CMS Price Transparency Data

Trauma team activation

Facility: CHI St Lukes Health Memorial San Augustine

Billing Code: G0390 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0390
Insurance Median: $1,970
Cash Discount Price: $531
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Trauma team activation at CHI St Lukes Health Memorial San Augustine is $1,970. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $531. Compared to the federal Medicare reimbursement reference rate of $1,361.78, this hospital’s rate is 1.45x the Medicare baseline. Located in 511 Hospital St, San Augustine, TX.

Cash / Self-Pay

$531

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,970

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,361.78

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,361.78 (100%)

Cash / Self-Pay: $531 (39%)

Insurance Median: $1,970 (145%)

Cash: $531 (39% of Medicare)

Ins. Median: $1,970 (145% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,361.78 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.

Out-of-Pocket Cost Estimator

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

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
United	$637 - $3,540	47%
Aetna	$885 - $1,207	65%
Humana	$1,207 - $2,478	89%
Wellpoint	$1,243 - $1,970	91%
Cigna	$1,268 - $1,280	93%
Blue Cross Blue Shield	$1,313 - $2,370	96%
Scanhealth	$1,338	98%
Md Save	$1,509	111%
PHCS	$2,407 - $2,832	177%
Multiplan	$2,478	182%
Galaxy	$3,186	234%
Angelina County	$3,296	242%
Brookshire Brothers	$3,622	266%
Entrust	$3,682	270%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $531.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0390.

Insurance In-Network Protection Plan

Contact your insurance company to confirm CHI St Lukes Health Memorial San Augustine is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0390.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.