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 |
|---|---|---|---|---|
| Ceftriaxone 1 gram solution for injection HCPCS J0696 | $2,643.58 | $17,623.85 | $0.50 – $35.06 | 10 |
| Cefuroxime in ns IV syringe 30 mg/ml (neo/ped) - cnr HCPCS J0697 | $971.72 | $6,478.08 | $2.12 – $35.06 | 10 |
| #celiac hla-dq2 CPT 81377 | $42.90 | $286.00 | $51.48 – $409.79 | 21 |
| #celiac hla-dq8 CPT 81383 | $42.90 | $286.00 | $51.48 – $471.11 | 21 |
| Cell count w differential body fluid CPT 89051 | $80.23 | $534.85 | $4.70 – $481.37 | 21 |
| Cell marker study CPT 88182 | $74.85 | $499.00 | $41.22 – $477.83 | 9 |
| Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit HCPCS J0717 | $20,820.44 | $138,802.89 | $5.25 – $119,087.30 | 9 |
| Cetuximab 100 mg/50 ml intravenous solution HCPCS J9055 | $36.44 | $242.89 | $34.01 – $218.61 | 9 |
| #cf-97variants CPT 81220 | $370.95 | $2,473.00 | $36.00 – $2,404.96 | 21 |
| Change cystostomy tube simple CPT 51705 | $135.10 | $900.61 | $162.11 – $936.64 | 8 |
| Change of windpipe airway 31502 CPT 31502 | $77.27 | $515.07 | $92.72 – $535.68 | 8 |
| Chemo adm cns w/lmbr punct CPT 96450 | $195.45 | $1,303.00 | $100.00 – $738.40 | 15 |
| Chest 2 vws w oblique CPT 71048 | $271.50 | $1,810.00 | $131.99 – $1,882.40 | 15 |
| Chest apical lordotic proj CPT 71047 | $251.70 | $1,678.00 | $109.09 – $1,745.12 | 15 |
| Chest CT scan (with and without contrast) CPT 71270 | $1,078.80 | $7,192.00 | $209.55 – $7,479.68 | 15 |
| Chest CT scan (with contrast) CPT 71260 | $918.45 | $6,123.00 | $209.55 – $6,367.92 | 15 |
| Chest CT scan (without contrast) CPT 71250 | $729.00 | $4,860.00 | $128.89 – $5,053.66 | 15 |
| Chest X-ray CPT 71046 | $199.95 | $1,333.00 | $103.03 – $1,386.32 | 15 |
| Chest X-ray (single view) CPT 71045 | $152.55 | $1,017.00 | $76.10 – $1,057.53 | 15 |
| Chlamydia culture CPT 87110 | $29.70 | $198.00 | $16.46 – $178.20 | 21 |
| Chloride CPT 82435 | $24.54 | $163.56 | $3.86 – $147.21 | 21 |
| Chloride 24 hour urine CPT 82436 | $40.35 | $269.00 | $4.83 – $242.10 | 21 |
| Chloroprocaine hcl injection HCPCS J2401 | $77.67 | $517.79 | $7.02 – $40.51 | 8 |
| Chlorothiazide sodium 500 mg intravenous solution HCPCS J1205 | $1,085.20 | $7,234.63 | $45.09 – $1,013.89 | 10 |
| Chlorpromazine 0.125 mg/ml IV syringe - cnr HCPCS J3230 | $114.88 | $765.81 | $5.46 – $38.95 | 10 |
| Chlorpromazine 100 mg tablet HCPCS Q0161 | $1.44 | $9.57 | $0.18 – $3.00 | 19 |
| Cholangiogram percutaneous compl CPT 47532 | $1,228.80 | $8,192.00 | $1,474.56 – $13,197.32 | 9 |
| Cholangiography and/or pancreatography intraoperative supervision & interpretation CPT 74300 | $291.38 | $1,942.50 | $35.23 – $2,020.20 | 9 |
| Cholesterol CPT 82465 | $39.00 | $260.00 | $3.06 – $19.45 | 21 |
| Cholesterol body fluid CPT 84999 | $24.90 | $166.00 | $10.44 – $96.56 | 8 |
| Cholesterol (Lipid) Test CPT 80061 | $102.36 | $682.38 | $2.70 – $58.34 | 21 |
| Cholinesterase CPT 82480 | $14.25 | $95.00 | $6.61 – $85.50 | 21 |
| Chrom analysis CPT 88273 | $97.80 | $652.00 | $29.24 – $151.07 | 21 |
| Chromogenic substrate assay CPT 85130 | $43.20 | $288.00 | $9.99 – $259.20 | 21 |
| Chromosome analys amniotic CPT 88269 | $159.45 | $1,063.00 | $145.87 – $956.70 | 21 |
