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 |
|---|---|---|---|---|
| Repair rpr lip full thickness vermilion only CPT 40650 | $403.52 | $1,152.90 | $691.74 – $864.68 | 7 |
| Repair tendon extensor foot 1/2 each tendon CPT 28208 | $1,502.24 | $4,292.10 | $2,575.26 – $3,219.08 | 7 |
| Repair tendon/muscle forearm/wrist prime sngl ea CPT 25260 | $1,887.48 | $5,392.80 | $3,235.68 – $4,044.60 | 7 |
| Replace duod/jej tube perc CPT 49451 | $907.90 | $2,594.00 | $1,556.40 – $1,945.50 | 8 |
| Replace g/c tube perc CPT 49450 | $907.90 | $2,594.00 | $1,556.40 – $1,945.50 | 8 |
| Replace g-j tube perc CPT 49452 | $907.90 | $2,594.00 | $1,556.40 – $1,945.50 | 8 |
| Replace tunneled cv cath CPT 36578 | $814.28 | $2,326.50 | $1,395.90 – $1,744.88 | 7 |
| Reposition pm/icd lead CPT 33215 | $1,622.57 | $4,635.90 | $2,781.54 – $3,476.93 | 8 |
| Repos sq defib eltrd CPT 33273 | $1,647.77 | $4,707.90 | $2,824.74 – $3,530.93 | 7 |
| Reptilase test CPT 85635 | $28.98 | $82.80 | $7.86 – $62.10 | 25 |
| #resp virpnl dfa-parainfluenza CPT 87279 | $26.15 | $74.70 | $13.11 – $56.03 | 25 |
| Resuscitation cardiopulmonary CPT 92950 | $862.40 | $2,464.00 | $100.00 – $1,848.00 | 11 |
| Reticulocyte automated CPT 85045 | $41.53 | $118.65 | $3.18 – $88.99 | 25 |
| Revasc intra lithotrip-ather HCPCS C9766 | $13,792.12 | $39,406.03 | $2,620.51 – $29,554.53 | 9 |
| Revsc opn/prq tib/pero stent CPT 37234 | $3,560.90 | $10,174.00 | $100.00 – $7,630.50 | 10 |
| Rheumatoid factor quantitative CPT 86431 | $94.15 | $269.00 | $4.52 – $201.75 | 25 |
| Right ventric recording CPT 93603 | $1,143.77 | $3,267.90 | $217.32 – $2,450.93 | 9 |
| Rmvl fecal impaction/fb spx under anes CPT 45915 | $985.01 | $2,814.30 | $1,688.58 – $2,110.73 | 7 |
| Rmvl foreign body upper arm/elbow subcutaneous CPT 24200 | $521.33 | $1,489.50 | $893.70 – $1,117.13 | 8 |
| Rmvl icd by tv extr CPT 33244 | $1,561.77 | $4,462.20 | $296.74 – $3,346.65 | 10 |
| Rmvl icd gen w/rplc icd gen dual lead sys CPT 33263 | $12,706.47 | $36,304.20 | $21,782.52 – $27,228.15 | 8 |
| Rmvl icd gen w/rplc icd gen mlt lead sys CPT 33264 | $15,633.77 | $44,667.90 | $26,800.74 – $33,500.93 | 8 |
| Rmvl icd gen w/rplc icd gen sgl lead sys CPT 33262 | $12,739.86 | $36,399.60 | $21,839.76 – $27,299.70 | 8 |
| Rmvl icd pulse gen only CPT 33241 | $1,640.52 | $4,687.20 | $2,812.32 – $3,515.40 | 8 |
| Rmvl ndwellg tun pleural cath CPT 32552 | $230.27 | $657.90 | $394.74 – $493.43 | 8 |
| Rmvl perm pm pulse gen CPT 33233 | $7,090.30 | $20,258.00 | $12,154.80 – $15,193.50 | 7 |
| Rmvl pm gen w/rplc pm gen mlt lead sys CPT 33229 | $5,967.05 | $17,048.70 | $10,229.22 – $12,786.53 | 8 |
| Rmvl pm gen w/rplc pm gen sgl lead sys CPT 33227 | $2,524.41 | $7,212.60 | $4,327.56 – $5,409.45 | 8 |
| Rmvl sq defib electrode CPT 33272 | $1,366.47 | $3,904.20 | $259.63 – $2,928.15 | 9 |
| Rmvl subq card rhythm mntr CPT 33286 | $701.82 | $2,005.20 | $1,203.12 – $1,503.90 | 7 |
| Rmvl tv pm lead dual CPT 33235 | $3,277.40 | $9,364.00 | $5,618.40 – $7,023.00 | 8 |
| Rmvl tv pm lead sgl CPT 33234 | $3,277.40 | $9,364.00 | $5,618.40 – $7,023.00 | 8 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | $34.55 | $98.70 | $0.03 – $98.70 | 11 |
