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 |
|---|---|---|---|---|
| Repos lv lead pm/icd CPT 33226 | $1,025.40 | $6,836.00 | $1,230.48 – $7,109.44 | 7 |
| Repos sq defib eltrd CPT 33273 | $1,153.35 | $7,689.00 | $1,384.02 – $7,996.56 | 7 |
| Reptilase test CPT 85635 | $17.85 | $119.00 | $8.27 – $107.10 | 21 |
| Respirator motion mgmt simul CPT 77293 | $68.85 | $459.00 | $82.62 – $477.36 | 9 |
| #resp virpnl dfa-adenovirus CPT 87260 | $25.35 | $169.00 | $12.12 – $152.10 | 21 |
| Resp virus 6-11 targets CPT 87632 | $231.60 | $1,544.00 | $183.17 – $1,389.60 | 21 |
| Resuscitation cardiopulmonary CPT 92950 | $242.05 | $1,613.64 | $100.00 – $1,511.12 | 14 |
| Reticulocyte automated CPT 85045 | $25.19 | $167.88 | $3.35 – $20.70 | 21 |
| Revasc intra lithotrip-ather HCPCS C9766 | $9,841.35 | $65,609.00 | $11,809.62 – $105,696.10 | 9 |
| Revasc intra lithotrip-stent HCPCS C9765 | $9,841.35 | $65,609.00 | $11,809.62 – $105,696.10 | 9 |
| Revasc intravasc lithotripsy HCPCS C9764 | $6,298.50 | $41,990.00 | $7,558.20 – $67,645.89 | 9 |
| Revasc lithotr-ather tib/per HCPCS C9774 | $9,841.35 | $65,609.00 | $11,809.62 – $68,233.36 | 7 |
| Revasc lithotrip-stent-ather HCPCS C9767 | $9,841.35 | $65,609.00 | $11,809.62 – $105,696.10 | 9 |
| Revasc lithotrip tibi/perone HCPCS C9772 | $6,154.95 | $41,033.00 | $7,385.94 – $42,674.32 | 7 |
| Revasc lithotr-stent tib/per HCPCS C9773 | $9,841.35 | $65,609.00 | $11,809.62 – $68,233.36 | 7 |
| Revasc lith-sten-ath tib/per HCPCS C9775 | $9,841.35 | $65,609.00 | $11,809.62 – $68,233.36 | 7 |
| Revision tips CPT 37183 | $1,857.15 | $12,381.00 | $2,228.58 – $19,945.80 | 9 |
| Revsc opn/prq tib/pero stent CPT 37234 | $4,021.65 | $26,811.00 | $100.00 – $43,192.53 | 10 |
| Rheumatoid factor qualitative CPT 86430 | $13.05 | $87.00 | $5.16 – $78.30 | 21 |
| Rheumatoid factor quantitative CPT 86431 | $28.20 | $188.00 | $4.14 – $23.94 | 21 |
| Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe HCPCS J2791 | $505.99 | $3,373.23 | $5.42 – $1,669.79 | 10 |
| Rho(d) immune globulin h, sd HCPCS J2792 | $902.12 | $6,014.09 | $38.80 – $5,412.69 | 9 |
| Rho d immune globulin inj HCPCS J2790 | $315.16 | $2,101.06 | $71.53 – $459.83 | 10 |
| Right ventric recording CPT 93603 | $2,524.79 | $16,831.90 | $100.00 – $27,116.20 | 10 |
| Rituximab 10 mg/ml concentrate,intravenous HCPCS J9312 | $326.05 | $2,173.67 | $109.01 – $1,630.26 | 9 |
| Rituximab-abbs 10 mg/ml intravenous solution HCPCS Q5115 | $293.44 | $1,956.27 | $47.36 – $1,760.65 | 9 |
| Rituximab-pvvr 10 mg/ml intravenous solution HCPCS Q5119 | $248.76 | $1,658.39 | $31.64 – $1,492.56 | 9 |
| Rmvl foreign body upper arm/elbow subcutaneous CPT 24200 | $404.40 | $2,696.00 | $485.28 – $2,803.84 | 7 |
| Rmvl icd by tv extr CPT 33244 | $1,071.75 | $7,145.00 | $1,286.10 – $11,510.60 | 9 |
| Rmvl icd gen w/rplc icd gen dual lead sys CPT 33263 | $7,964.25 | $53,095.00 | $9,557.10 – $55,218.80 | 7 |
| Rmvl icd gen w/rplc icd gen mlt lead sys CPT 33264 | $8,296.05 | $55,307.00 | $9,955.26 – $57,519.28 | 7 |
| Rmvl icd gen w/rplc icd gen sgl lead sys CPT 33262 | $7,715.40 | $51,436.00 | $9,258.48 – $53,493.44 | 7 |
