|
PR R&L HRT CATH CHD IMG CATH TRGT ZON ABNL NT CONNJ
|
Professional
|
Both
|
$1,655.82
|
|
|
Service Code
|
HCPCS 93597 26
|
| Min. Negotiated Rate |
$1,241.87 |
| Max. Negotiated Rate |
$1,241.87 |
| Rate for Payer: Cash Price |
$452.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,241.87
|
| Rate for Payer: SOMOS Essential |
$1,241.87
|
|
|
PR R&L HRT CATH CHD IMG CATH TRGT ZONE NML NT CONNJ
|
Professional
|
Both
|
$1,257.87
|
|
|
Service Code
|
HCPCS 93596 26
|
| Min. Negotiated Rate |
$943.40 |
| Max. Negotiated Rate |
$943.40 |
| Rate for Payer: Cash Price |
$345.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$943.40
|
| Rate for Payer: SOMOS Essential |
$943.40
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$4,183.73
|
|
|
Service Code
|
HCPCS 93461 TC
|
| Min. Negotiated Rate |
$3,137.80 |
| Max. Negotiated Rate |
$3,137.80 |
| Rate for Payer: Cash Price |
$1,120.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,137.80
|
| Rate for Payer: SOMOS Essential |
$3,137.80
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$5,951.79
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$4,463.84 |
| Max. Negotiated Rate |
$4,463.84 |
| Rate for Payer: Cash Price |
$1,592.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,463.84
|
| Rate for Payer: SOMOS Essential |
$4,463.84
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$1,768.06
|
|
|
Service Code
|
HCPCS 93461 26
|
| Min. Negotiated Rate |
$1,326.05 |
| Max. Negotiated Rate |
$1,326.05 |
| Rate for Payer: Cash Price |
$472.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,326.05
|
| Rate for Payer: SOMOS Essential |
$1,326.05
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$5,394.31
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$4,045.73 |
| Max. Negotiated Rate |
$4,045.73 |
| Rate for Payer: Cash Price |
$1,443.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,045.73
|
| Rate for Payer: SOMOS Essential |
$4,045.73
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$3,794.42
|
|
|
Service Code
|
HCPCS 93460 TC
|
| Min. Negotiated Rate |
$2,845.82 |
| Max. Negotiated Rate |
$2,845.82 |
| Rate for Payer: Cash Price |
$1,016.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,845.82
|
| Rate for Payer: SOMOS Essential |
$2,845.82
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,599.89
|
|
|
Service Code
|
HCPCS 93460 26
|
| Min. Negotiated Rate |
$1,199.92 |
| Max. Negotiated Rate |
$1,199.92 |
| Rate for Payer: Cash Price |
$427.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,199.92
|
| Rate for Payer: SOMOS Essential |
$1,199.92
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$1,352.96
|
|
|
Service Code
|
HCPCS 93453 26
|
| Min. Negotiated Rate |
$1,014.72 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Cash Price |
$361.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,014.72
|
| Rate for Payer: SOMOS Essential |
$1,014.72
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$4,974.87
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$3,731.15 |
| Max. Negotiated Rate |
$3,731.15 |
| Rate for Payer: Cash Price |
$1,330.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,731.15
|
| Rate for Payer: SOMOS Essential |
$3,731.15
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$3,621.94
|
|
|
Service Code
|
HCPCS 93453 TC
|
| Min. Negotiated Rate |
$2,716.45 |
| Max. Negotiated Rate |
$2,716.45 |
| Rate for Payer: Cash Price |
$969.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,716.45
|
| Rate for Payer: SOMOS Essential |
$2,716.45
|
|
|
PR RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX
|
Professional
|
Both
|
$2,773.40
|
|
|
Service Code
|
HCPCS 67343
|
| Min. Negotiated Rate |
$2,080.05 |
| Max. Negotiated Rate |
$2,080.05 |
| Rate for Payer: Cash Price |
$766.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,080.05
|
| Rate for Payer: SOMOS Essential |
$2,080.05
|
|
|
PR RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM
|
Professional
|
Both
|
