St. Luke's Health Memorial San Augustine
511 E. Hospital Street, San Augustine, TX · CommonSpirit Health · · NPI 1578547345
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 |
|---|---|---|---|---|
| 17-hydroxypregnenolone CPT 84143 | $18.75 | $125.00 | $19.16 – $112.50 | 21 |
| 17-ketosteroids CPT 83586 | $43.20 | $288.00 | $10.75 – $259.20 | 21 |
| 2d tee w or without fol w/con,in HCPCS C8925 | $1,057.95 | $7,053.00 | $100.00 – $7,335.12 | 9 |
| 2nd order venous cath CPT 36012 | $673.05 | $4,487.00 | $100.00 – $7,228.56 | 10 |
| 3-d radiotherapy plan CPT 77295 | $1,514.40 | $10,096.00 | $788.02 – $10,499.84 | 9 |
| 3d recon without postprocess indpndt CPT 76376 | $220.35 | $1,469.00 | $25.06 – $1,527.76 | 9 |
| 5' nucleotidase - sendout CPT 83915 | $32.01 | $213.38 | $9.37 – $192.05 | 21 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $26.85 | $179.00 | $32.19 – $186.16 | 9 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $4,676.57 | $31,177.11 | $49.09 – $28,059.40 | 9 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $24.60 | $164.00 | $10.09 – $147.60 | 21 |
| Abd aorta w/runoff s&i CPT 75630 | $1,494.90 | $9,966.00 | $291.44 – $10,364.64 | 15 |
| Abd/low ext cath 1st CPT 36245 | $261.00 | $1,740.00 | $100.00 – $2,575.99 | 10 |
| Abd/low ext cath 2nd CPT 36246 | $191.10 | $1,274.00 | $100.00 – $2,052.42 | 10 |
| Abd/low ext cath 3rd CPT 36247 | $227.40 | $1,516.00 | $100.00 – $2,442.28 | 10 |
| Abd/low ext cath addl CPT 36248 | $134.25 | $895.00 | $100.00 – $1,441.85 | 10 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $1,638.15 | $10,921.00 | $209.55 – $11,357.84 | 15 |
| Abdominal CT scan (with contrast) CPT 74160 | $1,449.75 | $9,665.00 | $209.55 – $10,050.68 | 15 |
| Abdominal CT scan (without contrast) CPT 74150 | $840.90 | $5,606.00 | $128.89 – $5,830.24 | 15 |
| Abdominal MRI (with and without contrast) CPT 74183 | $1,533.90 | $10,226.00 | $439.13 – $10,635.04 | 15 |
| Abdominal MRI (with contrast) CPT 74182 | $1,380.60 | $9,204.00 | $439.13 – $9,572.16 | 15 |
| Abdominal MRI (without contrast) CPT 74181 | $889.80 | $5,932.00 | $268.00 – $6,169.28 | 15 |
| Abdominal paracentesis w/image guidance CPT 49083 | $498.15 | $3,321.00 | $585.90 – $3,385.20 | 8 |
| Abdominal Ultrasound (complete) CPT 76700 | $520.50 | $3,470.00 | $131.99 – $3,608.80 | 15 |
| Abdominal Ultrasound (limited) CPT 76705 | $391.35 | $2,609.00 | $131.99 – $2,713.36 | 15 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $478.35 | $3,189.00 | $574.02 – $3,316.56 | 8 |
| Ablate arrhythmia add on CPT 93655 | $2,214.45 | $14,763.00 | $100.00 – $23,783.20 | 11 |
| Ablate bone tumor(s) perq CPT 20982 | $2,798.85 | $18,659.00 | $3,358.62 – $19,405.36 | 7 |
| Ablate heart dysrhythm focus CPT 93650 | $5,456.85 | $36,379.00 | $100.00 – $58,606.57 | 10 |
| Abscess drain retroperitoneal surg code CPT 49406 | $1,186.95 | $7,913.00 | $1,343.70 – $7,763.60 | 7 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $122.86 | $819.02 | $0.05 – $737.12 | 10 |
| Acetaminophen level CPT 80143 | $53.25 | $354.96 | $15.66 – $319.47 | 21 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $152.56 | $1,017.02 | $26.72 – $478.92 | 10 |
| Acetone qualitative CPT 82009 | $25.05 | $167.00 | $3.80 – $31.50 | 21 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $1,012.20 | $6,748.00 | $0.64 – $88.24 | 9 |
| Acetylcysteine non-comp unit HCPCS J7608 | $2.52 | $16.78 | $3.03 – $17.46 | 9 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | $9.30 | $62.00 | $11.16 – $64.48 | 19 |
| Acute hepatitis panel CPT 80074 | $191.85 | $1,279.00 | $8.08 – $206.39 | 21 |
| Acute venous thrombus image CPT 78456 | $308.85 | $2,059.00 | $370.62 – $2,141.36 | 15 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $120.90 | $805.98 | $0.03 – $285.96 | 10 |
| #acylcarnitineprfl CPT 82017 | $50.85 | $339.00 | $14.17 – $305.10 | 21 |
| Adapter b 8 channel 10cm HCPCS C1883 | $28,253.61 | $188,357.40 | $1,162.20 – $6,973.16 | 10 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $234.26 | $1,561.68 | $0.45 – $35.06 | 10 |
| Adenovirus antibody,serum - quest CPT 86603 | $46.53 | $310.20 | $10.81 – $279.18 | 21 |
| Adh-sendout CPT 84588 | $33.15 | $221.00 | $18.00 – $146.58 | 21 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $93.49 | $623.25 | $0.26 – $116.85 | 19 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $84.45 | $563.00 | $66.32 – $585.52 | 9 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $70.05 | $467.00 | $84.06 – $485.68 | 9 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $148.95 | $993.00 | $178.74 – $1,032.72 | 9 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $121.20 | $808.00 | $145.44 – $840.32 | 9 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $57.00 | $380.00 | $68.40 – $395.20 | 9 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $87.45 | $583.00 | $104.94 – $606.32 | 9 |
