|
PR REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Professional
|
Both
|
$214.06
|
|
|
Service Code
|
HCPCS 99454
|
| Min. Negotiated Rate |
$160.54 |
| Max. Negotiated Rate |
$160.54 |
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.54
|
| Rate for Payer: SOMOS Essential |
$160.54
|
|
|
PR REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Professional
|
Both
|
$84.53
|
|
|
Service Code
|
HCPCS 99453
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$63.40 |
| Rate for Payer: Cash Price |
$24.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.40
|
| Rate for Payer: SOMOS Essential |
$63.40
|
|
|
PR REMOTE E/M EST. PT 10MINS
|
Professional
|
Both
|
$118.23
|
|
|
Service Code
|
HCPCS G9983
|
| Min. Negotiated Rate |
$88.67 |
| Max. Negotiated Rate |
$88.67 |
| Rate for Payer: Cash Price |
$31.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.67
|
| Rate for Payer: SOMOS Essential |
$88.67
|
|
|
PR REMOTE E/M EST. PT 10MINS
|
Professional
|
Both
|
$76.55
|
|
|
Service Code
|
HCPCS G9486
|
| Min. Negotiated Rate |
$57.41 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Cash Price |
$20.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.41
|
| Rate for Payer: SOMOS Essential |
$57.41
|
|
|
PR REMOTE E/M EST. PT 15MINS
|
Professional
|
Both
|
$227.92
|
|
|
Service Code
|
HCPCS G9984
|
| Min. Negotiated Rate |
$170.94 |
| Max. Negotiated Rate |
$170.94 |
| Rate for Payer: Cash Price |
$62.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.94
|
| Rate for Payer: SOMOS Essential |
$170.94
|
|
|
PR REMOTE E/M EST. PT 15MINS
|
Professional
|
Both
|
$148.86
|
|
|
Service Code
|
HCPCS G9487
|
| Min. Negotiated Rate |
$111.64 |
| Max. Negotiated Rate |
$111.64 |
| Rate for Payer: Cash Price |
$40.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.64
|
| Rate for Payer: SOMOS Essential |
$111.64
|
|
|
PR REMOTE E/M EST. PT 25MINS
|
Professional
|
Both
|
$226.17
|
|
|
Service Code
|
HCPCS G9488
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$169.63 |
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.63
|
| Rate for Payer: SOMOS Essential |
$169.63
|
|
|
PR REMOTE E/M EST. PT 25MINS
|
Professional
|
Both
|
$344.05
|
|
|
Service Code
|
HCPCS G9985
|
| Min. Negotiated Rate |
$258.04 |
| Max. Negotiated Rate |
$258.04 |
| Rate for Payer: Cash Price |
$93.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.04
|
| Rate for Payer: SOMOS Essential |
$258.04
|
|
|
PR REMOTE E/M EST. PT 40MINS
|
Professional
|
Both
|
$318.99
|
|
|
Service Code
|
HCPCS G9489
|
| Min. Negotiated Rate |
$239.24 |
| Max. Negotiated Rate |
$239.24 |
| Rate for Payer: Cash Price |
$87.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.24
|
| Rate for Payer: SOMOS Essential |
$239.24
|
|
|
PR REMOTE E/M EST. PT 40MINS
|
Professional
|
Both
|
$495.81
|
|
|
Service Code
|
HCPCS G9986
|
| Min. Negotiated Rate |
$371.86 |
| Max. Negotiated Rate |
$371.86 |
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$371.86
|
| Rate for Payer: SOMOS Essential |
$371.86
|
|
|
PR REMOTE E/M NEW PT 10MINS
|
Professional
|
Both
|
$76.55
|
|
|
Service Code
|
HCPCS G9481
|
| Min. Negotiated Rate |
$57.41 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Cash Price |
$20.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.41
|
| Rate for Payer: SOMOS Essential |
$57.41
|
|
|
PR REMOTE E/M NEW PT 10MINS
|
Professional
|
Both
|
$118.23
|
|
|
Service Code
|
HCPCS G9978
|
| Min. Negotiated Rate |
$88.67 |
| Max. Negotiated Rate |
$88.67 |
| Rate for Payer: Cash Price |
$31.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.67
|
| Rate for Payer: SOMOS Essential |
$88.67
|
|
|
PR REMOTE E/M NEW PT 20MINS
|
Professional
|
Both
|
$197.30
|
|
|
Service Code
|
