Supplies, drugs & other prices at Chi St. Lukes Health Memorial San Augustine
San Augustine, TX · every code in this section with a posted price and a Medicare benchmark.
71 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $1,057.95 | $7,053 | 1.3× |
| 2d tte w or w/o fol w/con,fu (C8924) | $535.80 | $3,572 | 1.5× |
| Adm of soc dtr assess 5-15 m (G0136) | $16.95 | $113 | 0.5× |
| Admin influenza virus vac (G0008) | $24.68 | $164.50 | 0.5× |
| Admin pneumococcal vaccine (G0009) | $26.55 | $177 | 0.6× |
| BCR/ABL1 (eg, chronic myelogenous leukemia) translocation analysis, major breakpoint, quantitative Other Outpatient (0040U) | $254.85 | $1,699 | 0.6× |
| Catheterize for urine spec (P9612) | $42.30 | $282 | 4.5× |
| Covid-19 lab test non-cdc (U0002) | $31.35 | $209 | 0.6× |
| Diab manage trn per indiv (G0108) | $36.15 | $241 | 0.6× |
| Diab manage trn ind/group (G0109) | $15.45 | $103 | 1.0× |
| Direct refer hospital observ (G0379) | $118.20 | $788 | 0.2× |
| Drug test def 1-7 classes (G0480) | $48.08 | $320 | 0.4× |
| Elec stim other than wound (G0283) | $35.78 | $238.50 | 2.8× |
| Ephys eval ccm-d ld 1st impl (0930T) | $1,182.90 | $7,886 | 1.0× |
| Ephys eval ccm-d ld separate (0931T) | $1,182.90 | $7,886 | 1.0× |
| Hbot, full body chamber, 30m (G0277) | $215.40 | $1,436 | 1.6× |
| Inj for sacroiliac jt anesth (G0260) | $48.30 | $322 | 0.1× |
| Insj Perm Ccm-D Sys Dual Transvns Leads Only (0918T) | $10,890 | $72,600 | 1.3× |
| Insj perm ccm-d sys pg&dual transvns eltrds/lds (0915T) likely a partial charge, not the full procedure |
$4,540.50 | $30,270 | 0.1× |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) | $18,601.08 | $124,007.20 | 0.6× |
| Mra w/cont, abd (C8900) | $724.50 | $4,830 | 2.1× |
| Mra w/cont, chest (C8909) | $687.45 | $4,583 | 2.0× |
| Mra w/cont, lwr ext (C8912) | $821.85 | $5,479 | 2.3× |
| Mra w/cont, pelvis (C8918) | $649.95 | $4,333 | 1.9× |
| Mra w/o cont, abd (C8901) | $618.90 | $4,126 | 2.6× |
| Mra w/o cont, chest (C8910) | $633.75 | $4,225 | 2.6× |
| Mra w/o cont, lwr ext (C8913) | $651.38 | $4,342.50 | 2.7× |
| Mra w/o cont, pelvis (C8919) | $625.05 | $4,167 | 2.6× |
| Mra w/o fol w/cont, abd (C8902) | $1,030.20 | $6,868 | 2.9× |
| Mra w/o fol w/cont, chest (C8911) | $790.50 | $5,270 | 2.3× |
| Mra w/o fol w/cont, lwr ext (C8914) | $813.98 | $5,426.48 | 2.3× |
| Mra w/o fol w/cont, pelvis (C8920) | $555.90 | $3,706 | 1.6× |
| Mra, w/o&w/dye, spinal canal (C8933) | $687.45 | $4,583 | 2.0× |
| Mra, w/o&w/dye, upper extr (C8936) | $687.45 | $4,583 | 2.0× |
| Mri w/cont, breast, bi (C8906) | $674.85 | $4,499 | 1.9× |
| Mri w/cont, breast, uni (C8903) | $711.60 | $4,744 | 4.0× |
| Mri w/o fol w/cont, breast, (C8908) | $884.10 | $5,894 | 2.5× |
