TriWest Healthcare Alliance: disclosed hospital rates

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Based on the published hospital price files, TriWest Healthcare Alliance appears in disclosed negotiated rates across 4 hospitals and 553 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.

553 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
1ST OPN IMPLT BAT MODULJ SYS Outpatient	Ronald Reagan UCLA Medical Center	64654 HCPCS	—	—	$56,651 – $162,589	—
1ST OPN IMPLT BAT MODULJ SYS Outpatient	UCLA Santa Monica Medical Center	64654 HCPCS	—	—	$56,651 – $162,589	—
1ST OPN IMPLT BAT MODULJ SYS Outpatient	UCLA Resnick Neuropsychiatric Hospital	64654 HCPCS	—	—	$24,570 – $45,001	—
1ST OPN IMPLT BAT MODULJ SYS Outpatient	UCLA West Valley Medical Center	64654 HCPCS	—	—	$56,651 – $57,178	—
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	—
1ST PSYC COLLAB CARE MGMT Outpatient	UCLA Resnick Neuropsychiatric Hospital	99492 HCPCS	—	—	$56.67 – $104	—
1ST PSYC COLLAB CARE MGMT Outpatient	UCLA West Valley Medical Center	99492 HCPCS	—	—	$118 – $282	—
2019-ncov diagnostic p Outpatient	UCLA Santa Monica Medical Center	U0001 HCPCS	—	—	$35.91 – $103	—
2019-ncov diagnostic p Outpatient	UCLA Resnick Neuropsychiatric Hospital	U0001 HCPCS	—	—	$19.61 – $35.92	—
2019-ncov diagnostic p Outpatient	UCLA West Valley Medical Center	U0001 HCPCS	—	—	$35.91 – $86.21	—
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 cephal radio image Outpatient	UCLA Resnick Neuropsychiatric Hospital	D0702 HCPCS	—	—	$48.54 – $88.91	—
2d cephal radio image Outpatient	UCLA West Valley Medical Center	D0702 HCPCS	—	—	$112 – $269	—
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 cephalometric image Outpatient	UCLA Resnick Neuropsychiatric Hospital	D0340 HCPCS	—	—	$48.54 – $88.91	—
2d cephalometric image Outpatient	UCLA West Valley Medical Center	D0340 HCPCS	—	—	$112 – $269	—
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 oral/facial photo image Outpatient	UCLA Resnick Neuropsychiatric Hospital	D0703 HCPCS	—	—	$48.54 – $88.91	—
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	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	—