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 |
|---|---|---|---|---|
| Complx repair sal addl 5 cm/> 13122 CPT 13122 | $71.91 | $479.40 | $86.30 – $498.58 | 14 |
| Component ankle afo plastic jt mold to pt mdl foot cup HCPCS L1970 | $266.97 | $1,779.75 | $190.42 – $1,142.51 | 10 |
| Concentration infection agents any type CPT 87015 | $19.50 | $130.00 | $5.61 – $97.20 | 21 |
| Condylomata destruction 56420 CPT 56420 | $103.84 | $692.25 | $124.61 – $719.94 | 8 |
| Conivaptan hcl HCPCS C9488 | $59.88 | $399.14 | $51.37 – $415.11 | 9 |
| Conjugated estrogens 25 mg solution for injection HCPCS J1410 | $1,079.59 | $7,197.23 | $432.55 – $6,477.51 | 9 |
| Connect omega .5mm HCPCS L8613 | $950.67 | $6,337.80 | $811.60 – $4,869.59 | 10 |
| Consultation pathology during surgery cytological exam initial site CPT 88333 | $229.50 | $1,530.00 | $141.88 – $1,591.20 | 9 |
| Consultation pathology during surgery frozen section each additional block CPT 88332 | $42.19 | $281.25 | $41.76 – $292.50 | 9 |
| Consultation pathology during surgery frozen section first tissue block CPT 88331 | $154.76 | $1,031.68 | $179.30 – $1,072.95 | 9 |
| Consultation/report referred material w/preparation of slides CPT 88323 | $37.88 | $252.50 | $45.45 – $262.60 | 9 |
| Contrast exam abdominl aorta 75625-26 CPT 75625 | $1,205.55 | $8,037.00 | $272.03 – $8,358.18 | 15 |
| Contrast exam thoracic aorta 75605-26 CPT 75605 | $1,258.50 | $8,390.00 | $304.71 – $8,724.56 | 15 |
| Contrast x-ray of ankle CPT 73615 | $198.15 | $1,321.00 | $223.38 – $1,290.64 | 15 |
| Contrast x-ray of brain CPT 70015 | $336.00 | $2,240.00 | $403.20 – $2,329.60 | 15 |
| Contrast x-ray of elbow CPT 73085 | $198.15 | $1,321.00 | $223.38 – $1,290.64 | 15 |
| Contrast x-ray of hip CPT 73525 | $227.70 | $1,518.00 | $234.00 – $1,352.00 | 15 |
| Contrast x-ray of knee joint CPT 73580 | $247.71 | $1,651.37 | $275.58 – $1,592.24 | 15 |
| Contrast x-ray of wrist CPT 73115 | $206.10 | $1,374.00 | $232.38 – $1,342.64 | 15 |
| Controller infinity pt dbs HCPCS C1787 | $2,324.55 | $15,496.95 | $100.00 – $6,198.78 | 10 |
| Control nosebleed pack+caut 30905 CPT 30905 | $63.15 | $421.00 | $75.78 – $437.84 | 8 |
| Control of nosebleed ant comp 30903 CPT 30903 | $126.15 | $841.00 | $151.38 – $874.64 | 8 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $92.70 | $618.00 | $111.24 – $642.72 | 13 |
| Conversion ext bil drg cath CPT 47535 | $2,089.05 | $13,927.00 | $2,506.86 – $14,484.08 | 7 |
| Coombs direct CPT 86880 | $35.45 | $236.31 | $4.53 – $176.40 | 15 |
| Coombs indirect qualitative each reagent red cell reference CPT 86885 | $42.00 | $280.00 | $4.80 – $272.65 | 15 |
| Coombs indirect titer reference CPT 86886 | $57.45 | $383.00 | $4.35 – $344.70 | 15 |
| Core ndl bx lng/med perq CPT 32408 | $775.44 | $5,169.60 | $570.96 – $3,298.88 | 7 |
| Coronary angio/cath placement bypass graft/lv gram/lt heart CPT 93459 | $7,537.80 | $50,252.00 | $100.00 – $80,955.98 | 10 |
| Coronary angio/lv gram/lt heart CPT 93458 | $6,979.35 | $46,529.00 | $100.00 – $74,958.22 | 10 |
| Coronary angio/lv gram/rt< heart CPT 93460 | $8,375.25 | $55,835.00 | $100.00 – $89,950.19 | 10 |
| Coronary art/grft angio s&i CPT 93455 | $4,399.95 | $29,333.00 | $100.00 – $47,255.47 | 10 |
