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 |
|---|---|---|---|---|
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $217.62 | $1,450.75 | $1.45 – $35.06 | 10 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $47.66 | $317.73 | $0.72 – $35.06 | 10 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $17.07 | $113.76 | $0.11 – $35.06 | 10 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $220.72 | $1,471.45 | $2.47 – $35.06 | 10 |
| Sodium serum/plasma/whole blood CPT 84295 | $25.88 | $172.50 | $3.06 – $20.96 | 21 |
| Special physics consult CPT 77370 | $490.50 | $3,270.00 | $367.89 – $3,400.80 | 9 |
| Special radiation dosimetry CPT 77331 | $169.50 | $1,130.00 | $56.43 – $1,175.20 | 9 |
| Special radiation treatment CPT 77470 | $391.50 | $2,610.00 | $75.26 – $2,714.40 | 9 |
| Special teletx port plan CPT 77321 | $272.07 | $1,813.75 | $129.60 – $1,886.30 | 9 |
| Specific gravity body fluid CPT 84315 | $23.63 | $157.50 | $2.76 – $141.75 | 21 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $562.35 | $3,749.00 | $674.73 – $3,898.44 | 7 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $383.07 | $2,553.75 | $100.00 – $2,655.90 | 9 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $278.46 | $1,856.40 | $278.46 – $1,670.76 | 10 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $29.93 | $199.50 | $29.93 – $179.55 | 10 |
| Splint finger frog med HCPCS L3927 | $19.53 | $130.20 | $19.53 – $117.18 | 10 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | $800.10 | $5,334.00 | $960.12 – $5,547.36 | 9 |
| Srs linear based CPT 77372 | $4,444.65 | $29,631.00 | $3,160.48 – $30,816.24 | 9 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $117.75 | $785.00 | $100.00 – $816.40 | 9 |
| Staph a dna amp probe CPT 87640 | $22.02 | $146.74 | $26.42 – $151.07 | 21 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $100.65 | $671.00 | $100.00 – $655.20 | 9 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $11,492.55 | $76,617.00 | $13,791.06 – $79,681.68 | 7 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $31,950.30 | $213,001.95 | $89.15 – $534.87 | 10 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $1,308.20 | $8,721.30 | $90.60 – $543.60 | 10 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $31,950.30 | $213,001.95 | $0.48 – $2.84 | 10 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $4,604.83 | $30,698.85 | $4,604.83 – $27,628.97 | 10 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $5,773.05 | $38,487.00 | $6,927.66 – $40,026.48 | 7 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $2,482.50 | $16,550.00 | $100.00 – $26,662.05 | 10 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $9,808.80 | $65,392.00 | $11,770.56 – $68,007.68 | 7 |
| St evaluate speech sound production CPT 92522 | $120.75 | $805.00 | $100.00 – $837.20 | 9 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $136.35 | $909.00 | $100.00 – $945.36 | 9 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $148.20 | $988.00 | $100.00 – $1,027.52 | 9 |
| St evaluation swallow function CPT 92610 | $116.55 | $777.00 | $100.00 – $808.08 | 9 |
| Strep a ag ia CPT 87430 | $53.25 | $355.00 | $6.30 – $73.29 | 21 |
| St treatment speech individual CPT 92507 | $99.00 | $660.00 | $100.00 – $686.40 | 9 |
| St treatment swallow dysfunction/oral CPT 92526 | $73.95 | $493.00 | $88.59 – $511.81 | 9 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $69.34 | $462.24 | $0.95 – $35.06 | 10 |
| Sugars single quant CPT 84378 | $9.60 | $64.00 | $9.69 – $57.60 | 21 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $32.40 | $216.00 | $4.37 – $31.20 | 10 |
| Support clav 29.6-40.5in med HCPCS L3650 | $5.99 | $39.90 | $5.99 – $35.91 | 10 |
| Surgical pathology level 1 gross examination only CPT 88300 | $58.65 | $391.00 | $43.68 – $406.64 | 9 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $163.35 | $1,089.00 | $43.68 – $1,132.56 | 9 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $184.50 | $1,230.00 | $93.99 – $1,279.20 | 9 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $212.10 | $1,414.00 | $93.99 – $1,470.56 | 9 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $248.25 | $1,655.00 | $297.90 – $1,721.20 | 9 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $282.15 | $1,881.00 | $338.58 – $1,956.24 | 9 |
| Susceptibility mic per plate CPT 87186 | $49.80 | $332.00 | $7.27 – $234.90 | 21 |
| Svc venogram s&i CPT 75827 | $522.75 | $3,485.00 | $300.43 – $3,624.40 | 15 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $30.08 | $200.49 | $3.70 – $78.95 | 21 |
