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 |
|---|---|---|---|---|
| Strep b dna amp probe CPT 87653 | not published | not published | $35.09 – $140.36 | 30 |
| Streptokinase antibody CPT 86590 | not published | not published | $11.73 – $50.64 | 30 |
| Streptomycin injection HCPCS J3000 | $26.21 | $70.85 | $19.78 – $19.78 | 5 |
| Streptozocin injection HCPCS J9320 | $459.11 | $1,240.85 | $185.43 – $185.43 | 5 |
| Stress test pulmonary CPT 94618 | $135.61 | $366.50 | $19.03 – $490.44 | 28 |
| Stress tte complete CPT 93351 | not published | not published | $120.48 – $2,086.20 | 30 |
| Str markers spec anal addl CPT 81266 | not published | not published | $74.21 – $1,219.24 | 29 |
| Str markers specimen anal CPT 81265 | not published | not published | $233.07 – $932.28 | 29 |
| St treatment speech individual CPT 92507 | $66.05 | $178.50 | $32.14 – $285.48 | 30 |
| St treatment swallow dysfunction/oral CPT 92526 | $87.32 | $236.00 | $33.55 – $313.72 | 30 |
| Subdural tap fontanelle/sutur infant init 61000 CPT 61000 | not published | not published | $122.94 – $2,634.96 | 30 |
| Subq i/p critical care pr day age 28 days/less than 99469 CPT 99469 | not published | not published | $444.77 – $472.11 | 2 |
| Subq njx filling matrl 1cc/< CPT 11950 | not published | not published | $57.09 – $756.04 | 30 |
| Subq njx fil matrl 5.1-10cc CPT 11952 | not published | not published | $104.95 – $2,329.08 | 30 |
| Subsequent intensive care infant 1500-2500 grams 99479 CPT 99479 | not published | not published | $138.96 – $150.22 | 2 |
| Subsequent intensive care infant 2501-5000 grams 99480 CPT 99480 | not published | not published | $134.17 – $144.44 | 2 |
| Subtalar arthro w/deb CPT 29906 | not published | not published | $762.56 – $1,303.37 | 7 |
| Subtalar arthro w/exc CPT 29905 | not published | not published | $728.20 – $1,272.08 | 7 |
| Subtalar arthro w/fb rmvl CPT 29904 | not published | not published | $677.59 – $1,174.79 | 7 |
| Subtalar arthro w/fusion CPT 29907 | not published | not published | $943.30 – $1,614.92 | 7 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $61.83 | $167.10 | $8.63 – $8.63 | 5 |
| Suction lipectomy head&neck CPT 15876 | not published | not published | $880.60 – $943.50 | 5 |
| Suction lipectomy lwr extrem CPT 15879 | not published | not published | $1,570.80 – $1,683.00 | 5 |
| Suction lipectomy trunk CPT 15877 | not published | not published | $4,442.20 – $4,759.50 | 5 |
| Suction lipectomy upr extrem CPT 15878 | not published | not published | $880.60 – $943.50 | 5 |
| Sugars multiple quant CPT 84379 | not published | not published | $11.53 – $46.12 | 30 |
| Sugars single quant CPT 84378 | $92.91 | $251.10 | $11.53 – $46.12 | 30 |
| Sup of prep of antigen # of vials 95144 CPT 95144 | not published | not published | $3.53 – $175.56 | 25 |
| Supprelin la implant HCPCS J9226 | $25,852.66 | $69,872.05 | $6,421.31 – $6,421.31 | 5 |
| Surg dx exam anorectal CPT 45990 | not published | not published | $120.08 – $199.32 | 7 |
| Surg ect salp-oophorectomy 59120 CPT 59120 | not published | not published | $884.13 – $1,489.76 | 7 |
| Surg ect without salp-oophorectomy 59121 CPT 59121 | not published | not published | $886.93 – $1,491.11 | 7 |
| Surgery for urethra pouch CPT 53240 | not published | not published | $475.07 – $780.24 | 7 |
| Surgery to stop leg growth CPT 27475 | not published | not published | $716.55 – $1,216.29 | 7 |
| Surgery to stop leg growth CPT 27477 | not published | not published | $805.18 – $1,347.57 | 7 |
| Surgery to stop leg growth CPT 27479 | not published | not published | $1,017.65 – $1,611.51 | 7 |
| Surgery to stop leg growth CPT 27485 | not published | not published | $733.23 – $1,233.30 | 7 |
| Surgical exposure prostate 55860 CPT 55860 | not published | not published | $985.95 – $1,614.92 | 7 |
| Surgical opening of stomach CPT 43510 | not published | not published | $891.83 – $3,567.32 | 30 |
| Surgical opening of stomach 43500 CPT 43500 | not published | not published | $850.58 – $1,458.45 | 7 |
| Surgical opening of throat CPT 42955 | not published | not published | $805.35 – $1,416.96 | 7 |
| Surgical pathology level 1 gross examination only CPT 88300 | $23.31 | $63.00 | $5.24 – $93.20 | 30 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $48.56 | $131.25 | $7.98 – $149.36 | 30 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $50.14 | $135.50 | $13.40 – $203.28 | 30 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $68.45 | $185.00 | $29.83 – $203.28 | 30 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $160.30 | $433.25 | $97.83 – $1,368.68 | 30 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $208.22 | $562.75 | $169.10 – $3,108.20 | 30 |
| Surgical repair stomach bleedin ulcer 43501 CPT 43501 | not published | not published | $1,467.01 – $2,497.20 | 7 |
