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Charge Type Setting Price  
Service Code ICD 03770D6
Hospital Charge Code 3698
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03770DZ
Hospital Charge Code 3699
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03770EZ
Hospital Charge Code 3700
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03770FZ
Hospital Charge Code 3701
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03770GZ
Hospital Charge Code 3702
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 037734Z
Hospital Charge Code 1639
Min. Negotiated Rate $8,968.00
Max. Negotiated Rate $8,968.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $8,968.00
Service Code ICD 037735Z
Hospital Charge Code 1640
Min. Negotiated Rate $8,968.00
Max. Negotiated Rate $8,968.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $8,968.00
Service Code ICD 037736Z
Hospital Charge Code 1641
Min. Negotiated Rate $8,968.00
Max. Negotiated Rate $8,968.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $8,968.00
Service Code ICD 037737Z
Hospital Charge Code 1642
Min. Negotiated Rate $8,968.00
Max. Negotiated Rate $8,968.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $8,968.00
Service Code ICD 03773D1
Hospital Charge Code 3703
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03773D6
Hospital Charge Code 3704
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03773DZ
Hospital Charge Code 3705
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03773EZ
Hospital Charge Code 3706
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03773FZ
Hospital Charge Code 3707
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03773GZ
Hospital Charge Code 3708
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 037744Z
Hospital Charge Code 1643
Min. Negotiated Rate $8,968.00
Max. Negotiated Rate $8,968.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $8,968.00
Service Code ICD 037745Z
Hospital Charge Code 1644
Min. Negotiated Rate $8,968.00
Max. Negotiated Rate $8,968.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $8,968.00
Service Code ICD 037746Z
Hospital Charge Code 1645
Min. Negotiated Rate $8,968.00
Max. Negotiated Rate $8,968.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $8,968.00
Service Code ICD 037747Z
Hospital Charge Code 1646
Min. Negotiated Rate $8,968.00
Max. Negotiated Rate $8,968.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $8,968.00
Service Code ICD 03774D1
Hospital Charge Code 3709
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03774D6
Hospital Charge Code 3710
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03774DZ
Hospital Charge Code 3711
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03774EZ
Hospital Charge Code 3712
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03774FZ
Hospital Charge Code 3713
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00
Service Code ICD 03774GZ
Hospital Charge Code 3714
Min. Negotiated Rate $4,070.00
Max. Negotiated Rate $4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $4,070.00