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 |
|---|---|---|---|---|
| X-ray facial bones complete > 3 views CPT 70150 | $95.18 | $257.25 | $16.07 – $404.60 | 30 |
| X-ray fallopian tube CPT 74742 | not published | not published | $38.25 – $65.51 | 6 |
| X-ray femur >=2 views (both sides) CPT 73552 | $232.18 | $627.50 | $23.36 – $335.00 | 29 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $240.32 | $649.50 | $8.38 – $335.00 | 30 |
| X-ray foot 2 views (both sides) CPT 73620 | $232.18 | $627.50 | $9.79 – $335.00 | 30 |
| X-ray forearm 2 views (both sides) CPT 73090 | $235.32 | $636.00 | $9.79 – $335.00 | 30 |
| X-ray hand 2 views (both sides) CPT 73120 | $240.32 | $649.50 | $9.79 – $404.60 | 30 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $9.70 – $335.00 | 30 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $220.15 | $595.00 | $9.79 – $335.00 | 30 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $161.69 | $437.00 | $37.73 – $404.60 | 29 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $107.67 | $291.00 | $28.39 – $404.60 | 29 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $159.19 | $430.25 | $34.14 – $404.60 | 29 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | not published | not published | $40.96 – $404.60 | 29 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $100.27 | $271.00 | $20.49 – $335.00 | 29 |
| X-ray humerus >= 2 views left CPT 73060 | $124.23 | $335.75 | $10.66 – $335.00 | 30 |
| X-ray joint survey 1 view CPT 77077 | $284.16 | $768.00 | $19.51 – $404.60 | 30 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $207.20 | $560.00 | $10.66 – $335.00 | 30 |
| X-ray knee 3 views (both sides) CPT 73562 | $243.65 | $658.50 | $11.52 – $335.00 | 30 |
| X-ray knee ap standing bilateral CPT 73565 | $89.82 | $242.75 | $11.05 – $335.00 | 30 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $227.92 | $616.00 | $9.79 – $335.00 | 30 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $192.03 | $519.00 | $13.80 – $404.60 | 30 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $227.00 | $613.50 | $19.21 – $404.60 | 30 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $266.22 | $719.50 | $22.65 – $404.60 | 30 |
| X-ray male genital tract CPT 74440 | not published | not published | $23.98 – $919.72 | 30 |
| X-ray mandible complete > 4 views CPT 70110 | $113.31 | $306.25 | $15.60 – $404.60 | 30 |
| X-ray mandible ltd <4 views CPT 70100 | $81.12 | $219.25 | $11.12 – $335.00 | 30 |
| X-ray nasal bones complete > 3 views CPT 70160 | $95.37 | $257.75 | $10.66 – $335.00 | 30 |
| X-ray neck soft tissue CPT 70360 | $109.15 | $295.00 | $10.66 – $335.00 | 30 |
| X-ray nose to rectum for foreign body child CPT 76010 | $66.51 | $179.75 | $11.52 – $335.00 | 30 |
| X-ray of mammary ducts CPT 77054 | $233.56 | $631.25 | $28.46 – $919.72 | 30 |
| X-ray optic foramina CPT 70190 | not published | not published | $12.93 – $335.00 | 30 |
| X-ray pelvis 1-2 views CPT 72170 | $116.00 | $313.50 | $10.66 – $404.60 | 30 |
| X-ray pelvis complete > 3 views CPT 72190 | $127.74 | $345.25 | $13.33 – $404.60 | 30 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $289.25 | $781.75 | $23.05 – $1,358.84 | 30 |
| X-ray ribs 2 views left CPT 71100 | $172.88 | $467.25 | $13.80 – $335.00 | 30 |
| X-ray ribs 3 views bilateral CPT 71110 | $197.49 | $533.75 | $16.54 – $404.60 | 30 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $206.74 | $558.75 | $16.54 – $404.60 | 30 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $225.61 | $609.75 | $19.68 – $404.60 | 30 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $129.04 | $348.75 | $11.99 – $404.60 | 30 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $124.32 | $336.00 | $10.66 – $335.00 | 30 |
| X-ray scapula complete (both sides) CPT 73010 | $259.56 | $701.50 | $10.66 – $404.60 | 30 |
| X-ray sella turcica CPT 70240 | not published | not published | $11.99 – $335.00 | 30 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $224.04 | $605.50 | $9.32 – $335.00 | 30 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $95.37 | $257.75 | $15.20 – $335.00 | 30 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $245.22 | $662.75 | $29.11 – $2,086.20 | 30 |
| X-ray skull < 4 views CPT 70250 | $95.37 | $257.75 | $14.74 – $404.60 | 30 |
| X-ray skull > 4 views complete CPT 70260 | $115.35 | $311.75 | $20.91 – $404.60 | 30 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $240.59 | $650.25 | $36.45 – $404.60 | 30 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $172.14 | $465.25 | $29.40 – $677.36 | 30 |
| X-ray small intestine follow-through study CPT 74248 | $90.37 | $244.25 | $52.33 – $52.33 | 1 |
| X-ray spine single view CPT 72020 | $120.99 | $327.00 | $9.72 – $335.00 | 30 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $125.80 | $340.00 | $13.80 – $335.00 | 30 |
| X-ray sternum > 2 views CPT 71120 | $114.33 | $309.00 | $12.46 – $335.00 | 30 |
| X-ray surgical specimen CPT 76098 | $209.61 | $566.50 | $8.63 – $2,086.20 | 30 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $240.41 | $649.75 | $33.41 – $677.36 | 30 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $101.47 | $274.25 | $15.13 – $335.00 | 30 |
| X-ray thoracic spine 2 views CPT 72070 | $148.46 | $401.25 | $13.80 – $404.60 | 30 |
| X-ray thoracic spine 3 views CPT 72072 | $172.24 | $465.50 | $13.80 – $404.60 | 30 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $141.43 | $382.25 | $13.80 – $335.00 | 30 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $143.38 | $387.50 | $25.88 – $335.00 | 29 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $148.46 | $401.25 | $46.72 – $404.60 | 29 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $232.18 | $627.50 | $10.66 – $335.00 | 30 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $200.91 | $543.00 | $7.98 – $335.00 | 30 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $321.62 | $869.25 | $43.60 – $677.36 | 30 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $299.98 | $810.75 | $43.60 – $677.36 | 30 |
| X-ray wrist 2 views (both sides) CPT 73100 | $246.42 | $666.00 | $10.19 – $335.00 | 30 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $23.05 – $677.36 | 30 |
| Xylose absorption test blood &/or urine CPT 84620 | not published | not published | $12.51 – $51.64 | 30 |
| Yersinia antibody CPT 86793 | not published | not published | $13.19 – $52.76 | 30 |
| Ziconotide injection HCPCS J2278 | $2,571.72 | $6,950.60 | $6.78 – $8.63 | 6 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | $54.54 | $147.40 | $1.84 – $1.84 | 5 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $51.31 – $205.24 | 24 |
| Zika virus igm antibody CPT 86794 | not published | not published | $16.85 – $67.40 | 24 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $30.75 | $83.10 | $19.78 – $19.78 | 5 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | $36.26 | $98.00 | $19.78 – $19.78 | 5 |
| Zoster vaccine-live inj CPT 90736 | not published | not published | $161.60 – $206.19 | 6 |
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.