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 |
|---|---|---|---|---|
| Pulse ox multiple CPT 94761 | $62.06 | $177.30 | $9.25 – $88.65 | 4 |
| Pulse ox single CPT 94760 | $87.47 | $249.90 | $5.68 – $124.95 | 4 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $78.54 | $224.40 | $33.66 – $112.20 | 2 |
| Puncture aspiration abscess/hematoma/bulla/cyst CPT 10160 | $136.71 | $390.60 | $58.59 – $195.30 | 3 |
| Puncture spinal lumbar diagnostic CPT 62270 | $690.90 | $1,974.00 | $296.10 – $987.00 | 2 |
| Pvb thoracic cont infusion CPT 64463 | not published | not published | $76.67 – $76.67 | 1 |
| Pvb thoracic single inj site CPT 64461 | not published | not published | $65.21 – $65.21 | 1 |
| Quant diff pulm perf w/imaging CPT 78597 | $490.77 | $1,402.20 | $84.14 – $841.32 | 11 |
| Quest t3 uptake CPT 84479 | $45.94 | $131.25 | $5.43 – $65.63 | 23 |
| Radiation physics consult CPT 77336 | $706.15 | $2,017.56 | $278.99 – $1,008.78 | 6 |
| Radiation therapy dose plan CPT 77300 | $584.77 | $1,670.76 | $120.09 – $1,000.00 | 6 |
| Radiation treatment aid(s) CPT 77332 | $528.50 | $1,510.00 | $102.75 – $906.00 | 6 |
| Radiation treatment aid(s) CPT 77333 | $1,858.15 | $5,309.00 | $203.78 – $2,654.50 | 6 |
| Radiation treatment aid(s) CPT 77334 | $1,704.68 | $4,870.50 | $240.18 – $2,435.25 | 6 |
| Radiation treatment delivery CPT 77402 | $120.65 | $344.70 | $51.71 – $344.70 | 6 |
| Radiation treatment delivery CPT 77412 | $436.10 | $1,246.00 | $186.90 – $817.59 | 6 |
| Radiology port images(s) CPT 77417 | $247.05 | $705.84 | $38.80 – $423.51 | 6 |
| Radiotherapy dose plan imrt CPT 77301 | $8,681.53 | $24,804.36 | $1,000.00 – $12,402.18 | 6 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | $1,185.10 | $3,386.00 | $203.16 – $1,693.00 | 11 |
| Radphm lcl tmr plnr bdy two day img CPT 78804 | $1,185.10 | $3,386.00 | $203.16 – $1,693.00 | 11 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $1,185.10 | $3,386.00 | $203.16 – $1,693.00 | 11 |
| Radphm lcl tumor plr sgl day CPT 78800 | $427.77 | $1,222.20 | $73.34 – $733.32 | 11 |
| Ramucirumab 10 mg/ml intravenous solution HCPCS J9308 | $5,804.33 | $16,583.78 | $102.34 – $2,161.62 | 7 |
| Rbc count only automated CPT 85041 | $9.19 | $26.25 | $2.54 – $13.13 | 23 |
| Rbc serum pretx incubj drugs CPT 86975 | $170.10 | $486.00 | $15.05 – $291.60 | 6 |
| Reconstruction of nail bed CPT 11762 | not published | not published | $131.76 – $131.76 | 1 |
| Red blood cells each unit HCPCS P9021 | $277.20 | $792.00 | $118.80 – $396.00 | 3 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $309.52 | $884.33 | $132.65 – $442.17 | 3 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $303.66 | $867.60 | $130.14 – $433.80 | 5 |
| Redo endovas vena cava filtr CPT 37192 | $2,660.00 | $7,600.00 | $456.00 – $3,800.00 | 5 |
| Refill/maint pump/resvr syst CPT 96522 | $222.08 | $634.50 | $95.18 – $317.25 | 4 |
| Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 | $239.09 | $683.09 | $3.31 – $444.01 | 7 |
| Rem/biv cast full arm/leg CPT 29705 | not published | not published | $28.60 – $28.60 | 1 |
| Rem/biv cast shldr/hip spica CPT 29710 | not published | not published | $52.43 – $52.43 | 1 |
