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 |
|---|---|---|---|---|
| Drainage of urethra abscess 53060 CPT 53060 | not published | not published | $183.42 – $304.07 | 7 |
| Drainage of urinary leakage CPT 53080 | not published | not published | $469.25 – $2,539.64 | 30 |
| Drainage of urinary leakage CPT 53085 | not published | not published | $738.14 – $1,212.89 | 7 |
| Drain bladder by trocar/cath CPT 51101 | not published | not published | $58.87 – $3,871.04 | 30 |
| Drain blood from under nail 11740 CPT 11740 | $64.29 | $173.75 | $34.47 – $490.44 | 30 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | not published | not published | $241.31 – $412.23 | 6 |
| Drain cath image guided visceral pq CPT 49405 | $817.05 | $2,208.25 | $226.78 – $386.39 | 6 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $735.84 | $1,988.75 | $94.01 – $2,634.96 | 30 |
| Drain chest lesion CPT 21502 | not published | not published | $562.42 – $934.67 | 7 |
| Drain chst dry seal exp thorastat HCPCS A7041 | $58.28 | $157.50 | $148.45 – $148.45 | 1 |
| Drain finger abscess;simple 26010 CPT 26010 | $211.36 | $571.25 | $140.21 – $756.04 | 30 |
| Drain lower leg bursa CPT 27604 | not published | not published | $371.23 – $629.24 | 7 |
| Drain lower leg lesion 27603 CPT 27603 | not published | not published | $421.23 – $726.51 | 7 |
| Drain neck/chest lesion 21501 CPT 21501 | not published | not published | $338.36 – $598.62 | 7 |
| Drain open lung lesion 32200 CPT 32200 | not published | not published | $1,265.75 – $2,124.42 | 7 |
| Drain ovarn cyst abd CPT 58805 | not published | not published | $444.93 – $758.48 | 7 |
| Drain ovary abscess open CPT 58820 | not published | not published | $354.25 – $586.38 | 7 |
| Drain pancreatic pseudocyst 48510 CPT 48510 | not published | not published | $1,160.16 – $2,006.06 | 7 |
| Drain penis lesion CPT 54015 | $294.89 | $797.00 | $345.61 – $568.70 | 7 |
| Drain shoulder bone lesion CPT 23035 | not published | not published | $746.44 – $1,253.03 | 7 |
| Drain shoulder bursa 23031 CPT 23031 | not published | not published | $231.40 – $402.71 | 7 |
| Drain shoulder lesion CPT 23030 | not published | not published | $280.07 – $472.10 | 7 |
| Drain thigh/knee lesion 27301 CPT 27301 | not published | not published | $537.79 – $925.14 | 7 |
| Drain thyroid/tongue cyst CPT 60000 | not published | not published | $155.80 – $289.11 | 7 |
| Drain to peritoneal cavity CPT 49062 | not published | not published | $824.34 – $1,370.70 | 7 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $162.15 | $438.25 | $123.51 – $756.04 | 30 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $148.93 | $402.50 | $59.17 – $756.04 | 30 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $220.61 | $596.25 | $138.09 – $1,520.16 | 30 |
| Dressing change not for burn w/anes 15852 CPT 15852 | not published | not published | $52.74 – $2,329.08 | 30 |
| Drill hole evac+/drg subdural hematoma 61108 CPT 61108 | $1,051.36 | $2,841.50 | $937.30 – $1,664.57 | 7 |
| Drill hole implt ventricular cath/device 61107 CPT 61107 | $1,577.31 | $4,263.00 | $355.18 – $574.82 | 7 |
| Drng appendix abscess open 44900 CPT 44900 | not published | not published | $826.82 – $1,438.05 | 7 |
| Drng hand tendon sheath 26020 CPT 26020 | $1,334.22 | $3,606.00 | $451.76 – $795.21 | 7 |
| Drng of eyelid abscess 67700 CPT 67700 | $529.10 | $1,430.00 | $114.91 – $1,137.40 | 30 |
| Drng of finger abscess comp 26011 CPT 26011 | $1,468.35 | $3,968.50 | $196.22 – $339.45 | 7 |
| Drng of hydrocele 55000 CPT 55000 | not published | not published | $95.37 – $2,677.08 | 30 |
| Drng of mouth lesion 40801 CPT 40801 | not published | not published | $236.02 – $1,937.64 | 30 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | not published | not published | $325.48 – $559.85 | 7 |
| Drng of palm multi bursas 26030 CPT 26030 | not published | not published | $524.70 – $902.69 | 7 |
| Drng of palm single bursa 26025 CPT 26025 | not published | not published | $442.42 – $774.81 | 7 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | not published | not published | $445.87 – $789.77 | 7 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $244.94 – $421.08 | 7 |
| Drng of scrotum abscess 55100 CPT 55100 | $1,468.35 | $3,968.50 | $183.73 – $307.47 | 7 |
| Drng open retroperitoneal abscess 49060 CPT 49060 | not published | not published | $1,215.59 – $2,040.75 | 7 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | not published | not published | $1,086.01 – $1,863.89 | 7 |
| Drng ovary abscess perqt 58822 CPT 58822 | not published | not published | $769.85 – $1,393.16 | 7 |
| Drng peritoneal abscess open 49020 CPT 49020 | not published | not published | $1,734.89 – $2,951.61 | 7 |
