Anthem Blue Cross: disclosed hospital rates

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Based on the published hospital price files, Anthem Blue Cross appears in disclosed negotiated rates across 4 hospitals and 443 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

443 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
"Silver Nitrate Applicator 6""" Inpatient	UCLA West Valley Medical Center	12165010001 NDC	$165	$90.75	$34.65 – $165	—
0.9% SODIUM CHLORIDE--CONTROL FOR ATG Outpatient	Ronald Reagan UCLA Medical Center	63323018610 NDC	$40.00	$22.00	$10.00 – $200	—
0.9% SODIUM CHLORIDE--CONTROL FOR ATG Outpatient	UCLA Santa Monica Medical Center	63323018610 NDC	$40.00	$22.00	$1.03 – $200	—
0.9% SODIUM CHLORIDE--CONTROL FOR ATG Outpatient	UCLA Resnick Neuropsychiatric Hospital	63323018610 NDC	$40.00	$22.00	$10.00 – $37.60	—
2VHPV VACCINE 3 DOSE IM Outpatient	UCLA West Valley Medical Center	90650 HCPCS	—	—	$133 – $648	—
4VHPV VACCINE 3 DOSE IM Outpatient	UCLA West Valley Medical Center	90649 HCPCS	—	—	$163 – $629	—
5% dextrose and 0.45% saline Outpatient	UCLA West Valley Medical Center	S5010 HCPCS	—	—	$7.35 – $21.56	—
5% dextrose in lac ringers Outpatient	UCLA West Valley Medical Center	J7121 HCPCS	—	—	$4.57 – $21.11	—
5% dextrose in lactated ring Outpatient	UCLA West Valley Medical Center	S5011 HCPCS	—	—	$4.85 – $49.95	—
5% dextrose with potassium Outpatient	UCLA West Valley Medical Center	S5012 HCPCS	—	—	$12.97 – $27.06	—
5% dextrose/normal saline Outpatient	UCLA West Valley Medical Center	J7042 HCPCS	—	—	$3.02 – $76.44	—
5% dextrose/water Outpatient	UCLA West Valley Medical Center	J7060 HCPCS	—	—	$4.38 – $43.55	—
5%dextrose/0.45%saline1000ml Outpatient	UCLA West Valley Medical Center	S5013 HCPCS	—	—	$25.93 – $25.93	—
9VHPV VACCINE 2/3 DOSE IM Outpatient	UCLA West Valley Medical Center	90651 HCPCS	—	—	$291 – $861	—
Abacavir 300 MG Tablet Inpatient	UCLA West Valley Medical Center	00378410591 NDC	$116	$63.80	$24.36 – $116	—
ABACAVIR SULFATE 20 MG/ML PO SOLN Outpatient	Ronald Reagan UCLA Medical Center	64980040524 NDC	$218	$120	$54.51 – $196	—
ABACAVIR SULFATE 20 MG/ML PO SOLN Outpatient	UCLA Santa Monica Medical Center	64980040524 NDC	$218	$120	$54.51 – $196	—
ABACAVIR SULFATE 20 MG/ML PO SOLN Outpatient	UCLA Resnick Neuropsychiatric Hospital	64980040524 NDC	$218	$120	$54.51 – $205	—
ABACAVIR SULFATE 300 MG PO TABS Outpatient	Ronald Reagan UCLA Medical Center	68084002121 NDC	$9.05	$4.98	$2.26 – $8.15	—
ABACAVIR SULFATE 300 MG PO TABS Outpatient	UCLA Santa Monica Medical Center	68084002121 NDC	$9.05	$4.98	$2.26 – $8.15	—
ABACAVIR SULFATE 300 MG PO TABS Outpatient	UCLA Resnick Neuropsychiatric Hospital	68084002121 NDC	$9.05	$4.98	$2.26 – $8.51	—
ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS Outpatient	Ronald Reagan UCLA Medical Center	65862033530 NDC	$4.00	$2.20	$1.00 – $3.60	—
ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS Outpatient	UCLA Santa Monica Medical Center	65862033530 NDC	$4.00	$2.20	$1.00 – $3.60	—
ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS Outpatient	UCLA Resnick Neuropsychiatric Hospital	65862033530 NDC	$4.00	$2.20	$1.00 – $3.76	—
ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS Outpatient	Ronald Reagan UCLA Medical Center	49702023113 NDC	$424	$233	$106 – $382	—