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 |
|---|---|---|---|---|
| Thyroid met imaging CPT 78015 | $229.65 | $1,531.00 | $275.58 – $1,592.24 | 15 |
| Thyroid mets imag whole body CPT 78018 | $611.55 | $4,076.94 | $532.55 – $4,156.88 | 15 |
| Thyroid (TSH) Test CPT 84443 | $73.35 | $489.00 | $2.34 – $73.29 | 21 |
| Thyroid Ultrasound CPT 76536 | $522.00 | $3,480.00 | $131.99 – $3,619.20 | 15 |
| Thyroid uptake measurement CPT 78012 | $106.35 | $709.00 | $127.62 – $737.36 | 15 |
| Thyrotropin alfa 0.9 mg intramuscular solution HCPCS J3240 | $4,695.46 | $31,303.01 | $2,342.87 – $28,172.71 | 9 |
| Thyroxine binding globulin (tbg) CPT 84442 | $61.80 | $412.00 | $5.40 – $64.30 | 21 |
| Tib/per revasc stent & ather 37231 CPT 37231 | $10,397.40 | $69,316.00 | $12,476.88 – $72,088.64 | 7 |
| Tib/per revasc stnt & ather CPT 37235 | $5,198.70 | $34,658.00 | $100.00 – $55,834.04 | 10 |
| Tib/per revasc w/ather add-on 37233 CPT 37233 | $4,610.25 | $30,735.00 | $100.00 – $49,514.09 | 10 |
| Tigecycline injection HCPCS J3243 | $5,431.18 | $36,207.84 | $0.59 – $35.06 | 10 |
| Tilt table study CPT 93660 | $1,094.10 | $7,294.00 | $100.00 – $11,750.64 | 11 |
| Tirofiban 12.5 mg/50 ml HCPCS J3246 | $7.19 | $47.93 | $4.33 – $35.06 | 9 |
| Tissue culture placenta CPT 88235 | $141.15 | $941.00 | $126.25 – $846.90 | 21 |
| Tissue culture tumor CPT 88239 | $189.65 | $1,264.30 | $123.92 – $1,137.87 | 21 |
| Tissue exam koh skin/hair/nails CPT 87220 | $19.05 | $127.00 | $3.59 – $31.50 | 21 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | $7,473.38 | $49,822.50 | $116.22 – $4,680.59 | 10 |
| Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm HCPCS C9358 | $1,429.79 | $9,531.90 | $1,429.79 – $8,578.71 | 10 |
| Tissue transglutaminase iga CPT 86364 | $64.72 | $431.46 | $65.18 – $376.59 | 8 |
| Tl-201 thallium diag per mci HCPCS A9505 | $171.90 | $1,146.00 | $100.00 – $1,103.44 | 9 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $1,074.15 | $7,160.98 | $0.96 – $35.06 | 10 |
| Tobramycin peak therapeutic drug level CPT 80200 | $36.60 | $244.00 | $13.55 – $213.30 | 21 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $400.11 | $2,667.35 | $8.40 – $2,400.62 | 9 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $31.80 | $212.00 | $36.72 – $212.16 | 15 |
| Tomosynthesis breast screen bilateral CPT 77063 | $36.60 | $244.00 | $43.85 – $253.35 | 9 |
| Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 | $3,900.01 | $26,000.05 | $2.28 – $4,893.27 | 10 |
| Toxoplasma antibody igg CPT 86777 | $42.00 | $280.00 | $12.09 – $244.62 | 21 |
| Toxoplasma antibody igm CPT 86778 | $49.35 | $329.00 | $12.10 – $273.60 | 21 |
| Training self management diabetes individual outpatient department per 30 minutes HCPCS G0108 | $36.15 | $241.00 | $43.38 – $250.64 | 19 |
| Transcath biopsy CPT 37200 | $2,221.35 | $14,809.00 | $2,665.62 – $15,401.36 | 7 |
| Transcath closure of asd CPT 93580 | $5,798.40 | $38,656.00 | $100.00 – $62,274.82 | 10 |
| Transcatheter bx s&i CPT 75970 | $448.80 | $2,992.00 | $76.55 – $3,111.68 | 9 |
| Transferrin CPT 84466 | $49.83 | $332.16 | $10.72 – $298.95 | 21 |
| Transfusion blood/blood component(s) CPT 36430 | $409.95 | $2,733.00 | $194.76 – $1,125.28 | 7 |
