Ascension St. John Broken Arrow (St. John Broken Arrow, Inc.)
1000 W Boise Cir Broken Arrow OK 74012|3029 West Main St, Jenks, OK · Ascension · · NPI 1497988596
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 |
|---|---|---|---|---|
| Lip surgery procedure CPT 40799 | not published | not published | not published | 0 |
| Listeria monocytogenes CPT 86723 | not published | not published | $13.81 – $20.53 | 2 |
| Lithium therapeutic drug level CPT 80178 | $45.51 | $123.00 | $7.04 – $10.29 | 2 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | not published | not published | $1,297.06 – $1,351.10 | 2 |
| Liver elastography 91200 CPT 91200 | not published | not published | $25.15 – $25.15 | 1 |
| Liver Function Test CPT 80076 | $44.31 | $119.75 | $8.60 – $12.72 | 2 |
| Liver hem/re-expl wnd/remove pack 47362 CPT 47362 | not published | not published | $1,546.03 – $1,627.29 | 2 |
| Liver imaging CPT 78201 | $321.62 | $869.25 | $27.20 – $176.79 | 2 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $31.67 – $186.13 | 2 |
| Liver/spleen imag static only CPT 78215 | $406.08 | $1,097.50 | $30.74 – $179.30 | 2 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $429.48 | $1,160.75 | $35.68 – $104.93 | 2 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $79.04 – $79.99 | 2 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $511.34 – $528.26 | 2 |
| Loudness balance test CPT 92562 | not published | not published | $24.29 – $47.07 | 2 |
| Low back disk surgery CPT 63030 | not published | not published | $1,045.75 – $1,079.48 | 2 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $715.30 | $1,933.25 | $80.04 – $208.39 | 2 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $902.80 | $2,440.00 | $77.00 – $168.87 | 2 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $843.69 | $2,280.25 | $73.00 – $112.82 | 2 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $1,396.84 | $3,775.25 | $147.87 – $266.24 | 2 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $1,054.87 | $2,851.00 | $112.11 – $234.26 | 2 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $924.82 | $2,499.50 | $92.97 – $150.55 | 2 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $148.46 | $401.25 | $13.80 – $24.07 | 2 |
| Lower jaw bone graft CPT 21215 | not published | not published | $941.97 – $998.71 | 2 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $17.85 – $17.85 | 1 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $791.97 – $986.39 | 2 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $914.31 – $1,115.11 | 2 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $905.34 – $1,096.61 | 2 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $997.27 – $1,206.09 | 2 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $23.19 – $34.23 | 2 |
| Lumbar diskogram s&i CPT 72295 | not published | not published | $51.04 – $54.98 | 2 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $1,758.47 – $1,775.48 | 2 |
| Lung function test (mbc/mvv) CPT 94200 | $69.75 | $188.50 | $6.65 – $20.49 | 2 |
| Lung Function Test (Spirometry) CPT 94010 | $99.16 | $268.00 | $10.26 – $27.67 | 2 |
| Lung perfusion imaging CPT 78580 | $394.33 | $1,065.75 | $46.74 – $213.79 | 2 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $1,656.82 – $1,736.95 | 2 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $36.46 – $41.28 | 2 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $783.21 – $786.59 | 2 |
| Lymphatics/lymph node imaging CPT 78195 | $563.97 | $1,524.25 | $75.96 – $314.03 | 2 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $59.67 – $87.91 | 2 |
| Lymphocyte transformation mitogen CPT 86353 | $95.55 | $258.25 | $51.60 – $76.33 | 2 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $55.24 – $81.41 | 2 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $50.29 – $50.29 | 1 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $74.26 – $74.26 | 1 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $51.80 – $51.80 | 1 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $74.26 – $74.26 | 1 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $144.65 – $146.19 | 2 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $151.79 – $160.56 | 2 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $222.10 – $243.98 | 2 |
| Macro exam dissect molec study ea CPT 88387 | $36.54 | $98.75 | $7.55 – $7.55 | 1 |
| Macroscopic exam arthropod CPT 87168 | $49.03 | $132.50 | $4.43 – $6.65 | 2 |
