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 |
|---|---|---|---|---|
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $359.80 | $1,028.00 | $0.56 – $417.72 | 7 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $152.60 | $436.00 | $52.06 – $260.06 | 23 |
| Tc-99m depreotide HCPCS A9536 | $64.58 | $184.50 | $27.68 – $92.25 | 2 |
| Tc-99m disofenin HCPCS A9510 | $239.72 | $684.90 | $102.74 – $342.45 | 3 |
| Tc-99m exametazime diag HCPCS A9521 | $2,102.00 | $6,005.70 | $900.86 – $3,002.85 | 3 |
| Tc-99m labeled rbc HCPCS A9560 | $227.43 | $649.80 | $97.47 – $324.90 | 3 |
| Tc-99m maa HCPCS A9540 | $120.91 | $345.45 | $39.34 – $172.73 | 3 |
| Tc-99m mebrofenin HCPCS A9537 | $224.91 | $642.60 | $96.39 – $321.30 | 3 |
| Tc-99m medronate HCPCS A9503 | $229.32 | $655.20 | $25.64 – $327.60 | 3 |
| Tc-99m mertiatide HCPCS A9562 | $233.80 | $668.00 | $100.20 – $668.00 | 3 |
| Tc-99m pentetate dtpa HCPCS A9539 | $141.75 | $405.00 | $60.75 – $202.50 | 3 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $23.63 | $67.50 | $7.78 – $33.75 | 3 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $413.07 | $1,180.20 | $177.03 – $590.10 | 3 |
| Tc-99m sulfur colloid HCPCS A9541 | $126.70 | $362.00 | $54.30 – $181.00 | 3 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $271.22 | $774.90 | $116.24 – $387.45 | 3 |
| Tc-99m tilmanocept diag HCPCS A9520 | $978.71 | $2,796.30 | $419.45 – $1,398.15 | 3 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $254.80 | $728.00 | $39.46 – $364.00 | 23 |
| T cells absolute cd 4 count CPT 86361 | $214.20 | $612.00 | $22.50 – $306.00 | 23 |
| Telethx isodose plan cplx CPT 77307 | $402.57 | $1,150.20 | $172.53 – $690.12 | 6 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $6,050.26 | $17,286.44 | $181.38 – $11,236.19 | 7 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $7.72 | $22.05 | $2.61 – $14.34 | 7 |
| Testicular imaging w/vasc flow CPT 78761 | $412.34 | $1,178.10 | $70.69 – $706.86 | 11 |
| Test pathogen(s) for platelets reference HCPCS P9100 | $84.35 | $241.00 | $15.30 – $150.76 | 5 |
| Test stress cardiovascular tracing only CPT 93017 | $1,001.35 | $2,861.00 | $429.15 – $1,430.50 | 4 |
| Theophylline therapeutic drug level CPT 80198 | $67.73 | $193.50 | $11.88 – $96.75 | 23 |
| Therapeutic procd strg endur HCPCS G0237 | $11.97 | $34.20 | $5.13 – $19.90 | 4 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $33.31 | $95.15 | $14.28 – $98.98 | 19 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $15.75 | $45.00 | $6.75 – $86.03 | 19 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $425.57 | $1,215.90 | $72.96 – $729.54 | 11 |
| Ther/proph/diag inj ia CPT 96373 | $393.75 | $1,125.00 | $38.37 – $562.50 | 4 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $20.85 | $59.55 | $2.06 – $38.71 | 7 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $524.30 | $1,498.00 | $180.77 – $749.00 | 3 |
| Thrombectmy crnry perq mechanical CPT 92973 | $2,495.43 | $7,129.80 | $427.79 – $3,564.90 | 5 |
| Thrombectomy/inf pq dialysis circuit w/pta CPT 36905 | $8,804.88 | $25,156.80 | $1,600.00 – $12,578.40 | 3 |
