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 |
|---|---|---|---|---|
| Pelvic Ultrasound (complete) CPT 76856 | $485.35 | $1,311.75 | $43.20 – $404.60 | 30 |
| Pelvic Ultrasound (limited) CPT 76857 | $301.27 | $814.25 | $23.72 – $404.60 | 30 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | $98.35 | $265.80 | $61.63 – $66.03 | 5 |
| Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 | $122.56 | $331.25 | $92.63 – $92.63 | 5 |
| Peng benzathine/procaine inj HCPCS J0558 | $108.11 | $292.20 | $8.63 – $8.63 | 5 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $47.66 | $128.80 | $19.78 – $19.78 | 5 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $53.28 | $144.00 | $0.73 – $0.73 | 5 |
| Penicillin g procaine inj HCPCS J2510 | $16.56 | $44.75 | $19.78 – $19.78 | 5 |
| Penile injection CPT 54235 | $222.46 | $601.25 | $81.98 – $925.40 | 30 |
| Penile vascular study CPT 93980 | $319.22 | $862.75 | $60.72 – $404.60 | 30 |
| Penile vascular study CPT 93981 | not published | not published | $27.59 – $404.60 | 30 |
| Penile venous occlusion CPT 37790 | not published | not published | $547.06 – $897.26 | 7 |
| Penis plastic surgery CPT 54360 | not published | not published | $810.47 – $1,328.54 | 7 |
| Penis study CPT 54240 | not published | not published | $35.57 – $1,184.84 | 30 |
| Pentamidine non-comp unit HCPCS J2545 | $159.27 | $430.45 | $92.63 – $92.63 | 5 |
| Pentobarbital sodium inj HCPCS J2515 | $64.60 | $174.60 | $11.96 – $40.76 | 6 |
| Pentostatin 10 mg intravenous solution HCPCS J9268 | $1,838.79 | $4,969.70 | $1,297.26 – $1,297.26 | 5 |
| Perc cryo ablate renal tum CPT 50593 | $14,222.62 | $38,439.50 | $527.20 – $903.38 | 7 |
| Perc d-e cor revasc chro add HCPCS C9608 | $12,467.24 | $33,695.25 | $14,322.87 – $28,560.00 | 6 |
| Perc d-e cor revasc chro sin HCPCS C9607 | $12,467.24 | $33,695.25 | $14,322.87 – $28,560.00 | 6 |
| Perc d-e cor revasc t cabg b HCPCS C9605 | $12,467.24 | $33,695.25 | $14,322.87 – $28,560.00 | 6 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | $12,467.24 | $33,695.25 | $14,322.87 – $28,560.00 | 6 |
| Perc d-e cor stent ather br HCPCS C9603 | $12,467.24 | $33,695.25 | $14,322.87 – $28,560.00 | 6 |
| Perc d-e cor stent ather s HCPCS C9602 | $13,090.51 | $35,379.75 | $14,322.87 – $28,560.00 | 6 |
| Perc drug-el cor stent bran HCPCS C9601 | $13,090.51 | $35,379.75 | $14,322.87 – $28,560.00 | 6 |
| Perc drug-el cor stent sing HCPCS C9600 | $13,090.51 | $35,379.75 | $14,322.87 – $28,560.00 | 6 |
| Perc rf ablate renal tumor CPT 50592 | $12,484.54 | $33,742.00 | $392.97 – $676.85 | 7 |
| Percut ablate liver rf CPT 47382 | $6,242.27 | $16,871.00 | $856.83 – $1,457.78 | 7 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | $269.71 | $728.95 | $46.95 – $46.95 | 5 |
| Pericardiectomy/sub or com/w bypas 33031 CPT 33031 | not published | not published | $1,689.43 – $4,677.41 | 7 |
| Pericardiotomy/clot/for bod remove 33020 CPT 33020 | not published | not published | $990.11 – $1,645.53 | 7 |
| Peri-implt capslc brst compl CPT 19371 | not published | not published | $847.84 – $1,460.49 | 7 |
