|
PR BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC
|
Professional
|
Both
|
$4,284.81
|
|
|
Service Code
|
HCPCS 33891
|
| Min. Negotiated Rate |
$3,213.61 |
| Max. Negotiated Rate |
$3,213.61 |
| Rate for Payer: Cash Price |
$1,130.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,213.61
|
| Rate for Payer: SOMOS Essential |
$3,213.61
|
|
|
PR BYP OTH/THN VEIN AORTOBIFEMORAL
|
Professional
|
Both
|
$7,573.69
|
|
|
Service Code
|
HCPCS 35646
|
| Min. Negotiated Rate |
$5,680.27 |
| Max. Negotiated Rate |
$5,680.27 |
| Rate for Payer: Cash Price |
$2,004.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,680.27
|
| Rate for Payer: SOMOS Essential |
$5,680.27
|
|
|
PR BYP OTH/THN VEIN AORTOBI-ILIAC
|
Professional
|
Both
|
$7,709.35
|
|
|
Service Code
|
HCPCS 35638
|
| Min. Negotiated Rate |
$5,782.01 |
| Max. Negotiated Rate |
$5,782.01 |
| Rate for Payer: Cash Price |
$2,039.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,782.01
|
| Rate for Payer: SOMOS Essential |
$5,782.01
|
|
|
PR BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL
|
Professional
|
Both
|
$8,208.62
|
|
|
Service Code
|
HCPCS 35631
|
| Min. Negotiated Rate |
$6,156.47 |
| Max. Negotiated Rate |
$6,156.47 |
| Rate for Payer: Cash Price |
$2,177.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6,156.47
|
| Rate for Payer: SOMOS Essential |
$6,156.47
|
|
|
PR BYP OTH/THN VEIN AORTOFEMORAL
|
Professional
|
Both
|
$6,889.82
|
|
|
Service Code
|
HCPCS 35647
|
| Min. Negotiated Rate |
$5,167.36 |
| Max. Negotiated Rate |
$5,167.36 |
| Rate for Payer: Cash Price |
$1,823.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,167.36
|
| Rate for Payer: SOMOS Essential |
$5,167.36
|
|
|
PR BYP OTH/THN VEIN AORTOILIAC
|
Professional
|
Both
|
$7,377.62
|
|
|
Service Code
|
HCPCS 35637
|
| Min. Negotiated Rate |
$5,533.22 |
| Max. Negotiated Rate |
$5,533.22 |
| Rate for Payer: Cash Price |
$1,953.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,533.22
|
| Rate for Payer: SOMOS Essential |
$5,533.22
|
|
|
PR BYP OTH/THN VEIN AXILLARY-AXILLARY
|
Professional
|
Both
|
$4,547.24
|
|
|
Service Code
|
HCPCS 35650
|
| Min. Negotiated Rate |
$3,410.43 |
| Max. Negotiated Rate |
$3,410.43 |
| Rate for Payer: Cash Price |
$1,203.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,410.43
|
| Rate for Payer: SOMOS Essential |
$3,410.43
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$4,876.24
|
|
|
Service Code
|
HCPCS 35621
|
| Min. Negotiated Rate |
$3,657.18 |
| Max. Negotiated Rate |
$3,657.18 |
| Rate for Payer: Cash Price |
$1,289.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,657.18
|
| Rate for Payer: SOMOS Essential |
$3,657.18
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$6,054.06
|
|
|
Service Code
|
HCPCS 35654
|
| Min. Negotiated Rate |
$4,540.55 |
| Max. Negotiated Rate |
$4,540.55 |
| Rate for Payer: Cash Price |
$1,603.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,540.55
|
| Rate for Payer: SOMOS Essential |
$4,540.55
|
|
|
PR BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL
|
Professional
|
Both
|
$5,851.41
|
|
|
Service Code
|
HCPCS 35623
|
| Min. Negotiated Rate |
$4,388.56 |
| Max. Negotiated Rate |
$4,388.56 |
| Rate for Payer: Cash Price |
$1,548.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,388.56
|
| Rate for Payer: SOMOS Essential |
$4,388.56
|
|
|
PR BYP OTH/THN VEIN CAROTID-SUBCLAVIAN
|
Professional
|
Both
|
$5,206.57
|
|
|
Service Code
|
HCPCS 35606
|
| Min. Negotiated Rate |
$3,904.93 |
| Max. Negotiated Rate |
$3,904.93 |
| Rate for Payer: Cash Price |
$1,384.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,904.93
|
| Rate for Payer: SOMOS Essential |
$3,904.93
|
|
|
PR BYP OTH/THN VEIN CAROTID-VERTEBRAL
|
Professional
|
Both
|
$4,395.72
|
|
|
Service Code
|
HCPCS 35642
|
| Min. Negotiated Rate |
$3,296.79 |
| Max. Negotiated Rate |
$3,296.79 |
| Rate for Payer: Cash Price |
$1,165.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,296.79
|
| Rate for Payer: SOMOS Essential |
$3,296.79
|
|
|
PR BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID
|
Professional
|
Both
|
$6,235.71
|
|
|
Service Code
|
HCPCS 35601
|
| Min. Negotiated Rate |
$4,676.78 |
| Max. Negotiated Rate |
$4,676.78 |
| Rate for Payer: Cash Price |
