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 |
|---|---|---|---|---|
| Ultrasound spinal canal and contents CPT 76800 | $62.40 | $416.00 | $74.88 – $432.64 | 15 |
| Ultrasound transabd ea addl gest CPT 76812 | $199.50 | $1,330.00 | $100.00 – $1,383.20 | 15 |
| Ultrasound transvaginal non obstetric CPT 76830 | $311.70 | $2,078.00 | $131.99 – $2,117.44 | 15 |
| Unlisted procedure rectum CPT 45999 | $476.10 | $3,174.00 | $537.15 – $3,103.49 | 13 |
| Unlisted px med radj physics CPT 77399 | $61.80 | $412.00 | $74.16 – $428.48 | 9 |
| Unlisted px tongue flr mouth CPT 41599 | $80.70 | $538.00 | $96.84 – $559.52 | 13 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $543.90 | $3,626.00 | $100.00 – $3,771.04 | 9 |
| Upgrade pm system CPT 33214 | $1,932.66 | $12,884.40 | $2,319.20 – $13,399.78 | 7 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $2,534.40 | $16,896.00 | $439.13 – $17,571.84 | 15 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $2,159.55 | $14,397.00 | $439.13 – $14,972.88 | 15 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $1,499.70 | $9,998.00 | $268.00 – $10,397.14 | 15 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $633.60 | $4,224.00 | $760.32 – $4,392.96 | 7 |
| Urea nitrogen CPT 84520 | $31.37 | $209.10 | $3.06 – $16.46 | 21 |
| Urea nitrogen clearance CPT 84545 | $28.50 | $190.00 | $6.05 – $152.10 | 21 |
| Ureteral reflux study CPT 78740 | $174.45 | $1,163.00 | $209.34 – $1,209.52 | 15 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $157.59 | $1,050.60 | $185.40 – $1,071.20 | 15 |
| Urethrocystography void s&i CPT 74455 | $198.45 | $1,322.94 | $233.46 – $1,348.88 | 15 |
| Uric acid blood CPT 84550 | $42.39 | $282.54 | $3.06 – $19.45 | 21 |
| Uric acid urine CPT 84560 | $41.85 | $279.00 | $4.27 – $250.88 | 21 |
| Urinalysis microscopic only CPT 81015 | $14.10 | $94.00 | $2.56 – $84.60 | 21 |
| Urinalysis (with microscopy) CPT 81001 | $57.75 | $385.00 | $2.66 – $15.30 | 21 |
| Urinalysis (without microscopy) CPT 81003 | $25.13 | $167.50 | $1.89 – $84.60 | 21 |
| Urine Culture Test CPT 87086 | $55.80 | $372.00 | $5.22 – $34.40 | 21 |
| Urine pregnancy test CPT 81025 | $79.05 | $527.00 | $3.06 – $37.38 | 21 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $247.46 | $1,649.73 | $14.66 – $1,484.76 | 9 |
| Vaccine dtap < 7 years im CPT 90700 | $191.92 | $1,279.43 | $36.45 – $575.68 | 10 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $392.80 | $2,618.61 | $35.32 – $928.69 | 19 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $47.66 | $317.73 | $44.49 – $285.96 | 19 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $47.66 | $317.73 | $24.97 – $285.96 | 19 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | $5.85 | $38.95 | $5.46 – $35.99 | 19 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $136.04 | $906.94 | $24.97 – $408.24 | 19 |
| Vaccine mmr live subcutaneous CPT 90707 | $200.11 | $1,334.05 | $117.06 – $947.08 | 10 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $440.51 | $2,936.73 | $5.46 – $38.95 | 19 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | $1,570.75 | $10,471.63 | $286.57 – $4,712.24 | 19 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $1,761.83 | $11,745.54 | $822.20 – $5,285.55 | 9 |
