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 |
|---|---|---|---|---|
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | not published | not published | $132.60 – $132.60 | 1 |
| Drainage ext aud canal abscess 69020 CPT 69020 | not published | not published | $135.41 – $135.41 | 1 |
| Drainage external ear complex 69005 CPT 69005 | not published | not published | $101.77 – $101.77 | 1 |
| Drainage external ear simple 69000 CPT 69000 | not published | not published | $101.77 – $101.77 | 1 |
| Drainage of kidney lesion CPT 50390 | $438.80 | $1,253.70 | $188.06 – $626.85 | 2 |
| Drainage of nose lesion int 30000 CPT 30000 | not published | not published | $74.70 – $74.70 | 1 |
| Drainage of nose lesion sept 30020 CPT 30020 | not published | not published | $136.82 – $136.82 | 1 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $443.84 | $1,268.10 | $190.22 – $634.05 | 2 |
| Drain finger abscess;simple 26010 CPT 26010 | not published | not published | $64.59 – $64.59 | 1 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $252.81 | $722.30 | $64.59 – $361.15 | 3 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $246.40 | $704.00 | $105.60 – $352.00 | 2 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $504.09 | $1,440.24 | $216.04 – $720.12 | 2 |
| Drng of eyelid abscess 67700 CPT 67700 | not published | not published | $113.24 – $113.24 | 1 |
| Drng of hydrocele 55000 CPT 55000 | not published | not published | $49.07 – $49.07 | 1 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $8.41 | $24.02 | $3.31 – $15.62 | 7 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | $6,470.83 | $18,488.06 | $3.05 – $1,126.95 | 8 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $2,995.28 | $8,557.92 | $10.53 – $364.41 | 8 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | $1,702.28 | $4,863.63 | $25.30 – $275.32 | 7 |
| Drug admin & hemodynmic meas CPT 93463 | $378.32 | $1,080.90 | $64.86 – $1,080.90 | 6 |
| Drug assay voriconazole CPT 80285 | $104.30 | $298.00 | $16.27 – $149.00 | 23 |
| Drug test def 15-21 classes HCPCS G0482 | $101.50 | $290.00 | $43.50 – $833.95 | 23 |
| Drug test def 1-7 classes HCPCS G0480 | $250.95 | $717.00 | $19.65 – $480.91 | 23 |
| Drug test def 22+ classes HCPCS G0483 | $28.70 | $82.00 | $12.30 – $1,037.34 | 23 |
| Drug test def 8-14 classes HCPCS G0481 | $58.10 | $166.00 | $24.90 – $656.72 | 23 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $133.00 | $380.00 | $47.89 – $261.53 | 23 |
| Drvvt confirm - quest CPT 85597 | $18.27 | $52.20 | $7.83 – $75.56 | 23 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | not published | not published | $136.82 – $136.82 | 1 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $314.37 | $898.20 | $53.90 – $543.01 | 10 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $755.30 | $2,158.00 | $129.48 – $1,079.00 | 10 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $445.20 | $1,272.00 | $76.32 – $693.76 | 10 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | $3,357.42 | $9,592.62 | $117.82 – $1,498.94 | 7 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $152.65 – $152.65 | 1 |
| Ecg 12 lead tracing only CPT 93005 | $289.10 | $826.00 | $110.80 – $413.00 | 4 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | $199.15 | $569.00 | $85.35 – $284.50 | 4 |
| Ecg external < 48 hours recording CPT 93225 | $284.55 | $813.00 | $121.95 – $406.50 | 4 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $284.55 | $813.00 | $121.95 – $406.50 | 4 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $2,250.57 | $6,430.20 | $274.29 – $3,215.10 | 4 |
| Echocardiography doppler color flow mapping CPT 93325 | $311.85 | $891.00 | $45.48 – $445.50 | 4 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $656.60 | $1,876.00 | $97.53 – $938.00 | 9 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $263.34 | $752.40 | $40.51 – $376.20 | 4 |
| Echo guide for amniocentesis CPT 76946 | $282.56 | $807.30 | $25.46 – $484.38 | 5 |
| Echo guide for artery repair CPT 76936 | $229.32 | $655.20 | $39.32 – $734.44 | 11 |
| Echo stress CPT 93350 | $988.47 | $2,824.20 | $169.46 – $1,412.10 | 9 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $845.40 | $2,415.42 | $144.93 – $1,207.71 | 9 |
| Echo transesophageal CPT 93313 | $561.02 | $1,602.90 | $11.03 – $801.45 | 9 |
| Echo transesophageal CPT 93314 | $294.84 | $842.40 | $126.36 – $421.20 | 4 |
| Echo tte 2d comp wo ctrst wo clr/dplr CPT 93307 | $746.03 | $2,131.50 | $127.89 – $1,065.75 | 9 |
| Eeg/cerebral death evaluation only 95824 -26 CPT 95824 | $250.11 | $714.60 | $80.29 – $357.30 | 4 |
| Eeg monitor/record/awake/drowsy 95816 CPT 95816 | $606.01 | $1,731.45 | $259.72 – $865.73 | 4 |
| Eeg recording awake and asleep CPT 95819 | $586.90 | $1,676.85 | $251.53 – $838.43 | 4 |
