Home › Hospitals › Chi St. Lukes Health Memorial San Augustine Posts prices for 34 of the 66 common shoppable procedures we track. Price file retrieved 2026-07-18.
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Procedure Cash price Gross charge × Medicare
Upper GI endoscopy (EGD), diagnostic (43235) $633.60
$4,224
0.7×
Transforaminal epidural injection, lumbar/sacral (64483) $415.95
$2,773
0.5×
CT head/brain without contrast (70450) $815.40
$5,436
7.8×
MRI brain without contrast (70551) $1,335.72
$8,904.80
5.6×
MRI brain with contrast (70552) $1,843.35
$12,289
5.3×
MRI brain without and with contrast (70553) $2,177.25
$14,515
6.2×
X-ray lower spine, 4+ views (72110) $514.95
$3,433
4.9×
MRI lumbar spine without contrast (72148) $1,177.20
$7,847.94
4.9×
CT pelvis with contrast (72193) $1,482.30
$9,882
8.4×
MRI lower-extremity joint without contrast (73721) $1,606.80
$10,712
6.7×
CT abdomen and pelvis with contrast (74177) $2,042.40
$13,616
5.8×
Ultrasound, abdomen complete (76700) $520.50
$3,470
5.0×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $561.75
$3,745
5.3×
Ultrasound, transvaginal (76830) $308.55
$2,057
2.9×
Mammography, one breast (diagnostic) (77065) $100.35
$669
1.2×
Mammography, both breasts (diagnostic) (77066) $152.10
$1,014
1.4×
Mammography, screening (bilateral) (77067) $118.35
$789
1.3×
Basic metabolic panel (80048) $45.02
$300.07
5.3×
Comprehensive metabolic panel (80053) $4.65
$31
0.4×
Lipid panel (80061) $3.75
$25
0.3×
Renal function panel (80069) $73.78
$491.88
8.5×
Hepatic function panel (80076) $60.22
$401.50
7.4×
PSA, total (84153) $8.70
$58
0.5×
Thyroid stimulating hormone (TSH) (84443) $4.35
$29
0.3×
CBC with automated differential (85025) $53.86
$359.04
6.9×
CBC, automated (85027) $22.47
$149.77
3.5×
Prothrombin time (PT) (85610) $37.18
$247.86
8.7×
Partial thromboplastin time (PTT) (85730) $29.10
$194
4.8×
Left heart catheterization (93452) $6,062.55
$40,417
1.9×
Sleep study (attended polysomnography) (95810) $1,122.51
$7,483.34
1.3×
Physical therapy, therapeutic exercise (per 15 min) (97110) $42.90
$286
1.5×
Office visit, new patient (low complexity, ~30 min) (99203) $59.70
$398
0.4×
Office visit, new patient (moderate complexity, ~45 min) (99204) $98.30
$655.35
0.7×
Office visit, new patient (high complexity, ~60 min) (99205) $142.22
$948.13
1.1×
Rural Emergency Hospital — an outpatient-and-emergency-only facility. Medicare pays Rural Emergency Hospitals the OPPS rate plus 5%, so the Medicare benchmarks on this page run about 5% below what Medicare actually pays this facility.
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