LA Care Medi-Cal: disclosed hospital rates

iDirect answer

Based on the published hospital price files, LA Care Medi-Cal appears in disclosed negotiated rates across 1 hospital and 281 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.

281 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	—
1 em core session Outpatient	UCLA West Valley Medical Center	G9873 HCPCS	—	—	$20.00 – $20.00	—
12-24hr sealed lead acid Outpatient	UCLA West Valley Medical Center	K0733 HCPCS	—	—	$28.90 – $28.90	—
1ST HOSP IP/OBS HIGH 75 Outpatient	UCLA West Valley Medical Center	99223 HCPCS	—	—	$80.10 – $80.10	—
1ST HOSP IP/OBS MODERATE 55 Outpatient	UCLA West Valley Medical Center	99222 HCPCS	—	—	$73.20 – $73.20	—
1ST HOSP IP/OBS SF/LOW 40 Outpatient	UCLA West Valley Medical Center	99221 HCPCS	—	—	$34.30 – $34.30	—
1ST NF CARE HIGH MDM 50 Outpatient	UCLA West Valley Medical Center	99306 HCPCS	—	—	$72.10 – $72.10	—
1ST NF CARE MODERATE MDM 35 Outpatient	UCLA West Valley Medical Center	99305 HCPCS	—	—	$46.90 – $46.90	—
1ST NF CARE SF/LOW MDM 25 Outpatient	UCLA West Valley Medical Center	99304 HCPCS	—	—	$37.80 – $37.80	—
1ST PSYC COLLAB CARE MGMT Outpatient	UCLA West Valley Medical Center	99492 HCPCS	—	—	$118 – $282	—
1ST/SBSQ PSYC COLLAB CARE Outpatient	UCLA West Valley Medical Center	99494 HCPCS	—	—	$57.88 – $57.88	—
2 em core ms mo 10-12 no wl Outpatient	UCLA West Valley Medical Center	G9877 HCPCS	—	—	$12.00 – $12.00	—
2 em core ms mo 10-12 wl Outpatient	UCLA West Valley Medical Center	G9879 HCPCS	—	—	$48.00 – $48.00	—
2 em core ms mo 7-9 no wl Outpatient	UCLA West Valley Medical Center	G9876 HCPCS	—	—	$12.00 – $12.00	—
2 em core ms mo 7-9 wl Outpatient	UCLA West Valley Medical Center	G9878 HCPCS	—	—	$48.00 – $48.00	—
2 em ongoing ms mo 13-15 wl Outpatient	UCLA West Valley Medical Center	G9882 HCPCS	—	—	$40.00 – $40.00	—
2 em ongoing ms mo 16-18 wl Outpatient	UCLA West Valley Medical Center	G9883 HCPCS	—	—	$40.00 – $40.00	—
2 em ongoing ms mo 19-21 wl Outpatient	UCLA West Valley Medical Center	G9884 HCPCS	—	—	$40.00 – $40.00	—
2 em ongoing ms mo 22-24 wl Outpatient	UCLA West Valley Medical Center	G9885 HCPCS	—	—	$40.00 – $40.00	—
2019-ncov diagnostic p Outpatient	UCLA West Valley Medical Center	U0001 HCPCS	—	—	$35.91 – $86.21	—
22nf nonsealed leadacid Outpatient	UCLA West Valley Medical Center	E2360 HCPCS	—	—	$107 – $107	—
22nf sealed leadacid battery Outpatient	UCLA West Valley Medical Center	E2361 HCPCS	—	—	$128 – $128	—
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 ECHO IMG CGEN CAR ANOMAL Outpatient	UCLA West Valley Medical Center	93319 HCPCS	—	—	$55.05 – $55.05	—