SelfPayRates
Hospital Jacksonville, FL

St. Luke's-St. Vincent's Healthcare, Inc.

St. Luke's-St. Vincent's Healthcare, Inc. in Jacksonville, FL publishes cash prices for 39 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.

4201 Belfort Rd Jacksonville FL 32216 Collected Sep 22, 2026 Source price file

Scans and imaging

ProcedureCash price List priceOff list
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELV W/CONTRAST $693.10 $1,873.25 63%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELV W/CONTRAST $693.10 $1,873.25 63%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELV W/CONTRAST $693.10 $1,873.25 63%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONTRAST $676.55 $1,828.50 63%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONTRAST $676.55 $1,828.50 63%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONTRAST $676.55 $1,828.50 63%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST $670.16 $1,811.25 63%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST $670.16 $1,811.25 63%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST $670.16 $1,811.25 63%
Diagnostic mammogram, both breasts both sides CPT 77066 MA DX MAMMO BILATERAL $303.96 $821.50 63%
Diagnostic mammogram, both breasts both sides CPT 77066 MA DX MAMMO BILATERAL $303.96 $821.50 63%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA DX MAMMO BILATERAL $303.96 $821.50 63%
Diagnostic mammogram, one breast one side CPT 77065 MA DX MAMMO UNILATERAL LT $301.55 $815.00 63%
Diagnostic mammogram, one breast one side CPT 77065 MA DX MAMMO UNILATERAL RT $301.55 $815.00 63%
Diagnostic mammogram, one breast one side CPT 77065 MA DX MAMMO UNILATERAL LT $301.55 $815.00 63%
Diagnostic mammogram, one breast one side CPT 77065 MA DX MAMMO UNILATERAL RT $301.55 $815.00 63%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA DX MAMMO UNILATERAL LT $301.55 $815.00 63%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA DX MAMMO UNILATERAL RT $301.55 $815.00 63%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EXT JOINT W/O RT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EXT JOINT W/O LT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EXT JOINT RT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EXT JOINT LT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EXT JOINT W/O RT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EXT JOINT LT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EXT JOINT RT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EXT JOINT W/O LT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOW EXT JOINT RT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOW EXT JOINT LT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOW EXT JOINT W/O LT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOW EXT JOINT W/O RT $590.15 $1,595.00 63%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW EXT JOINT W/WO RT $654.35 $1,768.50 63%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW EXT JOINT W/WO RT $654.35 $1,768.50 63%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW EXT JOINT W/WO LT $654.35 $1,768.50 63%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW EXT JOINT W/WO LT $654.35 $1,768.50 63%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOW EXT JOINT W/WO LT $654.35 $1,768.50 63%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOW EXT JOINT W/WO RT $654.35 $1,768.50 63%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST $1,127.02 $3,046.00 63%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST $1,127.02 $3,046.00 63%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST $1,127.02 $3,046.00 63%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTRAST $622.25 $1,681.75 63%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTRAST $622.25 $1,681.75 63%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO CONTRAST $622.25 $1,681.75 63%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CONTRAST $1,136.27 $3,071.00 63%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CONTRAST $1,136.27 $3,071.00 63%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINE LUMBAR W/O CONTRAST $1,136.27 $3,071.00 63%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB FETAL MATERNAL EVAL $247.07 $667.75 63%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB FETAL MATERNAL EVAL $247.07 $667.75 63%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 L&D US>/= 14WKS SNGL FETUS $340.96 $921.50 63%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OBOP US >/=14WKS SNGL FETUS $340.96 $921.50 63%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 L&D US>/= 14WKS SNGL FETUS $340.96 $921.50 63%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB FETAL MATERNAL EVAL $340.96 $921.50 63%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OBOP US >/=14WKS SNGL FETUS $340.96 $921.50 63%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB FETAL MATERNAL EVAL $340.96 $921.50 63%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB FETAL MATERNAL EVAL $247.07 $667.75 63%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OBOP US >/=14WKS SNGL FETUS $340.96 $921.50 63%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB FETAL MATERNAL EVAL $340.96 $921.50 63%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 L&D US>/= 14WKS SNGL FETUS $340.96 $921.50 63%
Screening mammogram, both breasts both sides CPT 77067 MA SCREEN MAMMO BILATERAL $287.12 $776.00 63%
Screening mammogram, both breasts both sides CPT 77067 MA SCREEN MAMMO BILATERAL $287.12 $776.00 63%
Screening mammogram, both breasts one side CPT 77067 MA SCREEN MAMMO LT $256.87 $694.25 63%
Screening mammogram, both breasts one side CPT 77067 MA SCREEN MAMMO RT $256.87 $694.25 63%
Screening mammogram, both breasts one side CPT 77067 MA SCREEN MAMMO LT $256.87 $694.25 63%
Screening mammogram, both breasts one side CPT 77067 MA SCREEN MAMMO RT $256.87 $694.25 63%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA SCREEN MAMMO BILATERAL $287.12 $776.00 63%
Screening mammogram, both breasts inpatient one side CPT 77067 MA SCREEN MAMMO LT $256.87 $694.25 63%
Screening mammogram, both breasts inpatient one side CPT 77067 MA SCREEN MAMMO RT $256.87 $694.25 63%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY SLEEP STUDY 6YRS + $5,160.76 $13,948.00 63%
Sleep study in a lab (polysomnography) CPT 95810 TERMINATED POLYSOMNOGRAPY 6YRS + $5,160.76 $13,948.00 63%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY SLEEP STUDY 6YRS + $5,160.76 $13,948.00 63%
Sleep study in a lab (polysomnography) inpatient CPT 95810 TERMINATED POLYSOMNOGRAPY 6YRS + $5,160.76 $13,948.00 63%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL $514.67 $1,391.00 63%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL $514.67 $1,391.00 63%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL $514.67 $1,391.00 63%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE $897.07 $2,424.50 63%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE $897.07 $2,424.50 63%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE $897.07 $2,424.50 63%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBAR COMP W/OBLIQUES $371.20 $1,003.25 63%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBAR COMP 4+VIEWS $463.98 $1,254.00 63%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBAR COMP 4+VIEWS $463.98 $1,254.00 63%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE LUMBAR COMP W/OBLIQUES $371.20 $1,003.25 63%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE LUMBAR COMP 4+VIEWS $463.98 $1,254.00 63%

