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 |
|---|---|---|---|---|
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $3.54 | $10.11 | $0.72 – $3.66 | 7 |
| Ipilimumab 5 mg/ml intravenous solution (wrapper) HCPCS J9228 | $28,055.14 | $80,157.52 | $254.71 – $52,102.39 | 7 |
| Ipratropium bromide non-comp HCPCS J7644 | $3.31 | $9.45 | $0.41 – $4.73 | 4 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | $127.35 | $363.85 | $3.60 – $83.42 | 7 |
| Iron CPT 83540 | $36.05 | $103.00 | $5.43 – $51.50 | 23 |
| Iron binding capacity CPT 83550 | $12.60 | $36.00 | $5.40 – $36.31 | 23 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | $149.14 | $426.09 | $20.32 – $276.96 | 7 |
| Irradiation of blood product each unit reference CPT 86945 | $46.90 | $134.00 | $8.96 – $123.50 | 6 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $108.85 | $311.00 | $45.00 – $155.50 | 5 |
| Isatuximab-irfc 20 mg/ml intravenous solution HCPCS J9227 | $1,475.16 | $4,214.72 | $112.39 – $498.06 | 7 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $269.85 | $771.00 | $63.24 – $385.50 | 4 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $269.85 | $771.00 | $41.92 – $385.50 | 4 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $163.10 | $466.00 | $44.06 – $233.00 | 4 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $392.00 | $1,120.00 | $146.38 – $560.00 | 4 |
| Ivp w/nephrotomography CPT 74415 | $526.68 | $1,504.80 | $90.29 – $902.88 | 11 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $382.03 | $1,091.50 | $65.49 – $654.90 | 11 |
| Jak2 targeted sequence analysis CPT 81279 | $266.72 | $762.05 | $111.12 – $777.28 | 20 |
| Ketamine and metabolite screen - quest CPT 80357 | $0.63 | $1.80 | $0.27 – $12.94 | 9 |
| Ketogenic steroids fract CPT 83582 | $22.68 | $64.80 | $9.72 – $65.36 | 23 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $77.70 | $222.00 | $6.86 – $43.50 | 23 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $236.67 | $676.20 | $0.40 – $21.84 | 7 |
| Kidney imaging morphology CPT 78700 | $491.09 | $1,403.10 | $84.19 – $841.86 | 11 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $869.09 | $2,483.10 | $148.99 – $1,241.55 | 11 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $1,243.20 | $3,552.00 | $106.88 – $1,776.00 | 11 |
| Kit cast tcc 3in w/2reg boots total contact cast HCPCS Q4038 | $18.00 | $51.42 | $7.72 – $51.42 | 3 |
| Kit lead specify 5-6-5 HCPCS C1778 | $10,932.10 | $31,234.56 | $3,748.15 – $20,302.47 | 8 |
| Knee MRI (with and without contrast) CPT 73723 | $4,974.55 | $14,213.00 | $368.43 – $7,106.50 | 11 |
| Knee MRI (with contrast) CPT 73722 | $4,036.90 | $11,534.00 | $328.79 – $5,767.00 | 11 |
| Knee MRI (without contrast) CPT 73721 | $2,604.32 | $7,440.90 | $210.84 – $3,720.45 | 11 |
| Knee X-ray CPT 73564 | $670.95 | $1,917.00 | $39.30 – $1,000.00 | 11 |
| Kras gene variants exon 2 CPT 81275 | $248.85 | $711.00 | $106.65 – $810.70 | 23 |
| Lactate dehydrogenase (ldh) CPT 83615 | $40.25 | $115.00 | $5.07 – $57.50 | 23 |
| Lactated ringers intravenous solution HCPCS J7120 | $23.98 | $68.51 | $2.78 – $34.26 | 4 |
| Lactic acid CPT 83605 | $44.84 | $128.10 | $9.02 – $64.05 | 23 |
| Lactoferrin fecal quant CPT 83631 | $129.15 | $369.00 | $16.49 – $184.50 | 23 |
| Lanreotide 120 mg/0.5 ml subcutaneous syringe HCPCS J1930 | $7,655.90 | $21,874.00 | $71.96 – $14,218.10 | 7 |
| Laryngeal function studies CPT 92520 | $57.02 | $162.90 | $24.44 – $255.00 | 5 |
| Laryngoscopy telescopic CPT 31579 | not published | not published | $81.30 – $81.30 | 1 |
| Lead capillary CPT 83655 | $32.55 | $93.00 | $10.17 – $50.84 | 23 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $1,521.28 | $4,346.50 | $506.58 – $2,743.98 | 8 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,589.70 | $4,542.00 | $188.79 – $2,271.00 | 10 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $2,960.39 | $8,458.24 | $96.96 – $387.84 | 5 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $577.92 | $1,651.20 | $29.19 – $116.74 | 5 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $203.84 | $582.40 | $55.49 – $221.96 | 5 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $90.95 | $259.85 | $2.55 – $11.05 | 7 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $8,906.80 | $25,448.00 | $183.36 – $882.09 | 7 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $4,314.73 | $12,327.80 | $1,322.58 – $8,013.07 | 7 |
| Levalbuterol non-comp unit HCPCS J7614 | $12.13 | $34.65 | $0.09 – $17.33 | 4 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $36.58 | $104.49 | $0.07 – $67.92 | 7 |
