Ascension St. John Jane Phillips (Jane Phillips Memorial Medical Center, Inc.)
3500 SE Frank Phillips Blvd, Bartlesville, OK · Ascension · · NPI 1215914254
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $45.05 | $121.75 | $12.25 – $108.04 | 29 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | not published | not published | $135.82 – $404.20 | 6 |
| Ghs quinidine CPT 80194 | not published | not published | $14.60 – $129.19 | 29 |
| Ghs refill of implantable pump CPT 95990 | $219.87 | $594.25 | $63.94 – $760.30 | 29 |
| Ghs removal intranasal foreign body CPT 30300 | $107.67 | $291.00 | $113.48 – $295.47 | 29 |
| Ghs removal pharyngeal foreign body CPT 42809 | $348.36 | $941.50 | $135.96 – $914.67 | 29 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $1,554.46 | $4,201.25 | $588.01 – $1,168.46 | 7 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | not published | not published | $534.17 – $1,031.19 | 7 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $30.16 | $81.50 | $13.55 – $35.75 | 29 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $4.31 – $51.91 | 29 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | not published | not published | $12.77 – $113.14 | 29 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $3.65 – $51.91 | 29 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $12.31 – $113.79 | 29 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $9.38 – $113.79 | 29 |
| Ghs sensitivity (per antimicro) CPT 87184 | $29.14 | $78.75 | $7.30 – $16.83 | 29 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $201.10 | $543.50 | $107.76 – $915.79 | 29 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $191.94 | $518.75 | $145.37 – $915.79 | 29 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $161.78 | $437.25 | $132.45 – $915.79 | 29 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $216.08 | $584.00 | $176.61 – $915.79 | 29 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $136.16 | $368.00 | $84.59 – $455.47 | 29 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $178.34 | $482.00 | $82.51 – $455.47 | 29 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $102.49 | $277.00 | $106.72 – $455.47 | 29 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $275.56 | $744.75 | $165.52 – $455.47 | 29 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $223.85 | $605.00 | $199.91 – $455.47 | 29 |
| Ghs sleep study unattended CPT 95800 | not published | not published | $127.90 – $368.96 | 28 |
| Ghs somatosensory testing lower extremit CPT 95926 | $365.01 | $986.50 | $33.37 – $713.79 | 29 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $385.54 | $1,042.00 | $300.73 – $1,216.24 | 28 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $59.85 | $161.75 | $31.76 – $101.41 | 29 |
| Ghs sphenopalatine ganglion block CPT 64505 | $605.69 | $1,637.00 | $95.40 – $676.64 | 29 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $2.17 – $295.47 | 29 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $85.75 | $231.75 | $88.06 – $214.00 | 29 |
| Ghs st - eval for alt comm CPT 92567 | not published | not published | $12.11 – $89.98 | 29 |
| Ghs strapping shoulder - 29240 CPT 29240 | $126.82 | $342.75 | $20.57 – $295.47 | 29 |
| Ghs st - re-eval for alt comm CPT 92597 | $106.01 | $286.50 | $54.75 – $152.44 | 29 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $66.51 | $179.75 | $16.32 – $105.77 | 29 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $144.58 | $390.75 | $159.67 – $482.94 | 29 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $583.03 | $1,575.75 | $204.34 – $1,403.12 | 29 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $265.85 | $718.50 | $148.07 – $915.79 | 29 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $1,242.46 | $3,358.00 | $251.79 – $480.50 | 7 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.30 – $60.18 | 29 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $135.42 | $366.00 | $244.38 – $578.78 | 29 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $244.38 – $549.86 | 29 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $24.30 – $111.67 | 29 |
| Ghs urine, porphyrins quant CPT 84120 | $321.25 | $868.25 | $14.71 – $35.79 | 29 |
| Ghs vaginal delivery only CPT 59409 | $968.66 | $2,618.00 | $897.66 – $1,764.41 | 7 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $540.55 – $1,216.24 | 22 |
| Ghs windowing of cast CPT 29730 | not published | not published | $50.04 – $361.69 | 29 |