| Rpl non-tun cvc wo sbq prt/pmp CPT 36580 | $576.77 | $1,647.90 | $988.74 – $1,235.93 | 7 |
| Rp loclzj tum 2+area 1+d img CPT 78801 | $769.86 | $2,199.60 | $242.83 – $1,723.00 | 15 |
| Rpl picc wo subq port/pump incl image guidnc w/s&i CPT 36584 | $441.35 | $1,261.00 | $756.60 – $945.75 | 7 |
| Rpl tun cvc wo subq port CPT 36581 | $1,076.67 | $3,076.20 | $1,845.72 – $2,307.15 | 7 |
| Rubella antibody igg CPT 86762 | $55.76 | $159.30 | $11.49 – $119.48 | 25 |
| Rubeola antibody igg CPT 86765 | $29.93 | $85.50 | $10.28 – $64.13 | 25 |
| Russell viper venom diluted CPT 85613 | $72.45 | $207.00 | $7.65 – $93.83 | 25 |
| Salivary gland imaging CPT 78230 | $641.66 | $1,833.30 | $158.08 – $1,723.00 | 15 |
| Salmonella antibody CPT 86768 | $96.08 | $274.50 | $10.53 – $205.88 | 25 |
| Sarscov coronavirus ag ia CPT 87426 | $742.98 | $2,122.78 | $28.20 – $177.53 | 26 |
| Sarscov & inf vir a&b ag ia CPT 87428 | $132.30 | $378.00 | $45.17 – $283.50 | 26 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $873.95 | $2,497.00 | $221.84 – $1,872.75 | 13 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $598.50 | $1,710.00 | $101.54 – $1,282.50 | 15 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $299.25 | $855.00 | $101.54 – $641.25 | 13 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $1,006.60 | $2,876.00 | $101.54 – $2,157.00 | 13 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $1,113.16 | $3,180.45 | $221.84 – $2,385.34 | 13 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $679.35 | $1,941.00 | $101.54 – $1,455.75 | 13 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $751.10 | $2,146.00 | $101.54 – $1,529.25 | 13 |
| Sclerotherapy fluid collection pq w/img CPT 49185 | $358.79 | $1,025.10 | $68.17 – $768.83 | 9 |
| Screening Colonoscopy (average risk) HCPCS G0121 | $1,376.20 | $3,932.00 | $2,359.20 – $2,949.00 | 7 |
| Screening Colonoscopy (high risk) HCPCS G0105 | $1,376.20 | $3,932.00 | $2,359.20 – $2,949.00 | 7 |
| Screening Mammogram CPT 77067 | $312.55 | $893.00 | $140.00 – $669.75 | 11 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $26,250.00 | $75,000.00 | $0.01 – $0.01 | 14 |
| Sec abd wall suture evisceration/dehsn 49900 CPT 49900 | $1,281.42 | $3,661.20 | $243.47 – $2,745.90 | 10 |
| Sec art mech thrmbc non-intracranial add-on CPT 37186 | $1,001.70 | $2,862.00 | $100.00 – $2,146.50 | 10 |
| Serial casting application 97139app CPT 97139 | $53.55 | $153.00 | $22.10 – $293.00 | 9 |
| Shoulder MRI (with and without contrast) CPT 73223 | $6,378.75 | $18,225.00 | $348.10 – $13,668.75 | 16 |
| Shoulder MRI (with contrast) CPT 73222 | $5,163.55 | $14,753.00 | $306.94 – $11,064.75 | 16 |
| Shoulder MRI (without contrast) CPT 73221 | $4,105.50 | $11,730.00 | $198.70 – $8,797.50 | 16 |
| Shoulder X-ray CPT 73030 | $634.90 | $1,814.00 | $33.34 – $1,360.50 | 15 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $145.95 | $417.00 | $77.77 – $281.48 | 15 |
| Sialography s&i CPT 70390 | $349.34 | $998.10 | $110.14 – $748.58 | 15 |
