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 |
|---|---|---|---|---|
| MRI chest without contrast CPT 71550 | $667.39 | $4,449.24 | $268.00 – $4,536.48 | 15 |
| MRI chest without & w/contrast CPT 71552 | $1,189.65 | $7,931.00 | $439.13 – $8,248.24 | 15 |
| MRI chest w IV cont CPT 71551 | $796.80 | $5,312.00 | $782.94 – $5,524.48 | 15 |
| MRI guid ndl plc s&i CPT 77021 | $200.40 | $1,336.00 | $100.00 – $1,389.44 | 9 |
| MRI loex nonjt w IV cont CPT 73719 | $1,513.65 | $10,091.00 | $439.13 – $10,494.64 | 15 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $1,282.80 | $8,552.00 | $268.00 – $8,894.08 | 15 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $1,936.95 | $12,913.00 | $439.13 – $13,429.52 | 15 |
| MRI orbit/face/neck without contrast CPT 70540 | $673.65 | $4,491.00 | $268.00 – $4,670.64 | 15 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $1,005.30 | $6,702.00 | $439.13 – $6,970.08 | 15 |
| MRI orbit fac&nck w IV cont CPT 70542 | $794.25 | $5,295.00 | $439.13 – $5,506.80 | 15 |
| MRI tmj CPT 70336 | $3,037.65 | $20,251.00 | $268.00 – $21,061.04 | 15 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $1,168.20 | $7,788.00 | $268.00 – $8,099.52 | 15 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $1,576.95 | $10,513.00 | $439.13 – $10,933.52 | 15 |
| MRI upper extremity w/dye CPT 73219 | $1,273.20 | $8,488.00 | $439.13 – $8,827.52 | 15 |
| MRI w/cont, breast, bi HCPCS C8906 | $674.85 | $4,499.00 | $717.88 – $4,678.96 | 9 |
| MRI w/cont, breast, uni HCPCS C8903 | $711.60 | $4,744.00 | $342.57 – $4,933.76 | 9 |
| MRI without fol w/cont, breast HCPCS C8908 | $884.10 | $5,894.00 | $717.88 – $6,129.76 | 9 |
| MRI without fol w/cont, brst, un HCPCS C8905 | $831.45 | $5,543.00 | $717.88 – $5,764.72 | 9 |
| Mr safety implant elec prepj CPT 76018 | $19.95 | $133.00 | $23.94 – $138.32 | 8 |
| Mr sfty implt&/fb asmt stf 1 CPT 76014 | $7.95 | $53.00 | $9.54 – $55.12 | 8 |
| Mthfr gene analy common variants CPT 81291 | $82.01 | $546.72 | $54.89 – $287.10 | 21 |
| Multiple sleep latency test CPT 95805 | $603.30 | $4,022.00 | $100.00 – $4,182.88 | 9 |
| Mumps antibody igg CPT 86735 | $21.21 | $141.37 | $3.60 – $56.83 | 21 |
| Muscle test cran nerv unilat CPT 95867 | $41.25 | $275.00 | $49.50 – $286.00 | 9 |
| Muscle test larynx CPT 95865 | $39.00 | $260.00 | $46.80 – $270.40 | 9 |
| Mycophenolate mofetil 250 mg capsule HCPCS J7517 | $47.66 | $317.73 | $0.20 – $35.06 | 10 |
| Mycoplasma antibody igm CPT 86738 | $65.25 | $435.00 | $11.12 – $62.10 | 21 |
| Myelogphy 2/> spine regions CPT 72270 | $690.90 | $4,606.00 | $454.48 – $4,718.48 | 15 |
| Myelography l-s spine CPT 72265 | $378.15 | $2,521.00 | $315.38 – $2,463.76 | 15 |
| Myelography neck spine CPT 72240 | $379.35 | $2,529.00 | $322.85 – $2,591.68 | 15 |
| Myelography thoracic spine CPT 72255 | $555.60 | $3,704.00 | $328.86 – $3,620.24 | 15 |
| Myelography via inj w/s&i 2+ regions CPT 62305 | $1,249.20 | $8,328.00 | $1,499.04 – $8,661.12 | 7 |
| Myelography via inj w/s&i cervical CPT 62302 | $803.85 | $5,359.00 | $896.22 – $5,178.16 | 7 |
| Myelography via inj w/s&i lumbosacral CPT 62304 | $1,266.75 | $8,445.00 | $1,520.10 – $8,782.80 | 7 |
| Myelography via inj w/s&i thoracic CPT 62303 | $923.25 | $6,155.00 | $1,091.34 – $6,305.52 | 7 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $131.07 | $873.75 | $9.69 – $325.89 | 21 |
