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 |
|---|---|---|---|---|
| Liver imaging (3d) CPT 78205 | not published | not published | $1,070.26 – $1,070.26 | 1 |
| Liver imag w/vasclr flow CPT 78202 | $1,238.65 | $3,539.00 | $449.12 – $2,612.61 | 9 |
| Liver/spleen imag static only CPT 78215 | $1,246.00 | $3,560.00 | $421.72 – $1,950.38 | 9 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $258.28 – $1,950.38 | 9 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $95.48 – $5,821.00 | 8 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $1,746.72 – $10,103.00 | 9 |
| Lockingelbow forearm cntrbal HCPCS L6693 | not published | not published | $3,412.03 – $6,312.26 | 7 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $0.95 – $2.00 | 3 |
| Lomustine 10 mg HCPCS S0178 | not published | not published | $48.34 – $246.60 | 4 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $212.42 – $455.80 | 9 |
| Long tongue stirrup HCPCS L2265 | not published | not published | $180.44 – $333.81 | 7 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $198.79 | $567.98 | $1.32 – $32.55 | 5 |
| Lo rig pos pnl l1-l5 pre ots HCPCS L0641 | not published | not published | $26.67 – $159.45 | 7 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | $218.75 | $625.00 | $93.48 – $172.94 | 7 |
| Loudness balance test CPT 92562 | not published | not published | $70.74 – $513.77 | 7 |
| Low back disk surgery CPT 63030 | not published | not published | $3,409.47 – $18,416.00 | 9 |
| Low cost skin substitute app HCPCS C5271 | $432.60 | $1,236.00 | $352.70 – $5,977.00 | 4 |
| Low cost skin substitute app HCPCS C5273 | $2,292.50 | $6,550.00 | $352.70 – $15,861.00 | 4 |
| Low cost skin substitute app HCPCS C5275 | $432.60 | $1,236.00 | $352.70 – $5,977.00 | 4 |
| Low cost skin substitute app HCPCS C5277 | $432.60 | $1,236.00 | $352.70 – $5,977.00 | 4 |
| Low cost skin substitute app HCPCS C5272 | $288.40 | $824.00 | $1,487.00 – $1,487.00 | 1 |
| Low cost skin substitute app HCPCS C5274 | $961.45 | $2,747.00 | $1,487.00 – $1,487.00 | 1 |
| Low cost skin substitute app HCPCS C5276 | $288.40 | $824.00 | $1,487.00 – $1,487.00 | 1 |
| Low cost skin substitute app HCPCS C5278 | $288.40 | $824.00 | $1,487.00 – $1,487.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $2,605.75 | $7,445.00 | $225.59 – $823.77 | 8 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,493.75 | $7,125.00 | $448.71 – $830.11 | 8 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,411.15 | $6,889.00 | $134.46 – $473.15 | 8 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,895.55 | $8,273.00 | $448.71 – $1,316.74 | 8 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,561.30 | $7,318.00 | $448.71 – $1,074.63 | 8 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,227.75 | $6,365.00 | $306.88 – $834.41 | 8 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $441.35 | $1,261.00 | $73.26 – $516.16 | 9 |
| Lower jaw bone graft CPT 21215 | not published | not published | $3,409.47 – $14,539.00 | 9 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $258.05 – $477.39 | 6 |
| Loxapine for inhalation 1 mg HCPCS J2062 | not published | not published | $15.30 – $43.71 | 5 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $2,159.89 – $17,773.26 | 9 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $2,159.89 – $21,833.00 | 9 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $2,159.89 – $21,833.00 | 9 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $2,159.89 – $21,833.00 | 9 |
| Lso corset front HCPCS L0972 | not published | not published | $157.68 – $291.71 | 7 |
| Lso flex no ri stays pre ots HCPCS L0628 | not published | not published | $28.70 – $166.11 | 7 |
| Lso full corset HCPCS L0976 | not published | not published | $187.18 – $346.28 | 7 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | not published | not published | $194.26 – $359.38 | 7 |
| Lso sag-coronal panel custom HCPCS L0638 | not published | not published | $1,582.02 – $2,926.74 | 7 |
| Lso sag-co shell pnl pre ots HCPCS L0651 | not published | not published | $406.45 – $2,475.25 | 7 |
| Lso sag ctr rigi pos pre ots HCPCS L0643 | not published | not published | $55.42 – $331.37 | 7 |
| Lso sagit rigid panel prefab HCPCS L0635 | not published | not published | $1,466.58 – $2,713.17 | 7 |
| Lso sagittal rigid panel cus HCPCS L0636 | not published | not published | $2,171.08 – $4,016.50 | 7 |
| Lso sc r pos/lat pnl pre cst HCPCS L0633 | not published | not published | $343.97 – $636.34 | 7 |