| Vaccine rabies im CPT 90675 | $1,294.44 | $8,629.54 | $5.46 – $38.95 | 9 |
| Vaccine tdap >=7 years im CPT 90715 | $326.34 | $2,175.56 | $5.46 – $38.95 | 10 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $255.77 | $1,705.13 | $35.43 – $582.73 | 10 |
| Vaccine varicella live subcutaneous CPT 90716 | $446.12 | $2,974.14 | $231.60 – $2,349.12 | 10 |
| Valproic acid total therapeutic drug level CPT 80164 | $107.85 | $719.00 | $8.28 – $58.34 | 21 |
| Valvuloplasty aortic CPT 92986 | $1,324.05 | $8,827.00 | $100.00 – $14,220.30 | 10 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | $308.64 | $2,057.57 | $5.46 – $35.06 | 9 |
| Vancomycin 750 mg intravenous solution HCPCS J3374 | $148.54 | $990.26 | $5.46 – $35.06 | 9 |
| Vancomycin hcl injection HCPCS J3370 | $26.03 | $173.52 | $2.44 – $35.06 | 10 |
| Vancomycin peak therapeutic drug level CPT 80202 | $58.35 | $389.00 | $11.37 – $350.10 | 21 |
| Varicella zoster antibody igg CPT 86787 | $23.55 | $157.00 | $9.00 – $55.36 | 21 |
| Vasopressin 20 unit/ml intravenous solution HCPCS J2598 | $736.96 | $4,913.03 | $7.12 – $681.23 | 9 |
| Vedolizumab 300 mg intravenous solution HCPCS J3380 | $1,624.14 | $10,827.55 | $25.15 – $9,744.80 | 9 |
| Veeg unmon 12-26 hrs CPT 95714 | $217.35 | $1,449.00 | $100.00 – $1,506.96 | 9 |
| Veeg unmon 2-12 hrs CPT 95711 | $126.45 | $843.00 | $100.00 – $876.72 | 9 |
| Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture) CPT 36410 | $22.50 | $150.00 | $25.49 – $241.65 | 10 |
| Venogram ext bil s&i CPT 75822 | $411.00 | $2,740.00 | $149.74 – $2,805.92 | 15 |
| Venogram extremity supervision & interpretation unilateral CPT 75820 | $433.65 | $2,891.00 | $273.50 – $2,662.40 | 15 |
| Venous mech thrombectomy CPT 37187 | $1,141.05 | $7,607.00 | $1,369.26 – $7,911.28 | 7 |
| Venous m-thrombectomy add-on CPT 37188 | $1,141.05 | $7,607.00 | $1,369.26 – $7,911.28 | 7 |
| Ventilator each subsequent day CPT 94003 | $487.46 | $3,249.72 | $100.00 – $3,379.71 | 9 |
| Ventilator initial day CPT 94002 | $619.20 | $4,128.00 | $100.00 – $4,293.12 | 9 |
| Version cephalic external CPT 59412 | $1,148.85 | $7,659.00 | $1,378.62 – $7,965.36 | 7 |
| Vinblastine 1 mg/ml intravenous solution HCPCS J9360 | $11.50 | $76.66 | $6.25 – $69.00 | 10 |
| Vincristine 1 mg/ml intravenous solution HCPCS J9370 | $1,250.26 | $8,335.04 | $8.13 – $111.24 | 10 |
| Vinorelbine 10 mg/ml intravenous solution (wrapper) HCPCS J9390 | $345.69 | $2,304.54 | $10.70 – $416.45 | 10 |
| Virus isolation addl studies ea CPT 87253 | $16.05 | $107.00 | $16.97 – $96.30 | 21 |
| Vital capacity test CPT 94150 | $37.35 | $249.00 | $44.82 – $258.96 | 9 |
| Vitamin b-12 CPT 82607 | $33.30 | $222.00 | $6.30 – $65.81 | 21 |
| Vitamin D Test CPT 82306 | $63.45 | $423.00 | $9.36 – $128.60 | 21 |
| Volume measurement urine timed CPT 81050 | $7.20 | $48.00 | $3.06 – $38.07 | 21 |
| Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr HCPCS J3465 | $517.76 | $3,451.70 | $0.88 – $832.90 | 10 |