| Thrombin time CPT 85670 | $47.25 | $135.00 | $4.85 – $67.50 | 23 |
| Thyroglobulin antibody CPT 86800 | $56.97 | $162.75 | $13.36 – $81.38 | 23 |
| Thyroid imaging CPT 78013 | $527.29 | $1,506.54 | $90.40 – $903.93 | 11 |
| Thyroid (TSH) Test CPT 84443 | $99.96 | $285.60 | $14.11 – $142.80 | 23 |
| Thyroid Ultrasound CPT 76536 | $1,078.35 | $3,081.00 | $106.88 – $1,540.50 | 11 |
| Thyroxine binding globulin (tbg) CPT 84442 | $9.45 | $27.00 | $4.05 – $62.46 | 23 |
| Tib/per revasc stent & ather 37231 CPT 37231 | $14,634.20 | $41,812.00 | $1,600.00 – $20,906.00 | 3 |
| Tib/per revasc stnt & ather CPT 37235 | $6,287.75 | $17,965.00 | $1,077.90 – $8,982.50 | 5 |
| Tib/per revasc w/ather add-on 37233 CPT 37233 | $5,479.60 | $15,656.00 | $939.36 – $7,828.00 | 5 |
| Tigecycline injection HCPCS J3243 | $108.78 | $310.80 | $0.60 – $202.02 | 7 |
| Tilt table study CPT 93660 | $1,933.47 | $5,524.20 | $156.49 – $2,762.10 | 6 |
| Tissue transglutaminase iga CPT 86364 | $16.39 | $46.81 | $7.03 – $23.41 | 2 |
| Tl-201 thallium diag per mci HCPCS A9505 | $320.99 | $917.10 | $57.48 – $458.55 | 3 |
| Tobramycin peak therapeutic drug level CPT 80200 | $81.59 | $233.10 | $13.55 – $77.85 | 23 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $39.55 | $113.00 | $6.78 – $101.71 | 10 |
| Tomosynthesis breast screen bilateral CPT 77063 | $36.75 | $105.00 | $6.30 – $101.71 | 11 |
| Toxoplasma antibody igg CPT 86777 | $79.70 | $227.70 | $12.09 – $113.85 | 23 |
| Toxoplasma antibody igm CPT 86778 | $86.24 | $246.40 | $12.10 – $123.20 | 23 |
| Tpmt gene com vrnts CPT 81335 | $128.21 | $366.30 | $54.95 – $733.71 | 20 |
| Transcath occlusion non-cns CPT 61626 | $3,086.69 | $8,819.10 | $529.15 – $4,409.55 | 4 |
| Transferrin CPT 84466 | $33.60 | $96.00 | $10.72 – $53.77 | 23 |
| Transfusion blood/blood component(s) CPT 36430 | $268.10 | $766.00 | $27.20 – $325.00 | 3 |
| Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 | $3,379.17 | $9,654.76 | $35.04 – $2,170.73 | 7 |
| Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 | $1,495.47 | $4,272.77 | $27.60 – $991.90 | 7 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $2,249.10 | $6,426.00 | $963.90 – $3,213.00 | 3 |
| Treat foot dislocation CPT 28540 | not published | not published | $84.28 – $84.28 | 1 |
| Treat foot dislocation CPT 28570 | not published | not published | $84.28 – $84.28 | 1 |
| Treat foot dislocation CPT 28600 | not published | not published | $84.28 – $84.28 | 1 |
| Treatment inhalation pressurized/nonpressurized acute airway obstruction CPT 94640 | $186.20 | $532.00 | $79.68 – $369.03 | 4 |
| Treatment of anal fissure w/dilat 46940 CPT 46940 | not published | not published | $106.82 – $106.82 | 1 |
| Treatment of eyelid lesions CPT 68040 | not published | not published | $23.84 – $23.84 | 1 |
| Treatment of toe fracture 28510 CPT 28510 | not published | not published | $62.80 – $62.80 | 1 |
| Treatment radiation delivery level 2 CPT 77407 | $371.70 | $1,062.00 | $159.30 – $861.26 | 6 |