| Lso sc r pos/lat pnl pre ots HCPCS L0649 | not published | not published | $98.12 – $586.68 | 7 |
| Lso s/c shell/panel custom HCPCS L0640 | $1,618.71 | $4,624.88 | $1,255.19 – $2,322.10 | 7 |
| Lso s/c shell/panel prefab HCPCS L0639 | not published | not published | $1,451.22 – $2,684.76 | 7 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $21.99 – $68.20 | 9 |
| Lubricant per ounce HCPCS A4402 | not published | not published | $3.16 – $3.77 | 2 |
| Lumbar bolster pad HCPCS L1030 | not published | not published | $76.57 – $141.65 | 7 |
| Lumbar derotation pad HCPCS L1240 | not published | not published | $118.97 – $220.09 | 7 |
| Lumbar diskogram s&i CPT 72295 | $1,548.75 | $4,425.00 | $222.16 – $9,478.15 | 9 |
| Lumbar or lumbar rib pad HCPCS L1040 | not published | not published | $119.53 – $221.13 | 7 |
| Lumbar sling HCPCS L1090 | not published | not published | $140.44 – $259.81 | 7 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $3,409.47 – $30,073.00 | 9 |
| Lumizyme injection HCPCS J0221 | not published | not published | $202.65 – $433.38 | 9 |
| Lung function test (mbc/mvv) CPT 94200 | not published | not published | $61.21 – $140.37 | 7 |
| Lung Function Test (Spirometry) CPT 94010 | $204.05 | $583.00 | $101.01 – $513.77 | 7 |
| Lung perfusion imaging CPT 78580 | $1,327.55 | $3,793.00 | $443.12 – $1,950.38 | 9 |
| Lung transplant double CPT 32853 | not published | not published | $2,821.63 – $15,227.00 | 4 |
| Lung transplant single CPT 32851 | not published | not published | $2,455.49 – $15,227.00 | 4 |
| Lung transplant with bypass CPT 32852 | not published | not published | $2,821.63 – $15,227.00 | 4 |
| Lung transplant with bypass CPT 32854 | not published | not published | $3,409.47 – $15,227.00 | 4 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $1,528.38 – $15,227.00 | 4 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $206.13 – $440.84 | 9 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $41.13 – $88.67 | 9 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | not published | not published | $319.94 – $636.94 | 9 |
| Lutetium lu 177 vipivotide HCPCS A9607 | not published | not published | $259.60 – $516.43 | 8 |
| Lvad shower bag heartmate HCPCS Q0501 | $833.49 | $2,381.40 | $613.75 – $1,135.44 | 7 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $37.20 – $1,487.00 | 8 |
| Lwr ext dynamic prosth pylon HCPCS L5985 | not published | not published | $339.39 – $627.87 | 7 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $20.05 – $62.20 | 9 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $1,142.09 – $19,447.84 | 9 |
| Lymphatics/lymph node imaging CPT 78195 | $1,484.35 | $4,241.00 | $630.85 – $2,612.61 | 9 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $36.56 – $175.13 | 9 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $49.03 – $152.07 | 9 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $125.77 – $470.55 | 9 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $47.59 – $142.20 | 9 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $806.82 – $3,000.84 | 9 |
| Lymph vessel x-ray arms/legs CPT 75803 | $1,751.05 | $5,003.00 | $927.31 – $7,539.92 | 9 |
| Lymph vessel x-ray trunk CPT 75805 | $2,178.75 | $6,225.00 | $1,024.92 – $15,276.98 | 9 |
| Lymph vessel x-ray trunk CPT 75807 | $2,178.75 | $6,225.00 | $1,024.92 – $15,276.98 | 9 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $537.23 – $9,297.00 | 9 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $1,142.09 – $7,332.00 | 9 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $1,528.38 – $9,297.00 | 9 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $14.01 – $40.12 | 5 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $14.44 – $40.75 | 5 |
| Macroscopic exam arthropod CPT 87168 | not published | not published | $4.27 – $13.25 | 9 |
| Macroscopic exam parasite CPT 87169 | $71.40 | $204.00 | $4.31 – $13.25 | 9 |
| Magnesium CPT 83735 | $123.55 | $353.00 | $6.70 – $20.78 | 9 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $87.08 | $248.80 | $0.50 – $1.14 | 5 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $306.88 – $834.41 | 8 |
| Makena, 10 mg HCPCS J1726 | $411.36 | $1,175.32 | $19.60 – $29.71 | 4 |
| Malaria antibody CPT 86750 | not published | not published | $13.19 – $40.91 | 9 |
| Male sling procedure CPT 53440 | not published | not published | $1,528.38 – $22,059.69 | 9 |
| Mammosite ced HCPCS C1728 | $3,762.50 | $10,750.00 | not published | 0 |
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.