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Charge Type Setting Price  
Service Code HCPCS 61570
Min. Negotiated Rate $6,778.15
Max. Negotiated Rate $6,778.15
Rate for Payer: Cash Price $2,383.15
Rate for Payer: SOMOS CHP/HARP/Medicaid $6,778.15
Rate for Payer: SOMOS Essential $6,778.15
Service Code HCPCS 61305
Min. Negotiated Rate $7,261.57
Max. Negotiated Rate $7,261.57
Rate for Payer: Cash Price $2,551.55
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,261.57
Rate for Payer: SOMOS Essential $7,261.57
Service Code HCPCS 61304
Min. Negotiated Rate $5,901.29
Max. Negotiated Rate $5,901.29
Rate for Payer: Cash Price $2,082.88
Rate for Payer: SOMOS CHP/HARP/Medicaid $5,901.29
Rate for Payer: SOMOS Essential $5,901.29
Service Code HCPCS 61571
Min. Negotiated Rate $7,210.66
Max. Negotiated Rate $7,210.66
Rate for Payer: Cash Price $2,534.71
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,210.66
Rate for Payer: SOMOS Essential $7,210.66
Service Code HCPCS 61314
Min. Negotiated Rate $6,575.78
Max. Negotiated Rate $6,575.78
Rate for Payer: Cash Price $2,319.33
Rate for Payer: SOMOS CHP/HARP/Medicaid $6,575.78
Rate for Payer: SOMOS Essential $6,575.78
Service Code HCPCS 61312
Min. Negotiated Rate $7,496.68
Max. Negotiated Rate $7,496.68
Rate for Payer: Cash Price $2,632.48
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,496.68
Rate for Payer: SOMOS Essential $7,496.68
Service Code HCPCS 61313
Min. Negotiated Rate $7,165.70
Max. Negotiated Rate $7,165.70
Rate for Payer: Cash Price $2,525.07
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,165.70
Rate for Payer: SOMOS Essential $7,165.70
Service Code HCPCS 61315
Min. Negotiated Rate $7,485.19
Max. Negotiated Rate $7,485.19
Rate for Payer: Cash Price $2,633.56
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,485.19
Rate for Payer: SOMOS Essential $7,485.19
Service Code HCPCS 61501
Min. Negotiated Rate $3,918.76
Max. Negotiated Rate $3,918.76
Rate for Payer: Cash Price $1,386.15
Rate for Payer: SOMOS CHP/HARP/Medicaid $3,918.76
Rate for Payer: SOMOS Essential $3,918.76
Service Code HCPCS 61460
Min. Negotiated Rate $7,628.38
Max. Negotiated Rate $7,628.38
Rate for Payer: Cash Price $2,679.92
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,628.38
Rate for Payer: SOMOS Essential $7,628.38
Service Code HCPCS 61500
Min. Negotiated Rate $4,515.50
Max. Negotiated Rate $4,515.50
Rate for Payer: Cash Price $1,600.43
Rate for Payer: SOMOS CHP/HARP/Medicaid $4,515.50
Rate for Payer: SOMOS Essential $4,515.50
Service Code HCPCS 61510
Min. Negotiated Rate $7,949.18
Max. Negotiated Rate $7,949.18
Rate for Payer: Cash Price $2,798.44
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,949.18
Rate for Payer: SOMOS Essential $7,949.18
Service Code HCPCS 61580
Min. Negotiated Rate $8,281.59
Max. Negotiated Rate $8,281.59
Rate for Payer: Cash Price $2,962.04
Rate for Payer: SOMOS CHP/HARP/Medicaid $8,281.59
Rate for Payer: SOMOS Essential $8,281.59
Service Code HCPCS 61581
Min. Negotiated Rate $8,807.90
Max. Negotiated Rate $8,807.90
Rate for Payer: Cash Price $3,161.17
Rate for Payer: SOMOS CHP/HARP/Medicaid $8,807.90
Rate for Payer: SOMOS Essential $8,807.90
Service Code HCPCS 62140
Min. Negotiated Rate $3,603.44
Max. Negotiated Rate $3,603.44
Rate for Payer: Cash Price $1,277.46
Rate for Payer: SOMOS CHP/HARP/Medicaid $3,603.44
Rate for Payer: SOMOS Essential $3,603.44
Service Code HCPCS 62141
Min. Negotiated Rate $4,065.47
Max. Negotiated Rate $4,065.47
Rate for Payer: Cash Price $1,440.59
Rate for Payer: SOMOS CHP/HARP/Medicaid $4,065.47
Rate for Payer: SOMOS Essential $4,065.47
Service Code HCPCS 62145
Min. Negotiated Rate $5,110.04
Max. Negotiated Rate $5,110.04
Rate for Payer: Cash Price $1,807.47
Rate for Payer: SOMOS CHP/HARP/Medicaid $5,110.04
Rate for Payer: SOMOS Essential $5,110.04
Service Code HCPCS 62146
Min. Negotiated Rate $4,523.90
Max. Negotiated Rate $4,523.90
Rate for Payer: Cash Price $1,593.57
Rate for Payer: SOMOS CHP/HARP/Medicaid $4,523.90
Rate for Payer: SOMOS Essential $4,523.90
Service Code HCPCS 62147
Min. Negotiated Rate $5,041.08
Max. Negotiated Rate $5,041.08
Rate for Payer: Cash Price $1,782.53
Rate for Payer: SOMOS CHP/HARP/Medicaid $5,041.08
Rate for Payer: SOMOS Essential $5,041.08
Service Code HCPCS 61536
Min. Negotiated Rate $9,340.94
Max. Negotiated Rate $9,340.94
Rate for Payer: Cash Price $3,276.44
Rate for Payer: SOMOS CHP/HARP/Medicaid $9,340.94
Rate for Payer: SOMOS Essential $9,340.94
Service Code HCPCS 61534
Min. Negotiated Rate $5,974.79
Max. Negotiated Rate $5,974.79
Rate for Payer: Cash Price $2,102.71
Rate for Payer: SOMOS CHP/HARP/Medicaid $5,974.79
Rate for Payer: SOMOS Essential $5,974.79
Service Code HCPCS 61546
Min. Negotiated Rate $8,365.88
Max. Negotiated Rate $8,365.88
Rate for Payer: Cash Price $2,935.88
Rate for Payer: SOMOS CHP/HARP/Medicaid $8,365.88
Rate for Payer: SOMOS Essential $8,365.88
Service Code HCPCS 61538
Min. Negotiated Rate $9,647.08
Max. Negotiated Rate $9,647.08
Rate for Payer: Cash Price $3,381.27
Rate for Payer: SOMOS CHP/HARP/Medicaid $9,647.08
Rate for Payer: SOMOS Essential $9,647.08
Service Code HCPCS 61539
Min. Negotiated Rate $8,552.62
Max. Negotiated Rate $8,552.62
Rate for Payer: Cash Price $3,001.14
Rate for Payer: SOMOS CHP/HARP/Medicaid $8,552.62
Rate for Payer: SOMOS Essential $8,552.62
Service Code HCPCS 61540
Min. Negotiated Rate $7,883.92
Max. Negotiated Rate $7,883.92
Rate for Payer: Cash Price $2,769.44
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,883.92
Rate for Payer: SOMOS Essential $7,883.92