|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD D810BB1
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0GHS01Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0DHE31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 00H601Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 09HH71Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD D016BB1
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD DT12B6Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0CHY71Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0UH341Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD DU11BB1
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0UH901Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 09HD41Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD DF13B6Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD D91BBB1
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD DT13BB1
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0UH371Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD DB11BB1
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 07HT31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0UH331Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD DD17B6Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 09HY41Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 09HE31Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$23,184.00
|
|
|
Service Code
|
ICD 0YH731Z
|
| 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
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD DD15BB1
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0DH631Z
|
| Min. Negotiated Rate |
$8,040.00 |
| Max. Negotiated Rate |
$8,040.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,040.00
|
|