| E equine encephalitis igg CPT 86652 | $54.60 | $156.00 | $11.08 – $78.00 | 23 |
| Egfr gene com variants CPT 81235 | $252.32 | $720.90 | $108.14 – $1,362.80 | 23 |
| Elec analys infus pump w/reprog 62368 CPT 62368 | not published | not published | $71.78 – $71.78 | 1 |
| Elect analysis of infusion pump 62367 CPT 62367 | not published | not published | $51.88 – $51.88 | 1 |
| Elect anlys sp inf pmp w/reprg&fill 62369 CPT 62369 | not published | not published | $71.78 – $71.78 | 1 |
| Electrical bone stim 20974 CPT 20974 | not published | not published | $83.67 – $216.29 | 17 |
| Electrical stimulation/unattended 97014 CPT 97014 | $34.97 | $99.90 | $14.99 – $255.00 | 5 |
| Electrolyte panel CPT 80051 | $78.28 | $223.65 | $5.92 – $111.83 | 23 |
| Electron microscopy diagnostic CPT 88348 | $512.05 | $1,463.00 | $90.47 – $1,618.50 | 7 |
| Embo or occlude vascular arterial s&i CPT 37242 | $6,489.00 | $18,540.00 | $1,600.00 – $9,270.00 | 3 |
| Embo or occlude vascular hemorrhage s&i CPT 37244 | $4,178.48 | $11,938.50 | $1,790.78 – $5,969.25 | 2 |
| Embo or occlude vascular venous s&i CPT 37241 | $3,793.23 | $10,837.80 | $1,600.00 – $5,418.90 | 3 |
| Emb without cervical dilation 58100 CPT 58100 | $60.48 | $172.80 | $25.92 – $86.40 | 2 |
| Endoluminl ivus oct c 1st CPT 92978 | $2,412.55 | $6,893.00 | $196.83 – $3,446.50 | 6 |
| Endoluminl ivus oct c ea CPT 92979 | $1,833.65 | $5,239.00 | $158.46 – $2,619.50 | 6 |
| Endovas iliac a device addon CPT 34808 | $1,722.11 | $4,920.30 | $295.22 – $2,460.15 | 5 |
| Enfortumab vedotin-ejfv 20 mg intravenous solution HCPCS J9177 | $1,821.78 | $5,205.06 | $52.91 – $2,255.52 | 7 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $129.38 | $369.63 | $0.53 – $67.57 | 7 |
| Epoetin alfa, 100 units esrd HCPCS Q4081 | $961.85 | $2,748.14 | $0.86 – $146.62 | 4 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | $397.16 | $1,134.74 | $10.97 – $103.99 | 7 |
| Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr HCPCS J0885 | $517.88 | $1,479.65 | $10.84 – $157.01 | 7 |
| Epstein barr nuclear antigen antibody CPT 86664 | $36.02 | $102.90 | $12.84 – $63.93 | 23 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $43.37 | $123.90 | $15.24 – $75.56 | 23 |
| Ercp biliary & pancreas CPT 74330 | $861.53 | $2,461.50 | $88.80 – $1,230.75 | 5 |
| Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution HCPCS J9179 | $1,128.38 | $3,223.94 | $195.54 – $2,095.57 | 7 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $111.36 | $318.15 | $11.98 – $206.80 | 7 |
| ER Visit (level 1, minor) CPT 99281 | $276.85 | $791.00 | $47.46 – $395.50 | 8 |
| ER Visit (level 2) CPT 99282 | $520.80 | $1,488.00 | $51.36 – $744.00 | 8 |
| ER Visit (level 3) CPT 99283 | $846.30 | $2,418.00 | $51.36 – $1,209.00 | 8 |
| ER Visit (level 4) CPT 99284 | $1,269.45 | $3,627.00 | $217.62 – $1,813.50 | 8 |
| ER Visit (level 5, high severity) CPT 99285 | $1,627.50 | $4,650.00 | $279.00 – $2,790.00 | 9 |
| Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1364 | $78.65 | $224.70 | $33.71 – $146.06 | 7 |
| Establish access to aorta CPT 36160 | $244.44 | $698.40 | $41.91 – $698.40 | 5 |
| Establish access to artery CPT 36100 | $113.40 | $324.00 | $19.44 – $324.00 | 5 |
| Established Patient Office Visit (level 1) CPT 99211 | $85.33 | $243.78 | $18.47 – $101.25 | 4 |
| Established Patient Office Visit (level 2) CPT 99212 | $113.17 | $323.34 | $38.88 – $129.60 | 4 |
| Established Patient Office Visit (level 3) CPT 99213 | $142.09 | $405.96 | $45.00 – $162.00 | 4 |
| Established Patient Office Visit (level 4) CPT 99214 | $163.87 | $468.18 | $45.00 – $194.85 | 4 |
| Established Patient Office Visit (level 5) CPT 99215 | $190.64 | $544.68 | $45.00 – $226.80 | 4 |
| Estradiol total CPT 82670 | $67.55 | $193.00 | $23.47 – $117.67 | 23 |
| Estrogens total-sendout CPT 82672 | $44.73 | $127.80 | $18.23 – $91.51 | 23 |
| Ethylene glycol -sendout CPT 82693 | $5.04 | $14.40 | $2.16 – $62.46 | 23 |
| Etoposide 20 mg/ml intravenous solution HCPCS J9181 | $14.98 | $42.79 | $1.29 – $19.08 | 7 |
| Euglobulin lysis CPT 85360 | $41.58 | $118.80 | $7.06 – $59.40 | 23 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $89.95 | $257.00 | $38.55 – $257.00 | 5 |
| Evaluation of speech fluency 92521 CPT 92521 | $78.75 | $225.00 | $33.75 – $255.00 | 5 |
| Event monitor CPT 93270 | $97.65 | $279.00 | $7.30 – $139.50 | 5 |
| Exc face tum deep < 2 cm CPT 21013 | not published | not published | $236.91 – $236.91 | 1 |
| Exchange blood transfusion newborn 36450 CPT 36450 | not published | not published | $149.54 – $149.54 | 1 |
| Exchange nephrostomy cath CPT 50435 | not published | not published | $229.11 – $229.11 | 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.