SSM Health St. Anthony Hospital - Midwest
2825 Parklawn Drive, Midwest City, OK · SSM Health · · NPI 1700471497
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 |
|---|---|---|---|---|
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $1.06 – $2.25 | 4 |
| Lomustine 10 mg HCPCS S0178 | not published | not published | $118.11 – $171.08 | 2 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $226.61 – $441.89 | 9 |
| Long tongue stirrup HCPCS L2265 | not published | not published | $180.44 – $386.14 | 8 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | not published | not published | $1.79 – $2.50 | 4 |
| Lo rig pos pnl l1-l5 pre ots HCPCS L0641 | not published | not published | $57.10 – $122.19 | 8 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | not published | not published | $96.31 – $206.10 | 8 |
| Loudness balance test CPT 92562 | not published | not published | $69.44 – $544.95 | 8 |
| Low back disk surgery CPT 63030 | not published | not published | $1,388.55 – $14,934.65 | 10 |
| Low cost skin substitute app HCPCS C5271 | not published | not published | $731.00 – $1,579.00 | 4 |
| Low cost skin substitute app HCPCS C5273 | not published | not published | $1,411.00 – $8,185.00 | 4 |
| Low cost skin substitute app HCPCS C5275 | not published | not published | $731.00 – $1,579.00 | 4 |
| Low cost skin substitute app HCPCS C5277 | not published | not published | $731.00 – $1,579.00 | 4 |
| Low cost skin substitute app HCPCS C5272 | not published | not published | $731.00 – $1,496.00 | 2 |
| Low cost skin substitute app HCPCS C5274 | not published | not published | $731.00 – $1,496.00 | 2 |
| Low cost skin substitute app HCPCS C5276 | not published | not published | $731.00 – $1,496.00 | 2 |
| Low cost skin substitute app HCPCS C5278 | not published | not published | $731.00 – $1,496.00 | 2 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $4,397.25 | $7,995.00 | $168.70 – $361.01 | 8 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $4,180.55 | $7,601.00 | $167.16 – $718.05 | 8 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $4,180.55 | $7,601.00 | $100.55 – $215.17 | 8 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,833.97 | $6,970.85 | $317.58 – $718.05 | 8 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $3,833.97 | $6,970.85 | $279.73 – $892.83 | 8 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,060.27 | $3,745.95 | $182.50 – $604.30 | 8 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $1,045.00 | $1,900.00 | $42.13 – $215.17 | 9 |
| Lower jaw bone graft CPT 21215 | not published | not published | $1,198.98 – $12,184.12 | 11 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $27.69 – $412.94 | 8 |
| Loxapine for inhalation 1 mg HCPCS J2062 | not published | not published | $25.38 – $25.38 | 1 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $1,120.46 – $21,878.19 | 10 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $1,291.81 – $21,878.19 | 10 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $1,272.28 – $21,878.19 | 10 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $1,388.60 – $21,878.19 | 10 |
| Lso corset front HCPCS L0972 | not published | not published | $152.77 – $326.93 | 8 |
| Lso flex no ri stays pre ots HCPCS L0628 | not published | not published | $61.45 – $131.50 | 8 |
| Lso full corset HCPCS L0976 | not published | not published | $216.26 – $462.80 | 8 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | not published | not published | $200.06 – $428.13 | 8 |
| Lso sag-coronal panel custom HCPCS L0638 | not published | not published | $1,629.51 – $3,487.15 | 8 |
| Lso sag-co shell pnl pre ots HCPCS L0651 | not published | not published | $870.15 – $1,862.12 | 8 |
| Lso sag ctr rigi pos pre ots HCPCS L0643 | not published | not published | $118.63 – $253.87 | 8 |
| Lso sagit rigid panel prefab HCPCS L0635 | not published | not published | $1,222.44 – $2,616.02 | 8 |
| Lso sagittal rigid panel cus HCPCS L0636 | not published | not published | $1,657.19 – $3,546.39 | 8 |
| Lso sc r pos/lat pnl pre cst HCPCS L0633 | not published | not published | $354.31 – $758.22 | 8 |
| Lso sc r pos/lat pnl pre ots HCPCS L0649 | not published | not published | $210.07 – $449.55 | 8 |
| Lso s/c shell/panel custom HCPCS L0640 | not published | not published | $1,292.78 – $2,766.55 | 8 |
| Lso s/c shell/panel prefab HCPCS L0639 | not published | not published | $1,501.02 – $3,212.18 | 8 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $16.00 – $47.06 | 9 |
| Lubricant per ounce HCPCS A4402 | not published | not published | $2.93 – $3.12 | 2 |
