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 |
|---|---|---|---|---|
| Excise/repair mouth lesion CPT 40812 | not published | not published | $157.56 – $157.56 | 1 |
| Excision aural polyp CPT 69540 | not published | not published | $125.88 – $125.88 | 1 |
| Excision nasal polyp(s) simple 30110 CPT 30110 | not published | not published | $128.69 – $128.69 | 1 |
| Excision of gum lesion CPT 41826 | not published | not published | $178.59 – $178.59 | 1 |
| Excision of gum lesion CPT 41828 | not published | not published | $147.75 – $147.75 | 1 |
| Excision of gum lesion 41825 CPT 41825 | not published | not published | $126.45 – $126.45 | 1 |
| Exc les/mucos/sub/ves mouth/no rpr 40810 CPT 40810 | not published | not published | $123.36 – $123.36 | 1 |
| Exercise w/hemodynamic meas CPT 93464 | $630.32 | $1,800.90 | $108.06 – $1,600.00 | 6 |
| Expander tiss 133s-mv-12-t 300ml natrelle smth HCPCS C1789 | $2,499.00 | $7,140.00 | $125.00 – $677.04 | 8 |
| Ex sq tumor/face or scalp < 2 cm 21011 CPT 21011 | not published | not published | $179.15 – $179.15 | 1 |
| External chromosome analysis 20-25 cells CPT 88264 | $160.02 | $457.20 | $68.58 – $607.31 | 23 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $562.59 | $1,607.40 | $106.64 – $803.70 | 23 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $107.80 | $308.00 | $15.06 – $146.00 | 23 |
| F-18 fdg pet diag HCPCS A9552 | $433.65 | $1,239.00 | $185.85 – $619.50 | 3 |
| Facial bones <3 CPT 70140 | $292.95 | $837.00 | $29.46 – $502.20 | 11 |
| Factor ix CPT 85250 | $168.21 | $480.60 | $15.99 – $240.30 | 23 |
| Factor viii CPT 85240 | $183.75 | $525.00 | $15.04 – $262.50 | 23 |
| Fat/lipids feces qualitative CPT 82705 | $12.95 | $37.00 | $4.28 – $21.79 | 23 |
| Fem/popl revasc w/stent CPT 37226 | $9,181.20 | $26,232.00 | $1,600.00 – $13,116.00 | 3 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $56.97 | $162.75 | $0.77 – $10.92 | 7 |
| Fern test HCPCS Q0114 | $9.80 | $28.00 | $4.20 – $40.68 | 20 |
| Ferric carboxymaltose 50 mg iron/ml intravenous solution HCPCS J1439 | $1,058.80 | $3,025.13 | $1.27 – $1,966.34 | 7 |
| Ferritin CPT 82728 | $77.35 | $221.00 | $11.45 – $110.50 | 23 |
| Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution HCPCS Q0138 | $1,073.16 | $3,066.16 | $0.39 – $1,993.01 | 7 |
| Fetal contract stress test 59020 - 26 CPT 59020 | not published | not published | $26.63 – $67.50 | 2 |
| Fetal fibronectin CPT 82731 | $185.15 | $529.00 | $54.10 – $270.22 | 23 |
| Fetal fluid drainage w/us CPT 59074 | not published | not published | $116.30 – $116.30 | 1 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $48.83 | $139.50 | $6.49 – $69.75 | 23 |
| Fetal hemoglobin rosette CPT 85461 | $53.98 | $154.22 | $5.60 – $77.11 | 23 |
| Fetal non stress test CPT 59025 | not published | not published | $14.30 – $36.95 | 2 |
| #_fet/norfentcnfrmur CPT 80354 | $0.63 | $1.80 | $0.27 – $14.66 | 9 |
| Fibrin degradation d dimer quantitative CPT 85379 | $91.00 | $260.00 | $8.55 – $130.00 | 23 |
| Fibrin degradation products CPT 85362 | $67.55 | $193.00 | $5.79 – $96.50 | 23 |