| Remdesivir 100 mg intravenous powder for solution HCPCS J0248 | $468.19 | $1,337.67 | $200.66 – $869.49 | 6 |
| Rem endovas vena cava filter CPT 37193 | $2,660.00 | $7,600.00 | $456.00 – $3,800.00 | 5 |
| Removal biliary drg cath CPT 47537 | not published | not published | $210.91 – $210.91 | 1 |
| Removal central venous catheter tunneled without port/pump CPT 36589 | $395.96 | $1,131.30 | $169.70 – $565.65 | 2 |
| Removal central venous device tunneled w/port/pump central/peripheral insertion CPT 36590 | $1,832.04 | $5,234.40 | $785.16 – $2,617.20 | 2 |
| Removal cerumen impacted (both sides) CPT 69210 | $33.71 | $96.30 | $5.78 – $48.15 | 7 |
| Removal devitalized tissue non-selective debridement without anesthesia per session CPT 97602 | $85.75 | $245.00 | $34.29 – $255.00 | 5 |
| Removal foreign body foot subcutaneous right CPT 28190 | not published | not published | $146.63 – $146.63 | 1 |
| Removal of gum tissue CPT 41830 | not published | not published | $208.03 – $208.03 | 1 |
| Removal/replacement ppm generator dual lead system CPT 33228 | $5,054.81 | $14,442.30 | $1,600.00 – $7,221.15 | 3 |
| Removal tunnled intprtnl cath CPT 49422 | $919.80 | $2,628.00 | $394.20 – $1,314.00 | 2 |
| Removal w/reinsrt nonbiogrdble CPT 11983 | $54.50 | $155.70 | $23.36 – $77.85 | 2 |
| Remove cartilage for graft CPT 20910 | not published | not published | $191.10 – $191.10 | 1 |
| Remove cranial cavity fluid CPT 61001 | not published | not published | $213.92 – $213.92 | 1 |
| Renal function panel CPT 80069 | $289.23 | $826.35 | $7.33 – $413.18 | 23 |
| Renal venogram bil s&i CPT 75833 | $2,128.35 | $6,081.00 | $147.01 – $5,293.14 | 11 |
| Repair complex wound scalp/arms/legs 2.6 - 7.5 cm CPT 13121 | $192.50 | $550.00 | $82.50 – $275.00 | 2 |
| Repair dental ellis ii fx CPT 41899 | not published | not published | $615.20 – $615.20 | 1 |
| Repair eyelid wound CPT 67930 | not published | not published | $178.31 – $178.31 | 1 |
| Repair of body cast CPT 29720 | not published | not published | $45.13 – $45.13 | 1 |
| Replace g/c tube perc CPT 49450 | $401.10 | $1,146.00 | $171.90 – $573.00 | 2 |
| Reposition vad w/image rt/lt sep session CPT 33993 | $1,778.49 | $5,081.40 | $304.89 – $2,540.70 | 4 |
| Respirator motion mgmt simul CPT 77293 | $707.00 | $2,020.00 | $303.00 – $1,274.90 | 6 |
| Resuscitation cardiopulmonary CPT 92950 | $961.10 | $2,746.00 | $164.76 – $1,208.50 | 7 |
| Revision of cornea CPT 65600 | not published | not published | $186.72 – $186.72 | 1 |
| Revsc opn/prq tib/pero stent CPT 37234 | $4,782.05 | $13,663.00 | $819.78 – $6,831.50 | 5 |
| Rf abltj nrv nrvtg si jt CPT 64625 | not published | not published | $145.59 – $145.59 | 1 |
| Rheumatoid factor qualitative CPT 86430 | $52.56 | $150.15 | $4.79 – $75.08 | 23 |
| Rho d immune globulin inj HCPCS J2790 | $91.63 | $261.78 | $39.27 – $170.16 | 7 |
| Rituximab 10 mg/ml concentrate,intravenous HCPCS J9312 | $4,225.60 | $12,073.13 | $111.33 – $7,847.54 | 7 |
| Rituximab-abbs 10 mg/ml intravenous solution HCPCS Q5115 | $3,800.76 | $10,859.31 | $48.37 – $1,411.97 | 7 |
| Rituximab-arrx 10 mg/ml intravenous solution HCPCS Q5123 | $1,505.28 | $4,300.80 | $129.03 – $559.11 | 6 |
| Rituximab-pvvr 10 mg/ml intravenous solution HCPCS Q5119 | $644.40 | $1,841.13 | $32.31 – $1,196.74 | 7 |
