St. Luke's Health - Brazosport Hospital
100 Medical Drive, Lake Jackson, TX · CommonSpirit Health · · NPI 1972581940
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 |
|---|---|---|---|---|
| 17-ketosteroids CPT 83586 | $20.79 | $59.40 | $8.91 – $53.77 | 23 |
| 2019-ncov diagnostic p HCPCS U0001 | $12.95 | $37.00 | $5.55 – $93.39 | 23 |
| 2nd order venous cath CPT 36012 | $394.07 | $1,125.90 | $67.56 – $1,125.90 | 5 |
| 3-d radiotherapy plan CPT 77295 | $7,729.75 | $22,085.00 | $944.95 – $11,042.50 | 6 |
| 3d recon without postprocess indpndt CPT 76376 | $337.75 | $965.00 | $25.46 – $579.00 | 5 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $35.00 | $100.00 | $10.24 – $81.36 | 6 |
| Abd aorta w/runoff s&i CPT 75630 | $3,305.05 | $9,443.00 | $156.71 – $5,293.14 | 11 |
| Abd/low ext cath 1st CPT 36245 | $1,094.63 | $3,127.50 | $187.65 – $1,600.00 | 5 |
| Abd/low ext cath 2nd CPT 36246 | $524.65 | $1,499.00 | $89.94 – $1,499.00 | 5 |
| Abd/low ext cath 3rd CPT 36247 | $629.65 | $1,799.00 | $107.94 – $1,600.00 | 5 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $4,648.00 | $13,280.00 | $180.34 – $6,640.00 | 11 |
| Abdominal CT scan (with contrast) CPT 74160 | $4,113.09 | $11,751.66 | $180.34 – $5,875.83 | 11 |
| Abdominal CT scan (without contrast) CPT 74150 | $2,385.60 | $6,816.00 | $106.88 – $3,408.00 | 11 |
| Abdominal MRI (with and without contrast) CPT 74183 | $5,034.60 | $14,384.55 | $354.51 – $7,192.28 | 11 |
| Abdominal MRI (with contrast) CPT 74182 | $4,531.45 | $12,947.00 | $317.43 – $6,473.50 | 11 |
| Abdominal MRI (without contrast) CPT 74181 | $2,920.40 | $8,344.00 | $204.83 – $4,172.00 | 11 |
| Abdominal paracentesis w/image guidance CPT 49083 | $1,321.43 | $3,775.50 | $566.33 – $1,887.75 | 2 |
| Abdominal Ultrasound (complete) CPT 76700 | $1,649.55 | $4,713.00 | $106.88 – $2,356.50 | 11 |
| Abdominal Ultrasound (limited) CPT 76705 | $923.65 | $2,639.00 | $88.55 – $1,319.50 | 11 |
| Abscess drain retroperitoneal surg code CPT 49406 | $1,678.01 | $4,794.30 | $719.15 – $2,397.15 | 2 |
| Acetaminophen level CPT 80143 | $8.75 | $25.00 | $3.75 – $78.46 | 23 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $58.44 | $166.95 | $25.05 – $108.52 | 7 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $244.39 | $698.25 | $0.66 – $453.87 | 7 |
| Acetylcysteine non-comp unit HCPCS J7608 | $29.04 | $82.95 | $3.43 – $40.43 | 4 |
| Acute hepatitis panel CPT 80074 | $236.60 | $676.00 | $8.08 – $338.00 | 23 |
| Acyclovir 400 mg tablet HCPCS J8499 | $467.94 | $1,336.97 | $14.27 – $61.84 | 6 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $35.65 | $101.85 | $0.03 – $66.21 | 7 |
| #acylcarnitineprfl CPT 82017 | $39.38 | $112.50 | $14.17 – $71.20 | 23 |
| Adapter b 8 channel 10cm HCPCS C1883 | $1,837.50 | $5,250.00 | $630.00 – $3,412.50 | 10 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $32.64 | $93.25 | $0.46 – $60.62 | 7 |
