|
PR INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW
|
Professional
|
Both
|
$2,274.41
|
|
|
Service Code
|
HCPCS 23935
|
| Min. Negotiated Rate |
$1,705.81 |
| Max. Negotiated Rate |
$1,705.81 |
| Rate for Payer: Cash Price |
$619.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,705.81
|
| Rate for Payer: SOMOS Essential |
$1,705.81
|
|
|
PR INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE
|
Professional
|
Both
|
$2,833.22
|
|
|
Service Code
|
HCPCS 27303
|
| Min. Negotiated Rate |
$2,124.91 |
| Max. Negotiated Rate |
$2,124.91 |
| Rate for Payer: Cash Price |
$770.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,124.91
|
| Rate for Payer: SOMOS Essential |
$2,124.91
|
|
|
PR INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT
|
Professional
|
Both
|
$607.39
|
|
|
Service Code
|
HCPCS 62148
|
| Min. Negotiated Rate |
$455.54 |
| Max. Negotiated Rate |
$455.54 |
| Rate for Payer: Cash Price |
$158.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$455.54
|
| Rate for Payer: SOMOS Essential |
$455.54
|
|
|
PR INCISIONAL BIOPSY EYELID SKIN & LID MARGIN
|
Professional
|
Both
|
$281.40
|
|
|
Service Code
|
HCPCS 67810
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$211.05 |
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.05
|
| Rate for Payer: SOMOS Essential |
$211.05
|
|
|
PR INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$129.92
|
|
|
Service Code
|
HCPCS 11107
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$97.44 |
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.44
|
| Rate for Payer: SOMOS Essential |
$97.44
|
|
|
PR INCISIONAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$236.95
|
|
|
Service Code
|
HCPCS 11106
|
| Min. Negotiated Rate |
$177.71 |
| Max. Negotiated Rate |
$177.71 |
| Rate for Payer: Cash Price |
$64.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.71
|
| Rate for Payer: SOMOS Essential |
$177.71
|
|
|
PR INCISION ANAL SEPTUM INFANT
|
Professional
|
Both
|
$1,217.90
|
|
|
Service Code
|
HCPCS 46070
|
| Min. Negotiated Rate |
$913.42 |
| Max. Negotiated Rate |
$913.42 |
| Rate for Payer: Cash Price |
$327.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$913.42
|
| Rate for Payer: SOMOS Essential |
$913.42
|
|
|
PR INCISION AND DRAINAGE APPENDICEAL ABSCESS OPEN
|
Professional
|
Both
|
$3,558.66
|
|
|
Service Code
|
HCPCS 44900
|
| Min. Negotiated Rate |
$2,668.99 |
| Max. Negotiated Rate |
$2,668.99 |
| Rate for Payer: Cash Price |
$947.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,668.99
|
| Rate for Payer: SOMOS Essential |
$2,668.99
|
|
|
PR INCISION BONE CORTEX FOOT
|
Professional
|
Both
|
$2,384.80
|
|
|
Service Code
|
HCPCS 28005
|
| Min. Negotiated Rate |
$1,788.60 |
| Max. Negotiated Rate |
$1,788.60 |
| Rate for Payer: Cash Price |
$656.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,788.60
|
| Rate for Payer: SOMOS Essential |
$1,788.60
|
|
|
PR INCISION BONE CORTEX HAND/FINGER
|
Professional
|
Both
|
$2,440.27
|
|
|
Service Code
|
HCPCS 26034
|
| Min. Negotiated Rate |
$1,830.20 |
| Max. Negotiated Rate |
$1,830.20 |
| Rate for Payer: Cash Price |
$663.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,830.20
|
| Rate for Payer: SOMOS Essential |
$1,830.20
|
|
|
PR INCISION BONE CORTEX PELVIS&/HIP JOINT
|
Professional
|
Both
|
$4,460.75
|
|
|
Service Code
|
HCPCS 26992
|
| Min. Negotiated Rate |
$3,345.56 |
| Max. Negotiated Rate |
$3,345.56 |
| Rate for Payer: Cash Price |
$1,206.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,345.56
|
| Rate for Payer: SOMOS Essential |
$3,345.56
|
|
|
PR INCISION BONE CORTEX SHOULDER AREA
|
Professional
|
Both
|
$3,027.85
|
|
|
Service Code
|
HCPCS 23035
|
| Min. Negotiated Rate |
$2,270.89 |
| Max. Negotiated Rate |
$2,270.89 |
| Rate for Payer: Cash Price |
$812.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,270.89
|
| Rate for Payer: SOMOS Essential |
$2,270.89
|
|
|
PR INCISION CONJUNCTIVA DRAINAGE OF CYST
|
Professional
|
Both
|
$453.92
|
|
|
Service Code
|
HCPCS 68020
|
