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 |
|---|---|---|---|---|
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $50.35 | $136.09 | $19.78 – $19.78 | 5 |
| Dicyclomine injection HCPCS J0500 | $67.84 | $183.35 | $40.76 – $40.76 | 5 |
| Diffusing capacity CPT 94729 | $71.04 | $192.00 | $45.99 – $124.80 | 6 |
| Digital analysis of eeg CPT 95957 | not published | not published | $96.64 – $203.01 | 7 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $166.61 | $450.30 | $19.78 – $19.78 | 5 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $3,856.16 | $10,422.05 | $1,297.26 – $1,297.26 | 5 |
| Digoxin total therapeutic drug level CPT 80162 | $57.72 | $156.00 | $13.28 – $53.12 | 30 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $162.23 | $438.45 | $40.76 – $40.76 | 5 |
| Dilate biliary duct/ampulla CPT 47542 | $1,356.51 | $3,666.25 | $156.52 – $258.62 | 6 |
| Dilate esophagus CPT 43453 | not published | not published | $97.45 – $180.27 | 7 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $89.98 – $3,567.32 | 30 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | $822.14 | $2,222.00 | $396.01 – $823.79 | 7 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | $822.14 | $2,222.00 | $198.00 – $412.23 | 7 |
| Dilate ic vasospasm init CPT 61640 | $1,974.69 | $5,337.00 | $563.80 – $1,172.07 | 7 |
| Dilate tear duct opening CPT 68801 | $547.97 | $1,481.00 | $84.46 – $1,518.28 | 30 |
| Dilate urethra stricture CPT 53600 | $254.65 | $688.25 | $72.02 – $925.40 | 30 |
| Dilate urethra stricture CPT 53601 | not published | not published | $60.47 – $490.44 | 30 |
| Dilate urethra stricture CPT 53605 | not published | not published | $73.43 – $119.04 | 7 |
| Dilate urethra stricture CPT 53621 | $269.73 | $729.00 | $81.69 – $925.40 | 30 |
| Dilation/female urethra/initial 53660 CPT 53660 | $207.39 | $560.50 | $46.94 – $595.32 | 30 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $179.68 – $314.96 | 7 |
| Dilation of cervical canal 57800 CPT 57800 | not published | not published | $53.71 – $91.16 | 7 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $213.17 – $365.30 | 7 |
| Dilation of salivary duct CPT 42660 | not published | not published | $87.51 – $1,937.64 | 30 |
| Dilation of urethra CPT 53661 | not published | not published | $45.56 – $490.44 | 30 |
| Dilation of urethra CPT 53665 | not published | not published | $43.96 – $72.11 | 7 |
| Dilation of vagina CPT 57400 | not published | not published | $149.47 – $250.34 | 7 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $64.85 – $111.56 | 7 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $1,310.45 | $3,541.75 | $98.81 – $2,539.64 | 30 |
| Dimecaprol injection HCPCS J0470 | $147.91 | $399.75 | $40.76 – $40.76 | 5 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $807.90 | $2,183.50 | $92.63 – $92.63 | 5 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $9.56 | $25.85 | $19.78 – $19.78 | 5 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | not published | not published | $29.06 – $41.99 | 6 |
| Dir nsl mucous membrane test CPT 95065 | not published | not published | $23.01 – $149.36 | 30 |
| Disability dlco CPT 94727 | $89.45 | $241.75 | $30.19 – $595.32 | 29 |
| Disaccharidases CPT 82657 | $174.09 | $470.50 | $19.02 – $88.68 | 30 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $431.43 – $870.72 | 7 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | not published | not published | $1,659.82 – $2,737.32 | 7 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | not published | not published | $220.08 – $356.45 | 7 |
| Discography cerv/thor spine CPT 72285 | not published | not published | $52.82 – $246.49 | 7 |
| Dissolve clot heart vessel CPT 92975 | $423.47 | $1,144.50 | $429.23 – $725.82 | 7 |
| Dist revas ligation hemo CPT 36838 | not published | not published | $1,313.62 – $2,212.86 | 7 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $875.92 – $1,481.58 | 7 |
| Division of fallopian tube 58605 CPT 58605 | not published | not published | $361.03 – $619.71 | 7 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $105.74 – $1,116.00 | 29 |
| Dmpk gene detc abnor allele CPT 81234 | not published | not published | $137.00 – $548.00 | 28 |
| Dna antibody native/double stranded CPT 86225 | $65.77 | $177.75 | $13.74 – $54.96 | 30 |
| Dna gardnerella CPT 87510 | $66.05 | $178.50 | $20.05 – $80.20 | 30 |
| Dna probe chlamydia CPT 87490 | not published | not published | $21.11 – $91.00 | 30 |
| Dna probe gc CPT 87590 | not published | not published | $21.11 – $107.52 | 30 |