Lab tests

ProcedureCash price List priceOff list
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PROF 2000 $71.50 $193.25 63%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PROF 2000 $71.50 $193.25 63%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PROF 2000 $71.50 $193.25 63%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PROF 2000 $71.50 $193.25 63%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE-TOTAL 80061 $156.97 $424.25 63%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE-TOTAL 80061 $156.97 $424.25 63%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE $156.97 $424.25 63%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE $156.97 $424.25 63%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE-TOTAL 80061 $156.97 $424.25 63%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE $156.97 $424.25 63%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE-TOTAL 80061 $156.97 $424.25 63%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE $156.97 $424.25 63%
Complete blood count (CBC) with differential CPT 85025 CBC W/DIFFERENTIAL 85025 $51.25 $138.50 63%
Complete blood count (CBC) with differential CPT 85025 CBC W/DIFFERENTIAL $51.25 $138.50 63%
Complete blood count (CBC) with differential CPT 85025 CBC W/DIFFERENTIAL $51.25 $138.50 63%
Complete blood count (CBC) with differential CPT 85025 CBC W/DIFFERENTIAL 85025 $51.25 $138.50 63%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/DIFFERENTIAL 85025 $51.25 $138.50 63%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/DIFFERENTIAL 85025 $51.25 $138.50 63%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/DIFFERENTIAL $51.25 $138.50 63%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/DIFFERENTIAL $51.25 $138.50 63%
Complete blood count (CBC), no differential CPT 85027 CBC W/O DIFFERENTIAL $46.62 $126.00 63%
Complete blood count (CBC), no differential CPT 85027 HEMOGRAM CBC 85027 $46.62 $126.00 63%
Complete blood count (CBC), no differential CPT 85027 HEMOGRAM CBC 85027 $46.62 $126.00 63%
Complete blood count (CBC), no differential CPT 85027 CBC W/O DIFFERENTIAL $46.62 $126.00 63%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC W/O DIFFERENTIAL $46.62 $126.00 63%
Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM CBC 85027 $46.62 $126.00 63%
Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM CBC 85027 $46.62 $126.00 63%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC W/O DIFFERENTIAL $46.62 $126.00 63%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL 2000 $122.38 $330.75 63%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL 2000 $122.38 $330.75 63%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL 2000 $122.38 $330.75 63%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL 2000 $122.38 $330.75 63%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL 2000 $77.70 $210.00 63%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL 2000 $77.70 $210.00 63%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL 2000 $77.70 $210.00 63%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL 2000 $77.70 $210.00 63%
Liver function blood test panel CPT 80076 HEPATIC PANEL 2000 $50.14 $135.50 63%
Liver function blood test panel CPT 80076 HEPATIC PANEL 2000 $50.14 $135.50 63%
Liver function blood test panel inpatient CPT 80076 HEPATIC PANEL 2000 $50.14 $135.50 63%
Liver function blood test panel inpatient CPT 80076 HEPATIC PANEL 2000 $50.14 $135.50 63%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN $12.67 $34.25 63%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN $12.67 $34.25 63%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN $12.67 $34.25 63%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN $12.67 $34.25 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF FACTOR 2 INHIB PTT SUB $16.65 $45.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF FACTOR 2 INHIB PTT $16.65 $45.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF FACTOR 2 INHIB PTT SUB $16.65 $45.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF FACTOR 2 INHIB PTT $16.65 $45.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF MAYO PTT $22.20 $60.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF MAYO PTT $22.20 $60.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF THROMBOPLAST TM (PTT) (APC-P) $27.38 $74.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF THROMBOPLAST TM (PTT) (APC-P) $27.38 $74.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME PTT $48.56 $131.25 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME PTT $48.56 $131.25 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF FAC IX PTT (S44096) $88.06 $238.00 63%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF FAC IX PTT (S44096) $88.06 $238.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF FACTOR 2 INHIB PTT SUB $16.65 $45.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF FACTOR 2 INHIB PTT SUB $16.65 $45.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF FACTOR 2 INHIB PTT $16.65 $45.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF FACTOR 2 INHIB PTT $16.65 $45.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF MAYO PTT $22.20 $60.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF MAYO PTT $22.20 $60.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF THROMBOPLAST TM (PTT) (APC-P) $27.38 $74.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF THROMBOPLAST TM (PTT) (APC-P) $27.38 $74.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME PTT $48.56 $131.25 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME PTT $48.56 $131.25 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF FAC IX PTT (S44096) $88.06 $238.00 63%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF FAC IX PTT (S44096) $88.06 $238.00 63%
Prothrombin time (PT/INR) clotting test CPT 85610 REF MAYO PROTHOMBIN TIME $9.25 $25.00 63%
Prothrombin time (PT/INR) clotting test CPT 85610 REF MAYO PROTHOMBIN TIME $9.25 $25.00 63%
Prothrombin time (PT/INR) clotting test CPT 85610 REF FACTOR 2 INHIBIT PROTIME $16.65 $45.00 63%