| Rmvl icd pulse gen only CPT 33241 | $990.15 | $6,601.00 | $1,188.18 – $6,865.04 | 7 |
| Rmvl ndwellg tun pleural cath CPT 32552 | $145.65 | $971.00 | $174.78 – $1,009.84 | 7 |
| Rmvl perm pm pulse gen CPT 33233 | $1,399.50 | $9,330.00 | $776.64 – $4,487.24 | 7 |
| Rmvl perq right heart vad CPT 33997 | $779.36 | $5,195.70 | $935.23 – $8,370.28 | 9 |
| Rmvl pm gen w/rplc pm gen mlt lead sys CPT 33229 | $6,195.90 | $41,306.00 | $7,435.08 – $42,958.24 | 7 |
| Rmvl pm gen w/rplc pm gen sgl lead sys CPT 33227 | $5,611.35 | $37,409.00 | $6,733.62 – $38,905.36 | 7 |
| Rmvl pq vad left hrt vein sep session CPT 33992 | $983.25 | $6,555.00 | $1,179.90 – $10,560.11 | 9 |
| Rmvl sq defib electrode CPT 33272 | $1,153.35 | $7,689.00 | $1,384.02 – $12,386.98 | 9 |
| Rmvl subq card rhythm mntr CPT 33286 | $297.00 | $1,980.00 | $356.40 – $2,059.20 | 7 |
| Rmvl tv pm lead dual CPT 33235 | $730.20 | $4,868.00 | $876.24 – $5,062.72 | 7 |
| Rmvl tv pm lead sgl CPT 33234 | $730.20 | $4,868.00 | $876.24 – $5,062.72 | 7 |
| Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper) HCPCS J3111 | $5,413.24 | $36,088.21 | $12.62 – $16,239.70 | 9 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | $422.01 | $2,813.34 | $0.06 – $35.06 | 10 |
| Rp loclzj tum 2+area 1+d img CPT 78801 | $425.85 | $2,839.00 | $426.85 – $2,952.56 | 15 |
| Rp loclzj tum spect w/ct 1 CPT 78830 | $750.15 | $5,001.00 | $815.07 – $5,201.04 | 15 |
| Rpl picc wo subq port/pump incl image guidnc w/s&i CPT 36584 | $322.05 | $2,147.00 | $386.46 – $2,232.88 | 7 |
| Rubella antibody igg CPT 86762 | $24.18 | $161.16 | $3.60 – $62.83 | 21 |
| Rubeola antibody igg CPT 86765 | $47.55 | $317.00 | $3.60 – $55.36 | 21 |
| Russell viper venom diluted CPT 85613 | $44.55 | $297.00 | $8.05 – $267.30 | 21 |
| Salivary gland imaging CPT 78230 | $175.35 | $1,169.00 | $210.42 – $1,215.76 | 15 |
| Salmonella antibody CPT 86768 | $25.10 | $167.28 | $11.08 – $150.56 | 21 |
| Sarscov & inf vir a&b ag ia CPT 87428 | $30.15 | $201.00 | $28.46 – $210.87 | 21 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $512.85 | $3,419.00 | $294.24 – $3,555.76 | 15 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $307.80 | $2,052.00 | $134.67 – $2,134.08 | 15 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $348.75 | $2,325.00 | $294.24 – $2,418.00 | 15 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $374.40 | $2,496.00 | $134.67 – $2,595.84 | 15 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $398.40 | $2,656.00 | $134.67 – $2,762.24 | 15 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $465.45 | $3,103.00 | $294.24 – $3,226.96 | 15 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $279.30 | $1,862.00 | $134.67 – $1,936.48 | 15 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $218.70 | $1,458.00 | $134.67 – $1,516.32 | 15 |
| Sclerotherapy fluid collection pq w/img CPT 49185 | $501.60 | $3,344.00 | $601.92 – $5,387.19 | 9 |
| Screening Mammogram CPT 77067 | $118.35 | $789.00 | $142.02 – $820.56 | 9 |
| Screening prostate cancer PSA HCPCS G0103 | $63.29 | $421.88 | $2.34 – $83.75 | 19 |
