WHITE MEMORIAL MEDICAL CENTER
1720 E Cesar E Chavez Ave Los Angeles CA 90033|309 W Beverly Blvd, MONTEBELLO, CA · Adventisthealth · · NPI 1215927470
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 |
|---|---|---|---|---|
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $21.30 | $118.33 | $2.78 – $414.16 | 29 |
| Sodium serum/plasma/whole blood CPT 84295 | $48.96 | $272.00 | $1.38 – $53.42 | 61 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $61.81 | $343.40 | $0.75 – $1,201.90 | 58 |
| Somatosensory testing CPT 95927 | $12.60 | $70.00 | $21.00 – $416.57 | 86 |
| Sp bone agrft morsel add-on CPT 20937 | $105.30 | $585.00 | $65.00 – $373.35 | 77 |
| Sp bone algrft morsel add-on CPT 20930 | $29.88 | $166.00 | $112.89 – $265.60 | 33 |
| Special physics consult CPT 77370 | $534.60 | $2,970.00 | $70.90 – $4,544.10 | 60 |
| Special radiation dosimetry CPT 77331 | $120.78 | $671.00 | $21.91 – $259.31 | 86 |
| Special radiation treatment CPT 77470 | $638.82 | $3,549.00 | $85.22 – $2,321.44 | 86 |
| Special supplies phys/qhp CPT 99070 | $910.22 | $5,056.78 | $3.60 – $14.00 | 22 |
| Special teletx port plan CPT 77321 | $344.52 | $1,914.00 | $45.70 – $1,099.97 | 86 |
| Specific gravity body fluid CPT 84315 | $39.42 | $219.00 | $0.74 – $27.99 | 61 |
| Specimen fat stain CPT 89125 | $13.68 | $76.00 | $5.00 – $116.28 | 65 |
| Speech audiometry complete CPT 92556 | $88.02 | $489.00 | $38.73 – $748.17 | 60 |
| Speech recep thresh CPT 92555 | $90.90 | $505.00 | $16.07 – $772.65 | 60 |
| Sperm antibody test CPT 89325 | $8.69 | $48.25 | $9.07 – $168.88 | 64 |
| Spinal bone allograftstructural 20931 CPT 20931 | $69.30 | $385.00 | $82.95 – $248.06 | 77 |
| Spinal bone autograftlocal 20936 CPT 20936 | $31.50 | $175.00 | $24.00 – $218.00 | 33 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,030.14 | $5,723.00 | $238.13 – $8,756.19 | 53 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $403.92 | $2,244.00 | $9.30 – $719.91 | 86 |
| Splint finger 4 prong foam sm HCPCS A4570 | $36.36 | $202.00 | $100.80 – $392.00 | 22 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | $459.72 | $2,554.00 | $92.70 – $1,467.13 | 77 |
| Split blood or products CPT 86985 | $76.68 | $426.00 | $79.30 – $1,491.00 | 64 |
| Srs linear based CPT 77372 | $10,314.72 | $57,304.00 | $85.22 – $87,675.12 | 62 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $243.90 | $1,355.00 | $80.00 – $2,073.15 | 68 |
| Staph a dna amp probe CPT 87640 | $65.70 | $365.00 | $8.10 – $558.45 | 61 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $112.32 | $624.00 | $80.00 – $954.72 | 67 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $18,673.20 | $103,740.00 | $1,600.00 – $19,687.50 | 16 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $5,588.46 | $31,047.00 | $698.40 – $2,716.00 | 20 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $4,945.50 | $27,475.00 | $820.80 – $3,192.00 | 19 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $5,588.46 | $31,047.00 | $1,600.00 – $30,110.50 | 16 |
| Stereotactic radiation trmt CPT 77432 | $322.74 | $1,793.00 | $284.32 – $730.08 | 77 |
| Sterile water/saline, 10 ml HCPCS A4216 | $36.72 | $204.00 | $0.53 – $193.66 | 55 |
| Sterile water/saline, 500 ml HCPCS A4217 | $23.04 | $128.00 | $3.16 – $30.12 | 55 |
| St evaluate speech sound production CPT 92522 | $193.32 | $1,074.00 | $80.00 – $1,643.22 | 68 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $201.96 | $1,122.00 | $80.00 – $1,716.66 | 68 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $362.52 | $2,014.00 | $51.86 – $3,081.42 | 67 |
| St evaluation swallow function CPT 92610 | $289.80 | $1,610.00 | $52.72 – $2,463.30 | 67 |
| Stimulants synthetic CPT 80371 | $27.00 | $150.00 | $0.04 – $169.73 | 26 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $11.16 | $62.00 | $13.47 – $313.50 | 85 |
| Strapping of toes 29550 CPT 29550 | $7.02 | $39.00 | $8.47 – $113.81 | 85 |
| Strep b dna amp probe CPT 87653 | $52.20 | $290.00 | $7.92 – $382.67 | 61 |
| Streptomycin injection HCPCS J3000 | $21.30 | $118.33 | $12.04 – $414.16 | 28 |
| Stress test pulmonary CPT 94618 | $281.34 | $1,563.00 | $43.20 – $2,391.39 | 63 |
| Stress tte complete CPT 93351 | $1,279.80 | $7,110.00 | $73.84 – $1,820.42 | 86 |
| Str markers specimen anal CPT 81265 | $54.00 | $300.00 | $191.15 – $2,714.98 | 61 |
| St treatment speech individual CPT 92507 | $154.80 | $860.00 | $38.58 – $1,315.80 | 68 |
| St treatment swallow dysfunction/oral CPT 92526 | $155.52 | $864.00 | $48.51 – $1,321.92 | 67 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $19.09 | $106.08 | $4.22 – $61.01 | 29 |
