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 |
|---|---|---|---|---|
| Warde vitamin b-1 (thiamine) CPT 84425 | $30.42 | $86.89 | $13.04 – $88.62 | 23 |
| Warde vitamin b6 (pyridoxine) CPT 84207 | $46.20 | $132.00 | $19.80 – $117.67 | 23 |
| Warde vitamin c (ascorbic acid) CPT 82180 | $68.99 | $197.10 | $8.31 – $98.55 | 23 |
| Warde vitamin d (1 25 dihydroxy) CPT 82652 | $100.70 | $287.70 | $32.34 – $161.28 | 23 |
| Warde vitamin e (alpha-tocopherol) CPT 84446 | $24.15 | $69.00 | $10.35 – $59.57 | 23 |
| Warde zinc CPT 84630 | $17.00 | $48.55 | $7.29 – $47.94 | 23 |
| Wbc automated CPT 85048 | $13.23 | $37.80 | $2.13 – $18.90 | 23 |
| Wedging of cast CPT 29740 | not published | not published | $42.05 – $42.05 | 1 |
| Western blot test CPT 84181 | $67.55 | $193.00 | $14.31 – $96.50 | 23 |
| Wound therapy negative pressure per session <= 50 sq cm CPT 97607 | $371.00 | $1,060.00 | $55.29 – $530.00 | 3 |
| Wound therapy negative pressure per session > 50 sq cm CPT 97608 | $412.30 | $1,178.00 | $62.09 – $589.00 | 3 |
| Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 | $207.20 | $592.00 | $34.65 – $255.00 | 5 |
| Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 | $273.70 | $782.00 | $83.55 – $557.00 | 5 |
| Wrist X-ray CPT 73110 | $517.65 | $1,479.00 | $34.73 – $887.40 | 11 |
| Xe133 xenon 10mci HCPCS A9558 | $106.58 | $304.50 | $45.68 – $152.25 | 3 |
| Xpos opn axillary/sbclvn art w/cndt crtn CPT 34716 | $103.60 | $296.00 | $17.76 – $296.00 | 5 |
| X-ray abdomen 1 view CPT 74018 | $498.40 | $1,424.00 | $27.02 – $854.40 | 11 |
| X-ray abdomen 2 views CPT 74019 | $620.90 | $1,774.00 | $32.98 – $994.38 | 11 |
| X-ray abdomen >=3 views CPT 74021 | $387.45 | $1,107.00 | $38.59 – $664.20 | 11 |
| X-ray abdomen complete acute series including spine erect and/or decubitus single view chest CPT 74022 | $580.30 | $1,658.00 | $44.21 – $994.80 | 11 |
| X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 | $146.79 | $419.40 | $25.17 – $251.64 | 11 |
| X-ray ankle 2 views (both sides) CPT 73600 | $571.90 | $1,634.00 | $29.46 – $499.80 | 11 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $683.20 | $1,952.00 | $100.34 – $1,000.00 | 11 |
| X-ray bone age studies CPT 77072 | $206.35 | $589.56 | $22.80 – $353.74 | 11 |
| X-ray bone length studies CPT 77073 | $361.29 | $1,032.24 | $35.79 – $619.35 | 11 |
| X-ray bone survey complete CPT 77075 | $1,177.93 | $3,365.50 | $86.66 – $1,682.75 | 11 |
| X-ray bone survey infant CPT 77076 | $121.28 | $346.50 | $20.79 – $320.89 | 11 |
| X-ray cervical spine 2-3 views CPT 72040 | $576.10 | $1,646.00 | $32.98 – $987.60 | 11 |
| X-ray cervical spine 4-5 views CPT 72050 | $662.55 | $1,893.00 | $44.92 – $1,000.00 | 11 |
| X-ray cervical spine >= 6 views CPT 72052 | $679.70 | $1,942.00 | $55.43 – $1,000.00 | 11 |
| X-ray clavicle complete (both sides) CPT 73000 | $417.55 | $1,193.00 | $27.72 – $715.80 | 11 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | $903.00 | $2,580.00 | $148.76 – $1,290.00 | 11 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | $505.75 | $1,445.00 | $86.70 – $867.00 | 11 |
| X-ray elbow 2 views (both sides) CPT 73070 | $364.70 | $1,042.00 | $27.02 – $625.20 | 11 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $552.30 | $1,578.00 | $31.23 – $946.80 | 11 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | $905.71 | $2,587.74 | $87.72 – $1,293.87 | 11 |
| X-ray exam entire spi 6/> vw CPT 72084 | $900.55 | $2,573.00 | $86.66 – $1,286.50 | 11 |
| X-ray exam of arm infant CPT 73092 | $145.30 | $415.14 | $24.91 – $249.09 | 11 |
| X-ray exam of eye sockets CPT 70200 | $218.30 | $623.70 | $37.43 – $374.22 | 11 |
| X-ray exam of jaw joint CPT 70328 | $164.75 | $470.70 | $28.25 – $282.42 | 11 |
| X-ray exam of jaw joint CPT 70332 | $558.50 | $1,595.70 | $70.17 – $957.42 | 11 |
| X-ray exam of mastoids CPT 70120 | $147.74 | $422.10 | $25.33 – $253.26 | 11 |
| X-ray exam of middle ear CPT 70134 | $190.26 | $543.60 | $32.62 – $543.60 | 11 |
| X-ray exam of salivary gland CPT 70380 | $164.75 | $470.70 | $28.25 – $282.42 | 11 |
| X-ray exam of sinuses CPT 70210 | $193.41 | $552.60 | $29.46 – $331.56 | 11 |
| X-ray exam of tear duct CPT 70170 | $849.24 | $2,426.40 | $56.06 – $1,213.20 | 11 |
| X-ray exam si joints CPT 72200 | $449.40 | $1,284.00 | $28.07 – $770.40 | 11 |
| X-ray exam thorac spine4/>vw CPT 72074 | $273.00 | $780.00 | $38.59 – $468.00 | 11 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $111.20 | $317.70 | $19.07 – $190.62 | 11 |
| X-ray facial bones complete > 3 views CPT 70150 | $504.70 | $1,442.00 | $41.04 – $865.20 | 11 |
