Visits & medical services prices at San Gabriel Valley Medical Center
San Gabriel, CA · every code in this section with a posted price and a Medicare benchmark.
146 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Actinotherapy Ultraviolet Light (96900) | $73.50 | $245 | 1.5× |
| Airway Inhalation Treatment (94640) range across 22 matching MRF lines |
$33.30–$175.20 | $111–$584 | varies |
| Airway resistance by oscillometry (94728) | $88.80 | $296 | 0.5× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) | $79.20 | $264 | 5.5× |
| Behavral qualit analys voice (92524) | $66 | $220 | 0.6× |
| Breathing response to hypoxia (94450) | $89.40 | $298 | 0.5× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $162 | $540 | 0.3× |
| Cardiac Stress Tst,Tracing Only (93017) | $867.90 | $2,893 | 3.1× |
| Cardiopulmonary exercise testing (94621) | $98.99 | $329.97 | 0.2× |
| Cardiopulmonary resuscitation (92950) | $883.20 | $2,944 | 3.2× |
| Cardioversion (92960) | $478.20 | $1,594 | 0.6× |
| Cbt 1st hour (94644) | $175.20 | $584 | 1.0× |
| Chemo Anti-Neopl Sq/Im (96401) | $264 | $880 | 2.9× |
| Chemo Hormon Antineopl Sq/Im (96402) | $264 | $880 | 2.9× |
| Chemo IV infusion addl hr (96415) | $108.90 | $363 | 1.2× |
| Chemother Prolong Infuse W/Pump (96416) | $233.70 | $779 | 0.6× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $109.20 | $364 | 1.2× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) range across 7 matching MRF lines |
$131.40–$310.50 | $438–$1,035 | varies |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $143.10 | $477 | 0.3× |
| Chest Wall Manipulation (94668) | $40.80 | $136 | 0.2× |
| Circadian Respiratry Pattern Rec 12-24 Hr Infant (94772) range across 3 matching MRF lines |
$677.40–$712.80 | $2,258–$2,376 | varies |
| Color/duplex Doppler, complete (93975) | $803.70 | $2,679 | 2.6× |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $46.20 | $154 | 1.4× |
| Continuous Pulse Ox (94762) range across 2 matching MRF lines |
$76.50–$83.10 | $255–$277 | varies |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) range across 7 matching MRF lines |
$45.30–$540.60 | $151–$1,802 | varies |
| Cpt initial (94667) | $50.40 | $168 | 0.3× |
| Critical care first hour (99291) | $805.50 | $2,685 | 0.8× |
| Debridement Open Wound 20 Sq Cm< (97597) range across 4 matching MRF lines |
$155.40–$233.70 | $518–$779 | varies |
| Dialysis One Evaluation (90945) | $422.40 | $1,408 | 0.8× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $964.80 | $3,216 | 3.1× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) range across 2 matching MRF lines |
$258.90–$322.50 | $863–$1,075 | varies |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) range across 5 matching MRF lines |
$295.50–$966 | $985–$3,220 | varies |
| Dup-scan xtr veins unilateral/limited study (93971) | $295.50 | $985 | 2.2× |
| Duplex up extrem art bilat (93930) | $964.80 | $3,216 | 3.1× |
| Duplex up extrem art unilat/ltd (93931) | $322.50 | $1,075 | 2.4× |
| Echo transesophag montr cardiac pump functj (93318) | $879.60 | $2,932 | 1.3× |
| EEG awake and asleep (95819) | $385.50 | $1,285 | 1.4× |
| EEG awake drowsy (95816) | $257.40 | $858 | 0.9× |
| EEG cerebral death evaluation (95824) | $266.70 | $889 | 0.6× |
| Eeg Sleep Only (95822) | $385.50 | $1,285 | 1.4× |
| EKG signal averaged (93278) | $205.50 | $685 | 2.7× |
| Electrical Stimulation Ea 15 Min (97032) | $72.60 | $242 | 4.9× |
| Electrocardiogram Tracing (93005) range across 4 matching MRF lines |
$144.90–$174.30 | $483–$581 | varies |
| Electroconvulsive Therapy (90870) range across 2 matching MRF lines |
$159.75–$737.10 | $532.49–$2,457 | varies |
| Electrophysiology Evaluation (93642) | $1,079.53 | $3,598.42 | 0.7× |
| Emergency Dept Visit Level 2 (99282) range across 3 matching MRF lines |
$133.20–$251.10 | $444–$837 | varies |
| Emergency Dept Visit Level 3 (99283) range across 3 matching MRF lines |
$247.50–$444.30 | $825–$1,481 | varies |
| Emergency Dept Visit Level 4 (99284) range across 3 matching MRF lines |
$444.30–$730.50 | $1,481–$2,435 | varies |
| Emg 3 Extremities (95863) | $319.80 | $1,066 | 1.9× |
