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 |
|---|---|---|---|---|
| Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/< CPT 14040 | $2,004.20 | $5,416.75 | $696.52 – $700.10 | 2 |
| Xfer tis s/a/l 10 sq cm/< CPT 14020 | not published | not published | $613.38 – $622.97 | 2 |
| Xm archive tissue molec anal CPT 88363 | not published | not published | $22.27 – $22.27 | 1 |
| Xpos opn fmrl eprst aor uni add-on CPT 34812 | not published | not published | $388.49 – $426.83 | 2 |
| X-ray abdomen 1 view CPT 74018 | $116.83 | $315.75 | $21.25 – $21.25 | 1 |
| X-ray abdomen 2 views CPT 74019 | $158.73 | $429.00 | $26.13 – $26.13 | 1 |
| X-ray abdomen >=3 views CPT 74021 | $158.73 | $429.00 | $30.32 – $30.32 | 1 |
| X-ray abdomen complete acute series including spine erect and/or decubitus single view chest CPT 74022 | $199.80 | $540.00 | $20.08 – $28.75 | 2 |
| X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 | $117.94 | $318.75 | $12.86 – $25.15 | 2 |
| X-ray ankle 2 views (both sides) CPT 73600 | $230.51 | $623.00 | $9.79 – $21.57 | 2 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $267.14 | $722.00 | $33.88 – $73.30 | 2 |
| X-ray bone age studies CPT 77072 | $170.57 | $461.00 | $11.99 – $13.65 | 2 |
| X-ray bone length studies CPT 77073 | $150.41 | $406.50 | $16.94 – $21.57 | 2 |
| X-ray bone survey complete CPT 77075 | $330.04 | $892.00 | $33.88 – $60.72 | 2 |
| X-ray bone survey infant CPT 77076 | $158.36 | $428.00 | $42.47 – $62.16 | 2 |
| X-ray cervical spine 2-3 views CPT 72040 | $148.46 | $401.25 | $13.80 – $21.93 | 2 |
| X-ray cervical spine 4-5 views CPT 72050 | $184.82 | $499.50 | $19.21 – $29.83 | 2 |
| X-ray cervical spine >= 6 views CPT 72052 | $217.93 | $589.00 | $22.65 – $38.09 | 2 |
| X-ray clavicle complete (both sides) CPT 73000 | $242.35 | $655.00 | $10.19 – $19.41 | 2 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | $287.68 | $777.50 | $43.60 – $112.82 | 2 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | $340.40 | $920.00 | $62.34 – $112.82 | 2 |
| X-ray elbow 2 views (both sides) CPT 73070 | $225.89 | $610.50 | $9.32 – $19.41 | 2 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $238.28 | $644.00 | $10.66 – $22.64 | 2 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | $221.54 | $598.75 | $28.93 – $65.75 | 2 |
| X-ray exam entire spi 4/5 vw CPT 72083 | $195.36 | $528.00 | $50.67 – $50.67 | 1 |
| X-ray exam entire spi 6/> vw CPT 72084 | not published | not published | $60.72 – $60.72 | 1 |
| X-ray exam of arm infant CPT 73092 | $167.06 | $451.50 | $9.79 – $19.77 | 2 |
| X-ray exam of eye sockets CPT 70200 | $74.93 | $202.50 | $17.41 – $28.39 | 2 |
| X-ray exam of femur 1 CPT 73551 | $110.54 | $298.75 | $19.77 – $19.77 | 1 |
| X-ray exam of jaw joint CPT 70328 | $57.44 | $155.25 | $11.12 – $21.57 | 2 |
| X-ray exam of jaw joint CPT 70332 | not published | not published | $33.08 – $49.59 | 2 |
| X-ray exam of mastoids CPT 70120 | $48.01 | $129.75 | $11.12 – $24.80 | 2 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $21.31 – $34.49 | 2 |
| X-ray exam of penis CPT 74445 | not published | not published | $49.19 – $49.19 | 1 |
| X-ray exam of perineum CPT 74775 | $160.95 | $435.00 | $39.12 – $39.12 | 1 |
| X-ray exam of salivary gland CPT 70380 | $53.47 | $144.50 | $10.66 – $26.96 | 2 |
| X-ray exam of sinuses CPT 70210 | $70.67 | $191.00 | $10.66 – $21.20 | 2 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $18.74 – $18.74 | 1 |
| X-ray exam of teeth CPT 70300 | not published | not published | $6.58 – $8.99 | 2 |
| X-ray exam of teeth CPT 70310 | not published | not published | $10.19 – $28.39 | 2 |
| X-ray exam si joints CPT 72200 | $120.71 | $326.25 | $10.66 – $19.77 | 2 |
| X-ray exam thorac spine4/>vw CPT 72074 | $175.01 | $473.00 | $13.80 – $28.39 | 2 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $45.70 | $123.50 | $10.66 – $19.41 | 2 |
| X-ray facial bones complete > 3 views CPT 70150 | $95.18 | $257.25 | $16.07 – $28.39 | 2 |
| X-ray fallopian tube CPT 74742 | not published | not published | $38.25 – $38.25 | 1 |
| X-ray femur >=2 views (both sides) CPT 73552 | $232.18 | $627.50 | $23.36 – $23.36 | 1 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $240.32 | $649.50 | $8.38 – $24.80 | 2 |
| X-ray foot 2 views (both sides) CPT 73620 | $232.18 | $627.50 | $9.79 – $18.33 | 2 |
| X-ray forearm 2 views (both sides) CPT 73090 | $235.32 | $636.00 | $9.79 – $17.62 | 2 |