| Screen pap by tech w md supv HCPCS P3000 | $9.45 | $63.00 | $11.34 – $65.81 | 19 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $25,424.28 | $169,495.20 | $1.74 – $10.40 | 10 |
| Sec art mech thrmbc non-intracranial add-on CPT 37186 | $689.25 | $4,595.00 | $100.00 – $7,402.55 | 10 |
| Sedimentation rate erythrocyte automated CPT 85652 | $3.45 | $23.00 | $2.27 – $20.70 | 21 |
| Semen analysis presence/motility CPT 89321 | $10.65 | $71.00 | $12.05 – $63.90 | 19 |
| Serial casting application 97139app CPT 97139 | $43.65 | $291.00 | $32.40 – $302.64 | 9 |
| Serpina1 gene CPT 81332 | $105.27 | $701.76 | $36.67 – $631.59 | 21 |
| Set radiation therapy field CPT 77280 | $462.60 | $3,084.00 | $555.12 – $3,207.36 | 9 |
| Set radiation therapy field CPT 77285 | $763.20 | $5,088.00 | $915.84 – $5,291.52 | 9 |
| Set radiation therapy field CPT 77290 | $771.00 | $5,140.00 | $925.20 – $5,345.60 | 9 |
| Sheath gldlight lasr 12fx50cm HCPCS C2629 | $131.04 | $873.60 | $100.00 – $908.55 | 8 |
| Shoulder MRI (with and without contrast) CPT 73223 | $2,739.30 | $18,262.00 | $439.13 – $18,992.48 | 15 |
| Shoulder MRI (with contrast) CPT 73222 | $2,223.00 | $14,820.00 | $782.94 – $15,412.80 | 15 |
| Shoulder MRI (without contrast) CPT 73221 | $1,434.15 | $9,561.00 | $268.00 – $9,943.44 | 15 |
| Shoulder X-ray CPT 73030 | $188.10 | $1,254.00 | $109.09 – $1,278.16 | 15 |
| Shunt glaucoma baerveldt 350mm HCPCS C1783 | $1,171.96 | $7,813.05 | $152.15 – $912.87 | 10 |
| Sialography s&i CPT 70390 | $144.90 | $966.00 | $173.88 – $1,004.64 | 15 |
| Sickling rbc CPT 85660 | $12.75 | $85.00 | $3.60 – $23.94 | 21 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $47.70 | $317.95 | $44.52 – $286.16 | 10 |
| Sinus CT scan (with and without contrast) CPT 70488 | $1,363.35 | $9,089.00 | $209.55 – $9,452.56 | 15 |
| Sinus CT scan (with contrast) CPT 70487 | $1,126.65 | $7,511.00 | $209.55 – $7,811.44 | 15 |
| Sinus CT scan (without contrast) CPT 70486 | $946.80 | $6,312.00 | $128.89 – $6,564.24 | 15 |
| Sirolimus, oral HCPCS J7520 | $65.70 | $438.00 | $1.50 – $480.52 | 19 |
| Skin Biopsy CPT 11102 | $105.60 | $704.00 | $126.72 – $732.16 | 7 |
| Sleep Study (Polysomnography) CPT 95810 | $1,122.51 | $7,483.34 | $100.00 – $7,782.68 | 9 |
| Sleeve fing rolyan med HCPCS L3933 | $118.60 | $790.65 | $118.60 – $711.59 | 10 |
| Sling suprapubic suburetheral HCPCS C1771 | $10,941.21 | $72,941.40 | $1,728.72 – $10,372.32 | 10 |
| Slitting of prepuce CPT 54001 | $751.23 | $5,008.19 | $901.48 – $5,208.52 | 8 |
| Sm-153 lexidron ther HCPCS A9604 | $1,543.50 | $10,290.00 | $1,852.20 – $10,701.60 | 9 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $33.00 | $220.00 | $4.53 – $72.90 | 21 |
| Smear gram stain CPT 87205 | $37.95 | $253.00 | $3.59 – $31.50 | 21 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $16.05 | $107.00 | $5.03 – $85.45 | 21 |
| Smear wet mount CPT 87210 | $26.85 | $179.00 | $4.89 – $159.30 | 21 |
| Sodium 24 hour urine CPT 84300 | $30.57 | $203.75 | $3.06 – $22.43 | 21 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $47.66 | $317.73 | $2.90 – $330.44 | 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.