| Lumbar bolster pad HCPCS L1030 | not published | not published | $97.47 – $208.59 | 8 |
| Lumbar derotation pad HCPCS L1240 | not published | not published | $96.35 – $206.19 | 8 |
| Lumbar diskogram s&i CPT 72295 | not published | not published | $103.94 – $4,019.07 | 9 |
| Lumbar or lumbar rib pad HCPCS L1040 | not published | not published | $101.89 – $218.04 | 8 |
| Lumbar sling HCPCS L1090 | not published | not published | $117.80 – $252.09 | 8 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $2,399.76 – $36,087.88 | 9 |
| Lumizyme injection HCPCS J0221 | not published | not published | $211.13 – $411.70 | 9 |
| Lung function test (mbc/mvv) CPT 94200 | not published | not published | $17.69 – $121.42 | 8 |
| Lung Function Test (Spirometry) CPT 94010 | not published | not published | $27.76 – $444.41 | 8 |
| Lung perfusion imaging CPT 78580 | $1,918.81 | $3,488.75 | $261.00 – $822.80 | 9 |
| Lung transplant double CPT 32853 | not published | not published | $1,189.00 – $4,386.82 | 3 |
| Lung transplant single CPT 32851 | not published | not published | $1,189.00 – $4,386.82 | 3 |
| Lung transplant with bypass CPT 32852 | not published | not published | $1,189.00 – $4,386.82 | 3 |
| Lung transplant with bypass CPT 32854 | not published | not published | $1,189.00 – $4,386.82 | 3 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $1,189.00 – $4,386.82 | 3 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $215.95 – $421.10 | 9 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $43.51 – $84.85 | 9 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | not published | not published | $337.73 – $749.44 | 8 |
| Lutetium lu 177 vipivotide HCPCS A9607 | not published | not published | $267.32 – $572.06 | 8 |
| Lvad shower bag heartmate HCPCS Q0501 | not published | not published | $632.22 – $1,352.95 | 8 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $27.82 – $1,496.00 | 9 |
| Lwr ext dynamic prosth pylon HCPCS L5985 | not published | not published | $349.54 – $748.02 | 8 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $20.05 – $42.91 | 8 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $1,076.26 – $16,822.37 | 8 |
| Lymphatics/lymph node imaging CPT 78195 | $2,487.92 | $4,523.50 | $326.00 – $1,117.53 | 9 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $36.56 – $78.24 | 9 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $35.00 – $104.92 | 9 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $59.00 – $405.55 | 9 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $47.59 – $101.84 | 9 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $266.00 – $1,291.11 | 9 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $266.00 – $3,239.91 | 9 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $266.00 – $6,498.69 | 9 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $266.00 – $6,498.69 | 9 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $226.32 – $2,100.00 | 11 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $236.21 – $6,662.61 | 11 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $306.26 – $4,302.40 | 11 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $22.99 – $25.57 | 3 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $10.50 – $45.38 | 2 |
| Macroscopic exam arthropod CPT 87168 | $84.70 | $154.00 | $3.00 – $9.14 | 9 |
| Macroscopic exam parasite CPT 87169 | $42.35 | $77.00 | $3.00 – $9.22 | 9 |
| Magnesium CPT 83735 | $167.48 | $304.51 | $5.00 – $14.34 | 9 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | not published | not published | $0.56 – $1.13 | 4 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $229.48 – $491.09 | 8 |
| Makena, 10 mg HCPCS J1726 | not published | not published | $15.75 – $33.24 | 2 |
| Malaria antibody CPT 86750 | not published | not published | $9.00 – $28.23 | 9 |
| Male sling procedure CPT 53440 | not published | not published | $1,149.68 – $27,154.61 | 11 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $1,189.00 – $4,386.82 | 3 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $543.75 – $3,309.55 | 10 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $660.79 – $3,309.55 | 10 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $232.82 | $423.30 | $56.42 – $273.84 | 8 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $232.82 | $423.30 | $35.86 – $273.84 | 8 |
| Manipulation of hip joint CPT 27275 | not published | not published | $280.59 – $3,309.55 | 11 |
| Manipulation of spine CPT 22505 | not published | not published | $197.44 – $3,309.55 | 11 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $118.67 – $1,579.00 | 10 |
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.