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 |
|---|---|---|---|---|
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $557.90 | $1,594.00 | $66.75 – $516.16 | 9 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $613.90 | $1,754.00 | $80.50 – $516.16 | 9 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $674.45 | $1,927.00 | $96.80 – $516.16 | 9 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $260.75 | $745.00 | $47.88 – $427.38 | 9 |
| X-ray humerus >= 2 views left CPT 73060 | $383.25 | $1,095.00 | $51.86 – $427.38 | 9 |
| X-ray joint survey 1 view CPT 77077 | $212.80 | $608.00 | $64.68 – $516.16 | 9 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $305.90 | $874.00 | $53.56 – $427.38 | 9 |
| X-ray knee 3 views (both sides) CPT 73562 | $383.25 | $1,095.00 | $67.26 – $427.38 | 9 |
| X-ray knee ap standing bilateral CPT 73565 | $317.80 | $908.00 | $61.26 – $427.38 | 9 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $245.70 | $702.00 | $57.83 – $427.38 | 9 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $417.90 | $1,194.00 | $100.63 – $516.16 | 9 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $765.45 | $2,187.00 | $100.63 – $516.16 | 9 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $781.20 | $2,232.00 | $134.46 – $516.16 | 9 |
| X-ray male genital tract CPT 74440 | not published | not published | $169.96 – $1,173.24 | 9 |
| X-ray mandible complete > 4 views CPT 70110 | $627.20 | $1,792.00 | $68.98 – $516.16 | 9 |
| X-ray mandible ltd <4 views CPT 70100 | $268.45 | $767.00 | $60.41 – $427.38 | 9 |
| X-ray measurement of pelvis CPT 74710 | not published | not published | $186.11 – $193.00 | 2 |
| X-ray nasal bones complete > 3 views CPT 70160 | $466.90 | $1,334.00 | $62.13 – $427.38 | 9 |
| X-ray neck soft tissue CPT 70360 | $297.50 | $850.00 | $48.43 – $427.38 | 9 |
| X-ray nose to rectum for foreign body child CPT 76010 | $318.50 | $910.00 | $46.71 – $427.38 | 9 |
| X-ray of mammary ducts CPT 77054 | $449.75 | $1,285.00 | $174.23 – $1,173.24 | 9 |
| X-ray optic foramina CPT 70190 | not published | not published | $63.83 – $427.38 | 9 |
| X-ray pelvis 1-2 views CPT 72170 | $327.95 | $937.00 | $45.01 – $516.16 | 9 |
| X-ray pelvis complete > 3 views CPT 72190 | $399.00 | $1,140.00 | $77.53 – $516.16 | 9 |
| Xray place dist ext thor ao CPT 75959 | $1,139.60 | $3,256.00 | $398.99 – $1,271.76 | 2 |
| Xray place prox ext thor ao CPT 75958 | $1,139.60 | $3,256.00 | $454.59 – $1,452.58 | 2 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $736.40 | $2,104.00 | $422.12 – $1,733.40 | 9 |
| X-ray ribs 2 views left CPT 71100 | $366.10 | $1,046.00 | $54.43 – $427.38 | 9 |
| X-ray ribs 3 views bilateral CPT 71110 | $501.55 | $1,433.00 | $69.83 – $516.16 | 9 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $557.90 | $1,594.00 | $66.41 – $516.16 | 9 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $588.70 | $1,682.00 | $93.78 – $516.16 | 9 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $411.25 | $1,175.00 | $63.83 – $516.16 | 9 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $411.60 | $1,176.00 | $52.71 – $427.38 | 9 |
| X-ray scapula complete (both sides) CPT 73010 | $354.20 | $1,012.00 | $53.56 – $516.16 | 9 |
| X-ray sella turcica CPT 70240 | $197.05 | $563.00 | $51.01 – $427.38 | 9 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $227.50 | $650.00 | $40.73 – $427.38 | 9 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $627.20 | $1,792.00 | $67.26 – $427.38 | 9 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $531.30 | $1,518.00 | $89.51 – $2,661.28 | 9 |
| X-ray skull < 4 views CPT 70250 | $369.25 | $1,055.00 | $62.98 – $516.16 | 9 |
| X-ray skull > 4 views complete CPT 70260 | $700.35 | $2,001.00 | $77.53 – $516.16 | 9 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $448.70 | $1,282.00 | $134.46 – $516.16 | 9 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $619.85 | $1,771.00 | $210.18 – $864.05 | 9 |
