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 |
|---|---|---|---|---|
| MRA without cont, abd HCPCS C8901 | $560.27 | $1,514.25 | $950.85 – $950.85 | 5 |
| MRA without cont, lwr ext HCPCS C8913 | $1,120.55 | $3,028.50 | $757.13 – $957.08 | 6 |
| MRA without fol w/cont, abd HCPCS C8902 | $980.13 | $2,649.00 | $950.85 – $950.85 | 5 |
| MRA without fol w/cont, lwr ext HCPCS C8914 | $1,907.17 | $5,154.50 | $957.08 – $1,288.63 | 6 |
| MRA without fol w/cont, pelvis HCPCS C8920 | $810.76 | $2,191.25 | $2,149.97 – $2,149.97 | 5 |
| Mra, w/o&w/dye, spinal canal HCPCS C8933 | $555.93 | $1,502.50 | $964.89 – $964.89 | 5 |
| Mra, w/o&w/dye, upper extr HCPCS C8936 | $1,085.03 | $2,932.50 | $2,149.97 – $2,149.97 | 5 |
| Mr elastography CPT 76391 | not published | not published | $179.61 – $554.06 | 25 |
| MRI brain w/dye CPT 70558 | not published | not published | $181.36 – $987.50 | 28 |
| MRI brain without dye CPT 70557 | not published | not published | $183.36 – $1,256.81 | 28 |
| MRI brain without & w/dye CPT 70559 | not published | not published | $181.36 – $1,173.93 | 28 |
| MRI breast c- unilateral CPT 77046 | $663.69 | $1,793.75 | $172.28 – $554.06 | 23 |
| MRI breast c-+ w/cad uni CPT 77048 | not published | not published | $283.93 – $477.50 | 3 |
| MRI breast without cont bi CPT 77047 | $869.96 | $2,351.25 | $171.59 – $554.06 | 25 |
| MRI breast w IV cont bi CPT 77049 | not published | not published | $282.54 – $475.52 | 3 |
| MRI cardiac morph & func wo IV cont CPT 75557 | $717.52 | $1,939.25 | $152.98 – $744.91 | 29 |
| MRI cardiac morph & func wwo IV cont CPT 75561 | $884.49 | $2,390.50 | $168.98 – $989.07 | 29 |
| MRI cardiac morph & func wwo IV cont w/stress img CPT 75563 | not published | not published | $201.28 – $1,810.98 | 29 |
| MRI chest without contrast CPT 71550 | $901.97 | $2,437.75 | $91.34 – $953.19 | 29 |
| MRI chest without & w/contrast CPT 71552 | $1,182.06 | $3,194.75 | $142.78 – $1,348.65 | 29 |
| MRI chest w IV cont CPT 71551 | $927.41 | $2,506.50 | $108.17 – $1,810.98 | 29 |
| MRI fetal ea addl gestation CPT 74713 | not published | not published | $141.21 – $413.93 | 5 |
| MRI fetal sngl/1st gestation CPT 74712 | not published | not published | $112.82 – $855.95 | 27 |
| MRI guid ndl plc s&i CPT 77021 | $388.78 | $1,050.75 | $95.29 – $682.97 | 7 |
| MRI guid parenchymal tiss ablation CPT 77022 | not published | not published | $265.24 – $1,492.39 | 6 |
| MRI loex nonjt w IV cont CPT 73719 | $1,953.60 | $5,280.00 | $101.53 – $957.87 | 29 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $2,051.28 | $5,544.00 | $84.59 – $843.20 | 29 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $2,141.75 | $5,788.50 | $135.23 – $1,171.60 | 29 |
| MRI orbit/face/neck without contrast CPT 70540 | $932.86 | $2,521.25 | $84.59 – $826.82 | 29 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $1,270.49 | $3,433.75 | $134.83 – $1,146.64 | 29 |
| MRI orbit fac&nck w IV cont CPT 70542 | $940.26 | $2,541.25 | $101.53 – $932.91 | 29 |
| MRI tmj CPT 70336 | $372.68 | $1,007.25 | $92.97 – $734.78 | 29 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $1,932.33 | $5,222.50 | $84.19 – $848.67 | 29 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $2,248.86 | $6,078.00 | $135.23 – $1,163.79 | 29 |
