Supplies, drugs & other prices at Ascension St. John Medical Center
Tulsa, OK · every code in this section with a posted price and a Medicare benchmark.
55 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tte w or w/o fol w/con,fu (C8924) | $355.57 | $961 | 1.1× |
| Admin hepatitis b vaccine (G0010) | $35.34 | $95.50 | 0.8× |
| Admin influenza virus vac (G0008) | $21.83 | $59 | 0.5× |
| Admin pneumococcal vaccine (G0009) | $21.83 | $59 | 0.5× |
| Catheterize for urine spec (P9612) | $19.61 | $53 | 2.1× |
| Diab manage trn per indiv (G0108) | $40.89 | $110.50 | 0.7× |
| Diab manage trn ind/group (G0109) | $21.28 | $57.50 | 1.3× |
| Drug test def 1-7 classes (G0480) | $71.97 | $194.50 | 0.6× |
| Drug test def 15-21 classes (G0482) | $142.17 | $384.25 | 0.7× |
| Drug test def 22+ classes (G0483) | $426.24 | $1,152 | 1.7× |
| Drug test def 8-14 classes (G0481) | $133.39 | $360.50 | 0.9× |
| Elec stim other than wound (G0283) | $32.38 | $87.50 | 2.6× |
| Followup eval of foot pt lop (G0246) | $128.95 | $348.50 | 1.0× |
| Group mnt 2 or more 30 mins (G0271) | $37 | $100 | 2.2× |
| Hbot, full body chamber, 30m (G0277) | $207.29 | $560.25 | 1.6× |
| Home sleep test/type 3 porta (G0399) | $424.58 | $1,147.50 | 2.0× |
| Initial foot exam pt lops (G0245) | $142.17 | $384.25 | 1.1× |
| Inj for sacroiliac jt anesth (G0260) | $271.77 | $734.50 | 0.4× |
| Mnt subs tx for change dx (G0270) | $23.58 | $63.75 | 0.7× |
| Mra w/cont, abd (C8900) | $595.98 | $1,610.75 | 1.8× |
| Mra w/cont, chest (C8909) | $595.98 | $1,610.75 | 1.8× |
| Mra w/cont, lwr ext (C8912) | $595.98 | $1,610.75 | 1.8× |
| Mra w/o cont, abd (C8901) | $560.27 | $1,514.25 | 2.4× |
| Mra w/o cont, lwr ext (C8913) | $560.27 | $1,514.25 | 2.4× |
| Mra w/o fol w/cont, abd (C8902) | $980.13 | $2,649 | 2.9× |
| Mra w/o fol w/cont, chest (C8911) | $843.69 | $2,280.25 | 2.5× |
| Mra w/o fol w/cont, lwr ext (C8914) | $953.58 | $2,577.25 | 2.8× |
| Mra w/o fol w/cont, pelvis (C8920) | $810.76 | $2,191.25 | 2.4× |
| Mra, w/dye, upper extremity (C8934) | $887.26 | $2,398 | 2.6× |
| Mra, w/o&w/dye, spinal canal (C8933) | $555.93 | $1,502.50 | 1.7× |
| Mra, w/o&w/dye, upper extr (C8936) | $1,085.03 | $2,932.50 | 3.2× |
| Mri w/cont, breast, bi (C8906) | $991.69 | $2,680.25 | 3.0× |
| Mri w/cont, breast, uni (C8903) | $781.26 | $2,111.50 | 4.6× |
| Mri w/o fol w/cont, breast, (C8908) | $991.69 | $2,680.25 | 3.0× |
| Mri w/o fol w/cont, brst, un (C8905) | $781.26 | $2,111.50 | 2.3× |
| Oth resp proc, group (G0239) | $61.88 | $167.25 | 1.7× |
| Oth resp proc, indiv (G0238) | $20.54 | $55.50 | 0.7× |
| Perc d-e cor revasc chro sin (C9607) | $12,467.24 | $33,695.25 | 0.7× |
| Perc d-e cor revasc t cabg s (C9604) | $12,467.24 | $33,695.25 | 1.1× |
| Perc d-e cor stent ather s (C9602) | $13,090.51 | $35,379.75 | 0.7× |
| Perc drug-el cor stent sing (C9600) | $13,090.51 | $35,379.75 | 1.2× |
| Perq Sacral Augmt Bilat Inj (0201T) | $4,083.41 | $11,036.25 | 0.6× |
| Perq Sacral Augmt Unilat Inj (0200T) unusually low: confirm this is the full procedure |
$2,382.62 | $6,439.50 | 0.3× |
| Prostate biopsy, any mthd (G0416) | $599.68 | $1,620.75 | 1.7× |
| Routine footcare pt w lops (G0247) | $116.27 | $314.25 | 0.6× |
| Therapeutic procd strg endur (G0237) | $35.71 | $96.50 | 1.3× |
| Tomosynthesis, mammo (G0279) | $34.97 | $94.50 | 2.8× |
| Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation;… (0236T) | $9,557.93 | $25,832.25 | 0.9× |
| Trim nail(s) (G0127) | $132.92 | $359.25 | 2.3× |
| Trluml Perip Athrc Renal Art (0234T) | $9,557.93 | $25,832.25 | 0.9× |
| Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) | $11,110.64 | $30,028.75 | 1.0× |
| Trluml peripheral atherectomy iliac artery ea (0238T) | $11,191.48 | $30,247.25 | 0.6× |
| Tte w or w/o fol w/con,stres (C8928) | $458.06 | $1,238 | 0.6× |
| Tte w or w/o fol w/cont, f/u (C8922) | $941.56 | $2,544.75 | 1.2× |
| Tte w or wo fol wcon,doppler (C8929) | $1,110.09 | $3,000.25 | 1.5× |