Providence Saint John's Health Center
2121 Santa Monica Blvd, Santa Monica, CA · Providence · · NPI 1124026273
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 |
|---|---|---|---|---|
| Urine shunt to intestine CPT 50815 | not published | not published | $1,142.09 – $11,276.00 | 4 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $6.00 – $22.58 | 4 |
| Urofollitropin, 75 iu HCPCS J3355 | not published | not published | $126.10 – $231.43 | 5 |
| Urography, antegrade CPT 74425 | $576.10 | $1,646.00 | $223.33 – $1,733.40 | 9 |
| Urography inf drip &/or bolus CPT 74410 | $759.85 | $2,171.00 | $225.59 – $864.05 | 9 |
| Urokinase 250,000 iu inj HCPCS J3365 | not published | not published | $518.18 – $1,326.51 | 4 |
| Urokinase 5000 iu injection HCPCS J3364 | not published | not published | $10.36 – $161.22 | 3 |
| Use 1st target lesion CPT 76982 | not published | not published | $134.46 – $516.16 | 9 |
| User adjustable heel height HCPCS L5990 | not published | not published | $2,180.41 – $4,033.76 | 7 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | not published | not published | $11.62 – $27.54 | 9 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | not published | not published | $137.66 – $657.48 | 5 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $4,005.00 – $30,073.00 | 7 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | not published | not published | $144.64 – $347.55 | 4 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | not published | not published | $131.58 – $316.18 | 4 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | not published | not published | $139.49 – $335.19 | 4 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | not published | not published | $78.54 – $188.73 | 4 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | not published | not published | $58.65 – $140.93 | 4 |
| Vaccine dtap < 7 years im CPT 90700 | $71.72 | $204.92 | $29.80 – $76.76 | 4 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $333.06 | $951.60 | $105.05 – $265.72 | 4 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | not published | not published | $63.57 – $329.32 | 4 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $158.98 – $804.51 | 4 |
| Vaccine dtap-ipv/hib im CPT 90698 | not published | not published | $121.82 – $290.23 | 4 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | not published | not published | $31.06 – $155.12 | 4 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $49.68 | $141.94 | $13.30 – $73.39 | 4 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $271.85 | $776.70 | $82.82 – $189.77 | 4 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | not published | not published | $134.83 – $295.16 | 4 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | not published | not published | $39.49 – $90.99 | 4 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | not published | not published | $62.59 – $90.64 | 2 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $53.04 – $161.57 | 4 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | not published | not published | $70.06 – $153.37 | 4 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | not published | not published | $158.87 – $381.75 | 4 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $50.57 | $144.48 | $28.34 – $68.09 | 4 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | not published | not published | $313.63 – $793.31 | 4 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | not published | not published | $163.24 – $391.11 | 4 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | not published | not published | $67.71 – $179.50 | 4 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $249.17 | $711.91 | $74.70 – $179.50 | 4 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | not published | not published | $19.56 – $47.00 | 4 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | not published | not published | $20.00 – $48.05 | 4 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | not published | not published | $18.68 – $46.23 | 3 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | not published | not published | $57.99 – $151.52 | 3 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | not published | not published | $19.36 – $66.72 | 3 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | not published | not published | $20.00 – $54.96 | 3 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | not published | not published | $9.34 – $24.55 | 3 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | not published | not published | $24.86 – $67.53 | 4 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | not published | not published | $65.67 – $143.78 | 3 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $99.80 | $285.15 | $32.97 – $79.23 | 4 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $9.78 – $23.50 | 4 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $722.41 | $2,064.03 | $241.74 – $559.45 | 4 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | not published | not published | $211.34 – $2,531.91 | 4 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | not published | not published | $175.28 – $443.35 | 4 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $408.70 | $1,167.70 | $169.96 – $398.93 | 4 |