| Adh-sendout CPT 84588 | $62.65 | $179.00 | $26.85 – $142.39 | 23 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $45.72 | $130.62 | $0.26 – $47.99 | 7 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $256.15 | $731.85 | $62.53 – $365.93 | 5 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $256.20 | $732.00 | $109.80 – $366.00 | 5 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $508.99 | $1,454.25 | $218.14 – $727.13 | 5 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $509.25 | $1,455.00 | $218.25 – $727.50 | 5 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $323.05 | $923.00 | $115.24 – $461.50 | 5 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $321.57 | $918.75 | $115.24 – $459.38 | 5 |
| Administration immunization 1 vaccine CPT 90471 | $74.90 | $214.00 | $32.10 – $115.24 | 3 |
| Administration immunization each additional vaccine CPT 90472 | $38.15 | $109.00 | $16.35 – $54.50 | 3 |
| Administration vaccine hepatitis b HCPCS G0010 | $35.35 | $101.00 | $15.15 – $101.00 | 3 |
| Administration vaccine influenza virus HCPCS G0008 | $38.15 | $109.00 | $16.35 – $54.50 | 3 |
| Administration vaccine pneumococcal HCPCS G0009 | $38.15 | $109.00 | $16.35 – $94.51 | 3 |
| _afb id by dna probe rflx ast CPT 87149 | $43.47 | $124.20 | $16.84 – $84.25 | 23 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $135.77 | $387.90 | $58.19 – $483.81 | 23 |
| Air injection into abdomen 49400 CPT 49400 | $151.83 | $433.80 | $65.07 – $216.90 | 2 |
| Albumin body fluid quantitative each specimen CPT 82042 | $21.00 | $60.00 | $4.37 – $31.95 | 23 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $123.87 | $353.90 | $28.49 – $123.42 | 9 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $97.92 | $279.75 | $41.97 – $181.84 | 9 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $36.75 | $105.00 | $3.11 – $24.68 | 23 |
| Albumin serum plasma or whole blood CPT 82040 | $33.81 | $96.60 | $4.16 – $48.30 | 23 |
| Albuterol non-comp unit HCPCS J7613 | $3.31 | $9.45 | $0.08 – $4.73 | 4 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $14.00 | $40.00 | $6.00 – $72.62 | 23 |
| Alkaline phosphatase CPT 84075 | $28.35 | $81.00 | $4.35 – $40.50 | 23 |
| Allergen alpha lactalbumin ige CPT 86008 | $25.48 | $72.80 | $10.92 – $75.56 | 23 |
| Allergen egg white ige CPT 86003 | $9.10 | $26.00 | $3.90 – $21.79 | 23 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $2,854.39 | $8,155.39 | $35.08 – $908.55 | 8 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $3,621.72 | $10,347.75 | $179.82 – $6,208.65 | 8 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $657.15 | $1,877.57 | $225.31 – $1,220.43 | 10 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $33.25 | $95.00 | $14.25 – $270.22 | 23 |
| Alpha-fetoprotein tumor marker CPT 82105 | $74.03 | $211.50 | $14.09 – $79.65 | 23 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $7,917.98 | $22,622.80 | $50.88 – $220.45 | 7 |
| Alt/sgpt CPT 84460 | $29.40 | $84.00 | $4.45 – $42.00 | 23 |
| Amantadine (symmetrel)-sendout CPT 80375 | $45.99 | $131.40 | $13.30 – $78.84 | 9 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $23.16 | $66.15 | $0.89 – $43.00 | 7 |
| Amino acid screen, urine CPT 82128 | $38.75 | $110.70 | $11.65 – $58.10 | 23 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $61.68 | $176.22 | $0.40 – $9.56 | 7 |
