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 |
|---|---|---|---|---|
| Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 | not published | not published | $46.96 – $773.88 | 29 |
| Initial foot exam pt lops HCPCS G0245 | $142.17 | $384.25 | $48.10 – $91.26 | 6 |
| Initial hosp neonate 28 d/less than not critically ill 99477 CPT 99477 | not published | not published | $393.24 – $419.31 | 2 |
| Initial nursing facility care/day 35 minutes CPT 99305 | not published | not published | $138.99 – $143.61 | 2 |
| Initial nursing facility care/day 45 minutes CPT 99306 | not published | not published | $178.78 – $184.06 | 2 |
| Initial nursing facility care/day low severity 99304 CPT 99304 | not published | not published | $99.28 – $100.65 | 2 |
| Initiation & management bipap/cpap initial day CPT 94660 | $103.69 | $280.25 | $42.86 – $773.88 | 30 |
| Inj, abilify maintena, 1 mg HCPCS J0401 | $2,488.27 | $6,725.05 | $4.32 – $4.32 | 5 |
| Inj, bezlotoxumab, 10 mg HCPCS J0565 | $46.58 | $125.90 | $54.26 – $58.14 | 5 |
| Inj calcitriol per 0.1 mcg HCPCS J0636 | $11.21 | $30.30 | $0.73 – $0.73 | 5 |
| Inj ceftolozane tazobactam HCPCS J0695 | $164.93 | $445.75 | $5.92 – $6.35 | 5 |
| Inj, clevidipine butyrate HCPCS C9248 | $17.45 | $47.16 | $4.32 – $6.67 | 6 |
| Inj disk cerv-thor ea lev CPT 62291 | not published | not published | $189.48 – $316.32 | 7 |
| Inj dupuytren cord w/enzyme CPT 20527 | not published | not published | $73.92 – $1,123.16 | 29 |
| Inj dx for sinogram CPT 20501 | $139.12 | $376.00 | $43.22 – $70.74 | 7 |
| Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides) CPT 64454 | not published | not published | $658.74 – $2,634.96 | 23 |
| Injection arthrography hip without anesthesia (both sides) CPT 27093 | $212.66 | $574.75 | $78.93 – $131.30 | 7 |
| Injection, cangrelor HCPCS C9460 | $19.75 | $53.38 | $21.38 – $22.91 | 5 |
| Injection carpal tunnel therapeutic (both sides) CPT 20526 | $424.02 | $1,146.00 | $64.28 – $1,123.16 | 30 |
| Injection during cath supravalvular aortography CPT 93567 | $430.59 | $1,163.75 | $59.79 – $104.52 | 6 |
| Injection epidural blood patch or clot CPT 62273 | $402.84 | $1,088.75 | $127.60 – $2,634.96 | 30 |
| Injection eye drug CPT 67028 | not published | not published | $109.39 – $1,262.04 | 30 |
| Injection for arthrography wrist (both sides) CPT 25246 | $175.29 | $473.75 | $85.03 – $139.46 | 7 |
| Injection for bladder x-ray CPT 51600 | $128.95 | $348.50 | $50.28 – $81.63 | 7 |
| Injection for hip x-ray CPT 27095 | $202.48 | $547.25 | $93.58 – $153.74 | 7 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $141.06 | $381.25 | $57.68 – $109.20 | 7 |
| Injection for spleen x-ray CPT 38200 | not published | not published | $153.69 – $266.66 | 7 |
| Injection for tear sac x-ray CPT 68850 | not published | not published | $61.74 – $100.68 | 7 |
| Injection for ureter x-ray CPT 50684 | $107.86 | $291.50 | $56.16 – $92.52 | 7 |
| Injection for ureter x-ray CPT 50690 | $99.81 | $269.75 | $78.95 – $129.93 | 7 |
| Injection, fulvestrant HCPCS J9395 | $163.24 | $441.20 | $185.43 – $185.43 | 5 |
| Injection glatiramer acetate HCPCS J1595 | $272.52 | $736.55 | $185.43 – $185.43 | 5 |
