Supplies, drugs & other prices at Saint Francis Hospital, Inc
Tulsa, OK · every code in this section with a posted price and a Medicare benchmark.
90 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,co (C8923) | $820.04 | $2,050.10 | 1.1× |
| 2d tte w or w/o fol w/con,fu (C8924) | $566.96 | $1,417.40 | 1.7× |
| Admin hepatitis b vaccine (G0010) | $43.68 | $109.20 | 1.0× |
| Admin influenza virus vac (G0008) | $16.12 | $40.30 | 0.4× |
| Admin pneumococcal vaccine (G0009) | $16.12 | $40.30 | 0.4× |
| Alcohol/subs interv 15-30mn (G0396) | $52.82 | $132.05 | 1.5× |
| Blind interatrial shunt ide (C9758) | $16,388.26 | $40,970.65 | 1.0× |
| Catheterize for urine spec (P9612) | $28.80 | $72 | 3.1× |
| Covid-19 lab test non-cdc (U0002) | $73.44 | $183.60 | 1.4× |
| Direct refer hospital observ (G0379) | $126.90 | $317.24 | 0.2× |
| Drug test def 1-7 classes (G0480) | $140.16 | $350.40 | 1.2× |
| Drug test def 15-21 classes (G0482) | $244.80 | $612 | 1.2× |
| Drug test def 8-14 classes (G0481) | $334.56 | $836.40 | 2.1× |
| Elec stim other than wound (G0283) | $55.10 | $137.75 | 4.3× |
| Endovascular Venous Arterialization Tibl/Prnl Vn (0620T) unusually low: confirm this is the full procedure |
$14,948.06 | $37,370.15 | 0.4× |
| Fecal blood scrn immunoassay (G0328) | $27.36 | $68.40 | 1.5× |
| Hbot, full body chamber, 30m (G0277) | $226.48 | $566.20 | 1.7× |
| Hep c screen high risk/other (G0472) | $62.32 | $155.80 | 1.3× |
| Hiv combination assay (G0475) | $20.64 | $51.60 | 0.9× |
| Hospital outpt clinic visit (G0463) | $129.20 | $323 | 1.0× |
| Initial preventive exam (G0402) | $127.60 | $319 | 1.0× |
| Inj for sacroiliac jt anesth (G0260) | $989.14 | $2,472.85 | 1.5× |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) | $15,260.04 | $38,150.10 | 0.5× |
| Insj/Rplc Car Modulj Sys Ventr Electrode Only (0411T) | $4,681.22 | $11,703.05 | 0.6× |
| Insj/Rplc Cardiac Modulj Sys Atr Electrode Only (0410T) | $4,681.22 | $11,703.05 | 0.6× |
| Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) likely a partial charge, not the full procedure |
$6,339.92 | $15,849.80 | 0.3× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) unusually low: confirm this is the full procedure |
$10,140.68 | $25,351.70 | 0.3× |
| Mra w/cont, abd (C8900) | $1,045 | $2,612.50 | 3.1× |
| Mra w/cont, chest (C8909) | $1,064 | $2,660 | 3.2× |
| Mra w/cont, lwr ext (C8912) | $926.82 | $2,317.05 | 2.8× |
| Mra w/cont, pelvis (C8918) | $1,012.32 | $2,530.80 | 3.0× |
| Mra w/o cont, abd (C8901) | $732.64 | $1,831.60 | 3.2× |
| Mra w/o cont, chest (C8910) | $786.98 | $1,967.45 | 3.4× |
| Mra w/o cont, lwr ext (C8913) | $867.54 | $2,168.85 | 3.8× |
| Mra w/o cont, pelvis (C8919) | $867.54 | $2,168.85 | 3.8× |
| Mra w/o fol w/cont, abd (C8902) | $1,280.98 | $3,202.45 | 3.8× |
| Mra w/o fol w/cont, chest (C8911) | $976.60 | $2,441.50 | 2.9× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,156.72 | $2,891.80 | 3.4× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,156.72 | $2,891.80 | 3.4× |
| Mra, w/dye, spinal canal (C8931) | $750.50 | $1,876.25 | 2.2× |
| Mra, w/dye, upper extremity (C8934) | $750.50 | $1,876.25 | 2.2× |
| Mra, w/o dye, spinal canal (C8932) | $558.98 | $1,397.45 | 2.4× |
| Mra, w/o dye, upper extr (C8935) | $558.98 | $1,397.45 | 2.4× |
| Mra, w/o&w/dye, spinal canal (C8933) | $907.44 | $2,268.60 | 2.7× |
| Mra, w/o&w/dye, upper extr (C8936) | $907.44 | $2,268.60 | 2.7× |
| Mri w/o fol w/cont, breast, (C8908) | $1,284.02 | $3,210.05 | 3.8× |