| MRI upper extremity w/dye CPT 73219 | $1,854.07 | $5,011.00 | $101.53 – $942.27 | 29 |
| MRI w/cont, breast, bi HCPCS C8906 | $991.69 | $2,680.25 | $2,153.56 – $2,153.56 | 5 |
| MRI without fol w/cont, breast HCPCS C8908 | $991.69 | $2,680.25 | $1,245.69 – $1,245.69 | 5 |
| MRI without fol w/cont, brst, un HCPCS C8905 | $781.26 | $2,111.50 | $1,255.05 – $1,255.05 | 5 |
| Mr safety determination physician/other qhp CPT 76016 | not published | not published | $89.70 – $201.83 | 22 |
| Mr safety implant elec prepj CPT 76018 | not published | not published | $93.51 – $210.40 | 22 |
| Mr safety implt pos&/immoblj CPT 76019 | not published | not published | $60.51 – $136.15 | 22 |
| Mr sfty implt&/fb asmt stf 1 CPT 76014 | not published | not published | $24.95 – $56.14 | 22 |
| Mr sfty med physics xm cstmz CPT 76017 | not published | not published | $246.25 – $554.06 | 22 |
| Mr spectroscopy CPT 76390 | $442.89 | $1,197.00 | $86.43 – $928.23 | 29 |
| Msh2 gene dup/delete variant CPT 81297 | not published | not published | $79.86 – $479.93 | 28 |
| Msh2 gene full seq CPT 81295 | not published | not published | $79.86 – $858.82 | 28 |
| Msh2 gene known variants CPT 81296 | not published | not published | $79.86 – $759.89 | 28 |
| Msh6 gene dup/delete variant CPT 81300 | not published | not published | $79.86 – $535.50 | 28 |
| Msh6 gene full seq CPT 81298 | not published | not published | $79.86 – $1,444.16 | 28 |
| Msh6 gene known variants CPT 81299 | not published | not published | $79.86 – $693.00 | 28 |
| Mthfr gene analy common variants CPT 81291 | $383.14 | $1,035.50 | $65.34 – $147.02 | 28 |
| M.tuberculo dna dir probe CPT 87555 | not published | not published | $21.11 – $113.14 | 29 |
| Mucin synovial fluid CPT 83872 | not published | not published | $5.86 – $60.18 | 29 |
| Mucopolysaccharides CPT 83864 | not published | not published | $21.11 – $108.04 | 29 |
| Multi family grp psychotherapy CPT 90849 | not published | not published | $34.47 – $368.28 | 29 |
| Multifocal erg w/i&r CPT 92274 | not published | not published | $94.44 – $358.63 | 24 |
| Multiple sleep latency test CPT 95805 | $1,166.89 | $3,153.75 | $113.11 – $1,216.24 | 29 |
| Mumps antibody igg CPT 86735 | $45.23 | $122.25 | $13.05 – $31.75 | 29 |
| Muscle-skin graft arm CPT 15736 | not published | not published | $1,261.52 – $2,450.04 | 7 |
| Muscle-skin graft leg CPT 15738 | not published | not published | $1,365.17 – $2,652.07 | 7 |
| Muscle-skin graft trunk CPT 15734 | not published | not published | $1,461.78 – $2,818.22 | 7 |
| Muscle test cran nerv unilat CPT 95867 | $149.11 | $403.00 | $33.06 – $713.79 | 29 |
| Muscle test hemidiaphragm CPT 95866 | not published | not published | $29.98 – $358.63 | 29 |
| Muscle test larynx CPT 95865 | not published | not published | $33.96 – $295.47 | 29 |
| Muscle test one fiber CPT 95872 | not published | not published | $28.97 – $429.79 | 29 |
| Muscle transfers CPT 23397 | not published | not published | $1,264.32 – $2,411.04 | 7 |
| Muscle transfer shoulder/arm CPT 23395 | not published | not published | $1,416.72 – $2,723.05 | 7 |
| Musc/tdn transfer upr a/e 1 CPT 24301 | not published | not published | $823.98 – $1,576.41 | 7 |
