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 |
|---|---|---|---|---|
| Ghs plngl fx pm cl CPT 26725 | $270.75 | $731.75 | $228.18 – $912.72 | 30 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $4.31 – $17.24 | 30 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | not published | not published | $907.65 – $3,871.04 | 29 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $2.88 – $490.44 | 30 |
| Ghs ppd (tb intradermal) CPT 86580 | $25.25 | $68.25 | $5.07 – $93.20 | 30 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $47.82 | $129.25 | $9.66 – $38.64 | 30 |
| Ghs protein, misc fluid CPT 84160 | not published | not published | $5.47 – $22.44 | 30 |
| Ghs protoporphyrins fract CPT 84202 | $53.00 | $143.25 | $14.35 – $57.40 | 30 |
| Ghs pr without cont pulse ox CPT 94625 | not published | not published | $56.50 – $226.00 | 23 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $45.05 | $121.75 | $12.25 – $49.00 | 30 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | not published | not published | $135.82 – $352.50 | 6 |
| Ghs quinidine CPT 80194 | not published | not published | $14.60 – $58.40 | 30 |
| Ghs refill of implantable pump CPT 95990 | $219.87 | $594.25 | $63.94 – $1,262.04 | 30 |
| Ghs removal intranasal foreign body CPT 30300 | $283.24 | $765.50 | $113.48 – $490.44 | 30 |
| Ghs removal pharyngeal foreign body CPT 42809 | $348.36 | $941.50 | $135.96 – $1,518.28 | 30 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $1,554.46 | $4,201.25 | $588.01 – $1,019.01 | 7 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | not published | not published | $534.17 – $899.30 | 7 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $30.16 | $81.50 | $13.55 – $63.56 | 30 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $4.31 – $17.24 | 30 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | not published | not published | $12.77 – $55.64 | 30 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $3.65 – $17.08 | 30 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $12.31 – $49.24 | 30 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $9.38 – $39.36 | 30 |
| Ghs sensitivity (per antimicro) CPT 87184 | $29.14 | $78.75 | $7.30 – $29.92 | 30 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $201.10 | $543.50 | $107.76 – $1,520.16 | 30 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $200.82 | $542.75 | $145.37 – $1,520.16 | 30 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $221.82 | $599.50 | $132.45 – $1,520.16 | 30 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $242.07 | $654.25 | $176.61 – $1,520.16 | 30 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $136.16 | $368.00 | $84.59 – $756.04 | 30 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $178.34 | $482.00 | $82.51 – $756.04 | 30 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $139.12 | $376.00 | $106.72 – $756.04 | 30 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $275.56 | $744.75 | $165.52 – $756.04 | 30 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $288.23 | $779.00 | $189.01 – $756.04 | 30 |
| Ghs sleep study unattended CPT 95800 | not published | not published | $127.90 – $595.32 | 29 |
| Ghs somatosensory testing lower extremit CPT 95926 | $365.01 | $986.50 | $33.37 – $1,184.84 | 30 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $385.54 | $1,042.00 | $300.73 – $2,018.88 | 29 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $59.85 | $161.75 | $31.76 – $179.12 | 30 |
| Ghs sphenopalatine ganglion block CPT 64505 | $605.69 | $1,637.00 | $95.40 – $1,123.16 | 30 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $3.60 – $490.44 | 30 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $85.75 | $231.75 | $88.06 – $380.44 | 30 |
| Ghs st - eval for alt comm CPT 92567 | not published | not published | $12.11 – $149.36 | 30 |
| Ghs strapping shoulder - 29240 CPT 29240 | $126.82 | $342.75 | $20.57 – $490.44 | 30 |
| Ghs st - re-eval for alt comm CPT 92597 | $106.01 | $286.50 | $54.75 – $271.00 | 30 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $66.51 | $179.75 | $16.32 – $175.56 | 30 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $144.58 | $390.75 | $166.24 – $801.64 | 30 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $583.03 | $1,575.75 | $204.34 – $2,329.08 | 30 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $265.85 | $718.50 | $148.07 – $1,520.16 | 30 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $1,242.46 | $3,358.00 | $251.79 – $419.04 | 7 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.30 – $29.20 | 30 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $252.90 | $683.50 | $228.18 – $912.72 | 30 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $228.18 – $912.72 | 30 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $24.30 – $97.20 | 30 |