| Fibrinogen activity CPT 85384 | $85.63 | $244.65 | $7.17 – $122.33 | 23 |
| Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe HCPCS Q5110 | $303.58 | $867.36 | $0.39 – $325.65 | 7 |
| Filgrastim-sndz 300 mcg/0.5 ml injection syringe HCPCS Q5101 | $380.32 | $1,086.62 | $0.52 – $441.44 | 7 |
| Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 CPT 10007 | not published | not published | $171.44 – $171.44 | 1 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $621.18 | $1,774.80 | $106.49 – $887.40 | 4 |
| Fine needle asp without image guide 10021 CPT 10021 | not published | not published | $56.91 – $56.91 | 1 |
| Fitting of diaphragm/cap 57170 CPT 57170 | not published | not published | $19.90 – $19.90 | 1 |
| Fl exam g/colon tube w contrast CPT 49465 | $188.20 | $537.71 | $80.66 – $268.86 | 2 |
| Floor of mouth biopsy 41108 CPT 41108 | not published | not published | $84.39 – $84.39 | 1 |
| Flow cytometry marker each additional CPT 88185 | $37.11 | $106.02 | $10.24 – $92.98 | 6 |
| Flow cytometry one marker technical component CPT 88184 | $410.78 | $1,173.65 | $10.24 – $704.19 | 6 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $70.39 | $201.11 | $3.00 – $43.82 | 7 |
| Fluidotherapy charges pt CPT 97022 | $34.65 | $99.00 | $14.85 – $255.00 | 5 |
| Fluid pressure muscle 20950 CPT 20950 | not published | not published | $227.38 – $227.38 | 1 |
| Fluorescent antibody titer dna CPT 86256 | $28.35 | $81.00 | $10.12 – $50.84 | 23 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $754.60 | $2,156.00 | $131.47 – $1,078.00 | 5 |
| Fluoroguide needle placement CPT 77002 | $227.85 | $651.00 | $97.65 – $390.60 | 5 |
| Fluoroscopy up to 1 hour CPT 76000 | $605.84 | $1,730.95 | $43.44 – $1,000.00 | 11 |
| Fluorouracil 50 mg/ml intravenous solution (wrapper) HCPCS J9190 | $59.69 | $170.52 | $3.44 – $22.75 | 7 |
| Fmri brain by tech CPT 70554 | $1,207.40 | $3,449.70 | $206.99 – $1,724.85 | 11 |
| Fna bx w/ct gdn 1st les CPT 10009 | not published | not published | $233.03 – $233.03 | 1 |
| Fna bx w/mr gdn 1st les CPT 10011 | not published | not published | $233.03 – $233.03 | 1 |
| Folic acid CPT 82746 | $59.15 | $169.00 | $12.35 – $84.50 | 23 |
| Fomepizole 1 gram/ml intravenous solution HCPCS J1451 | $882.49 | $2,521.38 | $14.71 – $1,638.90 | 7 |
| Fondaparinux sodium HCPCS J1652 | $148.47 | $424.20 | $1.06 – $143.33 | 7 |
| Foot X-ray CPT 73630 | $563.15 | $1,609.00 | $29.13 – $965.40 | 11 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $77.46 | $221.31 | $0.20 – $143.86 | 7 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $25.96 | $74.15 | $2.70 – $11.69 | 7 |
| Fragmenting of kidney stone CPT 50590 | $7,302.75 | $20,865.00 | $3,129.75 – $10,432.50 | 2 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $89.25 | $255.00 | $38.25 – $127.50 | 5 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $107.80 | $308.00 | $46.20 – $154.00 | 3 |
| Fresh frozen plasma thawing ea un CPT 86927 | $53.20 | $152.00 | $8.96 – $91.20 | 6 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $11.80 | $33.71 | $2.37 – $10.24 | 6 |
| Ga-67 gallium 0.1 mci HCPCS A9556 | $266.49 | $761.40 | $114.21 – $380.70 | 3 |
| Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper) HCPCS A9579 | $5.12 | $14.61 | $2.20 – $7.31 | 3 |
| Gammaglobulin iga CPT 82784 | $44.80 | $128.00 | $7.81 – $43.00 | 23 |
| Gammaglobulin ige CPT 82785 | $48.13 | $137.50 | $13.83 – $69.73 | 23 |
| Gamma glutamyltransferase CPT 82977 | $51.45 | $147.00 | $6.05 – $73.50 | 23 |
| Gemcitabine 1 gram intravenous solution HCPCS J9201 | $20.61 | $58.86 | $4.02 – $38.26 | 7 |
| Generator barostim neo2 2014 HCPCS C1767 | $31,653.69 | $90,439.10 | $10,852.70 – $58,785.42 | 8 |
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | $23.60 | $67.41 | $1.42 – $6.15 | 7 |
| Gentamicin peak therapeutic drug level CPT 80170 | $80.33 | $229.50 | $13.76 – $70.00 | 23 |
| Ghs abscess postoperative iandd complex CPT 10180 | $330.75 | $945.00 | $141.75 – $472.50 | 2 |
| Ghs antibodies (torch) igm CPT 86694 | $22.40 | $64.00 | $9.60 – $61.04 | 23 |
| Ghs bladder cath - complex-foley CPT 51703 | not published | not published | $53.61 – $53.61 | 1 |
| Ghs block ilioinguinal/gentitofemoral CPT 64425 | not published | not published | $51.03 – $51.03 | 1 |
| Ghs central line insert < age 5, failed CPT 36555 | $421.16 | $1,203.30 | $180.50 – $601.65 | 2 |
| Ghs change cysto/gastrost CPT 43762 | not published | not published | $93.08 – $93.08 | 1 |
| Ghs chemo >8 hrs CPT 96416 | $509.25 | $1,455.00 | $218.25 – $727.50 | 5 |
| Ghs chemo infusion >8 hrs CPT 96425 | $280.35 | $801.00 | $120.15 – $400.50 | 5 |
| Ghs chemo IV push, ea addtl CPT 96411 | $269.85 | $771.00 | $115.65 – $385.50 | 5 |
| Ghs chlamydia pneumoniae by pcr (arup) (306630) CPT 87486 | $55.13 | $157.50 | $23.63 – $146.76 | 23 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | not published | not published | $84.28 – $84.28 | 1 |
| Ghs closure surg wound/dehiscence-13160 CPT 13160 | $1,503.60 | $4,296.00 | $644.40 – $2,148.00 | 2 |
| Ghs cl tx metacarpophal disloc without anes CPT 26700 | not published | not published | $84.28 – $84.28 | 1 |
| Ghs community re-entry 15 minutes CPT 97537 | $30.24 | $86.40 | $12.96 – $255.00 | 5 |
| Ghs cricothyroidotomy CPT 31605 | $469.35 | $1,341.00 | $186.69 – $670.50 | 3 |
| Ghs diphtheria toxoid ab igg CPT 86648 | $21.62 | $61.75 | $9.27 – $63.93 | 23 |
| Ghs ed rmvl or bivalving cast CPT 29700 | not published | not published | $31.96 – $31.96 | 1 |
| Ghs fb removal - non-incisional CPT 20520 | not published | not published | $101.77 – $101.77 | 1 |
| Ghs fish cytogen CPT 88271 | $286.65 | $819.00 | $17.99 – $409.50 | 23 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $72.77 | $207.90 | $31.19 – $215.02 | 23 |
| Ghs gastric intub aspiration lavage CPT 43753 | $182.70 | $522.00 | $31.32 – $261.00 | 7 |
| Ghs histoplasma antigen CPT 87385 | $66.47 | $189.90 | $10.13 – $94.95 | 23 |
| Ghs i and d pilonidal cyst simple CPT 10080 | not published | not published | $103.17 – $103.17 | 1 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | not published | not published | $91.12 – $91.12 | 1 |
| Ghs inf midline insertion CPT 36140 | $871.29 | $2,489.40 | $149.37 – $1,600.00 | 5 |
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.