Prime Health- PPO: disclosed hospital rates

iDirect answer

Based on the published hospital price files, Prime Health- PPO appears in disclosed negotiated rates across 2 hospitals and 86 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.

86 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	—
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	—
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 Outpatient	UCLA Santa Monica Medical Center	00003218811 NDC	$3,869	$2,128	$43.44 – $3,702	—
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 125 MG/ML SC SOSY\|DISCARDED DRUG NOT ADMINISTERED Outpatient	UCLA Santa Monica Medical Center	00003218811_2 NDC	$3,869	$2,128	$43.44 – $3,702	—
ABATACEPT 250 MG IV SOLR Outpatient	Ronald Reagan UCLA Medical Center	00003218713 NDC	$3,974	$2,186	$993 – $19,878	—
ABATACEPT 250 MG IV SOLR Outpatient	UCLA Santa Monica Medical Center	00003218713 NDC	$3,974	$2,186	$43.44 – $19,878	—
ABIRATERONE ACETATE 250 MG PO TABS Outpatient	Ronald Reagan UCLA Medical Center	60687079021 NDC	$23.36	$12.85	$5.84 – $117	—
ABIRATERONE ACETATE 250 MG PO TABS Outpatient	UCLA Santa Monica Medical Center	60687079021 NDC	$23.36	$12.85	$5.84 – $117	—
ABOBOTULINUMTOXINA 300 UNITS IM SOLR Outpatient	Ronald Reagan UCLA Medical Center	15054053006 NDC	$2,062	$1,134	$516 – $10,315	—
ABOBOTULINUMTOXINA 300 UNITS IM SOLR Outpatient	UCLA Santa Monica Medical Center	15054053006 NDC	$2,062	$1,134	$8.53 – $10,315	—
ABOBOTULINUMTOXINA 500 UNITS IM SOLR Outpatient	Ronald Reagan UCLA Medical Center	15054050001 NDC	$3,436	$1,890	$859 – $17,189	—
ABOBOTULINUMTOXINA 500 UNITS IM SOLR Outpatient	UCLA Santa Monica Medical Center	15054050001 NDC	$3,436	$1,890	$8.53 – $17,189	—
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY Inpatient	Ronald Reagan UCLA Medical Center	770 MS-DRG	—	—	$2,175 – $26,370	—
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY Inpatient	UCLA Santa Monica Medical Center	770 MS-DRG	—	—	$2,175 – $24,994	—
ABORTION WITHOUT D&C Inpatient	Ronald Reagan UCLA Medical Center	779 MS-DRG	—	—	$2,175 – $23,013	—