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 |
|---|---|---|---|---|
| Smear gram stain CPT 87205 | $147.00 | $420.00 | $3.07 – $420.00 | 40 |
| Smear nasal eosinophil CPT 89190 | $38.50 | $110.00 | $4.17 – $110.00 | 40 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $44.45 | $127.00 | $4.31 – $127.00 | 39 |
| Smear wet mount CPT 87210 | $82.60 | $236.00 | $4.19 – $236.00 | 40 |
| Sodium 24 hour urine CPT 84300 | $44.10 | $126.00 | $3.64 – $126.00 | 39 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $7.35 | $21.00 | $0.59 – $2.64 | 23 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $18.82 | $53.77 | $0.87 – $3.95 | 23 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $7.21 | $20.58 | $0.41 – $1.86 | 23 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $24.14 | $68.95 | $0.05 – $13.13 | 23 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $62.61 | $178.87 | $1.74 – $86.61 | 23 |
| Sodium hyaluronate 20 mg/2 ml syringe HCPCS J7321 | $269.10 | $768.85 | $92.26 – $768.85 | 23 |
| Sodium serum/plasma/whole blood CPT 84295 | $39.20 | $112.00 | $3.46 – $112.00 | 39 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $150.27 | $429.32 | $25.73 – $116.94 | 22 |
| Somatosensory testing CPT 95927 | $173.95 | $497.00 | $100.00 – $497.00 | 16 |
| Somatropin injection HCPCS J2941 | $112.60 | $321.69 | $59.54 – $321.69 | 23 |
| Special physics consult CPT 77370 | $2,781.10 | $7,946.00 | $185.22 – $7,946.00 | 19 |
| Special pump services CPT 99190 | $238.35 | $681.00 | $100.00 – $681.00 | 16 |
| Special radiation dosimetry CPT 77331 | $112.00 | $320.00 | $28.41 – $320.00 | 18 |
| Special radiation treatment CPT 77470 | $3,141.95 | $8,977.00 | $37.89 – $8,977.00 | 19 |
| Special teletx port plan CPT 77321 | $1,542.45 | $4,407.00 | $65.25 – $4,407.00 | 18 |
| Specific gravity body fluid CPT 84315 | $22.40 | $64.00 | $2.36 – $64.00 | 39 |
| Specimen fat stain CPT 89125 | $28.70 | $82.00 | $4.23 – $82.00 | 40 |
| Sphenoid sinus surgery CPT 31051 | not published | not published | $1,929.00 – $1,929.00 | 1 |
| Sphincteroplasty inc/prolapse adult 46750 CPT 46750 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,234.80 | $3,528.00 | $952.56 – $3,528.00 | 16 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $833.35 | $2,381.00 | $68.93 – $2,381.00 | 16 |
| Spleen imaging CPT 78185 | $539.70 | $1,542.00 | $123.36 – $1,542.00 | 23 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $18.90 | $54.00 | $11.34 – $54.00 | 20 |
| Splint finger frog med HCPCS L3927 | $37.23 | $106.37 | $22.34 – $106.37 | 20 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Split blood or products CPT 86985 | $92.75 | $265.00 | $61.97 – $265.00 | 17 |
| Splt agrft f/s/n/h/f/g/m ea CPT 15121 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | $8,479.80 | $24,228.00 | $2,095.19 – $24,228.00 | 16 |
| Srsf2 gene common variants CPT 81348 | $276.85 | $791.00 | $126.29 – $791.00 | 37 |
| Srs linear based CPT 77372 | $23,033.50 | $65,810.00 | $1,591.14 – $65,810.00 | 19 |
| Srs multisource CPT 77371 | $42,976.15 | $122,789.00 | $1,591.14 – $122,789.00 | 19 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $372.05 | $1,063.00 | $100.00 – $1,063.00 | 16 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $191.80 | $548.00 | $100.00 – $548.00 | 16 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $19,250.00 | $55,000.00 | $14,850.00 – $55,000.00 | 19 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $80,850.00 | $231,000.00 | $0.27 – $419.90 | 23 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $3,452.30 | $9,863.70 | $10.57 – $50.30 | 23 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $71,644.13 | $204,697.50 | $0.27 – $102.38 | 23 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $3,307.50 | $9,450.00 | $981.23 – $4,672.50 | 23 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $12,390.35 | $35,401.00 | $8,602.47 – $31,861.00 | 19 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $4,956.35 | $14,161.00 | $100.00 – $14,161.00 | 22 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $7,073.15 | $20,209.00 | $5,456.43 – $20,209.00 | 19 |
| St evaluate speech sound production CPT 92522 | $194.60 | $556.00 | $100.00 – $556.00 | 16 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $284.90 | $814.00 | $100.00 – $814.00 | 16 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $400.40 | $1,144.00 | $100.00 – $1,144.00 | 16 |
| St evaluation swallow function CPT 92610 | $298.20 | $852.00 | $100.00 – $852.00 | 16 |
