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 |
|---|---|---|---|---|
| Insert hepatic shunt (tips) CPT 37182 | $320.10 | $2,134.00 | $384.12 – $3,437.88 | 9 |
| Insertion catheter bladder non indwelling CPT 51701 | $39.90 | $266.00 | $47.88 – $276.64 | 13 |
| Insertion catheter bladder temporary simple CPT 51702 | $101.10 | $674.00 | $121.28 – $700.70 | 13 |
| Insertion intra aortic balloon assist device percutaneous CPT 33967 | $950.59 | $6,337.26 | $1,140.71 – $10,209.33 | 9 |
| Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance CPT 37191 | $1,589.55 | $10,597.00 | $1,061.10 – $9,496.85 | 9 |
| Insertion nontunneled centrally inserted central venous catheter >= 5 years old CPT 36556 | $478.95 | $3,193.00 | $574.74 – $3,320.72 | 8 |
| Insertion of heart electrode 33211 CPT 33211 | $4,443.00 | $29,620.00 | $5,331.60 – $30,804.80 | 7 |
| Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular CPT 33208 | $4,653.45 | $31,023.00 | $5,584.14 – $32,263.92 | 7 |
| Insertion of new/replacement ppm w/transvenous electrode(s) ventricular CPT 33207 | $4,188.15 | $27,921.00 | $5,025.78 – $29,037.84 | 7 |
| Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator CPT 33225 | $3,278.10 | $21,854.00 | $3,933.72 – $35,206.80 | 9 |
| Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years CPT 36569 | $888.30 | $5,922.00 | $1,065.96 – $6,158.88 | 8 |
| Insertion picc without port or pump with imaging guidance=>5y CPT 36573 | $786.15 | $5,241.00 | $943.26 – $5,449.93 | 8 |
| Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber CPT 33249 | $10,273.50 | $68,490.00 | $12,328.20 – $71,229.60 | 7 |
| Insertion/replacement temporary single chamber electrode/pacemaker catheter CPT 33210 | $4,231.35 | $28,209.00 | $5,077.62 – $29,337.36 | 7 |
| Insertion single tranvenous electrode/ppm/implantable defibrillator CPT 33216 | $1,505.25 | $10,035.00 | $1,806.30 – $10,436.40 | 7 |
| Insertion subcutaneous cardiac rhythm monitor CPT 33285 | $2,506.50 | $16,710.00 | $3,007.80 – $17,378.40 | 7 |
| Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) CPT 36561 | $1,295.25 | $8,635.00 | $1,520.28 – $8,783.84 | 7 |
| Insert pm/icd lead dual CPT 33217 | $1,381.86 | $9,212.40 | $1,658.24 – $9,580.90 | 7 |
| Insert/repl sq defib w/eltrd CPT 33270 | $14,739.90 | $98,266.00 | $17,687.88 – $102,196.64 | 7 |
| Insert sq defib electrode CPT 33271 | $2,809.65 | $18,731.00 | $3,371.58 – $19,480.24 | 7 |
| Insert swan-ganz cath CPT 93503 | $7,584.45 | $50,563.00 | $100.00 – $81,457.00 | 10 |
| Insert uteri tandem/ovoids CPT 57155 | $684.30 | $4,562.00 | $821.16 – $4,744.48 | 8 |
| Insert vad art access left hrt arterial access CPT 33990 | $1,846.65 | $12,311.00 | $2,215.98 – $19,833.03 | 9 |
| Ins icd gen exist mlt leads CPT 33231 | $11,040.60 | $73,604.00 | $13,248.72 – $76,548.16 | 7 |
| Ins icd gen exist sgl lead CPT 33240 | $6,620.55 | $44,137.00 | $7,944.66 – $45,902.48 | 7 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $211.65 | $1,411.00 | $253.98 – $1,467.44 | 9 |
| Insj perq vad r hrt venous CPT 33995 | $779.36 | $5,195.70 | $935.23 – $8,370.28 | 9 |
| Ins lv lead exist pm/icd CPT 33224 | $4,822.80 | $32,152.00 | $5,787.36 – $33,438.08 | 7 |
| Ins picad w subq port 5yr> CPT 36571 | $2,979.15 | $19,861.00 | $3,574.98 – $20,655.44 | 7 |
