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 |
|---|---|---|---|---|
| Ghs ppd (tb intradermal) CPT 86580 | not published | not published | $14.06 – $68.82 | 9 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | not published | not published | $9.66 – $29.96 | 9 |
| Ghs protein, misc fluid CPT 84160 | not published | not published | $5.61 – $16.05 | 9 |
| Ghs protoporphyrins fract CPT 84202 | not published | not published | $14.35 – $44.50 | 9 |
| Ghs pr without cont pulse ox CPT 94625 | not published | not published | $75.87 – $140.37 | 7 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | not published | not published | $12.25 – $38.00 | 9 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | not published | not published | $337.27 – $337.27 | 1 |
| Ghs quinidine CPT 80194 | not published | not published | $14.60 – $45.29 | 9 |
| Ghs refill of implantable pump CPT 95990 | $1,175.65 | $3,359.00 | $252.96 – $1,487.00 | 8 |
| Ghs removal intranasal foreign body CPT 30300 | $280.35 | $801.00 | $112.54 – $1,487.00 | 8 |
| Ghs removal pharyngeal foreign body CPT 42809 | $591.15 | $1,689.00 | $112.54 – $5,977.00 | 9 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $1,763.65 | $5,039.00 | $1,746.72 – $10,103.00 | 9 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $3,490.55 | $9,973.00 | $2,159.89 – $12,557.00 | 9 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $15.89 – $39.99 | 9 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $4.31 – $13.34 | 9 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $83.30 | $238.00 | $13.91 – $34.53 | 9 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $4.27 – $10.99 | 9 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $12.31 – $37.38 | 9 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $9.84 – $27.66 | 9 |
| Ghs sensitivity (per antimicro) CPT 87184 | $88.55 | $253.00 | $7.48 – $21.42 | 9 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $326.90 | $934.00 | $206.01 – $9,297.00 | 9 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $408.80 | $1,168.00 | $206.01 – $9,297.00 | 9 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $408.80 | $1,168.00 | $206.01 – $9,297.00 | 9 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $510.65 | $1,459.00 | $206.01 – $9,297.00 | 9 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $261.45 | $747.00 | $206.01 – $1,487.00 | 8 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $261.45 | $747.00 | $206.01 – $1,487.00 | 8 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $326.90 | $934.00 | $206.01 – $1,487.00 | 8 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $510.65 | $1,459.00 | $206.01 – $9,297.00 | 9 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $638.40 | $1,824.00 | $258.05 – $9,297.00 | 9 |
| Ghs sleep study unattended CPT 95800 | not published | not published | $277.71 – $513.77 | 7 |
| Ghs somatosensory testing lower extremit CPT 95926 | $1,024.45 | $2,927.00 | $156.69 – $513.77 | 7 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $1,793.05 | $5,123.00 | $456.42 – $1,484.00 | 7 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $113.75 | $325.00 | $53.18 – $116.16 | 6 |
| Ghs sphenopalatine ganglion block CPT 64505 | $375.20 | $1,072.00 | $394.79 – $5,977.00 | 9 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $130.01 – $316.58 | 7 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $236.60 | $676.00 | $113.30 – $264.49 | 6 |
| Ghs st - eval for alt comm CPT 92567 | not published | not published | $48.04 – $88.87 | 7 |
| Ghs strapping shoulder - 29240 CPT 29240 | $203.35 | $581.00 | $171.12 – $1,487.00 | 8 |
| Ghs st - re-eval for alt comm CPT 92597 | $71.75 | $205.00 | $77.39 – $215.91 | 6 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $83.30 | $238.00 | $41.37 – $111.42 | 7 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $139.65 | $399.00 | $273.57 – $506.11 | 7 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,186.15 | $3,389.00 | $857.14 – $5,977.00 | 9 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $661.50 | $1,890.00 | $522.85 – $5,977.00 | 9 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $1,227.10 | $3,506.00 | $1,142.09 – $5,977.00 | 9 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.30 – $22.64 | 9 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $675.85 | $1,931.00 | $259.12 – $1,487.00 | 8 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $497.00 | $1,420.00 | $259.12 – $1,487.00 | 8 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $24.30 – $75.40 | 9 |
