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 |
|---|---|---|---|---|
| Semen analysis w/count CPT 89310 | $35.35 | $101.00 | $7.27 – $50.50 | 20 |
| Serial casting application 97139app CPT 97139 | $55.65 | $159.00 | $23.85 – $255.00 | 5 |
| Set radiation therapy field CPT 77280 | $1,797.60 | $5,136.00 | $770.40 – $2,568.00 | 6 |
| Set radiation therapy field CPT 77285 | $2,966.25 | $8,475.00 | $1,000.00 – $4,237.50 | 6 |
| Set radiation therapy field CPT 77290 | $2,995.95 | $8,559.84 | $1,000.00 – $4,279.92 | 6 |
| Shoulder MRI (with and without contrast) CPT 73223 | $6,097.70 | $17,422.00 | $368.43 – $8,711.00 | 11 |
| Shoulder MRI (with contrast) CPT 73222 | $4,442.55 | $12,693.00 | $328.45 – $6,346.50 | 11 |
| Shoulder MRI (without contrast) CPT 73221 | $4,316.85 | $12,333.84 | $211.18 – $6,166.92 | 11 |
| Shoulder X-ray CPT 73030 | $617.40 | $1,764.00 | $29.13 – $1,000.00 | 11 |
| Shunt glaucoma baerveldt 350mm HCPCS C1783 | $8,268.75 | $23,625.00 | $162.54 – $880.43 | 8 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $341.67 | $976.19 | $58.58 – $585.72 | 11 |
| Sialography s&i CPT 70390 | $561.96 | $1,605.60 | $93.32 – $963.36 | 11 |
| Sialolithotomy 42330 CPT 42330 | not published | not published | $114.66 – $114.66 | 1 |
| Sickling rbc CPT 85660 | $9.45 | $27.00 | $4.05 – $23.26 | 23 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $56.70 | $162.00 | $24.30 – $162.00 | 7 |
| Sinus CT scan (with and without contrast) CPT 70488 | $3,552.85 | $10,151.00 | $180.34 – $5,075.50 | 11 |
| Sinus CT scan (with contrast) CPT 70487 | $2,936.15 | $8,389.00 | $157.71 – $4,194.50 | 11 |
| Sinus CT scan (without contrast) CPT 70486 | $2,467.15 | $7,049.00 | $106.88 – $3,524.50 | 11 |
| Sinus/juglr venogram s&i CPT 75860 | $3,364.90 | $9,614.00 | $126.30 – $5,293.14 | 11 |
| Skin Biopsy CPT 11102 | $332.85 | $951.00 | $57.71 – $401.85 | 3 |
| Sleep Study (Polysomnography) CPT 95810 | $1,601.25 | $4,575.00 | $686.25 – $2,287.50 | 4 |
| Sleeve fing rolyan med HCPCS L3933 | $167.00 | $477.12 | $57.26 – $310.13 | 7 |
| Sling suprapubic suburetheral HCPCS C1771 | $5,084.56 | $14,527.30 | $1,743.28 – $9,442.75 | 8 |
| Slp eval non-spch gen comm dev CPT 92605 | $114.03 | $325.80 | $48.87 – $255.00 | 5 |
| Slp ther svc non-spch gen CPT 92606 | $84.42 | $241.20 | $36.18 – $255.00 | 5 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $19.25 | $55.00 | $4.53 – $27.50 | 23 |
| Smear gram stain CPT 87205 | $54.03 | $154.35 | $3.59 – $77.18 | 23 |
| Smear nasal eosinophil CPT 89190 | $12.92 | $36.90 | $4.01 – $24.68 | 23 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $94.19 | $269.10 | $5.03 – $134.55 | 23 |
| Smear wet mount CPT 87210 | $60.27 | $172.20 | $3.61 – $68.40 | 23 |
| Sodium 24 hour urine CPT 84300 | $81.04 | $231.54 | $4.11 – $115.77 | 23 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $23.60 | $67.41 | $2.96 – $41.64 | 7 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $23.88 | $68.22 | $1.47 – $34.11 | 4 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $23.84 | $68.11 | $0.74 – $34.06 | 4 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $21.47 | $61.34 | $0.02 – $30.67 | 4 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $51.52 | $147.18 | $2.52 – $95.67 | 7 |
| Sodium serum/plasma/whole blood CPT 84295 | $23.10 | $66.00 | $4.04 – $33.00 | 23 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $104.30 | $298.00 | $44.70 – $193.70 | 6 |
| Special physics consult CPT 77370 | $282.80 | $808.00 | $121.20 – $484.80 | 6 |
| Special radiation dosimetry CPT 77331 | $267.75 | $765.00 | $66.72 – $459.00 | 6 |
| Special radiation treatment CPT 77470 | $2,992.02 | $8,548.62 | $91.34 – $4,274.31 | 6 |
| Special teletx port plan CPT 77321 | $987.57 | $2,821.61 | $154.06 – $1,410.81 | 6 |
| Specific gravity body fluid CPT 84315 | $5.67 | $16.20 | $2.12 – $13.06 | 23 |
| Speech evaluation complex CPT 70371 | $352.80 | $1,008.00 | $60.48 – $604.80 | 11 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $925.75 | $2,645.00 | $396.75 – $1,322.50 | 2 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $204.75 | $585.00 | $87.75 – $292.50 | 4 |
| Spleen imaging CPT 78185 | $513.45 | $1,467.00 | $88.02 – $880.20 | 11 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $201.81 | $576.58 | $69.19 – $374.78 | 7 |
| Splint func pos polyflex ii med HCPCS L3999 | $22.11 | $63.17 | $7.59 – $41.07 | 7 |
