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 |
|---|---|---|---|---|
| Fl exam g/colon tube w contrast CPT 49465 | $92.55 | $617.00 | $111.06 – $993.99 | 9 |
| Flow cytometry interp 16 or more CPT 88189 | $44.85 | $299.00 | $53.82 – $310.96 | 9 |
| Flow cytometry marker each additional CPT 88185 | $35.10 | $234.00 | $32.73 – $189.08 | 9 |
| Flow cytometry one marker technical component CPT 88184 | $166.35 | $1,109.00 | $199.47 – $1,152.46 | 9 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $74.07 | $493.80 | $2.95 – $35.06 | 10 |
| Fludarabine 50 mg intravenous solution HCPCS J9185 | $1,061.43 | $7,076.15 | $139.78 – $4,164.48 | 9 |
| Fluidotherapy charges pt CPT 97022 | $41.85 | $279.00 | $39.33 – $272.48 | 9 |
| Fluorescent antibody titer dna CPT 86256 | $24.15 | $161.00 | $10.12 – $144.90 | 21 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $185.25 | $1,235.00 | $100.00 – $1,116.96 | 9 |
| Fluoroguide needle placement CPT 77002 | $169.20 | $1,128.00 | $100.00 – $1,173.12 | 9 |
| Fluoroscopy up to 1 hour CPT 76000 | $161.70 | $1,078.00 | $60.29 – $1,121.12 | 15 |
| Fluorouracil 50 mg/ml intravenous solution (wrapper) HCPCS J9190 | $20.83 | $138.82 | $3.37 – $67.31 | 10 |
| Fna bx w/ct gdn 1st les CPT 10009 | $820.80 | $5,472.00 | $984.96 – $5,690.88 | 7 |
| Fna bx w/ct gdn ea addl CPT 10010 | $599.85 | $3,999.00 | $100.00 – $4,158.96 | 8 |
| Folic acid CPT 82746 | $62.25 | $415.00 | $6.30 – $62.83 | 21 |
| Follow-up angiography CPT 75898 | $203.55 | $1,357.00 | $191.81 – $4,017.96 | 15 |
| Fomepizole 1 gram/ml intravenous solution HCPCS J1451 | $14,265.66 | $95,104.39 | $5.46 – $35.06 | 9 |
| Fondaparinux sodium HCPCS J1652 | $1,446.58 | $9,643.86 | $1.04 – $35.06 | 10 |
| Foot X-ray CPT 73630 | $278.37 | $1,855.74 | $109.09 – $1,892.14 | 15 |
| Foreskn manip w/lss preputial ads+stretching 54450 CPT 54450 | $163.05 | $1,087.00 | $195.66 – $1,130.48 | 8 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $1,161.32 | $7,742.08 | $0.20 – $5,574.33 | 10 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $274.63 | $1,830.83 | $4.12 – $46.86 | 9 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $81.45 | $543.00 | $93.60 – $540.80 | 8 |
| Fresh frozen plasma thawing ea un CPT 86927 | $49.35 | $329.00 | $24.64 – $342.16 | 9 |
| Fructosamine glycated protein CPT 82985 | $39.75 | $265.00 | $14.08 – $76.50 | 21 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $51.89 | $345.89 | $5.46 – $35.06 | 9 |
| Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr HCPCS J1940 | $5.85 | $38.95 | $0.45 – $35.06 | 10 |
| Ga-67 gallium 0.1 mci HCPCS A9556 | $22.80 | $152.00 | $27.36 – $158.08 | 9 |
| Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper) HCPCS A9579 | $4.22 | $28.09 | $3.03 – $19.44 | 10 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | $49.20 | $328.00 | $17.70 – $295.20 | 21 |
| Gammaglobulin iga CPT 82784 | $29.25 | $195.00 | $7.81 – $175.50 | 21 |
| Gammaglobulin ige CPT 82785 | $65.55 | $437.00 | $13.83 – $393.30 | 21 |
| Gamma glutamyltransferase CPT 82977 | $38.85 | $259.00 | $4.14 – $31.42 | 21 |
| Gamunex-c/gammaked HCPCS J1561 | $48.47 | $323.12 | $45.24 – $290.81 | 9 |
| Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr HCPCS J1570 | $360.72 | $2,404.80 | $51.34 – $1,424.26 | 10 |
| Gemcitabine 1 gram intravenous solution HCPCS J9201 | $2,571.40 | $17,142.62 | $3.93 – $191.40 | 10 |
| Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln HCPCS J9203 | $29,311.00 | $195,406.66 | $323.83 – $175,866.00 | 9 |
| Generator barostim neo2 2014 HCPCS C1767 | $26,885.25 | $179,235.00 | $20,334.20 – $122,005.17 | 10 |
| Generator emblem MRI sicd subq HCPCS C1722 | $47,738.57 | $318,257.10 | $8,662.98 – $51,977.84 | 10 |
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | $239.68 | $1,597.83 | $3.10 – $35.06 | 10 |
| Gentamicin peak therapeutic drug level CPT 80170 | $43.95 | $293.00 | $13.76 – $244.80 | 21 |
| Ghs abscess perianal iandd CPT 46050 | $476.10 | $3,174.00 | $571.32 – $3,300.96 | 8 |
| Ghs abscess postoperative iandd complex CPT 10180 | $661.20 | $4,408.00 | $793.44 – $4,584.32 | 7 |
| Ghs alcohol, methyl (methanol)-medtox CPT 84600 | $49.80 | $332.00 | $14.37 – $298.80 | 21 |
| Ghs antibodies (torch) igm CPT 86694 | $67.35 | $449.00 | $12.09 – $404.10 | 21 |
| Ghs bladder cath - complex-foley CPT 51703 | $123.30 | $822.00 | $147.96 – $854.88 | 8 |
| Ghs bleeding time (ivy) CPT 85002 | $3.75 | $25.00 | $4.05 – $22.50 | 21 |
| Ghs central line insert < age 5, failed CPT 36555 | $478.95 | $3,193.00 | $574.74 – $3,320.72 | 8 |
| Ghs change cysto/gastrost CPT 43762 | $215.63 | $1,437.50 | $258.75 – $1,495.00 | 8 |
| Ghs chemo >8 hrs CPT 96416 | $148.95 | $993.00 | $178.74 – $1,032.72 | 9 |
| Ghs chemo IV push, ea addtl CPT 96411 | $84.45 | $563.00 | $101.34 – $585.52 | 9 |
| Ghs chlamydia pneumoniae by pcr (arup) (306630) CPT 87486 | $28.05 | $187.00 | $29.48 – $168.00 | 21 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | $192.00 | $1,280.00 | $230.40 – $1,331.20 | 8 |
| Ghs closed reduction ankle dislocation CPT 27840 | $126.30 | $842.00 | $151.56 – $875.68 | 8 |
| Ghs closed tx bimalleolar fracture w/manip CPT 27810 | $244.96 | $1,633.02 | $293.95 – $1,698.35 | 8 |
| Ghs closed tx tibial fracture w/manip CPT 27752 | $785.25 | $5,235.00 | $942.30 – $5,444.40 | 8 |
| Ghs closure surg wound/dehiscence-13160 CPT 13160 | $857.70 | $5,718.00 | $1,029.24 – $5,946.72 | 7 |
| Ghs clsd red med malleolus fx w manip CPT 27762 | $785.25 | $5,235.00 | $942.30 – $5,444.40 | 8 |
| Ghs cl tx knee disl; wo anesth CPT 27550 | $78.00 | $520.00 | $93.60 – $540.80 | 8 |
| Ghs cl tx metacarpophal disloc without anes CPT 26700 | $131.10 | $874.00 | $157.32 – $908.96 | 8 |
| Ghs community re-entry 15 minutes CPT 97537 | $30.75 | $205.00 | $36.90 – $213.20 | 9 |
| Ghs conjunctiva foreign body-embed bil CPT 65210 | $170.25 | $1,135.00 | $204.30 – $1,180.40 | 13 |
| Ghs conjunctiva foreign body-superf bil CPT 65205 | $68.32 | $455.43 | $81.98 – $473.65 | 13 |
| Ghs corneal fb without slit lamp bilat CPT 65220 | $175.34 | $1,168.92 | $210.41 – $1,215.68 | 13 |
| Ghs corneal fb with slit lamp bilat CPT 65222 | $214.05 | $1,427.00 | $256.86 – $1,484.08 | 13 |
| Ghs cricothyroidotomy CPT 31605 | $80.70 | $538.00 | $96.84 – $559.52 | 8 |
| Ghs diphtheria toxoid ab igg CPT 86648 | $18.75 | $125.00 | $12.78 – $112.50 | 21 |
