PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$722.12
|
|
Service Code
|
HCPCS 19126
|
Min. Negotiated Rate |
$541.59 |
Max. Negotiated Rate |
$541.59 |
Rate for Payer: Cash Price |
$191.70
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$541.59
|
Rate for Payer: SOMOS Essential |
$541.59
|
|
PR EXC CAROTID BODY TUMOR W EXC CAROTID ARTERY
|
Professional
|
Both
|
$7,336.98
|
|
Service Code
|
HCPCS 60605
|
Min. Negotiated Rate |
$5,502.74 |
Max. Negotiated Rate |
$5,502.74 |
Rate for Payer: Cash Price |
$1,942.68
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,502.74
|
Rate for Payer: SOMOS Essential |
$5,502.74
|
|
PR EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY
|
Professional
|
Both
|
$6,084.51
|
|
Service Code
|
HCPCS 60600
|
Min. Negotiated Rate |
$4,563.38 |
Max. Negotiated Rate |
$4,563.38 |
Rate for Payer: Cash Price |
$1,622.31
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,563.38
|
Rate for Payer: SOMOS Essential |
$4,563.38
|
|
PR EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR
|
Professional
|
Both
|
$3,642.66
|
|
Service Code
|
HCPCS 57545
|
Min. Negotiated Rate |
$2,732.00 |
Max. Negotiated Rate |
$2,732.00 |
Rate for Payer: Cash Price |
$980.91
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,732.00
|
Rate for Payer: SOMOS Essential |
$2,732.00
|
|
PR EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT
|
Professional
|
Both
|
$1,518.44
|
|
Service Code
|
HCPCS 67808
|
Min. Negotiated Rate |
$1,138.83 |
Max. Negotiated Rate |
$1,138.83 |
Rate for Payer: Cash Price |
$419.16
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,138.83
|
Rate for Payer: SOMOS Essential |
$1,138.83
|
|
PR EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET
|
Professional
|
Both
|
$5,672.38
|
|
Service Code
|
HCPCS 33851
|
Min. Negotiated Rate |
$4,254.28 |
Max. Negotiated Rate |
$4,254.28 |
Rate for Payer: Cash Price |
$1,511.39
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,254.28
|
Rate for Payer: SOMOS Essential |
$4,254.28
|
|
PR EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS
|
Professional
|
Both
|
$5,525.31
|
|
Service Code
|
HCPCS 33840
|
Min. Negotiated Rate |
$4,143.98 |
Max. Negotiated Rate |
$4,143.98 |
Rate for Payer: Cash Price |
$1,471.36
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,143.98
|
Rate for Payer: SOMOS Essential |
$4,143.98
|
|
PR EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR
|
Professional
|
Both
|
$3,490.59
|
|
Service Code
|
HCPCS 15922
|
Min. Negotiated Rate |
$2,617.94 |
Max. Negotiated Rate |
$2,617.94 |
Rate for Payer: Cash Price |
$942.40
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,617.94
|
Rate for Payer: SOMOS Essential |
$2,617.94
|
|
PR EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR
|
Professional
|
Both
|
$2,847.43
|
|
Service Code
|
HCPCS 15920
|
Min. Negotiated Rate |
$2,135.57 |
Max. Negotiated Rate |
$2,135.57 |
Rate for Payer: Cash Price |
$755.89
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,135.57
|
Rate for Payer: SOMOS Essential |
$2,135.57
|
|
PR EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES
|
Professional
|
Both
|
$3,640.46
|
|
Service Code
|
HCPCS 26596
|
Min. Negotiated Rate |
$2,730.34 |
Max. Negotiated Rate |
$2,730.34 |
Rate for Payer: Cash Price |
$980.58
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,730.34
|
Rate for Payer: SOMOS Essential |
$2,730.34
|
|
PR EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR
|
Professional
|
Both
|
$2,709.88
|
|
Service Code
|
HCPCS 57555
|
Min. Negotiated Rate |
$2,032.41 |
Max. Negotiated Rate |
$2,032.41 |
Rate for Payer: Cash Price |
$730.35
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,032.41
|
Rate for Payer: SOMOS Essential |
$2,032.41
|
|
PR EXC CRV STUMP VAG APPR W/RPR NTRCL
|
Professional
|
Both
|
$2,572.50
|
|
Service Code
|
HCPCS 57556
|
Min. Negotiated Rate |
$1,929.38 |
Max. Negotiated Rate |
$1,929.38 |
Rate for Payer: Cash Price |
$693.65
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,929.38
|
Rate for Payer: SOMOS Essential |
$1,929.38
|
|
PR EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ
|
Professional
|
Both
|
$4,639.36
|
|
Service Code
|
HCPCS 38555
|
Min. Negotiated Rate |
$3,479.52 |
Max. Negotiated Rate |
$3,479.52 |