| Split blood or products CPT 86985 | $19.53 | $55.80 | $8.37 – $108.98 | 6 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $256.73 | $733.50 | $90.00 – $366.75 | 5 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $14,634.20 | $41,812.00 | $1,600.00 – $20,906.00 | 3 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $13,340.25 | $38,115.00 | $324.66 – $1,758.56 | 8 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $382.20 | $1,092.00 | $56.61 – $306.64 | 8 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $2,572.62 | $7,350.34 | $339.50 – $1,838.93 | 8 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $3,707.87 | $10,593.90 | $1,589.09 – $5,296.95 | 3 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $3,080.70 | $8,802.00 | $528.12 – $4,401.00 | 5 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $14,634.20 | $41,812.00 | $1,600.00 – $20,906.00 | 3 |
| St evaluate speech sound production CPT 92522 | $86.00 | $245.70 | $36.86 – $255.00 | 5 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $270.85 | $773.85 | $90.00 – $397.94 | 5 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $457.10 | $1,306.00 | $90.00 – $653.00 | 5 |
| St evaluation swallow function CPT 92610 | $129.73 | $370.65 | $55.60 – $255.00 | 5 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $43.79 | $125.10 | $8.97 – $62.55 | 3 |
| Strapping of chest CPT 29200 | $41.58 | $118.80 | $12.34 – $59.40 | 3 |
| Strapping of elbow or wrist 29260 CPT 29260 | $38.43 | $109.80 | $16.47 – $54.90 | 2 |
| Strapping of hand or finger CPT 29280 | $35.60 | $101.70 | $15.26 – $50.85 | 2 |
| Strapping of hip CPT 29520 | $41.58 | $118.80 | $17.82 – $59.40 | 2 |
| Strapping of knee CPT 29530 | $39.38 | $112.50 | $16.88 – $56.25 | 2 |
| Strapping of toes 29550 CPT 29550 | $34.02 | $97.20 | $14.58 – $48.60 | 2 |
| Strep a ag ia CPT 87430 | $106.40 | $304.00 | $10.13 – $152.00 | 23 |
| Strep b dna amp probe CPT 87653 | $413.35 | $1,181.00 | $29.48 – $590.50 | 23 |
| Stress test pulmonary CPT 94618 | $106.75 | $305.00 | $45.75 – $207.98 | 4 |
| Stress tte complete CPT 93351 | $2,309.27 | $6,597.90 | $299.87 – $3,298.95 | 4 |
| St treatment speech individual CPT 92507 | $83.65 | $239.00 | $35.85 – $255.00 | 5 |
| St treatment swallow dysfunction/oral CPT 92526 | $121.10 | $346.00 | $51.90 – $255.00 | 5 |
| Subdural tap fontanelle/sutur infant init 61000 CPT 61000 | not published | not published | $213.92 – $213.92 | 1 |
| Subq njx filling matrl 1cc/< CPT 11950 | not published | not published | $34.48 – $34.48 | 1 |
| Subq njx fil matrl 5.1-10cc CPT 11952 | not published | not published | $44.86 – $44.86 | 1 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $36.75 | $105.00 | $0.34 – $11.18 | 7 |
| Sulfonylurea screen qn-sendout CPT 80377 | $0.63 | $1.80 | $0.27 – $14.83 | 9 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $186.00 | $531.42 | $47.90 – $345.43 | 7 |
| Surgical pathology level 1 gross examination only CPT 88300 | $33.95 | $97.00 | $10.24 – $58.20 | 7 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $129.15 | $369.00 | $10.24 – $221.40 | 7 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $123.48 | $352.80 | $21.89 – $211.68 | 7 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $253.75 | $725.00 | $21.89 – $251.37 | 7 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $403.20 | $1,152.00 | $33.85 – $873.90 | 7 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $910.53 | $2,601.50 | $33.85 – $1,560.90 | 7 |
| Susceptibility agar dilution per agent CPT 87181 | $25.83 | $73.80 | $3.99 – $36.90 | 23 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $11.90 | $34.00 | $3.99 – $20.36 | 23 |
| Susceptibility mic per plate CPT 87186 | $93.24 | $266.40 | $7.27 – $114.45 | 23 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $39.55 | $113.00 | $3.70 – $52.20 | 23 |
| System pacing micra av HCPCS C1786 | $5,129.72 | $14,656.32 | $337.89 – $1,830.20 | 8 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $6,080.39 | $17,372.54 | $368.85 – $1,997.93 | 8 |
| T3 (triiodothyronine) free CPT 84481 | $41.90 | $119.70 | $14.23 – $71.20 | 23 |
| T3 (triiodothyronine) total CPT 84480 | $69.83 | $199.50 | $11.91 – $91.80 | 23 |
| T4 (thyroxine) free CPT 84439 | $62.85 | $179.55 | $7.58 – $89.78 | 23 |
| T4 (thyroxine) total CPT 84436 | $70.56 | $201.60 | $5.77 – $100.80 | 23 |
| Tacrolimus therapeutic drug level CPT 80197 | $84.00 | $240.00 | $11.53 – $120.00 | 23 |
| Target gsa panel hmtlmph neop CPT 81450 | $1,428.53 | $4,081.50 | $53.90 – $3,189.05 | 23 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $103.79 – $103.79 | 1 |
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.