| Treponema pallidum antibody CPT 86780 | $19.76 | $56.44 | $8.47 – $55.20 | 23 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $17.64 | $50.40 | $1.04 – $32.76 | 7 |
| #tricyclicantidprssnt CPT 80337 | $0.95 | $2.70 | $0.41 – $14.62 | 9 |
| Triglycerides CPT 84478 | $61.25 | $175.00 | $4.82 – $56.50 | 23 |
| Trim nondyst nails CPT 11719 | $40.60 | $116.00 | $17.40 – $58.00 | 2 |
| Triptorelin pamoate HCPCS J3315 | $2,194.59 | $6,270.25 | $306.33 – $1,327.43 | 7 |
| Trnscath plc vas stent w/s&i ea addl artery CPT 37237 | $1,500.98 | $4,288.50 | $257.31 – $2,144.25 | 5 |
| Trnscath plc vas stent w/s&i ini vein CPT 37238 | $3,233.79 | $9,239.40 | $1,385.91 – $4,619.70 | 2 |
| Trnscath retrv pq vasc fb w/guide CPT 37197 | $1,772.51 | $5,064.30 | $759.65 – $2,532.15 | 3 |
| Trnscath tx thromblytc artery non-intracrn ini day CPT 37211 | $2,198.70 | $6,282.00 | $942.30 – $3,141.00 | 3 |
| Trnscath tx thromblytc vein ini day CPT 37212 | $1,754.87 | $5,013.90 | $752.09 – $2,506.95 | 3 |
| Troponin quantitative CPT 84484 | $71.40 | $204.00 | $8.31 – $102.00 | 23 |
| Tx contour defects >10.0 cc CPT 11954 | not published | not published | $65.33 – $65.33 | 1 |
| Tx contour defects 1.1-5.0cc 11951 CPT 11951 | not published | not published | $40.66 – $40.66 | 1 |
| Tympanic membrane repair CPT 69610 | not published | not published | $162.89 – $162.89 | 1 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $716.45 | $2,047.00 | $93.11 – $1,023.50 | 11 |
| Ultrasound breast complete CPT 76641 | $864.50 | $2,470.00 | $103.91 – $1,235.00 | 11 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $700.35 | $2,001.00 | $65.23 – $1,000.50 | 11 |
| Ultrasound chest CPT 76604 | $530.67 | $1,516.20 | $56.80 – $909.72 | 11 |
| Ultrasound encephalogram CPT 76506 | $461.79 | $1,319.40 | $79.17 – $791.64 | 11 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $189.93 | $542.64 | $32.56 – $325.59 | 11 |
| Ultrasound guidance for vascular access CPT 76937 | $823.90 | $2,354.00 | $37.86 – $1,177.00 | 5 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $963.90 | $2,754.00 | $48.19 – $1,377.00 | 5 |
| Ultrasound guide intraoperative CPT 76998 | $250.11 | $714.60 | $107.19 – $428.76 | 5 |
| Ultrasound hips infant dynamic CPT 76885 | $460.53 | $1,315.80 | $65.23 – $789.48 | 11 |
| Ultrasound infant hips ltd without stress CPT 76886 | $301.46 | $861.30 | $51.68 – $516.78 | 11 |
| Ultrasound joint complete left CPT 76881 | $1,101.10 | $3,146.00 | $96.28 – $1,573.00 | 11 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $980.00 | $2,800.00 | $30.35 – $1,400.00 | 11 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $779.10 | $2,226.00 | $82.61 – $1,113.00 | 10 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $536.90 | $1,534.00 | $41.98 – $920.40 | 10 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $456.75 | $1,305.00 | $78.30 – $783.00 | 11 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $337.75 | $965.00 | $57.90 – $579.00 | 11 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $383.67 | $1,096.20 | $65.78 – $657.72 | 11 |
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.