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 |
|---|---|---|---|---|
| Lymphocyte culture mixed CPT 86821 | not published | not published | $36.56 – $87.91 | 29 |
| Lymphocyte transformation mitogen CPT 86353 | $95.55 | $258.25 | $49.03 – $110.32 | 29 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $49.47 – $426.40 | 29 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $50.29 – $1,417.18 | 28 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $74.26 – $542.92 | 6 |
| Lymph vessel x-ray trunk CPT 75805 | $711.05 | $1,921.75 | $51.80 – $542.92 | 6 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $74.26 – $542.92 | 6 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $144.65 – $1,167.30 | 29 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $151.79 – $294.84 | 7 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $222.10 – $420.44 | 7 |
| Macro exam dissect molec study ea CPT 88387 | $36.54 | $98.75 | $7.55 – $63.27 | 6 |
| Macroscopic exam arthropod CPT 87168 | $49.03 | $132.50 | $4.27 – $56.64 | 29 |
| Macroscopic exam parasite CPT 87169 | $30.43 | $82.25 | $4.31 – $56.64 | 29 |
| Magnesium CPT 83735 | $51.06 | $138.00 | $6.70 – $16.30 | 29 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $31.45 | $85.00 | $0.31 – $0.38 | 5 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $100.99 – $893.90 | 29 |
| Malaria antibody CPT 86750 | not published | not published | $11.38 – $79.86 | 29 |
| Male sling procedure CPT 53440 | not published | not published | $846.35 – $1,592.01 | 7 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $3,346.88 – $6,431.27 | 7 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $319.63 – $701.24 | 7 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $411.63 – $869.72 | 7 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $27.47 | $74.25 | $20.91 – $295.47 | 29 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $78.81 | $213.00 | $22.19 – $295.47 | 29 |
| Manipulation of hip joint CPT 27275 | not published | not published | $194.96 – $386.90 | 7 |
| Manipulation of spine CPT 22505 | $1,649.37 | $4,457.75 | $136.52 – $262.09 | 7 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $81.74 – $549.86 | 28 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $9.25 | $25.00 | $2.80 – $9.29 | 5 |
| Manual diff wbc count b-coat CPT 85009 | $15.73 | $42.50 | $3.91 – $11.41 | 29 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | not published | not published | $51.48 – $523.40 | 7 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | $156.53 – $255.09 | 6 |
| Map tachycard site(s) CPT 93609 | $1,092.24 | $2,952.00 | $119.19 – $8,949.00 | 7 |
| Marker biop eviva buckle ss HCPCS A4648 | $2,042.79 | $5,521.05 | $276.91 – $415.37 | 5 |
| Marsupialization liver lesion 47300 CPT 47300 | not published | not published | $1,211.79 – $2,409.48 | 7 |
| Mastectomy partial CPT 19301 | not published | not published | $668.64 – $1,379.08 | 7 |
| Mast mod rad CPT 19307 | not published | not published | $1,255.34 – $2,529.60 | 7 |
| Mastoidectomy CPT 69501 | not published | not published | $796.19 – $1,577.21 | 7 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $1,061.42 – $2,094.36 | 7 |
| Mastoids complete CPT 70130 | $93.61 | $253.00 | $21.31 – $243.74 | 29 |
| Mastoid surgery revision CPT 69603 | not published | not published | $1,371.08 – $2,701.98 | 7 |
| Mastopexy CPT 19316 | not published | not published | $847.18 – $1,636.48 | 7 |
| Mast simple complete CPT 19303 | not published | not published | $1,035.23 – $2,137.25 | 7 |
| M.avium-intra dna amp prob CPT 87561 | $113.31 | $306.25 | $35.09 – $113.14 | 29 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $21.11 – $113.14 | 29 |
| Maxillofacial fixation CPT 21100 | not published | not published | $426.65 – $732.44 | 7 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $42.09 | $113.75 | $14.46 – $108.04 | 29 |
| Mayo aathr protein s free CPT 85306 | $99.44 | $268.75 | $15.32 – $100.82 | 29 |
| Mayo activated protein c resistance assay CPT 85307 | $95.92 | $259.25 | $15.32 – $108.04 | 29 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | not published | not published | $38.57 – $86.78 | 23 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $66.79 | $180.50 | $14.78 – $108.04 | 29 |
