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 |
|---|---|---|---|---|
| Hemophilus influenza antibdy CPT 86684 | $13.96 | $93.06 | $13.31 – $83.76 | 21 |
| Heparin assay CPT 85520 | $44.84 | $298.88 | $11.00 – $234.00 | 21 |
| Heparin bolus from bag HCPCS J1644 | $180.47 | $1,203.08 | $0.25 – $35.06 | 10 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $281.97 | $1,879.80 | $0.02 – $35.06 | 10 |
| Hepatitis a antibody igm CPT 86709 | $40.80 | $272.00 | $9.46 – $213.30 | 21 |
| Hepatitis b core antibody igm CPT 86705 | $36.57 | $243.78 | $3.91 – $50.86 | 21 |
| Hepatitis b core antibody total CPT 86704 | $48.38 | $322.50 | $10.12 – $290.25 | 21 |
| Hepatitis b immune globulin greater than 1,560 units/5 ml im solution CPT 90371 | $613.92 | $4,092.76 | $190.54 – $3,332.56 | 9 |
| Hepatitis b surface antibody CPT 86706 | $54.75 | $365.00 | $5.22 – $46.37 | 21 |
| Hepatitis c antibody CPT 86803 | $55.20 | $368.00 | $8.28 – $61.32 | 21 |
| Hepatobiliary system imaging CPT 78226 | $897.30 | $5,982.00 | $489.74 – $6,221.28 | 15 |
| Herpes simplex type 1 antibody igg CPT 86695 | $22.95 | $153.00 | $11.08 – $63.00 | 21 |
| Herpes simplex type 2 antibody igg CPT 86696 | $44.85 | $299.00 | $16.25 – $83.75 | 21 |
| Herpes simplex virus isolation CPT 87255 | $49.35 | $329.00 | $28.44 – $209.31 | 21 |
| Heterophile antibodies screening CPT 86308 | $38.87 | $259.08 | $4.35 – $36.00 | 21 |
| Hhv-6 dna quant CPT 87533 | $114.75 | $765.00 | $35.08 – $568.80 | 21 |
| Hip X-ray CPT 73502 | $131.85 | $879.00 | $109.09 – $913.35 | 15 |
| Histamine CPT 83088 | $48.45 | $323.00 | $24.81 – $290.70 | 21 |
| Hla class i high defin qual CPT 86832 | $305.85 | $2,039.00 | $271.95 – $1,835.10 | 21 |
| Hla class ii high defin qual CPT 86833 | $305.85 | $2,039.00 | $273.67 – $1,835.10 | 21 |
| Hla i & ii typing lr CPT 81370 | $841.50 | $5,610.00 | $337.78 – $5,049.00 | 21 |
| Hla i typing high res 1 allele grp ea CPT 81381 | $183.06 | $1,220.40 | $142.72 – $811.80 | 21 |
| Hla i typing low res one locus ea CPT 81373 | $33.60 | $224.00 | $40.32 – $550.37 | 21 |
| Hocm 350-399mg/ml iodine,1ml HCPCS Q9963 | $241.84 | $1,612.23 | $0.41 – $35.06 | 10 |
| Homocysteine CPT 83090 | $52.65 | $351.00 | $10.44 – $77.78 | 21 |
| Homogenization tissue CPT 87176 | $3.38 | $22.48 | $4.05 – $25.41 | 21 |
| Homovanillic acid (hva) CPT 83150 | $35.85 | $239.00 | $18.82 – $215.10 | 21 |
| Hpv types 16 & 18 only CPT 87625 | $30.75 | $205.00 | $34.06 – $184.50 | 21 |
| H pylori (c-13) breath CPT 83013 | $60.44 | $402.90 | $56.58 – $362.61 | 21 |
| Human epididymis protein 4 (he4) CPT 86305 | $95.55 | $637.00 | $17.48 – $573.30 | 21 |
| Hyaluronidase 150 unit/ml injection solution HCPCS J3470 | $193.65 | $1,290.99 | $64.32 – $1,161.90 | 10 |
| Hyaluronidase 200 units/ml inj HCPCS J3471 | $395.57 | $2,637.12 | $0.58 – $1,320.49 | 10 |
| Hydralazine 20 mg/ml injection solution HCPCS J0360 | $369.40 | $2,462.64 | $4.57 – $35.06 | 10 |
| Hydration IV infusion each additional hour CPT 96361 | $39.60 | $264.00 | $29.30 – $274.56 | 9 |