| Injection into brain canal CPT 61026 | $459.45 | $1,241.75 | $116.83 – $2,634.96 | 30 |
| Injection into brain canal CPT 61055 | $421.43 | $1,139.00 | $136.82 – $1,123.16 | 30 |
| Injection into hemorrhoid(s) CPT 46500 | $193.05 | $521.75 | $131.02 – $3,468.96 | 30 |
| Injection into spinal artery CPT 62294 | not published | not published | $846.86 – $3,387.44 | 30 |
| Injection into vocal cord CPT 31513 | not published | not published | $146.85 – $1,477.48 | 30 |
| Injection, isavuconazonium HCPCS J1833 | $389.92 | $1,053.85 | $0.91 – $0.98 | 5 |
| Injection jugular CPT 36299 | not published | not published | $2,621.52 – $2,621.52 | 5 |
| Injection of sinus tract CPT 20500 | $1,773.41 | $4,793.00 | $92.47 – $159.18 | 7 |
| Injection,onabotulinumtoxina HCPCS J0585 | $17.91 | $48.40 | $5.46 – $19.78 | 6 |
| Injection, peramivir HCPCS J2547 | $9.71 | $26.25 | $2.27 – $2.43 | 5 |
| Injection px peyronie ds CPT 54200 | not published | not published | $92.00 – $1,364.25 | 30 |
| Injection radioactive tracer sentinel node (both sides) CPT 38792 | $1,007.33 | $2,722.50 | $43.87 – $1,528.92 | 30 |
| Injection, renflexis HCPCS Q5104 | $592.94 | $1,602.55 | $107.59 – $115.28 | 4 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | $543.53 | $1,469.00 | $79.37 – $367.25 | 6 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | $744.81 | $2,013.00 | $75.56 – $2,634.96 | 30 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $1,110.37 | $3,001.00 | $50.36 – $2,634.96 | 30 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $1,285.20 | $3,473.50 | $123.80 – $3,387.44 | 30 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | not published | not published | $67.80 – $115.65 | 6 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | $1,985.61 | $5,366.50 | $118.45 – $3,387.44 | 29 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | $349.28 | $944.00 | $58.41 – $98.64 | 6 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $992.80 | $2,683.25 | $100.81 – $3,387.44 | 29 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $660.73 | $1,785.75 | $123.44 – $2,634.96 | 29 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $660.73 | $1,785.75 | $112.63 – $2,634.96 | 29 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $416.07 | $1,124.50 | $44.27 – $1,123.16 | 30 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $263.90 | $713.25 | $41.98 – $1,123.16 | 30 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $319.77 | $864.25 | $46.70 – $1,123.16 | 30 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 | $75.11 | $203.00 | $23.12 – $175.56 | 30 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $75.48 | $204.00 | $15.56 – $154.80 | 6 |
| Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 | $84.55 | $228.50 | $59.10 – $801.64 | 30 |
| Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 | $61.14 | $165.25 | $24.21 – $270.80 | 30 |
| Injection torsemide 10 mg/ml HCPCS J3265 | $16.02 | $43.30 | $19.78 – $19.78 | 5 |
| Injection treatment of eye CPT 66020 | not published | not published | $131.64 – $241.49 | 7 |
| Injection treatment of eye CPT 66030 | $2,911.53 | $7,869.00 | $109.53 – $208.16 | 7 |
