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Charge Type Setting Price  
Service Code HCPCS 61544
Min. Negotiated Rate $6,877.32
Max. Negotiated Rate $6,877.32
Rate for Payer: Cash Price $2,417.01
Rate for Payer: SOMOS CHP/HARP/Medicaid $6,877.32
Rate for Payer: SOMOS Essential $6,877.32
Service Code HCPCS 61545
Min. Negotiated Rate $11,540.11
Max. Negotiated Rate $11,540.11
Rate for Payer: Cash Price $4,048.97
Rate for Payer: SOMOS CHP/HARP/Medicaid $11,540.11
Rate for Payer: SOMOS Essential $11,540.11
Service Code HCPCS 62121
Min. Negotiated Rate $5,298.59
Max. Negotiated Rate $5,298.59
Rate for Payer: Cash Price $1,885.33
Rate for Payer: SOMOS CHP/HARP/Medicaid $5,298.59
Rate for Payer: SOMOS Essential $5,298.59
Service Code HCPCS 61567
Min. Negotiated Rate $9,243.10
Max. Negotiated Rate $9,243.10
Rate for Payer: Cash Price $3,245.92
Rate for Payer: SOMOS CHP/HARP/Medicaid $9,243.10
Rate for Payer: SOMOS Essential $9,243.10
Service Code HCPCS 61543
Min. Negotiated Rate $7,873.19
Max. Negotiated Rate $7,873.19
Rate for Payer: Cash Price $2,765.43
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,873.19
Rate for Payer: SOMOS Essential $7,873.19
Service Code HCPCS 61566
Min. Negotiated Rate $8,114.66
Max. Negotiated Rate $8,114.66
Rate for Payer: Cash Price $2,849.92
Rate for Payer: SOMOS CHP/HARP/Medicaid $8,114.66
Rate for Payer: SOMOS Essential $8,114.66
Service Code HCPCS 61541
Min. Negotiated Rate $7,792.34
Max. Negotiated Rate $7,792.34
Rate for Payer: Cash Price $2,735.45
Rate for Payer: SOMOS CHP/HARP/Medicaid $7,792.34
Rate for Payer: SOMOS Essential $7,792.34
Service Code HCPCS 61535
Min. Negotiated Rate $3,623.00
Max. Negotiated Rate $3,623.00
Rate for Payer: Cash Price $1,281.80
Rate for Payer: SOMOS CHP/HARP/Medicaid $3,623.00
Rate for Payer: SOMOS Essential $3,623.00
Service Code HCPCS 61533
Min. Negotiated Rate $5,528.49
Max. Negotiated Rate $5,528.49
Rate for Payer: Cash Price $1,945.11
Rate for Payer: SOMOS CHP/HARP/Medicaid $5,528.49
Rate for Payer: SOMOS Essential $5,528.49
Service Code HCPCS 61537
Min. Negotiated Rate $8,916.34
Max. Negotiated Rate $8,916.34
Rate for Payer: Cash Price $3,123.54
Rate for Payer: SOMOS CHP/HARP/Medicaid $8,916.34
Rate for Payer: SOMOS Essential $8,916.34
Service Code HCPCS 61790
Min. Negotiated Rate $3,179.38
Max. Negotiated Rate $3,179.38
Rate for Payer: Cash Price $1,119.45
Rate for Payer: SOMOS CHP/HARP/Medicaid $3,179.38
Rate for Payer: SOMOS Essential $3,179.38
Service Code HCPCS 61791
Min. Negotiated Rate $4,075.87
Max. Negotiated Rate $4,075.87
Rate for Payer: Cash Price $1,436.10
Rate for Payer: SOMOS CHP/HARP/Medicaid $4,075.87
Rate for Payer: SOMOS Essential $4,075.87
Service Code HCPCS 63600
Min. Negotiated Rate $3,956.06
Max. Negotiated Rate $3,956.06
Rate for Payer: Cash Price $1,394.51
Rate for Payer: SOMOS CHP/HARP/Medicaid $3,956.06
Rate for Payer: SOMOS Essential $3,956.06
Service Code HCPCS 43030
Min. Negotiated Rate $1,701.89
Max. Negotiated Rate $1,701.89
Rate for Payer: Cash Price $616.34
Rate for Payer: SOMOS CHP/HARP/Medicaid $1,701.89
Rate for Payer: SOMOS Essential $1,701.89
Service Code HCPCS 31592
Min. Negotiated Rate $5,616.74
Max. Negotiated Rate $5,616.74
Rate for Payer: Cash Price $2,020.61
Rate for Payer: SOMOS CHP/HARP/Medicaid $5,616.74
Rate for Payer: SOMOS Essential $5,616.74
Service Code HCPCS G0509
Min. Negotiated Rate $578.32
Max. Negotiated Rate $578.32
Rate for Payer: Cash Price $212.23
Rate for Payer: SOMOS CHP/HARP/Medicaid $578.32
Rate for Payer: SOMOS Essential $578.32
Service Code HCPCS G0508
Min. Negotiated Rate $634.18
Max. Negotiated Rate $634.18
Rate for Payer: Cash Price $230.71
Rate for Payer: SOMOS CHP/HARP/Medicaid $634.18
Rate for Payer: SOMOS Essential $634.18
Service Code HCPCS 99292
Min. Negotiated Rate $331.96
Max. Negotiated Rate $331.96
Rate for Payer: Cash Price $120.36
Rate for Payer: SOMOS CHP/HARP/Medicaid $331.96
Rate for Payer: SOMOS Essential $331.96
Service Code HCPCS 99291
Min. Negotiated Rate $658.77
Max. Negotiated Rate $658.77
Rate for Payer: Cash Price $237.83
Rate for Payer: SOMOS CHP/HARP/Medicaid $658.77
Rate for Payer: SOMOS Essential $658.77
Service Code HCPCS 99466
Min. Negotiated Rate $701.17
Max. Negotiated Rate $701.17
Rate for Payer: Cash Price $256.45
Rate for Payer: SOMOS CHP/HARP/Medicaid $701.17
Rate for Payer: SOMOS Essential $701.17
Service Code HCPCS 99467
Min. Negotiated Rate $357.26
Max. Negotiated Rate $357.26
Rate for Payer: Cash Price $128.91
Rate for Payer: SOMOS CHP/HARP/Medicaid $357.26
Rate for Payer: SOMOS Essential $357.26
Service Code HCPCS 61860
Min. Negotiated Rate $5,664.99
Max. Negotiated Rate $5,664.99
Rate for Payer: Cash Price $1,990.68
Rate for Payer: SOMOS CHP/HARP/Medicaid $5,664.99
Rate for Payer: SOMOS Essential $5,664.99
Service Code HCPCS 61518
Min. Negotiated Rate $10,010.07
Max. Negotiated Rate $10,010.07
Rate for Payer: Cash Price $3,519.73
Rate for Payer: SOMOS CHP/HARP/Medicaid $10,010.07
Rate for Payer: SOMOS Essential $10,010.07
Service Code HCPCS 61530
Min. Negotiated Rate $11,139.56
Max. Negotiated Rate $11,139.56
Rate for Payer: Cash Price $3,902.59
Rate for Payer: SOMOS CHP/HARP/Medicaid $11,139.56
Rate for Payer: SOMOS Essential $11,139.56
Service Code HCPCS 61519
Min. Negotiated Rate $10,672.81
Max. Negotiated Rate $10,672.81
Rate for Payer: Cash Price $3,732.38
Rate for Payer: SOMOS CHP/HARP/Medicaid $10,672.81
Rate for Payer: SOMOS Essential $10,672.81