|
PR STIMULUS EVOKED RESPONSE
|
Professional
|
Both
|
$1,169.39
|
|
|
Service Code
|
HCPCS 51792
|
| Min. Negotiated Rate |
$877.04 |
| Max. Negotiated Rate |
$877.04 |
| Rate for Payer: Cash Price |
$322.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$877.04
|
| Rate for Payer: SOMOS Essential |
$877.04
|
|
|
PR STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$2,239.02
|
|
|
Service Code
|
HCPCS 59525
|
| Min. Negotiated Rate |
$1,679.27 |
| Max. Negotiated Rate |
$1,679.27 |
| Rate for Payer: Cash Price |
$590.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,679.27
|
| Rate for Payer: SOMOS Essential |
$1,679.27
|
|
|
PR STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE
|
Professional
|
Both
|
$2,819.81
|
|
|
Service Code
|
HCPCS 67318
|
| Min. Negotiated Rate |
$2,114.86 |
| Max. Negotiated Rate |
$2,114.86 |
| Rate for Payer: Cash Price |
$777.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,114.86
|
| Rate for Payer: SOMOS Essential |
$2,114.86
|
|
|
PR STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC
|
Professional
|
Both
|
$1,183.18
|
|
|
Service Code
|
HCPCS 67340
|
| Min. Negotiated Rate |
$887.38 |
| Max. Negotiated Rate |
$887.38 |
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$887.38
|
| Rate for Payer: SOMOS Essential |
$887.38
|
|
|
PR STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION
|
Professional
|
Both
|
$790.41
|
|
|
Service Code
|
HCPCS 67334
|
| Min. Negotiated Rate |
$592.81 |
| Max. Negotiated Rate |
$592.81 |
| Rate for Payer: Cash Price |
$173.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$592.81
|
| Rate for Payer: SOMOS Essential |
$592.81
|
|
|
PR STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC
|
Professional
|
Both
|
$803.01
|
|
|
Service Code
|
HCPCS 67331
|
| Min. Negotiated Rate |
$602.26 |
| Max. Negotiated Rate |
$602.26 |
| Rate for Payer: Cash Price |
$176.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$602.26
|
| Rate for Payer: SOMOS Essential |
$602.26
|
|
|
PR STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC
|
Professional
|
Both
|
$1,872.22
|
|
|
Service Code
|
HCPCS 67311
|
| Min. Negotiated Rate |
$1,404.16 |
| Max. Negotiated Rate |
$1,404.16 |
| Rate for Payer: Cash Price |
$516.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,404.16
|
| Rate for Payer: SOMOS Essential |
$1,404.16
|
|
|
PR STRABISMUS RECESSION/RESCJ 1 VER MUSC
|
Professional
|
Both
|
$1,872.22
|
|
|
Service Code
|
HCPCS 67314
|
| Min. Negotiated Rate |
$1,404.16 |
| Max. Negotiated Rate |
$1,404.16 |
| Rate for Payer: Cash Price |
$516.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,404.16
|
| Rate for Payer: SOMOS Essential |
$1,404.16
|
|
|
PR STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC
|
Professional
|
Both
|
$2,725.03
|
|
|
Service Code
|
HCPCS 67312
|
| Min. Negotiated Rate |
$2,043.77 |
| Max. Negotiated Rate |
$2,043.77 |
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,043.77
|
| Rate for Payer: SOMOS Essential |
$2,043.77
|
|
|
PR STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC
|
Professional
|
Both
|
$2,920.51
|
|
|
Service Code
|
HCPCS 67316
|
| Min. Negotiated Rate |
$2,190.38 |
| Max. Negotiated Rate |
$2,190.38 |
| Rate for Payer: Cash Price |
$803.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,190.38
|
| Rate for Payer: SOMOS Essential |
$2,190.38
|
|
|
PR STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY
|
Professional
|
Both
|
$855.82
|
|
|
Service Code
|
HCPCS 67332
|
| Min. Negotiated Rate |
$641.87 |
| Max. Negotiated Rate |
$641.87 |
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$641.87
|
| Rate for Payer: SOMOS Essential |
$641.87
|
|
|
PR STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$72.73
|
|
|
Service Code
|
HCPCS 29540
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$54.55 |
