St. Luke's Health - Patients Medical Center
4600 E. Sam Houston Parkway South, Pasadena, TX · CommonSpirit Health · · NPI 1407990088
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 |
|---|---|---|---|---|
| Giardia lamblia antibody CPT 86674 | $53.87 | $153.90 | $11.74 – $115.43 | 26 |
| Gi inhouse confirmation CPT 87045 | $141.86 | $405.30 | $7.53 – $303.98 | 25 |
| Glove finger flexion right lg xl HCPCS L3912 | $59.54 | $170.10 | $33.96 – $121.28 | 11 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $444.68 | $1,270.50 | $90.08 – $952.88 | 10 |
| Glucagon plasma - sendout CPT 82943 | $46.31 | $132.30 | $11.40 – $99.23 | 26 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $13.55 | $38.70 | $3.28 – $29.03 | 24 |
| Glucose blood quantitative CPT 82947 | $72.40 | $206.85 | $3.13 – $95.18 | 26 |
| Glucose body fluid CPT 82945 | $77.91 | $222.60 | $3.13 – $152.55 | 26 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $114.98 | $328.50 | $10.27 – $246.38 | 26 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $14.49 | $41.40 | $3.13 – $31.05 | 25 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $147.35 | $421.00 | $14.83 – $315.75 | 25 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $105.21 | $300.60 | $14.78 – $225.45 | 25 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $2,575.81 | $7,359.45 | $37.26 – $129.15 | 14 |
| Graft axiofill 1000mg HCPCS J3590 | $8,324.61 | $23,784.60 | $325.50 – $4,840.29 | 14 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $7,763.07 | $22,180.20 | $10.17 – $34.65 | 14 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $15,750.00 | $45,000.00 | $415.43 – $1,483.65 | 14 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $5,815.32 | $16,615.20 | $86.00 – $307.13 | 14 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $6,703.94 | $19,154.10 | $24.72 – $84.27 | 14 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $811.08 | $2,317.35 | $146.50 – $1,738.02 | 14 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $4,325.48 | $12,358.50 | $87.98 – $314.22 | 14 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $2,361.19 | $6,746.25 | $29.57 – $100.80 | 14 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | $816.22 | $2,332.05 | $478.14 – $1,749.04 | 14 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $49.62 | $141.75 | $21.39 – $76.39 | 14 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $492.09 | $1,405.95 | $195.42 – $1,054.47 | 14 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $19,459.86 | $55,599.60 | $43.66 – $155.93 | 14 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $349.50 | $998.55 | $66.60 – $237.83 | 14 |
| Great toe with reduction 28495 CPT 28495 | $79.07 | $225.90 | $135.54 – $169.43 | 8 |
| G-tube reposition CPT 43761 | $116.24 | $332.10 | $199.26 – $249.08 | 7 |
| Gu dilat ureter/urethra s&i CPT 74485 | $589.37 | $1,683.90 | $113.65 – $1,683.90 | 15 |
| Guided cath fluid drainage 10030 CPT 10030 | $374.85 | $1,071.00 | $642.60 – $803.25 | 8 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $2,048.08 | $5,851.65 | $6.40 – $19.80 | 14 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $534.35 | $1,526.70 | $54.47 – $177.19 | 14 |
