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 |
|---|---|---|---|---|
| Prothrombin complex kcentra HCPCS J7168 | $3,962.19 | $26,414.57 | $3,698.04 – $23,773.12 | 9 |
| Prothrombin time substitution plasma fractions each CPT 85611 | $12.15 | $81.00 | $3.31 – $72.90 | 21 |
| Prq cardiac angio addl art CPT 92921 | $4,309.95 | $28,733.00 | $100.00 – $46,288.87 | 10 |
| Prq card revasc chronic addl CPT 92944 | $6,200.25 | $41,335.00 | $100.00 – $66,590.69 | 10 |
| Prq card revasc mi 1 vsl CPT 92941 | $6,200.25 | $41,335.00 | $100.00 – $66,590.69 | 10 |
| Prq card revasc mi 1 vsl drug-eluting HCPCS C9606 | $7,561.20 | $50,408.00 | $100.00 – $81,207.29 | 10 |
| Prq card stent w/angio addl CPT 92929 | $6,200.25 | $41,335.00 | $100.00 – $66,590.69 | 10 |
| Prq revasc byp graft 1 art and/or branches CPT 92937 | $6,200.25 | $41,335.00 | $100.00 – $66,590.69 | 10 |
| Prq revasc byp graft addl CPT 92938 | $6,200.25 | $41,335.00 | $100.00 – $66,590.69 | 10 |
| Prq tcat plmt ntrac st 1 les CPT 92928 | $6,200.25 | $41,335.00 | $100.00 – $66,590.69 | 10 |
| Prq trlml c athrc st angiop1 CPT 92933 | $6,200.25 | $41,335.00 | $100.00 – $66,590.69 | 10 |
| Prq trluml c angiop 1art&/br CPT 92920 | $4,309.95 | $28,733.00 | $100.00 – $46,288.87 | 10 |
| Prq trluml c athrc 1 art&/br CPT 92924 | $8,619.75 | $57,465.00 | $100.00 – $92,576.12 | 10 |
| Prq trluml revsc ch occ ant CPT 92943 | $6,200.25 | $41,335.00 | $100.00 – $66,590.69 | 10 |
| Pr removal drug delivery implant CPT 11982 | $207.90 | $1,386.00 | $249.48 – $1,441.44 | 8 |
| Pr removal foreign body external auditory canal without anesthesia CPT 69200 | $74.07 | $493.78 | $88.89 – $513.54 | 13 |
| Pr removal intrauterine device CPT 58301 | $26.03 | $173.52 | $31.24 – $180.47 | 8 |
| Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm CPT 12032 | $193.05 | $1,287.00 | $231.66 – $1,338.48 | 8 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm CPT 12011 | $212.25 | $1,415.00 | $254.70 – $1,471.60 | 13 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm CPT 12013 | $220.80 | $1,472.00 | $264.96 – $1,530.88 | 13 |
| Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm CPT 12001 | $212.25 | $1,415.00 | $254.70 – $1,471.60 | 13 |
| Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm CPT 12002 | $278.10 | $1,854.00 | $333.72 – $1,928.16 | 13 |
| Pr tube thoracostomy w/connection to drainage open CPT 32551 | $516.97 | $3,446.42 | $180.00 – $1,665.78 | 9 |
| PSA (Prostate) Test CPT 84153 | $99.75 | $665.00 | $9.00 – $79.25 | 21 |
| Pt application of modality >=1 area electrical stimulation each 15 minutes CPT 97032 | $33.45 | $223.00 | $32.40 – $231.40 | 9 |
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $43.05 | $287.00 | $30.09 – $298.48 | 9 |
| Pt application of modality traction mechanical CPT 97012 | $37.65 | $251.00 | $32.40 – $261.04 | 9 |
| Pt evaluation high complexity patient/family CPT 97163 | $167.25 | $1,115.00 | $100.00 – $1,159.60 | 9 |
| Pt evaluation low complexity patient/family CPT 97161 | $100.35 | $669.00 | $100.00 – $695.76 | 9 |
| Pt evaluation moderate complexity patient/family CPT 97162 | $133.80 | $892.00 | $100.00 – $927.68 | 9 |
| Pt re-evaluation patient/family CPT 97164 | $100.35 | $669.00 | $100.00 – $695.76 | 9 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $40.05 | $267.00 | $47.93 – $276.90 | 9 |
| Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan HCPCS G0283 | $39.90 | $266.00 | $30.86 – $221.52 | 9 |
| Pt therapeutic procedure >=1 area gait training each 15 minutes CPT 97116 | $34.35 | $229.00 | $41.22 – $238.16 | 9 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $24.60 | $164.00 | $29.52 – $170.56 | 9 |
| Pt wheelchair management each 15 minutes CPT 97542 | $31.80 | $212.00 | $38.01 – $219.59 | 9 |
| Pulmonary vent imaging CPT 78579 | $521.55 | $3,477.00 | $317.08 – $3,616.08 | 15 |
| Pulse ox continuous overnight monitoring CPT 94762 | $57.23 | $381.48 | $68.67 – $396.74 | 9 |
| Pulse ox single CPT 94760 | $20.10 | $134.00 | $5.39 – $139.36 | 9 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $28.05 | $187.00 | $33.53 – $193.70 | 7 |
| Puncture aspiration abscess/hematoma/bulla/cyst CPT 10160 | $174.00 | $1,160.00 | $177.48 – $1,044.00 | 8 |
| Puncture spinal lumbar diagnostic CPT 62270 | $421.80 | $2,812.00 | $506.16 – $2,924.48 | 8 |
| Pyridoxine hcl 100 mg HCPCS J3415 | $66.15 | $440.98 | $16.54 – $243.45 | 10 |
| Quant diff pulm perf and vent w/imaging CPT 78598 | $362.40 | $2,416.00 | $434.88 – $2,512.64 | 15 |
| Quest t3 uptake CPT 84479 | $28.35 | $189.00 | $4.14 – $28.43 | 21 |
| Rabies ig heat-treated human im/subq 90376 CPT 90376 | $1,253.76 | $8,358.37 | $572.77 – $7,522.54 | 9 |
| Rabies ig ht&sol human im/sc CPT 90377 | $1,293.80 | $8,625.30 | $87.24 – $623.13 | 9 |
| Rabies immune globulin (pf) 300 unit/ml intramuscular solution CPT 90375 | $2,464.39 | $16,429.26 | $424.26 – $13,959.69 | 9 |
| Radiation handling CPT 77790 | $106.35 | $709.00 | $44.95 – $737.36 | 9 |
| Radiation physics consult CPT 77336 | $302.85 | $2,019.00 | $236.21 – $2,099.76 | 9 |
| Radiation therapy dose plan CPT 77300 | $256.95 | $1,713.00 | $100.34 – $1,781.52 | 9 |
| Radiation treatment aid(s) CPT 77332 | $145.65 | $971.00 | $84.65 – $1,009.84 | 9 |
| Radiation treatment aid(s) CPT 77333 | $511.80 | $3,412.00 | $206.94 – $3,548.48 | 9 |
| Radiation treatment aid(s) CPT 77334 | $469.50 | $3,130.00 | $200.68 – $3,255.20 | 9 |
| Radiation treatment delivery CPT 77402 | $97.65 | $651.00 | $117.18 – $677.04 | 9 |
| Radiation treatment delivery CPT 77412 | $307.05 | $2,047.00 | $368.46 – $2,128.88 | 9 |
| Radiology port images(s) CPT 77417 | $100.05 | $667.00 | $33.44 – $693.68 | 9 |
| Radiotherapy dose plan imrt CPT 77301 | $2,297.40 | $15,316.00 | $2,756.88 – $15,928.64 | 9 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | $483.90 | $3,226.00 | $549.49 – $3,355.04 | 15 |
| Radphm lcl tmr spect/ct 2+ areas/2+ days CPT 78831 | $1,028.25 | $6,855.00 | $1,210.08 – $7,129.20 | 15 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $536.55 | $3,577.00 | $564.39 – $3,720.08 | 15 |
| Radphm lcl tumor plr sgl day CPT 78800 | $401.70 | $2,678.00 | $314.37 – $2,785.12 | 15 |
| Rasburicase 1.5 mg intravenous solution HCPCS J2783 | $2,357.59 | $15,717.25 | $523.52 – $3,885.77 | 9 |
| Ravulizumab-cwvz 100 mg/ml intravenous solution HCPCS J1303 | $7,408.15 | $49,387.65 | $249.45 – $44,444.26 | 9 |
| Red blood cells each unit HCPCS P9021 | $132.75 | $885.00 | $100.00 – $920.40 | 8 |
| Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit HCPCS P9057 | $483.30 | $3,222.00 | $100.00 – $3,350.88 | 8 |
