|
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 09HK41Z
|
| 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 0DH801Z
|
| 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 D810B6Z
|
| 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 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 09HK31Z
|
| 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 DB17BB1
|
| 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 01HY41Z
|
| 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 DD14B6Z
|
| 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 0DHE41Z
|
| 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 09HK81Z
|
| 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 DV11B6Z
|
| 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 0DH841Z
|
| 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 0DH881Z
|
| 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 0DH971Z
|
| 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 DB18BB1
|
| 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 09HD01Z
|
| 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 09HN71Z
|
| 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 0YHL01Z
|
| 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 DU12BB1
|
| 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 DW1RBBZ
|
| 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 DM10BB1
|
| 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 09HD31Z
|
| 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 0DHE71Z
|
| 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
|
|
