Ascension St. John Medical Center (St. John Medical Center, Inc.)
1923 S Utica Ave, Tulsa, OK · Ascension · · NPI 1154417368
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 |
|---|---|---|---|---|
| Closure paravalvlr leak pq CPT 33999 | not published | not published | $476.38 – $2,621.52 | 29 |
| Clot factor fletcher fact CPT 85292 | not published | not published | $18.93 – $75.72 | 30 |
| Clot factor viii reltd antgn CPT 85244 | not published | not published | $20.42 – $81.68 | 30 |
| Clot factor wght kininogen CPT 85293 | not published | not published | $18.93 – $75.72 | 30 |
| Clot factor xii hageman CPT 85280 | $95.74 | $258.75 | $19.35 – $77.40 | 30 |
| Clot factor xiii fibrin scrn CPT 85291 | not published | not published | $9.11 – $36.44 | 30 |
| Clot factor xiii fibrin stab CPT 85290 | $84.27 | $227.75 | $16.34 – $65.36 | 30 |
| Clotting assay whole blood CPT 85396 | $59.39 | $160.50 | $15.24 – $42.90 | 7 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $381.75 | $1,031.75 | $228.18 – $912.72 | 30 |
| Clsd tx bimalleol ank fx without manip 27808 CPT 27808 | $512.82 | $1,386.00 | $228.18 – $912.72 | 30 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | $450.48 | $1,217.50 | $228.18 – $912.72 | 30 |
| Clsd tx clav dislc without manip 23520 CPT 23520 | $2,628.48 | $7,104.00 | $225.20 – $428.57 | 7 |
| Clsd tx clavicle dislocation without manip 23540 CPT 23540 | $271.03 | $732.50 | $219.05 – $912.72 | 30 |
| Clsd tx clavicle fracture w/manip 23505 CPT 23505 | $1,321.64 | $3,572.00 | $340.75 – $611.55 | 7 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | $264.55 | $715.00 | $214.70 – $912.72 | 30 |
| Clsd tx coccygeal fracture 27200 CPT 27200 | $188.05 | $508.25 | $183.19 – $912.72 | 30 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | $148.37 | $401.00 | $174.93 – $912.72 | 30 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $511.06 | $1,381.25 | $228.18 – $912.72 | 30 |
| Clsd tx/dis tib/wt bear no manip 27824 CPT 27824 | $377.03 | $1,019.00 | $228.18 – $912.72 | 30 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $292.49 | $790.50 | $92.21 – $912.72 | 30 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $2,587.60 | $6,993.50 | $840.79 – $1,425.81 | 7 |
| Clsd tx finger tendon w/wo perq pin 26432 CPT 26432 | not published | not published | $514.12 – $899.97 | 7 |
| Clsd tx fracture of radius 25500 CPT 25500 | $415.88 | $1,124.00 | $228.18 – $912.72 | 30 |
| Clsd tx/fx grt toe/phalanx/phalang 28490 CPT 28490 | $376.11 | $1,016.50 | $121.99 – $912.72 | 30 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $130.89 | $353.75 | $147.76 – $912.72 | 30 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $393.96 | $1,064.75 | $228.18 – $912.72 | 30 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $975.88 | $2,637.50 | $554.67 – $950.31 | 7 |
| Clsd tx fx radius/ulna without manip 25560 CPT 25560 | $335.68 | $907.25 | $228.18 – $912.72 | 30 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $882.64 | $2,385.50 | $499.51 – $870.05 | 7 |
| Clsd tx/grt hum tube fx without manip 23620 CPT 23620 | $482.85 | $1,305.00 | $228.18 – $912.72 | 30 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $489.51 | $1,323.00 | $228.18 – $912.72 | 30 |
| Clsd tx humeral fract without manip 24530 CPT 24530 | $456.86 | $1,234.75 | $228.18 – $912.72 | 30 |