| Drng salivary gland simple 42300 CPT 42300 | $957.38 | $2,587.50 | $166.27 – $289.11 | 7 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $135.69 – $1,937.64 | 30 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $19.15 | $51.75 | $19.78 – $19.78 | 5 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $22.68 | $61.30 | $4.78 – $13.38 | 6 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $31.39 | $84.85 | $14.79 – $14.79 | 5 |
| Drug admin & hemodynmic meas CPT 93463 | $419.58 | $1,134.00 | $111.03 – $226.21 | 6 |
| Drug assay caffeine CPT 80155 | $89.17 | $241.00 | $22.02 – $154.28 | 29 |
| Drug assay posaconazole CPT 80187 | $107.30 | $290.00 | $27.11 – $108.44 | 24 |
| Drug assay rufinamide CPT 80210 | not published | not published | $27.11 – $108.44 | 24 |
| Drug assay vedolizumab CPT 80280 | not published | not published | $38.57 – $154.28 | 24 |
| Drug assay voriconazole CPT 80285 | $116.64 | $315.25 | $27.11 – $108.44 | 24 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $18.64 – $74.56 | 23 |
| Drug of abuse screen urine CPT 80305 | not published | not published | $12.60 – $50.40 | 29 |
| Drug screen quant tiagabine CPT 80199 | $55.04 | $148.75 | $27.11 – $108.44 | 29 |
| Drug test def 15-21 classes HCPCS G0482 | $142.17 | $384.25 | $231.93 – $268.97 | 6 |
| Drug test def 1-7 classes HCPCS G0480 | $157.16 | $424.75 | $120.88 – $133.53 | 6 |
| Drug test def 22+ classes HCPCS G0483 | $426.24 | $1,152.00 | $288.14 – $348.68 | 6 |
| Drug test def 8-14 classes HCPCS G0481 | $161.88 | $437.50 | $182.72 – $199.25 | 6 |
| Drug test prsmv instrmnt CPT 80306 | not published | not published | $17.14 – $68.56 | 29 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $268.90 | $726.75 | $62.14 – $248.56 | 29 |
| Drvvt confirm - quest CPT 85597 | $85.47 | $231.00 | $17.98 – $71.92 | 30 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $278.91 – $1,050.99 | 7 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | $213.86 | $578.00 | $233.79 – $1,520.16 | 30 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $197.70 – $1,520.16 | 30 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $233.07 – $2,329.08 | 30 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $313.40 – $2,329.08 | 30 |
| Ductogram sgl duct CPT 77053 | $171.22 | $462.75 | $22.65 – $919.72 | 30 |
| Duodenal motility study CPT 91022 | not published | not published | $93.42 – $2,018.88 | 30 |
| Duplex scan bilateral study 93985 CPT 93985 | not published | not published | $229.93 – $919.72 | 23 |
| Duplex scan unilateral study 93986 CPT 93986 | not published | not published | $101.15 – $404.60 | 23 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $256.04 | $692.00 | $15.39 – $404.60 | 30 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $278.24 | $752.00 | $32.09 – $595.32 | 30 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $358.35 | $968.50 | $29.12 – $919.72 | 30 |
| Dxa bone density axl vrt fx CPT 77085 | not published | not published | $40.96 – $404.60 | 29 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $148.83 – $595.32 | 23 |
| Dx bronchoscope/brush 31623 CPT 31623 | $1,898.47 | $5,131.00 | $151.84 – $280.26 | 7 |
| Dx bronchoscope/lavage 31624 CPT 31624 | $1,161.06 | $3,138.00 | $153.65 – $282.30 | 7 |
| Dx bronchoscope/wash 31622 CPT 31622 | $2,211.40 | $5,976.75 | $149.25 – $278.22 | 7 |
| Dx dark adaptation exam i&r CPT 92284 | not published | not published | $14.34 – $1,518.28 | 30 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $56.59 – $3,567.32 | 29 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $87.01 – $3,567.32 | 29 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $38.86 – $1,184.84 | 29 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $67.15 – $595.32 | 29 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $174.61 – $1,477.48 | 30 |
| Dx laryngoscopy w/oper scope CPT 31526 | not published | not published | $175.37 – $296.60 | 7 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $131.05 – $925.40 | 30 |
| Dynamic surface emg CPT 96002 | not published | not published | $24.27 – $1,184.84 | 30 |
| Ear and throat examination CPT 92502 | not published | not published | $105.77 – $1,937.64 | 30 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $69.56 – $119.04 | 7 |
| Ear cartilage graft CPT 21235 | not published | not published | $613.35 – $1,063.23 | 7 |
| Ear irrigation 69209 CPT 69209 | $99.16 | $268.00 | $12.94 – $226.00 | 29 |
| Ear protector evaluation CPT 92596 | not published | not published | $37.23 – $149.36 | 30 |
| Ecg 12 lead tracing only CPT 93005 | $68.82 | $186.00 | $8.63 – $226.00 | 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.