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 |
|---|---|---|---|---|
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $213.57 | $610.20 | $11.49 – $457.65 | 26 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $187.74 | $536.40 | $13.44 – $402.30 | 26 |
| Cyto/molecular report CPT 88291 | $93.24 | $266.40 | $49.46 – $199.80 | 11 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $131.25 | $375.00 | $67.05 – $281.25 | 11 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $64.89 | $185.40 | $47.70 – $139.05 | 11 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $249.62 | $713.20 | $46.98 – $534.90 | 11 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $208.60 | $596.00 | $67.05 – $447.00 | 11 |
| Cytopath smear other source CPT 88162 | $55.13 | $157.50 | $67.05 – $118.13 | 11 |
| Cytopath smear oth prep screen & interp CPT 88161 | $47.88 | $136.80 | $33.57 – $102.60 | 11 |
| D&c after delivery 59160 CPT 59160 | $1,145.66 | $3,273.30 | $1,963.98 – $2,454.98 | 7 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | $1,145.66 | $3,273.30 | $1,963.98 – $2,454.98 | 7 |
| Dch glucoscan CPT 82948 | $19.60 | $56.00 | $4.02 – $34.50 | 26 |
| Dch validity tests CPT 81002 | $13.23 | $37.80 | $2.77 – $28.35 | 25 |
| Debrid ecz/inf skin up tp 10% body 11000 CPT 11000 | $214.52 | $612.90 | $367.74 – $459.68 | 8 |
| Debridement (>20 cm) charge pt CPT 97598 | $142.10 | $406.00 | $16.83 – $304.50 | 11 |
| Debridement bone <= 20 sq cm CPT 11044 | $4,326.70 | $12,362.00 | $7,417.20 – $9,271.50 | 7 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $1,013.60 | $2,896.00 | $100.00 – $2,172.00 | 10 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $1,787.80 | $5,108.00 | $100.00 – $3,831.00 | 10 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $1,138.52 | $3,252.90 | $1,951.74 – $2,439.68 | 7 |
| Debride nail1-5 11720 CPT 11720 | $37.80 | $108.00 | $7.19 – $81.00 | 12 |
| Debride nail6 or more 11721 CPT 11721 | $57.96 | $165.60 | $11.02 – $124.20 | 12 |
| Debride skin bone at fx site CPT 11012 | $793.80 | $2,268.00 | $1,360.80 – $1,701.00 | 7 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $489.65 | $1,399.00 | $93.04 – $1,049.25 | 10 |
| Debrid/rmv fgn bdy/open fx/skin/sq 11010 CPT 11010 | $226.80 | $648.00 | $388.80 – $486.00 | 7 |
| Debr inf skin add-on 11001 CPT 11001 | $67.41 | $192.60 | $12.81 – $144.45 | 12 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $2,892.05 | $8,263.00 | $4,957.80 – $6,197.25 | 7 |
| Decalcification CPT 88311 | $115.40 | $329.70 | $13.15 – $247.28 | 11 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $276.26 | $789.30 | $473.40 – $591.75 | 8 |
| Delivery of placenta 59414 CPT 59414 | $1,154.48 | $3,298.50 | $1,979.10 – $2,473.88 | 8 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $208.25 | $595.00 | $100.00 – $978.00 | 9 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $68.04 | $194.40 | $12.93 – $145.80 | 11 |
| Dermagraft HCPCS Q4106 | $66.52 | $190.05 | $36.04 – $122.85 | 14 |
| Desoxycorticosterone CPT 82633 | $90.41 | $258.30 | $24.72 – $193.73 | 25 |
| Detect agnt mult dna direc CPT 87800 | $57.33 | $163.80 | $34.85 – $122.85 | 25 |
| Device sut capio slim opn HCPCS C2631 | $3,840.75 | $10,973.55 | $2,304.45 – $8,230.17 | 14 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $9.56 | $27.30 | $0.02 – $22.05 | 11 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $9.93 | $28.35 | $1.69 – $21.27 | 9 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $8.09 | $23.10 | $2.57 – $17.33 | 9 |
| Dextrose 5 % IV bolus HCPCS J7070 | $9.56 | $27.30 | $5.14 – $18.65 | 9 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $38.67 | $110.48 | $17.74 – $82.86 | 25 |
| Diabetes (HbA1c) Test CPT 83036 | $89.60 | $256.00 | $7.75 – $117.75 | 25 |
| Diab manage trn ind/group HCPCS G0109 | $22.05 | $63.00 | $15.47 – $72.00 | 22 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $94.50 | $270.00 | $17.96 – $202.50 | 12 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $110.25 | $315.00 | $189.00 – $236.25 | 8 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $123.17 | $351.90 | $211.14 – $263.93 | 8 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $771.05 | $2,203.00 | $140.00 – $1,652.25 | 11 |
| Diagnostic Mammogram (one breast) CPT 77065 | $393.40 | $1,124.00 | $132.62 – $843.00 | 11 |
| Diathermy eg microwave CPT 97024 | $38.75 | $110.70 | $10.53 – $317.00 | 9 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $42.63 | $121.80 | $6.76 – $121.80 | 11 |