| Clsd tx humerus fract without manip 24500 CPT 24500 | $546.86 | $1,478.00 | $228.18 – $912.72 | 30 |
| Clsd tx iphal jnt disl w/manip req anes CPT 26775 | $1,233.58 | $3,334.00 | $252.63 – $1,010.52 | 30 |
| Clsd tx mandibular fx without manip 21450 CPT 21450 | $483.22 | $1,306.00 | $475.45 – $1,937.64 | 30 |
| Clsd tx/metacar/interphal artic fx 26740 CPT 26740 | $376.11 | $1,016.50 | $209.62 – $912.72 | 30 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $353.72 | $956.00 | $228.18 – $912.72 | 30 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $257.98 | $697.25 | $228.18 – $912.72 | 30 |
| Clsd tx metacarp fx w/manip&ext fix ea bone 26607 CPT 26607 | not published | not published | $466.08 – $836.03 | 7 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $393.68 | $1,064.00 | $228.18 – $912.72 | 30 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | $267.51 | $723.00 | $196.58 – $912.72 | 30 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | $1,888.11 | $5,103.00 | $148.28 – $252.38 | 7 |
| Clsd tx nose fx without manip 21310 CPT 21310 | not published | not published | $30.87 – $51.71 | 7 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $2,628.48 | $7,104.00 | $311.44 – $591.14 | 7 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $441.69 | $1,193.75 | $228.18 – $912.72 | 30 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | $495.80 | $1,340.00 | $228.18 – $912.72 | 30 |
| Clsd tx pelvic ring fx CPT 27197 | $203.59 | $550.25 | $127.87 – $912.72 | 29 |
| Clsd tx pelvic ring fx CPT 27198 | not published | not published | $228.18 – $912.72 | 29 |
| Clsd tx prox fib/shaft fx w/manip 27781 CPT 27781 | $2,557.07 | $6,911.00 | $407.99 – $713.58 | 7 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | $159.29 | $430.50 | $175.64 – $912.72 | 30 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | $314.69 | $850.50 | $228.18 – $912.72 | 30 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $2,628.48 | $7,104.00 | $410.37 – $734.67 | 7 |
| Clsd tx/scapular fx without manip 23570 CPT 23570 | $279.17 | $754.50 | $228.18 – $912.72 | 30 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $2,628.48 | $7,104.00 | $409.89 – $727.88 | 7 |
| Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 CPT 23675 | $2,628.48 | $7,104.00 | $529.13 – $919.02 | 7 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $2,132.50 | $5,763.50 | $405.22 – $735.35 | 7 |
| Clsd tx/talotarsal dislocat/anes 28575 CPT 28575 | not published | not published | $323.59 – $606.11 | 7 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $224.59 | $607.00 | $36.05 – $912.72 | 30 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $225.24 | $608.75 | $93.91 – $912.72 | 30 |
| Clsd tx trimall ankle fx without manip 27816 CPT 27816 | $384.62 | $1,039.50 | $228.18 – $912.72 | 30 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $832.32 | $2,249.50 | $468.59 – $806.10 | 7 |
| Clsd tx/ulnar shaft fx without manip 25530 CPT 25530 | $399.60 | $1,080.00 | $228.18 – $912.72 | 30 |
| Clsd tx vert body fx without manip req &w/csting/bracing CPT 22310 | not published | not published | $228.18 – $912.72 | 30 |
| Clsd tx wrist carpal fx without manip 25630 CPT 25630 | $466.20 | $1,260.00 | $228.18 – $912.72 | 30 |
| Clsd tx wrist scaphoid fx without manip 25622 CPT 25622 | $366.58 | $990.75 | $228.18 – $912.72 | 30 |
