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 |
|---|---|---|---|---|
| Hc nm kidney imaging with flow CPT 78701 | $725.13 | $2,071.80 | $124.31 – $1,035.90 | 11 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | $725.13 | $2,071.80 | $310.77 – $1,035.90 | 6 |
| Head CT scan (with and without contrast) CPT 70470 | $4,134.20 | $11,812.00 | $180.34 – $5,906.00 | 11 |
| Head CT scan (with contrast) CPT 70460 | $3,529.05 | $10,083.00 | $153.36 – $5,041.50 | 11 |
| Head CT scan (without contrast) CPT 70450 | $2,521.05 | $7,203.00 | $106.88 – $3,601.50 | 11 |
| Heart first pass add-on CPT 78496 | $613.31 | $1,752.30 | $38.54 – $1,000.00 | 6 |
| Heart image spect CPT 78494 | $674.73 | $1,927.80 | $115.67 – $1,000.00 | 11 |
| Heart infarct image CPT 78466 | $449.82 | $1,285.20 | $77.12 – $771.12 | 11 |
| Helicobacter pylori antibody igm CPT 86677 | $74.97 | $214.20 | $12.25 – $107.10 | 23 |
| Hematocrit CPT 85014 | $30.51 | $87.15 | $1.99 – $43.58 | 23 |
| Hemodialysis one evaluation CPT 90935 | $1,234.15 | $3,526.14 | $528.93 – $1,763.07 | 2 |
| Hemoglobin CPT 85018 | $31.98 | $91.35 | $1.99 – $45.68 | 23 |
| Hemophilus influenza antibdy CPT 86684 | $18.21 | $52.02 | $7.81 – $66.83 | 23 |
| Heparin bolus from bag HCPCS J1644 | $40.45 | $115.56 | $0.25 – $13.65 | 7 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $6.99 | $19.95 | $0.02 – $12.97 | 7 |
| Hepatitis a antibody igm CPT 86709 | $20.30 | $58.00 | $8.70 – $47.94 | 23 |
| Hepatitis b core antibody igm CPT 86705 | $31.15 | $89.00 | $9.89 – $49.41 | 23 |
| Hepatitis b core antibody total CPT 86704 | $17.98 | $51.37 | $7.71 – $50.84 | 23 |
| Hepatitis b immune globulin greater than 1,560 units/5 ml im solution CPT 90371 | $89.66 | $256.16 | $38.43 – $254.85 | 7 |
| Hepatitis b surface antibody CPT 86706 | $54.39 | $155.40 | $9.02 – $77.70 | 23 |
| Hepatitis c antibody CPT 86803 | $94.08 | $268.80 | $11.99 – $79.20 | 23 |
| Hepatitis c rna dir probe CPT 87520 | $49.63 | $141.78 | $16.93 – $130.76 | 23 |
| Hepatobiliary system imaging CPT 78226 | $797.30 | $2,278.00 | $136.68 – $1,139.00 | 11 |
| Herpes simplex type 1 antibody igg CPT 86695 | $19.69 | $56.23 | $8.44 – $55.20 | 23 |
| Herpes simplex type 2 antibody igg CPT 86696 | $69.09 | $197.40 | $16.25 – $98.70 | 23 |
| Herpes simplex virus isolation CPT 87255 | $137.55 | $393.00 | $28.44 – $196.50 | 23 |
| Heterophile antibodies screening CPT 86308 | $46.20 | $132.00 | $4.35 – $66.00 | 23 |
| Hip X-ray CPT 73502 | $571.92 | $1,634.04 | $41.04 – $980.43 | 11 |
| Histamine CPT 83088 | $137.34 | $392.40 | $24.81 – $196.20 | 23 |
| Hla ii typing 1 loc hr CPT 81382 | $175.75 | $502.14 | $75.33 – $518.69 | 23 |
| Homocysteine CPT 83090 | $48.65 | $139.00 | $14.24 – $75.56 | 23 |
| Homogenization tissue CPT 87176 | $23.10 | $66.00 | $4.94 – $33.00 | 23 |
| H pylori (c-13) breath CPT 83013 | $140.35 | $401.00 | $45.90 – $283.32 | 23 |
| H pylori drug admin CPT 83014 | $12.95 | $37.00 | $5.55 – $33.42 | 23 |
| Human epididymis protein 4 (he4) CPT 86305 | $137.55 | $393.00 | $17.48 – $196.50 | 23 |
| Hydralazine 20 mg/ml injection solution HCPCS J0360 | $26.83 | $76.65 | $4.65 – $49.83 | 7 |
| Hydration IV infusion each additional hour CPT 96361 | $132.65 | $379.00 | $27.72 – $189.50 | 4 |
| Hydration IV infusion initial 31minutes - 1 hour CPT 96360 | $257.60 | $736.00 | $91.00 – $368.00 | 4 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | $33.08 | $94.50 | $3.96 – $20.48 | 7 |
| Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) HCPCS J1171 | $118.34 | $338.10 | $2.52 – $10.92 | 6 |
| Hydrxycorticsterds 17- (17-ohcs) CPT 83491 | $27.41 | $78.30 | $11.75 – $75.56 | 23 |
| Hysterosalpingography s&i CPT 74740 | $312.90 | $894.00 | $53.64 – $536.40 | 11 |
| Icd crtp serena MRI HCPCS C2621 | $995.84 | $2,845.25 | $341.43 – $1,849.42 | 8 |
| I&d lacrimal sac CPT 68420 | not published | not published | $182.52 – $182.52 | 1 |
| Ifosfamide 1 gram intravenous solution HCPCS J9208 | $72.03 | $205.80 | $30.87 – $102.90 | 4 |
| Igh@ var region somatic mutation analy CPT 81263 | $258.30 | $738.00 | $110.70 – $1,236.40 | 23 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $27.13 | $77.49 | $11.63 – $258.63 | 7 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $34.07 | $97.34 | $14.61 – $284.58 | 7 |
| Iliac revasc add-on 37222 CPT 37222 | $1,696.91 | $4,848.30 | $290.90 – $2,424.15 | 5 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | $134.49 | $384.24 | $55.92 – $242.29 | 7 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $81.22 | $232.05 | $17.48 – $116.03 | 23 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $66.50 | $190.00 | $17.48 – $95.00 | 23 |