| Perineoplasty rpr per nonob CPT 56810 | not published | not published | $287.23 – $488.42 | 7 |
| Peripheral vascular rehab CPT 93668 | $53.65 | $145.00 | $18.63 – $226.00 | 30 |
| Peri-proc device eval icd CPT 93287 | not published | not published | $13.65 – $73.32 | 7 |
| Peri-proc device eval pm CPT 93286 | $41.44 | $112.00 | $12.22 – $55.38 | 7 |
| Peritoneal cath sub q resv per CPT 49419 | not published | not published | $496.10 – $813.59 | 7 |
| Peritoneogram rs&i CPT 74190 | $295.26 | $798.00 | $30.27 – $2,086.20 | 29 |
| Perit-vens shunt pat tst CPT 78291 | $272.41 | $736.25 | $55.59 – $1,528.92 | 30 |
| Perq art m-thrombect &/nfs CPT 61645 | $1,628.00 | $4,400.00 | $892.45 – $1,513.73 | 6 |
| Perq clsr tcat l atr apndge CPT 33340 | $6,954.34 | $18,795.50 | $903.78 – $1,559.40 | 6 |
| Perq dev breast 1st mr guide CPT 19287 | $1,606.36 | $4,341.50 | $146.29 – $2,677.08 | 29 |
| Perq dev breast 1st strtctc CPT 19283 | $541.31 | $1,463.00 | $116.11 – $2,677.08 | 29 |
| Perq nl/pl lithotrp cplx>2cm CPT 50081 | not published | not published | $1,439.85 – $2,357.75 | 7 |
| Perq nl/pl lithotrp smpl<2cm CPT 50080 | not published | not published | $979.43 – $1,604.72 | 7 |
| Perq plmt bile duct stent CPT 47538 | $5,790.13 | $15,649.00 | $271.04 – $642.32 | 6 |
| Perq plmt bile duct stent CPT 47539 | $5,514.67 | $14,904.50 | $492.07 – $869.30 | 6 |
| Perq plmt bile duct stent CPT 47540 | $5,514.67 | $14,904.50 | $509.62 – $1,038.66 | 6 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $434.66 | $1,174.75 | $231.35 – $925.40 | 27 |
| Perq skel fix rad/uln dislc CPT 25671 | not published | not published | $554.48 – $974.12 | 7 |
| Perq skel fix ulnar styld fx CPT 25651 | not published | not published | $503.22 – $888.41 | 7 |
| Perqt bx lung/mediastinum 32405 CPT 32405 | not published | not published | $103.04 – $193.88 | 7 |
| Perq transcath closure each CPT 93592 | $10,970.41 | $29,649.75 | $495.73 – $855.24 | 6 |
| Perq transcath closure pda CPT 93582 | $43,742.23 | $118,222.25 | $745.77 – $1,210.85 | 6 |
| Perq transcath cls aortic CPT 93591 | not published | not published | $1,124.15 – $1,939.59 | 6 |
| Perq transcath cls mitral CPT 93590 | $12,589.07 | $34,024.50 | $1,354.68 – $2,337.35 | 6 |
| Perq transcath septal reduxn CPT 93583 | $4,664.50 | $12,606.75 | $844.37 – $1,347.57 | 6 |
| Perq tx big toe fracture w/manip 28496 CPT 28496 | not published | not published | $241.01 – $440.12 | 7 |
| Perq tx malar fracture CPT 21355 | not published | not published | $351.63 – $601.34 | 7 |
| Perq tx mndblr fx xtrnl fixj CPT 21452 | not published | not published | $341.68 – $628.55 | 7 |
| Perq tx nasoethmoid fx CPT 21340 | not published | not published | $882.67 – $1,529.21 | 7 |
| Pertussis ag if CPT 87265 | $82.42 | $222.75 | $11.98 – $47.92 | 30 |
| Pertuzumab 30 mg/ml desensitization HCPCS J9306 | $40.22 | $108.70 | $19.78 – $19.78 | 5 |
| Pet CT skull-mid thgh initial CPT 78815 | $2,937.43 | $7,939.00 | $154.30 – $1,865.25 | 6 |
| Pet CT whole body initial CPT 78816 | $2,959.91 | $7,999.75 | $158.31 – $1,863.89 | 6 |
| Pet fdg brain metoblic eval sb CPT 78608 | $1,792.56 | $4,844.75 | $94.41 – $1,839.39 | 6 |
