Ascension St. John Sapulpa (St. John Sapulpa, Inc.)
1004 E Bryan Ave, Sapulpa, OK · Ascension · · NPI 1922076603
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 |
|---|---|---|---|---|
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $0.51 | $1.39 | $0.57 – $0.57 | 5 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $71.78 | $194.00 | $29.67 – $54.42 | 7 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $77.70 | $210.00 | $67.15 – $123.81 | 7 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $246.51 | $666.25 | $141.16 – $247.60 | 7 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $123.95 | $335.00 | $113.66 – $193.19 | 7 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $56.89 | $153.75 | $33.98 – $57.83 | 7 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $65.86 | $178.00 | $75.90 – $131.29 | 7 |
| Administration immunization 1 vaccine CPT 90471 | $29.05 | $78.50 | $24.21 – $45.57 | 7 |
| Administration immunization each additional component CPT 90461 | not published | not published | $13.67 – $23.13 | 6 |
| Administration immunization each additional vaccine CPT 90472 | $27.66 | $74.75 | $9.72 – $23.13 | 7 |
| Administration immunization first component each vaccine CPT 90460 | not published | not published | $26.70 – $45.57 | 6 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | not published | not published | $10.26 – $45.57 | 7 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | not published | not published | $9.32 – $23.13 | 7 |
| Administration vaccine hepatitis b HCPCS G0010 | $35.34 | $95.50 | $9.80 – $10.50 | 5 |
| Administration vaccine influenza virus HCPCS G0008 | $21.83 | $59.00 | $9.80 – $10.50 | 5 |
| Administration vaccine pneumococcal HCPCS G0009 | $21.83 | $59.00 | $9.80 – $10.50 | 5 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $69.82 | $188.70 | $37.04 – $37.04 | 5 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $46.74 – $761.88 | 7 |
| Adrenalectomy expl w/exc retro tumor 60545 CPT 60545 | not published | not published | $1,368.96 – $2,252.31 | 7 |
| Advance care planning each additional 30 min 99498 CPT 99498 | not published | not published | $79.36 – $79.36 | 1 |
| _afb id by dna probe rflx ast CPT 87149 | not published | not published | $21.11 – $48.80 | 7 |
| #afb mycobacteria suscep. #1 CPT 87190 | $12.03 | $32.50 | $5.99 – $13.76 | 7 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | not published | not published | $179.60 – $280.67 | 6 |
| Aflibercept injection HCPCS J0178 | $2,738.00 | $7,400.00 | $1,023.23 – $1,023.23 | 5 |
| After cataract laser surgery CPT 66821 | not published | not published | $299.98 – $585.69 | 7 |
| Air conduction bilat CPT 92552 | not published | not published | $23.10 – $55.09 | 7 |
| Air injection into abdomen 49400 CPT 49400 | $209.33 | $565.75 | $106.20 – $178.23 | 7 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | $269.36 | $728.00 | $27.31 – $80.95 | 6 |
| Albumin body fluid quantitative each specimen CPT 82042 | $39.50 | $106.75 | $5.47 – $12.59 | 7 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $138.05 | $373.12 | $58.19 – $69.66 | 6 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | $36.72 | $99.25 | $34.85 – $37.34 | 5 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $551.82 | $1,491.40 | $63.07 – $67.58 | 5 |
| Albumin ischemia modified CPT 82045 | not published | not published | $35.70 – $82.59 | 7 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $38.30 | $103.50 | $5.99 – $14.07 | 7 |
| Albumin serum plasma or whole blood CPT 82040 | $28.21 | $76.25 | $5.21 – $12.03 | 7 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | not published | not published | $19.60 – $19.60 | 1 |
| Aldesleukin injection HCPCS J9015 | $2,310.41 | $6,244.35 | $1,023.23 – $1,023.23 | 5 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $27,257.23 | $73,668.20 | $2,350.25 – $2,518.13 | 5 |
| Alkaline phosphatase CPT 84075 | $27.29 | $73.75 | $5.47 – $12.59 | 7 |
| Allergen alpha lactalbumin ige CPT 86008 | $24.48 | $66.15 | $20.35 – $20.35 | 1 |
| Allergen egg white ige CPT 86003 | $36.82 | $99.50 | $5.47 – $12.69 | 7 |
| Allergen specific ige qual multi scrn ea CPT 86005 | not published | not published | $8.34 – $19.39 | 7 |
| Allergy injections; 2 or more 95117 CPT 95117 | not published | not published | $10.43 – $13.74 | 2 |
| Allergy injection; single 95115 CPT 95115 | not published | not published | $8.99 – $11.35 | 2 |
| Allergy Skin Testing CPT 95004 | not published | not published | $6.34 – $11.56 | 7 |
| Allg patch or app # of tests 95044 CPT 95044 | not published | not published | $5.75 – $9.53 | 7 |
| Allgrft implnt knee w/scope CPT 29867 | not published | not published | $1,400.31 – $2,358.42 | 7 |
| All tstg perq&iq drugs/biol CPT 95018 | not published | not published | $7.87 – $13.61 | 6 |