| X-ray small intestine follow-through study CPT 74248 | $207.20 | $592.00 | $116.54 – $240.13 | 3 |
| X-ray spine single view CPT 72020 | $330.75 | $945.00 | $40.73 – $427.38 | 9 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $282.10 | $806.00 | $67.26 – $427.38 | 9 |
| X-ray sternum > 2 views CPT 71120 | $407.05 | $1,163.00 | $56.13 – $427.38 | 9 |
| X-ray surgical specimen CPT 76098 | not published | not published | $27.88 – $2,661.28 | 9 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $521.85 | $1,491.00 | $164.83 – $864.05 | 9 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $386.05 | $1,103.00 | $91.23 – $427.38 | 9 |
| X-ray thoracic spine 2 views CPT 72070 | $368.55 | $1,053.00 | $57.83 – $516.16 | 9 |
| X-ray thoracic spine 3 views CPT 72072 | $501.55 | $1,433.00 | $68.11 – $516.16 | 9 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $396.20 | $1,132.00 | $62.98 – $427.38 | 9 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $303.10 | $866.00 | $60.75 – $427.38 | 9 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $393.05 | $1,123.00 | $110.52 – $516.16 | 9 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $368.55 | $1,053.00 | $48.43 – $427.38 | 9 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $235.55 | $673.00 | $57.83 – $427.38 | 9 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $624.05 | $1,783.00 | $211.62 – $864.05 | 9 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $465.15 | $1,329.00 | $195.63 – $864.05 | 9 |
| X-ray upper gi delay w/kub CPT 74241 | not published | not published | $274.10 – $274.10 | 1 |
| X-ray upper gi&small intest CPT 74245 | not published | not published | $408.01 – $408.01 | 1 |
| X-ray wrist 2 views (both sides) CPT 73100 | $304.50 | $870.00 | $55.28 – $427.38 | 9 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $153.71 – $864.05 | 9 |
| Xtrnl ecg rec up to 48 hrs CPT 93224 | not published | not published | $623.51 – $1,101.38 | 2 |
| Xwrap 1 sq cm HCPCS Q4204 | not published | not published | $160.06 – $6,297.39 | 9 |
| Xylose absorption test blood &/or urine CPT 84620 | not published | not published | $12.91 – $36.75 | 9 |
| Xyntha inj HCPCS J7185 | $2,987.78 | $8,536.52 | $1.49 – $3.20 | 9 |
| Yersinia antibody CPT 86793 | not published | not published | $13.19 – $40.91 | 9 |
| Yttrium y-90 ibritumomab ther HCPCS A9543 | not published | not published | $56,824.55 – $135,600.07 | 9 |
| Zenith amniotic membrane psc HCPCS Q4253 | not published | not published | $142.29 – $296.10 | 8 |
| Ziconotide injection HCPCS J2278 | not published | not published | $10.13 – $20.86 | 9 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | $104.90 | $299.71 | $1.49 – $3.25 | 9 |
| Zidovudine, oral, 100 mg HCPCS S0104 | not published | not published | $0.98 – $3.19 | 4 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $51.31 – $138.74 | 9 |
| Zika virus igm antibody CPT 86794 | not published | not published | $16.85 – $45.55 | 9 |
| Zinc paste band w >=3"<5"/yd HCPCS A6456 | $8.15 | $23.28 | $2.48 – $3.00 | 2 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | not published | not published | $3.14 – $53.36 | 5 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | $2,905.51 | $8,301.45 | $7.98 – $17.85 | 9 |
| Zolbetuximab-clzb 100 mg intravenous solution HCPCS J1326 | not published | not published | $32.64 – $62.25 | 6 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | $241.98 | $691.36 | $5.20 – $499.38 | 5 |
| Zoster vaccine-live inj CPT 90736 | not published | not published | $216.92 – $526.33 | 4 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $193.25 – $479.83 | 9 |
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.