| Chromosome analysis 15-20 cell count CPT 88262 | $188.55 | $1,257.00 | $105.41 – $688.50 | 21 |
| Chromosome analysis 20-25 CPT 88245 | $185.25 | $1,235.00 | $145.46 – $1,111.50 | 21 |
| Chromosome karyotype study CPT 88280 | $61.35 | $409.00 | $28.11 – $368.10 | 21 |
| Chromosome study additional CPT 88289 | $57.45 | $383.00 | $28.92 – $344.70 | 21 |
| Chylomicron screen, bf - sendout CPT 82664 | $75.30 | $502.00 | $51.66 – $401.01 | 21 |
| Cinacalcet 30 mg tablet HCPCS J0604 | $88.79 | $591.91 | $0.02 – $1,371.51 | 19 |
| Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback HCPCS J0744 | $86.76 | $578.40 | $2.10 – $35.06 | 10 |
| Circumcision (newborn) CPT 54150 | $301.50 | $2,010.00 | $361.80 – $2,090.40 | 7 |
| Cisplatin 1 mg/ml desensitization HCPCS J9060 | $11.22 | $74.78 | $3.34 – $35.06 | 10 |
| Cladribine 10 mg/10 ml intravenous solution HCPCS J9065 | $156.17 | $1,041.12 | $20.09 – $905.78 | 9 |
| Clamp isol transpolr 5mmx6.5cm transpolar HCPCS C1733 | $6,615.32 | $44,102.10 | $75.60 – $4,389.42 | 10 |
| Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 | $73.95 | $492.99 | $7.02 – $35.06 | 9 |
| Clip ligating vesolock lg HCPCS C1760 | $31,286.28 | $208,575.15 | $136.40 – $818.37 | 10 |
| Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution HCPCS J0735 | $15.27 | $101.80 | $7.02 – $40.51 | 9 |
| Closed carpo/metacarpal disl thumb w/manip CPT 26641 | $126.30 | $842.00 | $151.56 – $875.68 | 8 |
| Closed tx humerus fx with manip 23605 CPT 23605 | $493.80 | $3,292.00 | $592.56 – $3,423.68 | 8 |
| Closed tx humerus fx w/manip 24505 CPT 24505 | $221.40 | $1,476.00 | $265.68 – $1,535.04 | 8 |
| Closed tx metatarsophalangeal jnt disl without anes CPT 28630 | $126.30 | $842.00 | $151.56 – $875.68 | 8 |
| Closed tx post hip arthroplasty disloc w/anes 27266 CPT 27266 | $885.45 | $5,903.00 | $1,062.54 – $6,139.12 | 8 |
| Close lac/mouth vest/2.5 cm or < 40830 CPT 40830 | $134.55 | $897.00 | $161.46 – $932.88 | 8 |
| Clos txnose fx without stablz 21315 CPT 21315 | $845.48 | $5,636.52 | $1,014.58 – $5,861.99 | 8 |
| Clot factor wght kininogen CPT 85293 | $56.55 | $377.00 | $15.90 – $339.30 | 21 |
| Clot factor xii hageman CPT 85280 | $129.45 | $863.00 | $16.25 – $776.70 | 21 |
| Clot factor xiii fibrin stab CPT 85290 | $150.75 | $1,005.00 | $13.73 – $904.50 | 21 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $243.75 | $1,625.00 | $292.50 – $1,690.00 | 8 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | $94.65 | $631.00 | $113.58 – $656.24 | 8 |
| Clsd tx clavicle fracture w/manip 23505 CPT 23505 | $531.45 | $3,543.00 | $637.74 – $3,684.72 | 8 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $131.10 | $874.00 | $157.32 – $908.96 | 8 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $120.35 | $802.33 | $144.42 – $834.43 | 8 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $640.05 | $4,267.00 | $768.06 – $4,437.68 | 8 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $93.15 | $621.00 | $111.78 – $645.84 | 8 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $849.12 | $5,660.76 | $1,018.94 – $5,887.20 | 8 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $586.65 | $3,911.00 | $703.98 – $4,067.44 | 8 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $123.72 | $824.76 | $139.50 – $806.00 | 8 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $128.83 | $858.84 | $154.60 – $893.20 | 8 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $78.00 | $520.00 | $93.60 – $540.80 | 8 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $126.19 | $841.26 | $151.43 – $874.92 | 8 |