| Trastuzumab 150 mg intravenous solution HCPCS J9355 | $15,864.48 | $105,763.14 | $109.90 – $48,680.18 | 9 |
| Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 | $13,215.92 | $88,106.13 | $34.31 – $79,295.52 | 9 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $531.00 | $3,540.00 | $100.00 – $3,681.60 | 9 |
| Treat clavicle dislocation 23545 CPT 23545 | $78.00 | $520.00 | $93.60 – $540.80 | 8 |
| Treat elbow fracture CPT 24620 | $853.51 | $5,690.04 | $1,024.21 – $5,917.65 | 8 |
| Treat finger fracture each CPT 26742 | $903.32 | $6,022.08 | $1,083.98 – $6,262.97 | 8 |
| Treat foot bone lesion CPT 28005 | $912.60 | $6,084.00 | $1,095.12 – $6,327.36 | 7 |
| Treat fracture of radius CPT 25505 | $852.06 | $5,680.38 | $1,022.47 – $5,907.60 | 8 |
| Treat fracture of ulna CPT 25535 | $123.75 | $825.00 | $148.50 – $858.00 | 8 |
| Treat hip socket fracture CPT 27222 | $582.17 | $3,881.10 | $698.60 – $4,036.35 | 13 |
| Treat humerus fracture CPT 24535 | $790.14 | $5,267.57 | $948.17 – $5,478.28 | 8 |
| Treat humerus fracture CPT 24565 | $531.45 | $3,543.00 | $637.74 – $3,684.72 | 8 |
| Treat knee fracture(s) CPT 27538 | $94.65 | $631.00 | $113.58 – $656.24 | 8 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $52.18 | $347.82 | $62.61 – $361.74 | 9 |
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $48.30 | $322.00 | $36.25 – $334.88 | 9 |
| Treatment inhalation pressurized/nonpressurized acute airway obstruction CPT 94640 | $72.62 | $484.11 | $41.76 – $241.28 | 9 |
| Treatment of thigh fracture CPT 27510 | $835.35 | $5,569.00 | $1,002.42 – $5,791.76 | 8 |
| Treatment radiation delivery level 2 CPT 77407 | $107.40 | $716.00 | $128.88 – $744.64 | 9 |
| Treat ulnar fracture CPT 24675 | $531.45 | $3,543.00 | $637.74 – $3,684.72 | 8 |
| Treponema pallidum antibody CPT 86780 | $47.74 | $318.24 | $11.12 – $286.42 | 21 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $32.40 | $215.94 | $1.02 – $146.11 | 10 |
| Triglycerides CPT 84478 | $31.83 | $212.16 | $4.82 – $149.24 | 21 |
| Trimethobenzamide hcl inj HCPCS J3250 | $1,837.68 | $12,251.19 | $19.99 – $128.48 | 10 |
| Trim nondyst nails CPT 11719 | $28.05 | $187.00 | $33.66 – $301.26 | 9 |
| Trnscath plc stent crv crtd without prtct CPT 37216 | $1,794.15 | $11,961.00 | $2,152.98 – $19,269.18 | 9 |
| Trnscath plc stent crv crtd w/prtct CPT 37215 | $2,454.98 | $16,366.50 | $2,945.97 – $26,366.44 | 9 |
| Trnscath plc stnt ante carotid art CPT 37218 | $2,719.58 | $18,130.50 | $3,263.49 – $29,208.24 | 9 |
| Trnscath plc vas stent w/s&i ea addl artery CPT 37237 | $3,944.40 | $26,296.00 | $100.00 – $42,362.86 | 10 |
| Trnscath plc vas stent w/s&i ea addl vein CPT 37239 | $4,062.90 | $27,086.00 | $100.00 – $43,635.55 | 10 |
| Trnscath plc vas stent w/s&i ini vein CPT 37238 | $4,279.35 | $28,529.00 | $5,135.22 – $29,670.16 | 7 |
| Trnscath retrv pq vasc fb w/guide CPT 37197 | $1,017.00 | $6,780.00 | $871.92 – $5,037.76 | 7 |
| Trnscath tx thromblytc artery non-intracrn ini day CPT 37211 | $2,382.60 | $15,884.00 | $2,796.48 – $16,157.44 | 7 |
| Trnscath tx thromblytc art/ven sbsq day CPT 37213 | $2,479.80 | $16,532.00 | $2,573.28 – $23,030.86 | 9 |
