|
Inpatient Brachytherapy
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0FHB41Z
|
| 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 0WH941Z
|
| 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 0UHC71Z
|
| 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 0WHF31Z
|
| 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 0XH441Z
|
| 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 0XH331Z
|
| 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 0XH501Z
|
| 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 0DHP81Z
|
| 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 0XHC41Z
|
| 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 0XH431Z
|
| 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 0FHB01Z
|
| 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 0HHV01Z
|
| 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 0HHV31Z
|
| 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 0WHP41Z
|
| 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 0XH541Z
|
| 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 0UHC01Z
|
| 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 0WH501Z
|
| 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 0WH041Z
|
| 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 0XHJ01Z
|
| 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 0UHC31Z
|
| 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 C-Section Delivery
|
Facility
IP
|
$13,936.00
|
|
|
Service Code
|
ICD 10D00Z0
|
| Min. Negotiated Rate |
$4,712.00 |
| Max. Negotiated Rate |
$13,936.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$13,229.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,936.00
|
| Rate for Payer: Blue Shield of California EPN |
$11,944.00
|
|
|
Inpatient C-Section Delivery
|
Facility
IP
|
$13,936.00
|
|
|
Service Code
|
ICD 10D00Z2
|
| Min. Negotiated Rate |
$4,712.00 |
| Max. Negotiated Rate |
$13,936.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$13,229.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,936.00
|
| Rate for Payer: Blue Shield of California EPN |
$11,944.00
|
|
|
Inpatient C-Section Delivery
|
Facility
IP
|
$13,936.00
|
|
|
Service Code
|
ICD 10D00Z1
|
| Min. Negotiated Rate |
$4,712.00 |
| Max. Negotiated Rate |
$13,936.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$13,229.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,936.00
|
| Rate for Payer: Blue Shield of California EPN |
$11,944.00
|
|
