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 |
|---|---|---|---|---|
| Wound therapy negative pressure per session <= 50 sq cm CPT 97607 | $467.25 | $1,335.00 | $34.21 – $1,001.25 | 10 |
| Wound therapy negative pressure per session > 50 sq cm CPT 97608 | $397.25 | $1,135.00 | $38.41 – $851.25 | 10 |
| Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 | $260.05 | $743.00 | $49.41 – $557.25 | 11 |
| Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 | $413.35 | $1,181.00 | $78.54 – $885.75 | 11 |
| Wrist X-ray CPT 73110 | $539.00 | $1,540.00 | $39.37 – $1,155.00 | 15 |
| Xcapsl ctrc rmvl cplx wo ecp CPT 66982 | $2,816.80 | $8,048.00 | $4,828.80 – $6,036.00 | 7 |
| Xe133 xenon 10mci HCPCS A9558 | $290.43 | $829.80 | $100.00 – $622.35 | 9 |
| Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/< CPT 14040 | $1,041.39 | $2,975.40 | $1,785.24 – $2,231.55 | 7 |
| X-ray abdomen 1 view CPT 74018 | $472.15 | $1,349.00 | $28.88 – $1,008.00 | 15 |
| X-ray abdomen 2 views CPT 74019 | $568.75 | $1,625.00 | $34.91 – $1,218.60 | 15 |
| X-ray abdomen >=3 views CPT 74021 | $568.75 | $1,625.00 | $40.95 – $799.50 | 15 |
| X-ray abdomen complete acute series including spine erect and/or decubitus single view chest CPT 74022 | $568.75 | $1,625.00 | $47.62 – $1,218.75 | 15 |
| X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 | $249.17 | $711.90 | $27.63 – $533.93 | 15 |
| X-ray ankle 2 views (both sides) CPT 73600 | $368.90 | $1,054.00 | $30.79 – $790.50 | 15 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $737.86 | $2,108.16 | $125.39 – $1,581.12 | 15 |
| X-ray bone age studies CPT 77072 | $163.49 | $467.10 | $24.76 – $350.33 | 15 |
| X-ray bone survey complete CPT 77075 | $519.75 | $1,485.00 | $94.91 – $1,113.75 | 15 |
| X-ray cervical spine 2-3 views CPT 72040 | $513.10 | $1,466.00 | $37.77 – $1,099.50 | 15 |
| X-ray cervical spine 4-5 views CPT 72050 | $693.35 | $1,981.00 | $51.11 – $1,485.75 | 15 |
| X-ray cervical spine >= 6 views CPT 72052 | $811.30 | $2,318.00 | $59.67 – $1,738.50 | 15 |
| X-ray clavicle complete (both sides) CPT 73000 | $397.28 | $1,135.07 | $31.11 – $851.25 | 15 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | $872.55 | $2,493.00 | $140.00 – $1,869.75 | 15 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | $1,710.45 | $4,887.00 | $140.00 – $3,665.25 | 15 |
| X-ray elbow 2 views (both sides) CPT 73070 | $471.80 | $1,348.00 | $27.93 – $1,011.00 | 15 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $535.99 | $1,531.38 | $31.43 – $1,148.54 | 15 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | $887.95 | $2,537.00 | $92.68 – $1,902.75 | 15 |
| X-ray exam of arm infant CPT 73092 | $41.27 | $117.90 | $69.57 – $140.00 | 15 |
| X-ray exam of eye sockets CPT 70200 | $148.68 | $424.80 | $45.70 – $318.60 | 15 |
| X-ray exam of femur 1 CPT 73551 | $393.75 | $1,125.00 | $27.93 – $843.75 | 15 |
| X-ray exam of penis CPT 74445 | $115.92 | $331.20 | $99.51 – $248.40 | 15 |
| X-ray exam of sinuses CPT 70210 | $66.73 | $190.65 | $30.79 – $142.99 | 15 |
| X-ray exam si joints CPT 72200 | $420.35 | $1,201.00 | $31.74 – $900.75 | 15 |
| X-ray facial bones complete > 3 views CPT 70150 | $488.10 | $1,394.56 | $45.08 – $1,045.92 | 15 |
| X-ray femur >=2 views (both sides) CPT 73552 | $479.85 | $1,371.00 | $33.96 – $1,028.07 | 15 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $388.50 | $1,110.00 | $36.51 – $832.50 | 15 |
| X-ray foot 2 views (both sides) CPT 73620 | $515.55 | $1,473.00 | $27.30 – $1,104.75 | 15 |
| X-ray forearm 2 views (both sides) CPT 73090 | $473.55 | $1,353.00 | $27.93 – $1,014.64 | 15 |
| X-ray hand 2 views (both sides) CPT 73120 | $347.90 | $994.00 | $30.15 – $745.50 | 15 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $356.46 | $1,018.44 | $27.30 – $763.83 | 15 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $706.65 | $2,019.00 | $57.13 – $1,514.25 | 15 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $482.30 | $1,378.00 | $39.37 – $1,033.50 | 15 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $633.85 | $1,811.00 | $51.42 – $1,358.25 | 15 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $729.05 | $2,083.00 | $59.04 – $1,562.25 | 15 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $387.10 | $1,106.00 | $31.43 – $829.50 | 15 |