| Gw stiffened micro access kit HCPCS C1894 | $1,167.60 | $3,336.00 | $0.01 – $1,071.53 | 14 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $3.68 | $10.50 | $1.73 – $10.50 | 11 |
| Hand X-ray CPT 73130 | $535.15 | $1,529.00 | $35.56 – $1,146.75 | 15 |
| Haptoglobin quantitative CPT 83010 | $126.70 | $362.00 | $10.04 – $271.50 | 25 |
| Hbot, full body chamber, 30m HCPCS G0277 | $349.30 | $998.00 | $100.00 – $1,296.00 | 9 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | $2,303.70 | $6,582.00 | $140.00 – $4,936.50 | 15 |
| Hcg quantitative CPT 84702 | $134.40 | $384.00 | $12.01 – $288.00 | 25 |
| Hc metata joint dislocation anes CPT 28635 | $868.46 | $2,481.30 | $1,488.78 – $1,860.98 | 7 |
| Hc nm kidney imaging with flow CPT 78701 | $1,531.25 | $4,375.00 | $200.62 – $3,281.25 | 15 |
| Head CT scan (with and without contrast) CPT 70470 | $4,055.45 | $11,587.00 | $166.31 – $8,690.25 | 16 |
| Head CT scan (with contrast) CPT 70460 | $3,462.20 | $9,892.00 | $144.74 – $7,419.00 | 16 |
| Head CT scan (without contrast) CPT 70450 | $2,473.10 | $7,066.00 | $99.51 – $5,299.50 | 16 |
| Helicobacter pylori antibody igm CPT 86677 | $80.91 | $231.15 | $13.44 – $141.75 | 26 |
| Hematocrit CPT 85014 | $87.15 | $249.00 | $1.89 – $114.00 | 26 |
| Hemoglobin CPT 85018 | $72.40 | $206.85 | $1.89 – $95.18 | 26 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $30.87 | $88.20 | $6.55 – $66.15 | 25 |
| Hemoglobin plasma CPT 83051 | $24.57 | $70.20 | $5.83 – $52.65 | 25 |
| Hemolysins/agglutinins auto CPT 86940 | $54.18 | $154.80 | $7.00 – $116.10 | 25 |
| Hemolysins and agglutinins incubated CPT 86941 | $60.20 | $172.00 | $9.66 – $129.00 | 25 |
| Hemophilus influenza antibdy CPT 86684 | $69.93 | $199.80 | $12.64 – $149.85 | 26 |
| Hemorrhoidectomy intrnl lig rbbr band ligations CPT 46221 | $327.92 | $936.90 | $562.14 – $702.68 | 8 |
| Heparin assay CPT 85520 | $76.55 | $218.70 | $10.45 – $164.03 | 25 |
| Heparin bolus from bag HCPCS J1644 | $15.75 | $45.00 | $0.15 – $7.35 | 11 |
| Heparin neutralization CPT 85525 | $55.13 | $157.50 | $9.45 – $118.13 | 25 |
| Hepatitis a antibody igm CPT 86709 | $90.72 | $259.20 | $8.99 – $194.40 | 26 |
| Hepatitis b core antibody igm CPT 86705 | $96.60 | $276.00 | $9.40 – $207.00 | 26 |
| Hepatitis b core antibody total CPT 86704 | $129.85 | $371.00 | $9.61 – $178.50 | 26 |
| Hepatitis b surface antibody CPT 86706 | $143.70 | $410.55 | $8.57 – $188.33 | 26 |
| Hepatitis c antibody CPT 86803 | $77.69 | $221.95 | $11.39 – $166.47 | 25 |
| Hepatobiliary system imaging CPT 78226 | $1,752.80 | $5,008.00 | $287.91 – $3,756.00 | 15 |
| Herpes simplex type 1 antibody igg CPT 86695 | $204.40 | $584.00 | $10.53 – $438.00 | 26 |
| Herpes simplex type 2 antibody igg CPT 86696 | $67.20 | $192.00 | $15.44 – $144.00 | 26 |
| Heterophile antibodies screening CPT 86308 | $121.45 | $347.00 | $4.13 – $260.25 | 26 |
| Hip X-ray CPT 73502 | $560.70 | $1,602.00 | $45.39 – $1,201.50 | 15 |
