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 |
|---|---|---|---|---|
| CT upper extremity w/contrast (both sides) CPT 73201 | $1,671.95 | $4,777.00 | $209.84 – $2,388.50 | 11 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,337.42 | $3,821.20 | $106.88 – $1,910.60 | 11 |
| CT uppr extremity w/o&w/dye CPT 73202 | $2,073.05 | $5,923.00 | $180.34 – $2,961.50 | 11 |
| Culture aerobic additional method definitive id each CPT 87077 | $58.80 | $168.00 | $6.79 – $33.42 | 23 |
| Culture afb any source CPT 87116 | $98.70 | $282.00 | $9.07 – $141.00 | 23 |
| Culture anaerobic additional method definitive id each CPT 87076 | $141.44 | $404.10 | $6.79 – $202.05 | 23 |
| Culture anaerobic except blood CPT 87075 | $108.05 | $308.70 | $7.95 – $154.35 | 23 |
| Culture bact stool aero addl path ea CPT 87046 | $43.05 | $123.00 | $7.93 – $61.50 | 23 |
| Culture body fluid CPT 87070 | $127.75 | $365.00 | $7.24 – $80.00 | 23 |
| Culture fungi definitive id mold CPT 87107 | $76.47 | $218.48 | $8.67 – $109.24 | 23 |
| Culture fungi definitive id yeast CPT 87106 | $50.09 | $143.10 | $8.67 – $71.55 | 23 |
| Culture fungi other (except blood) CPT 87102 | $64.75 | $185.00 | $7.06 – $92.50 | 23 |
| Culture quantitative aerobic other source CPT 87071 | $28.04 | $80.10 | $7.97 – $42.15 | 23 |
| Culture screening strep group a CPT 87081 | $112.70 | $322.00 | $5.57 – $58.50 | 23 |
| Culture typing immunologic CPT 87147 | $50.72 | $144.90 | $4.35 – $72.45 | 23 |
| Culture urine each isolate CPT 87088 | $93.80 | $268.00 | $6.80 – $134.00 | 23 |
| Curette/treat cornea CPT 65435 | not published | not published | $35.89 – $35.89 | 1 |
| Curette/treat cornea CPT 65436 | not published | not published | $162.60 – $162.60 | 1 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $10.62 | $30.33 | $1.32 – $19.72 | 7 |
| Cyclic citrullinated peptide antibody CPT 86200 | $21.70 | $62.00 | $9.30 – $53.77 | 23 |
| Cyclosporine 2 hour CPT 80158 | $31.19 | $89.10 | $13.37 – $75.56 | 23 |
| Cystatin c CPT 82610 | $39.55 | $113.00 | $11.48 – $78.46 | 23 |
| Cystine urine quantitative CPT 82131 | $27.72 | $79.20 | $11.88 – $95.88 | 23 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $477.40 | $1,364.00 | $37.89 – $818.40 | 11 |
| Cystometrogram w/up 51727 CPT 51727 | not published | not published | $160.92 – $160.92 | 1 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $36.02 | $102.90 | $12.09 – $61.04 | 23 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $170.10 | $486.00 | $14.15 – $243.00 | 23 |
| Cyto/molecular report CPT 88291 | $18.90 | $54.00 | $8.10 – $89.03 | 7 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $63.32 | $180.90 | $17.02 – $90.45 | 23 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $78.28 | $223.65 | $10.24 – $179.97 | 7 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $21.74 | $62.10 | $6.62 – $37.26 | 7 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $23.94 | $68.40 | $10.24 – $82.62 | 7 |
| Cytopath smear other source CPT 88160 | $41.90 | $119.70 | $10.24 – $197.39 | 7 |
| Cytopath smear other source CPT 88162 | $113.05 | $323.00 | $21.89 – $319.26 | 7 |
| Cytopath smear oth prep screen & interp CPT 88161 | $44.45 | $127.00 | $10.24 – $207.59 | 7 |
| Cytopath tbs c/v manual CPT 88164 | $27.65 | $79.00 | $8.92 – $63.93 | 23 |
| Cytp urine 3-5 probes cmptr CPT 88121 | $175.00 | $500.00 | $33.85 – $1,661.91 | 7 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | $24.09 | $68.81 | $6.15 – $43.18 | 7 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $342.88 | $979.65 | $0.03 – $636.78 | 7 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | $7,140.18 | $20,400.51 | $74.03 – $13,260.34 | 7 |
| Debrid ecz/inf skin up tp 10% body 11000 CPT 11000 | not published | not published | $24.95 – $24.95 | 1 |
| Debridement (>20 cm) charge pt CPT 97598 | $110.60 | $316.00 | $22.73 – $255.00 | 4 |
| Debridement bone <= 20 sq cm CPT 11044 | $2,593.50 | $7,410.00 | $1,111.50 – $3,705.00 | 2 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $607.60 | $1,736.00 | $45.00 – $868.00 | 4 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $682.50 | $1,950.00 | $292.50 – $975.00 | 2 |
| Debride nail1-5 11720 CPT 11720 | $53.55 | $153.00 | $22.95 – $76.50 | 3 |
| Debride nail6 or more 11721 CPT 11721 | $51.98 | $148.50 | $22.28 – $74.25 | 3 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $293.65 | $839.00 | $125.85 – $419.50 | 2 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $1,733.55 | $4,953.00 | $742.95 – $2,476.50 | 2 |