| Clsd tx wrist trans-scaph fx w/manip 25680 CPT 25680 | $579.88 | $1,567.25 | $228.18 – $912.72 | 30 |
| Clsd tx wrist ulnar styloid fx 25650 CPT 25650 | $386.37 | $1,044.25 | $228.18 – $912.72 | 30 |
| Clsd/ulnar fx/prox end without manip 24670 CPT 24670 | $444.74 | $1,202.00 | $228.18 – $912.72 | 30 |
| Cls tx of heel fracture w/manip 28405 CPT 28405 | not published | not published | $228.18 – $912.72 | 30 |
| Cltx carpl scphd fx w/mnpj CPT 25624 | not published | not published | $433.84 – $793.85 | 7 |
| Cltx gr hmrl tbrs fx w/mnpj CPT 23625 | $2,558.00 | $6,913.50 | $366.99 – $651.00 | 7 |
| Cltx hum epcndylr fx wo mnpj CPT 24560 | $388.13 | $1,049.00 | $228.18 – $912.72 | 30 |
| Cltx humrl cndylr fx w/mnpj CPT 24577 | not published | not published | $512.38 – $920.39 | 7 |
| Cltx humrl cndylr fx wo mnpj CPT 24576 | $520.22 | $1,406.00 | $228.18 – $912.72 | 30 |
| Cltx lunate dislc w/mnpj CPT 25690 | $2,691.75 | $7,275.00 | $491.15 – $881.61 | 7 |
| Cltx mndblr fx ntrdntl fixj CPT 21453 | not published | not published | $776.16 – $1,448.94 | 7 |
| Cltx mndblr fx w/mnpj CPT 21451 | $728.07 | $1,967.75 | $644.36 – $1,177.52 | 7 |
| Cltx mndblr/max alv ridge fx CPT 21440 | $1,288.53 | $3,482.50 | $453.10 – $870.72 | 7 |
| Cltx palatal/max fx wire fix CPT 21421 | not published | not published | $648.90 – $1,232.61 | 7 |
| Cltx post ankle fx CPT 27767 | $431.42 | $1,166.00 | $228.18 – $912.72 | 30 |
| Cltx post ankle fx w/mnpj CPT 27768 | $2,628.48 | $7,104.00 | $433.41 – $808.14 | 7 |
| Cltx scap fx w/mnpj +-tractj CPT 23575 | $2,628.48 | $7,104.00 | $375.51 – $687.06 | 7 |
| Cltx strnclav dislc w/mnpj CPT 23525 | $759.61 | $2,053.00 | $228.18 – $912.72 | 30 |
| Cltx thigh fx CPT 27267 | $2,345.99 | $6,340.50 | $448.99 – $805.41 | 7 |
| Cltx tmprmand dislc comp CPT 21485 | not published | not published | $575.66 – $1,078.88 | 7 |
| Cmbn ant pst colprhy CPT 57260 | not published | not published | $921.05 – $1,569.33 | 7 |
| C motor evoked lwr limbs CPT 95929 | $127.28 | $344.00 | $92.02 – $2,018.88 | 30 |
| C motor evoked uppr limbs CPT 95928 | $347.80 | $940.00 | $91.62 – $3,871.04 | 30 |
| C motor evoked upr&lwr limbs CPT 95939 | $200.36 | $541.50 | $390.20 – $3,871.04 | 29 |
| Cmptr ophth dx img ant segmt CPT 92132 | not published | not published | $14.73 – $226.00 | 29 |
| Cmptr ophth img optic nerve CPT 92133 | not published | not published | $15.10 – $226.00 | 29 |
| #cms hgb-carboxyhemoglobin CPT 82376 | not published | not published | $6.25 – $56.28 | 30 |
| #cms hgb-sulfhemoglobin CPT 83060 | not published | not published | $8.60 – $35.20 | 30 |
| #cmvcul-virus inoculation shell CPT 87254 | $132.28 | $357.50 | $19.56 – $78.24 | 30 |
| Cmv pcr-sendout CPT 87496 | $164.84 | $445.50 | $35.09 – $140.36 | 30 |
| Co2 monitor per day CPT 94681 | not published | not published | $11.66 – $1,184.84 | 30 |
| Coagulation factor viia 1,000 mcg/ml inj 1 ml HCPCS J7189 | $746.08 | $2,016.43 | $1.84 – $1.84 | 5 |
| Coagulation time activated teg CPT 85347 | $18.78 | $50.75 | $4.28 – $17.12 | 30 |
| Coagulation time otr method CPT 85348 | not published | not published | $3.91 – $17.96 | 30 |
| Cochlear implt f/up exam <7 CPT 92601 | not published | not published | $135.09 – $595.32 | 30 |
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.