|
PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR
|
Professional
|
Both
|
$2,786.81
|
|
|
Service Code
|
HCPCS 15950
|
| Min. Negotiated Rate |
$2,090.11 |
| Max. Negotiated Rate |
$2,090.11 |
| Rate for Payer: Cash Price |
$754.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,090.11
|
| Rate for Payer: SOMOS Essential |
$2,090.11
|
|
|
PR EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$5,118.23
|
|
|
Service Code
|
HCPCS 15956
|
| Min. Negotiated Rate |
$3,838.67 |
| Max. Negotiated Rate |
$3,838.67 |
| Rate for Payer: Cash Price |
$1,412.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,838.67
|
| Rate for Payer: SOMOS Essential |
$3,838.67
|
|
|
PR EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE
|
Professional
|
Both
|
$4,010.65
|
|
|
Service Code
|
HCPCS 15952
|
| Min. Negotiated Rate |
$3,007.99 |
| Max. Negotiated Rate |
$3,007.99 |
| Rate for Payer: Cash Price |
$1,082.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,007.99
|
| Rate for Payer: SOMOS Essential |
$3,007.99
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,385.15
|
|
|
Service Code
|
HCPCS 25073
|
| Min. Negotiated Rate |
$1,788.86 |
| Max. Negotiated Rate |
$1,788.86 |
| Rate for Payer: Cash Price |
$644.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,788.86
|
| Rate for Payer: SOMOS Essential |
$1,788.86
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$2,004.14
|
|
|
Service Code
|
HCPCS 21552
|
| Min. Negotiated Rate |
$1,503.11 |
| Max. Negotiated Rate |
$1,503.11 |
| Rate for Payer: Cash Price |
$539.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,503.11
|
| Rate for Payer: SOMOS Essential |
$1,503.11
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$3,309.29
|
|
|
Service Code
|
HCPCS 21933
|
| Min. Negotiated Rate |
$2,481.97 |
| Max. Negotiated Rate |
$2,481.97 |
| Rate for Payer: Cash Price |
$887.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,481.97
|
| Rate for Payer: SOMOS Essential |
$2,481.97
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,980.04
|
|
|
Service Code
|
HCPCS 21932
|
| Min. Negotiated Rate |
$2,235.03 |
| Max. Negotiated Rate |
$2,235.03 |
| Rate for Payer: Cash Price |
$795.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,235.03
|
| Rate for Payer: SOMOS Essential |
$2,235.03
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>
|
Professional
|
Both
|
$2,294.95
|
|
|
Service Code
|
HCPCS 21014
|
| Min. Negotiated Rate |
$1,721.21 |
| Max. Negotiated Rate |
$1,721.21 |
| Rate for Payer: Cash Price |
$619.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,721.21
|
| Rate for Payer: SOMOS Essential |
$1,721.21
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM
|
Professional
|
Both
|
$1,762.32
|
|
|
Service Code
|
HCPCS 21013
|
| Min. Negotiated Rate |
$1,321.74 |
| Max. Negotiated Rate |
$1,321.74 |
| Rate for Payer: Cash Price |
$476.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,321.74
|
| Rate for Payer: SOMOS Essential |
$1,321.74
|
|
|
PR EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>
|
Professional
|
Both
|
$1,889.97
|
|
|
Service Code
|
HCPCS 25071
|
| Min. Negotiated Rate |
$1,417.48 |
| Max. Negotiated Rate |
$1,417.48 |
| Rate for Payer: Cash Price |
$510.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,417.48
|
| Rate for Payer: SOMOS Essential |
$1,417.48
|
|
|
PR EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM
|
Professional
|
Both
|
$2,298.42
|
|
|
Service Code
|
HCPCS 25076
|
| Min. Negotiated Rate |
$1,723.82 |
| Max. Negotiated Rate |
$1,723.82 |
| Rate for Payer: Cash Price |
$623.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,723.82
|
| Rate for Payer: SOMOS Essential |
$1,723.82
|
|
|
PR EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,346.16
|
|
|
Service Code
|
HCPCS 21556
|
| Min. Negotiated Rate |
$1,759.62 |
| Max. Negotiated Rate |
$1,759.62 |
| Rate for Payer: Cash Price |
$631.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,759.62
|
| Rate for Payer: SOMOS Essential |
$1,759.62
|
|
|
PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Professional
|
Both
|
$2,423.89
|
|
|
Service Code
|
HCPCS 23076
|
| Min. Negotiated Rate |
$1,817.92 |
| Max. Negotiated Rate |
