|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0THB41Z
|
| 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 07HM31Z
|
| 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 DD13B6Z
|
| 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 D715BB1
|
| 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 D010BB1
|
| 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 0DHB01Z
|
| 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 07HN01Z
|
| 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 00H641Z
|
| 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 DW1QBBZ
|
| 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 D711B6Z
|
| 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 D718BB1
|
| 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 0YH131Z
|
| 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
|
$23,184.00
|
|
|
Service Code
|
ICD 0YHM01Z
|
| 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 0FHG31Z
|
| 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 D017B6Z
|
| 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 DB16B6Z
|
| 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 00HV01Z
|
| 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 DU10BB1
|
| 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 0YH141Z
|
| 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 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 D915BB1
|
| 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 D91DBB1
|
| 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
|
|
