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 |
|---|---|---|---|---|
| Closure of salivary fistula CPT 42600 | not published | not published | $1,142.09 – $7,332.00 | 9 |
| Closure of valve CPT 33600 | not published | not published | $5,821.00 – $12,235.00 | 3 |
| Closure of valve CPT 33602 | not published | not published | $5,821.00 – $12,235.00 | 3 |
| Closure of windpipe lesion 31820 CPT 31820 | not published | not published | $1,142.09 – $7,332.00 | 9 |
| Closure paravalvlr leak pq CPT 33999 | $13,982.15 | $39,949.00 | $806.82 – $9,891.00 | 9 |
| Closure ureter/bowel fistula CPT 50930 | not published | not published | $1,142.09 – $9,891.00 | 4 |
| Closure ureter/skin fistula CPT 50920 | not published | not published | $1,142.09 – $9,891.00 | 4 |
| Clot factor fletcher fact CPT 85292 | not published | not published | $18.93 – $58.76 | 9 |
| Clot factor viii reltd antgn CPT 85244 | not published | not published | $20.42 – $63.31 | 9 |
| Clot factor wght kininogen CPT 85293 | not published | not published | $18.93 – $58.76 | 9 |
| Clot factor xii hageman CPT 85280 | $137.55 | $393.00 | $19.35 – $60.01 | 9 |
| Clot factor xiii fibrin scrn CPT 85291 | $84.00 | $240.00 | $9.11 – $27.57 | 9 |
| Clot factor xiii fibrin stab CPT 85290 | not published | not published | $16.34 – $50.70 | 9 |
| Clotting assay whole blood CPT 85396 | not published | not published | $31.58 – $102.82 | 5 |
| Clozapine, 25 mg HCPCS S0136 | not published | not published | $0.66 – $5.65 | 4 |
| Clsd ostomy pouch w/flange HCPCS A5054 | not published | not published | $3.56 – $4.23 | 2 |
| Clsd ostomy pouch without barr HCPCS A5052 | not published | not published | $2.95 – $3.50 | 2 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $1,183.35 | $3,381.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx bimalleol ank fx without manip 27808 CPT 27808 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx clav dislc without manip 23520 CPT 23520 | $1,706.60 | $4,876.00 | $878.26 – $5,977.00 | 9 |
| Clsd tx clavicle dislocation without manip 23540 CPT 23540 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx clavicle fracture w/manip 23505 CPT 23505 | $1,351.35 | $3,861.00 | $1,142.09 – $5,977.00 | 9 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx coccygeal fracture 27200 CPT 27200 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $775.95 | $2,217.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx/dis tib/wt bear no manip 27824 CPT 27824 | $1,554.70 | $4,442.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $494.90 | $1,414.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $1,933.05 | $5,523.00 | $1,528.38 – $9,297.00 | 9 |
| Clsd tx finger tendon w/wo perq pin 26432 CPT 26432 | $1,706.60 | $4,876.00 | $1,746.72 – $10,103.00 | 9 |
| Clsd tx fracture of radius 25500 CPT 25500 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx/fx grt toe/phalanx/phalang 28490 CPT 28490 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $1,351.35 | $3,861.00 | $878.26 – $10,103.00 | 9 |
| Clsd tx fx radius/ulna without manip 25560 CPT 25560 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $2,320.50 | $6,630.00 | $878.26 – $9,297.00 | 9 |
| Clsd tx/grt hum tube fx without manip 23620 CPT 23620 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $775.95 | $2,217.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx humeral fract without manip 24530 CPT 24530 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx humerus fract without manip 24500 CPT 24500 | $675.85 | $1,931.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx iphal jnt disl w/manip req anes CPT 26775 | $675.85 | $1,931.00 | $359.73 – $9,891.00 | 9 |
| Clsd tx mandibular fx without manip 21450 CPT 21450 | $761.60 | $2,176.00 | $537.23 – $10,103.00 | 9 |
| Clsd tx/metacar/interphal artic fx 26740 CPT 26740 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $675.85 | $1,931.00 | $259.12 – $9,297.00 | 9 |
| Clsd tx metacarp fx w/manip&ext fix ea bone 26607 CPT 26607 | $2,457.00 | $7,020.00 | $1,528.38 – $9,297.00 | 9 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | $4,558.75 | $13,025.00 | $1,528.38 – $9,297.00 | 9 |