| X-ray humerus >= 2 views left CPT 73060 | $445.60 | $1,273.14 | $30.48 – $954.75 | 15 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $494.20 | $1,412.00 | $32.69 – $1,059.00 | 15 |
| X-ray knee 3 views (both sides) CPT 73562 | $595.35 | $1,701.00 | $39.05 – $1,275.75 | 15 |
| X-ray knee ap standing bilateral CPT 73565 | $583.45 | $1,667.00 | $38.09 – $1,250.25 | 15 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $167.58 | $478.80 | $75.75 – $359.10 | 15 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $926.89 | $2,648.25 | $49.52 – $1,986.00 | 15 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $1,093.75 | $3,125.00 | $58.41 – $2,343.75 | 15 |
| X-ray mandible complete > 4 views CPT 70110 | $586.50 | $1,675.69 | $41.59 – $1,256.77 | 15 |
| X-ray nasal bones complete > 3 views CPT 70160 | $169.16 | $483.30 | $35.87 – $362.48 | 15 |
| X-ray neck soft tissue CPT 70360 | $347.55 | $993.00 | $29.84 – $744.75 | 15 |
| X-ray nose to rectum for foreign body child CPT 76010 | $95.45 | $272.70 | $66.27 – $204.53 | 15 |
| X-ray of mammary ducts CPT 77054 | $669.06 | $1,911.60 | $66.02 – $1,433.70 | 15 |
| X-ray pelvis 1-2 views CPT 72170 | $457.46 | $1,307.02 | $26.66 – $980.25 | 15 |
| X-ray pelvis complete > 3 views CPT 72190 | $690.90 | $1,974.00 | $40.32 – $1,480.50 | 15 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $1,772.09 | $5,063.10 | $65.55 – $3,797.33 | 15 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $566.30 | $1,618.00 | $40.32 – $1,213.50 | 15 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $889.00 | $2,540.00 | $50.15 – $1,905.00 | 15 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $494.55 | $1,413.00 | $37.46 – $1,059.75 | 15 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $411.95 | $1,177.00 | $31.11 – $882.75 | 15 |
| X-ray scapula complete (both sides) CPT 73010 | $222.71 | $636.30 | $22.86 – $477.00 | 15 |
| X-ray sella turcica CPT 70240 | $63.32 | $180.90 | $31.43 – $140.00 | 15 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $355.60 | $1,016.00 | $20.62 – $762.00 | 15 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $783.30 | $2,238.00 | $35.87 – $1,678.13 | 15 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $345.24 | $986.40 | $56.82 – $739.50 | 15 |
| X-ray skull < 4 views CPT 70250 | $234.50 | $670.00 | $34.29 – $502.20 | 15 |
| X-ray skull > 4 views complete CPT 70260 | $458.15 | $1,309.00 | $42.54 – $981.75 | 15 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $770.70 | $2,202.00 | $115.86 – $1,651.50 | 15 |
| X-ray small intestine follow-through study CPT 74248 | $523.95 | $1,497.00 | $67.58 – $1,122.75 | 15 |
| X-ray spine single view CPT 72020 | $314.65 | $899.00 | $23.17 – $674.25 | 15 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $142.89 | $408.25 | $39.37 – $306.19 | 15 |
| X-ray sternum > 2 views CPT 71120 | $336.35 | $961.00 | $32.06 – $227.48 | 15 |
| X-ray surgical specimen CPT 76098 | $580.30 | $1,658.00 | $40.64 – $1,243.50 | 15 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $986.30 | $2,818.00 | $118.71 – $2,113.50 | 15 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $493.15 | $1,409.00 | $50.47 – $1,056.75 | 15 |
| X-ray thoracic spine 2 views CPT 72070 | $424.90 | $1,214.00 | $31.43 – $910.50 | 15 |
| X-ray thoracic spine 3 views CPT 72072 | $744.92 | $2,128.34 | $37.77 – $1,596.00 | 15 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $583.96 | $1,668.45 | $30.15 – $1,251.34 | 15 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $278.25 | $795.00 | $27.93 – $596.25 | 15 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $1,054.20 | $3,012.00 | $132.37 – $2,259.00 | 15 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $446.42 | $1,275.48 | $116.81 – $956.61 | 15 |
| X-ray wrist 2 views (both sides) CPT 73100 | $442.05 | $1,263.00 | $32.39 – $947.25 | 15 |
| Xylose absorption test blood &/or urine CPT 84620 | $57.02 | $162.90 | $10.30 – $122.18 | 25 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $63.35 | $181.00 | $10.27 – $135.75 | 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.