| Min. Negotiated Rate |
$340.44 |
| Max. Negotiated Rate |
$340.44 |
| Rate for Payer: Cash Price |
$124.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$340.44
|
| Rate for Payer: SOMOS Essential |
$340.44
|
|
|
PR INCISION DEEP BONE CORTEX FOREARM&/WRIST
|
Professional
|
Both
|
$2,596.90
|
|
|
Service Code
|
HCPCS 25035
|
| Min. Negotiated Rate |
$1,947.67 |
| Max. Negotiated Rate |
$1,947.67 |
| Rate for Payer: Cash Price |
$711.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,947.67
|
| Rate for Payer: SOMOS Essential |
$1,947.67
|
|
|
PR INCISION DEEP OPENING BONE CORTEX THORAX
|
Professional
|
Both
|
$2,029.34
|
|
|
Service Code
|
HCPCS 21510
|
| Min. Negotiated Rate |
$1,522.01 |
| Max. Negotiated Rate |
$1,522.01 |
| Rate for Payer: Cash Price |
$545.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,522.01
|
| Rate for Payer: SOMOS Essential |
$1,522.01
|
|
|
PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE
|
Professional
|
Both
|
$779.94
|
|
|
Service Code
|
HCPCS 10061
|
| Min. Negotiated Rate |
$584.96 |
| Max. Negotiated Rate |
$584.96 |
| Rate for Payer: Cash Price |
$215.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$584.96
|
| Rate for Payer: SOMOS Essential |
$584.96
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Professional
|
Both
|
$444.40
|
|
|
Service Code
|
HCPCS 10060
|
| Min. Negotiated Rate |
$333.30 |
| Max. Negotiated Rate |
$333.30 |
| Rate for Payer: Cash Price |
$124.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$333.30
|
| Rate for Payer: SOMOS Essential |
$333.30
|
|
|
PR INCISION&DRAINAGE BURSA FOOT
|
Professional
|
Both
|
$396.06
|
|
|
Service Code
|
HCPCS 28001
|
| Min. Negotiated Rate |
$297.05 |
| Max. Negotiated Rate |
$297.05 |
| Rate for Payer: Cash Price |
$107.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.05
|
| Rate for Payer: SOMOS Essential |
$297.05
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$791.32
|
|
|
Service Code
|
HCPCS 10180
|
| Min. Negotiated Rate |
$593.49 |
| Max. Negotiated Rate |
$593.49 |
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$593.49
|
| Rate for Payer: SOMOS Essential |
$593.49
|
|
|
PR INCISION & DRAINAGE FOREARM&/WRIST BURSA
|
Professional
|
Both
|
$1,641.57
|
|
|
Service Code
|
HCPCS 25031
|
| Min. Negotiated Rate |
$1,231.18 |
| Max. Negotiated Rate |
$1,231.18 |
| Rate for Payer: Cash Price |
$447.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,231.18
|
| Rate for Payer: SOMOS Essential |
$1,231.18
|
|
|
PR INCISION DRAINAGE LACRIMAL GLAND
|
Professional
|
Both
|
$540.86
|
|
|
Service Code
|
HCPCS 68400
|
| Min. Negotiated Rate |
$405.64 |
| Max. Negotiated Rate |
$405.64 |
| Rate for Payer: Cash Price |
$149.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$405.64
|
| Rate for Payer: SOMOS Essential |
$405.64
|
|
|
PR INCISION DRAINAGE LACRIMAL SAC
|
Professional
|
Both
|
$684.15
|
|
|
Service Code
|
HCPCS 68420
|
| Min. Negotiated Rate |
$513.11 |
| Max. Negotiated Rate |
$513.11 |
| Rate for Payer: Cash Price |
$188.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$513.11
|
| Rate for Payer: SOMOS Essential |
$513.11
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,721.13
|
|
|
Service Code
|
HCPCS 27603
|
| Min. Negotiated Rate |
$1,290.85 |
| Max. Negotiated Rate |
$1,290.85 |
| Rate for Payer: Cash Price |
$463.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,290.85
|
| Rate for Payer: SOMOS Essential |
$1,290.85
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA
|
Professional
|
Both
|
$1,394.75
|
|
|
Service Code
|
HCPCS 27604
|
| Min. Negotiated Rate |
$1,046.06 |
| Max. Negotiated Rate |
$1,046.06 |
| Rate for Payer: Cash Price |
$381.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,046.06
|
| Rate for Payer: SOMOS Essential |
$1,046.06
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 10081
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: Cash Price |
$202.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$558.00
|
| Rate for Payer: SOMOS Essential |
$558.00
|
|