| Clsd tx nose fx without manip 21310 CPT 21310 | not published | not published | $601.00 – $9,891.00 | 3 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $2,026.50 | $5,790.00 | $259.12 – $9,297.00 | 9 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $675.85 | $1,931.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | $675.85 | $1,931.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx pelvic ring fx CPT 27197 | $613.55 | $1,753.00 | $317.26 – $5,977.00 | 9 |
| Clsd tx pelvic ring fx CPT 27198 | $613.55 | $1,753.00 | $317.26 – $5,977.00 | 9 |
| Clsd tx prox fib/shaft fx w/manip 27781 CPT 27781 | $2,320.50 | $6,630.00 | $1,142.09 – $5,977.00 | 9 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $2,320.50 | $6,630.00 | $878.26 – $5,977.00 | 9 |
| Clsd tx/scapular fx without manip 23570 CPT 23570 | $675.85 | $1,931.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $1,351.35 | $3,861.00 | $878.26 – $9,297.00 | 9 |
| Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 CPT 23675 | $2,320.50 | $6,630.00 | $259.12 – $9,297.00 | 9 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $1,685.60 | $4,816.00 | $1,142.09 – $5,977.00 | 9 |
| Clsd tx/talotarsal dislocat/anes 28575 CPT 28575 | $2,457.00 | $7,020.00 | $1,142.09 – $7,332.00 | 9 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $343.70 | $982.00 | $184.68 – $5,977.00 | 9 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx trimall ankle fx without manip 27816 CPT 27816 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $1,554.70 | $4,442.00 | $878.26 – $5,977.00 | 9 |
| Clsd tx/ulnar shaft fx without manip 25530 CPT 25530 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx vert body fx without manip req &w/csting/bracing CPT 22310 | $368.90 | $1,054.00 | $317.26 – $5,977.00 | 9 |
| Clsd tx wrist carpal fx without manip 25630 CPT 25630 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx wrist scaphoid fx without manip 25622 CPT 25622 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Clsd tx wrist trans-scaph fx w/manip 25680 CPT 25680 | $497.00 | $1,420.00 | $259.12 – $9,297.00 | 9 |
| Clsd tx wrist ulnar styloid fx 25650 CPT 25650 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Clsd/ulnar fx/prox end without manip 24670 CPT 24670 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Clsr 1 vsd w/wo patch w/vlvt CPT 33684 | not published | not published | $5,821.00 – $15,227.00 | 3 |
| Clsr 1vsd w/wo ptch rmvl bnd CPT 33688 | not published | not published | $5,821.00 – $15,227.00 | 3 |
| Cls tx of heel fracture w/manip 28405 CPT 28405 | $675.85 | $1,931.00 | $317.26 – $9,297.00 | 9 |
| Cltx carpl scphd fx w/mnpj CPT 25624 | $2,320.50 | $6,630.00 | $878.26 – $9,297.00 | 9 |
| Cltx craniofacial separation CPT 21431 | not published | not published | $1,142.09 – $14,085.70 | 9 |
| Cltx gr hmrl tbrs fx w/mnpj CPT 23625 | $1,706.60 | $4,876.00 | $1,528.38 – $9,297.00 | 9 |
| Cltx hum epcndylr fx wo mnpj CPT 24560 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Cltx humrl cndylr fx w/mnpj CPT 24577 | $2,320.50 | $6,630.00 | $259.12 – $5,977.00 | 9 |
| Cltx humrl cndylr fx wo mnpj CPT 24576 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Cltx lunate dislc w/mnpj CPT 25690 | $1,351.35 | $3,861.00 | $1,142.09 – $5,977.00 | 9 |
| Cltx mndblr fx ntrdntl fixj CPT 21453 | $4,296.25 | $12,275.00 | $1,746.72 – $12,111.00 | 9 |
| Cltx mndblr fx w/mnpj CPT 21451 | $1,657.95 | $4,737.00 | $1,286.82 – $12,557.00 | 9 |
| Cltx mndblr/max alv ridge fx CPT 21440 | $2,658.60 | $7,596.00 | $1,746.72 – $10,103.00 | 9 |
| Cltx palatal/max fx wire fix CPT 21421 | $2,122.40 | $6,064.00 | $2,159.89 – $12,557.00 | 9 |
| Cltx post ankle fx CPT 27767 | $497.00 | $1,420.00 | $259.12 – $5,977.00 | 9 |
| Cltx post ankle fx w/mnpj CPT 27768 | $2,320.50 | $6,630.00 | $259.12 – $5,977.00 | 9 |
| Cltx scap fx w/mnpj +-tractj CPT 23575 | $2,320.50 | $6,630.00 | $878.26 – $5,977.00 | 9 |
| Cltx strnclav dislc w/mnpj CPT 23525 | $675.85 | $1,931.00 | $317.26 – $5,977.00 | 9 |
| Cltx thigh fx CPT 27267 | $1,824.55 | $5,213.00 | $259.12 – $7,332.00 | 9 |
| Cltx thigh fx w/mnpj CPT 27268 | $1,824.55 | $5,213.00 | $1,528.38 – $9,891.00 | 9 |
| Cltx tmprmand dislc comp CPT 21485 | not published | not published | $1,528.38 – $9,297.00 | 9 |
| Cmbn ant pst colprhy CPT 57260 | not published | not published | $2,455.49 – $13,207.00 | 9 |
| C motor evoked lwr limbs CPT 95929 | $986.65 | $2,819.00 | $207.39 – $887.89 | 7 |
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.