Prothrombin time (PT/INR) clotting test CPT 85610 REF FACTOR 2 INHIBIT PROTIME $16.65 $45.00 63%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT) $21.46 $58.00 63%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME WITH INR $21.46 $58.00 63%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME WITH INR $21.46 $58.00 63%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT) $21.46 $58.00 63%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 REF MAYO PROTHOMBIN TIME $9.25 $25.00 63%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 REF MAYO PROTHOMBIN TIME $9.25 $25.00 63%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 REF FACTOR 2 INHIBIT PROTIME $16.65 $45.00 63%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 REF FACTOR 2 INHIBIT PROTIME $16.65 $45.00 63%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT) $21.46 $58.00 63%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT) $21.46 $58.00 63%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME WITH INR $21.46 $58.00 63%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME WITH INR $21.46 $58.00 63%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ULTRASENSITIVE TSH3 $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HTSH II ULTRASENSITIVE $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH - ED FAST TSH $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HTSH II ULTRASENSITIVE $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH - ED FAST TSH $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ULTRASENSITIVE TSH3 $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH - ED FAST TSH $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ULTRASENSITIVE TSH3 $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HTSH II ULTRASENSITIVE $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ULTRASENSITIVE TSH3 $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH - ED FAST TSH $36.17 $97.75 63%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HTSH II ULTRASENSITIVE $36.17 $97.75 63%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS ROUT W/MICROSCOPIC $22.20 $60.00 63%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS ROUT W/MICROSCOPIC $22.20 $60.00 63%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS ROUT W/MICROSCOPIC $22.20 $60.00 63%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS ROUT W/MICROSCOPIC $22.20 $60.00 63%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS DIPSTICK 81000 $12.03 $32.50 63%
Urinalysis with microscope exam, manual CPT 81000 URINALY NON-AUTO W/MICRO 81000 $12.03 $32.50 63%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS DIPSTICK 81000 $12.03 $32.50 63%
Urinalysis with microscope exam, manual CPT 81000 URINALY NON-AUTO W/MICRO 81000 $12.03 $32.50 63%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS DIPSTICK 81000 $12.03 $32.50 63%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALY NON-AUTO W/MICRO 81000 $12.03 $32.50 63%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS DIPSTICK 81000 $12.03 $32.50 63%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALY NON-AUTO W/MICRO 81000 $12.03 $32.50 63%
Urinalysis without microscope exam, automated CPT 81003 UA MACROSCOPIC AUTO WO MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTOMATED W/O MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated CPT 81003 UA COMPONENT PH AUTO WO MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated CPT 81003 UA MACROSCOPIC AUTO WO MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTOMATED W/O MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated CPT 81003 UA COMPONENT PH AUTO WO MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTOMATED W/O MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTOMATED W/O MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA MACROSCOPIC AUTO WO MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA MACROSCOPIC AUTO WO MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA COMPONENT PH AUTO WO MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA COMPONENT PH AUTO WO MICRO $10.45 $28.25 63%
Urinalysis without microscope exam, manual CPT 81002 UA REDUCING SUB NON-AU WO MICR $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 ED OB URINALYSIS DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 UA NONAUTO W/0 SCOPE 81002 $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 L&D URINALYSIS BY DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 OBOP URINALYSIS DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 UA NONAUTO W/0 SCOPE 81002 $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 ED OB URINALYSIS DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 OBOP URINALYSIS DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 UA REDUCING SUB NON-AU WO MICR $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 UA SPEC GRAVI NON-AUTO WO MICR $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 L&D URINALYSIS BY DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual CPT 81002 UA SPEC GRAVI NON-AUTO WO MICR $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA NONAUTO W/0 SCOPE 81002 $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA SPEC GRAVI NON-AUTO WO MICR $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA REDUCING SUB NON-AU WO MICR $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA SPEC GRAVI NON-AUTO WO MICR $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA NONAUTO W/0 SCOPE 81002 $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 L&D URINALYSIS BY DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 ED OB URINALYSIS DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 OBOP URINALYSIS DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 L&D URINALYSIS BY DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 ED OB URINALYSIS DIP STICK $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA REDUCING SUB NON-AU WO MICR $4.90 $13.25 63%
Urinalysis without microscope exam, manual inpatient CPT 81002 OBOP URINALYSIS DIP STICK $4.90 $13.25 63%

