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 |
|---|---|---|---|---|
| Liver Function Test CPT 80076 | $326.55 | $933.00 | $5.88 – $933.00 | 39 |
| Liver/spleen imag static only CPT 78215 | $444.50 | $1,270.00 | $101.60 – $1,270.00 | 23 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $954.80 | $2,728.00 | $128.64 – $2,728.00 | 23 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $1.75 | $5.00 | $0.73 – $5.00 | 23 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | $67,730.25 | $193,515.00 | $42,573.30 – $193,515.00 | 22 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $52.60 | $150.28 | $0.40 – $53.52 | 23 |
| Low cost skin substitute app HCPCS C5271 | $518.00 | $1,480.00 | $90.00 – $1,480.00 | 18 |
| Low cost skin substitute app HCPCS C5275 | $518.00 | $1,480.00 | $90.00 – $1,480.00 | 18 |
| Low cost skin substitute app HCPCS C5272 | $73.50 | $210.00 | $36.00 – $210.00 | 19 |
| Low cost skin substitute app HCPCS C5276 | $408.45 | $1,167.00 | $36.00 – $1,167.00 | 19 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $5,346.60 | $15,276.00 | $175.06 – $15,276.00 | 24 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $4,547.90 | $12,994.00 | $173.75 – $12,994.00 | 24 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $3,471.65 | $9,919.00 | $104.75 – $9,919.00 | 24 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $5,892.95 | $16,837.00 | $329.13 – $16,837.00 | 24 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $5,010.95 | $14,317.00 | $279.00 – $14,317.00 | 24 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $3,528.70 | $10,082.00 | $197.14 – $10,082.00 | 24 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $713.65 | $2,039.00 | $40.10 – $2,039.00 | 23 |
| Lower jaw bone graft CPT 21215 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Lumbar diskogram s&i CPT 72295 | $1,321.60 | $3,776.00 | $111.26 – $3,776.00 | 23 |
| Lumizyme injection HCPCS J0221 | $2,274.33 | $6,498.08 | $172.69 – $6,498.08 | 23 |
| Lung Function Test (Spirometry) CPT 94010 | $339.50 | $970.00 | $100.00 – $970.00 | 16 |
| Lung perfusion imaging CPT 78580 | $724.15 | $2,069.00 | $165.52 – $2,069.00 | 23 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $20,566.53 | $58,761.51 | $186.17 – $58,761.51 | 23 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $29,435.46 | $84,101.30 | $37.35 – $28,268.79 | 23 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $277.90 | $794.00 | $206.44 – $794.00 | 17 |
| Lutetium lu 177 vipivotide HCPCS A9607 | $480.20 | $1,372.00 | $100.00 – $1,372.00 | 15 |
| Lvad shower bag heartmate HCPCS Q0501 | $1,696.10 | $4,846.00 | $791.28 – $3,768.00 | 20 |
| Lymphatics/lymph node imaging CPT 78195 | $1,491.70 | $4,262.00 | $329.79 – $4,262.00 | 23 |
| Lymphocyte transformation mitogen CPT 86353 | $44.45 | $127.00 | $34.29 – $159.35 | 39 |
| Lymphocytotoxicity assay CPT 86805 | $241.15 | $689.00 | $136.45 – $689.00 | 39 |
| Lymph vessel x-ray trunk CPT 75805 | $3,310.30 | $9,458.00 | $140.00 – $9,458.00 | 23 |
| Lymph vessel x-ray trunk CPT 75807 | $4,792.55 | $13,693.00 | $140.00 – $13,693.00 | 23 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $958.00 – $958.00 | 1 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Magnesium CPT 83735 | $168.70 | $482.00 | $4.82 – $482.00 | 39 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $58.44 | $166.96 | $0.06 – $0.25 | 23 |
| Magnetic image bone marrow CPT 77084 | $1,301.65 | $3,719.00 | $233.47 – $3,719.00 | 24 |
| Makena, 10 mg HCPCS J1726 | $119.03 | $340.07 | $19.73 – $340.07 | 22 |
| Male sling procedure CPT 53440 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Mammosite ced HCPCS C1728 | $5,212.99 | $14,894.25 | $100.00 – $14,894.25 | 15 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $135.80 | $388.00 | $100.00 – $388.00 | 16 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $128.80 | $368.00 | $99.36 – $368.00 | 16 |
| Manipulation of hip joint CPT 27275 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Manipulation of spine CPT 22505 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $23.22 | $66.32 | $3.35 – $28.84 | 23 |
| Manual diff wbc count b-coat CPT 85009 | $33.95 | $97.00 | $3.65 – $97.00 | 40 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | $106.75 | $305.00 | $82.35 – $305.00 | 16 |