$1,648.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,676.78
|
| Rate for Payer: SOMOS Essential |
$4,676.78
|
|
|
PR BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL
|
Professional
|
Both
|
$5,717.29
|
|
|
Service Code
|
HCPCS 35666
|
| Min. Negotiated Rate |
$4,287.97 |
| Max. Negotiated Rate |
$4,287.97 |
| Rate for Payer: Cash Price |
$1,514.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,287.97
|
| Rate for Payer: SOMOS Essential |
$4,287.97
|
|
|
PR BYP OTH/THN VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$4,809.39
|
|
|
Service Code
|
HCPCS 35661
|
| Min. Negotiated Rate |
$3,607.04 |
| Max. Negotiated Rate |
$3,607.04 |
| Rate for Payer: Cash Price |
$1,273.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,607.04
|
| Rate for Payer: SOMOS Essential |
$3,607.04
|
|
|
PR BYP OTH/THN VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$4,770.82
|
|
|
Service Code
|
HCPCS 35656
|
| Min. Negotiated Rate |
$3,578.11 |
| Max. Negotiated Rate |
$3,578.11 |
| Rate for Payer: Cash Price |
$1,261.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,578.11
|
| Rate for Payer: SOMOS Essential |
$3,578.11
|
|
|
PR BYP OTH/THN VEIN ILIOFEMORAL
|
Professional
|
Both
|
$5,201.98
|
|
|
Service Code
|
HCPCS 35665
|
| Min. Negotiated Rate |
$3,901.49 |
| Max. Negotiated Rate |
$3,901.49 |
| Rate for Payer: Cash Price |
$1,379.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,901.49
|
| Rate for Payer: SOMOS Essential |
$3,901.49
|
|
|
PR BYP OTH/THN VEIN ILIOILIAC
|
Professional
|
Both
|
$5,419.37
|
|
|
Service Code
|
HCPCS 35663
|
| Min. Negotiated Rate |
$4,064.53 |
| Max. Negotiated Rate |
$4,064.53 |
| Rate for Payer: Cash Price |
$1,437.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,064.53
|
| Rate for Payer: SOMOS Essential |
$4,064.53
|
|
|
PR BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART
|
Professional
|
Both
|
$5,035.98
|
|
|
Service Code
|
HCPCS 35671
|
| Min. Negotiated Rate |
$3,776.99 |
| Max. Negotiated Rate |
$3,776.99 |
| Rate for Payer: Cash Price |
$1,332.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,776.99
|
| Rate for Payer: SOMOS Essential |
$3,776.99
|
|
|
PR BYP OTH/THN VEIN SPLENORENAL
|
Professional
|
Both
|
$7,099.65
|
|
|
Service Code
|
HCPCS 35636
|
| Min. Negotiated Rate |
$5,324.74 |
| Max. Negotiated Rate |
$5,324.74 |
| Rate for Payer: Cash Price |
$1,878.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,324.74
|
| Rate for Payer: SOMOS Essential |
$5,324.74
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY
|
Professional
|
Both
|
$4,901.96
|
|
|
Service Code
|
HCPCS 35616
|
| Min. Negotiated Rate |
$3,676.47 |
| Max. Negotiated Rate |
$3,676.47 |
| Rate for Payer: Cash Price |
$1,298.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,676.47
|
| Rate for Payer: SOMOS Essential |
$3,676.47
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN
|
Professional
|
Both
|
$4,652.27
|
|
|
Service Code
|
HCPCS 35612
|
| Min. Negotiated Rate |
$3,489.20 |
| Max. Negotiated Rate |
$3,489.20 |
| Rate for Payer: Cash Price |
$1,233.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,489.20
|
| Rate for Payer: SOMOS Essential |
$3,489.20
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL
|
Professional
|
Both
|
$4,215.65
|
|
|
Service Code
|
HCPCS 35645
|
| Min. Negotiated Rate |
$3,161.74 |
| Max. Negotiated Rate |
$3,161.74 |
| Rate for Payer: Cash Price |
$1,117.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,161.74
|
| Rate for Payer: SOMOS Essential |
$3,161.74
|
|
|
PR BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL
|
Professional
|
Both
|
$6,551.58
|
|
|
Service Code
|
HCPCS 35570
|
| Min. Negotiated Rate |
$4,913.69 |
| Max. Negotiated Rate |
$4,913.69 |
| Rate for Payer: Cash Price |
$1,737.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,913.69
|
| Rate for Payer: SOMOS Essential |
$4,913.69
|
|
|
PR BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL
|
Professional
|
Both
|
$5,883.19
|
|
|
Service Code
|
HCPCS 35571
|
| Min. Negotiated Rate |
$4,412.39 |
| Max. Negotiated Rate |
$4,412.39 |
| Rate for Payer: Cash Price |
$1,556.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,412.39
|
| Rate for Payer: SOMOS Essential |
$4,412.39
|
|