| Warde 1003990 aldosterone CPT 82088 | $84.30 | $562.00 | $34.23 – $495.90 | 21 |
| Warde 1005020 citrate 24 hour urine CPT 82507 | $27.54 | $183.60 | $23.35 – $162.18 | 21 |
| Warde 1005055 5-hiaa 24 hour urine CPT 83497 | $55.80 | $372.00 | $10.84 – $334.80 | 21 |
| Warde 1006955 catecholamines fractionated 24 hour urine CPT 82384 | $52.20 | $348.00 | $21.21 – $313.20 | 21 |
| Warde 1007138 vanillymandelic acid 24 hour urine CPT 84585 | $58.05 | $387.00 | $13.02 – $348.30 | 21 |
| Warde 1015200 kappa light chain free CPT 83521 | $22.20 | $148.00 | $26.64 – $153.92 | 8 |
| Warde 3004000 immunoglobulin subclass 1 CPT 82787 | $34.02 | $226.80 | $6.74 – $143.10 | 21 |
| Warde 3008005 oligoclonal bands CPT 83916 | $79.65 | $531.00 | $23.01 – $477.90 | 21 |
| Warde 3016000 west nile virus antibody CPT 86788 | $44.37 | $295.80 | $14.15 – $266.22 | 21 |
| Warde 3016300 saccharomyces cerevisiae iga antibody CPT 86671 | $23.63 | $157.50 | $10.29 – $67.50 | 21 |
| Warde 3400652 ova & parasites direct smear concentration and id CPT 87177 | $52.05 | $347.00 | $4.14 – $38.89 | 21 |
| Warde 3400652 smear complex special stain ova/parasites CPT 87209 | $12.66 | $84.36 | $15.10 – $77.78 | 21 |
| Warde 3400852 arsenic CPT 82175 | $26.93 | $179.52 | $15.93 – $158.40 | 21 |
| Warde 3708165 mercury urine CPT 83825 | $48.66 | $324.36 | $10.44 – $70.31 | 21 |
| Warde actin (smooth muscle) antibody each CPT 86015 | $49.35 | $329.00 | $59.22 – $342.16 | 8 |
| Warde adenosine deaminase pleural fluid CPT 84311 | $75.00 | $500.00 | $5.40 – $34.40 | 21 |
| Warde adrenocorticotropic hormone (acth) CPT 82024 | $105.00 | $700.00 | $32.44 – $630.00 | 21 |
| Warde aldolase CPT 82085 | $53.25 | $355.00 | $8.16 – $319.50 | 21 |
| Warde amino acids 6 or more quantitative each specimen CPT 82139 | $23.85 | $159.00 | $14.17 – $143.10 | 21 |
| Warde amiodarone therapeutic drug level CPT 80151 | $53.25 | $355.00 | $15.66 – $319.50 | 21 |
| Warde antiepileptics nos definitive assay 1-3 clobazam w metabolites CPT 80339 | $72.15 | $481.00 | $4.20 – $500.24 | 14 |
| Warde apolipoprotein b CPT 82172 | $40.95 | $273.00 | $17.72 – $245.25 | 21 |
| Warde bile acids CPT 82239 | $79.25 | $528.28 | $14.38 – $475.46 | 21 |
| Warde cadmium blood CPT 82300 | $21.60 | $144.00 | $19.86 – $129.60 | 21 |
| Warde calcitonin CPT 82308 | $72.06 | $480.34 | $22.50 – $432.31 | 21 |
| Warde calculus (stone) infrared CPT 82365 | $28.65 | $191.00 | $10.84 – $171.90 | 21 |
| Warde cobalt heavy metal quantitative each nes CPT 83018 | $45.30 | $302.00 | $17.10 – $94.21 | 21 |
| Warde collagen cross links c-telopeptide CPT 82523 | $100.20 | $668.00 | $7.64 – $80.77 | 21 |
| Warde complement total hemolytic CPT 86162 | $78.19 | $521.25 | $17.07 – $469.13 | 21 |
| Warde copper CPT 82525 | $41.34 | $275.60 | $10.42 – $62.10 | 21 |
| Warde cryoglobulin CPT 82595 | $40.39 | $269.24 | $5.43 – $242.32 | 21 |
| Warde erythropoietin CPT 82668 | $66.10 | $440.64 | $15.78 – $396.58 | 21 |
| Warde folic acid rbc CPT 82747 | $6.00 | $40.00 | $7.20 – $76.27 | 21 |
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.