| Ins pm gen exist dual lead CPT 33230 | $7,854.00 | $52,360.00 | $8,451.90 – $48,833.20 | 7 |
| Ins pm gen w/exist mlt leads CPT 33221 | $7,002.01 | $46,680.02 | $8,402.41 – $48,547.23 | 7 |
| Ins pq tunnld ip cath w/img CPT 49418 | $589.50 | $3,930.00 | $707.40 – $4,087.20 | 7 |
| Ins/rpl ldless pm right vent w img & eval CPT 33274 | $7,709.85 | $51,399.00 | $9,251.82 – $82,803.79 | 9 |
| Ins/rpl pm gen exist dual lead CPT 33213 | $2,002.86 | $13,352.40 | $2,403.44 – $13,886.50 | 7 |
| Ins/rpl pm gen exist sgl lead CPT 33212 | $2,012.45 | $13,416.30 | $2,414.94 – $13,952.96 | 7 |
| Ins/rpl pm w/tv ld atrl CPT 33206 | $3,955.50 | $26,370.00 | $4,746.60 – $27,424.80 | 7 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $988.05 | $6,587.00 | $1,185.66 – $6,850.48 | 7 |
| Ins tun cvad 2 cath w/subq port(s) CPT 36566 | $410.85 | $2,739.00 | $493.02 – $2,848.56 | 8 |
| Ins tun cv cath wo subq prt/pm CPT 36558 | $897.00 | $5,980.00 | $1,052.82 – $6,082.96 | 7 |
| Insulin total CPT 83525 | $52.18 | $347.82 | $6.30 – $49.35 | 21 |
| Ins vag brachytx device CPT 57156 | $163.80 | $1,092.00 | $196.56 – $1,135.68 | 7 |
| Intra-atrial pacing CPT 93610 | $2,524.79 | $16,831.90 | $100.00 – $27,116.20 | 10 |
| Intracard echo interv w/s&i CPT 93662 | $185.55 | $1,237.00 | $100.00 – $1,992.81 | 11 |
| Intraventricular pacing CPT 93612 | $1,198.80 | $7,992.00 | $100.00 – $12,875.12 | 10 |
| Intrinsic factor antibody CPT 86340 | $50.95 | $339.66 | $12.67 – $305.70 | 21 |
| Intro cath dialysis circuit CPT 36901 | $1,237.35 | $8,249.00 | $1,484.82 – $8,578.96 | 7 |
| Intro catheter aorta CPT 36200 | $362.40 | $2,416.00 | $100.00 – $3,452.38 | 10 |
| Intro cath svc/ivc CPT 36010 | $123.45 | $823.00 | $100.00 – $1,325.86 | 10 |
| Intrvasc Ultrasound noncoronary 1st vessel CPT 37252 | $141.00 | $940.00 | $100.00 – $1,514.34 | 10 |
| Intrvasc Ultrasound noncoronary addl vessel CPT 37253 | $126.90 | $846.00 | $100.00 – $1,362.91 | 10 |
| Intubation endotracheal emergency procedure CPT 31500 | $171.45 | $1,143.00 | $205.65 – $1,188.20 | 8 |
| Iodine i-123 sod iodide mil HCPCS A9509 | $193.35 | $1,289.00 | $100.00 – $1,340.56 | 9 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $9.12 | $60.79 | $0.60 – $15.17 | 10 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $112.36 | $749.01 | $0.14 – $0.86 | 10 |
| Ipratropium bromide non-comp HCPCS J7644 | $7.13 | $47.52 | $0.24 – $1.38 | 9 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | $399.30 | $2,661.99 | $3.53 – $138.82 | 10 |
| Irinotecan liposomal 4.3 mg/ml intravenous HCPCS J9205 | $562.21 | $3,748.04 | $91.31 – $3,373.24 | 9 |
| Iron CPT 83540 | $34.80 | $232.00 | $5.22 – $28.43 | 21 |
| Iron binding capacity CPT 83550 | $49.80 | $332.00 | $5.22 – $37.38 | 21 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | $130.14 | $867.60 | $19.97 – $390.42 | 9 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $200.42 | $1,336.11 | $0.26 – $240.51 | 10 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $83.55 | $557.00 | $100.00 – $579.28 | 9 |
| Ivc venogram s&i CPT 75825 | $1,258.35 | $8,389.00 | $276.49 – $8,724.56 | 15 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $47.85 | $319.00 | $57.42 – $331.76 | 9 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $50.70 | $338.00 | $45.50 – $351.52 | 9 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $44.85 | $299.00 | $47.04 – $310.96 | 9 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $179.40 | $1,196.00 | $100.00 – $1,926.76 | 11 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $240.60 | $1,604.00 | $180.22 – $1,668.16 | 15 |
