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 |
|---|---|---|---|---|
| Emb/throm/fempop/aor/ilia/leg inc 34201 CPT 34201 | $837.26 | $5,581.72 | $1,004.71 – $8,992.16 | 9 |
| Emb/throm/pop-tib-pero art/leg inc 34203 CPT 34203 | $890.70 | $5,938.00 | $1,068.84 – $9,566.12 | 9 |
| Emg 2 ext w-w/o paraspinal area 95861 CPT 95861 | $52.05 | $347.00 | $62.46 – $360.88 | 9 |
| Emg cranial nerve bilateral CPT 95868 | $46.05 | $307.00 | $55.26 – $319.28 | 9 |
| Emg needle test 1-extremity CPT 95860 | $42.45 | $283.00 | $50.94 – $294.32 | 9 |
| Emg needle test 4-extremities CPT 95864 | $77.85 | $519.00 | $93.42 – $539.76 | 9 |
| Emg thor paraspinal without t1/t2 CPT 95869 | $43.35 | $289.00 | $52.02 – $300.56 | 9 |
| Encephalitis, st louis igg/igm CPT 86653 | $36.45 | $243.00 | $11.08 – $190.80 | 21 |
| Encephalitis, western equine igg/igm CPT 86654 | $39.30 | $262.00 | $11.08 – $217.80 | 21 |
| Endo cath bile duct s&i CPT 74328 | $218.25 | $1,455.00 | $68.43 – $1,513.20 | 9 |
| Endo cath panc duct s&i CPT 74329 | $255.45 | $1,703.00 | $68.43 – $1,771.12 | 9 |
| Endoluminl ivus oct c 1st CPT 92978 | $460.32 | $3,068.75 | $100.00 – $4,943.76 | 11 |
| Endoluminl ivus oct c ea CPT 92979 | $359.10 | $2,394.00 | $100.00 – $3,856.74 | 11 |
| Endovasc rpr a-biiliac endogft 34705 CPT 34705 | $4,587.60 | $30,584.00 | $5,505.12 – $49,270.83 | 9 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $1,526.98 | $10,179.84 | $0.64 – $35.06 | 10 |
| Ep & ablate supravent arrhyt CPT 93653 | $7,908.45 | $52,723.00 | $100.00 – $84,936.76 | 10 |
| Ep & ablate ventric tachy CPT 93654 | $9,490.20 | $63,268.00 | $100.00 – $101,924.75 | 10 |
| Epidural/lumbar/sacral/ea add level64484 CPT 64484 | $110.55 | $737.00 | $100.00 – $1,187.31 | 10 |
| Ep induct arrhy by elect pacing CPT 93618 | $1,198.80 | $7,992.00 | $100.00 – $12,875.12 | 11 |
| Epinephrine 1 mg/ml im kit - pediatric HCPCS J0165 | $5.85 | $38.95 | $5.46 – $35.06 | 9 |
| Epirubicin 200 mg/100 ml intravenous solution HCPCS J9178 | $11.22 | $74.78 | $2.28 – $67.31 | 10 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | $382.79 | $2,551.91 | $10.74 – $459.32 | 9 |
| Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr HCPCS J0885 | $7,419.72 | $49,464.77 | $10.62 – $797.85 | 9 |
| Epoprostenol (arginine) 1 mg in 50 ml ns inhalation syringe - cnr HCPCS J1325 | $5.85 | $38.95 | $5.46 – $35.06 | 10 |
| Epstein barr early antigen antibody CPT 86663 | $21.75 | $145.00 | $11.02 – $67.50 | 21 |
| Epstein barr nuclear antigen antibody CPT 86664 | $28.65 | $191.00 | $12.84 – $153.00 | 21 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $32.10 | $214.00 | $15.24 – $191.87 | 21 |
| Eptifibatide 0.75 mg/ml intravenous solution HCPCS J1327 | $17.18 | $114.54 | $5.46 – $35.06 | 9 |
| Eptinezumab-jjmr 100 mg/ml intravenous solution HCPCS J3032 | $5,726.86 | $38,179.03 | $21.12 – $34,361.13 | 9 |
| Ercp biliary & pancreas CPT 74330 | $319.16 | $2,127.72 | $87.40 – $2,212.83 | 9 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $421.63 | $2,810.84 | $11.77 – $827.36 | 10 |
| ER Visit (level 1, minor) CPT 99281 | $97.65 | $651.00 | $15.30 – $788.00 | 15 |