| Injection treatment of nerve CPT 64605 | not published | not published | $383.97 – $631.95 | 7 |
| Injection treatment of nerve CPT 64610 | not published | not published | $536.06 – $889.77 | 7 |
| Injection treatment of nerve CPT 64681 | not published | not published | $246.44 – $3,387.44 | 30 |
| Injection treatment of nose CPT 30200 | not published | not published | $64.55 – $1,937.64 | 30 |
| Inject sacroiliac joint CPT 27096 | $170.57 | $461.00 | $81.94 – $160.55 | 7 |
| Inject/treat eye socket CPT 67500 | not published | not published | $80.29 – $1,137.40 | 30 |
| Inject/treat eye socket CPT 67505 | not published | not published | $82.54 – $1,137.40 | 30 |
| Inject/treat eye socket CPT 67515 | not published | not published | $90.04 – $1,137.40 | 30 |
| Inj., emicizumab-kxwh 0.5 mg HCPCS J7170 | $20,238.04 | $54,697.40 | $70.83 – $75.89 | 4 |
| Inj epidural sgl cerv-thor without img CPT 62320 | $516.89 | $1,397.00 | $114.44 – $2,634.96 | 29 |
| Inj epidural sgl lumb-sacral without img CPT 62322 | $520.31 | $1,406.25 | $98.47 – $3,387.44 | 29 |
| Inj for ext venography CPT 36005 | $395.53 | $1,069.00 | $54.98 – $91.16 | 7 |
| Inj for mammo ductogram CPT 19030 | $469.16 | $1,268.00 | $88.29 – $164.59 | 7 |
| Inj hrt cath w/s&i nonsel p-art angrp CPT 93568 | $983.74 | $2,658.75 | $53.95 – $94.38 | 6 |
| Inj hrt cath w/s&i sel hrt ang CPT 93563 | $407.56 | $1,101.50 | $66.57 – $119.35 | 6 |
| Inj hrt cath w/s&i sel hrt art CPT 93564 | $722.52 | $1,952.75 | $69.93 – $121.69 | 6 |
| Inj hrt cath w/s&i sel left vent CPT 93565 | not published | not published | $51.68 – $92.04 | 6 |
| Inj hrt cath w/s&i sel right vent CPT 93566 | $965.33 | $2,609.00 | $52.78 – $92.04 | 6 |
| Inj/inf neurolyt sbst spinal canal lesion 62282 CPT 62282 | not published | not published | $156.09 – $3,387.44 | 30 |
| Inj intralesional <= 7 lsn(s) CPT 11900 | $159.19 | $430.25 | $34.89 – $756.04 | 30 |
| Inj intralesional > 7 lsns CPT 11901 | not published | not published | $54.22 – $756.04 | 30 |
| Inj ivig privigen 500 mg HCPCS J1459 | $520.15 | $1,405.80 | $38.66 – $92.63 | 6 |
| Inj levocarnitine per 1 gm HCPCS J1955 | $65.60 | $177.30 | $8.63 – $8.63 | 5 |
| Inj mepivacaine hcl/10 ml HCPCS J0670 | $19.37 | $52.35 | $19.78 – $19.78 | 5 |
| Inj, moxifloxacin 100 mg HCPCS J2280 | $73.08 | $197.50 | $19.78 – $19.78 | 5 |
| Inj nephrosto/ureterogram w/img exstng access CPT 50431 | $702.35 | $1,898.25 | $74.34 – $2,539.64 | 29 |
| Inj peritoneal venous shunt CPT 49427 | $47.55 | $128.50 | $52.15 – $97.51 | 7 |
| Inj proc ankle arthr CPT 27648 | $316.54 | $855.50 | $59.32 – $97.95 | 7 |
| Inj proc elbow arthro CPT 24220 | $302.66 | $818.00 | $77.53 – $146.65 | 7 |
| Inj proc for lymphang CPT 38790 | $212.29 | $573.75 | $92.58 – $154.41 | 7 |
| Inj proc lumbr disk ea lvl CPT 62290 | not published | not published | $191.02 – $328.56 | 7 |
| Inj proc myelogram lumbar CPT 62284 | $446.68 | $1,207.25 | $98.44 – $159.86 | 7 |
| Inj proc sialogram CPT 42550 | $130.24 | $352.00 | $71.83 – $117.00 | 7 |
| Inj progesterone per 50 mg HCPCS J2675 | $35.00 | $94.60 | $19.78 – $19.78 | 5 |
| Inj retro urethrocysto CPT 51610 | $111.28 | $300.75 | $71.95 – $118.37 | 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.