| Emg 4 Extremities (95864) | $525.30 | $1,751 | 3.2× |
| Er level 1 (99281) range across 3 matching MRF lines |
$60.30–$137.40 | $201–$458 | varies |
| Er level v (99285) range across 3 matching MRF lines |
$494.40–$837.50 | $1,648–$2,791.65 | varies |
| Esophagus acid perfusion test esophagitis (91030) | $159.75 | $532.49 | 0.3× |
| Evaluate pt use of inhaler (94664) range across 3 matching MRF lines |
$67.50–$175.20 | $225–$584 | varies |
| Evaluate Swallowing Function (92610) range across 6 matching MRF lines |
$110.40–$596.70 | $368–$1,989 | varies |
| Evaluation of speech fluency (92521) range across 4 matching MRF lines |
$56.10–$201.60 | $187–$672 | varies |
| External Ecg Scanning Analysis Report (93226) | $421.50 | $1,405 | 5.6× |
| Extracranial Bilat Study (93880) range across 2 matching MRF lines |
$770.10–$885.90 | $2,567–$2,953 | varies |
| Extracranial Uni/Ltd Study (93882) | $306.90 | $1,023 | 2.3× |
| Gastric motility studies (91020) | $449.10 | $1,497 | 0.9× |
| Gi tract capsule endoscopy (91110) | $1,462.50 | $4,875 | 1.3× |
| Group Therapeutic Procedures (97150) range across 4 matching MRF lines |
$28.50–$110.40 | $95–$368 | varies |
| Holter monitor recording (93225) | $144.90 | $483 | 0.8× |
| Immunization administration (90471) range across 8 matching MRF lines |
$8.70–$36 | $29–$120 | varies |
| Insert/Place Heart Catheter (93503) | $383.74 | $1,279.13 | 0.2× |
| Iontophoresis 15 min (97033) | $112.80 | $376 | 5.9× |
| IV infusion hydration each additional hour (96361) range across 5 matching MRF lines |
$29.70–$102 | $99–$340 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 5 matching MRF lines |
$102–$176.40 | $340–$588 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) | $176.40 | $588 | 1.9× |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 5 matching MRF lines |
$102–$176.40 | $340–$588 | varies |
| IV push initial (96374) | $143.10 | $477 | 0.5× |
| Lung Function Test (Mbc/Mvv) (94200) | $81.90 | $273 | 1.1× |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $33.90 | $113 | 1.1× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) range across 2 matching MRF lines |
$8.70–$62.40 | $29–$208 | varies |
| Motion Fluoroscopy/Swallow (92611) range across 5 matching MRF lines |
$105.30–$313.80 | $351–$1,046 | varies |
| Multiple Family Group Psychotherapy (90849) | $99.60 | $332 | 0.4× |
| Multiple Sleep Latency Test (95805) | $921 | $3,070 | 0.8× |
| Muscle Test 2 Limbs (95861) | $237.30 | $791 | 1.4× |
| Muscle Test One Limb (95860) | $233.70 | $779 | 1.4× |
| Neuromuscular Reeducation (97112) range across 3 matching MRF lines |
$75.60–$139.80 | $252–$466 | varies |
| Oral Function Therapy (92526) range across 4 matching MRF lines |
$47.40–$186 | $158–$620 | varies |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $54.60 | $182 | 1.2× |
| Ot Contrast Bath Ea 15 Min (97034) | $43.20 | $144 | 3.1× |
| Ot eval high complexity (97167) | $289.20 | $964 | 2.9× |
| Ot Eval Low Complex (97165) | $144.90 | $483 | 1.4× |
| Ot Eval Moderate Complexity (97166) | $217.20 | $724 | 2.2× |
| Ot manual therapy 15 min (97140) | $76.50 | $255 | 2.8× |
| Ot paraffin bath (97018) | $39.60 | $132 | 6.6× |
| Ot Prosthetic Training, Each 15 Min (97761) | $54.60 | $182 | 1.4× |
| Ot Re-Eval Est Plan Care (97168) range across 2 matching MRF lines |
$24–$54.60 | $80–$182 | varies |
| Perq transcath closure pda (93582) | $13,815 | $46,050 | 0.6× |
| Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) unusually low: confirm this is the full procedure |
$3,017.10 | $10,057 | 0.4× |
| Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) unusually low: confirm this is the full procedure |
$4,582.50 | $15,275 | 0.3× |
| Physical Performance Test (97750) | $81 | $270 | 2.4× |
| Plethysmography (94726) | $88.80 | $296 | 0.2× |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) | $2,128.50 | $7,095 | 1.9× |
| Prq Card Angio/Athrect 1 Art (92924) unusually low: confirm this is the full procedure |
$5,753.10 | $19,177 | 0.4× |
| Prq Card Stent W/Angio 1 Vsl (92928) unusually low: confirm this is the full procedure |