| Surgical repair stomach gastric lac 43502 CPT 43502 | not published | not published | $1,662.19 – $2,824.40 | 7 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | not published | not published | $408.56 – $771.41 | 7 |
| Susceptibility agar dilution per agent CPT 87181 | $20.72 | $56.00 | $1.84 – $19.00 | 30 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $13.97 | $37.75 | $1.84 – $19.00 | 30 |
| Susceptibility mic per plate CPT 87186 | $163.98 | $443.20 | $8.65 – $34.60 | 30 |
| Suscept studies macrobroth dilution ea CPT 87188 | not published | not published | $6.64 – $26.56 | 30 |
| Suspension of testis CPT 54620 | not published | not published | $336.60 – $551.69 | 7 |
| Suspension of uterus 58400 CPT 58400 | not published | not published | $484.76 – $822.42 | 7 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | not published | not published | $1,163.76 – $1,963.88 | 7 |
| Suture bile duct injury 47900 CPT 47900 | not published | not published | $1,482.23 – $2,549.58 | 7 |
| Svc venogram s&i CPT 75827 | $867.10 | $2,343.50 | $70.46 – $315.91 | 7 |
| Sweat collection by iontophoresis CPT 89230 | $50.14 | $135.50 | $2.73 – $203.28 | 30 |
| Sympathectomy cervical CPT 64802 | not published | not published | $675.86 – $993.17 | 7 |
| Sympathectomy digital artery CPT 64820 | not published | not published | $784.98 – $1,382.96 | 7 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $837.88 – $1,463.90 | 7 |
| Synthetic sentence id test CPT 92576 | not published | not published | $22.59 – $149.36 | 30 |
| Synvisc or synvisc-one HCPCS J7325 | $1,242.63 | $3,358.45 | $19.78 – $19.78 | 5 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $45.70 | $123.50 | $4.40 – $17.60 | 30 |
| T3 (triiodothyronine) free CPT 84481 | $89.82 | $242.75 | $16.94 – $67.76 | 30 |
| T3 (triiodothyronine) total CPT 84480 | $59.02 | $159.50 | $14.18 – $56.72 | 30 |
| T4 (thyroxine) free CPT 84439 | $61.33 | $165.75 | $9.02 – $36.08 | 30 |
| T4 (thyroxine) total CPT 84436 | $41.26 | $111.50 | $6.87 – $27.48 | 30 |
| Tacrol envarsus ex rel oral HCPCS J7503 | $2.74 | $7.40 | $1.39 – $1.49 | 5 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $1.36 | $3.68 | $2.03 – $2.03 | 5 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $176.77 | $477.75 | $185.43 – $185.43 | 5 |
| Tacrolimus therapeutic drug level CPT 80197 | $96.66 | $261.25 | $13.73 – $54.92 | 30 |
| Tah rad debulk/lymph remove 58954 CPT 58954 | not published | not published | $2,410.24 – $3,994.43 | 7 |
| Tah rad dissect for debulk 58953 CPT 58953 | not published | not published | $2,219.74 – $3,685.59 | 7 |
| Tah w/mmk 58152 CPT 58152 | not published | not published | $1,383.96 – $2,352.99 | 7 |
| Tap block bilat cont infusion 64489 CPT 64489 | not published | not published | $89.95 – $369.38 | 6 |
| Tap block uni by cont infusion 64487 CPT 64487 | not published | not published | $76.90 – $265.98 | 6 |
| Target gsa panel hmtlmph neop CPT 81450 | $925.19 | $2,500.50 | $741.09 – $3,038.12 | 24 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $1,259.70 | $3,404.60 | $3,313.75 – $3,313.75 | 1 |
| Target gsa panel organ neop CPT 81445 | $1,426.07 | $3,854.25 | $597.91 – $2,391.64 | 24 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $147.82 – $2,329.08 | 30 |
| Tavr perq femoral CPT 33361 | not published | not published | $1,547.39 – $2,514.21 | 6 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $332.56 | $898.80 | $1.19 – $1.28 | 5 |
| Tbs techl calculation only CPT 77091 | not published | not published | $83.75 – $335.00 | 23 |
| Tbs techl prep&transmis data CPT 77090 | not published | not published | $83.75 – $335.00 | 23 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $85.93 | $232.25 | $100.00 – $400.00 | 29 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $77.52 | $209.50 | $61.98 – $247.92 | 30 |
| Tc-99m bicisate HCPCS A9557 | $2,525.34 | $6,825.25 | $463.03 – $463.03 | 5 |
| Tc-99m exametazime diag HCPCS A9521 | $2,832.07 | $7,654.25 | $1,811.81 – $1,811.81 | 5 |
| Tc-99m labeled rbc HCPCS A9560 | $265.66 | $718.00 | $116.23 – $116.23 | 5 |
| Tc-99m maa HCPCS A9540 | $281.20 | $760.00 | $24.83 – $24.83 | 5 |
| Tc-99m mebrofenin HCPCS A9537 | $111.28 | $300.75 | $59.32 – $59.32 | 5 |
| Tc-99m medronate HCPCS A9503 | $43.11 | $116.50 | $16.18 – $16.18 | 5 |
| Tc-99m mertiatide HCPCS A9562 | $582.84 | $1,575.25 | $964.13 – $964.13 | 5 |
| Tc-99m oxidronate HCPCS A9561 | $83.99 | $227.00 | $40.10 – $40.10 | 5 |
| Tc-99m pentetate dtpa HCPCS A9539 | $161.23 | $435.75 | $38.99 – $38.99 | 5 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $49.12 | $132.75 | $10.92 – $10.92 | 5 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $130.80 | $353.50 | $21.86 – $21.86 | 5 |
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.