| Map tachycard site(s) CPT 93609 | $1,641.85 | $4,691.00 | $100.00 – $4,691.00 | 17 |
| Marker biop eviva buckle ss HCPCS A4648 | $3,583.13 | $10,237.50 | $7.56 – $36.00 | 23 |
| Mastectomy partial CPT 19301 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Mastoidectomy CPT 69501 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Mastoids complete CPT 70130 | $106.40 | $304.00 | $24.32 – $304.00 | 23 |
| Mastoid surgery revision CPT 69603 | not published | not published | $3,115.00 – $3,115.00 | 1 |
| Mastopexy CPT 19316 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Mast simple complete CPT 19303 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Maxillofacial fixation CPT 21100 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $126.00 | $360.00 | $10.41 – $360.00 | 39 |
| Mayo aathr protein s free CPT 85306 | $204.75 | $585.00 | $11.03 – $585.00 | 39 |
| Mayo activated protein c resistance assay CPT 85307 | $173.25 | $495.00 | $11.03 – $495.00 | 39 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $59.50 | $170.00 | $11.31 – $170.00 | 21 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $127.05 | $363.00 | $10.64 – $363.00 | 39 |
| Mayo alpha 1 antitrypsin CPT 82103 | $131.25 | $375.00 | $9.68 – $375.00 | 39 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $46.55 | $133.00 | $10.86 – $133.00 | 39 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $1,454.25 | $4,155.00 | $87.57 – $4,155.00 | 39 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $233.45 | $667.00 | $66.00 – $667.00 | 40 |
| Mayo androstenedione CPT 82157 | $99.40 | $284.00 | $21.08 – $284.00 | 39 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $81.20 | $232.00 | $10.51 – $232.00 | 39 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $73.50 | $210.00 | $10.84 – $210.00 | 40 |
| Mayo avwpr vw factor activity CPT 85397 | $171.50 | $490.00 | $22.22 – $490.00 | 39 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $44.45 | $127.00 | $7.33 – $127.00 | 40 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $292.25 | $835.00 | $104.28 – $835.00 | 40 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $42.00 | $120.00 | $9.29 – $120.00 | 40 |
| Mayo brcmg brucella antibody igm CPT 86622 | $45.15 | $129.00 | $6.43 – $129.00 | 40 |
| Mayo c1 esterase inhibitor CPT 83883 | $90.30 | $258.00 | $9.79 – $258.00 | 39 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $195.30 | $558.00 | $19.28 – $558.00 | 39 |
| Mayo ceruloplasmin CPT 82390 | $95.55 | $273.00 | $7.73 – $273.00 | 39 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $44.10 | $126.00 | $10.17 – $126.00 | 39 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $92.75 | $265.00 | $9.27 – $265.00 | 39 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $202.65 | $579.00 | $83.87 – $579.00 | 40 |
| Mayo coccidioides antibody CPT 86635 | $53.90 | $154.00 | $8.26 – $154.00 | 40 |
| Mayo cocou cortisone urine CPT 82542 | $123.20 | $352.00 | $17.34 – $352.00 | 39 |
| Mayo cortisol free CPT 82530 | $46.55 | $133.00 | $12.03 – $133.00 | 39 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $73.85 | $211.00 | $30.33 – $211.00 | 39 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $35.35 | $101.00 | $8.73 – $101.00 | 40 |
| Mayo cyanide CPT 82600 | $38.15 | $109.00 | $13.97 – $109.00 | 39 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $44.10 | $126.00 | $18.19 – $126.00 | 39 |
| Mayo efpo chloride stool CPT 82438 | $29.05 | $83.00 | $3.60 – $83.00 | 39 |
| Mayo estriol CPT 82677 | $75.25 | $215.00 | $17.41 – $215.00 | 39 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $64.75 | $185.00 | $11.76 – $185.00 | 39 |
| Mayo factor ii CPT 85210 | $79.10 | $226.00 | $9.35 – $226.00 | 39 |
| Mayo factor v CPT 85220 | $220.50 | $630.00 | $12.71 – $630.00 | 39 |
| Mayo factor vii CPT 85230 | $198.80 | $568.00 | $12.89 – $568.00 | 39 |
| Mayo factor viii vw factor antigen CPT 85246 | $99.40 | $284.00 | $16.52 – $284.00 | 39 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $192.15 | $549.00 | $16.52 – $549.00 | 39 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $121.80 | $348.00 | $16.52 – $348.00 | 39 |
| Mayo factor x CPT 85260 | $196.35 | $561.00 | $12.89 – $561.00 | 39 |
| Mayo factor xi CPT 85270 | $113.05 | $323.00 | $12.89 – $323.00 | 39 |
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.