LA Care Covered CA: disclosed hospital rates

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Based on the published hospital price files, LA Care Covered CA appears in disclosed negotiated rates across 2 hospitals and 135 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.

135 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	—
0.9% SODIUM CHLORIDE--CONTROL FOR ATG Outpatient	UCLA Santa Monica Medical Center	63323018610 NDC	$40.00	$22.00	$1.03 – $200	—
1ST PSYC COLLAB CARE MGMT Outpatient	Ronald Reagan UCLA Medical Center	99492 HCPCS	—	—	$111 – $375	—
1ST PSYC COLLAB CARE MGMT Outpatient	UCLA Santa Monica Medical Center	99492 HCPCS	—	—	$118 – $375	—
2019-ncov diagnostic p Outpatient	UCLA Santa Monica Medical Center	U0001 HCPCS	—	—	$35.91 – $103	—
2d cephal radio image Outpatient	Ronald Reagan UCLA Medical Center	D0702 HCPCS	—	—	$112 – $321	—
2d cephal radio image Outpatient	UCLA Santa Monica Medical Center	D0702 HCPCS	—	—	$112 – $321	—
2d cephalometric image Outpatient	Ronald Reagan UCLA Medical Center	D0340 HCPCS	—	—	$112 – $321	—
2d cephalometric image Outpatient	UCLA Santa Monica Medical Center	D0340 HCPCS	—	—	$112 – $321	—
2d oral/facial photo image Outpatient	Ronald Reagan UCLA Medical Center	D0703 HCPCS	—	—	$112 – $321	—
2d oral/facial photo image Outpatient	UCLA Santa Monica Medical Center	D0703 HCPCS	—	—	$112 – $321	—
2d tee w or w/o fol w/con,in Outpatient	Ronald Reagan UCLA Medical Center	C8925 HCPCS	—	—	$1,000 – $2,894	—
2d tee w or w/o fol w/con,in Outpatient	UCLA Santa Monica Medical Center	C8925 HCPCS	—	—	$1,004 – $2,894	—
2d tte w or w/o fol w/con,co Outpatient	Ronald Reagan UCLA Medical Center	C8923 HCPCS	—	—	$1,000 – $2,894	—
2d tte w or w/o fol w/con,co Outpatient	UCLA Santa Monica Medical Center	C8923 HCPCS	—	—	$1,004 – $2,894	—
3-D RADIOTHERAPY PLAN Outpatient	Ronald Reagan UCLA Medical Center	77295 HCPCS	—	—	$430 – $5,109	—
3-D RADIOTHERAPY PLAN Outpatient	UCLA Santa Monica Medical Center	77295 HCPCS	—	—	$430 – $5,109	—
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	—
ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS Outpatient	UCLA Santa Monica Medical Center	49702023113 NDC	$424	$233	$106 – $382	—