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.55
|
| Rate for Payer: SOMOS Essential |
$54.55
|
|
|
PR STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$79.91
|
|
|
Service Code
|
HCPCS 29260
|
| Min. Negotiated Rate |
$59.93 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.93
|
| Rate for Payer: SOMOS Essential |
$59.93
|
|
|
PR STRAPPING HAND/FINGER
|
Professional
|
Both
|
$82.78
|
|
|
Service Code
|
HCPCS 29280
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$62.09 |
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.09
|
| Rate for Payer: SOMOS Essential |
$62.09
|
|
|
PR STRAPPING HIP
|
Professional
|
Both
|
$73.01
|
|
|
Service Code
|
HCPCS 29520
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$54.76 |
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.76
|
| Rate for Payer: SOMOS Essential |
$54.76
|
|
|
PR STRAPPING KNEE
|
Professional
|
Both
|
$73.01
|
|
|
Service Code
|
HCPCS 29530
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$54.76 |
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.76
|
| Rate for Payer: SOMOS Essential |
$54.76
|
|
|
PR STRAPPING SHOULDER
|
Professional
|
Both
|
$73.01
|
|
|
Service Code
|
HCPCS 29240
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$54.76 |
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.76
|
| Rate for Payer: SOMOS Essential |
$54.76
|
|
|
PR STRAPPING THORAX
|
Professional
|
Both
|
$74.45
|
|
|
Service Code
|
HCPCS 29200
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$55.84 |
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.84
|
| Rate for Payer: SOMOS Essential |
$55.84
|
|
|
PR STRAPPING TOES
|
Professional
|
Both
|
$45.40
|
|
|
Service Code
|
HCPCS 29550
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Cash Price |
$12.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.05
|
| Rate for Payer: SOMOS Essential |
$34.05
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$111.06
|
|
|
Service Code
|
HCPCS 29580
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Cash Price |
$29.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.30
|
| Rate for Payer: SOMOS Essential |
$83.30
|
|
|
PR STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR
|
Professional
|
Both
|
$6,674.26
|
|
|
Service Code
|
HCPCS 61751
|
| Min. Negotiated Rate |
$5,005.69 |
| Max. Negotiated Rate |
$5,005.69 |
| Rate for Payer: Cash Price |
$1,765.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,005.69
|
| Rate for Payer: SOMOS Essential |
$5,005.69
|
|
|
PR STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL
|
Professional
|
Both
|
$1,141.60
|
|
|
Service Code
|
HCPCS 61781
|
| Min. Negotiated Rate |
$856.20 |
| Max. Negotiated Rate |
$856.20 |
| Rate for Payer: Cash Price |
$297.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$856.20
|
| Rate for Payer: SOMOS Essential |
$856.20
|
|
|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$739.76
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$554.82 |
| Max. Negotiated Rate |
$554.82 |
| Rate for Payer: Cash Price |
$198.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$554.82
|
| Rate for Payer: SOMOS Essential |
$554.82
|
|
|
PR STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING
|
Professional
|
Both
|
$7,660.77
|
|
|
Service Code
|
HCPCS 61760
|
| Min. Negotiated Rate |
$5,745.58 |
| Max. Negotiated Rate |
$5,745.58 |
| Rate for Payer: Cash Price |
$2,005.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,745.58
|
| Rate for Payer: SOMOS Essential |
$5,745.58
|
|
|
PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY
|
Professional
|
Both
|
$7,247.45
|
|
|
Service Code
|
HCPCS 61863
|
| Min. Negotiated Rate |
$5,435.59 |
| Max. Negotiated Rate |
$5,435.59 |
| Rate for Payer: Cash Price |
$1,917.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,435.59
|
| Rate for Payer: SOMOS Essential |
$5,435.59
|
|