Doctor visits and therapy

ProcedureCash price List priceOff list
New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT NEW PT LEVEL III $135.70 $366.75 63%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT NEW PT LEVEL III $135.70 $366.75 63%
New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT NEW PT LEVEL IV $186.11 $503.00 63%
New patient office visit, about 45 minutes inpatient CPT 99204 SPOC OFFICE VISIT NEW PT LEVEL IV $62.81 $169.75 63%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT NEW PT LEVEL IV $186.11 $503.00 63%
New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT NEW PT LEVEL V $313.67 $847.75 63%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT NEW PT LEVEL V $313.67 $847.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT LYMPH THERAPEUTIC EX 15MIN $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXER 15M OTA $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT LYMPH THERAPEUTIC EX 15M OTA $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT LYMPH THERAPEUT EXERCISE 15 MIN $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXER 15MIN $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT LYMPH THERAPEUT EXER 15M PTA $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT PELVIC FLOOR THER EXER 15 MIN $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXER 15 MN $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXER 15M PTA $32.10 $86.75 63%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT PELVIC FLR THER EXER 15M PTA $32.10 $86.75 63%
Psychotherapy session, 45 minutes CPT 90834 PSYCH THERAPY 45MIN W-PT $224.83 $607.65 63%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCH THERAPY 45MIN W-PT $224.83 $607.65 63%
Psychotherapy session, 60 minutes CPT 90837 PSYCH THERAPY 60MIN W-PT $224.83 $607.65 63%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCH THERAPY 60MIN W-PT $224.83 $607.65 63%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OP OFFICE CONSULT LEVEL III $77.70 $210.00 63%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OP OFFICE CONSULT LEVEL IV $89.17 $241.00 63%

Source file: https://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/fl-csv/260479484_st-lukes-st-vincents-healthcare-inc_standardcharges.csv