| Mayo alpha 1 antitrypsin CPT 82103 | $55.04 | $148.75 | $13.44 – $32.69 | 29 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $65.86 | $178.00 | $15.08 – $129.19 | 29 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $83.99 | $227.00 | $121.63 – $273.67 | 28 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $258.35 | $698.25 | $79.86 – $206.23 | 28 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | not published | not published | $137.00 – $308.25 | 25 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $1,287.60 | $3,480.00 | $79.86 – $1,316.60 | 6 |
| Mayo androstenedione CPT 82157 | $115.44 | $312.00 | $29.28 – $111.67 | 29 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $61.61 | $166.50 | $14.60 – $108.04 | 29 |
| Mayo antithrombin iii antigen CPT 85301 | $103.51 | $279.75 | $10.81 – $100.82 | 29 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $59.29 | $160.25 | $15.05 – $36.65 | 29 |
| Mayo avwpr vw factor activity CPT 85397 | $159.66 | $431.50 | $24.23 – $100.82 | 29 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | not published | not published | $35.09 – $78.95 | 22 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $27.38 | $74.00 | $10.18 – $22.91 | 29 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $109.24 | $295.25 | $79.86 – $325.89 | 28 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | not published | not published | $79.86 – $482.89 | 28 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $55.04 | $148.75 | $12.90 – $31.39 | 29 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $34.04 | $92.00 | $13.19 – $32.09 | 29 |
| Mayo brcmg brucella antibody igm CPT 86622 | $92.50 | $250.00 | $8.93 – $21.73 | 29 |
| Mayo c1 esterase inhibitor CPT 83883 | $47.18 | $127.50 | $13.60 – $79.86 | 29 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $106.93 | $289.00 | $16.87 – $108.04 | 29 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $121.46 | $328.26 | $26.78 – $65.13 | 29 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | not published | not published | $79.86 – $275.00 | 28 |
| Mayo ceruloplasmin CPT 82390 | $44.22 | $119.50 | $10.74 – $108.04 | 29 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $97.59 | $263.75 | $14.12 – $60.18 | 29 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $170.94 | $462.00 | $12.88 – $62.53 | 29 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $59.11 | $159.75 | $11.82 – $56.64 | 29 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $53.65 | $145.00 | $12.68 – $56.64 | 29 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $346.32 | $936.00 | $116.49 – $262.10 | 29 |
| Mayo chromium CPT 82495 | $134.22 | $362.75 | $20.28 – $49.35 | 29 |
| Mayo coccidioides antibody CPT 86635 | $58.37 | $157.75 | $11.47 – $27.91 | 29 |
| Mayo cocou cortisone urine CPT 82542 | $195.82 | $529.25 | $19.02 – $108.04 | 29 |
| Mayo cortisol free CPT 82530 | $120.34 | $325.25 | $16.71 – $60.18 | 29 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | not published | not published | $42.13 – $94.79 | 22 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $79.83 | $215.75 | $12.12 – $79.86 | 29 |
| Mayo cyanide CPT 82600 | $71.97 | $194.50 | $19.40 – $112.27 | 29 |
| Mayo cytopathology in situ hybridization urinary tract 3-5 probes each specimen manual CPT 88120 | not published | not published | $174.57 – $580.96 | 28 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $43.75 | $118.25 | $13.25 – $62.53 | 29 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $117.85 | $318.50 | $25.27 – $108.04 | 29 |
| Mayo dihydrotestosterone CPT 82642 | $93.98 | $254.00 | $29.28 – $65.88 | 25 |
| Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid CPT 83518 | not published | not published | $8.86 – $62.53 | 29 |
| Mayo efpo chloride stool CPT 82438 | $62.62 | $169.25 | $5.00 – $11.89 | 29 |
| Mayo estriol CPT 82677 | $98.70 | $266.75 | $24.18 – $111.67 | 29 |
| Mayo estrone CPT 82679 | $75.20 | $203.25 | $24.95 – $111.67 | 29 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $66.51 | $179.75 | $16.34 – $129.19 | 29 |
| Mayo everolimus therapeutic drug level CPT 80169 | $75.85 | $205.00 | $13.73 – $129.19 | 28 |
| Mayo factor ii CPT 85210 | $96.76 | $261.50 | $12.98 – $38.30 | 29 |
| Mayo factor v CPT 85220 | $104.16 | $281.50 | $17.65 – $100.82 | 29 |
| Mayo factor vii CPT 85230 | $97.22 | $262.75 | $17.90 – $100.82 | 29 |
| Mayo factor viii vw factor antigen CPT 85246 | $100.46 | $271.50 | $22.94 – $100.82 | 29 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $147.63 | $399.00 | $22.94 – $100.82 | 29 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $92.41 | $249.75 | $22.94 – $100.82 | 29 |
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.