| Trnscath tx thromblytc cath rmv sbsq day CPT 37214 | $794.10 | $5,294.00 | $952.92 – $8,528.64 | 9 |
| Trnscath tx thromblytc vein ini day CPT 37212 | $2,382.60 | $15,884.00 | $2,796.48 – $16,157.44 | 7 |
| Troponin quantitative CPT 84484 | $76.50 | $510.00 | $10.47 – $302.03 | 21 |
| Tte w or without fol w/con,stres HCPCS C8928 | $392.40 | $2,616.00 | $100.00 – $2,720.64 | 9 |
| Tube trach disp innr can 5 xlt HCPCS A7521 | $91.04 | $606.90 | $42.53 – $242.76 | 10 |
| Tube trach fen sz 6 uncuffed HCPCS A7520 | $91.04 | $606.90 | $89.91 – $546.21 | 10 |
| Tx atrial fib pulm vein isol CPT 93656 | $7,908.45 | $52,723.00 | $100.00 – $84,936.76 | 10 |
| Tx closed distal humerus fx CPT 24999 | $126.30 | $842.00 | $151.56 – $875.68 | 13 |
| Tx closed hip disl traumatic without anes CPT 27250 | $117.99 | $786.60 | $141.59 – $818.07 | 8 |
| Tx l/r atrial fib addl CPT 93657 | $2,609.85 | $17,399.00 | $100.00 – $28,029.79 | 11 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $91.80 | $612.00 | $110.03 – $635.70 | 15 |
| Ultrasound breast complete CPT 76641 | $375.30 | $2,502.00 | $131.99 – $2,602.08 | 15 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $312.75 | $2,085.00 | $109.09 – $2,168.40 | 15 |
| Ultrasound chest CPT 76604 | $414.56 | $2,763.71 | $131.99 – $2,817.36 | 15 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $96.70 | $644.64 | $95.55 – $657.28 | 15 |
| Ultrasound elastography parenchyma CPT 76981 | $37.51 | $250.02 | $45.01 – $340.83 | 15 |
| Ultrasound encephalogram CPT 76506 | $182.40 | $1,216.00 | $131.99 – $1,264.64 | 15 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $184.65 | $1,231.00 | $94.85 – $1,279.33 | 15 |
| Ultrasound guidance for vascular access CPT 76937 | $384.45 | $2,563.00 | $37.26 – $2,665.22 | 9 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $382.05 | $2,547.00 | $47.43 – $2,648.88 | 9 |
| Ultrasound guide intraoperative CPT 76998 | $105.30 | $702.00 | $100.00 – $730.08 | 9 |
| Ultrasound hips infant dynamic CPT 76885 | $217.11 | $1,447.38 | $109.09 – $1,505.28 | 15 |
| Ultrasound joint complete left CPT 76881 | $130.20 | $868.00 | $109.08 – $902.72 | 15 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $154.95 | $1,033.00 | $137.30 – $1,074.06 | 15 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $358.35 | $2,389.00 | $81.31 – $2,484.56 | 15 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $247.05 | $1,647.00 | $41.32 – $1,712.88 | 15 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $184.80 | $1,232.00 | $159.22 – $1,281.28 | 15 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $324.00 | $2,160.00 | $131.99 – $2,246.40 | 15 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $285.15 | $1,901.00 | $131.99 – $1,977.04 | 15 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $324.00 | $2,160.00 | $131.99 – $2,246.37 | 15 |
| Ultrasound prostate/transrectal CPT 76872 | $298.50 | $1,990.00 | $131.99 – $2,069.60 | 15 |
| Ultrasound retroperitoneal limited CPT 76775 | $300.30 | $2,002.00 | $131.99 – $2,082.08 | 15 |
| Ultrasound scrotum and contents CPT 76870 | $546.75 | $3,645.00 | $131.99 – $3,714.88 | 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.