| Mri w/o fol w/cont, brst, un (C8905) | $831.45 | $5,543 | 2.4× |
| Perc d-e cor revasc chro sin (C9607) unusually low: confirm this is the full procedure |
$7,561.20 | $50,408 | 0.4× |
| Perc d-e cor revasc t cabg s (C9604) | $7,561.20 | $50,408 | 0.7× |
| Perc d-e cor stent ather s (C9602) unusually low: confirm this is the full procedure |
$7,561.20 | $50,408 | 0.4× |
| Perc drug-el cor stent sing (C9600) | $7,561.13 | $50,407.50 | 0.7× |
| Perq Sacral Augmt Bilat Inj (0201T) unusually low: confirm this is the full procedure |
$2,955.60 | $19,704 | 0.4× |
| Perq Sacral Augmt Unilat Inj (0200T) likely a partial charge, not the full procedure |
$1,122.60 | $7,484 | 0.2× |
| Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) | $8,550.45 | $57,003 | 0.7× |
| Prostate biopsy, any mthd (G0416) | $176.87 | $1,179.12 | 0.5× |
| Psa screening (G0103) | $7.35 | $49 | 0.4× |
| Relocation skin pocket implanted ccm-d pg (0925T) | $1,182.90 | $7,886 | 0.6× |
| Removal perm ccm-d system pulse generator only (0919T) | $1,049.70 | $6,998 | 0.3× |
| Repositioning prev impl ccm-d transvns eltrd/ld (0924T) | $1,182.90 | $7,886 | 1.9× |
| Revasc intra lithotrip-ather (C9766) | $9,841.35 | $65,609 | 0.5× |
| Revasc intra lithotrip-stent (C9765) | $9,841.35 | $65,609 | 0.5× |
| Revasc intravasc lithotripsy (C9764) | $6,298.50 | $41,990 | 0.5× |
| Revasc lith-sten-ath tib/per (C9775) | $9,841.35 | $65,609 | 0.5× |
| Revasc lithotr-ather tib/per (C9774) | $9,841.35 | $65,609 | 0.5× |
| Revasc lithotr-stent tib/per (C9773) | $9,841.35 | $65,609 | 0.5× |
| Revasc lithotrip tibi/perone (C9772) | $6,154.95 | $41,033 | 0.5× |
| Revasc lithotrip-stent-ather (C9767) | $9,841.35 | $65,609 | 0.5× |
| Rmvl Perm Ccm-D Sys 1 Transvns Dfb Lead Only (0921T) | $1,049.70 | $6,998 | 0.3× |
| Rmvl perm ccm-d sys 1 transvns pacing lead only (0920T) | $1,072.95 | $7,153 | 0.3× |
| Rmvl Perm Ccm-D Sys Dual Transvns Leads Only (0922T) | $1,049.70 | $6,998 | 0.3× |
| Rmvl&Rplcmt Permanent Ccm-D Pulse Generator Only (0923T) unusually low: confirm this is the full procedure |
$10,890 | $72,600 | 0.5× |
| Screen pap by tech w md supv (P3000) | $9.45 | $63 | 0.5× |
| Tcat Implt Wrls L Atr Prs Snr L-T L Atr Prs Mntr (0933T) | $1,182.90 | $7,886 | 0.4× |
| Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) | $11,807.70 | $78,718 | 0.6× |
| Tomosynthesis, mammo (G0279) | $31.20 | $208 | 2.5× |
| Trauma respons w/hosp criti (G0390) | $531 | $3,540 | 0.4× |
| Tte w or w/o fol w/con,stres (C8928) | $392.40 | $2,616 | 0.5× |
| Tte w or wo fol wcon,doppler (C8929) | $1,356.90 | $9,046 | 1.7× |
| Unsched dialysis esrd pt hos (G0257) | $543.90 | $3,626 | 0.8× |
| Vitamin D, 25 hydroxy D2 and D3, by LC-MS/MS, serum microsample, quantitative Other Outpatient (0038U) | $30.30 | $202 | 1.0× |