| Myocrd img pet mlt rst&strs CPT 78492 | $1,307.70 | $8,717.94 | $1,569.23 – $9,066.66 | 9 |
| Nalbuphine 10 mg/ml injection solution HCPCS J2300 | $12.57 | $83.80 | $3.85 – $35.06 | 10 |
| Natriuretic peptide CPT 83880 | $75.60 | $504.00 | $15.66 – $169.01 | 21 |
| Natural killer cells total count CPT 86357 | $36.30 | $242.00 | $18.00 – $163.00 | 21 |
| Ndl insj without njx 1 or 2 musc CPT 20560 | $6.00 | $40.00 | $7.02 – $40.56 | 8 |
| Ndl insj without njx 3+ musc CPT 20561 | $8.40 | $56.00 | $10.08 – $58.24 | 8 |
| Neck (Cervical Spine) CT scan (with and without contrast) CPT 72127 | $1,568.25 | $10,455.00 | $209.55 – $10,873.20 | 15 |
| Neck (Cervical Spine) CT scan (with contrast) CPT 72126 | $1,341.15 | $8,941.00 | $439.13 – $9,298.64 | 15 |
| Neck (Cervical Spine) CT scan (without contrast) CPT 72125 | $1,031.70 | $6,878.00 | $128.89 – $7,153.12 | 15 |
| Neck (Cervical Spine) MRI (with and without contrast) CPT 72156 | $2,065.35 | $13,769.00 | $439.13 – $14,319.76 | 15 |
| Neck (Cervical Spine) MRI (with contrast) CPT 72142 | $1,782.60 | $11,884.00 | $439.13 – $12,359.36 | 15 |
| Neck (Cervical Spine) MRI (without contrast) CPT 72141 | $1,229.40 | $8,196.00 | $268.00 – $8,523.84 | 15 |
| Neck MRA (blood vessel MRI, with and without contrast) CPT 70549 | $1,625.40 | $10,836.00 | $439.13 – $11,269.44 | 15 |
| Neck MRA (blood vessel MRI, with contrast) CPT 70548 | $1,158.15 | $7,721.00 | $439.13 – $8,029.84 | 15 |
| Neck MRA (blood vessel MRI, without contrast) CPT 70547 | $1,015.95 | $6,773.00 | $268.00 – $7,043.40 | 15 |
| Neostigmine methylsulfate 1 mg/ml injection (wrapper) HCPCS J2710 | $339.26 | $2,261.70 | $0.93 – $35.06 | 10 |
| Nerve conduction 7-8 studies CPT 95910 | $51.45 | $343.00 | $61.74 – $356.72 | 9 |
| Nerve conduction studies 11-12 CPT 95912 | $219.90 | $1,466.00 | $100.00 – $1,524.64 | 9 |
| Nerve conduction studies 1-2 CPT 95907 | $25.95 | $173.00 | $31.14 – $179.92 | 9 |
| Nerve conduction studies 13+ CPT 95913 | $72.30 | $482.00 | $86.76 – $501.28 | 9 |
| Nerve conduction studies 3-4 CPT 95908 | $122.85 | $819.00 | $100.00 – $851.76 | 9 |
| Nerve conduction studies 5-6 CPT 95909 | $44.55 | $297.00 | $53.46 – $308.88 | 9 |
| Nerve conduction studies 9-10 CPT 95911 | $219.90 | $1,466.00 | $100.00 – $1,524.64 | 9 |
| Nesiritide injection HCPCS J2325 | $734.69 | $4,897.93 | $68.08 – $4,408.14 | 10 |
| Neuromuscular junction testing ea nerve any 1 method CPT 95937 | $39.00 | $260.00 | $46.80 – $270.40 | 9 |
| New Patient Office Visit (level 2) CPT 99202 | $66.56 | $443.70 | $43.56 – $251.68 | 15 |
| New Patient Office Visit (level 3) CPT 99203 | $68.55 | $456.96 | $22.68 – $376.11 | 15 |
| New Patient Office Visit (level 4) CPT 99204 | $102.36 | $682.38 | $100.00 – $653.46 | 15 |
| New Patient Office Visit (level 5) CPT 99205 | $246.90 | $1,646.00 | $100.00 – $776.51 | 15 |
| Nicardipine 25 mg/10 ml intravenous solution HCPCS J2404 | $812.77 | $5,418.46 | $7.02 – $40.51 | 8 |
| Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous HCPCS J2305 | $53.97 | $359.77 | $7.02 – $40.51 | 8 |
| Nivolumab 10 mg/ml intravenous solution (wrapper) HCPCS J9299 | $1,103.97 | $7,359.80 | $10.47 – $67.31 | 9 |
| Njx px nfrosgrm &/urtrgrm CPT 50430 | $2,007.75 | $13,385.00 | $2,409.30 – $21,563.24 | 9 |
