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 |
|---|---|---|---|---|
| Subsequent intensive care infant 1500-2500 grams 99479 CPT 99479 | not published | not published | $138.96 – $150.22 | 2 |
| Subsequent intensive care infant 2501-5000 grams 99480 CPT 99480 | not published | not published | $134.17 – $144.44 | 2 |
| Subtalar arthro w/deb CPT 29906 | not published | not published | $762.56 – $1,494.53 | 7 |
| Subtalar arthro w/exc CPT 29905 | not published | not published | $728.20 – $1,458.65 | 7 |
| Subtalar arthro w/fb rmvl CPT 29904 | not published | not published | $677.59 – $1,347.09 | 7 |
| Subtalar arthro w/fusion CPT 29907 | not published | not published | $943.30 – $1,851.77 | 7 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $61.83 | $167.10 | $0.45 – $9.29 | 5 |
| Suction lipectomy head&neck CPT 15876 | not published | not published | $1,081.88 – $1,081.88 | 5 |
| Suction lipectomy lwr extrem CPT 15879 | not published | not published | $1,929.84 – $1,929.84 | 5 |
| Suction lipectomy trunk CPT 15877 | not published | not published | $5,457.56 – $5,457.56 | 5 |
| Suction lipectomy upr extrem CPT 15878 | not published | not published | $1,081.88 – $1,081.88 | 5 |
| Sugars multiple quant CPT 84379 | not published | not published | $11.53 – $60.18 | 29 |
| Sugars single quant CPT 84378 | $92.91 | $251.10 | $11.53 – $60.18 | 29 |
| Sup of prep of antigen # of vials 95144 CPT 95144 | not published | not published | $3.53 – $105.77 | 24 |
| Supprelin la implant HCPCS J9226 | $25,852.66 | $69,872.05 | $6,909.77 – $28,243.06 | 5 |
| Surg dx exam anorectal CPT 45990 | not published | not published | $120.08 – $228.55 | 7 |
| Surg ect salp-oophorectomy 59120 CPT 59120 | not published | not published | $884.13 – $1,708.25 | 7 |
| Surg ect without salp-oophorectomy 59121 CPT 59121 | not published | not published | $886.93 – $1,709.80 | 7 |
| Surgery for urethra pouch CPT 53240 | not published | not published | $475.07 – $894.68 | 7 |
| Surgery to stop leg growth CPT 27475 | not published | not published | $716.55 – $1,394.68 | 7 |
| Surgery to stop leg growth CPT 27477 | not published | not published | $805.18 – $1,545.21 | 7 |
| Surgery to stop leg growth CPT 27479 | not published | not published | $1,017.65 – $1,847.86 | 7 |
| Surgery to stop leg growth CPT 27485 | not published | not published | $733.23 – $1,414.18 | 7 |
| Surgical exposure prostate 55860 CPT 55860 | not published | not published | $985.95 – $1,851.77 | 7 |
| Surgical opening of stomach CPT 43510 | not published | not published | $955.15 – $2,149.09 | 29 |
| Surgical opening of stomach 43500 CPT 43500 | not published | not published | $850.58 – $1,672.36 | 7 |
| Surgical opening of throat CPT 42955 | not published | not published | $805.35 – $1,624.78 | 7 |
| Surgical pathology level 1 gross examination only CPT 88300 | $23.31 | $63.00 | $5.24 – $56.14 | 29 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $48.56 | $131.25 | $7.98 – $113.79 | 29 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $50.14 | $135.50 | $13.40 – $122.47 | 29 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $68.45 | $185.00 | $29.83 – $122.47 | 29 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $160.30 | $433.25 | $97.83 – $824.56 | 29 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $208.22 | $562.75 | $169.10 – $1,872.50 | 29 |
| Surgical repair stomach bleedin ulcer 43501 CPT 43501 | not published | not published | $1,467.01 – $2,863.46 | 7 |
| Surgical repair stomach gastric lac 43502 CPT 43502 | not published | not published | $1,662.19 – $3,238.64 | 7 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | not published | not published | $408.56 – $884.54 | 7 |
| Susceptibility agar dilution per agent CPT 87181 | $20.72 | $56.00 | $1.84 – $10.69 | 29 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $13.97 | $37.75 | $1.84 – $10.69 | 29 |
| Susceptibility mic per plate CPT 87186 | $163.98 | $443.20 | $8.65 – $56.64 | 29 |
| Suscept studies macrobroth dilution ea CPT 87188 | not published | not published | $6.64 – $56.64 | 29 |
| Suspension of testis CPT 54620 | not published | not published | $336.60 – $632.60 | 7 |
| Suspension of uterus 58400 CPT 58400 | not published | not published | $484.76 – $943.04 | 7 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | not published | not published | $1,163.76 – $2,251.91 | 7 |
| Suture bile duct injury 47900 CPT 47900 | not published | not published | $1,482.23 – $2,923.52 | 7 |
| Svc venogram s&i CPT 75827 | $867.10 | $2,343.50 | $70.46 – $542.92 | 7 |
| Sweat collection by iontophoresis CPT 89230 | $50.14 | $135.50 | $2.73 – $122.47 | 29 |
| Sympathectomy cervical CPT 64802 | not published | not published | $675.86 – $1,138.83 | 7 |