Rate for Payer: Cash Price |
$1,238.99
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,479.52
|
Rate for Payer: SOMOS Essential |
$3,479.52
|
|
PR EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ
|
Professional
|
Both
|
$2,352.32
|
|
Service Code
|
HCPCS 38550
|
Min. Negotiated Rate |
$1,764.24 |
Max. Negotiated Rate |
$1,764.24 |
Rate for Payer: Cash Price |
$632.95
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,764.24
|
Rate for Payer: SOMOS Essential |
$1,764.24
|
|
PR EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT
|
Professional
|
Both
|
$2,694.58
|
|
Service Code
|
HCPCS 26205
|
Min. Negotiated Rate |
$2,020.94 |
Max. Negotiated Rate |
$2,020.94 |
Rate for Payer: Cash Price |
$729.42
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,020.94
|
Rate for Payer: SOMOS Essential |
$2,020.94
|
|
PR EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT
|
Professional
|
Both
|
$2,531.62
|
|
Service Code
|
HCPCS 26215
|
Min. Negotiated Rate |
$1,898.72 |
Max. Negotiated Rate |
$1,898.72 |
Rate for Payer: Cash Price |
$685.54
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,898.72
|
Rate for Payer: SOMOS Essential |
$1,898.72
|
|
PR EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT
|
Professional
|
Both
|
$1,597.37
|
|
Service Code
|
HCPCS 28103
|
Min. Negotiated Rate |
$1,198.03 |
Max. Negotiated Rate |
$1,198.03 |
Rate for Payer: Cash Price |
$441.96
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,198.03
|
Rate for Payer: SOMOS Essential |
$1,198.03
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT
|
Professional
|
Both
|
$3,265.36
|
|
Service Code
|
HCPCS 27637
|
Min. Negotiated Rate |
$2,449.02 |
Max. Negotiated Rate |
$2,449.02 |
Rate for Payer: Cash Price |
$890.99
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,449.02
|
Rate for Payer: SOMOS Essential |
$2,449.02
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT
|
Professional
|
Both
|
$3,265.40
|
|
Service Code
|
HCPCS 27638
|
Min. Negotiated Rate |
$2,449.05 |
Max. Negotiated Rate |
$2,449.05 |
Rate for Payer: Cash Price |
$879.35
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,449.05
|
Rate for Payer: SOMOS Essential |
$2,449.05
|
|
PR EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT
|
Professional
|
Both
|
$3,094.46
|
|
Service Code
|
HCPCS 23145
|
Min. Negotiated Rate |
$2,320.84 |
Max. Negotiated Rate |
$2,320.84 |
Rate for Payer: Cash Price |
$836.39
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,320.84
|
Rate for Payer: SOMOS Essential |
$2,320.84
|
|
PR EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT
|
Professional
|
Both
|
$2,772.00
|
|
Service Code
|
HCPCS 23146
|
Min. Negotiated Rate |
$2,079.00 |
Max. Negotiated Rate |
$2,079.00 |
Rate for Payer: Cash Price |
$752.48
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,079.00
|
Rate for Payer: SOMOS Essential |
$2,079.00
|
|
PR EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT
|
Professional
|
Both
|
$2,769.34
|
|
Service Code
|
HCPCS 24125
|
Min. Negotiated Rate |
$2,077.00 |
Max. Negotiated Rate |
$2,077.00 |
Rate for Payer: Cash Price |
$751.27
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,077.00
|
Rate for Payer: SOMOS Essential |
$2,077.00
|
|
PR EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT
|
Professional
|
Both
|
$2,892.75
|
|
Service Code
|
HCPCS 24126
|
Min. Negotiated Rate |
$2,169.56 |
Max. Negotiated Rate |
$2,169.56 |
Rate for Payer: Cash Price |
$783.46
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,169.56
|
Rate for Payer: SOMOS Essential |
$2,169.56
|
|
PR EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL
|
Professional
|
Both
|
$1,494.43
|
|
Service Code
|
HCPCS 28104
|
Min. Negotiated Rate |
$1,120.82 |
Max. Negotiated Rate |
$1,120.82 |
Rate for Payer: Cash Price |
$413.58
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,120.82
|
Rate for Payer: SOMOS Essential |
$1,120.82
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT
|
Professional
|
Both
|
$3,813.43
|
|
Service Code
|
HCPCS 24116
|
Min. Negotiated Rate |
$2,860.07 |
Max. Negotiated Rate |
$2,860.07 |
Rate for Payer: Cash Price |
$1,029.99
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,860.07
|
Rate for Payer: SOMOS Essential |
$2,860.07
|
|