| Levetiracetam therapeutic drug level CPT 80177 | $52.85 | $151.00 | $10.85 – $55.20 | 23 |
| Liberta rc ipg HCPCS C1820 | $59,382.36 | $169,663.87 | $1,743.28 – $9,442.75 | 8 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $135.24 | $386.40 | $3.54 – $251.16 | 7 |
| Lipase CPT 83690 | $39.90 | $114.00 | $5.79 – $29.05 | 23 |
| Lipoprotein blood high res frac & quant CPT 83701 | $123.48 | $352.80 | $20.96 – $176.40 | 23 |
| Lipoprotein direct measurement hdl CPT 83718 | $27.41 | $78.30 | $6.88 – $39.15 | 23 |
| Lipoprotein direct measurement ldl CPT 83721 | $32.55 | $93.00 | $8.05 – $46.50 | 23 |
| Lithium therapeutic drug level CPT 80178 | $110.95 | $317.00 | $5.55 – $158.50 | 23 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $1,855.00 | $5,300.00 | $318.00 – $2,650.00 | 5 |
| Liver Function Test CPT 80076 | $215.95 | $617.00 | $6.89 – $308.50 | 23 |
| Liver imaging CPT 78201 | $459.59 | $1,313.10 | $78.79 – $787.86 | 11 |
| Liver imag w/vasclr flow CPT 78202 | $703.71 | $2,010.60 | $120.64 – $1,005.30 | 11 |
| Liver/spleen imag static only CPT 78215 | $466.83 | $1,333.80 | $80.03 – $800.28 | 11 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $3.94 | $11.24 | $0.65 – $3.25 | 7 |
| Low cost skin substitute app HCPCS C5271 | $208.95 | $597.00 | $45.00 – $298.50 | 3 |
| Low cost skin substitute app HCPCS C5273 | $208.95 | $597.00 | $89.55 – $298.50 | 2 |
| Low cost skin substitute app HCPCS C5275 | $208.95 | $597.00 | $45.00 – $298.50 | 3 |
| Low cost skin substitute app HCPCS C5277 | $208.95 | $597.00 | $89.55 – $298.50 | 2 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $5,453.35 | $15,581.00 | $180.34 – $7,790.50 | 11 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $4,638.90 | $13,254.00 | $175.43 – $6,627.00 | 11 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $3,541.09 | $10,117.38 | $106.88 – $5,058.69 | 11 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $6,868.40 | $19,624.00 | $333.80 – $9,812.00 | 11 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $5,840.10 | $16,686.00 | $282.68 – $8,343.00 | 11 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $4,112.66 | $11,750.45 | $199.14 – $5,875.23 | 11 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $582.05 | $1,663.00 | $34.73 – $997.80 | 11 |
| Low frequency non-thermal Ultrasound CPT 97610 | $122.54 | $350.10 | $52.52 – $334.52 | 5 |
| Lumbar diskogram s&i CPT 72295 | $865.62 | $2,473.20 | $96.48 – $2,473.20 | 11 |
| Lung function test (mbc/mvv) CPT 94200 | $71.51 | $204.30 | $30.65 – $129.82 | 4 |
| Lung Function Test (Spirometry) CPT 94010 | $231.53 | $661.50 | $99.23 – $330.75 | 4 |
| Lung perfusion imaging CPT 78580 | $419.65 | $1,199.00 | $71.94 – $719.40 | 11 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $6,565.08 | $18,757.35 | $293.18 – $12,192.28 | 7 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $9,599.06 | $27,425.88 | $58.49 – $5,955.23 | 7 |
| Lymphatics/lymph node imaging CPT 78195 | $888.99 | $2,539.95 | $152.40 – $1,269.98 | 11 |
| Magnesium CPT 83735 | $105.48 | $301.35 | $5.63 – $150.68 | 23 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $23.60 | $67.41 | $0.14 – $6.83 | 7 |
| Magnetic image bone marrow CPT 77084 | $1,858.19 | $5,309.10 | $233.52 – $2,654.55 | 11 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $65.80 | $188.00 | $28.20 – $188.00 | 4 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $65.80 | $188.00 | $28.20 – $188.00 | 4 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $48.50 – $48.50 | 1 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $5.88 | $16.80 | $2.52 – $10.92 | 7 |
| Marker biop eviva buckle ss HCPCS A4648 | $275.63 | $787.50 | $94.50 – $511.88 | 8 |
| Mastoids complete CPT 70130 | $205.07 | $585.90 | $35.16 – $351.54 | 11 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $540.30 | $1,543.69 | $22.74 – $146.06 | 6 |
| Mayo aathr protein s free CPT 85306 | $44.10 | $126.00 | $12.87 – $63.93 | 23 |
| Mayo activated protein c resistance assay CPT 85307 | $147.35 | $421.00 | $12.87 – $210.50 | 23 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $185.50 | $530.00 | $23.14 – $265.00 | 23 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $47.95 | $137.00 | $8.82 – $82.20 | 9 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $90.68 | $259.08 | $9.42 – $155.45 | 9 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $24.26 | $69.30 | $10.40 – $62.46 | 23 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $0.95 | $2.70 | $0.41 – $24.51 | 9 |
| Mayo alpha 1 antitrypsin CPT 82103 | $79.80 | $228.00 | $11.29 – $63.00 | 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.