St. Luke's Health - The Vintage Hospital
20171 Chasewood Park Drive, Houston, TX · CommonSpirit Health · · NPI 1710314141
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 |
|---|---|---|---|---|
| Hydration IV infusion initial 31minutes - 1 hour CPT 96360 | $534.45 | $1,527.00 | $56.30 – $1,527.00 | 16 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | $120.36 | $343.86 | $10.83 – $51.53 | 23 |
| Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) HCPCS J1171 | $145.92 | $416.90 | $12.49 – $56.74 | 22 |
| Hydroxyzine hcl 50 mg/ml intramuscular solution HCPCS J3410 | $49.32 | $140.90 | $0.74 – $79.87 | 23 |
| Hydrxycorticsterds 17- (17-ohcs) CPT 83491 | $21.35 | $61.00 | $12.89 – $61.00 | 39 |
| Hymenotomy CPT 56442 | not published | not published | $958.00 – $958.00 | 1 |
| Hyoscyamine sulfate inj HCPCS J1980 | $61.29 | $175.11 | $12.94 – $147.09 | 23 |
| Hysterosalpingography s&i CPT 74740 | $530.60 | $1,516.00 | $66.83 – $1,516.00 | 23 |
| Hysteroscopy ablation CPT 58563 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Hysteroscopy biopsy CPT 58558 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Hysteroscopy dx sep proc CPT 58555 | not published | not published | $958.00 – $958.00 | 1 |
| Hysteroscopy lysis CPT 58559 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Hysteroscopy remove fb CPT 58562 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Hysteroscopy remove myoma CPT 58561 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Hysteroscopy resect septum CPT 58560 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Hzv zoster vacc recombinant adjuvanted im inj CPT 90750 | $272.59 | $778.82 | $144.76 – $658.00 | 23 |
| I-123 iobenguane diag HCPCS A9582 | $5,995.85 | $17,131.00 | $2,962.83 – $17,131.00 | 16 |
| I-123 ioflupane diag HCPCS A9584 | $4,077.15 | $11,649.00 | $100.00 – $11,649.00 | 16 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | $198.45 | $567.00 | $100.00 – $567.00 | 16 |
| I131 iodide cap, rx HCPCS A9517 | $24.85 | $71.00 | $18.46 – $71.00 | 16 |
| I131 iodide sol, rx HCPCS A9530 | $10.15 | $29.00 | $7.54 – $29.00 | 16 |
| I-131 sod iodide sol diag per mci HCPCS A9529 | $144.55 | $413.00 | $100.00 – $413.00 | 16 |
| Iaadi respiratory synctial virus CPT 87280 | $26.25 | $75.00 | $9.66 – $75.00 | 39 |
| Ia nfct ab sarscov2 covid19 CPT 86328 | $52.85 | $151.00 | $32.60 – $151.00 | 39 |
| Ibuprofen injection HCPCS J1741 | $75.56 | $215.87 | $2.19 – $84.48 | 23 |
| Ibutilide fumarate 0.1 mg/ml intravenous solution HCPCS J1742 | $302.25 | $863.57 | $79.84 – $362.88 | 23 |
| Icatibant injection HCPCS J1744 | $5,545.09 | $15,843.10 | $192.87 – $15,843.10 | 23 |
| Icd cobalt xt dr MRI is1 df1 HCPCS C1721 | $72,856.88 | $208,162.50 | $0.21 – $1.00 | 23 |
| Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 | $98,986.13 | $282,817.50 | $0.21 – $1.00 | 23 |
| Icd crtp serena MRI HCPCS C2621 | $30,484.13 | $87,097.50 | $7,827.75 – $37,275.00 | 23 |
| Icd reliance df4 ib 64cm HCPCS C1895 | $15,435.00 | $44,100.00 | $0.21 – $1.00 | 23 |
| I&d abscss rtrphryngl/paraphryngl intraorl apprch CPT 42720 | not published | not published | $958.00 – $958.00 | 1 |
| Idarubicin hcl injection HCPCS J9211 | $552.66 | $1,579.02 | $43.26 – $628.23 | 23 |
| I&d frarm&/wrst deep absc/hematoma CPT 25028 | not published | not published | $958.00 – $958.00 | 1 |
| I&d intramural/intramuscular/submuc abscess transanal anes CPT 46045 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| I&d upper arm/elbow deep abscess/hematoma CPT 23930 | not published | not published | $958.00 – $958.00 | 1 |
| I & d vag hematoma non-ob 57023 CPT 57023 | not published | not published | $958.00 – $958.00 | 1 |
| Ifosfamide 1 gram intravenous solution HCPCS J9208 | $409.57 | $1,170.18 | $27.01 – $555.24 | 23 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $187.60 | $536.00 | $94.18 – $536.00 | 18 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $296.45 | $847.00 | $228.69 – $847.00 | 18 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $272.30 | $778.00 | $161.82 – $778.00 | 18 |
| Iliac/fem angio cath insert HCPCS G0278 | $1,571.50 | $4,490.00 | $100.00 – $4,490.00 | 19 |
| Iliac revasc add-on 37222 CPT 37222 | $1,487.15 | $4,249.00 | $100.00 – $4,249.00 | 22 |
| Immobilizer shldr cntor adlt HCPCS L3670 | $146.30 | $418.00 | $79.80 – $380.00 | 20 |
| Immobilizer shldr dlx str 24-36in med HCPCS L1830 | $146.30 | $418.00 | $26.58 – $126.53 | 20 |
| Immt breast prosthesis 19340 CPT 19340 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution HCPCS J1569 | $1,497.37 | $4,278.18 | $50.77 – $4,278.18 | 23 |
| Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution HCPCS J1566 | $2,037.52 | $5,821.47 | $32.00 – $5,821.47 | 23 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | $6,891.95 | $19,691.28 | $70.40 – $1,641.69 | 23 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $126.00 | $360.00 | $14.98 – $360.00 | 39 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $122.50 | $350.00 | $14.98 – $350.00 | 39 |
| Immunofixation electrophoresis serum CPT 86334 | $138.60 | $396.00 | $16.08 – $396.00 | 39 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $277.55 | $793.00 | $65.34 – $793.00 | 17 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $567.35 | $1,621.00 | $285.75 – $1,264.00 | 18 |
| Immunoglobulin assay CPT 86023 | $59.85 | $171.00 | $8.97 – $171.00 | 39 |
| Immunology procedure CPT 86849 | $1.40 | $4.00 | $1.08 – $4.00 | 16 |
| Impedence cardiogram CPT 93701 | $102.20 | $292.00 | $78.84 – $292.00 | 16 |
| Implant 11 volt lithium-ion backup battery for controller pocket HCPCS Q0506 | $2,827.30 | $8,078.00 | $1,469.79 – $6,999.00 | 20 |
| Implant cartilage 10mm synthetic HCPCS L8699 | $25,088.70 | $71,682.00 | $0.27 – $195.00 | 23 |
| Implant cochlear device CPT 69930 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Implant cochlear osia osi300 HCPCS L8690 | $20,396.25 | $58,275.00 | $350.45 – $13,537.06 | 27 |
| Implant eye drug system CPT 67027 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Implant neuroelectrodes CPT 64553 | not published | not published | $958.00 – $958.00 | 1 |
| Implant neuroelectrodes CPT 64561 | $2,614.85 | $7,471.00 | $1,609.00 – $7,471.00 | 16 |
| Implant neurostim arrays CPT 61886 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Implant open hernia repair w/mesh 49568 CPT 49568 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Implant power module patient cable cable 14 volt HCPCS Q0477 | $4,275.95 | $12,217.00 | $2,565.57 – $12,217.00 | 20 |
| Implant spine infusion pump CPT 62361 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Implant spine infusion pump CPT 62362 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Implant tcat pulm vlv perq CPT 33477 | $8,654.45 | $24,727.00 | $1,978.16 – $24,727.00 | 19 |
| Implant ureth bulk agent HCPCS L8606 | $3,950.63 | $11,287.50 | $432.39 – $2,059.00 | 23 |
| Impl neurostim electr perc CPT 63650 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Implnt spinl canal catheter 62350 CPT 62350 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Impl oi implt skull perq esp CPT 69714 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Imuglucerase injection HCPCS J1786 | $3,965.20 | $11,329.12 | $43.65 – $11,329.12 | 23 |
| In-111 autol wbc diag per dose HCPCS A9570 | $3,927.00 | $11,220.00 | $100.00 – $11,220.00 | 16 |
| In-111 pentetate dtpa / 0.5 mci HCPCS A9548 | $1,541.75 | $4,405.00 | $100.00 – $4,405.00 | 16 |
| In-111 pentetreotide HCPCS A9572 | $6,028.40 | $17,224.00 | $100.00 – $17,224.00 | 16 |
| Inc dp bone crtx f/arm&/wrst CPT 25035 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Inc dp opn b1 crtx hum/elbw CPT 23935 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Incise diaphragm nerve CPT 64746 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Incise hand/finger tendon CPT 26460 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Incise inner ear CPT 69801 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Incise inner ear nerve CPT 69915 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Incise inner eye adhesions CPT 65865 | not published | not published | $958.00 – $958.00 | 1 |
| Incise inner eye adhesions CPT 65870 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Incise inner eye adhesions CPT 65875 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Incise inner eye adhesions CPT 65880 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Incise inner eye strands CPT 67030 | not published | not published | $958.00 – $958.00 | 1 |
| Incise nerve back of head CPT 64744 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Incise perq finger tendon 26060 CPT 26060 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Incise tendon(s) & muscle(s) CPT 23406 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Incise thigh tendon & fascia CPT 27305 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Incise wrist/forearm tendon CPT 25290 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $945.00 | $2,700.00 | $729.00 – $2,700.00 | 19 |
| Incision of achilles tendon CPT 27605 | not published | not published | $958.00 – $958.00 | 1 |
| Incision of achilles tendon CPT 27606 | not published | not published | $958.00 – $958.00 | 1 |
| Incision of anal sphincter CPT 46080 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Incision of ankle bone CPT 28302 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Incision of breast lesion CPT 19020 | $1,358.35 | $3,881.00 | $1,047.87 – $3,881.00 | 16 |
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.