| Nm imaging bone/joint 3 phase study CPT 78315 | $1,004.40 | $6,696.00 | $489.74 – $6,963.84 | 15 |
| Nm imaging bone/joint whole body CPT 78306 | $851.25 | $5,675.00 | $489.74 – $5,901.56 | 15 |
| Nm imaging cardiac blood pooling planar single study at rest or stress CPT 78472 | $386.48 | $2,576.52 | $353.67 – $2,627.04 | 15 |
| Nm imaging gastric emptying study CPT 78264 | $418.69 | $2,791.25 | $401.94 – $2,322.32 | 15 |
| Nm imaging gastrointestinal acute blood loss CPT 78278 | $286.65 | $1,911.00 | $343.98 – $1,987.44 | 15 |
| Nm imaging hepatobiliary system w/pharmacologic intervention CPT 78227 | $1,229.25 | $8,195.00 | $635.67 – $8,522.80 | 15 |
| Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention CPT 78708 | $786.00 | $5,240.00 | $231.03 – $5,449.60 | 15 |
| Nm imaging pulmonary ventilation/perfusion CPT 78582 | $914.85 | $6,099.00 | $551.52 – $6,342.96 | 15 |
| Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) CPT 78014 | $690.75 | $4,605.00 | $423.45 – $4,789.20 | 15 |
| Nm radiopharmaceutical therapy oral administration CPT 79005 | $494.65 | $3,297.66 | $95.54 – $3,172.00 | 15 |
| Nr lnr acclrtr tx max 5 sessions CPT 77373 | $1,068.00 | $7,120.00 | $1,281.60 – $7,404.80 | 9 |
| Ntsty modul rad tx dlvr cplx CPT 77386 | $1,087.20 | $7,248.00 | $1,304.64 – $7,537.92 | 9 |
| Ntsty modul rad tx dlvr smpl CPT 77385 | $1,032.90 | $6,886.00 | $1,239.48 – $7,161.44 | 9 |
| Nuclear Stress Test (Heart) CPT 78452 | $2,204.25 | $14,695.00 | $769.67 – $15,282.80 | 15 |
| Nushield 1 square cm HCPCS Q4160 | $931.43 | $6,209.50 | $41.53 – $266.95 | 9 |
| Observation direct referral from physician office for admission HCPCS G0379 | $126.00 | $840.00 | $137.34 – $793.52 | 14 |
| Observation per hour HCPCS G0378 | $34.54 | $230.25 | $23.58 – $136.24 | 14 |
| Ocrelizumab 30 mg/ml intravenous solution HCPCS J2350 | $5,639.40 | $37,596.00 | $67.57 – $33,836.40 | 9 |
| Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 | $199.52 | $1,330.13 | $1.21 – $35.06 | 10 |
| Octreotide,microspheres ER 20 mg intramuscular susp, extended release HCPCS J2353 | $22,162.47 | $147,749.78 | $302.98 – $88,802.17 | 9 |
| Omalizumab 150 mg/ml subcutaneous syringe (wrapper) HCPCS J2357 | $3,778.61 | $25,190.67 | $43.27 – $26,198.30 | 9 |
| Oncoprotein dcp CPT 83951 | $70.80 | $472.00 | $54.10 – $424.80 | 21 |
| Oncoprotein her-2/neu CPT 83950 | $30.00 | $200.00 | $36.00 – $278.17 | 21 |
| Ondansetron 8 mg disintegrating tablet HCPCS Q0162 | $100.31 | $668.70 | $0.01 – $2.23 | 19 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | $173.81 | $1,158.73 | $0.90 – $35.06 | 10 |
| Oral aprepitant HCPCS J8501 | $409.66 | $2,731.02 | $3.70 – $1,907.69 | 10 |
| Organic acids total quant ea spec CPT 83918 | $173.10 | $1,154.00 | $19.82 – $873.00 | 21 |
| Oritavancin 400 mg intravenous solution HCPCS J2407 | $3,354.72 | $22,364.80 | $32.16 – $20,128.32 | 9 |
| Orphenadrine citrate 30 mg/ml injection solution HCPCS J2360 | $65.07 | $433.80 | $5.46 – $35.06 | 10 |
| Ortho elbow without jnt cstm w/fit&adj HCPCS L3702 | $203.65 | $1,357.65 | $203.65 – $1,221.89 | 10 |
| Ortho ewh rgd without jnt cstm w/fit&adj HCPCS L3763 | $251.37 | $1,675.80 | $251.37 – $1,508.22 | 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.