| X-ray hand 2 views (both sides) CPT 73120 | $240.32 | $649.50 | $9.79 – $17.97 | 2 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $9.70 – $10.66 | 2 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $220.15 | $595.00 | $9.79 – $19.05 | 2 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $161.69 | $437.00 | $37.73 – $37.73 | 1 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $107.67 | $291.00 | $28.39 – $28.39 | 1 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $159.19 | $430.25 | $34.14 – $34.14 | 1 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | not published | not published | $40.96 – $40.96 | 1 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $100.27 | $271.00 | $20.49 – $20.49 | 1 |
| X-ray humerus >= 2 views left CPT 73060 | $124.23 | $335.75 | $10.66 – $20.85 | 2 |
| X-ray joint survey 1 view CPT 77077 | $284.16 | $768.00 | $19.51 – $21.20 | 2 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $207.20 | $560.00 | $10.66 – $22.64 | 2 |
| X-ray knee 3 views (both sides) CPT 73562 | $243.65 | $658.50 | $11.52 – $26.59 | 2 |
| X-ray knee ap standing bilateral CPT 73565 | $89.82 | $242.75 | $11.05 – $27.31 | 2 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $227.92 | $616.00 | $9.79 – $19.77 | 2 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $192.03 | $519.00 | $13.80 – $29.46 | 2 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $227.00 | $613.50 | $19.21 – $33.41 | 2 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $266.22 | $719.50 | $22.65 – $45.99 | 2 |
| X-ray male genital tract CPT 74440 | not published | not published | $23.98 – $63.24 | 2 |
| X-ray mandible complete > 4 views CPT 70110 | $113.31 | $306.25 | $15.60 – $25.51 | 2 |
| X-ray mandible ltd <4 views CPT 70100 | $81.12 | $219.25 | $11.12 – $24.07 | 2 |
| X-ray nasal bones complete > 3 views CPT 70160 | $95.37 | $257.75 | $10.66 – $24.07 | 2 |
| X-ray neck soft tissue CPT 70360 | $109.15 | $295.00 | $10.66 – $19.77 | 2 |
| X-ray nose to rectum for foreign body child CPT 76010 | $66.51 | $179.75 | $11.52 – $17.25 | 2 |
| X-ray of mammary ducts CPT 77054 | $233.56 | $631.25 | $28.46 – $55.33 | 2 |
| X-ray optic foramina CPT 70190 | not published | not published | $12.93 – $24.44 | 2 |
| X-ray pelvis 1-2 views CPT 72170 | $116.00 | $313.50 | $10.66 – $23.36 | 2 |
| X-ray pelvis complete > 3 views CPT 72190 | $127.74 | $345.25 | $13.33 – $27.31 | 2 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $289.25 | $781.75 | $23.05 – $52.99 | 2 |
| X-ray ribs 2 views left CPT 71100 | $172.88 | $467.25 | $13.80 – $21.93 | 2 |
| X-ray ribs 3 views bilateral CPT 71110 | $197.49 | $533.75 | $16.54 – $24.07 | 2 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $206.74 | $558.75 | $16.54 – $23.00 | 2 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $225.61 | $609.75 | $19.68 – $31.98 | 2 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $129.04 | $348.75 | $11.99 – $23.72 | 2 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $124.32 | $336.00 | $10.66 – $19.41 | 2 |
| X-ray scapula complete (both sides) CPT 73010 | $259.56 | $701.50 | $10.66 – $21.20 | 2 |
| X-ray sella turcica CPT 70240 | not published | not published | $11.99 – $20.49 | 2 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $224.04 | $605.50 | $9.32 – $15.10 | 2 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $95.37 | $257.75 | $15.20 – $25.15 | 2 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $245.22 | $662.75 | $29.11 – $34.28 | 2 |
| X-ray skull < 4 views CPT 70250 | $95.37 | $257.75 | $14.74 – $23.72 | 2 |
| X-ray skull > 4 views complete CPT 70260 | $115.35 | $311.75 | $20.91 – $28.39 | 2 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $240.59 | $650.25 | $36.45 – $60.72 | 2 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $172.14 | $465.25 | $29.40 – $80.85 | 2 |
| X-ray small intestine follow-through study CPT 74248 | $90.37 | $244.25 | $52.33 – $52.33 | 1 |
| X-ray spine single view CPT 72020 | $120.99 | $327.00 | $9.72 – $14.38 | 2 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $125.80 | $340.00 | $13.80 – $24.80 | 2 |
| X-ray sternum > 2 views CPT 71120 | $114.33 | $309.00 | $12.46 – $19.41 | 2 |
| X-ray surgical specimen CPT 76098 | $209.61 | $566.50 | $8.63 – $10.19 | 2 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $240.41 | $649.75 | $33.41 – $102.40 | 2 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $101.47 | $274.25 | $15.13 – $35.93 | 2 |
| X-ray thoracic spine 2 views CPT 72070 | $148.46 | $401.25 | $13.80 – $23.00 | 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.