| Sugars single quant CPT 84378 | $1.84 | $10.24 | $3.97 – $127.78 | 61 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $16.52 | $91.80 | $0.12 – $139.65 | 26 |
| Sulfonylurea screen qn-sendout CPT 80377 | $22.61 | $125.59 | $0.04 – $236.13 | 26 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $27.00 | $149.98 | $55.11 – $524.93 | 28 |
| Surg dx exam anorectal CPT 45990 | $59.04 | $328.00 | $47.00 – $5,354.94 | 85 |
| Surgical pathology level 1 gross examination only CPT 88300 | $47.52 | $264.00 | $12.01 – $403.92 | 64 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $62.82 | $349.00 | $30.04 – $533.97 | 64 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $85.86 | $477.00 | $6.10 – $100.54 | 86 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $110.52 | $614.00 | $56.97 – $318.09 | 64 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $196.20 | $1,090.00 | $125.71 – $1,667.70 | 64 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $281.34 | $1,563.00 | $228.71 – $2,391.39 | 64 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | $289.08 | $1,606.00 | $138.50 – $8,032.41 | 53 |
| Susceptibility agar dilution per agent CPT 87181 | $26.82 | $149.00 | $0.39 – $25.14 | 61 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $26.82 | $149.00 | $0.31 – $32.11 | 61 |
| Susceptibility mic per plate CPT 87186 | $90.72 | $504.00 | $2.93 – $96.34 | 61 |
| Suscept studies macrobroth dilution ea CPT 87188 | $1.06 | $5.90 | $2.22 – $73.91 | 61 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | $575.64 | $3,198.00 | $75.00 – $2,075.49 | 77 |
| Svc venogram s&i CPT 75827 | $1,409.58 | $7,831.00 | $8.08 – $3,036.95 | 86 |
| Sweat collection by iontophoresis CPT 89230 | $103.14 | $573.00 | $0.57 – $876.69 | 65 |
| Synvisc or synvisc-one HCPCS J7325 | $9.00 | $50.00 | $5.92 – $116.45 | 61 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $43.20 | $240.00 | $1.41 – $49.07 | 61 |
| System cardiomems hosp electronics HCPCS C2624 | $16,267.50 | $90,375.00 | $1,600.00 – $316,312.50 | 16 |
| System pacing micra av HCPCS C1786 | $13,050.00 | $72,500.00 | $1,600.00 – $42,000.00 | 16 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $12,574.08 | $69,856.00 | $1,600.00 – $42,000.00 | 16 |
| T3 (triiodothyronine) free CPT 84481 | $94.14 | $523.00 | $4.59 – $188.86 | 61 |
| T3 (triiodothyronine) total CPT 84480 | $82.98 | $461.00 | $4.92 – $157.95 | 61 |
| T4 (thyroxine) free CPT 84439 | $74.52 | $414.00 | $3.08 – $100.47 | 61 |
| T4 (thyroxine) total CPT 84436 | $57.78 | $321.00 | $2.30 – $420.75 | 61 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $15.18 | $84.33 | $0.54 – $121.00 | 28 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $98.70 | $548.33 | $220.96 – $1,919.16 | 60 |
| Tacrolimus therapeutic drug level CPT 80197 | $2.20 | $12.21 | $4.76 – $165.37 | 61 |
| Tamoxifen 10 mg tabs 60 each bottle HCPCS S0187 | $5.82 | $32.33 | $6.34 – $113.16 | 26 |
| Target gsa panel hmtlmph neop CPT 81450 | $441.00 | $2,450.00 | $645.60 – $24,509.03 | 60 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $525.53 | $2,919.60 | $1,964.13 – $24,509.03 | 61 |
| Target gsa panel organ neop CPT 81445 | $129.15 | $717.49 | $508.22 – $24,509.03 | 61 |
| Tavr perq femoral CPT 33361 | $9,835.38 | $54,641.00 | $125.00 – $81,961.50 | 85 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $600.71 | $3,337.26 | $0.21 – $7,772.48 | 61 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $229.14 | $1,273.00 | $18.12 – $1,790.10 | 61 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $92.88 | $516.00 | $11.27 – $675.68 | 61 |
| Tc-99m bicisate HCPCS A9557 | $369.18 | $2,051.00 | $85.22 – $16,114.78 | 63 |
| Tc-99m diag per dose HCPCS A4641 | $176.04 | $978.00 | $85.22 – $3,423.00 | 23 |
| Tc-99m exametazime diag HCPCS A9521 | $459.36 | $2,552.00 | $85.22 – $8,932.00 | 31 |
| Tc-99m labeled rbc HCPCS A9560 | $37.98 | $211.00 | $67.24 – $738.50 | 31 |
| Tc-99m maa HCPCS A9540 | $9.90 | $55.00 | $38.94 – $192.50 | 31 |
| Tc-99m mebrofenin HCPCS A9537 | $37.26 | $207.00 | $58.88 – $724.50 | 31 |
| Tc-99m medronate HCPCS A9503 | $60.30 | $335.00 | $24.49 – $1,172.50 | 31 |
| Tc-99m mertiatide HCPCS A9562 | $108.00 | $600.00 | $85.22 – $3,405.42 | 31 |
| Tc-99m oxidronate HCPCS A9561 | $57.60 | $320.00 | $29.11 – $1,120.00 | 31 |
| Tc-99m pentetate dtpa HCPCS A9539 | $12.06 | $67.00 | $16.87 – $234.50 | 31 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $37.26 | $207.00 | $3.58 – $724.50 | 31 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $133.74 | $743.00 | $85.22 – $2,362.50 | 31 |
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.