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 |
|---|---|---|---|---|
| Lipoprotein direct measurement hdl CPT 83718 | $54.81 | $156.60 | $6.54 – $117.45 | 25 |
| Lipoprotein direct measurement ldl CPT 83721 | $32.45 | $92.70 | $8.38 – $69.53 | 25 |
| Lithium therapeutic drug level CPT 80178 | $40.60 | $116.00 | $5.27 – $83.03 | 25 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $3,095.75 | $8,845.00 | $100.00 – $6,633.75 | 8 |
| Liver Function Test CPT 80076 | $326.55 | $933.00 | $6.52 – $447.75 | 25 |
| Liver/spleen imag static only CPT 78215 | $445.22 | $1,272.03 | $175.22 – $1,723.00 | 15 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $957.60 | $2,736.00 | $122.21 – $2,052.00 | 15 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $21.69 | $61.95 | $0.73 – $46.47 | 9 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $1.84 | $5.25 | $0.40 – $5.25 | 11 |
| Low cost skin substitute app HCPCS C5271 | $288.05 | $823.00 | $54.73 – $617.25 | 9 |
| Low cost skin substitute app HCPCS C5275 | $288.05 | $823.00 | $54.73 – $617.25 | 9 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $5,881.05 | $16,803.00 | $166.31 – $12,602.25 | 16 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $5,002.90 | $14,294.00 | $165.06 – $10,720.50 | 16 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $3,818.85 | $10,911.00 | $99.51 – $8,183.25 | 16 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $4,822.30 | $13,778.00 | $312.67 – $10,333.50 | 16 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $4,100.25 | $11,715.00 | $265.05 – $8,786.25 | 16 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,887.45 | $8,249.85 | $187.28 – $6,187.39 | 16 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $714.00 | $2,040.00 | $38.09 – $1,530.00 | 15 |
| Lung Function Test (Spirometry) CPT 94010 | $224.28 | $640.80 | $100.00 – $597.00 | 9 |
| Lung perfusion imaging CPT 78580 | $720.67 | $2,059.05 | $210.14 – $1,723.00 | 15 |
| Lymphatics/lymph node imaging CPT 78195 | $1,315.65 | $3,759.00 | $313.30 – $2,819.25 | 15 |
| Macroscopic exam arthropod CPT 87168 | $13.23 | $37.80 | $3.41 – $28.35 | 25 |
| Macroscopic exam parasite CPT 87169 | $19.85 | $56.70 | $3.44 – $42.53 | 25 |
| Magnesium CPT 83735 | $159.25 | $455.00 | $5.35 – $208.50 | 25 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $24.63 | $70.35 | $0.08 – $3.94 | 9 |
| Magnetic image bone marrow CPT 77084 | $995.40 | $2,844.00 | $221.80 – $2,133.00 | 16 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $128.10 | $366.00 | $100.00 – $978.00 | 9 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $128.10 | $366.00 | $100.00 – $978.00 | 9 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $4.05 | $11.55 | $3.35 – $8.67 | 9 |
| Manual diff wbc count b-coat CPT 85009 | $34.02 | $97.20 | $4.05 – $72.90 | 26 |
| Marker biop eviva buckle ss HCPCS A4648 | $183.75 | $525.00 | $75.20 – $232.74 | 14 |
| Mastectomy partial CPT 19301 | $1,707.62 | $4,878.90 | $2,927.34 – $3,659.18 | 7 |
| Mayo aathr protein s free CPT 85306 | $144.20 | $412.00 | $12.23 – $198.45 | 25 |
| Mayo activated protein c resistance assay CPT 85307 | $132.62 | $378.90 | $12.23 – $284.18 | 25 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $75.60 | $216.00 | $11.80 – $162.00 | 25 |
| Mayo alpha 1 antitrypsin CPT 82103 | $86.10 | $246.00 | $10.73 – $184.50 | 25 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $37.80 | $108.00 | $12.04 – $81.00 | 25 |
| Mayo androstenedione CPT 82157 | $93.24 | $266.40 | $23.37 – $199.80 | 25 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $43.47 | $124.20 | $11.65 – $87.75 | 25 |
| Mayo antithrombin iii antigen CPT 85301 | $66.15 | $189.00 | $8.63 – $141.75 | 25 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $35.60 | $101.70 | $12.01 – $76.28 | 26 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $39.38 | $112.50 | $8.12 – $84.38 | 26 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $248.22 | $709.20 | $115.59 – $531.90 | 26 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $26.78 | $76.50 | $10.30 – $57.38 | 26 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $27.09 | $77.40 | $10.53 – $58.05 | 26 |
| Mayo brcmg brucella antibody igm CPT 86622 | $31.19 | $89.10 | $7.13 – $66.83 | 26 |
| Mayo c1 esterase inhibitor CPT 83883 | $53.87 | $153.90 | $10.85 – $115.43 | 25 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $97.97 | $279.90 | $13.46 – $209.93 | 25 |