| Immunofixation electrophoresis serum CPT 86334 | $142.10 | $406.00 | $18.77 – $203.00 | 23 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $227.50 | $650.00 | $26.23 – $390.00 | 7 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $53.55 | $153.00 | $21.89 – $502.53 | 7 |
| Implant ureth bulk agent HCPCS L8606 | $3,950.63 | $11,287.50 | $473.04 – $2,562.27 | 8 |
| Impres&prep oral surg splint CPT 21085 | not published | not published | $186.69 – $186.69 | 1 |
| In-111 pentetate dtpa / 0.5 mci HCPCS A9548 | $3,237.57 | $9,250.20 | $814.85 – $4,625.10 | 3 |
| In-111 pentetreotide HCPCS A9572 | $1,761.17 | $5,031.90 | $754.79 – $5,031.90 | 3 |
| Incise/drain eyelid lining CPT 68020 | not published | not published | $52.14 – $52.14 | 1 |
| Incise tear duct opening 68440 CPT 68440 | not published | not published | $51.03 – $51.03 | 1 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $111.51 | $318.60 | $47.79 – $159.30 | 2 |
| Incision of eyelid CPT 67710 | not published | not published | $144.11 – $144.11 | 1 |
| Incision of toe tendons 28011 CPT 28011 | $727.65 | $2,079.00 | $311.85 – $1,039.50 | 2 |
| Incisn of toe tndn CPT 28010 | $749.39 | $2,141.10 | $321.17 – $1,070.55 | 2 |
| Incobotulinumtoxin a HCPCS J0588 | $417.12 | $1,191.75 | $6.14 – $774.64 | 7 |
| Infect ag eia influenza a or b ea CPT 87400 | $117.60 | $336.00 | $10.13 – $168.00 | 23 |
| Infect ag genotype na dna hepatitis b CPT 87912 | $647.15 | $1,849.00 | $212.33 – $1,080.96 | 23 |
| Infect ag genotype na hiv-1 other region CPT 87906 | $131.60 | $376.00 | $56.40 – $540.48 | 23 |
| Infect ag ia optc obs influenza CPT 87804 | $35.35 | $101.00 | $10.13 – $69.73 | 23 |
| Infect ag if pneumocystis carinii CPT 87281 | $72.45 | $207.00 | $10.06 – $103.50 | 23 |
| Infect ag na herpes simplex quant CPT 87530 | $132.65 | $379.00 | $35.99 – $189.50 | 23 |
| Infect ag na hpv high-risk types CPT 87624 | $35.91 | $102.60 | $15.39 – $146.76 | 23 |
| Infect ag na resp virus 12-25 targets CPT 87633 | $567.32 | $1,620.90 | $243.14 – $1,749.26 | 23 |
| Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 | $59.98 | $171.36 | $24.89 – $107.59 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $78.75 | $225.00 | $10.06 – $112.50 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $31.50 | $90.00 | $10.13 – $58.10 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $38.12 | $108.90 | $10.06 – $54.45 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $25.73 | $73.50 | $11.03 – $61.04 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $40.80 | $116.55 | $8.68 – $58.28 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $38.43 | $109.80 | $8.68 – $54.90 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $101.43 | $289.80 | $20.23 – $101.71 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $64.05 | $183.00 | $10.06 – $91.50 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $75.25 | $215.00 | $10.06 – $107.50 | 23 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | $26.67 | $76.19 | $10.06 – $50.84 | 23 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $102.38 | $292.50 | $29.48 – $146.76 | 23 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $112.46 | $321.30 | $29.48 – $160.65 | 23 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $63.70 | $182.00 | $27.30 – $156.92 | 23 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $245.70 | $702.00 | $105.30 – $1,749.26 | 20 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $141.40 | $404.00 | $29.48 – $202.00 | 23 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $99.80 | $285.12 | $29.48 – $146.76 | 23 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $92.05 | $263.00 | $30.79 – $133.41 | 23 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $101.50 | $290.00 | $43.50 – $370.84 | 22 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $54.86 | $156.72 | $23.51 – $146.76 | 23 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | $707.90 | $2,022.57 | $303.39 – $1,749.26 | 23 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $237.20 | $677.70 | $35.99 – $338.85 | 23 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $237.78 | $679.35 | $35.99 – $339.68 | 23 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $244.02 | $697.20 | $35.99 – $195.50 | 23 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $200.03 | $571.50 | $71.48 – $357.41 | 23 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $148.75 | $425.00 | $63.75 – $598.58 | 23 |
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.