HealthCare Partners HMO: disclosed hospital rates

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Based on the published hospital price files, HealthCare Partners HMO appears in disclosed negotiated rates across 3 hospitals and 374 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.

374 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	—
1ST OPN IMPLT BAT MODULJ SYS Outpatient	UCLA West Valley Medical Center	64654 HCPCS	—	—	$56,651 – $57,178	—
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	—
3-D RADIOTHERAPY PLAN Outpatient	UCLA West Valley Medical Center	77295 HCPCS	—	—	$430 – $4,172	—
361 hct/p skin subs, nos Outpatient	UCLA West Valley Medical Center	Q4433 HCPCS	—	—	$160 – $162	—
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	—
510(k) skin subs, nos Outpatient	UCLA West Valley Medical Center	Q4432 HCPCS	—	—	$160 – $162	—
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 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-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-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS Outpatient	Ronald Reagan UCLA Medical Center	49702023113 NDC	$424	$233	$106 – $382	—