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Charge Type Setting Price  
Service Code ICD 061049Q
Hospital Charge Code 2485
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 061049R
Hospital Charge Code 2486
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104AP
Hospital Charge Code 2487
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104AQ
Hospital Charge Code 2488
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104AR
Hospital Charge Code 2489
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104JP
Hospital Charge Code 2490
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104JQ
Hospital Charge Code 2491
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104JR
Hospital Charge Code 2492
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104KP
Hospital Charge Code 2493
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104KQ
Hospital Charge Code 2494
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104KR
Hospital Charge Code 2495
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104ZP
Hospital Charge Code 2496
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104ZQ
Hospital Charge Code 2497
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06104ZR
Hospital Charge Code 2498
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06183J4
Hospital Charge Code 2499
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06183JY
Hospital Charge Code 2500
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06184J4
Hospital Charge Code 2501
Min. Negotiated Rate $10,777.00
Max. Negotiated Rate $10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $10,777.00
Service Code ICD 06700DZ
Hospital Charge Code 4741
Min. Negotiated Rate $3,913.00
Max. Negotiated Rate $3,913.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,913.00
Service Code ICD 06703DZ
Hospital Charge Code 4742
Min. Negotiated Rate $3,913.00
Max. Negotiated Rate $3,913.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,913.00
Service Code ICD 06704DZ
Hospital Charge Code 4743
Min. Negotiated Rate $3,913.00
Max. Negotiated Rate $3,913.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,913.00
Service Code ICD 06710DZ
Hospital Charge Code 4744
Min. Negotiated Rate $3,913.00
Max. Negotiated Rate $3,913.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,913.00
Service Code ICD 06713DZ
Hospital Charge Code 4745
Min. Negotiated Rate $3,913.00
Max. Negotiated Rate $3,913.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,913.00
Service Code ICD 06714DZ
Hospital Charge Code 4746
Min. Negotiated Rate $3,913.00
Max. Negotiated Rate $3,913.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,913.00
Service Code ICD 06720DZ
Hospital Charge Code 4747
Min. Negotiated Rate $3,913.00
Max. Negotiated Rate $3,913.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,913.00
Service Code ICD 06723DZ
Hospital Charge Code 4748
Min. Negotiated Rate $3,913.00
Max. Negotiated Rate $3,913.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $3,913.00