ASCENSION ST JOHN SAPULPA
Critical Access Hospitals
16
Procedure Prices at ASCENSION ST JOHN SAPULPA
COLLECTION VENOUS BLOOD VENIPUNCTURE
CPT 36415
$2.25
BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC
CPT 85025
$6.8
EKG Tracing
CPT 93005
$8.35
EKG Interpretation
CPT 93010
$9.15
Chest X-Ray (1 view)
CPT 71045
$9.55
COMPREHENSIVE METABOLIC PANEL
CPT 80053
$10.17
Chest X-Ray (2 views)
CPT 71046
$11.54
Thoracic Spine X-Ray
CPT 72072
$11.93
Mechanical Traction
CPT 97012
$12.85
EKG
CPT 93000
$17.5
Therapeutic Exercises
CPT 97110
$25.52
Therapeutic Activities
CPT 97530
$27.58
Abdominal Ultrasound — Limited
CPT 76705
$32.22
Retroperitoneal Ultrasound
CPT 76770
$40.18
Screening Mammogram (bilateral)
CPT 77067
$40.58
Diagnostic Mammogram (unilateral)
CPT 77065
$42.96
Abdominal Ultrasound
CPT 76700
$44.16
Echocardiogram
CPT 93307
$49.33
ER Visit — Low-Moderate Complexity
CPT 99283
$51.14
Diagnostic Mammogram (bilateral)
CPT 77066
$53.31
OFFICE OUTPATIENT VISIT 15 MINUTES
CPT 99213
$53.43
OB Ultrasound
CPT 76805
$55.29
CT Chest
CPT 71250
$56.09
Echocardiogram w/ Doppler
CPT 93306
$69.62
MRI Joint of Lower Extremity
CPT 73721
$74.39
MRI Brain w/o Contrast
CPT 70551
$81.15
ER Visit — Moderate Complexity
CPT 99284
$94.12
CT Abdomen & Pelvis
CPT 74177
$99.85
NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL
CPT 64483
$121.73
MRI Brain w/ Contrast
CPT 70553
$125.7
PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES
CPT 90837
$133.45
ER Visit — High Complexity
CPT 99285
$138.46
Upper GI Endoscopy w/ Biopsy
CPT 43239
$154.74
Colonoscopy
CPT 45378
$206.46
Colonoscopy w/ Biopsy
CPT 45380
$223.96
Tonsillectomy & Adenoidectomy (under 12)
CPT 42820
$312.27
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$325.4
Laparoscopic Hernia Repair
CPT 49650
$465.03
Inguinal Hernia Repair
CPT 49505
$566.47
Knee Arthroscopy
CPT 29881
$579.99
Recurrent Inguinal Hernia Repair
CPT 49520
$632.7
Cataract Surgery
CPT 66984
$677.06
Laparoscopic Cholecystectomy
CPT 47562
$679.59
Appendectomy
CPT 44950
$680.33
Cataract Surgery — Complex
CPT 66982
$843.34
ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR
CPT 29827
$1,128.58
TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
CPT 27245
$1,333.03
Hip Replacement
CPT 27130
$1,335.73
Knee Replacement
CPT 27447
$1,433.68
Vaginal Delivery
CPT 59400
$1,736
VBAC Delivery
CPT 59610
$1,805.44
C-Section
CPT 59510
$1,957.55
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Prices sourced from federally mandated hospital price transparency files. Cash prices reflect self-pay discounted rates. Negotiated rates vary by insurance plan. Data may not reflect current pricing — always confirm with the hospital before scheduling.