| ER Visit (level 2) CPT 99282 | $174.45 | $1,163.00 | $209.34 – $1,209.52 | 15 |
| ER Visit (level 3) CPT 99283 | $306.90 | $2,046.00 | $49.14 – $1,638.00 | 15 |
| ER Visit (level 4) CPT 99284 | $481.35 | $3,209.00 | $577.62 – $3,623.00 | 15 |
| ER Visit (level 5, high severity) CPT 99285 | $697.50 | $4,650.00 | $837.00 – $4,836.00 | 15 |
| Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1364 | $315.41 | $2,102.70 | $73.88 – $1,107.07 | 9 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | $1,623.02 | $10,820.13 | $7.02 – $40.51 | 8 |
| Established Patient Office Visit (level 1) CPT 99211 | $43.00 | $286.62 | $20.05 – $275.60 | 15 |
| Established Patient Office Visit (level 2) CPT 99212 | $57.53 | $383.52 | $55.53 – $353.25 | 15 |
| Established Patient Office Visit (level 3) CPT 99213 | $66.87 | $445.74 | $14.76 – $395.20 | 15 |
| Established Patient Office Visit (level 4) CPT 99214 | $83.39 | $555.90 | $88.50 – $511.31 | 15 |
| Established Patient Office Visit (level 5) CPT 99215 | $253.49 | $1,689.92 | $99.88 – $577.08 | 15 |
| Estradiol total CPT 82670 | $105.60 | $704.00 | $10.44 – $121.13 | 21 |
| Estrogens total-sendout CPT 82672 | $89.25 | $595.00 | $10.44 – $94.21 | 21 |
| Ethylene glycol -sendout CPT 82693 | $78.00 | $520.00 | $12.52 – $468.00 | 21 |
| Etoposide 20 mg/ml intravenous solution HCPCS J9181 | $75.81 | $505.35 | $1.39 – $67.31 | 10 |
| Etoposide 50 mg cap HCPCS J8560 | $184.44 | $1,229.54 | $108.09 – $1,106.59 | 9 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $80.10 | $534.00 | $96.12 – $555.36 | 9 |
| Evaluation heart device CPT 93640 | $877.91 | $5,852.70 | $100.00 – $9,428.70 | 11 |
| Evaluation of speech fluency 92521 CPT 92521 | $98.70 | $658.00 | $100.00 – $684.32 | 9 |
| Evasc rpr a-ao ndgft 34701 CPT 34701 | $648.60 | $4,324.00 | $778.32 – $6,965.97 | 9 |
| Evasc rpr a-ao ndgft rpt 34702 CPT 34702 | $834.75 | $5,565.00 | $1,001.70 – $8,965.22 | 9 |
| Evasc rpr a-unilac ndgft 34703 CPT 34703 | $696.30 | $4,642.00 | $835.56 – $7,478.27 | 9 |
| Evasc rpr a-unilac ndgft rpt CPT 34704 | $834.75 | $5,565.00 | $1,001.70 – $8,965.22 | 9 |
| Evoked potentials upper limbs CPT 95925 | $93.75 | $625.00 | $100.00 – $650.00 | 9 |
| Exc ben+marg excep skin tag snhfg 0.6-1cm 11421 CPT 11421 | $297.75 | $1,985.00 | $357.30 – $2,064.40 | 8 |
| Exc excsv skin forearm/hand CPT 15837 | $889.20 | $5,928.00 | $1,067.04 – $6,165.12 | 13 |
| Exchange biliary drg cath CPT 47536 | $2,089.05 | $13,927.00 | $2,506.86 – $14,484.08 | 7 |
| Exchange nephrostomy cath CPT 50435 | $1,446.75 | $9,645.00 | $1,736.10 – $10,030.80 | 7 |
| Exercise w/hemodynamic meas CPT 93464 | $113.40 | $756.00 | $100.00 – $1,217.92 | 11 |
| Expander breast 300cc mod hght extra proj smth natrelle HCPCS L8600 | $2,551.50 | $17,010.00 | $1,162.50 – $6,975.00 | 10 |
| Expander tiss 133s-mv-12-t 300ml natrelle smth HCPCS C1789 | $3,473.04 | $23,153.55 | $65.52 – $393.12 | 10 |
| External chromosome analysis 20-25 cells CPT 88264 | $64.65 | $431.00 | $77.58 – $625.17 | 21 |
| External newborn metabolic screening panel HCPCS S3620 | $11.10 | $74.00 | $13.32 – $76.96 | 8 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $182.55 | $1,217.00 | $120.75 – $1,095.30 | 21 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $68.10 | $454.00 | $5.22 – $77.78 | 21 |