| Stimulation of spinal cord CPT 63610 | not published | not published | $958.00 – $958.00 | 1 |
| Strapping of elbow or wrist 29260 CPT 29260 | $86.80 | $248.00 | $19.84 – $248.00 | 24 |
| Strep b dna amp probe CPT 87653 | $422.80 | $1,208.00 | $25.26 – $1,208.00 | 39 |
| Streptomycin injection HCPCS J3000 | $50.02 | $142.90 | $31.44 – $142.90 | 23 |
| Streptozocin injection HCPCS J9320 | $954.71 | $2,727.74 | $392.08 – $2,727.74 | 23 |
| Stress test pulmonary CPT 94618 | $211.05 | $603.00 | $100.00 – $603.00 | 16 |
| Stress tte complete CPT 93351 | $2,513.00 | $7,180.00 | $100.00 – $7,180.00 | 16 |
| St treatment speech individual CPT 92507 | $216.30 | $618.00 | $100.00 – $618.00 | 16 |
| St treatment swallow dysfunction/oral CPT 92526 | $141.40 | $404.00 | $100.00 – $404.00 | 16 |
| Subsequent repair of nerve CPT 64872 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $94.93 | $271.21 | $1.45 – $55.54 | 23 |
| Suction lipectomy head&neck CPT 15876 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Suction lipectomy lwr extrem CPT 15879 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Suction lipectomy trunk CPT 15877 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Suction lipectomy upr extrem CPT 15878 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution HCPCS C9399 | $4,207.07 | $12,020.20 | $301.44 – $1,370.14 | 22 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $291.52 | $832.89 | $15.37 – $69.84 | 23 |
| Support clav 29.6-40.5in med HCPCS L3650 | $15.73 | $44.94 | $9.44 – $44.94 | 20 |
| Surg dx exam anorectal CPT 45990 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Surgery for urethra pouch CPT 53240 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Surgical opening of throat CPT 42955 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Surgical pathology level 1 gross examination only CPT 88300 | $122.50 | $350.00 | $26.21 – $350.00 | 18 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $273.70 | $782.00 | $33.57 – $782.00 | 18 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $322.70 | $922.00 | $67.05 – $922.00 | 18 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $408.10 | $1,166.00 | $67.05 – $1,166.00 | 18 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $534.80 | $1,528.00 | $323.15 – $1,528.00 | 18 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,093.75 | $3,125.00 | $708.41 – $3,125.00 | 18 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | not published | not published | $958.00 – $958.00 | 1 |
| Susceptibility agar dilution per agent CPT 87181 | $42.70 | $122.00 | $3.42 – $122.00 | 39 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $36.40 | $104.00 | $3.42 – $104.00 | 39 |
| Susceptibility mic per plate CPT 87186 | $172.20 | $492.00 | $6.23 – $492.00 | 39 |
| Suscept studies macrobroth dilution ea CPT 87188 | $43.05 | $123.00 | $4.78 – $123.00 | 39 |
| Suspension of testis CPT 54620 | not published | not published | $1,609.00 – $1,609.00 | 1 |
| Svc venogram s&i CPT 75827 | $1,691.55 | $4,833.00 | $118.95 – $4,833.00 | 23 |
| Sympathectomy cervical CPT 64802 | not published | not published | $1,285.00 – $1,285.00 | 1 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $46.90 | $134.00 | $3.17 – $134.00 | 40 |
| System cardiomems hosp electronics HCPCS C2624 | $68,860.05 | $196,743.00 | $100.00 – $127,882.95 | 23 |
| System pacing micra av HCPCS C1786 | $89,302.50 | $255,150.00 | $0.21 – $1.00 | 23 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $75,466.13 | $215,617.50 | $0.21 – $1.00 | 23 |
| T3 (triiodothyronine) free CPT 84481 | $40.95 | $117.00 | $12.20 – $117.00 | 39 |
| T3 (triiodothyronine) total CPT 84480 | $130.20 | $372.00 | $10.21 – $372.00 | 39 |
| T4 (thyroxine) free CPT 84439 | $62.65 | $179.00 | $6.49 – $179.00 | 39 |
| T4 (thyroxine) total CPT 84436 | $83.30 | $238.00 | $4.95 – $238.00 | 39 |
| Tacrol envarsus ex rel oral HCPCS J7503 | $1.93 | $5.49 | $1.21 – $5.48 | 23 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $12.25 | $34.98 | $0.06 – $0.25 | 23 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $373.01 | $1,065.73 | $220.28 – $1,065.73 | 23 |
| Tacrolimus therapeutic drug level CPT 80197 | $233.10 | $666.00 | $9.89 – $666.00 | 39 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | $26,747.47 | $76,421.33 | $1,338.41 – $6,083.65 | 22 |
| Tap block bilat cont infusion 64489 CPT 64489 | $520.80 | $1,488.00 | $100.00 – $1,488.00 | 16 |
| Tap block uni by cont infusion 64487 CPT 64487 | $390.60 | $1,116.00 | $100.00 – $1,116.00 | 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.