HCPCS G9979
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.98
|
| Rate for Payer: SOMOS Essential |
$147.98
|
|
|
PR REMOTE E/M NEW PT 20MINS
|
Professional
|
Both
|
$138.36
|
|
|
Service Code
|
HCPCS G9482
|
| Min. Negotiated Rate |
$103.77 |
| Max. Negotiated Rate |
$103.77 |
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.77
|
| Rate for Payer: SOMOS Essential |
$103.77
|
|
|
PR REMOTE E/M NEW PT 30 MINS
|
Professional
|
Both
|
$322.11
|
|
|
Service Code
|
HCPCS G9980
|
| Min. Negotiated Rate |
$241.58 |
| Max. Negotiated Rate |
$241.58 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.58
|
| Rate for Payer: SOMOS Essential |
$241.58
|
|
|
PR REMOTE E/M NEW PT 30MINS
|
Professional
|
Both
|
$224.35
|
|
|
Service Code
|
HCPCS G9483
|
| Min. Negotiated Rate |
$168.26 |
| Max. Negotiated Rate |
$168.26 |
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.26
|
| Rate for Payer: SOMOS Essential |
$168.26
|
|
|
PR REMOTE E/M NEW PT 45MINS
|
Professional
|
Both
|
$367.29
|
|
|
Service Code
|
HCPCS G9484
|
| Min. Negotiated Rate |
$275.47 |
| Max. Negotiated Rate |
$275.47 |
| Rate for Payer: Cash Price |
$99.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$275.47
|
| Rate for Payer: SOMOS Essential |
$275.47
|
|
|
PR REMOTE E/M NEW PT 45MINS
|
Professional
|
Both
|
$526.86
|
|
|
Service Code
|
HCPCS G9981
|
| Min. Negotiated Rate |
$395.14 |
| Max. Negotiated Rate |
$395.14 |
| Rate for Payer: Cash Price |
$144.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$395.14
|
| Rate for Payer: SOMOS Essential |
$395.14
|
|
|
PR REMOTE E/M NEW PT 60MINS
|
Professional
|
Both
|
$481.85
|
|
|
Service Code
|
HCPCS G9485
|
| Min. Negotiated Rate |
$361.39 |
| Max. Negotiated Rate |
$361.39 |
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.39
|
| Rate for Payer: SOMOS Essential |
$361.39
|
|
|
PR REMOTE E/M NEW PT 60MINS
|
Professional
|
Both
|
$703.22
|
|
|
Service Code
|
HCPCS G9982
|
| Min. Negotiated Rate |
$527.42 |
| Max. Negotiated Rate |
$527.42 |
| Rate for Payer: Cash Price |
$192.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$527.42
|
| Rate for Payer: SOMOS Essential |
$527.42
|
|
|
PR REMOTE MNTR WIRELESS P-ART PRS SNR UP TO 30 D
|
Professional
|
Both
|
$145.64
|
|
|
Service Code
|
HCPCS 93264
|
| Min. Negotiated Rate |
$109.23 |
| Max. Negotiated Rate |
$109.23 |
| Rate for Payer: Cash Price |
$40.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.23
|
| Rate for Payer: SOMOS Essential |
$109.23
|
|
|
PR REMOTE PHYSIOLOGIC MONITORING 1ST 20 MIN MONTH
|
Professional
|
Both
|
$121.84
|
|
|
Service Code
|
HCPCS 99457
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$91.38 |
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.38
|
| Rate for Payer: SOMOS Essential |
$91.38
|
|
|
PR REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO
|
Professional
|
Both
|
$121.84
|
|
|
Service Code
|
HCPCS 99458
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$91.38 |
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.38
|
| Rate for Payer: SOMOS Essential |
$91.38
|
|
|
PR REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP
|
Professional
|
Both
|
$84.53
|
|
|
Service Code
|
HCPCS 98975
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$63.40 |
| Rate for Payer: Cash Price |
$24.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.40
|
| Rate for Payer: SOMOS Essential |
$63.40
|
|
|
PR REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN
|
Professional
|
Both
|
$124.53
|
|
|
Service Code
|
HCPCS 98980
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$93.40 |
| Rate for Payer: Cash Price |
$33.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.40
|
| Rate for Payer: SOMOS Essential |
$93.40
|
|