| Sympathectomy digital artery CPT 64820 | not published | not published | $784.98 – $1,585.79 | 7 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $837.88 – $1,678.60 | 7 |
| Synthetic sentence id test CPT 92576 | not published | not published | $22.59 – $89.98 | 29 |
| Synvisc or synvisc-one HCPCS J7325 | $1,242.63 | $3,358.45 | $20.38 – $21.84 | 5 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $45.70 | $123.50 | $4.40 – $62.53 | 29 |
| T3 (triiodothyronine) free CPT 84481 | $89.82 | $242.75 | $16.94 – $85.28 | 29 |
| T3 (triiodothyronine) total CPT 84480 | $59.02 | $159.50 | $14.18 – $85.28 | 29 |
| T4 (thyroxine) free CPT 84439 | $61.33 | $165.75 | $9.02 – $85.28 | 29 |
| T4 (thyroxine) total CPT 84436 | $41.26 | $111.50 | $6.87 – $16.71 | 29 |
| Tacrol envarsus ex rel oral HCPCS J7503 | $2.74 | $7.40 | $1.39 – $1.49 | 4 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $1.36 | $3.68 | $2.03 – $2.49 | 5 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $176.77 | $477.75 | $199.53 – $231.22 | 5 |
| Tacrolimus therapeutic drug level CPT 80197 | $96.66 | $261.25 | $13.73 – $129.19 | 29 |
| Tah rad debulk/lymph remove 58954 CPT 58954 | not published | not published | $2,410.24 – $4,580.27 | 7 |
| Tah rad dissect for debulk 58953 CPT 58953 | not published | not published | $2,219.74 – $4,226.14 | 7 |
| Tah w/mmk 58152 CPT 58152 | not published | not published | $1,383.96 – $2,698.10 | 7 |
| Tap block bilat cont infusion 64489 CPT 64489 | not published | not published | $89.95 – $369.38 | 5 |
| Tap block uni by cont infusion 64487 CPT 64487 | not published | not published | $76.90 – $265.98 | 5 |
| Target gsa panel hmtlmph neop CPT 81450 | $925.19 | $2,500.50 | $741.09 – $1,708.94 | 23 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $1,259.70 | $3,404.60 | $3,313.75 – $3,313.75 | 1 |
| Target gsa panel organ neop CPT 81445 | $1,426.07 | $3,854.25 | $597.91 – $1,345.30 | 23 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $147.82 – $1,403.12 | 29 |
| Tavr perq femoral CPT 33361 | not published | not published | $1,547.39 – $2,882.96 | 6 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $332.56 | $898.80 | $1.19 – $1.27 | 4 |
| Tbs techl calculation only CPT 77091 | not published | not published | $89.70 – $201.83 | 22 |
| Tbs techl prep&transmis data CPT 77090 | not published | not published | $89.70 – $201.83 | 22 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $85.93 | $232.25 | $79.86 – $225.00 | 28 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $77.52 | $209.50 | $61.98 – $139.45 | 29 |
| Tc-99m bicisate HCPCS A9557 | $2,525.34 | $6,825.25 | $463.03 – $569.29 | 5 |
| Tc-99m exametazime diag HCPCS A9521 | $2,832.07 | $7,654.25 | $1,811.81 – $2,227.64 | 5 |
| Tc-99m labeled rbc HCPCS A9560 | $265.66 | $718.00 | $116.23 – $142.91 | 5 |
| Tc-99m maa HCPCS A9540 | $281.20 | $760.00 | $24.83 – $30.52 | 5 |
| Tc-99m mebrofenin HCPCS A9537 | $111.28 | $300.75 | $59.32 – $72.93 | 5 |
| Tc-99m medronate HCPCS A9503 | $43.11 | $116.50 | $16.18 – $19.89 | 5 |
| Tc-99m mertiatide HCPCS A9562 | $582.84 | $1,575.25 | $964.13 – $1,106.38 | 5 |
| Tc-99m oxidronate HCPCS A9561 | $83.99 | $227.00 | $40.10 – $49.30 | 5 |
| Tc-99m pentetate dtpa HCPCS A9539 | $161.23 | $435.75 | $38.99 – $47.94 | 5 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $49.12 | $132.75 | $6.35 – $9.53 | 5 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $130.80 | $353.50 | $21.86 – $26.88 | 5 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $373.42 | $1,009.25 | $745.92 – $917.12 | 5 |
| Tc-99m sulfur colloid HCPCS A9541 | $199.25 | $538.50 | $66.54 – $81.81 | 5 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $138.29 | $373.75 | $90.96 – $111.84 | 5 |
| Tc-99m tilmanocept diag HCPCS A9520 | $801.70 | $2,166.75 | $281.76 – $346.43 | 5 |
| Tca peel dermal 15789 CPT 15789 | not published | not published | $454.09 – $1,403.12 | 29 |
| Tcd emboli detect w/inj CPT 93893 | not published | not published | $70.83 – $720.73 | 29 |
| Tcd emboli detect without inj CPT 93892 | not published | not published | $70.43 – $676.27 | 29 |
| T-cell depletion of harvest CPT 38210 | not published | not published | $93.21 – $1,002.11 | 29 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $185.28 | $500.75 | $46.98 – $105.70 | 29 |
| T cells absolute cd 4 count CPT 86361 | $110.72 | $299.25 | $26.78 – $79.86 | 29 |
| T cells total count CPT 86359 | $68.92 | $186.26 | $37.73 – $84.89 | 29 |
| Tcranial magn stim tx deli CPT 90868 | not published | not published | $317.24 – $767.92 | 27 |
| Tcranial magn stim tx plan CPT 90867 | not published | not published | $317.24 – $857.53 | 27 |
| Tcran magn stim redetemine CPT 90869 | not published | not published | $317.24 – $767.92 | 27 |
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.