Blue Shield of California: disclosed hospital rates

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Based on the published hospital price files, Blue Shield of California appears in disclosed negotiated rates across 1 hospital and 271 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.

271 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	—
1ST PSYC COLLAB CARE MGMT Outpatient	UCLA West Valley Medical Center	99492 HCPCS	—	—	$118 – $282	—
2019-ncov diagnostic p Outpatient	UCLA West Valley Medical Center	U0001 HCPCS	—	—	$35.91 – $86.21	—
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	—
2VHPV VACCINE 3 DOSE IM Outpatient	UCLA West Valley Medical Center	90650 HCPCS	—	—	$133 – $648	—
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	—
4VHPV VACCINE 3 DOSE IM Outpatient	UCLA West Valley Medical Center	90649 HCPCS	—	—	$163 – $629	—
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/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	—
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	—
Abatacept injection Outpatient	UCLA West Valley Medical Center	J0129 HCPCS	—	—	$41.21 – $117	—
Abciximab injection Outpatient	UCLA West Valley Medical Center	J0130 HCPCS	—	—	$1,375 – $3,823	—
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	—
ABETA42 & PTAU181 ECLIA CSF Outpatient	UCLA West Valley Medical Center	0445U HCPCS	—	—	$261 – $625	—