| Ghs urine, porphyrins quant CPT 84120 | not published | not published | $14.71 – $45.62 | 9 |
| Ghs vaginal delivery only CPT 59409 | $2,732.10 | $7,806.00 | $1,528.38 – $9,891.00 | 9 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $1,437.45 | $4,107.00 | $479.94 – $1,197.36 | 7 |
| Ghs windowing of cast CPT 29730 | $163.10 | $466.00 | $194.49 – $1,487.00 | 8 |
| Giardia ag if CPT 87269 | not published | not published | $13.61 – $33.81 | 9 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $14.72 – $45.66 | 9 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $261.70 – $1,173.24 | 9 |
| Gi inhouse confirmation CPT 87045 | $273.35 | $781.00 | $9.44 – $29.26 | 9 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $1,528.38 – $9,891.00 | 9 |
| Gi protein loss CPT 78282 | not published | not published | $257.33 – $1,950.38 | 9 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $1,166.53 – $4,099.00 | 8 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $1,196.08 – $2,212.75 | 7 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $1,166.53 – $4,099.00 | 8 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $1,166.53 – $4,099.00 | 8 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $75.45 – $251.09 | 8 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $60.35 – $152.76 | 8 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.00 – $86.91 | 8 |
| Glassia injection HCPCS J0257 | not published | not published | $0.57 – $11.72 | 9 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $37.20 – $182.60 | 7 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $48.04 – $110.81 | 7 |
| Glaucoma surgery CPT 66150 | not published | not published | $2,159.89 – $12,557.00 | 9 |
| Glaucoma surgery CPT 66155 | not published | not published | $2,159.89 – $12,557.00 | 9 |
| Glaucoma surgery CPT 66160 | not published | not published | $1,528.38 – $9,297.00 | 9 |
| Glaucoma surgery CPT 66170 | not published | not published | $2,159.89 – $12,557.00 | 9 |
| Glove finger flexion right lg xl HCPCS L3912 | not published | not published | $142.19 – $263.05 | 7 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $623.51 | $1,781.47 | $117.32 – $410.13 | 9 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $772.47 | $2,207.07 | $135.00 – $323.45 | 9 |
| Glucagon plasma - sendout CPT 82943 | not published | not published | $14.29 – $44.33 | 9 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $46.07 – $142.90 | 9 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $50.50 – $156.63 | 9 |
| Glucagon tolerance test CPT 82946 | not published | not published | $17.77 – $46.76 | 9 |
| Glucose 1 hr post dose CPT 82950 | $112.35 | $321.00 | $4.75 – $14.74 | 9 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $134.75 | $385.00 | $6.05 – $18.77 | 9 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | not published | not published | $3.28 – $8.14 | 9 |
| Glucose blood quantitative CPT 82947 | $97.30 | $278.00 | $3.93 – $12.18 | 9 |
| Glucose body fluid CPT 82945 | $89.95 | $257.00 | $3.93 – $12.18 | 9 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $75.87 – $140.37 | 6 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $218.40 | $624.00 | $12.87 – $39.92 | 9 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $64.75 | $185.00 | $3.92 – $12.15 | 9 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $33.20 | $94.86 | $0.43 – $1.28 | 5 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $17.50 – $60.00 | 4 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $7,179.63 | $20,513.24 | $11.03 – $40.78 | 9 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $89.25 | $255.00 | $18.58 – $57.64 | 9 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $148.41 – $460.34 | 9 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $89.25 | $255.00 | $18.52 – $57.44 | 9 |
| Gonioscopy CPT 92020 | not published | not published | $56.85 – $316.58 | 7 |
| Goniotomy CPT 65820 | not published | not published | $1,142.09 – $9,835.10 | 9 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $11,127.94 | $31,794.10 | $379.64 – $1,516.05 | 5 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $2,052.75 | $5,865.00 | $60.42 – $296.10 | 9 |
| Graft axiofill 1000mg HCPCS J3590 | $19,901.45 | $56,861.28 | not published | 0 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $160.06 – $2,270.34 | 8 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $16,032.49 | $45,807.11 | $126.60 – $296.10 | 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.