| System pacing micra av HCPCS C1786 | $22,733.55 | $151,557.00 | $1,275.91 – $7,655.45 | 10 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $33,047.60 | $220,317.30 | $481.48 – $2,888.87 | 10 |
| T3 (triiodothyronine) free CPT 84481 | $78.30 | $522.00 | $4.14 – $73.29 | 21 |
| T3 (triiodothyronine) total CPT 84480 | $55.85 | $372.30 | $6.30 – $61.32 | 21 |
| T4 (thyroxine) free CPT 84439 | $54.75 | $365.00 | $4.14 – $38.89 | 21 |
| T4 (thyroxine) total CPT 84436 | $58.80 | $392.00 | $4.14 – $29.90 | 21 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $8.31 | $55.39 | $0.29 – $116.85 | 19 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $572.65 | $3,817.64 | $287.90 – $3,435.88 | 9 |
| Tacrolimus therapeutic drug level CPT 80197 | $50.26 | $335.02 | $11.53 – $82.80 | 21 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $10,397.32 | $69,315.46 | $0.55 – $5,202.66 | 9 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $63.04 | $420.24 | $27.00 – $432.22 | 21 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $43.65 | $291.00 | $31.14 – $267.71 | 21 |
| Tc-99m apcitide diag HCPCS A9504 | $157.80 | $1,052.00 | $100.00 – $1,094.08 | 8 |
| Tc-99m bicisate HCPCS A9557 | $436.80 | $2,912.00 | $100.00 – $3,028.48 | 9 |
| Tc-99m exametazime diag HCPCS A9521 | $524.70 | $3,498.00 | $100.00 – $3,637.92 | 9 |
| Tc-99m labeled rbc HCPCS A9560 | $134.82 | $898.75 | $100.00 – $746.72 | 9 |
| Tc-99m maa HCPCS A9540 | $155.10 | $1,034.00 | $63.94 – $1,075.36 | 9 |
| Tc-99m mebrofenin HCPCS A9537 | $157.65 | $1,051.00 | $100.00 – $1,093.04 | 9 |
| Tc-99m medronate HCPCS A9503 | $132.45 | $883.00 | $27.71 – $918.32 | 9 |
| Tc-99m mertiatide HCPCS A9562 | $290.54 | $1,936.92 | $100.00 – $1,817.92 | 9 |
| Tc-99m pentetate dtpa HCPCS A9539 | $112.80 | $752.00 | $66.79 – $782.08 | 9 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $11.25 | $75.00 | $8.41 – $75.92 | 9 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $87.37 | $582.42 | $100.00 – $593.84 | 9 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $200.63 | $1,337.50 | $100.00 – $1,112.80 | 9 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $146.25 | $975.00 | $100.00 – $1,014.00 | 9 |
| Tc-99m sulfur colloid HCPCS A9541 | $107.19 | $714.58 | $100.00 – $682.24 | 9 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $59.25 | $395.00 | $63.18 – $365.04 | 9 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $108.75 | $725.00 | $39.46 – $652.50 | 21 |
| T cells absolute cd 4 count CPT 86361 | $71.46 | $476.34 | $22.50 – $428.71 | 21 |
| T cells total count CPT 86359 | $17.10 | $114.00 | $20.52 – $163.00 | 21 |
| Telehealth original site facility fee HCPCS Q3014 | $12.60 | $84.00 | $15.12 – $87.36 | 8 |
| Telethx isodose plan cplx CPT 77307 | $558.26 | $3,721.68 | $407.60 – $3,870.55 | 9 |
| Telethx isodose plan simple CPT 77306 | $206.70 | $1,378.00 | $225.74 – $1,433.12 | 9 |
| Temozolomide HCPCS J8700 | $540.06 | $3,600.35 | $0.38 – $2,159.87 | 19 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $22,553.12 | $150,354.12 | $178.22 – $125,720.10 | 9 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $93.97 | $626.41 | $2.57 – $83.30 | 10 |
| Test for urine cystines CPT 82615 | $88.65 | $591.00 | $8.02 – $531.90 | 21 |
| Testicular imaging w/vasc flow CPT 78761 | $286.95 | $1,913.00 | $343.51 – $1,989.52 | 15 |
| Test stress cardiovascular tracing only CPT 93017 | $637.35 | $4,249.00 | $100.00 – $4,418.70 | 9 |
| Tetanus immune globulin inj HCPCS J1670 | $2,187.25 | $14,581.66 | $657.41 – $13,123.50 | 9 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | $7,938.24 | $52,921.59 | $7,409.03 – $47,629.44 | 9 |
| Theophylline therapeutic drug level CPT 80198 | $34.95 | $233.00 | $11.88 – $175.13 | 21 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $25.56 | $170.34 | $25.34 – $146.40 | 19 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $18.45 | $123.00 | $19.98 – $115.44 | 19 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $385.73 | $2,571.47 | $2.02 – $35.06 | 10 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $755.10 | $5,034.00 | $906.12 – $5,235.34 | 8 |
| Thrombectmy crnry perq mechanical CPT 92973 | $1,044.30 | $6,962.00 | $100.00 – $11,215.79 | 10 |
| Thrombectomy/inf pq dialysis circuit CPT 36904 | $994.50 | $6,630.00 | $1,193.40 – $6,895.20 | 7 |
| Thrombin time CPT 85670 | $23.85 | $159.00 | $4.85 – $143.10 | 21 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $17.55 | $117.00 | $5.43 – $105.30 | 21 |
| Thyroglobulin antibody CPT 86800 | $45.75 | $304.98 | $10.44 – $68.80 | 21 |
| Thyroid imaging CPT 78013 | $545.70 | $3,638.00 | $340.13 – $3,783.52 | 15 |
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.