| Mayo ceruloplasmin CPT 82390 | $82.95 | $237.00 | $8.57 – $177.75 | 25 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $36.23 | $103.50 | $11.27 – $77.63 | 25 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $75.92 | $216.90 | $10.28 – $153.23 | 25 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $38.50 | $110.00 | $9.43 – $82.50 | 26 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $36.86 | $105.30 | $10.12 – $78.98 | 26 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $170.73 | $487.80 | $92.96 – $365.85 | 26 |
| Mayo coccidioides antibody CPT 86635 | $41.27 | $117.90 | $9.15 – $88.43 | 26 |
| Mayo cocou cortisone urine CPT 82542 | $125.88 | $359.64 | $19.23 – $199.13 | 25 |
| Mayo cortisol free CPT 82530 | $45.68 | $130.50 | $13.34 – $91.80 | 25 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $82.85 | $236.70 | $33.62 – $177.53 | 25 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $30.87 | $88.20 | $9.67 – $66.15 | 26 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $59.54 | $170.10 | $10.57 – $127.58 | 25 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $38.43 | $109.80 | $20.17 – $82.35 | 25 |
| Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid CPT 83518 | $17.22 | $49.20 | $7.69 – $36.90 | 25 |
| Mayo efpo chloride stool CPT 82438 | $30.87 | $88.20 | $3.99 – $66.15 | 25 |
| Mayo estriol CPT 82677 | $75.60 | $216.00 | $19.29 – $162.00 | 25 |
| Mayo estrone CPT 82679 | $37.80 | $108.00 | $19.91 – $81.00 | 25 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $60.80 | $173.70 | $13.04 – $130.28 | 25 |
| Mayo factor ii CPT 85210 | $86.31 | $246.60 | $10.36 – $184.95 | 25 |
| Mayo factor vii CPT 85230 | $169.40 | $484.00 | $14.29 – $363.00 | 25 |
| Mayo factor viii vw factor antigen CPT 85246 | $79.70 | $227.70 | $18.31 – $170.78 | 25 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $99.54 | $284.40 | $18.31 – $213.30 | 25 |
| Mayo factor x CPT 85260 | $125.06 | $357.30 | $14.29 – $267.98 | 25 |
| Mayo factor xi CPT 85270 | $111.20 | $317.70 | $14.29 – $238.28 | 25 |
| Mayo fat/lipids feces quantitative CPT 82710 | $24.26 | $69.30 | $13.40 – $51.98 | 25 |
| Mayo fbl culture fungi blood CPT 87103 | $81.59 | $233.10 | $16.33 – $174.83 | 25 |
| Mayo ffspg allergen clam igg CPT 86001 | $21.34 | $60.95 | $6.24 – $37.80 | 25 |
| Mayo gamma-globin full gene sequencing CPT 81479 | $464.00 | $1,325.70 | $37.45 – $994.28 | 11 |
| Mayo hemosiderin qualitative urine CPT 83070 | $68.04 | $194.40 | $3.79 – $145.80 | 25 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | $153.72 | $439.20 | $28.01 – $329.40 | 25 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $36.54 | $104.40 | $11.00 – $78.30 | 26 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $96.71 | $276.30 | $20.60 – $195.08 | 25 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $63.63 | $181.80 | $7.10 – $136.35 | 26 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $23.52 | $67.19 | $10.79 – $50.40 | 26 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $56.00 | $160.00 | $21.68 – $120.00 | 25 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $114.92 | $328.32 | $13.78 – $214.65 | 25 |
| Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 | $23.63 | $67.50 | $11.96 – $50.63 | 25 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $123.48 | $352.80 | $16.61 – $264.60 | 25 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $73.08 | $208.80 | $16.61 – $156.60 | 25 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $27.96 | $79.87 | $12.82 – $59.91 | 25 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $63.95 | $182.70 | $9.56 – $137.03 | 25 |
| Mayo inhab inhibin a CPT 86336 | $58.28 | $166.50 | $12.44 – $124.88 | 25 |
| Mayo insulin antibodies CPT 86337 | $45.05 | $128.70 | $17.08 – $96.53 | 25 |
| Mayo iodine CPT 83789 | $57.96 | $165.60 | $19.24 – $124.20 | 25 |
| Mayo ld_i lactate dehydrogenase isoenzymes CPT 83625 | $27.41 | $78.30 | $10.20 – $58.73 | 25 |
| Mayo legionella antibody CPT 86713 | $112.77 | $322.20 | $12.21 – $241.65 | 25 |
| Mayo leptospira antibody igm CPT 86720 | $33.39 | $95.40 | $12.93 – $71.55 | 25 |
| Mayo lipoprotein electrophoresis CPT 83700 | $37.80 | $108.00 | $8.99 – $81.00 | 25 |
| Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory CPT 86617 | $51.03 | $145.80 | $12.36 – $109.35 | 26 |
| Mayo metanephrines plasma CPT 83835 | $74.34 | $212.40 | $13.52 – $159.30 | 25 |
| Mayo microsomal antibody liver-kidney CPT 86376 | $66.15 | $189.00 | $11.61 – $111.38 | 25 |
| Mayo mitotane (lysodren) therapeutic drug level CPT 80299 | $71.82 | $205.20 | $14.88 – $153.90 | 25 |
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.