Anthem Workers Comp: disclosed hospital rates

iDirect answer

Based on the published hospital price files, Anthem Workers Comp appears in disclosed negotiated rates across 2 hospitals and 168 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.

168 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
0.9% SODIUM CHLORIDE--CONTROL FOR ATG Outpatient	Ronald Reagan UCLA Medical Center	63323018610 NDC	$40.00	$22.00	$10.00 – $200	—
1ST PSYC COLLAB CARE MGMT Outpatient	UCLA West Valley Medical Center	99492 HCPCS	—	—	$118 – $282	—
2d cephal radio image Outpatient	UCLA West Valley Medical Center	D0702 HCPCS	—	—	$112 – $269	—
2d cephalometric image Outpatient	UCLA West Valley Medical Center	D0340 HCPCS	—	—	$112 – $269	—
2d oral/facial photo image Outpatient	UCLA West Valley Medical Center	D0703 HCPCS	—	—	$112 – $269	—
2d tee w or w/o fol w/con,in Outpatient	UCLA West Valley Medical Center	C8925 HCPCS	—	—	$1,004 – $2,409	—
2d tte w or w/o fol w/con,co Outpatient	UCLA West Valley Medical Center	C8923 HCPCS	—	—	$1,004 – $2,409	—
3-D RADIOTHERAPY PLAN Outpatient	UCLA West Valley Medical Center	77295 HCPCS	—	—	$430 – $4,172	—
3d anat seg imaging preop Outpatient	UCLA West Valley Medical Center	C8001 HCPCS	—	—	$112 – $477	—
3d bn img algor drvd fr mri Outpatient	UCLA West Valley Medical Center	G0566 HCPCS	—	—	$166 – $477	—
3D CNTR SIMULA TRGT LVR LES Outpatient	UCLA West Valley Medical Center	0944T HCPCS	—	—	$307 – $737	—
ABACAVIR SULFATE 20 MG/ML PO SOLN Outpatient	Ronald Reagan UCLA Medical Center	64980040524 NDC	$218	$120	$54.51 – $196	—
ABACAVIR SULFATE 300 MG PO TABS Outpatient	Ronald Reagan UCLA Medical Center	68084002121 NDC	$9.05	$4.98	$2.26 – $8.15	—
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-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS Outpatient	Ronald Reagan UCLA Medical Center	49702023113 NDC	$424	$233	$106 – $382	—
ABATACEPT 125 MG/ML SC SOSY Outpatient	Ronald Reagan UCLA Medical Center	00003218811 NDC	$3,869	$2,128	$967 – $3,482	—
ABATACEPT 125 MG/ML SC SOSY\|DISCARDED DRUG NOT ADMINISTERED Outpatient	Ronald Reagan UCLA Medical Center	00003218811_2 NDC	$3,869	$2,128	$967 – $3,482	—
ABATACEPT 250 MG IV SOLR Outpatient	Ronald Reagan UCLA Medical Center	00003218713 NDC	$3,974	$2,186	$993 – $19,878	—
Abatacept injection Outpatient	UCLA West Valley Medical Center	J0129 HCPCS	—	—	$41.21 – $117	—
ABD PARACENTESIS Outpatient	UCLA West Valley Medical Center	49082 HCPCS	—	—	$1,167 – $2,859	—
ABD PARACENTESIS W/IMAGING Outpatient	UCLA West Valley Medical Center	49083 HCPCS	—	—	$1,167 – $2,859	—
ABIRATERONE ACETATE 250 MG PO TABS Outpatient	Ronald Reagan UCLA Medical Center	60687079021 NDC	$23.36	$12.85	$5.84 – $117	—
ABLATE BONE TUMOR(S) PERQ Outpatient	UCLA West Valley Medical Center	20982 HCPCS	—	—	$9,077 – $39,237	—
ABLATE INF TURBINATE SUBMUC Outpatient	UCLA West Valley Medical Center	30802 HCPCS	—	—	$1,882 – $4,517	—
ABLATE INF TURBINATE SUPERF Outpatient	UCLA West Valley Medical Center	30801 HCPCS	—	—	$1,882 – $4,517	—