| Mri w/o fol w/cont, brst, un (C8905) | $967.10 | $2,417.75 | 2.9× |
| Neuro csf detcj prion prtn quakg conf conv qual (0035U) | $977.76 | $2,444.40 | 1.8× |
| Obtaining screen pap smear (Q0091) | $28 | $70 | 1.0× |
| Onc aml DNA gntyp int tandem dup detcj/nondetcj (0023U) | $418.08 | $1,045.20 | 1.7× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $599.04 | $1,497.60 | 1.9× |
| Onc thyr 10 microrna seq +/- rslt mod hi rsk mal (0018U) | $2,801.28 | $7,003.20 | 0.9× |
| Oth resp proc, group (G0239) | $8.74 | $21.85 | 0.2× |
| Oth resp proc, indiv (G0238) | $42.94 | $107.35 | 1.5× |
| Perc d-e cor revasc chro sin (C9607) | $10,440.12 | $26,100.30 | 0.6× |
| Perc d-e cor revasc t cabg s (C9604) | $10,711.82 | $26,779.55 | 1.0× |
| Perc d-e cor stent ather s (C9602) | $10,965.28 | $27,413.20 | 0.6× |
| Perc drug-el cor stent sing (C9600) | $8,481.22 | $21,203.05 | 0.8× |
| Perq Sacral Augmt Unilat Inj (0200T) unusually low: confirm this is the full procedure |
$2,272.56 | $5,681.40 | 0.3× |
| Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) | $6,499.90 | $16,249.75 | 0.6× |
| Ppps, initial visit (G0438) | $135.60 | $339 | 0.8× |
| Ppps, subseq visit (G0439) | $90 | $225 | 0.7× |
| Prgrmg Device Evaluation Cardiac Modulj System (0417T) | $52.82 | $132.05 | 1.5× |
| Prolonged iv inf, req pump (C8957) | $298.68 | $746.70 | 1.5× |
| Psa screening (G0103) | $82.84 | $207.10 | 4.3× |
| Quan CT tiss charac i&r w/cncrnt CT exam (0722T) | $538.46 | $1,346.15 | 0.9× |
| Quan CT tiss charac w/o CT (0721T) | $538.46 | $1,346.15 | 0.9× |
| Revasc intra lithotrip-ather (C9766) unusually low: confirm this is the full procedure |
$8,556.08 | $21,390.20 | 0.5× |
| Revasc intra lithotrip-stent (C9765) | $23,475.26 | $58,688.15 | 1.3× |
| Revasc intravasc lithotripsy (C9764) | $5,685.94 | $14,214.85 | 0.5× |
| Revasc lith-sten-ath tib/per (C9775) | $9,248.44 | $23,121.10 | 0.5× |
| Revasc lithotr-ather tib/per (C9774) | $9,248.44 | $23,121.10 | 0.5× |
| Revasc lithotr-stent tib/per (C9773) | $9,248.44 | $23,121.10 | 0.5× |
| Revasc lithotrip tibi/perone (C9772) | $7,429 | $18,572.50 | 0.7× |
| Revasc lithotrip-stent-ather (C9767) | $18,399.22 | $45,998.05 | 1.0× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) | $11,966.96 | $29,917.40 | 0.6× |
| Tcat insj perm 2chmbr ldls pm r atr pm compnt (0796T) | $11,966.96 | $29,917.40 | 0.6× |
| Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) | $11,966.96 | $29,917.40 | 0.6× |
| Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) | $11,966.96 | $29,917.40 | 0.6× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) unusually low: confirm this is the full procedure |
$1,646.16 | $4,115.40 | 0.3× |
| Therapeutic procd strg endur (G0237) | $42.94 | $107.35 | 1.5× |
| Tomosynthesis, mammo (G0279) | $75.84 | $189.60 | 6.0× |
| Tpmt Nudt15 Gene Analysis Common Variants (0034U) | $493.44 | $1,233.60 | 1.1× |
| Trauma respons w/hosp criti (G0390) | $3,745 | $9,362.50 | 2.9× |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $3,615.36 | $9,038.40 | 1.0× |
| Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) | $7,193.02 | $17,982.55 | 0.6× |
| Trluml peripheral atherectomy iliac artery ea (0238T) | $10,693.96 | $26,734.90 | 0.6× |
| Tte w or w/o contr, cont ecg (C8930) | $1,051.84 | $2,629.60 | 1.4× |
| Tte w or w/o fol w/con,stres (C8928) | $752.02 | $1,880.05 | 1.0× |
| Tte w or wo fol wcon,doppler (C8929) | $1,115.30 | $2,788.25 | 1.5× |