| Ghs urine, porphyrins quant CPT 84120 | $321.25 | $868.25 | $14.71 – $58.84 | 30 |
| Ghs vaginal delivery only CPT 59409 | $968.66 | $2,618.00 | $897.66 – $1,538.73 | 7 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $504.72 – $2,018.88 | 23 |
| Ghs windowing of cast CPT 29730 | not published | not published | $50.04 – $600.36 | 30 |
| Giardia lamblia antibody CPT 86674 | $85.93 | $232.25 | $14.72 – $58.88 | 30 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $51.51 – $919.72 | 29 |
| Gi inhouse confirmation CPT 87045 | $46.34 | $125.25 | $9.44 – $37.76 | 30 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $277.90 – $502.02 | 7 |
| Gi protein loss CPT 78282 | not published | not published | $23.98 – $1,528.92 | 29 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $238.27 – $3,567.32 | 30 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $867.24 – $3,468.96 | 23 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $66.50 – $3,567.32 | 30 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $891.83 – $3,567.32 | 29 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $101.12 – $847.48 | 29 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $61.52 – $299.95 | 29 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.00 – $140.00 | 29 |
| Glaucoma surgery CPT 66150 | not published | not published | $857.08 – $1,610.15 | 7 |
| Glaucoma surgery CPT 66155 | not published | not published | $854.35 – $1,609.47 | 7 |
| Glaucoma surgery CPT 66160 | not published | not published | $975.36 – $1,816.95 | 7 |
| Glaucoma surgery CPT 66170 | not published | not published | $1,181.01 – $2,250.95 | 7 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $354.90 | $959.20 | $185.43 – $185.43 | 5 |
| Glucagon plasma - sendout CPT 82943 | $77.42 | $209.25 | $14.29 – $57.16 | 30 |
| Glucose 1 hr post dose CPT 82950 | $22.85 | $61.75 | $4.75 – $19.00 | 30 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.05 – $24.20 | 30 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | not published | not published | $2.35 – $13.12 | 30 |
| Glucose blood quantitative CPT 82947 | $25.35 | $68.50 | $3.93 – $15.72 | 30 |
| Glucose body fluid CPT 82945 | $27.01 | $73.00 | $3.93 – $15.72 | 30 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $65.95 | $178.25 | $56.50 – $226.00 | 28 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $46.25 | $125.00 | $12.87 – $51.48 | 30 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $12.12 | $32.75 | $3.92 – $15.68 | 30 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $61.33 | $165.75 | $18.58 – $74.32 | 30 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $59.48 | $160.75 | $18.52 – $74.08 | 30 |
| Gonioscopy CPT 92020 | not published | not published | $23.22 – $490.44 | 30 |
| Goniotomy CPT 65820 | not published | not published | $745.42 – $1,376.82 | 7 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $790.43 | $2,136.30 | $185.43 – $185.43 | 5 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $63.51 | $171.65 | $36.27 – $56.73 | 6 |
| Graft axiofill 1000mg HCPCS J3590 | $1,395.12 | $3,770.60 | $19.78 – $19.78 | 5 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $824.12 – $1,379.55 | 7 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | $1,837.09 | $4,965.10 | $586.87 – $586.87 | 5 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $1,188.04 – $2,023.74 | 7 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $543.12 | $1,467.90 | $183.04 – $183.04 | 5 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $74.43 | $201.15 | $31.94 – $31.94 | 5 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $543.12 | $1,467.90 | $183.04 – $183.04 | 5 |
| Granisetron hcl injection HCPCS J1626 | $1.83 | $4.95 | $0.62 – $0.62 | 5 |
| Great toe with reduction 28495 CPT 28495 | $329.30 | $890.00 | $157.56 – $912.72 | 30 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $37.00 | $100.00 | $16.66 – $28.58 | 6 |
| Growth hormone antibody CPT 86277 | not published | not published | $15.74 – $62.96 | 30 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $34.24 – $302.40 | 29 |
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.