| Rmv implant contraceptive capsule 11976 CPT 11976 | not published | not published | $146.48 – $146.48 | 1 |
| Rmvl foreign body upper arm/elbow subcutaneous CPT 24200 | not published | not published | $106.26 – $106.26 | 1 |
| Rmvl icd pulse gen only CPT 33241 | $985.64 | $2,816.10 | $422.42 – $1,600.00 | 3 |
| Rmvl ndwellg tun pleural cath CPT 32552 | not published | not published | $288.55 – $288.55 | 1 |
| Rmvl perm pm pulse gen CPT 33233 | $5,672.45 | $16,207.00 | $1,600.00 – $8,103.50 | 3 |
| Rmvl pm gen w/rplc pm gen sgl lead sys CPT 33227 | $4,325.58 | $12,358.80 | $1,600.00 – $6,179.40 | 3 |
| Rmvl pq iabp CPT 33968 | $4,563.41 | $13,038.30 | $782.30 – $6,519.15 | 5 |
| Rmvl pq vad left hrt vein sep session CPT 33992 | $1,678.01 | $4,794.30 | $287.66 – $2,397.15 | 4 |
| Rmvl subq card rhythm mntr CPT 33286 | $871.61 | $2,490.30 | $233.03 – $1,600.00 | 4 |
| Romiplostim 125 mcg subcutaneous solution HCPCS J2802 | $1,872.88 | $5,351.07 | $802.67 – $3,478.20 | 6 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | $60.56 | $173.02 | $0.07 – $58.70 | 7 |
| Rp loclzj tum 2+area 1+d img CPT 78801 | $662.76 | $1,893.60 | $113.62 – $1,000.00 | 11 |
| Rpl tun cvc wo subq port CPT 36581 | $2,660.35 | $7,601.00 | $1,140.15 – $3,800.50 | 2 |
| Rsv assay w/optic CPT 87807 | $46.20 | $132.00 | $10.13 – $66.00 | 23 |
| Rubella antibody igg CPT 86762 | $55.86 | $159.60 | $12.09 – $79.80 | 23 |
| Rubeola antibody igg CPT 86765 | $33.25 | $95.00 | $10.82 – $53.77 | 23 |
| Russell viper venom diluted CPT 85613 | $56.97 | $162.75 | $8.05 – $81.38 | 23 |
| Sacituzumab govitecan-hziy 180 mg intravenous solution HCPCS J9317 | $1,857.27 | $5,306.46 | $49.92 – $3,449.20 | 7 |
| Sarscov coronavirus ag ia CPT 87426 | $60.20 | $172.00 | $25.80 – $117.60 | 23 |
| Sarscov & inf vir a&b ag ia CPT 87428 | $60.20 | $172.00 | $25.80 – $101.92 | 23 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $1,043.00 | $2,980.00 | $178.80 – $1,490.00 | 10 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $657.30 | $1,878.00 | $112.68 – $939.00 | 10 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | $553.00 | $1,580.00 | $94.80 – $790.00 | 10 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $330.05 | $943.00 | $56.58 – $471.50 | 10 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $747.25 | $2,135.00 | $106.88 – $1,067.50 | 10 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $740.95 | $2,117.00 | $127.02 – $1,058.50 | 10 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $548.45 | $1,567.00 | $94.02 – $783.50 | 10 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $494.48 | $1,412.78 | $84.77 – $706.39 | 10 |
| Screening Mammogram CPT 77067 | $330.40 | $944.00 | $141.60 – $566.40 | 6 |
| Screening prostate cancer PSA HCPCS G0103 | $89.67 | $256.20 | $15.53 – $128.10 | 20 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $10,639.13 | $30,397.50 | $30.16 – $163.37 | 8 |
| Sec art mech thrmbc non-intracranial add-on CPT 37186 | $998.87 | $2,853.90 | $171.24 – $1,600.00 | 5 |
| Sedimentation rate erythrocyte automated CPT 85652 | $37.86 | $108.15 | $2.27 – $54.08 | 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.