| Vaccine mmr live subcutaneous CPT 90707 | $350.71 | $1,002.04 | $96.72 – $244.65 | 4 |
| Vaccine mmrv live subcutaneous CPT 90710 | not published | not published | $283.21 – $716.36 | 4 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $439.44 | $1,255.55 | $53.34 – $286.96 | 4 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | not published | not published | $230.83 – $554.68 | 4 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | not published | not published | $233.66 – $561.47 | 4 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $834.65 | $2,384.71 | $279.96 – $672.74 | 4 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | not published | not published | $45.50 – $115.09 | 4 |
| Vaccine rabies im CPT 90675 | $1,587.72 | $4,536.33 | $315.22 – $922.52 | 9 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | $1,059.79 | $3,027.96 | $312.94 – $922.72 | 4 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $1,830.15 | $5,229.01 | $567.26 – $2,869.65 | 4 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | not published | not published | $567.26 – $1,548.40 | 4 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | not published | not published | $312.48 – $875.87 | 4 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | not published | not published | $149.83 – $333.53 | 4 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | not published | not published | $100.67 – $254.62 | 4 |
| Vaccine tdap >=7 years im CPT 90715 | $169.43 | $484.09 | $47.97 – $126.11 | 4 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $35.25 | $100.71 | $28.55 – $89.85 | 4 |
| Vaccine typhoid vicps im CPT 90691 | not published | not published | $120.06 – $326.68 | 4 |
| Vaccine varicella live subcutaneous CPT 90716 | $649.32 | $1,855.21 | $186.53 – $471.82 | 4 |
| Vaccine yellow fever live subcutaneous CPT 90717 | not published | not published | $168.28 – $499.19 | 4 |
| Vaccinia vrs vac 0.3 ml perq CPT 90622 | not published | not published | $0.01 – $0.02 | 9 |
| Vacuum drain bottle/tube kit HCPCS A7048 | not published | not published | $81.86 – $81.86 | 1 |
| Vad battery clip set hmii 14-v li-ion HCPCS Q0497 | $1,008.32 | $2,880.90 | $562.64 – $1,040.88 | 7 |
| Vad cable power module dc input HCPCS Q0478 | not published | not published | $220.87 – $408.61 | 7 |
| Vad univ batt charger hm 1440 HCPCS Q0495 | $11,376.29 | $32,503.68 | $5,020.16 – $9,287.30 | 7 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | not published | not published | $1,142.09 – $15,861.00 | 9 |
| Vag hyst incl t/o complex CPT 58291 | not published | not published | $1,142.09 – $11,902.87 | 9 |
| Vag hyst including t/o CPT 58262 | not published | not published | $1,142.09 – $15,861.00 | 9 |
| Vag hyst t/o & repair compl CPT 58292 | not published | not published | $1,142.09 – $16,065.00 | 9 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | not published | not published | $1,142.09 – $11,902.87 | 9 |
| Vag hyst w/enterocele repair CPT 58270 | not published | not published | $1,142.09 – $15,861.00 | 9 |
| Vag hyst w/uro repair compl 58293 CPT 58293 | not published | not published | $9,891.00 – $12,235.00 | 2 |
| Vaginal bx CPT 58999 | $137.55 | $393.00 | $22.58 – $9,891.00 | 9 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | $2,732.10 | $7,806.00 | $1,528.38 – $9,891.00 | 9 |
| Vaginal Delivery (full care) CPT 59400 | not published | not published | $1,528.38 – $9,891.00 | 3 |
| Vaginal hysterectomy CPT 58260 | not published | not published | $1,142.09 – $15,861.00 | 9 |
| Vaginectomy partial w/nodes CPT 57109 | not published | not published | $2,455.49 – $9,891.00 | 9 |
| Vag inser rectal control sys HCPCS A4563 | not published | not published | $1,640.30 – $3,034.56 | 6 |
| Vagnc compl rmvl paravag tis CPT 57111 | not published | not published | $1,528.38 – $9,891.00 | 4 |
| Vagnc compl rmvl vag wall CPT 57110 | not published | not published | $1,142.09 – $9,891.00 | 4 |
| Vagotomy pfrmd w/prtl dstl gstrct 43635 CPT 43635 | not published | not published | $1,142.09 – $9,891.00 | 4 |
| Vagotomy & pylorus repair CPT 43641 | not published | not published | $1,142.09 – $9,891.00 | 4 |
| Vagotomy & pylorus repair 43640 CPT 43640 | not published | not published | $1,142.09 – $9,891.00 | 4 |
| Valproic acid total therapeutic drug level CPT 80164 | $280.00 | $800.00 | $13.54 – $42.03 | 9 |
| Valrubicin injection HCPCS J9357 | not published | not published | $1,270.52 – $3,105.78 | 9 |
| Valvuloplasty aortic CPT 92986 | $3,157.00 | $9,020.00 | $2,141.77 – $13,460.00 | 8 |
| Valvuloplasty aortic valve CPT 33390 | not published | not published | $1,746.72 – $15,227.00 | 3 |
| Valvuloplasty aortic valve CPT 33391 | not published | not published | $1,746.72 – $15,227.00 | 3 |
| Valvuloplasty mitral CPT 92987 | not published | not published | $2,216.35 – $27,468.35 | 8 |
| Valvuloplasty pulmonary CPT 92990 | not published | not published | $1,766.49 – $27,468.35 | 8 |
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.