| X-ray femur >=2 views (both sides) CPT 73552 | $504.35 | $1,441.00 | $32.63 – $864.60 | 11 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $292.60 | $836.00 | $31.92 – $501.60 | 11 |
| X-ray foot 2 views (both sides) CPT 73620 | $428.05 | $1,223.00 | $25.97 – $733.80 | 11 |
| X-ray forearm 2 views (both sides) CPT 73090 | $482.97 | $1,379.91 | $25.61 – $827.95 | 11 |
| X-ray hand 2 views (both sides) CPT 73120 | $369.25 | $1,055.00 | $28.07 – $633.00 | 11 |
| X-ray head for orthodontia CPT 70350 | $111.51 | $318.60 | $16.38 – $191.16 | 11 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $357.35 | $1,021.00 | $27.02 – $612.60 | 11 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $568.05 | $1,623.00 | $37.18 – $973.80 | 11 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $285.95 | $817.00 | $29.82 – $490.20 | 11 |
| X-ray humerus >= 2 views left CPT 73060 | $468.30 | $1,338.00 | $28.77 – $802.80 | 11 |
| X-ray joint survey 1 view CPT 77077 | $121.28 | $346.50 | $20.79 – $214.07 | 11 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $484.40 | $1,384.00 | $30.87 – $830.40 | 11 |
| X-ray knee 3 views (both sides) CPT 73562 | $583.23 | $1,666.36 | $35.44 – $999.82 | 11 |
| X-ray knee ap standing bilateral CPT 73565 | $571.90 | $1,634.00 | $35.44 – $980.40 | 11 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $140.66 | $401.88 | $24.12 – $241.13 | 11 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $593.60 | $1,696.00 | $40.35 – $1,000.00 | 11 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $756.70 | $2,162.00 | $48.42 – $1,081.00 | 11 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $890.40 | $2,544.00 | $61.05 – $1,272.00 | 11 |
| X-ray mandible complete > 4 views CPT 70110 | $166.95 | $477.00 | $28.62 – $286.20 | 11 |
| X-ray mandible ltd <4 views CPT 70100 | $395.50 | $1,130.00 | $32.63 – $678.00 | 11 |
| X-ray nasal bones complete > 3 views CPT 70160 | $306.95 | $877.00 | $32.63 – $526.20 | 11 |
| X-ray neck soft tissue CPT 70360 | $179.60 | $513.14 | $28.07 – $307.89 | 11 |
| X-ray nose to rectum for foreign body child CPT 76010 | $178.42 | $509.75 | $30.59 – $305.85 | 11 |
| X-ray optic foramina CPT 70190 | $166.95 | $477.00 | $28.62 – $286.20 | 11 |
| X-ray pelvis 1-2 views CPT 72170 | $466.61 | $1,333.16 | $28.06 – $799.90 | 11 |
| X-ray pelvis complete > 3 views CPT 72190 | $466.90 | $1,334.00 | $37.54 – $800.40 | 11 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $1,772.15 | $5,063.26 | $77.19 – $2,531.63 | 11 |
| X-ray ribs 2 views left CPT 71100 | $566.65 | $1,619.00 | $32.98 – $971.40 | 11 |
| X-ray ribs 3 views bilateral CPT 71110 | $562.80 | $1,608.00 | $39.65 – $964.80 | 11 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $542.50 | $1,550.00 | $37.89 – $930.00 | 11 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $677.95 | $1,937.00 | $46.66 – $1,000.00 | 11 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $528.85 | $1,511.00 | $32.63 – $906.60 | 11 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $440.65 | $1,259.00 | $28.07 – $755.40 | 11 |
| X-ray scapula complete (both sides) CPT 73010 | $406.35 | $1,161.00 | $23.73 – $696.60 | 11 |
| X-ray sella turcica CPT 70240 | $132.30 | $378.00 | $22.68 – $226.80 | 11 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $339.50 | $970.00 | $21.71 – $582.00 | 11 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $798.79 | $2,282.25 | $37.18 – $1,141.13 | 11 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $497.24 | $1,420.66 | $54.38 – $852.40 | 11 |
| X-ray skull < 4 views CPT 70250 | $428.75 | $1,225.00 | $36.09 – $735.00 | 11 |
| X-ray skull > 4 views complete CPT 70260 | $436.72 | $1,247.75 | $44.78 – $748.65 | 11 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $421.47 | $1,204.20 | $72.26 – $722.52 | 11 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $703.50 | $2,010.00 | $102.44 – $1,005.00 | 11 |
| X-ray small intestine follow-through study CPT 74248 | $478.45 | $1,367.00 | $81.39 – $820.20 | 10 |
| X-ray spine single view CPT 72020 | $314.30 | $898.00 | $22.10 – $538.80 | 11 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $184.28 | $526.50 | $31.59 – $315.90 | 11 |
| X-ray sternum > 2 views CPT 71120 | $336.35 | $961.00 | $29.46 – $576.60 | 11 |
| X-ray surgical specimen CPT 76098 | $497.24 | $1,420.66 | $16.84 – $919.82 | 11 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $956.74 | $2,733.54 | $120.18 – $1,366.77 | 11 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $202.23 | $577.80 | $34.67 – $346.68 | 11 |
| X-ray thoracic spine 2 views CPT 72070 | $439.95 | $1,257.00 | $33.08 – $754.20 | 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.