| Diffusing capacity CPT 94729 | $548.68 | $1,567.65 | $68.40 – $1,175.74 | 9 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $8.09 | $23.10 | $4.14 – $17.33 | 9 |
| Digoxin total therapeutic drug level CPT 80162 | $88.57 | $253.05 | $10.60 – $189.79 | 25 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $191.10 | $546.00 | $58.61 – $409.50 | 9 |
| Dilate esophagus 1/mult pass CPT 43450 | $551.25 | $1,575.00 | $945.00 – $1,181.25 | 7 |
| Dilat xst trc ndurlgc px CPT 50436 | $1,164.10 | $3,326.00 | $1,995.60 – $2,494.50 | 7 |
| Dilat xst trc new access rcs CPT 50437 | $1,164.10 | $3,326.00 | $1,995.60 – $2,494.50 | 7 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $2.58 | $7.35 | $0.02 – $7.35 | 11 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $2.21 | $6.30 | $0.75 – $6.30 | 11 |
| Disability dlco CPT 94727 | $186.90 | $534.00 | $100.00 – $597.00 | 9 |
| Disaccharidases CPT 82657 | $140.49 | $401.40 | $17.69 – $301.05 | 25 |
| Discography cerv/thor spine CPT 72285 | $969.89 | $2,771.10 | $125.69 – $2,510.25 | 15 |
| Dissolve clot heart vessel CPT 92975 | $13.86 | $39.60 | $2.64 – $29.70 | 9 |
| Dmd dup/delet analysis CPT 81161 | $50.75 | $145.00 | $87.00 – $418.50 | 25 |
| Dna antibody native/double stranded CPT 86225 | $135.45 | $387.00 | $10.96 – $290.25 | 25 |
| Dna probe chlamydia CPT 87490 | $46.62 | $133.20 | $18.15 – $99.90 | 25 |
| Dna probe gc CPT 87590 | $46.62 | $133.20 | $21.45 – $99.90 | 25 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $59.91 | $171.15 | $3.11 – $128.37 | 9 |
| Doppler echo complete CPT 93320 | $712.60 | $2,036.00 | $52.09 – $1,527.00 | 9 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $899.96 | $2,571.30 | $100.00 – $1,928.48 | 8 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $1,123.15 | $3,209.00 | $121.89 – $2,406.75 | 13 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $870.80 | $2,488.00 | $159.18 – $1,866.00 | 9 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $197.82 | $565.20 | $339.12 – $423.90 | 8 |
| Drainage external ear complex 69005 CPT 69005 | $681.03 | $1,945.80 | $1,167.48 – $1,459.35 | 8 |
| Drainage external ear simple 69000 CPT 69000 | $195.93 | $559.80 | $335.88 – $419.85 | 8 |
| Drainage mouth roof lesion CPT 42000 | $211.68 | $604.80 | $362.88 – $453.60 | 7 |
| Drainage of arm bursa 23931 CPT 23931 | $715.68 | $2,044.80 | $1,226.88 – $1,533.60 | 7 |
| Drainage of kidney lesion CPT 50390 | $564.48 | $1,612.80 | $967.68 – $1,209.60 | 7 |
| Drainage of mouth lesion CPT 41005 | $180.81 | $516.60 | $309.96 – $387.45 | 7 |
| Drainage of rectal abscess CPT 45005 | $595.98 | $1,702.80 | $1,021.68 – $1,277.10 | 7 |
| Drainage of salivary gland CPT 42305 | $1,208.34 | $3,452.40 | $2,071.44 – $2,589.30 | 7 |
| Drainage of salivary gland CPT 42320 | $180.81 | $516.60 | $309.96 – $387.45 | 7 |
| Drain blood from under nail 11740 CPT 11740 | $66.47 | $189.90 | $12.63 – $142.43 | 12 |
| Drain cath image guided visceral pq CPT 49405 | $2,269.75 | $6,485.00 | $431.26 – $4,863.57 | 10 |
| Drain finger abscess;simple 26010 CPT 26010 | $177.66 | $507.60 | $304.56 – $380.70 | 8 |
| Drain lower leg bursa CPT 27604 | $1,786.37 | $5,103.90 | $3,062.34 – $3,827.93 | 7 |
| Drain thigh/knee lesion 27301 CPT 27301 | $793.80 | $2,268.00 | $1,360.80 – $1,701.00 | 7 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $102.06 | $291.60 | $174.96 – $218.70 | 7 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $78.09 | $223.10 | $133.86 – $167.33 | 8 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $205.70 | $587.70 | $352.62 – $440.78 | 7 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | $136.71 | $390.60 | $42.49 – $292.95 | 14 |
| Drng of eyelid abscess 67700 CPT 67700 | $684.81 | $1,956.60 | $1,173.96 – $1,467.45 | 8 |
| Drng of finger abscess comp 26011 CPT 26011 | $481.01 | $1,374.30 | $824.58 – $1,030.73 | 7 |
| Drng of mouth lesion 40801 CPT 40801 | $399.74 | $1,142.10 | $685.26 – $856.58 | 7 |
| Drng of scrotum abscess 55100 CPT 55100 | $692.06 | $1,977.30 | $1,186.38 – $1,482.98 | 7 |
| Drng salivary gland simple 42300 CPT 42300 | $378.00 | $1,080.00 | $648.00 – $810.00 | 7 |
| Drng salivary gland submax/subling 42310 CPT 42310 | $180.81 | $516.60 | $309.96 – $387.45 | 7 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $479.96 | $1,371.30 | $287.98 – $1,028.48 | 14 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $54.03 | $154.35 | $7.17 – $24.42 | 14 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $18.01 | $51.45 | $10.81 – $38.59 | 14 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | $34.92 | $99.75 | $20.81 – $74.82 | 14 |
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.