| Giardia lamblia antibody CPT 86674 | $85.93 | $232.25 | $14.72 – $62.53 | 29 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $51.51 – $554.06 | 28 |
| Gi inhouse confirmation CPT 87045 | $46.34 | $125.25 | $9.44 – $56.64 | 29 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $277.90 – $575.65 | 7 |
| Gi protein loss CPT 78282 | not published | not published | $23.98 – $921.08 | 28 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $238.27 – $2,149.09 | 29 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $928.81 – $2,089.82 | 22 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $66.50 – $2,149.09 | 29 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $955.15 – $2,352.55 | 28 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $79.86 – $227.52 | 28 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $61.52 – $138.42 | 28 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.00 – $79.86 | 28 |
| Glaucoma surgery CPT 66150 | not published | not published | $857.08 – $1,846.30 | 7 |
| Glaucoma surgery CPT 66155 | not published | not published | $854.35 – $1,845.53 | 7 |
| Glaucoma surgery CPT 66160 | not published | not published | $975.36 – $2,083.44 | 7 |
| Glaucoma surgery CPT 66170 | not published | not published | $1,181.01 – $2,581.08 | 7 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $354.90 | $959.20 | $199.53 – $225.87 | 5 |
| Glucagon plasma - sendout CPT 82943 | $77.42 | $209.25 | $14.29 – $111.67 | 29 |
| Glucose 1 hr post dose CPT 82950 | $22.85 | $61.75 | $4.75 – $33.65 | 29 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.05 – $60.18 | 29 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | not published | not published | $2.35 – $33.65 | 29 |
| Glucose blood quantitative CPT 82947 | $25.35 | $68.50 | $3.93 – $33.65 | 29 |
| Glucose body fluid CPT 82945 | $27.01 | $73.00 | $3.93 – $60.18 | 29 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $65.95 | $178.25 | $60.51 – $136.15 | 27 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $46.25 | $125.00 | $12.87 – $60.18 | 29 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $12.12 | $32.75 | $3.92 – $9.54 | 29 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $61.33 | $165.75 | $18.58 – $111.67 | 29 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $59.48 | $160.75 | $18.52 – $111.67 | 29 |
| Gonioscopy CPT 92020 | not published | not published | $23.22 – $295.47 | 29 |
| Goniotomy CPT 65820 | not published | not published | $745.42 – $1,578.75 | 7 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $790.43 | $2,136.30 | $199.53 – $330.15 | 5 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $63.51 | $171.65 | $36.27 – $69.75 | 6 |
| Graft axiofill 1000mg HCPCS J3590 | $1,395.12 | $3,770.60 | $21.29 – $24.00 | 5 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $824.12 – $1,581.88 | 7 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | $1,837.09 | $4,965.10 | $586.87 – $721.56 | 5 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $1,188.04 – $2,320.56 | 7 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $543.12 | $1,467.90 | $183.04 – $225.04 | 5 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $74.43 | $201.15 | $31.94 – $39.27 | 5 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $543.12 | $1,467.90 | $183.04 – $225.04 | 5 |
| Granisetron hcl injection HCPCS J1626 | $1.83 | $4.95 | $0.62 – $0.77 | 5 |
| Great toe with reduction 28495 CPT 28495 | $329.30 | $890.00 | $157.56 – $549.86 | 29 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $37.00 | $100.00 | $16.66 – $32.77 | 6 |
| Growth hormone antibody CPT 86277 | not published | not published | $15.74 – $111.67 | 29 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $34.24 – $170.10 | 28 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $2,068.90 – $4,084.97 | 7 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $748.42 – $1,487.49 | 7 |
| G-tube reposition CPT 43761 | $536.50 | $1,450.00 | $116.88 – $557.48 | 29 |
| Gu dilat ureter/urethra s&i CPT 74485 | $1,213.69 | $3,280.25 | $34.57 – $542.92 | 7 |
| Guided cath fluid drainage 10030 CPT 10030 | $1,261.42 | $3,409.25 | $174.28 – $1,612.78 | 28 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $7,743.36 | $20,928.00 | $476.99 – $928.83 | 6 |
| Gum graft CPT 41870 | not published | not published | $336.71 – $571.04 | 6 |
| Gynecomastia (males) 19300 CPT 19300 | not published | not published | $413.55 – $867.38 | 7 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $83.92 – $1,403.12 | 28 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.