| Eye implant band 40 HCPCS C1784 | $32,751.50 | $218,343.30 | $5,392.65 – $32,355.86 | 10 |
| F-18 fdg pet diag HCPCS A9552 | $177.00 | $1,180.00 | $100.00 – $1,227.20 | 9 |
| Facial bones <3 CPT 70140 | $153.45 | $1,023.00 | $100.00 – $1,063.92 | 15 |
| Factor ix CPT 85250 | $73.80 | $492.00 | $15.99 – $442.80 | 21 |
| Factor viii CPT 85240 | $92.64 | $617.58 | $15.04 – $555.83 | 21 |
| Factor viii recomb novoeight HCPCS J7182 | $16,750.76 | $111,671.69 | $1.56 – $100,504.53 | 9 |
| Fallopian tube recnl CPT 58345 | $442.35 | $2,949.00 | $530.82 – $4,750.84 | 9 |
| Fat/lipids feces qualitative CPT 82705 | $11.40 | $76.00 | $4.28 – $68.40 | 21 |
| Fatty acids nonesterified CPT 82725 | $8.85 | $59.00 | $10.62 – $80.77 | 21 |
| #fecal-sodium CPT 84302 | $14.25 | $95.00 | $4.08 – $85.50 | 21 |
| Fem/popl revasc w/stent CPT 37226 | $8,402.25 | $56,015.00 | $10,082.70 – $58,255.60 | 7 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $87.20 | $581.30 | $0.83 – $35.06 | 10 |
| Ferric carboxymaltose 50 mg iron/ml intravenous solution HCPCS J1439 | $263.68 | $1,757.83 | $1.24 – $1,582.05 | 9 |
| Ferritin CPT 82728 | $75.75 | $505.00 | $7.20 – $58.34 | 21 |
| Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution HCPCS Q0138 | $1,776.61 | $11,844.01 | $0.38 – $10,659.61 | 9 |
| Fetal contract stress test 59020 - 26 CPT 59020 | not published | not published | $63.69 – $63.69 | 1 |
| Fetal fibronectin CPT 82731 | $106.80 | $712.00 | $54.10 – $640.80 | 21 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $22.95 | $153.00 | $6.49 – $137.70 | 21 |
| Fetal non stress test CPT 59025 | $113.87 | $759.12 | $35.61 – $713.44 | 9 |
| Fibrin degradation d dimer quantitative CPT 85379 | $46.65 | $311.00 | $8.55 – $46.80 | 21 |
| Fibrin degradation products CPT 85362 | $49.19 | $327.91 | $5.79 – $295.12 | 21 |
| Fibrinogen activity CPT 85384 | $58.80 | $392.00 | $7.20 – $41.87 | 21 |
| Fibrinolytic antiplasmin CPT 85410 | $31.20 | $208.00 | $6.48 – $187.20 | 21 |
| Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe HCPCS Q5110 | $1,520.04 | $10,133.57 | $0.38 – $10,538.92 | 9 |
| Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr HCPCS J1442 | $1,665.80 | $11,105.28 | $1.41 – $35.06 | 9 |
| Filgrastim-sndz 300 mcg/0.5 ml injection syringe HCPCS Q5101 | $1,904.31 | $12,695.40 | $0.51 – $11,425.60 | 9 |
| Filter spider fx 3mmx320cm HCPCS C1884 | $1,890.00 | $12,600.00 | $100.00 – $1,134.00 | 10 |
| Filter vena cava fem denali HCPCS C1880 | $7,869.02 | $52,460.10 | $1,266.93 – $7,601.58 | 10 |
| Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 CPT 10007 | $678.75 | $4,525.00 | $814.50 – $4,706.00 | 7 |
| Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008 CPT 10008 | $442.05 | $2,947.00 | $100.00 – $3,064.88 | 8 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $357.90 | $2,386.00 | $100.00 – $2,481.44 | 8 |
| Flebogamma injection HCPCS J1572 | $36.75 | $244.97 | $34.30 – $220.48 | 9 |
| Flecainide (tambocor)-sendout CPT 80181 | $53.25 | $355.00 | $15.66 – $319.50 | 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.