| Dna trichomonas CPT 87660 | $66.05 | $178.50 | $20.05 – $80.20 | 30 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $33.23 | $89.80 | $19.78 – $19.78 | 5 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $32.38 | $87.50 | $5.50 – $5.50 | 5 |
| Dolasetron mesylate HCPCS J1260 | $33.30 | $90.00 | $8.63 – $8.63 | 5 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $31.45 | $85.00 | $0.73 – $0.73 | 5 |
| Doppler echo complete CPT 93320 | $265.66 | $718.00 | $25.28 – $80.27 | 7 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $208.03 | $562.25 | $121.63 – $166.67 | 6 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $280.46 | $758.00 | $28.25 – $595.32 | 30 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $194.71 | $526.25 | $15.50 – $490.44 | 30 |
| Doripenem 50 mg/ml inj 10 ml HCPCS J1267 | $70.91 | $191.65 | $0.73 – $0.73 | 5 |
| Dornhoffer fixed part w/window HCPCS L8614 | $32,112.76 | $86,791.25 | $28,526.54 – $32,295.99 | 6 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | $87.26 | $235.85 | $19.78 – $19.78 | 5 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | $2,469.31 | $6,673.80 | $648.99 – $648.99 | 5 |
| Dpyd gene common variants CPT 81232 | not published | not published | $174.81 – $699.24 | 29 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $579.70 | $1,566.75 | $133.74 – $2,677.08 | 30 |
| Drainage ext aud canal abscess 69020 CPT 69020 | not published | not published | $151.97 – $2,677.08 | 30 |
| Drainage external ear complex 69005 CPT 69005 | not published | not published | $171.57 – $295.23 | 7 |
| Drainage external ear simple 69000 CPT 69000 | $579.70 | $1,566.75 | $126.25 – $2,677.08 | 30 |
| Drainage lymph node lesion 38300 CPT 38300 | $1,062.27 | $2,871.00 | $196.35 – $346.25 | 7 |
| Drainage lymph node lesion 38305 CPT 38305 | not published | not published | $503.55 – $861.20 | 7 |
| Drainage mouth roof lesion CPT 42000 | $315.33 | $852.25 | $111.16 – $883.56 | 30 |
| Drainage of arm bursa 23931 CPT 23931 | $228.48 | $617.50 | $167.62 – $293.87 | 7 |
| Drainage of bladder abscess CPT 51080 | not published | not published | $458.19 – $750.99 | 7 |
| Drainage of eye CPT 65800 | $1,095.20 | $2,960.00 | $100.84 – $174.83 | 7 |
| Drainage of eye CPT 65810 | $3,667.81 | $9,913.00 | $464.60 – $876.17 | 7 |
| Drainage of eye CPT 65815 | not published | not published | $471.74 – $910.86 | 7 |
| Drainage of forearm bursa CPT 25031 | not published | not published | $394.38 – $640.11 | 7 |
| Drainage of kidney lesion CPT 50390 | $685.43 | $1,852.50 | $109.78 – $2,677.08 | 30 |
| Drainage of mouth lesion CPT 41005 | not published | not published | $134.88 – $883.56 | 30 |
| Drainage of mouth lesion CPT 41006 | not published | not published | $280.85 – $495.90 | 7 |
| Drainage of mouth lesion CPT 41007 | not published | not published | $272.31 – $463.25 | 7 |
| Drainage of mouth lesion CPT 41008 | not published | not published | $291.32 – $503.39 | 7 |
| Drainage of mouth lesion CPT 41009 | not published | not published | $315.93 – $1,937.64 | 30 |
| Drainage of mouth lesion CPT 41015 | not published | not published | $361.28 – $1,937.64 | 30 |
| Drainage of mouth lesion CPT 41016 | not published | not published | $374.87 – $659.85 | 7 |
| Drainage of mouth lesion CPT 41017 | not published | not published | $376.47 – $658.49 | 7 |
| Drainage of mouth lesion CPT 41018 | not published | not published | $442.72 – $776.16 | 7 |
| Drainage of nose lesion int 30000 CPT 30000 | $326.80 | $883.25 | $126.51 – $883.56 | 30 |
| Drainage of nose lesion sept 30020 CPT 30020 | $425.59 | $1,150.25 | $127.31 – $1,937.64 | 30 |
| Drainage of pelvis bursa CPT 26991 | not published | not published | $564.68 – $965.96 | 7 |
| Drainage of pelvis lesion 26990 CPT 26990 | not published | not published | $665.69 – $1,150.31 | 7 |
| Drainage of prostate abscess CPT 52700 | not published | not published | $495.03 – $810.18 | 7 |
| Drainage of prostate abscess CPT 55720 | not published | not published | $506.63 – $831.27 | 7 |
| Drainage of prostate abscess CPT 55725 | not published | not published | $728.47 – $1,091.81 | 7 |
| Drainage of rectal abscess CPT 45005 | $1,318.50 | $3,563.50 | $164.09 – $295.23 | 7 |
| Drainage of rectal abscess 45020 CPT 45020 | not published | not published | $583.59 – $1,061.19 | 7 |
| Drainage of salivary gland CPT 42305 | not published | not published | $478.87 – $808.82 | 7 |
| Drainage of salivary gland CPT 42320 | not published | not published | $192.86 – $1,937.64 | 30 |
| Drainage of throat abscess CPT 42725 | not published | not published | $908.20 – $1,528.52 | 7 |
| Drainage of urethra abscess CPT 53040 | $2,186.61 | $5,909.75 | $439.06 – $721.74 | 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.