| Macroscopic exam parasite CPT 87169 | $30.43 | $82.25 | $4.43 – $6.65 | 2 |
| Magnesium CPT 83735 | $51.06 | $138.00 | $7.04 – $10.43 | 2 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $100.99 – $313.29 | 2 |
| Malaria antibody CPT 86750 | not published | not published | $11.38 – $14.29 | 2 |
| Male sling procedure CPT 53440 | not published | not published | $846.35 – $1,097.78 | 2 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $3,346.88 – $3,421.84 | 2 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $319.63 – $355.50 | 2 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $411.63 – $446.08 | 2 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $27.47 | $74.25 | $20.91 – $29.83 | 2 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $78.81 | $213.00 | $22.19 – $26.96 | 2 |
| Manipulation of hip joint CPT 27275 | not published | not published | $194.96 – $199.01 | 2 |
| Manipulation of spine CPT 22505 | not published | not published | $136.52 – $146.51 | 2 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $81.74 – $81.74 | 1 |
| Manual diff wbc count b-coat CPT 85009 | $15.73 | $42.50 | $3.91 – $5.80 | 2 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | not published | not published | $51.48 – $89.11 | 2 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | $156.53 – $156.53 | 1 |
| Map tachycard site(s) CPT 93609 | not published | not published | $119.19 – $8,949.00 | 2 |
| Marsupialization liver lesion 47300 CPT 47300 | not published | not published | $1,211.79 – $1,268.32 | 2 |
| Mastectomy partial CPT 19301 | not published | not published | $668.64 – $724.79 | 2 |
| Mast mod rad CPT 19307 | not published | not published | $1,255.34 – $1,328.12 | 2 |
| Mastoidectomy CPT 69501 | not published | not published | $796.19 – $798.63 | 2 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $1,061.42 – $1,064.85 | 2 |
| Mastoids complete CPT 70130 | $93.61 | $253.00 | $21.31 – $37.73 | 2 |
| Mastoid surgery revision CPT 69603 | not published | not published | $1,371.08 – $1,372.38 | 2 |
| Mastopexy CPT 19316 | not published | not published | $847.18 – $850.92 | 2 |
| Mast simple complete CPT 19303 | not published | not published | $1,035.23 – $1,124.05 | 2 |
| M.avium-intra dna amp prob CPT 87561 | $113.31 | $306.25 | $37.00 – $54.64 | 2 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $21.11 – $31.22 | 2 |
| Maxillofacial fixation CPT 21100 | not published | not published | $426.65 – $443.19 | 2 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $42.09 | $113.75 | $15.37 – $22.52 | 2 |
| Mayo aathr protein s free CPT 85306 | $99.44 | $268.75 | $16.16 – $23.86 | 2 |
| Mayo activated protein c resistance assay CPT 85307 | $95.92 | $259.25 | $16.16 – $23.86 | 2 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | not published | not published | $43.78 – $43.78 | 1 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $66.79 | $180.50 | $15.63 – $23.02 | 2 |
| Mayo alpha 1 antitrypsin CPT 82103 | $55.04 | $148.75 | $14.07 – $20.92 | 2 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $65.86 | $178.00 | $15.90 – $23.47 | 2 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $83.99 | $227.00 | $189.36 – $189.36 | 1 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $258.35 | $698.25 | $142.71 – $142.71 | 1 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | not published | not published | $155.50 – $155.50 | 1 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $1,287.60 | $3,480.00 | $1,316.60 – $1,316.60 | 1 |
| Mayo androstenedione CPT 82157 | $115.44 | $312.00 | $31.01 – $45.58 | 2 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $61.61 | $166.50 | $15.37 – $22.73 | 2 |
| Mayo antithrombin iii antigen CPT 85301 | $103.51 | $279.75 | $11.47 – $16.83 | 2 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $59.29 | $160.25 | $15.90 – $23.44 | 2 |
| Mayo avwpr vw factor activity CPT 85397 | $159.66 | $431.50 | $24.23 – $35.72 | 2 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $27.38 | $74.00 | $10.68 – $14.29 | 2 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $109.24 | $295.25 | $225.50 – $225.50 | 1 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | not published | not published | $250.42 – $250.42 | 1 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $55.04 | $148.75 | $13.55 – $20.09 | 2 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $34.04 | $92.00 | $13.81 – $20.53 | 2 |
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.