| Sickling rbc CPT 85660 | $46.62 | $133.20 | $4.40 – $99.90 | 26 |
| Sigmoidoscopy and biopsy CPT 45331 | $1,200.85 | $3,431.00 | $2,058.60 – $2,573.25 | 7 |
| Sigmoidoscopy w/fb removal 45332 CPT 45332 | $570.78 | $1,630.80 | $978.48 – $1,223.10 | 7 |
| Sinus CT scan (with and without contrast) CPT 70488 | $3,249.75 | $9,285.00 | $166.31 – $6,963.75 | 16 |
| Sinus CT scan (with contrast) CPT 70487 | $2,685.55 | $7,673.00 | $148.56 – $5,754.75 | 16 |
| Sinus CT scan (without contrast) CPT 70486 | $2,256.63 | $6,447.50 | $99.51 – $4,835.63 | 16 |
| Sinus/juglr venogram s&i CPT 75860 | $1,064.35 | $3,041.00 | $119.36 – $3,041.00 | 15 |
| Skin Biopsy CPT 11102 | $286.97 | $819.90 | $491.94 – $614.93 | 7 |
| Skin split graft addl 100sq cm 15101 CPT 15101 | $638.82 | $1,825.20 | $100.00 – $1,368.90 | 9 |
| Sleep Study (Polysomnography) CPT 95810 | $2,838.81 | $8,110.86 | $100.00 – $6,083.15 | 12 |
| Sleeve fing rolyan med HCPCS L3933 | $116.50 | $332.85 | $42.56 – $151.99 | 11 |
| Sling suprapubic suburetheral HCPCS C1771 | $2,510.76 | $7,173.60 | $385.44 – $1,376.55 | 14 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $91.00 | $260.00 | $4.30 – $195.00 | 25 |
| Smear gram stain CPT 87205 | $138.95 | $397.00 | $3.41 – $297.75 | 26 |
| Smear nasal eosinophil CPT 89190 | $30.87 | $88.20 | $4.62 – $66.15 | 26 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $33.39 | $95.40 | $4.78 – $67.50 | 25 |
| Smear wet mount CPT 87210 | $88.90 | $254.00 | $4.65 – $118.80 | 26 |
| Sodium 24 hour urine CPT 84300 | $43.74 | $124.95 | $4.04 – $93.72 | 25 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $9.56 | $27.30 | $3.57 – $20.48 | 9 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $8.46 | $24.15 | $1.79 – $18.12 | 9 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $10.29 | $29.40 | $0.90 – $12.60 | 9 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $11.40 | $32.55 | $0.05 – $24.42 | 9 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $37.80 | $108.00 | $1.74 – $81.00 | 9 |
| Sodium serum/plasma/whole blood CPT 84295 | $37.10 | $106.00 | $3.84 – $48.75 | 25 |
| Specimen fat stain CPT 89125 | $30.56 | $87.30 | $4.69 – $65.48 | 26 |
| Sperm antibody test CPT 89325 | $105.21 | $300.60 | $10.67 – $225.45 | 24 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $832.65 | $2,379.00 | $1,427.40 – $1,784.25 | 7 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $756.00 | $2,160.00 | $68.93 – $1,620.00 | 9 |
| Spleen imaging CPT 78185 | $541.17 | $1,546.20 | $150.46 – $1,723.00 | 15 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $230.79 | $659.40 | $106.29 – $379.58 | 11 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $24.63 | $70.35 | $14.78 – $45.73 | 11 |
| Splint finger frog med HCPCS L3927 | $24.63 | $70.35 | $9.71 – $34.65 | 11 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $39.33 | $112.35 | $23.60 – $84.27 | 11 |
| Sputum specimen collection CPT 89220 | $64.26 | $183.60 | $45.24 – $193.77 | 11 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $439.60 | $1,256.00 | $100.00 – $942.00 | 9 |
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.