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 |
|---|---|---|---|---|
| Laparo new ureter/bladder CPT 50947 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laparo new ureter/bladder CPT 50948 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laparoscopic myomectomy CPT 58545 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laparoscopic salpingostomy 58673 CPT 58673 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Laparoscopy aspiration CPT 49322 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Laparoscopy biopsy CPT 49321 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Laparoscopy excise lesions CPT 58662 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Laparoscopy gastrostomy CPT 43653 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laparoscopy lymphadenectomy CPT 38571 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laparoscopy lymphadenectomy CPT 38572 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laparoscopy lymph node biop CPT 38570 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laparoscopy lysis CPT 58660 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Laparoscopy orchiectomy CPT 54690 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laparoscopy remove adnexa CPT 58661 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Laparoscopy tubal block 58671 CPT 58671 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Laparo sling operation 51992 CPT 51992 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Lap fimbrioplasty 58672 CPT 58672 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Lap ing hernia repair init CPT 49650 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Lap ing hernia repair recur CPT 49651 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Largsc w/removal lesion CPT 31578 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Largsc w/rmvl foreign bdy(s) CPT 31577 | $232.05 | $663.00 | $179.01 – $663.00 | 16 |
| Laryngoplasty laryngeal web CPT 31580 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Laryngoscope w/vc inj CPT 31570 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laryngoscop w/arytenoidectom CPT 31560 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Laryngoscop w/vc inj + scope CPT 31571 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laryngoscopy and dilation CPT 31528 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laryngoscopy and dilation CPT 31529 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laryngoscopy direct w/wo tracheoscopy dx exc newborn CPT 31525 | $1,452.85 | $4,151.00 | $958.00 – $4,151.00 | 16 |
| Laryngoscopy for treatment CPT 31527 | not published | not published | $958.00 – $958.00 | 1 |
| Laryngoscopy w/biopsy CPT 31535 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laryngoscopy w/bx & op scope CPT 31536 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Laryngoscopy w/exc of tumor CPT 31540 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Laryngoscopy w/fb & op scope CPT 31531 | $3,087.70 | $8,822.00 | $1,609.00 – $8,822.00 | 16 |
| Laryngoscopy w/fb removal CPT 31530 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laryngoscopy with biopsy CPT 31576 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laryngoscopy with biopsy 31510 CPT 31510 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laryngoscopy w/w/o tracheoscopy aspiration CPT 31515 | not published | not published | $958.00 – $958.00 | 1 |
| Larynscop remve cart + scop CPT 31561 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Larynscop w/tumr exc + scope CPT 31541 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Laser surgery eye strands CPT 67031 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laser surgery of cervix 57513 CPT 57513 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Laser surgery of prostate CPT 52647 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laser surgery of prostate CPT 52648 | not published | not published | $5,460.00 – $5,460.00 | 1 |
| Laser surg penis lesion(s) CPT 54057 | not published | not published | $958.00 – $958.00 | 1 |
| Laser treatment of retina CPT 67039 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Laser treatment of retina CPT 67040 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Lateral canthopexy CPT 21282 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Lat retinacular release open CPT 27425 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Lb with mastopexy 15839 CPT 15839 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $9,555.00 | $27,300.00 | $0.21 – $1.00 | 23 |
| Lead capillary CPT 83655 | $46.55 | $133.00 | $8.72 – $133.00 | 39 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $2,887.50 | $8,250.00 | $0.21 – $1.00 | 23 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $22,417.50 | $64,050.00 | $0.21 – $1.00 | 23 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,336.65 | $3,819.00 | $188.79 – $3,819.00 | 21 |
| Lengthening of hand tendon CPT 26478 | not published | not published | $958.00 – $958.00 | 1 |
| Lengthening of palate+pharyngeal flap 42226 CPT 42226 | not published | not published | $2,177.00 – $2,177.00 | 1 |
| Lengthening of thigh tendon CPT 27393 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Lengthening of thigh tendons CPT 27394 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Lengthening of thigh tendons CPT 27395 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Lengthen metacarpal/finger CPT 26568 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Lengthen radius or ulna CPT 25391 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Lengthen radius & ulna CPT 25393 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Lens, intraocular (new tech) HCPCS C1780 | $312.38 | $892.50 | $100.00 – $892.50 | 22 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $3,675.00 | $10,500.00 | $100.00 – $750.00 | 22 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $1,819.13 | $5,197.50 | $100.00 – $525.00 | 22 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $735.00 | $2,100.00 | $100.00 – $646.00 | 22 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $113.50 | $324.28 | $2.80 – $56.62 | 23 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $831.70 | $2,376.28 | $230.09 – $1,045.86 | 23 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $12,963.00 | $37,037.13 | $828.52 – $12,599.33 | 23 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $40.05 | $114.42 | $0.07 – $55.25 | 23 |
| Levetiracetam therapeutic drug level CPT 80177 | $57.40 | $164.00 | $9.54 – $164.00 | 39 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $371.48 | $1,061.36 | $1.57 – $59.43 | 23 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $187.29 | $535.11 | $26.25 – $119.28 | 22 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | $10,973.90 | $31,354.00 | $100.00 – $31,354.00 | 18 |
| Liberta rc ipg HCPCS C1820 | $97,020.00 | $277,200.00 | $0.27 – $1,706.25 | 23 |
| Lidocaine injection HCPCS J2001 | $26.64 | $76.10 | $11.87 – $53.94 | 22 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $31.21 | $89.16 | $12.05 – $54.77 | 22 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $27.97 | $79.90 | $17.58 – $79.90 | 22 |
| Lidocaine therapeutic drug level CPT 80176 | $70.70 | $202.00 | $10.58 – $202.00 | 39 |
| Ligate leg veins radical 37760 CPT 37760 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Ligate/strip long leg vein CPT 37722 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Ligate/strip short leg vein CPT 37718 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Ligation/major artery/extremity 37618 CPT 37618 | $2,636.90 | $7,534.00 | $602.72 – $7,534.00 | 22 |
| Ligation nasal sinus artery CPT 30915 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Ligation of femoral vein CPT 37650 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Ligation of salivary duct CPT 42665 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Ligation upper jaw artery CPT 30920 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Lig/band angioaccess av fistula CPT 37607 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Lig&div&compl strpg saph vn CPT 37735 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Liletta, 52 mg HCPCS J7297 | $2,360.29 | $6,743.68 | $816.85 – $6,743.68 | 23 |
| Limb nerve surgery add-on CPT 64783 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $125.66 | $359.01 | $4.26 – $83.18 | 23 |
| Lipase CPT 83690 | $160.65 | $459.00 | $4.96 – $459.00 | 39 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Lipoprotein direct measurement hdl CPT 83718 | $60.90 | $174.00 | $5.90 – $174.00 | 39 |
| Lithium therapeutic drug level CPT 80178 | $60.55 | $173.00 | $4.76 – $173.00 | 39 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $4,824.75 | $13,785.00 | $100.00 – $13,785.00 | 18 |
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.