|
Brachytherapy Seeds - #2074
|
Facility
IP
|
$8,040.00
|
|
|
Service Code
|
ICD 0CHA81Z
|
| 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 D91BB6Z
|
| 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 0HHVX1Z
|
| 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 0FH431Z
|
| 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 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 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 0THB01Z
|
| 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 DB15B6Z
|
| 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 D011BB1
|
| 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 0YH631Z
|
| 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 0CHS81Z
|
| 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 D712B6Z
|
| 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 0THD31Z
|
| 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 DW1PBB1
|
| 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 DW1XBBZ
|
| 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 DW1KBBZ
|
| 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 D913BB1
|
| 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 DV10BB1
|
| 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 0TH901Z
|
| 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 DW13B6Z
|
| 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
|
|
