IV push, single drug at St. Luke's Health Memorial San Augustine. CPT 96374.
What St. Luke's Health Memorial San Augustine publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$114cash price (self-pay)
$762list price
$84.83–$792range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS-TX | Commercial|Blue Premier | $84.83 |
| BCBS-TX | Commercial|Blue Advantage HMO | $96.72 |
| BCBS-TX | Commercial|HMO | $97.12 |
| Cigna | Commercial|All Plans | $100 |
| BCBS-TX | Commercial|PPO | $105 |
| United | Commercial|Exchange | $137 |
| United | Commercial|All Other Plans | $175 |
| AETNA | Medicare|All Plans | $189 |
| HUMANA | Medicare|All Plans | $189 |
| Aetna | Commercial|All Plans | $190 |
| Wellpoint | Medicare|All Plans | $195 |
| CIGNA HEALTHSPRING | Medicare|All Other Plans | $198 |
| CIGNA HEALTHSPRING | Medicare|PPO | $200 |
| BCBS | Medicare|All Plans | $209 |
| UNITED | Medicare|All Plans | $209 |
| SCANHealth | Medicare|All Plans | $213 |
| MD Save | Commercial|All Plans | $236 |
| Wellpoint | Commercial|Exchange | $314 |
| Angelina County | Commercial|All Plans | $516 |
| PHCS | Commercial|All Plans | $518 |
| Humana | Commercial|All Plans | $533 |
| Multiplan | Commercial|All Plans | $533 |
| Brookshire Brothers | Commercial|All Plans | $567 |
| Galaxy | Commercial|All Plans | $686 |
| Entrust | Commercial|All Plans | $792 |
Inpatient
$114cash price (self-pay)
$762list price
$190–$762range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Commercial|All Plans | $190 |
| Humana | Commercial|All Plans | $533 |
| Multiplan | Commercial|All Plans | $533 |
| PHCS | Commercial|All Plans | $610 |
| Galaxy | Commercial|All Plans | $686 |
| United | Commercial|Exchange | $762 |
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All common services at St. Luke's Health Memorial San Augustine