| Hydration IV infusion initial 31minutes - 1 hour CPT 96360 | $179.40 | $1,196.00 | $82.52 – $1,243.84 | 9 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | $499.16 | $3,327.73 | $13.10 – $84.16 | 10 |
| Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) HCPCS J1171 | $43.38 | $289.20 | $5.46 – $35.06 | 9 |
| Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge HCPCS J7999 | $47.66 | $317.73 | $57.20 – $330.44 | 8 |
| Hydroxyzine hcl 50 mg/ml intramuscular solution HCPCS J3410 | $23.52 | $156.75 | $1.46 – $35.06 | 10 |
| Hydroxyzine pamoate 25 mg capsule HCPCS Q0177 | $0.29 | $1.91 | $0.08 – $0.52 | 10 |
| Hydrxycorticsterds 17- (17-ohcs) CPT 83491 | $29.85 | $199.00 | $15.04 – $179.10 | 21 |
| #hypersens-actinomyces ab CPT 86602 | $17.34 | $115.54 | $8.55 – $103.99 | 21 |
| Hysterosalpingography s&i CPT 74740 | $263.55 | $1,757.00 | $289.96 – $1,699.36 | 15 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | $21.00 | $140.00 | $25.20 – $145.60 | 9 |
| I-131 iobenguane sulf diag mibg HCPCS A9508 | $303.15 | $2,021.00 | $100.00 – $2,101.84 | 9 |
| I131 iodide cap, rx HCPCS A9517 | $31.22 | $208.08 | $37.46 – $216.41 | 9 |
| Iadna legionella pneumophila amplified probe tq CPT 87541 | $22.19 | $147.90 | $26.63 – $151.07 | 21 |
| Ia nfct ab sarscov2 covid19 CPT 86328 | $21.60 | $144.00 | $25.92 – $135.84 | 21 |
| Ibandronate 3 mg/3 ml intravenous syringe HCPCS J1740 | $508.02 | $3,386.79 | $25.64 – $2,920.93 | 10 |
| Ibutilide fumarate 0.1 mg/ml intravenous solution HCPCS J1742 | $156.96 | $1,046.37 | $96.63 – $690.15 | 9 |
| Icatibant injection HCPCS J1744 | $1,503.84 | $10,025.60 | $107.42 – $9,023.04 | 9 |
| Icd cobalt xt dr MRI is1 df1 HCPCS C1721 | $47,909.77 | $319,398.45 | $10,080.48 – $60,482.84 | 10 |
| Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 | $63,194.04 | $421,293.60 | $2,309.58 – $13,857.48 | 10 |
| Icd crtp serena MRI HCPCS C2621 | $16,854.24 | $112,361.55 | $16,854.24 – $101,125.40 | 10 |
| Icd reliance df4 ib 64cm HCPCS C1895 | $16,010.67 | $106,737.75 | $1,303.32 – $7,819.88 | 10 |
| Idarubicin hcl injection HCPCS J9211 | $173.52 | $1,156.80 | $53.35 – $342.95 | 10 |
| I&d upper arm/elbow deep abscess/hematoma CPT 23930 | $481.35 | $3,209.00 | $577.62 – $3,337.36 | 7 |
| Ifosfamide 1 gram intravenous solution HCPCS J9208 | $396.87 | $2,645.80 | $10.47 – $67.31 | 10 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $37.84 | $252.23 | $45.41 – $266.24 | 9 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $131.85 | $879.00 | $158.22 – $914.16 | 9 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $84.17 | $561.09 | $93.60 – $540.80 | 9 |
| Iliac/fem angio cath insert HCPCS G0278 | $198.15 | $1,321.00 | $100.00 – $1,746.33 | 10 |
| Iliac revasc add-on 37222 CPT 37222 | $2,136.00 | $14,240.00 | $100.00 – $22,940.64 | 10 |
| Immobilizer shldr cntor adlt HCPCS L3670 | $118.29 | $788.55 | $37.80 – $226.80 | 10 |
| Immobilizer shldr dlx str 24-36in med HCPCS L1830 | $30.40 | $202.65 | $30.40 – $182.39 | 10 |
| Immobilizer shldr sling med HCPCS L3660 | $37.96 | $253.05 | $20.79 – $124.74 | 10 |
| Immune complex assay CPT 86332 | $32.40 | $216.00 | $20.47 – $194.40 | 21 |
| Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution HCPCS J1569 | $58.84 | $392.21 | $54.91 – $352.99 | 9 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | $67.42 | $449.42 | $22.42 – $144.12 | 9 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $71.70 | $478.00 | $9.36 – $89.75 | 21 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $90.30 | $602.00 | $12.42 – $89.75 | 21 |
| Immunofixation electrophoresis serum CPT 86334 | $77.70 | $518.00 | $12.42 – $97.23 | 21 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $30.75 | $205.00 | $36.90 – $393.16 | 9 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $93.00 | $620.00 | $111.60 – $644.80 | 9 |
| Immunology procedure CPT 86849 | $191.25 | $1,275.00 | $96.56 – $1,326.00 | 8 |
| Impl ahmed 6x25x9.6mm glaucoma vlv w/sil ped ster HCPCS L8612 | $2,573.71 | $17,158.05 | $2,573.71 – $15,442.25 | 10 |
| Implant cartilage 10mm synthetic HCPCS L8699 | $4,604.04 | $30,693.60 | $372.18 – $2,233.04 | 10 |
| Implant ureth bulk agent HCPCS L8606 | $643.55 | $4,290.30 | $643.55 – $3,861.27 | 10 |
| In-111 pentetate dtpa / 0.5 mci HCPCS A9548 | $552.64 | $3,684.24 | $100.00 – $3,756.48 | 9 |
| In-111 pentetreotide HCPCS A9572 | $2,321.40 | $15,476.00 | $100.00 – $16,095.04 | 9 |
| In-111 satumomab pend HCPCS A4642 | $3,450.15 | $23,001.00 | $100.00 – $23,921.04 | 8 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $374.55 | $2,497.00 | $449.46 – $2,596.88 | 8 |
| Incision of achilles tendon CPT 27605 | $967.20 | $6,448.00 | $1,160.64 – $6,705.92 | 7 |
| Incision of breast lesion CPT 19020 | $659.59 | $4,397.22 | $791.50 – $4,573.11 | 8 |
| Incision of toe tendons 28011 CPT 28011 | $595.20 | $3,968.00 | $714.24 – $4,126.72 | 7 |
| Incisn of toe tndn CPT 28010 | $595.20 | $3,968.00 | $714.24 – $4,126.72 | 7 |
| Infect ag eia influenza a or b ea CPT 87400 | $43.50 | $290.00 | $11.87 – $261.00 | 21 |
| Infect ag genotype na hiv-1 revr trn/prt CPT 87901 | $228.00 | $1,520.00 | $142.47 – $1,112.75 | 21 |
| Infect ag ia optc obs influenza CPT 87804 | $22.50 | $150.00 | $13.90 – $132.30 | 21 |
| Infect ag if pneumocystis carinii CPT 87281 | $21.15 | $141.00 | $10.06 – $90.90 | 21 |
| Infect ag na hep b amp CPT 87516 | $123.63 | $824.16 | $29.48 – $287.10 | 21 |
| Infect ag na hpv high-risk types CPT 87624 | $40.95 | $273.00 | $29.48 – $231.30 | 21 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | $46.20 | $308.00 | $55.44 – $320.32 | 8 |
| Infect ag na resp virus 12-25 targets CPT 87633 | $289.50 | $1,930.00 | $347.40 – $1,800.71 | 21 |
| Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 | $30.15 | $201.00 | $36.18 – $180.90 | 21 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $65.10 | $434.00 | $8.28 – $52.33 | 21 |
| Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 | $62.58 | $417.18 | $11.27 – $331.29 | 21 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $58.35 | $389.00 | $10.06 – $350.10 | 21 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $38.25 | $255.00 | $12.08 – $82.80 | 21 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $49.80 | $332.00 | $5.22 – $44.86 | 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.