$6,099.49
|
|
|
Service Code
|
HCPCS 33243
|
| Min. Negotiated Rate |
$4,574.62 |
| Max. Negotiated Rate |
$4,574.62 |
| Rate for Payer: Cash Price |
$1,625.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,574.62
|
| Rate for Payer: SOMOS Essential |
$4,574.62
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$3,826.94
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$2,870.20 |
| Max. Negotiated Rate |
$2,870.20 |
| Rate for Payer: Cash Price |
$1,012.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,870.20
|
| Rate for Payer: SOMOS Essential |
$2,870.20
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$3,929.84
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$2,947.38 |
| Max. Negotiated Rate |
$2,947.38 |
| Rate for Payer: Cash Price |
$1,048.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,947.38
|
| Rate for Payer: SOMOS Essential |
$2,947.38
|
|
|
PR RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET
|
Professional
|
Both
|
$362.46
|
|
|
Service Code
|
HCPCS 29710
|
| Min. Negotiated Rate |
$271.85 |
| Max. Negotiated Rate |
$271.85 |
| Rate for Payer: Cash Price |
$97.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.85
|
| Rate for Payer: SOMOS Essential |
$271.85
|
|
|
PR RMVL BLOOD CLOT ANTERIOR SEGMENT EYE
|
Professional
|
Both
|
$2,650.38
|
|
|
Service Code
|
HCPCS 65930
|
| Min. Negotiated Rate |
$1,987.79 |
| Max. Negotiated Rate |
$1,987.79 |
| Rate for Payer: Cash Price |
$728.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,987.79
|
| Rate for Payer: SOMOS Essential |
$1,987.79
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$4,248.23
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$3,186.17 |
| Max. Negotiated Rate |
$3,186.17 |
| Rate for Payer: Cash Price |
$1,128.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,186.17
|
| Rate for Payer: SOMOS Essential |
$3,186.17
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,908.96
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$2,181.72 |
| Max. Negotiated Rate |
$2,181.72 |
| Rate for Payer: Cash Price |
$777.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,181.72
|
| Rate for Payer: SOMOS Essential |
$2,181.72
|
|
|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,319.51
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$3,989.63 |
| Max. Negotiated Rate |
$3,989.63 |
| Rate for Payer: Cash Price |
$1,410.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,989.63
|
| Rate for Payer: SOMOS Essential |
$3,989.63
|
|
|
PR RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT
|
Professional
|
Both
|
$1,521.42
|
|
|
Service Code
|
HCPCS 65436
|
| Min. Negotiated Rate |
$1,141.07 |
| Max. Negotiated Rate |
$1,141.07 |
| Rate for Payer: Cash Price |
$419.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,141.07
|
| Rate for Payer: SOMOS Essential |
$1,141.07
|
|
|
PR RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION
|
Professional
|
Both
|
$283.89
|
|
|
Service Code
|
HCPCS 65435
|
| Min. Negotiated Rate |
$212.92 |
| Max. Negotiated Rate |
$212.92 |
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.92
|
| Rate for Payer: SOMOS Essential |
$212.92
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.25
|
| Rate for Payer: SOMOS Essential |
$281.25
|
|
|
PR RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL
|
Professional
|
Both
|
$9,970.17
|
|
|
Service Code
|
HCPCS 22864
|
| Min. Negotiated Rate |
$7,477.63 |
| Max. Negotiated Rate |
$7,477.63 |
| Rate for Payer: Cash Price |
$2,629.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7,477.63
|
| Rate for Payer: SOMOS Essential |
$7,477.63
|
|
|
PR RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE LUMBAR
|
Professional
|
Both
|
$10,886.58
|
|
|
Service Code
|
HCPCS 22865
|
| Min. Negotiated Rate |
$8,164.94 |
| Max. Negotiated Rate |
$8,164.94 |
| Rate for Payer: Cash Price |
$2,872.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8,164.94
|
| Rate for Payer: SOMOS Essential |
$8,164.94
|
|