UCLA Santa Monica Medical Center — price list

← Hospital overviewVerified from UCLA Santa Monica Medical Center’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

133 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
0.9% SODIUM CHLORIDE--CONTROL FOR ATG Outpatient	63323018610 NDC	$40.00	$22.00	$1.03 – $200	—
1 em core session Outpatient	G9873 HCPCS	—	—	$20.00 – $20.00	—
1 pc ost pou w built-in conv Outpatient	A5057 HCPCS	—	—	$22.28 – $22.28	—
1 pc ost pouch w filter Outpatient	A5056 HCPCS	—	—	$10.85 – $10.85	—
12-24hr sealed lead acid Outpatient	K0733 HCPCS	—	—	$5.25 – $28.90	—
1pc ost pch drain hgh output Outpatient	A4435 HCPCS	—	—	$13.37 – $13.37	—
1ST HOSP IP/OBS HIGH 75 Outpatient	99223 HCPCS	—	—	$80.10 – $80.10	—
1ST HOSP IP/OBS MODERATE 55 Outpatient	99222 HCPCS	—	—	$73.20 – $73.20	—
1ST HOSP IP/OBS SF/LOW 40 Outpatient	99221 HCPCS	—	—	$34.30 – $34.30	—
1ST NF CARE HIGH MDM 50 Outpatient	99306 HCPCS	—	—	$72.10 – $72.10	—
1ST NF CARE MODERATE MDM 35 Outpatient	99305 HCPCS	—	—	$46.90 – $46.90	—
1ST NF CARE SF/LOW MDM 25 Outpatient	99304 HCPCS	—	—	$37.80 – $37.80	—
1ST OPN IMPLT BAT MODULJ SYS Outpatient	64654 HCPCS	—	—	$56,651 – $162,589	—
1ST PSYC COLLAB CARE MGMT Outpatient	99492 HCPCS	—	—	$118 – $375	—
1ST/SBSQ PSYC COLLAB CARE Outpatient	99494 HCPCS	—	—	$57.88 – $57.88	—
2 em core ms mo 10-12 no wl Outpatient	G9877 HCPCS	—	—	$12.00 – $12.00	—
2 em core ms mo 10-12 wl Outpatient	G9879 HCPCS	—	—	$48.00 – $48.00	—
2 em core ms mo 7-9 no wl Outpatient	G9876 HCPCS	—	—	$12.00 – $12.00	—
2 em core ms mo 7-9 wl Outpatient	G9878 HCPCS	—	—	$48.00 – $48.00	—
2 em ongoing ms mo 13-15 wl Outpatient	G9882 HCPCS	—	—	$40.00 – $40.00	—
2 em ongoing ms mo 16-18 wl Outpatient	G9883 HCPCS	—	—	$40.00 – $40.00	—
2 em ongoing ms mo 19-21 wl Outpatient	G9884 HCPCS	—	—	$40.00 – $40.00	—
2 em ongoing ms mo 22-24 wl Outpatient	G9885 HCPCS	—	—	$40.00 – $40.00	—
2 pc drainable ost pouch Outpatient	A4413 HCPCS	—	—	$12.79 – $12.79	—
2019-ncov diagnostic p Outpatient	U0001 HCPCS	—	—	$35.91 – $103	—
22nf nonsealed leadacid Outpatient	E2360 HCPCS	—	—	$21.49 – $107	—
22nf sealed leadacid battery Outpatient	E2361 HCPCS	—	—	$22.26 – $128	—
2d cephal radio image Outpatient	D0702 HCPCS	—	—	$112 – $321	—
2d cephalometric image Outpatient	D0340 HCPCS	—	—	$112 – $321	—
2d oral/facial photo image Outpatient	D0703 HCPCS	—	—	$112 – $321	—