| Administration immunization 1 vaccine CPT 90471 | $46.65 | $311.00 | $42.25 – $175.76 | 9 |
| Administration immunization each additional vaccine CPT 90472 | $22.35 | $149.00 | $27.76 – $149.76 | 9 |
| Administration vaccine influenza virus HCPCS G0008 | $33.00 | $220.00 | $38.50 – $160.16 | 9 |
| Administration vaccine pneumococcal HCPCS G0009 | $31.50 | $210.00 | $40.50 – $168.48 | 9 |
| _afb id by dna probe rflx ast CPT 87149 | $31.65 | $211.00 | $16.84 – $151.53 | 21 |
| Albumin body fluid quantitative each specimen CPT 82042 | $25.20 | $168.00 | $6.54 – $150.56 | 21 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $763.44 | $5,089.54 | $5.46 – $38.95 | 9 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $8.79 | $58.55 | $5.46 – $38.95 | 9 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | $5.85 | $38.95 | $7.02 – $40.51 | 9 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $41.85 | $279.00 | $4.14 – $25.41 | 21 |
| Albumin serum plasma or whole blood CPT 82040 | $35.10 | $234.00 | $3.06 – $20.96 | 21 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $75.60 | $504.00 | $14.51 – $453.60 | 21 |
| Alkaline phosphatase CPT 84075 | $46.65 | $311.00 | $4.35 – $243.90 | 21 |
| Allergen egg white ige CPT 86003 | $20.40 | $136.00 | $3.06 – $22.43 | 21 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $7,581.58 | $50,543.85 | $43.77 – $281.34 | 10 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $12,951.86 | $86,345.70 | $34.47 – $9,906.55 | 10 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $1,028.25 | $6,855.00 | $179.09 – $6,169.50 | 10 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $2,167.02 | $14,446.76 | $97.13 – $2,621.90 | 10 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $8,447.99 | $56,319.90 | $3,651.01 – $21,906.05 | 10 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $103.50 | $689.94 | $96.60 – $620.95 | 9 |
| All tstg perq&iq drugs/biol CPT 95018 | $19.35 | $129.00 | $23.22 – $134.16 | 9 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $1,590.60 | $10,604.00 | $5.58 – $6,104.09 | 9 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $28.65 | $191.00 | $34.38 – $278.17 | 21 |
| Alpha-fetoprotein amniotic CPT 82106 | $58.95 | $393.00 | $14.28 – $353.70 | 21 |
| Alpha-fetoprotein tumor marker CPT 82105 | $44.25 | $295.00 | $10.44 – $71.78 | 21 |
| Alprostadil for injection HCPCS J0270 | $533.06 | $3,553.69 | $0.41 – $35.06 | 10 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $30,540.77 | $203,605.10 | $80.57 – $3,187.57 | 9 |
| Alt/sgpt CPT 84460 | $60.30 | $402.00 | $3.06 – $22.43 | 21 |
| Aluminum - quest CPT 82108 | $31.80 | $212.00 | $21.40 – $190.80 | 21 |
| Amantadine (symmetrel)-sendout CPT 80375 | $43.05 | $287.00 | $18.09 – $298.48 | 14 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $116.26 | $775.06 | $0.87 – $35.06 | 10 |
| Amino acid screen, urine CPT 82128 | $38.25 | $255.00 | $11.65 – $229.50 | 21 |
| Aminolevulinic acid delta CPT 82135 | $42.75 | $285.00 | $13.82 – $256.50 | 21 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $47.73 | $318.14 | $1.46 – $35.06 | 10 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $151.08 | $1,007.19 | $100.00 – $787.62 | 8 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $28.52 | $190.13 | $0.43 – $35.06 | 10 |
| Ammonia CPT 82140 | $38.41 | $256.02 | $7.20 – $62.83 | 21 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $942.60 | $6,284.00 | $1,109.73 – $6,411.73 | 8 |
| Amniocentesis therapeutic CPT 59001 | not published | not published | $4,153.00 – $4,153.00 | 1 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | $1,301.53 | $8,676.84 | $1,561.84 – $9,023.92 | 8 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $927.61 | $6,184.06 | $26.36 – $5,565.66 | 9 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $506.10 | $3,374.00 | $0.88 – $35.06 | 10 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $275.90 | $1,839.32 | $2.28 – $35.06 | 10 |
| Amputation toe metatarsophalangeal joint CPT 28820 | $893.10 | $5,954.00 | $1,071.72 – $6,192.16 | 7 |
| Amylase CPT 82150 | $77.85 | $519.00 | $5.22 – $28.43 | 21 |
| Ana ds-dna CPT 86226 | $55.24 | $368.22 | $10.17 – $331.40 | 21 |
| Anal/urinary muscle study CPT 51785 | $104.55 | $697.00 | $125.46 – $724.88 | 7 |
| Analysis gene f2 20210g>a variant CPT 81240 | $84.30 | $562.00 | $55.18 – $505.80 | 21 |
| Analysis gene f5 leiden variant CPT 81241 | $94.65 | $631.00 | $61.63 – $567.90 | 21 |
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.