|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0XH901Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0XH841Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0XH701Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WHL41Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WHL31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WHL01Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WHC41Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WHC31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WH531Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0UHG31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0UHG01Z
|
| Min. Negotiated Rate |
$23,184.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0UHC81Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0HHU01Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0XHK31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0XHD01Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0XHD31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0XHK41Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WHQ81Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0BH081Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0DHP41Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0DHP31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WHR41Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WHR01Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0HHU81Z
|
| Min. Negotiated Rate |
$23,184.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
|
|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0WH931Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$23,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
