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 |
|---|---|---|---|---|
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $222.00 | $1,480.00 | $107.48 – $1,539.20 | 15 |
| X-ray scapula complete (both sides) CPT 73010 | $132.90 | $886.00 | $67.12 – $921.44 | 15 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $171.15 | $1,141.00 | $62.62 – $1,186.64 | 15 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $397.20 | $2,648.00 | $109.09 – $2,753.92 | 15 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $122.55 | $817.00 | $147.06 – $849.68 | 15 |
| X-ray skull < 4 views CPT 70250 | $110.25 | $735.00 | $120.96 – $764.40 | 15 |
| X-ray skull > 4 views complete CPT 70260 | $136.05 | $907.00 | $131.99 – $943.02 | 15 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $588.85 | $3,925.66 | $220.58 – $4,082.69 | 15 |
| X-ray spine single view CPT 72020 | $140.10 | $934.00 | $74.59 – $971.36 | 15 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $75.89 | $505.92 | $89.28 – $515.84 | 15 |
| X-ray sternum > 2 views CPT 71120 | $96.39 | $642.60 | $108.99 – $655.20 | 15 |
| X-ray surgical specimen CPT 76098 | $229.65 | $1,531.00 | $113.48 – $1,591.54 | 15 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $258.45 | $1,723.00 | $220.58 – $1,791.40 | 15 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $114.62 | $764.10 | $109.09 – $794.67 | 15 |
| X-ray thoracic spine 2 views CPT 72070 | $227.29 | $1,515.23 | $103.03 – $1,575.84 | 15 |
| X-ray thoracic spine 3 views CPT 72072 | $299.03 | $1,993.48 | $126.92 – $2,073.22 | 15 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $65.55 | $437.00 | $78.66 – $454.48 | 15 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $107.55 | $717.00 | $128.89 – $744.69 | 15 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $271.80 | $1,812.00 | $106.01 – $1,847.04 | 15 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $166.54 | $1,110.21 | $101.51 – $1,131.98 | 15 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $447.75 | $2,985.00 | $220.58 – $3,104.40 | 15 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $371.02 | $2,473.42 | $220.58 – $2,572.36 | 15 |
| X-ray wrist 2 views (both sides) CPT 73100 | $195.45 | $1,303.00 | $109.09 – $1,355.12 | 15 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | $130.05 | $867.00 | $155.96 – $901.06 | 15 |
| Xylose absorption test blood &/or urine CPT 84620 | $71.40 | $476.00 | $10.84 – $428.40 | 21 |
| Yersinia antibody CPT 86793 | $16.95 | $113.00 | $11.08 – $101.70 | 21 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | $101.31 | $675.38 | $1.71 – $607.81 | 10 |
| Zika virus igm antibody CPT 86794 | $12.00 | $80.00 | $14.15 – $73.29 | 21 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $1,137.95 | $7,586.30 | $8.40 – $545.39 | 10 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | $1,388.16 | $9,254.40 | $9.17 – $8,328.96 | 9 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | $2,757.85 | $18,385.61 | $5.46 – $35.06 | 10 |
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.