| Ghs dislocation elbow closed treatment CPT 24600 | $133.73 | $891.48 | $160.47 – $927.14 | 8 |
| Ghs ed therapeutic lp, drain csf w fluoro CPT 62329 | $295.80 | $1,972.00 | $354.96 – $2,050.88 | 7 |
| Ghs excision ingrown nail CPT 11765 | $131.85 | $879.00 | $158.22 – $914.16 | 13 |
| Ghs fb removal - incisional CPT 10121 | $483.45 | $3,223.00 | $580.14 – $3,351.92 | 8 |
| Ghs febrile agglutinns(mayo) CPT 86000 | $20.10 | $134.00 | $5.86 – $115.20 | 21 |
| Ghs fish cytogen CPT 88271 | $97.80 | $652.00 | $17.99 – $146.70 | 21 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $45.90 | $306.00 | $43.00 – $239.40 | 21 |
| Ghs hcv amplificaiton CPT 87521 | $158.85 | $1,059.00 | $29.48 – $953.10 | 21 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | $40.40 | $269.28 | $13.01 – $242.36 | 21 |
| Ghs histoplasma antigen CPT 87385 | $71.91 | $479.40 | $11.13 – $431.46 | 21 |
| Ghs i and d perirectal abscess 46040 CPT 46040 | $622.18 | $4,147.84 | $746.62 – $4,313.76 | 8 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $257.04 | $1,713.60 | $308.45 – $1,782.15 | 8 |
| Ghs immun0electrophoresis CPT 86320 | $79.49 | $529.88 | $25.13 – $476.90 | 21 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $166.47 | $1,109.76 | $199.76 – $1,154.16 | 8 |
| Ghs inf midline insertion CPT 36140 | $339.75 | $2,265.00 | $100.00 – $3,196.23 | 10 |
| Ghs inhibitor screen CPT 85335 | $94.50 | $630.00 | $10.81 – $567.00 | 21 |
| Ghs init tx 1st degree burn CPT 16000 | $112.31 | $748.68 | $134.77 – $778.63 | 13 |
| Ghs inj tendon origin/insertion CPT 20551 | $120.45 | $803.00 | $144.54 – $835.12 | 7 |
| Ghs insertion of needle - bone CPT 36680 | $185.90 | $1,239.30 | $223.08 – $1,288.88 | 13 |
| Ghs intermed repair 12.6 - 20.0 cm-12035 CPT 12035 | $242.85 | $1,619.00 | $291.42 – $1,683.76 | 8 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $284.40 | $1,896.00 | $341.28 – $1,971.84 | 8 |
| Ghs intermed repair over 30 cm - 12037 CPT 12037 | $330.00 | $2,200.00 | $396.00 – $2,288.00 | 8 |
| Ghs intro needle/intracath vein - 36000 CPT 36000 | $127.50 | $850.00 | $100.00 – $1,369.35 | 10 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | $166.33 | $1,108.82 | $199.59 – $1,153.18 | 8 |
| Ghs IV infusion sotrovimab HCPCS M0247 | $5.85 | $38.95 | $9.74 – $40.51 | 8 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $118.95 | $793.00 | $142.66 – $824.25 | 13 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $148.84 | $992.26 | $178.61 – $1,031.96 | 13 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $153.60 | $1,024.00 | $184.32 – $1,064.96 | 8 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $106.50 | $710.00 | $127.80 – $738.40 | 8 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $219.90 | $1,466.00 | $263.88 – $1,524.64 | 8 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $259.50 | $1,730.00 | $311.40 – $1,799.20 | 8 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $143.82 | $958.80 | $172.59 – $997.16 | 8 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $279.30 | $1,862.00 | $335.16 – $1,936.48 | 8 |
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.