| Decalcification CPT 88311 | $27.93 | $79.80 | $6.62 – $47.88 | 7 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | $675.10 | $1,928.83 | $2.35 – $1,253.74 | 7 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $172.94 | $494.10 | $24.39 – $247.05 | 3 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | $685.79 | $1,959.38 | $6.02 – $816.45 | 7 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $183.75 | $525.00 | $78.75 – $369.03 | 4 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $2,304.05 | $6,583.00 | $35.15 – $2,306.72 | 7 |
| Dermagraft HCPCS Q4106 | $1,178.50 | $3,367.13 | $51.68 – $2,188.64 | 7 |
| Design mlc device for imrt CPT 77338 | $2,198.79 | $6,282.25 | $942.34 – $3,141.13 | 6 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $64.68 | $184.80 | $2.55 – $120.12 | 7 |
| Destruction anal lesion(s) CPT 46910 | not published | not published | $142.71 – $142.71 | 1 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | not published | not published | $123.41 – $123.41 | 1 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | not published | not published | $64.59 – $64.59 | 1 |
| Destruction les conjunctiva CPT 68135 | not published | not published | $67.28 – $67.28 | 1 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $55.51 – $55.51 | 1 |
| Detect agnt mult dna direc CPT 87800 | $60.17 | $171.90 | $25.79 – $183.07 | 23 |
| Device tiss remov myosure reach HCPCS C1782 | $1,449.79 | $4,142.25 | $621.34 – $2,071.13 | 2 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $36.05 | $103.00 | $6.18 – $91.35 | 11 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $2.71 | $7.73 | $0.02 – $5.03 | 7 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $10.29 | $29.40 | $0.04 – $10.24 | 7 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $551.88 | $1,576.79 | $118.27 – $512.47 | 7 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $23.97 | $68.48 | $1.31 – $34.24 | 4 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $23.83 | $68.07 | $0.02 – $34.04 | 4 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $23.60 | $67.41 | $2.09 – $33.71 | 4 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $43.75 | $125.00 | $18.67 – $92.98 | 23 |
| Diabetes (HbA1c) Test CPT 83036 | $44.10 | $126.00 | $8.16 – $63.00 | 23 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $95.13 | $271.80 | $40.77 – $135.90 | 2 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $806.05 | $2,303.00 | $345.45 – $1,151.50 | 2 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $815.15 | $2,329.00 | $229.91 – $1,164.50 | 6 |
| Diagnostic Mammogram (one breast) CPT 77065 | $537.95 | $1,537.00 | $179.65 – $922.20 | 6 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $36.75 | $105.00 | $4.49 – $68.25 | 7 |
| Dicyclomine injection HCPCS J0500 | $87.47 | $249.90 | $18.25 – $162.44 | 7 |
| Diffusing capacity CPT 94729 | $103.64 | $296.10 | $44.42 – $148.05 | 4 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $10.66 | $30.45 | $4.57 – $19.80 | 7 |
| Digoxin total therapeutic drug level CPT 80162 | $98.35 | $281.00 | $11.16 – $140.50 | 23 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $156.12 | $446.03 | $55.29 – $341.55 | 7 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $7.89 | $22.54 | $0.02 – $14.66 | 7 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $5.88 | $16.80 | $0.86 – $10.92 | 7 |
| Disaccharidases CPT 82657 | $32.13 | $91.80 | $13.77 – $92.98 | 23 |
| Discography cerv/thor spine CPT 72285 | $936.81 | $2,676.60 | $111.23 – $2,676.60 | 11 |
| Dna antibody native/double stranded CPT 86225 | $135.45 | $387.00 | $11.54 – $193.50 | 23 |
| Dna probe chlamydia CPT 87490 | $40.35 | $115.26 | $16.93 – $95.88 | 23 |
| Dna probe gc CPT 87590 | $40.84 | $116.66 | $16.93 – $113.34 | 23 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $68.43 | $195.49 | $3.88 – $16.80 | 7 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $1,314.32 | $3,755.18 | $1.09 – $869.31 | 7 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $40.90 | $116.84 | $0.24 – $75.95 | 9 |
| Doppler echo complete CPT 93320 | $358.79 | $1,025.10 | $72.49 – $512.55 | 4 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $34.02 | $97.20 | $5.84 – $97.20 | 5 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $848.75 | $2,425.00 | $88.74 – $739.50 | 10 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $543.20 | $1,552.00 | $196.50 – $655.00 | 5 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | $50.08 | $143.07 | $4.75 – $41.64 | 7 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | $79.14 | $226.11 | $33.92 – $226.11 | 7 |
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.