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 |
|---|---|---|---|---|
| Culture bact stool aero addl path ea CPT 87046 | $19.46 | $129.72 | $5.22 – $40.36 | 21 |
| Culture body fluid CPT 87070 | $71.25 | $475.00 | $5.22 – $37.38 | 21 |
| Culture fungi other (except blood) CPT 87102 | $20.25 | $135.00 | $7.06 – $121.50 | 21 |
| Culture mycoplasma any source CPT 87109 | $18.00 | $120.00 | $12.42 – $65.81 | 21 |
| Culture screening strep group a CPT 87081 | $66.15 | $441.00 | $5.57 – $31.50 | 21 |
| Culture typing immunologic CPT 87147 | $10.50 | $70.00 | $4.35 – $63.00 | 21 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $27.54 | $183.60 | $29.48 – $155.70 | 21 |
| Culture virus isolation CPT 87250 | $112.76 | $751.70 | $16.43 – $676.53 | 21 |
| Cutter lead HCPCS C1773 | $905.79 | $6,038.55 | $100.00 – $1,984.92 | 10 |
| Cv line/pic reposition CPT 36597 | $339.15 | $2,261.00 | $406.98 – $2,351.44 | 7 |
| Cyanocobalamin unsat binding capacity CPT 82608 | $33.30 | $222.00 | $12.03 – $199.80 | 21 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $34.65 | $230.98 | $1.30 – $143.86 | 10 |
| Cyclic citrullinated peptide antibody CPT 86200 | $60.90 | $405.96 | $10.88 – $62.10 | 21 |
| Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 | $2,542.07 | $16,947.12 | $42.90 – $275.73 | 9 |
| Cyclophosphamide 25 mg capsule HCPCS J8530 | $12.49 | $83.23 | $1.24 – $36.33 | 10 |
| Cyclosporine 250 mg/5 ml intravenous solution HCPCS J7516 | $150.79 | $1,005.26 | $25.34 – $162.87 | 10 |
| Cyclosporine 2 hour CPT 80158 | $130.82 | $872.10 | $12.42 – $77.78 | 21 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | $5.85 | $38.95 | $0.96 – $35.06 | 10 |
| Cyclosporine oral 100 mg HCPCS J7502 | $22.56 | $150.36 | $2.70 – $35.06 | 10 |
| Cylinder pump set 20cm titan zero angl HCPCS C1813 | $22,594.80 | $150,631.95 | $100.00 – $1,999.62 | 10 |
| Cystatin c CPT 82610 | $33.60 | $224.00 | $15.56 – $201.60 | 21 |
| Cystine urine quantitative CPT 82131 | $46.65 | $311.00 | $19.30 – $148.50 | 21 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $312.60 | $2,084.00 | $114.95 – $2,166.53 | 15 |
| Cystostomy cystotomy w/drainage 51040 CPT 51040 | $839.21 | $5,594.70 | $1,007.05 – $5,818.49 | 8 |
| Cytogenom microarray copy nmbr var CPT 81228 | $305.27 | $2,035.10 | $366.32 – $3,890.08 | 19 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $61.50 | $410.00 | $12.09 – $67.50 | 21 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $53.85 | $359.00 | $14.15 – $323.10 | 21 |
| Cytomegalovirus imm IV /vial HCPCS J0850 | $3,058.32 | $20,388.80 | $2,050.88 – $18,349.92 | 9 |
| Cytopath c/v auto in fluid CPT 88174 | $40.50 | $270.00 | $21.31 – $243.00 | 21 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $21.90 | $146.00 | $15.48 – $115.16 | 21 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $28.65 | $191.00 | $17.02 – $99.00 | 21 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $63.90 | $426.00 | $63.52 – $443.04 | 9 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $53.82 | $358.75 | $63.52 – $373.10 | 9 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $49.05 | $327.00 | $58.86 – $340.08 | 9 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $62.37 | $415.74 | $74.84 – $432.37 | 9 |
| Cytopath tbs c/v manual CPT 88164 | $25.05 | $167.00 | $14.54 – $142.20 | 21 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | $65.60 | $437.28 | $6.02 – $249.88 | 10 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | $2,157.32 | $14,382.11 | $397.80 – $12,943.90 | 9 |
| Dalbavancin 500 mg intravenous solution HCPCS J0875 | $6,174.31 | $41,162.03 | $17.64 – $37,045.83 | 9 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $1,546.04 | $10,306.90 | $0.03 – $1,301.40 | 10 |
| Daptomycin (xellia) unrefrig HCPCS J0872 | $208.23 | $1,388.16 | $62.19 – $399.80 | 9 |
| Daunorubicin 5 mg/ml intravenous solution HCPCS J9150 | $122.77 | $818.44 | $10.47 – $74.78 | 9 |
| Deamidated gliadin antibody iga CPT 86258 | $59.83 | $398.82 | $71.79 – $414.78 | 8 |
| Debridement (>20 cm) charge pt CPT 97598 | $65.55 | $437.00 | $24.67 – $454.48 | 15 |
| Debridement bone <= 20 sq cm CPT 11044 | $1,047.45 | $6,983.00 | $1,256.94 – $7,262.32 | 7 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $245.40 | $1,636.00 | $100.00 – $2,635.60 | 10 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $432.75 | $2,885.00 | $100.00 – $4,647.74 | 10 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $275.70 | $1,838.00 | $330.84 – $1,911.52 | 8 |
| Debride nail1-5 11720 CPT 11720 | $52.20 | $348.00 | $62.64 – $560.63 | 9 |
