Report for UCLA Santa Monica Medical Center

The table of average charges for outpatient cases shows the average charges for the most common outpatient services, procedures and surgeries. As is the case for all data on this site, these are averages to provide a general idea of expected charges. Actual charges will vary.

In all cases except where noted, this does not include the prices for physician services — this is for hospital services only.

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Evaluation & Management Services (CPT Codes 99201-99499)

Service Title CPT Code Avg. Charge
"Emergency Room Visit, Level 2 (low to moderate severity)" 99282 $510.00
"Emergency Room Visit, Level 3 (moderate severity)" 99283 $780.00
"Emergency Room Visit, Level 4 (high severity with significant threat)" 99285 $1,870.00
"Emergency Room Visit, Level 4 (high severity without signigicant threat)" 99284 $1,310.00
"Outpatient Visit, established patient, 15 minutes" G0463 $330.00
 

Laboratory & Pathology Services (CPT Codes 80047-89398)

Service Title CPT Code Avg. Charge
"Blood Gas Analysis, including 02 saturation" 82805 $180.00
"Complete Blood Count, automated" 85027 $40.00
"Complete Blood Count, with differential WBC, automated" 85025 $50.00
"Creatine Kinase (CK), (CPK), Total" 82550 $50.00
"Troponin, Quantitative" 84484 $130.00
"Urinalysis, with microscopy" 81000 or 81001 $80.00
"Urinalysis, without microscopy" 81002 or 81003 $60.00
Basic Metabolic Panel 80048 $250.00
Comprehensive Metabolic Panel 80053 $440.00
Lipid Panel 80061 $110.00
Partial Thromboplastin Time 85730 $110.00
Prothrombin Time 85610 $70.00
Thyroid Stimulating Hormone 84443 $100.00
 

Medicine Services (CPT Codes 90281-99607)

Service Title CPT Code Avg. Charge
"Cardiac Catheterization, Left Heart, percutaneous " 93452 NA
"Echocardiography, Transthoracic, complete" 93307 $1,700.00
"Electrocardiogram, routine, with interpretation and report" 93005 $360.00
"Inhalation Treatment, pressurized or nonpressurized" 94640 $220.00
"Physical Therapy, Evaluation" 97161 $250.00
"Physical Therapy, Gait Training" 97116 $120.00
"Physical Therapy, Therapeutic Exercise" 97110 $180.00
 

Other Common Outpatient Procedures (list as needed)

Service Title CPT Code Avg. Charge
DESTROY LUMB/SAC FACET JNT 64635 $5,467.37
DRAIN/INJ JOINT/BURSA W/O US 20610 $4,536.46
EXPLORE PARATHYROID GLANDS 60500 $25,878.81
HYSTEROSCOPY BIOPSY 58558 $11,285.23
INJ PARAVERT F JNT C/T 1 LEV 64490 $3,395.92
INJ PARAVERT F JNT L/S 1 LEV 64493 $3,173.72
INJ TRIGGER POINT 1/2 MUSCL 20552 $4,819.25
INSERT TUNNELED CV CATH 36561 $15,955.47
NJX INTERLAMINAR CRV/THRC 62321 $3,391.64
TOTAL KNEE ARTHROPLASTY 27447 $53,539.96
 

Radiology Services (CPT Codes 70010-79999)

Service Title CPT Code Avg. Charge
"CT Scan, Abdomen, with contrast" 74160 $2,590.00
"CT Scan, Head or Brain, without contrast" 70450 $2,500.00
"CT Scan, Pelvis, with contrast" 72193 $2,160.00
"Mammography, Screening, Bilateral" 77067 $450.00
"MRI, Brain, without contrast, followed by contrast" 70553 $7,840.00
"Ultrasound, Abdomen, Complete" 76700 $810.00
"Ultrasound, OB, 14 weeks or more, transabdominal" 76805 $1,300.00
"X-Ray, Chest, two views" 71046 $270.00
"X-Ray, Lower Back, minimum four views" 72110 $420.00
 

Surgery Services (CPT Codes 10021-69990)

Service Title CPT Code Avg. Charge
"Arthroscopy, Knee, with meniscectomy (medial or lateral)" 29881 $12,482.24
"Arthroscopy, Shoulder, with partial acromioplasty" 29826 $23,520.13
"Cataract Removal with Insertion of Intraocular Lens, 1 Stage" 66984 $7,459.86
"Colonoscopy, diagnostic" 45378 $2,166.05
"Colonoscopy, with biopsy" 45380 $3,323.77
"Colonoscopy, with lesion removal, by snare technique" 45385 $3,873.19
"Discission, secondary membranous cataract, laser surgery" 66821 $2,003.39
"Endoscopy, Upper GI, diagnostic" 43235 $3,637.15
"Endoscopy, Upper GI, with biopsy" 43239 $3,135.73
"Excision, Breast Lesion, without preoperative radiological marker" 19120 $8,570.89
"Hernia Repair, Inguinal, 5 years and older" 49505 $13,649.68
"Injection, Anesthetic or Steroid, transforaminal epidural, lumbar" 64483 $3,041.12
"Injection, Diagnostic or Therapeutic substance, epidural, lumbar" 62322-62323 $10,233.04
"Tonsillectomy with Adenoidectomy, less than 12 years old" 42820 $11,570.46
"Tympanostomy (insert ventilating tube, general anesthesia)" 69436 $10,300.28
Carpal Tunnel Surgery 64721 $6,599.00
Laparoscopic Cholecystectomy 47562 $21,557.98