| Clsd tx prox fib/shaft fx w/manip 27781 CPT 27781 | $853.35 | $5,689.00 | $1,024.02 – $5,916.56 | 8 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $894.00 | $5,960.00 | $1,072.80 – $6,198.40 | 8 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $616.95 | $4,113.00 | $740.34 – $4,277.52 | 8 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $126.30 | $842.00 | $151.56 – $875.68 | 8 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $131.10 | $874.00 | $157.32 – $908.96 | 8 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $870.42 | $5,802.78 | $1,044.51 – $6,034.90 | 8 |
| Clsd tx wrist ulnar styloid fx 25650 CPT 25650 | $94.65 | $631.00 | $113.58 – $656.24 | 8 |
| Cls tx of heel fracture w/manip 28405 CPT 28405 | $78.00 | $520.00 | $93.60 – $540.80 | 8 |
| C motor evoked upr&lwr limbs CPT 95939 | $216.75 | $1,445.00 | $100.00 – $1,502.80 | 9 |
| #cmvcul-virus inoculation shell CPT 87254 | $147.75 | $985.00 | $16.43 – $208.80 | 21 |
| Cmv pcr-sendout CPT 87496 | $84.45 | $563.00 | $29.48 – $506.70 | 21 |
| Coagulation factor viia 1,000 mcg/ml inj 1 ml HCPCS J7189 | $16,657.92 | $111,052.80 | $2.85 – $99,947.52 | 9 |
| Cocaine 4 % nasal solution HCPCS C9046 | $16,155.00 | $107,700.00 | $1.76 – $1,635.40 | 9 |
| Coil axium 3d 14mmx40cm qc HCPCS C1770 | $1,260.16 | $8,401.05 | $1,260.16 – $7,560.95 | 10 |
| Cold agglutinin titer CPT 86157 | $10.50 | $70.00 | $6.77 – $63.00 | 21 |
| Colistimethate sodium inj HCPCS J0770 | $164.85 | $1,098.96 | $9.07 – $58.32 | 10 |
| Collar cerv 18.25x3.5in serp firm density sm HCPCS L0120 | $3.00 | $19.95 | $3.00 – $17.96 | 10 |
| Collar cerv adlt perfit ace extric HCPCS L0140 | $110.10 | $733.95 | $66.47 – $398.79 | 10 |
| Collection blood specimen from completely implantable venous access device CPT 36591 | not published | not published | $207.16 – $207.16 | 1 |
| Collection of venous blood by venipuncture CPT 36415 | $10.65 | $71.00 | $3.06 – $63.90 | 20 |
| Colpocentesis 57020 CPT 57020 | $1,914.45 | $12,763.00 | $2,297.34 – $13,273.52 | 8 |
| Colposcopy/cervix/inc up/adjacent vag 57452 CPT 57452 | $40.95 | $273.00 | $49.14 – $283.92 | 8 |
| Colposcopy vulva 56820 CPT 56820 | $21.00 | $140.00 | $25.20 – $145.60 | 8 |
| Compatibility test each unit antiglobulin technique CPT 86922 | $85.95 | $573.00 | $61.20 – $353.60 | 9 |
| Complement antigen each component c3 CPT 86160 | $51.75 | $345.00 | $10.08 – $52.33 | 21 |
| Complx repair fccmnaxghf 13131 CPT 13131 | $157.80 | $1,052.00 | $189.36 – $1,094.08 | 8 |
| Complx repair fccmnaxghf 13132 CPT 13132 | $333.30 | $2,222.00 | $385.02 – $2,224.56 | 8 |
| Complx repair fccmnaxghf 13133 CPT 13133 | $72.45 | $483.00 | $86.94 – $502.32 | 14 |
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.