| Coronary catheterization w/angiography supervision & interpretation CPT 93454 | $4,074.00 | $27,160.00 | $100.00 – $32,816.07 | 10 |
| Coronary thrombolysis/iv infusion 92977 CPT 92977 | $163.05 | $1,087.00 | $100.00 – $1,751.16 | 10 |
| Correct rectal prolapse CPT 45541 | $1,751.40 | $11,675.94 | $2,101.67 – $12,142.98 | 8 |
| Cortisol total am CPT 82533 | $73.50 | $490.00 | $5.22 – $70.31 | 21 |
| Cosyntropin 0.25 mg solution for injection HCPCS J0834 | $2,783.27 | $18,555.08 | $28.35 – $1,541.39 | 10 |
| Co-treatment - group 15 mins, st CPT 92508 | $31.80 | $212.00 | $38.16 – $220.48 | 9 |
| Counseling smoke cess interm >10mins CPT 99407 | $16.95 | $113.00 | $20.34 – $117.52 | 15 |
| Covid-19 lab test non-cdc HCPCS U0002 | $31.35 | $209.00 | $37.62 – $188.10 | 21 |
| #covid19rsv-rsv CPT 87634 | $19.64 | $130.92 | $23.57 – $303.62 | 21 |
| #coxa-coxsackie a serotype a16 CPT 86658 | $23.70 | $158.00 | $8.64 – $56.83 | 21 |
| C-peptide CPT 84681 | $52.33 | $348.84 | $7.20 – $89.75 | 21 |
| Crbrospnl fld flw imag cistern CPT 78630 | $450.90 | $3,006.00 | $541.08 – $3,126.24 | 15 |
| C-reactive protein CPT 86140 | $41.70 | $278.00 | $4.14 – $22.43 | 21 |
| Creatine kinase CPT 82550 | $43.00 | $286.62 | $5.22 – $28.43 | 21 |
| Creatine kinase isoenzymes CPT 82552 | $101.63 | $677.50 | $11.25 – $609.75 | 21 |
| Creatine kinase mb CPT 82553 | $82.80 | $552.00 | $8.28 – $49.35 | 21 |
| Creatinine CPT 82565 | $30.57 | $203.75 | $3.06 – $22.43 | 21 |
| Creatinine 24 hour urine CPT 82570 | $30.57 | $203.75 | $4.14 – $22.43 | 21 |
| Creatinine clearance urine CPT 82575 | $70.04 | $466.93 | $7.95 – $420.24 | 21 |
| #creutz-prot.,western blot CPT 84182 | $96.00 | $640.00 | $24.54 – $254.65 | 21 |
| Critical care 30-74 minutes CPT 99291 | $947.07 | $6,313.80 | $1,136.49 – $6,566.36 | 15 |
| Critical care each additional 30 minutes CPT 99292 | $255.75 | $1,705.00 | $242.93 – $4,804.00 | 15 |
| Crotalidae poly immune fab HCPCS J0840 | $8,495.54 | $56,636.93 | $1,991.46 – $42,321.53 | 9 |
| Cryofibrinogen qualitative - sendout CPT 82585 | $8.10 | $54.00 | $9.72 – $61.32 | 21 |
| Cryoprecipitate each unit HCPCS P9012 | $58.50 | $390.00 | $70.20 – $405.60 | 8 |
| Cryptococcus abs qn - sendout CPT 86641 | $17.70 | $118.00 | $12.10 – $106.20 | 21 |
| Cryptosporidium antigen CPT 87272 | $36.30 | $242.00 | $10.06 – $217.80 | 21 |
| Crystal identification light microscopy CPT 89060 | $58.50 | $390.00 | $6.16 – $201.21 | 21 |
| Csf leakage imaging CPT 78650 | $630.60 | $4,204.00 | $485.79 – $4,372.16 | 15 |
| Cta abdomen without & /or w/contrast CPT 74175 | $1,724.85 | $11,499.00 | $209.55 – $11,958.96 | 15 |
| Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast CPT 75635 | $1,728.60 | $11,523.95 | $209.55 – $11,984.91 | 15 |
| Cta lower extremity without & w/contrast (both sides) CPT 73706 | $1,881.25 | $12,541.65 | $209.55 – $13,043.32 | 15 |
| Cta neck without &/or w/contrast CPT 70498 | $1,170.00 | $7,800.00 | $209.55 – $8,111.94 | 15 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $1,895.36 | $12,635.73 | $334.05 – $12,879.36 | 15 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $1,226.76 | $8,178.36 | $209.55 – $8,335.60 | 15 |