| Red blood cells leukocytes reduced cmv negative irradiated each unit HCPCS P9058 | $237.30 | $1,582.00 | $98.64 – $569.92 | 8 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $177.00 | $1,180.00 | $100.00 – $854.88 | 8 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $246.15 | $1,641.00 | $100.00 – $1,706.64 | 8 |
| Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 | $173.70 | $1,157.96 | $3.25 – $92.55 | 10 |
| Relocation skin pocket pm CPT 33222 | $353.10 | $2,354.00 | $423.72 – $2,448.16 | 7 |
| Remdesivir 100 mg intravenous powder for solution HCPCS J0248 | $1,983.28 | $13,221.84 | $100.00 – $13,750.72 | 8 |
| Rem endovas vena cava filter CPT 37193 | $1,117.13 | $7,447.50 | $1,340.55 – $11,997.93 | 9 |
| Removal biliary drg cath CPT 47537 | $272.55 | $1,817.00 | $327.06 – $1,889.68 | 7 |
| Removal central venous catheter tunneled without port/pump CPT 36589 | $423.60 | $2,824.00 | $508.32 – $2,936.96 | 7 |
| Removal cerumen impacted (both sides) CPT 69210 | $40.95 | $273.00 | $49.14 – $283.92 | 13 |
| Removal devitalized tissue non-selective debridement without anesthesia per session CPT 97602 | $68.95 | $459.66 | $80.28 – $463.84 | 15 |
| Removal foreign body foot subcutaneous right CPT 28190 | $380.67 | $2,537.76 | $456.80 – $2,639.28 | 8 |
| Removal of artery clot 34101 CPT 34101 | $1,769.10 | $11,794.00 | $2,122.92 – $19,000.14 | 9 |
| Removal/replacement ppm generator dual lead system CPT 33228 | $5,845.20 | $38,968.00 | $7,014.15 – $40,526.20 | 7 |
| Removal skin tags fibrocutaneous any area <= 15 lesions CPT 11200 | $107.70 | $718.00 | $129.24 – $746.72 | 13 |
| Removal sutr or stapl no anes CPT 15853 | $68.55 | $457.00 | $82.26 – $736.23 | 10 |
| Removal tunnled intprtnl cath CPT 49422 | $587.85 | $3,919.00 | $705.42 – $4,075.76 | 7 |
| Remove cva lumen obstruct CPT 75902 | $91.95 | $613.00 | $100.00 – $637.52 | 9 |
| Remove ureter stent percut CPT 50384 | $419.85 | $2,799.00 | $503.82 – $2,910.96 | 7 |
| Renal cyst study s&i CPT 74470 | $173.25 | $1,155.00 | $196.10 – $1,201.20 | 15 |
| Renal function panel CPT 80069 | $142.32 | $948.75 | $6.30 – $37.38 | 21 |
| Renal venogram bil s&i CPT 75833 | $1,258.35 | $8,389.00 | $349.61 – $8,724.56 | 15 |
| Repair blood vessel dir lower extr CPT 35226 | $816.60 | $5,444.00 | $279.18 – $1,613.04 | 13 |
| Repair complex wound scalp/arms/legs 2.6 - 7.5 cm CPT 13121 | $271.40 | $1,809.27 | $325.67 – $1,881.65 | 8 |
| Repair dental ellis ii fx CPT 41899 | $126.90 | $846.00 | $152.28 – $879.84 | 13 |
| Repair pm/icd lead dual CPT 33220 | $1,112.27 | $7,415.10 | $1,334.72 – $7,711.71 | 7 |
| Repair pm/icd lead sgl CPT 33218 | $597.78 | $3,985.20 | $717.34 – $4,144.61 | 7 |
| Repair rpr lac tongue floor mouth > 2.6 cm/cmplx CPT 41252 | $129.60 | $864.00 | $155.52 – $898.56 | 8 |
| Repair rpr lip full thickness vermilion only CPT 40650 | $195.15 | $1,301.00 | $234.18 – $1,353.04 | 8 |
| Repair tongue lac <2.5cm past 1/3 tongue 41251 CPT 41251 | $80.70 | $538.00 | $96.84 – $559.52 | 8 |
| Replace duod/jej tube perc CPT 49451 | $195.75 | $1,305.00 | $234.90 – $1,357.20 | 7 |
| Replace g/c tube perc CPT 49450 | $180.45 | $1,203.00 | $216.54 – $1,251.12 | 7 |
| Reposition pm/icd lead CPT 33215 | $1,115.85 | $7,439.00 | $1,240.38 – $7,166.64 | 7 |
| Reposition vad w/image rt/lt sep session CPT 33993 | $983.25 | $6,555.00 | $1,179.90 – $10,560.11 | 9 |
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.