| Jak2 targeted sequence analysis CPT 81279 | $191.25 | $1,275.00 | $185.20 – $1,147.50 | 19 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $22.35 | $149.00 | $6.86 – $88.20 | 21 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $144.60 | $964.00 | $0.39 – $35.06 | 10 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $974.70 | $6,498.00 | $363.84 – $6,757.92 | 15 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $545.85 | $3,639.00 | $131.99 – $3,784.37 | 15 |
| Kit cath ivl 2.5x40mm 135cm shockwave s4 HCPCS C1761 | $7,402.82 | $49,352.10 | $100.00 – $17,766.00 | 10 |
| Kit ipg optimizer smart HCPCS C1824 | $40,950.00 | $273,000.00 | $40,950.00 – $245,700.00 | 10 |
| Kit lead specify 5-6-5 HCPCS C1778 | $7,910.13 | $52,734.15 | $3,624.24 – $21,745.40 | 10 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $702.93 | $4,686.15 | $426.20 – $2,557.17 | 10 |
| Knee MRI (with and without contrast) CPT 73723 | $2,608.50 | $17,390.00 | $439.13 – $18,085.60 | 15 |
| Knee MRI (with contrast) CPT 73722 | $2,241.30 | $14,942.00 | $782.94 – $15,539.68 | 15 |
| Knee MRI (without contrast) CPT 73721 | $1,606.80 | $10,712.00 | $268.00 – $11,140.48 | 15 |
| Knee X-ray CPT 73564 | $223.50 | $1,490.00 | $131.99 – $1,549.60 | 15 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $23.52 | $156.75 | $5.46 – $35.06 | 9 |
| Lacosamide 200 mg/20 ml intravenous solution HCPCS C9254 | $188.92 | $1,259.44 | $0.23 – $330.44 | 8 |
| Lactate dehydrogenase (ldh) CPT 83615 | $42.75 | $285.00 | $3.06 – $25.41 | 21 |
| Lactated ringers intravenous solution HCPCS J7120 | $47.66 | $317.73 | $2.73 – $330.44 | 9 |
| Lactic acid CPT 83605 | $53.25 | $355.00 | $7.56 – $49.35 | 21 |
| Lactoferrin fecal quant CPT 83631 | $39.75 | $265.00 | $16.49 – $238.50 | 21 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $9,747.68 | $64,984.50 | $1,378.29 – $8,269.70 | 10 |
| Lead capillary CPT 83655 | $23.40 | $156.00 | $7.20 – $52.33 | 21 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $2,027.19 | $13,514.55 | $334.85 – $2,009.07 | 10 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $2,835.16 | $18,901.05 | $2,835.16 – $17,010.95 | 10 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $622.50 | $4,150.00 | $294.24 – $4,315.34 | 15 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $297.73 | $1,984.83 | $5.50 – $135.36 | 10 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $38,606.44 | $257,376.24 | $10.47 – $74.78 | 9 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $201.87 | $1,345.75 | $0.07 – $35.06 | 10 |
| Levetiracetam therapeutic drug level CPT 80177 | $68.70 | $458.00 | $11.13 – $412.20 | 21 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $97.03 | $646.85 | $1.30 – $35.06 | 10 |
| Liberta rc ipg HCPCS C1820 | $15,561.63 | $103,744.20 | $15,561.63 – $93,369.78 | 10 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $30.08 | $200.52 | $7.02 – $40.51 | 8 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $318.12 | $2,120.80 | $3.48 – $35.06 | 10 |
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.