$4,582.50 | $15,275 | 0.3× |
| Prq Card Stent/Ath/Angio (92933) range across 5 matching MRF lines |
$5,387.68–$5,387.69 | $17,958.93–$17,958.96 | varies |
| Prq Revasc Byp Graft 1 Vsl (92937) unusually low: confirm this is the full procedure |
$4,582.50 | $15,275 | 0.3× |
| Prq Tcat Clsr Cgen Ventr Septal Dfct W/Implt (93581) likely a partial charge, not the full procedure |
$5,538.30 | $18,461 | 0.2× |
| Psychiatric diagnostic evaluation (90791) | $195.30 | $651 | 0.9× |
| Pt Eval High Complex (97163) | $217.20 | $724 | 2.2× |
| Pt eval low complex 20 min (97161) range across 3 matching MRF lines |
$17.10–$73.50 | $57–$245 | varies |
| Pt Eval Mod Complex (97162) | $144.90 | $483 | 1.5× |
| Pt gait training 15 min (97116) | $54.90 | $183 | 1.9× |
| Pt mechanical traction (97012) | $60.90 | $203 | 4.2× |
| Pt Re-Eval Est Plan Care (97164) range across 3 matching MRF lines |
$24–$54.60 | $80–$182 | varies |
| Pulm function test by gas (94727) | $65.40 | $218 | 0.2× |
| Pulmonary Stress Testing (94618) range across 3 matching MRF lines |
$60.90–$160.80 | $203–$536 | varies |
| Refill/Maint Portable Pump (96521) | $297.30 | $991 | 1.1× |
| Refill/Maint Pump/Resvr Syst (96522) | $297.30 | $991 | 1.1× |
| Respiratory flow volume loop (94375) | $127.50 | $425 | 0.5× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) | $58.20 | $194 | 0.8× |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) | $155.40 | $518 | 0.6× |
| Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) | $70.20 | $234 | 1.5× |
| Self Care Mngment Training (97535) range across 3 matching MRF lines |
$58.20–$66.90 | $194–$223 | varies |
| Sensory Integration Ea 15 Min (97533) | $49.50 | $165 | 0.8× |
| Slp Stdy Unatnd W/Anal (95801) | $440.10 | $1,467 | 5.8× |
| Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) | $440.10 | $1,467 | 1.6× |
| Speech sound lang comprehen (92523) | $131.70 | $439 | 0.6× |
| Spirometry (94010) range across 5 matching MRF lines |
$81.60–$224.70 | $272–$749 | varies |
| Stress Tte Only (93350) | $1,050 | $3,500 | 1.5× |
| Surfactant Admin Thru Tube (94610) | $67.50 | $225 | 0.2× |
| Temp transcutaneous pacing (92953) | $184.74 | $615.79 | 0.2× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) | $60.90 | $203 | 2.0× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) range across 5 matching MRF lines |
$57.60–$161.10 | $192–$537 | varies |
| Ther/Proph/Diag Inj Sc/Im (96372) | $143.10 | $477 | 1.5× |
| Ther/Proph/Diag Iv Inf Init (96365) | $176.40 | $588 | 0.6× |
| Therapeutic Activities (97530) | $67.20 | $224 | 1.9× |
| Tobacco Use Cessation Intensive >10 Minutes (99407) range across 2 matching MRF lines |
$9.90–$12 | $33–$40 | varies |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) range across 2 matching MRF lines |
$7.80–$12 | $26–$40 | varies |
| Transcath Closure of Asd (93580) likely a partial charge, not the full procedure |
$5,387.68 | $17,958.93 | 0.2× |
| Tte w/doppler, complete (93306) | $1,530.30 | $5,101 | 2.2× |
| Tte W/O Doppler Complete (93307) | $754.80 | $2,516 | 2.5× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) range across 3 matching MRF lines |
$110.70–$220.20 | $369–$734 | varies |
| Tx/Pro/Dx Inj New Drug Addon (96375) | $143.10 | $477 | 2.4× |
| Unlisted otorhinolaryngological service (92700) | $114.60 | $382 | 3.1× |
| Upr/L Xtremity Art 2 Levels (93922) range across 2 matching MRF lines |
$488.70–$563.10 | $1,629–$1,877 | varies |
| Vasopneumatic device (97016) | $61.20 | $204 | 5.1× |
| Vent Mgmt Inpat Init Day (94002) range across 9 matching MRF lines |
$955.80–$1,099.80 | $3,186–$3,666 | varies |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) range across 10 matching MRF lines |
$783.90–$901.80 | $2,613–$3,006 | varies |
| Visual Evoked Potential Test (95930) | $266.40 | $888 | 1.0× |
| Vital capacity, total (94150) | $48 | $160 | 0.3× |
| Wheelchair Mgmt Ea 15 Min (97542) | $56.10 | $187 | 1.8× |
| Whirlpool Therapy (97022) range across 3 matching MRF lines |
$82.80–$110.40 | $276–$368 | varies |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.