| Pet image full body CPT 78813 | $758.40 | $2,049.72 | $127.30 – $1,855.04 | 6 |
| Pet image ltd area CPT 78811 | $2,480.20 | $6,703.25 | $98.55 – $1,846.88 | 6 |
| Pet image skull-thigh CPT 78812 | $2,783.07 | $7,521.80 | $122.82 – $1,852.32 | 6 |
| Pet image w/ct lmtd CPT 78814 | $2,098.18 | $5,670.75 | $139.46 – $1,860.48 | 6 |
| Pet scan brain perf study CPT 78609 | $1,575.29 | $4,257.55 | $83.40 – $142.86 | 7 |
| Phalangectomy ea toe 28150 CPT 28150 | not published | not published | $310.55 – $527.19 | 7 |
| Pharmacologic management w/psytx CPT 90863 | not published | not published | $276.30 – $276.30 | 5 |
| Ph body fluid CPT 83986 | $30.25 | $81.75 | $3.58 – $14.32 | 30 |
| Phencyclidine (pcp) CPT 83992 | not published | not published | $15.63 – $41.00 | 7 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $90.27 | $243.98 | $19.78 – $19.78 | 5 |
| Phenobarbital therapeutic drug level CPT 80184 | $59.57 | $161.00 | $11.99 – $61.20 | 30 |
| Phentolaine mesylate inj HCPCS J2760 | $198.12 | $535.45 | $53.82 – $185.43 | 6 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | $9.25 | $25.00 | $0.73 – $0.73 | 5 |
| Phenytoin total therapeutic drug level CPT 80185 | $68.54 | $185.25 | $13.25 – $53.00 | 30 |
| Phlebotomy therapeutic CPT 99195 | $74.83 | $202.25 | $77.51 – $490.44 | 30 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | $3,662.26 | $9,898.00 | $508.50 – $859.83 | 7 |
| Phleb veins 1 extrm >20 stab CPT 37766 | $3,662.26 | $9,898.00 | $621.99 – $1,058.48 | 7 |
| Phosphorus CPT 84100 | $32.93 | $89.00 | $4.74 – $18.96 | 30 |
| Phosphorus 24 hour urine CPT 84105 | $26.36 | $71.25 | $5.47 – $23.12 | 30 |
| Photchmtx tar&uvb/ptrltm&uvb CPT 96910 | not published | not published | $56.50 – $226.00 | 30 |
| Photochemotherapy puva CPT 96912 | not published | not published | $56.50 – $226.00 | 30 |
| Photochemotherapy uv-a or b CPT 96913 | not published | not published | $122.50 – $1,520.16 | 30 |
| Photo patch test CPT 95052 | not published | not published | $6.83 – $226.00 | 30 |
| Photopheresis CPT 36522 | not published | not published | $114.10 – $191.84 | 7 |
| Photosensitivity tests CPT 95056 | not published | not published | $37.76 – $490.44 | 30 |
| Phys blood bank serv authrj CPT 86079 | not published | not published | $37.99 – $203.28 | 30 |
| Phys blood bank serv reactj CPT 86078 | not published | not published | $37.73 – $652.00 | 30 |
| Phys blood bank serv xmatch CPT 86077 | not published | not published | $23.30 – $107.64 | 30 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $75.04 | $202.80 | $8.63 – $8.63 | 5 |
| Pierce earlobes 69090 CPT 69090 | not published | not published | $33.66 – $98.04 | 6 |
| Pik3ca gene trgt seq alys CPT 81309 | not published | not published | $274.83 – $1,099.32 | 24 |
| Pinch graft 1/mlt c> sm ulcer tip/oth area 2cm 15050 CPT 15050 | not published | not published | $469.80 – $2,329.08 | 30 |
| Pin finger dislocation CPT 26776 | not published | not published | $461.40 – $808.82 | 7 |
| Pin finger fracture each CPT 26756 | not published | not published | $432.84 – $765.29 | 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.