CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: CHI St Lukes Health Memorial San Augustine

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71250
  • Insurance Median: $875
  • Cash Discount Price: $729
  • vs. Medicare Baseline: 8.19x Medicare
The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at CHI St Lukes Health Memorial San Augustine is $875. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $729. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.19x the Medicare baseline. Located in 511 Hospital St, San Augustine, TX.
Cash / Self-Pay
$729

Average discount available for prompt cash payment at this facility.

Insurance Median
$875

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $729 (683%)
Insurance Median: $875 (819%)
Cash: $729 (683% of Medicare)
Ins. Median: $875 (819% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 819% of the Medicare baseline (a markup of 719%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Aetna $97 - $1,215 91%
Humana $97 - $3,402 91%
Wellpoint $100 - $207 94%
Cigna $102 - $1,103 95%
Blue Cross Blue Shield $106 - $447 99%
United $106 - $4,860 99%
Scanhealth $108 101%
Md Save $121 113%
Superior $132 - $207 124%
Tchp $135 126%
Angelina County $265 248%
Brookshire Brothers $291 272%
PHCS $3,304 - $3,888 3093%
Multiplan $3,402 3185%
Galaxy $4,373 - $4,374 4094%
Entrust $5,054 4732%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 511 Hospital St, San Augustine, TX 75972
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Rural Emergency Hospital