| Ammonia CPT 82140 | $133.41 | $381.15 | $12.24 – $190.58 | 23 |
| Amniocentesisdiagnostic 59000 CPT 59000 | not published | not published | $55.23 – $55.23 | 1 |
| Amniocentesis therapeutic CPT 59001 | not published | not published | $116.30 – $116.30 | 1 |
| Amniotic fluid scan CPT 82143 | $3.15 | $9.00 | $1.35 – $39.21 | 23 |
| Amphetamines 5 or more CPT 80326 | $0.63 | $1.80 | $0.27 – $12.69 | 9 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $31.98 | $91.35 | $0.90 – $17.07 | 7 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $55.45 | $158.41 | $2.32 – $29.35 | 7 |
| Amylase CPT 82150 | $93.45 | $267.00 | $5.44 – $133.50 | 23 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $96.39 | $275.40 | $9.63 – $88.74 | 9 |
| Analysis gene f2 20210g>a variant CPT 81240 | $103.60 | $296.00 | $40.28 – $276.05 | 23 |
| Analysis gene f5 leiden variant CPT 81241 | $116.55 | $333.00 | $49.95 – $308.00 | 23 |
| Anca screen with reflex to titer -quest CPT 86021 | $100.32 | $286.62 | $12.64 – $66.00 | 23 |
| An fluoro guide for cvp CPT 77001 | $193.55 | $553.00 | $82.95 – $331.80 | 5 |
| Angio balloon ctrl dialysis seg add-on CPT 36907 | $3,864.42 | $11,041.20 | $662.48 – $5,520.60 | 5 |
| Angioplasty fem/pop unilat 37224 CPT 37224 | $4,770.15 | $13,629.00 | $1,600.00 – $6,814.50 | 3 |
| Angioplasty/iliac/init ves/unilat 37220 CPT 37220 | $3,291.44 | $9,404.10 | $1,410.62 – $4,702.05 | 3 |
| Angioplasty tib/pero/unilat/ea add 37232 CPT 37232 | $3,384.85 | $9,671.00 | $580.26 – $4,835.50 | 5 |
| Angiotensin ii 0.5 mg/ml soln 1 ml vial HCPCS J3490 | $147.37 | $421.05 | $5.99 – $25.94 | 6 |
| Angio tib/peroneal/init ves/unila 37228 CPT 37228 | $9,181.20 | $26,232.00 | $1,600.00 – $13,116.00 | 3 |
| Angio trnslmnl balloon same artery ea addl CPT 37247 | $2,454.80 | $7,013.70 | $420.83 – $3,506.85 | 5 |
| Angio trnslmnl balloon same artery ini CPT 37246 | $4,770.15 | $13,629.00 | $1,600.00 – $6,814.50 | 3 |
| Angio trnslmnl balloon same vein ea addl CPT 37249 | $2,862.41 | $8,178.30 | $490.70 – $4,089.15 | 5 |
| Angio trnslmnl balloon same vein ini CPT 37248 | $4,770.15 | $13,629.00 | $1,600.00 – $6,814.50 | 3 |
| Ankle X-ray CPT 73610 | $582.45 | $1,664.13 | $31.23 – $998.48 | 11 |
| Anl sp inf pmp w/mdreprg&fil CPT 62370 | not published | not published | $95.22 – $95.22 | 1 |
| Anodyne therapy charges pt CPT 97026 | $8.05 | $23.00 | $3.45 – $255.00 | 5 |
| Anora (draw only) CPT 99001 | $20.00 | $57.12 | $4.69 – $28.56 | 4 |
| Anoscopy and biopsy CPT 46606 | not published | not published | $141.30 – $141.30 | 1 |
| Anoscopy control bleeding 46614 CPT 46614 | not published | not published | $70.10 – $70.10 | 1 |
| Antibody elution rbc reference CPT 86860 | $126.63 | $361.80 | $15.05 – $345.84 | 7 |
| Antibody htlv/hiv confirm test CPT 86689 | $30.87 | $88.20 | $13.23 – $81.36 | 23 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $133.88 | $382.50 | $15.43 – $180.00 | 23 |
| Antibody id rbc panel CPT 86870 | $423.15 | $1,209.00 | $9.67 – $725.40 | 7 |
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.