| Mycobacteria dna amp probe CPT 87551 | $145.04 | $392.00 | $37.00 – $113.14 | 29 |
| Mycophenolate mofetil 250 mg capsule HCPCS J7517 | $359.47 | $971.55 | $1.50 – $1.84 | 5 |
| Mycoplasma antibody igm CPT 86738 | $25.35 | $68.50 | $13.24 – $32.22 | 29 |
| Myd88 gene p.leu265pro vrnt CPT 81305 | $275.65 | $745.00 | $175.40 – $394.65 | 25 |
| Myelogphy 2/> spine regions CPT 72270 | $542.14 | $1,465.25 | $60.72 – $1,810.98 | 29 |
| Myelography l-s spine CPT 72265 | $482.85 | $1,305.00 | $51.38 – $1,810.98 | 29 |
| Myelography neck spine CPT 72240 | $436.60 | $1,180.00 | $53.54 – $1,810.98 | 29 |
| Myelography thoracic spine CPT 72255 | $464.81 | $1,256.25 | $52.46 – $1,810.98 | 29 |
| Myelography via inj w/s&i 2+ regions CPT 62305 | $911.87 | $2,464.50 | $142.23 – $1,810.98 | 27 |
| Myelography via inj w/s&i cervical CPT 62302 | $690.14 | $1,865.25 | $138.70 – $1,810.98 | 27 |
| Myelography via inj w/s&i lumbosacral CPT 62304 | $849.61 | $2,296.25 | $135.98 – $1,810.98 | 27 |
| Myelography via inj w/s&i thoracic CPT 62303 | $715.86 | $1,934.75 | $139.78 – $1,810.98 | 27 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $295.72 | $799.25 | $11.53 – $28.07 | 29 |
| Myocardial resection 33542 CPT 33542 | not published | not published | $2,976.58 – $5,715.20 | 7 |
| Myocrd img pet 1std rst/strs CPT 78491 | not published | not published | $98.80 – $2,111.51 | 6 |
| Myocrd img pet mlt rst&strs CPT 78492 | not published | not published | $124.41 – $2,120.88 | 6 |
| Myomectomy abdom complex CPT 58146 | not published | not published | $1,277.60 – $2,501.52 | 7 |
| Myomectomy abdom method CPT 58140 | not published | not published | $1,017.31 – $1,987.49 | 7 |
| Myomectomy vag method CPT 58145 | not published | not published | $604.16 – $1,174.71 | 7 |
| Myringoplasty CPT 69620 | not published | not published | $531.16 – $1,049.91 | 7 |
| Nalbuphine 10 mg/ml injection solution HCPCS J2300 | $14.10 | $38.10 | $2.60 – $21.29 | 5 |
| Narcosynthesis CPT 90865 | not published | not published | $143.78 – $368.28 | 29 |
| Nasal endoscopy dx uni/bi separate proc CPT 31231 | $139.12 | $376.00 | $72.22 – $445.00 | 29 |
| Nasal endoscopy with removal of nasal foreign body CPT 30999 | not published | not published | $236.58 – $4,162.07 | 27 |
| Nasal function studies CPT 92512 | not published | not published | $31.77 – $713.79 | 29 |
| Nasal/sinus endoscopy surg CPT 31287 | not published | not published | $257.76 – $499.21 | 7 |
| Nasal/sinus endoscopy surg w/bx 31237 CPT 31237 | not published | not published | $178.39 – $389.24 | 7 |
| Nasal/sinus endo spendt remove tiss 31288 CPT 31288 | not published | not published | $299.08 – $578.78 | 7 |
| Nasal/sinus endo surg w/concha bullosa resct 31240 CPT 31240 | not published | not published | $178.09 – $345.55 | 7 |
| Nasal/sinus endo w/ethmoidectomy part 31254 CPT 31254 | not published | not published | $303.75 – $586.57 | 7 |
| Nasal/sinus endo w/ethmoidectomy tot 31255 CPT 31255 | not published | not published | $445.50 – $859.59 | 7 |
| Nasal/sinus endo w/front sinus expl 31276 CPT 31276 | not published | not published | $562.20 – $1,085.01 | 7 |
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.