| All tstg perq&iq w/venoms CPT 95017 | not published | not published | $3.94 – $6.81 | 6 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $13.14 | $35.50 | $3.40 – $3.40 | 5 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | not published | not published | $68.01 – $156.72 | 7 |
| Alpha-fetoprotein amniotic CPT 82106 | $54.95 | $148.50 | $17.72 – $40.81 | 7 |
| Alpha-fetoprotein tumor marker CPT 82105 | $69.84 | $188.75 | $17.72 – $40.81 | 7 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $5,084.26 | $13,741.25 | $32.15 – $32.15 | 5 |
| Alt/sgpt CPT 84460 | $31.73 | $85.75 | $5.47 – $12.87 | 7 |
| Aluminum - quest CPT 82108 | $81.49 | $220.25 | $23.21 – $45.51 | 7 |
| Alveoloplasty each quadrant CPT 41874 | not published | not published | $275.16 – $476.85 | 7 |
| Alys cplx sp/pn npgt w/prgrm CPT 95972 | $183.89 | $497.00 | $46.66 – $93.18 | 7 |
| Ambl bp mntr w/sw a/r CPT 93788 | not published | not published | $5.39 – $234.18 | 7 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $36.30 | $98.10 | $6.81 – $6.81 | 5 |
| Amino acid screen, urine CPT 82128 | not published | not published | $14.59 – $33.73 | 7 |
| Amino acid single qual CPT 82127 | not published | not published | $14.59 – $33.73 | 7 |
| Amino acids quant 2-5 CPT 82136 | not published | not published | $17.72 – $41.02 | 7 |
| Aminolevulinic acid delta CPT 82135 | $48.14 | $130.10 | $17.46 – $40.03 | 7 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $16.58 | $44.80 | $15.60 – $15.60 | 5 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $58.46 | $158.00 | $6.81 – $6.81 | 5 |
| Ammonia CPT 82140 | $60.31 | $163.00 | $15.37 – $35.46 | 7 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $368.15 | $995.00 | $90.92 – $151.69 | 7 |
| Amniocentesis therapeutic CPT 59001 | not published | not published | $202.15 – $338.08 | 7 |
| Amniotic fluid scan CPT 82143 | not published | not published | $7.30 – $16.71 | 7 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | $1,922.98 | $5,197.25 | $679.70 – $1,165.28 | 7 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | $47.45 | $128.25 | $15.60 – $15.60 | 5 |
| Amphotericin b lipid complex HCPCS J0287 | $270.17 | $730.20 | $15.60 – $15.60 | 5 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $28.90 | $78.10 | $15.24 – $15.60 | 6 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $14.69 | $39.71 | $15.60 – $15.60 | 5 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $14.42 | $38.96 | $15.60 – $15.60 | 5 |
| Amp metatarsal w/toe single 28810 CPT 28810 | not published | not published | $480.01 – $820.38 | 7 |
| Amp thigh through femur re-amp 27596 CPT 27596 | not published | not published | $806.99 – $1,367.31 | 7 |
| Amputate hand at wrist CPT 25922 | not published | not published | $562.06 – $1,072.76 | 7 |
| Amputate metacarpal bone 26910 CPT 26910 | $3,227.33 | $8,722.50 | $754.80 – $1,295.19 | 7 |
| Amputate thigh through femur 27590 CPT 27590 | not published | not published | $900.84 – $1,522.39 | 7 |
| Amputation follow-up surgery CPT 24925 | not published | not published | $572.06 – $1,038.06 | 7 |
| Amputation follow-up surgery CPT 25907 | not published | not published | $667.65 – $1,124.46 | 7 |
| Amputation follow-up surgery CPT 25909 | not published | not published | $749.96 – $1,257.78 | 7 |
| Amputation follow-up surgery CPT 25929 | not published | not published | $611.02 – $1,095.21 | 7 |
| Amputation follow-up surgery CPT 25931 | not published | not published | $760.71 – $1,348.26 | 7 |
| Amputation follow-up surgery CPT 27594 | not published | not published | $560.04 – $946.90 | 7 |
| Amputation follow-up surgery CPT 27884 | not published | not published | $642.08 – $1,088.40 | 7 |
| Amputation leg thr tib/fib 27880 CPT 27880 | not published | not published | $1,032.03 – $1,729.88 | 7 |
| Amputation leg; tib/fib f/u 27886 CPT 27886 | not published | not published | $733.83 – $1,243.50 | 7 |
| Amputation of foot at ankle CPT 27889 | not published | not published | $728.67 – $1,227.86 | 7 |
| Amputation of lower leg CPT 27882 | not published | not published | $673.78 – $1,149.63 | 7 |
| Amputation of midtarsal 28800 CPT 28800 | not published | not published | $602.81 – $1,031.27 | 7 |
| Amputation thru metatarsal CPT 28805 | not published | not published | $821.20 – $1,398.60 | 7 |
| Amputation toe interphalangeal joint CPT 28825 | $2,179.86 | $5,891.50 | $410.37 – $699.98 | 7 |
| Amputation toe metatarsophalangeal joint CPT 28820 | not published | not published | $390.68 – $750.32 | 7 |
| Amylase CPT 82150 | $30.16 | $81.50 | $6.78 – $15.77 | 7 |
| Ana ds-dna CPT 86226 | not published | not published | $12.77 – $29.48 | 7 |
| Anal pressure record CPT 91122 | not published | not published | $111.52 – $139.41 | 7 |
| Anal/urinary muscle study CPT 51784 | not published | not published | $31.98 – $346.94 | 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.