| Debride nail6 or more 11721 CPT 11721 | $60.75 | $405.00 | $72.90 – $652.46 | 9 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $118.65 | $791.00 | $100.00 – $1,274.31 | 10 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $700.20 | $4,668.00 | $840.24 – $4,854.72 | 7 |
| Decalcification CPT 88311 | $22.05 | $147.00 | $17.12 – $152.88 | 9 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | $5,937.86 | $39,585.70 | $2.30 – $33,845.78 | 10 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $69.45 | $463.00 | $75.01 – $433.37 | 8 |
| Deferoxamine 500 mg solution for injection HCPCS J0895 | $223.70 | $1,491.31 | $5.46 – $35.06 | 10 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | $4,685.74 | $31,238.23 | $5.89 – $28,114.41 | 9 |
| Delivery of placenta 59414 CPT 59414 | $371.85 | $2,479.00 | $446.22 – $2,578.16 | 7 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $70.88 | $472.50 | $85.05 – $491.40 | 9 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $6,508.51 | $43,390.03 | $38.01 – $27,157.52 | 9 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $83.63 | $557.50 | $100.35 – $579.80 | 13 |
| Dermagraft HCPCS Q4106 | $31.52 | $210.10 | $29.42 – $189.09 | 10 |
| Design mlc device for imrt CPT 77338 | $311.10 | $2,074.00 | $373.32 – $2,156.96 | 9 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $229.25 | $1,528.33 | $4.62 – $178.38 | 9 |
| Desoxycorticosterone CPT 82633 | $21.45 | $143.00 | $25.74 – $134.61 | 21 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $1,054.20 | $7,028.00 | $1,265.04 – $7,309.12 | 7 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $358.50 | $2,390.00 | $100.00 – $3,850.29 | 10 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $316.35 | $2,109.00 | $100.00 – $3,397.60 | 10 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $1,054.20 | $7,028.00 | $1,265.01 – $7,308.92 | 7 |
| Device ablt adv novasure HCPCS C1886 | $3,261.67 | $21,744.45 | $100.00 – $22,614.23 | 8 |
| Device sut capio slim opn HCPCS C2631 | $3,313.65 | $22,090.95 | $3,313.65 – $19,881.86 | 10 |
| Device tiss remov myosure reach HCPCS C1782 | $670.95 | $4,473.00 | $100.00 – $4,651.92 | 8 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $5.85 | $38.95 | $0.02 – $116.85 | 19 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $45.55 | $303.66 | $0.04 – $35.06 | 10 |
| Dextran 40 infusion HCPCS J7100 | $80.28 | $535.19 | $45.00 – $301.16 | 10 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $18.22 | $121.47 | $6.32 – $40.61 | 10 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $47.66 | $317.73 | $2.06 – $285.96 | 10 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $111.00 | $740.00 | $5.22 – $95.72 | 21 |
| Diabetes (HbA1c) Test CPT 83036 | $57.90 | $386.00 | $2.34 – $41.87 | 21 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | $16.95 | $113.00 | $20.34 – $117.52 | 15 |
| Diab manage trn ind/group HCPCS G0109 | $15.45 | $103.00 | $15.24 – $107.12 | 19 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $12.60 | $84.00 | $15.12 – $87.36 | 13 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $104.25 | $695.00 | $125.08 – $722.68 | 8 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $152.10 | $1,014.00 | $182.52 – $1,054.56 | 9 |
| Diagnostic Mammogram (one breast) CPT 77065 | $100.35 | $669.00 | $120.42 – $695.76 | 9 |
| Dialysis one evaluation CPT 90945 | $403.95 | $2,693.00 | $100.00 – $969.28 | 8 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $0.52 | $3.41 | $0.15 – $0.95 | 10 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $85.43 | $569.48 | $5.46 – $35.06 | 10 |
| Dicyclomine injection HCPCS J0500 | $262.55 | $1,750.32 | $17.93 – $256.13 | 10 |
| Diffusing capacity CPT 94729 | $228.60 | $1,524.00 | $100.00 – $1,584.96 | 9 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $207.88 | $1,385.85 | $5.46 – $35.06 | 10 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $12,628.79 | $84,191.91 | $5.46 – $38.95 | 9 |
| Digoxin total therapeutic drug level CPT 80162 | $48.30 | $322.00 | $8.28 – $56.83 | 21 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $576.48 | $3,843.16 | $5.46 – $38.95 | 10 |
| Dilator fascial 10fx20cm HCPCS C2627 | $107.42 | $716.10 | $39.88 – $230.42 | 8 |
| Dilat xst trc new access rcs CPT 50437 | $1,439.10 | $9,594.00 | $1,726.92 – $9,977.76 | 7 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $42.94 | $286.24 | $5.46 – $38.95 | 9 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $0.49 | $3.26 | $0.02 – $2.58 | 19 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $9.55 | $63.63 | $0.85 – $35.06 | 10 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | $133.96 | $893.05 | $80.38 – $803.75 | 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.