$1,817.92 |
| Rate for Payer: Cash Price |
$654.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,817.92
|
| Rate for Payer: SOMOS Essential |
$1,817.92
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,536.42
|
|
|
Service Code
|
HCPCS 22900
|
| Min. Negotiated Rate |
$1,902.32 |
| Max. Negotiated Rate |
$1,902.32 |
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,902.32
|
| Rate for Payer: SOMOS Essential |
$1,902.32
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>
|
Professional
|
Both
|
$2,994.15
|
|
|
Service Code
|
HCPCS 22901
|
| Min. Negotiated Rate |
$2,245.61 |
| Max. Negotiated Rate |
$2,245.61 |
| Rate for Payer: Cash Price |
$803.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,245.61
|
| Rate for Payer: SOMOS Essential |
$2,245.61
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Professional
|
Both
|
$1,983.73
|
|
|
Service Code
|
HCPCS 22903
|
| Min. Negotiated Rate |
$1,487.80 |
| Max. Negotiated Rate |
$1,487.80 |
| Rate for Payer: Cash Price |
$532.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,487.80
|
| Rate for Payer: SOMOS Essential |
$1,487.80
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM
|
Professional
|
Both
|
$1,492.51
|
|
|
Service Code
|
HCPCS 22902
|
| Min. Negotiated Rate |
$1,119.38 |
| Max. Negotiated Rate |
$1,119.38 |
| Rate for Payer: Cash Price |
$404.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,119.38
|
| Rate for Payer: SOMOS Essential |
$1,119.38
|
|
|
PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Professional
|
Both
|
$1,906.56
|
|
|
Service Code
|
HCPCS 28041
|
| Min. Negotiated Rate |
$1,429.92 |
| Max. Negotiated Rate |
$1,429.92 |
| Rate for Payer: Cash Price |
$523.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,429.92
|
| Rate for Payer: SOMOS Essential |
$1,429.92
|
|
|
PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM
|
Professional
|
Both
|
$1,458.66
|
|
|
Service Code
|
HCPCS 28045
|
| Min. Negotiated Rate |
$1,093.99 |
| Max. Negotiated Rate |
$1,093.99 |
| Rate for Payer: Cash Price |
$400.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,093.99
|
| Rate for Payer: SOMOS Essential |
$1,093.99
|
|
|
PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM
|
Professional
|
Both
|
$1,402.14
|
|
|
Service Code
|
HCPCS 25075
|
| Min. Negotiated Rate |
$1,051.61 |
| Max. Negotiated Rate |
$1,051.61 |
| Rate for Payer: Cash Price |
$380.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,051.61
|
| Rate for Payer: SOMOS Essential |
$1,051.61
|
|
|
PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>
|
Professional
|
Both
|
$2,985.22
|
|
|
Service Code
|
HCPCS 27634
|
| Min. Negotiated Rate |
$2,238.91 |
| Max. Negotiated Rate |
$2,238.91 |
| Rate for Payer: Cash Price |
$800.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,238.91
|
| Rate for Payer: SOMOS Essential |
$2,238.91
|
|
|
PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,042.64
|
|
|
Service Code
|
HCPCS 27619
|
| Min. Negotiated Rate |
$1,531.98 |
| Max. Negotiated Rate |
$1,531.98 |
| Rate for Payer: Cash Price |
$558.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,531.98
|
| Rate for Payer: SOMOS Essential |
$1,531.98
|
|
|
PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM
|
Professional
|
Both
|
$1,346.77
|
|
|
Service Code
|
HCPCS 27618
|
| Min. Negotiated Rate |
$1,010.08 |
| Max. Negotiated Rate |
$1,010.08 |
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,010.08
|
| Rate for Payer: SOMOS Essential |
$1,010.08
|
|
|
PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM
|
Professional
|
Both
|
$1,357.58
|
|
|
Service Code
|
HCPCS 21555
|
| Min. Negotiated Rate |
$1,018.18 |
| Max. Negotiated Rate |
$1,018.18 |
| Rate for Payer: Cash Price |
$368.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,018.18
|
| Rate for Payer: SOMOS Essential |
$1,018.18
|
|
|
PR EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>
|
Professional
|
Both
|
$3,253.15
|
|
|
Service Code
|
HCPCS 21554
|
| Min. Negotiated Rate |
$2,439.86 |
| Max. Negotiated Rate |
$2,439.86 |
| Rate for Payer: Cash Price |
$874.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,439.86
|
| Rate for Payer: SOMOS Essential |
$2,439.86
|
|