| Histamine CPT 83088 | $137.34 | $392.40 | $23.57 – $294.30 | 25 |
| Hiv-1 ag ia CPT 87390 | $84.67 | $241.90 | $19.20 – $150.53 | 25 |
| Hla class i high defin qual CPT 86832 | $189.00 | $540.00 | $258.35 – $540.00 | 25 |
| Hla class ii high defin qual CPT 86833 | $113.09 | $323.10 | $193.86 – $533.12 | 25 |
| Hla class i&ii antibody qual CPT 86828 | $114.03 | $325.80 | $51.22 – $244.35 | 25 |
| Hla class ii semiquant panel CPT 86835 | $1,677.38 | $4,792.50 | $257.73 – $3,594.38 | 25 |
| Hla class i semiquant panel CPT 86834 | $1,653.75 | $4,725.00 | $285.33 – $3,543.75 | 25 |
| Hla i & ii typing lr CPT 81370 | $2,335.41 | $6,672.60 | $320.89 – $5,004.45 | 26 |
| Hla typing a b or c CPT 86813 | $174.51 | $498.60 | $46.28 – $373.95 | 25 |
| Hla typing dr/dq CPT 86816 | $493.92 | $1,411.20 | $24.07 – $1,058.40 | 25 |
| Hla x-math non-cytotoxic CPT 86825 | $169.79 | $485.10 | $87.37 – $363.83 | 25 |
| Hocm 350-399mg/ml iodine,1ml HCPCS Q9963 | $34.18 | $97.65 | $0.21 – $73.24 | 9 |
| Home sleep test/type 3 porta HCPCS G0399 | $330.86 | $945.30 | $100.00 – $708.98 | 11 |
| Homocysteine CPT 83090 | $86.80 | $248.00 | $14.30 – $186.00 | 25 |
| Homovanillic acid (hva) CPT 83150 | $53.87 | $153.90 | $17.88 – $115.43 | 25 |
| Hyaluronidase 200 units/ml inj HCPCS J3471 | $2.58 | $7.35 | $0.45 – $7.35 | 11 |
| Hydration IV infusion each additional hour CPT 96361 | $197.72 | $564.90 | $19.99 – $423.68 | 9 |
| Hydration IV infusion initial 31minutes - 1 hour CPT 96360 | $520.80 | $1,488.00 | $56.30 – $1,116.00 | 9 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | $38.22 | $109.20 | $10.83 – $65.10 | 11 |
| Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) HCPCS J1171 | $2.21 | $6.30 | $3.78 – $6.30 | 8 |
| Hydroxyzine hcl 50 mg/ml intramuscular solution HCPCS J3410 | $2.58 | $7.35 | $0.74 – $17.58 | 11 |
| Hydroxyzine pamoate 25 mg capsule HCPCS Q0177 | $36.02 | $102.90 | $0.04 – $5.25 | 11 |
| Hydrxycorticsterds 17- (17-ohcs) CPT 83491 | $21.42 | $61.20 | $14.29 – $45.90 | 25 |
| Hyoscyamine sulfate inj HCPCS J1980 | $95.55 | $273.00 | $12.94 – $273.00 | 11 |
| Hysterosalpingography s&i CPT 74740 | $501.20 | $1,432.00 | $63.49 – $1,074.00 | 15 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | $198.60 | $567.41 | $100.00 – $425.56 | 9 |
| Ia nfct ab sarscov2 covid19 CPT 86328 | $82.85 | $236.70 | $36.14 – $177.53 | 25 |
| Icd cobalt xt dr MRI is1 df1 HCPCS C1721 | $166,489.63 | $475,684.65 | $995.56 – $3,555.57 | 14 |
| Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 | $33,787.59 | $96,535.95 | $2,642.70 – $9,438.19 | 14 |
| Icd crtp serena MRI HCPCS C2621 | $15,750.00 | $45,000.00 | $4,820.80 – $17,217.12 | 14 |
| Icd reliance df4 ib 64cm HCPCS C1895 | $10,831.70 | $30,947.70 | $2,606.54 – $9,309.04 | 14 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $262.03 | $748.65 | $161.82 – $511.50 | 11 |
| Iliac/fem angio cath insert HCPCS G0278 | $1,367.10 | $3,906.00 | $100.00 – $2,929.50 | 9 |
| Iliac revasc add-on 37222 CPT 37222 | $2,622.20 | $7,492.00 | $100.00 – $5,618.70 | 10 |
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.