235.69 33
X-ray hip with pelvis when performed bilateral 2 views CPT 73521 $254.28 $687.25 $82.99 – $235.69 33
X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 $265.75 $718.25 $102.47 – $235.69 33
X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 $278.52 $752.75 $102.47 – $235.69 33
X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 $199.34 $538.75 $64.42 – $194.81 33
X-ray humerus >= 2 views left CPT 73060 $196.93 $532.25 $66.47 – $194.81 33
X-ray joint survey 1 view CPT 77077 not published not published $82.99 – $235.69 33
X-ray knee 1-2 views (both sides) CPT 73560 $263.26 $711.50 $72.66 – $194.81 33
X-ray knee 3 views (both sides) CPT 73562 $294.43 $795.75 $84.84 – $194.81 33
X-ray knee ap standing bilateral CPT 73565 $236.43 $639.00 $84.84 – $194.81 33
X-ray lower extremities infant > 2 views (both sides) CPT 73592 $137.64 $372.00 $64.42 – $194.81 33
X-ray l/s-spine bend vw only 2-3 vw CPT 72120 not published not published $81.93 – $235.69 33
X-ray lumbosacral spine >= 4 views CPT 72110 $463.98 $1,254.00 $102.47 – $235.69 33
X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 not published not published $102.47 – $235.69 33
X-ray male genital tract CPT 74440 not published not published $213.91 – $525.31 33
X-ray mandible complete > 4 views CPT 70110 $258.08 $697.50 $86.07 – $235.69 33
X-ray mandible ltd <4 views CPT 70100 not published not published $79.88 – $194.81 33
X-ray measurement of pelvis CPT 74710 not published not published $65.44 – $65.44 1
X-ray nasal bones complete > 3 views CPT 70160 $269.55 $728.50 $79.88 – $194.81 33
X-ray neck soft tissue CPT 70360 $199.25 $538.50 $62.36 – $194.81 33
X-ray nose to rectum for foreign body child CPT 76010 $199.71 $539.75 $57.20 – $194.81 33
X-ray of mammary ducts CPT 77054 not published not published $147.92 – $525.31 33
X-ray optic foramina CPT 70190 not published not published $78.86 – $194.81 33
X-ray pelvis 1-2 views CPT 72170 $188.15 $508.50 $57.20 – $235.69 33
X-ray pelvis complete > 3 views CPT 72190 not published not published $80.91 – $235.69 33
Xray place dist ext thor ao CPT 75959 not published not published not published 0
Xray place prox ext thor ao CPT 75958 not published not published not published 0
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 not published not published $140.70 – $824.45 33
X-ray ribs 2 views left CPT 71100 $334.02 $902.75 $70.60 – $194.81 33
X-ray ribs 3 views bilateral CPT 71110 $301.09 $813.75 $81.93 – $235.69 33
X-ray ribs w/posterior anterior chest 3 views left CPT 71101 $340.03 $919.00 $79.88 – $235.69 33
X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 $496.08 $1,340.75 $101.54 – $235.69 33
X-ray sacroiliac joints >= 3 views CPT 72202 not published not published $76.80 – $235.69 33
X-ray sacrum/coccyx >= 2 views CPT 72220 $207.57 $561.00 $65.44 – $194.81 33
X-ray scapula complete (both sides) CPT 73010 $277.13 $749.00 $54.12 – $235.69 33
X-ray sella turcica CPT 70240 not published not published $68.56 – $194.81 33
X-ray shoulder 1 view (both sides) CPT 73020 $110.08 $297.50 $39.68 – $194.81 33
X-ray sinuses paranasal complete > 3 views CPT 70220 $263.44 $712.00 $73.69 – $194.81 33
X-ray sinus tract/fistula/abscess CPT 76080 not published not published $96.37 – $1,182.67 33
X-ray skull < 4 views CPT 70250 $267.14 $722.00 $73.69 – $235.69 33
X-ray skull > 4 views complete CPT 70260 not published not published $86.07 – $235.69 33
X-ray slg plne bdy sect without urogr CPT 76100 not published not published $102.47 – $235.69 33
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 not published not published $171.54 – $393.89 33
X-ray small intestine follow-through study CPT 74248 not published not published $137.14 – $137.14 1
X-ray spine single view CPT 72020 $302.29 $817.00 $46.90 – $194.81 33
X-ray sternoclavicular joint(s) > 3 views CPT 71130 $307.01 $829.75 $82.99 – $194.81 33
X-ray sternum > 2 views CPT 71120 $259.09 $700.25 $65.44 – $194.81 33
X-ray surgical specimen CPT 76098 not published not published $78.86 – $1,182.67 33
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 not published not published $171.54 – $393.89 33
X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 not published not published $84.84 – $194.81 33
X-ray thoracic spine 2 views CPT 72070 not published not published $62.36 – $235.69 33
X-ray thoracic spine 3 views CPT 72072 $179.45 $485.00 $77.83 – $235.69 33
X-ray thoracolumbar spine >=2 views CPT 72080 $197.86 $534.75 $67.50 – $194.81 33
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 not published not published $81.93 – $194.81 33
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 $233.19 $630.25 $102.47 – $235.69 33
X-ray tibia/fibula 2 views (both sides) CPT 73590 $269.45 $728.25 $65.44 – $194.81 33
X-ray toe(s) > 2 views (both sides) CPT 73660 $163.73 $442.50 $62.36 – $194.81 33
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 not published not published $171.54 – $393.89 33
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 not published not published $171.54 – $393.89 33
X-ray wrist 2 views (both sides) CPT 73100 $210.62 $569.25 $70.60 – $194.81 33
X-ray xm phrnx&/crv esoph c+ CPT 74210 not published not published $171.54 – $393.89 33
Xtrnl ecg rec>48hr<7d CPT 93241 not published not published $614.53 – $1,636.00 3
Xtrnl ecg rec up to 48 hrs CPT 93224 not published not published $163.55 – $1,636.00 3
Xylose absorption test blood &/or urine CPT 84620 not published not published $11.36 – $32.28 35
Yersinia antibody CPT 86793 not published not published $11.61 – $32.98 35
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 $4.38 $11.83 $1.84 – $2.27 4
Zika virus dna/rna amp probe CPT 87662 $59.66 $161.25 $45.15 – $128.28 35
Zika virus igm antibody CPT 86794 $33.30 $90.00 $14.83 – $42.13 35
Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 $42.04 $113.61 $6.32 – $10.79 4
Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 $44.47 $120.20 $8.40 – $11.61 4
Zoster vaccine-live inj CPT 90736 not published not published $162.19 – $606.10 6
Zrsr2 gene common variants CPT 81360 not published not published $185.52 – $483.13 34

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.