| CT Angiogram of the Head CPT 70496 | $1,106.19 | $7,374.60 | $209.55 – $7,517.12 | 15 |
| CT angio hrt w/3d image CPT 75574 | $201.30 | $1,342.00 | $220.58 – $1,395.68 | 15 |
| CT angio pelvis CPT 72191 | $679.50 | $4,530.00 | $209.55 – $4,711.20 | 15 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $639.09 | $4,260.54 | $209.55 – $4,344.08 | 15 |
| CT guidance for needle placement CPT 77012 | $489.84 | $3,265.56 | $100.00 – $2,973.36 | 9 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $506.55 | $3,377.00 | $100.00 – $3,301.36 | 9 |
| CT heart w/evaluation of calcium without contrast CPT 75571 | $43.50 | $290.00 | $52.20 – $1,103.00 | 15 |
| CT hrt c+ strux cgen hrt ds CPT 75573 | $167.85 | $1,119.00 | $201.42 – $1,163.76 | 15 |
| CT hrt w/3d image CPT 75572 | $171.75 | $1,145.00 | $206.10 – $1,190.80 | 15 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $807.15 | $5,381.00 | $209.55 – $5,596.24 | 15 |
| CT lower extremity without contrast (both sides) CPT 73700 | $625.65 | $4,171.00 | $128.89 – $4,337.62 | 15 |
| CT lwr extremity w/o&w/dye CPT 73702 | $944.70 | $6,298.00 | $209.55 – $6,549.92 | 15 |
| CT neck soft tissue w/contrast CPT 70491 | $1,042.65 | $6,951.00 | $209.55 – $7,229.04 | 15 |
| CT neck soft tissue without contrast CPT 70490 | $844.50 | $5,630.00 | $128.89 – $5,855.20 | 15 |
| CT neck soft tissue without & w/contrast CPT 70492 | $1,251.15 | $8,341.00 | $209.55 – $8,674.64 | 15 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $740.85 | $4,939.00 | $209.55 – $5,136.56 | 15 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $634.95 | $4,233.00 | $209.55 – $4,402.32 | 15 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $556.95 | $3,713.00 | $128.89 – $3,861.52 | 15 |
| CT scan for therapy guide CPT 77014 | $317.70 | $2,118.00 | $100.00 – $2,202.72 | 9 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $2,242.50 | $14,950.00 | $439.13 – $15,548.00 | 15 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $2,042.40 | $13,616.00 | $439.13 – $14,160.64 | 15 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $1,672.82 | $11,152.07 | $268.00 – $11,598.08 | 15 |
| CT thoracic spine w/contrast CPT 72129 | $1,149.30 | $7,662.00 | $209.55 – $7,968.48 | 15 |
| CT thoracic spine without contrast CPT 72128 | $877.35 | $5,849.00 | $128.89 – $6,082.96 | 15 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $270.19 | $1,801.25 | $31.50 – $1,103.00 | 15 |
| CT t-spine w /wo contrast CPT 72130 | $1,351.05 | $9,007.00 | $209.55 – $9,367.28 | 15 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $1,275.90 | $8,506.00 | $439.13 – $8,846.24 | 15 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,020.75 | $6,805.00 | $128.89 – $7,076.89 | 15 |
| CT uppr extremity w/o&w/dye CPT 73202 | $1,582.20 | $10,548.00 | $209.55 – $10,969.92 | 15 |
| Culture aerobic additional method definitive id each CPT 87077 | $36.45 | $243.00 | $6.79 – $37.80 | 21 |
| Culture afb any source CPT 87116 | $74.85 | $499.00 | $9.07 – $77.40 | 21 |
| Culture anaerobic additional method definitive id each CPT 87076 | $15.00 | $100.00 | $6.79 – $90.00 | 21 |
| Culture anaerobic except blood CPT 87075 | $113.85 | $759.00 | $6.30 – $40.36 | 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.