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Charge Type Setting Price  
Service Code HCPCS 78300 TC
Min. Negotiated Rate $593.62
Max. Negotiated Rate $593.62
Rate for Payer: Cash Price $210.52
Rate for Payer: SOMOS CHP/HARP/Medicaid $593.62
Rate for Payer: SOMOS Essential $593.62
Service Code HCPCS 78300 26
Min. Negotiated Rate $90.17
Max. Negotiated Rate $90.17
Rate for Payer: Cash Price $31.75
Rate for Payer: SOMOS CHP/HARP/Medicaid $90.17
Rate for Payer: SOMOS Essential $90.17
Service Code HCPCS 78305 TC
Min. Negotiated Rate $711.14
Max. Negotiated Rate $711.14
Rate for Payer: Cash Price $250.05
Rate for Payer: SOMOS CHP/HARP/Medicaid $711.14
Rate for Payer: SOMOS Essential $711.14
Service Code HCPCS 78305 26
Min. Negotiated Rate $117.44
Max. Negotiated Rate $117.44
Rate for Payer: Cash Price $42.06
Rate for Payer: SOMOS CHP/HARP/Medicaid $117.44
Rate for Payer: SOMOS Essential $117.44
Service Code HCPCS 78305
Min. Negotiated Rate $828.58
Max. Negotiated Rate $828.58
Rate for Payer: Cash Price $292.11
Rate for Payer: SOMOS CHP/HARP/Medicaid $828.58
Rate for Payer: SOMOS Essential $828.58
Service Code HCPCS 78306 TC
Min. Negotiated Rate $765.06
Max. Negotiated Rate $765.06
Rate for Payer: Cash Price $272.05
Rate for Payer: SOMOS CHP/HARP/Medicaid $765.06
Rate for Payer: SOMOS Essential $765.06
Service Code HCPCS 78306 26
Min. Negotiated Rate $120.26
Max. Negotiated Rate $120.26
Rate for Payer: Cash Price $43.50
Rate for Payer: SOMOS CHP/HARP/Medicaid $120.26
Rate for Payer: SOMOS Essential $120.26
Service Code HCPCS 78306
Min. Negotiated Rate $885.31
Max. Negotiated Rate $885.31
Rate for Payer: Cash Price $315.55
Rate for Payer: SOMOS CHP/HARP/Medicaid $885.31
Rate for Payer: SOMOS Essential $885.31
Service Code HCPCS 77073
Min. Negotiated Rate $144.85
Max. Negotiated Rate $144.85
Rate for Payer: Cash Price $52.99
Rate for Payer: SOMOS CHP/HARP/Medicaid $144.85
Rate for Payer: SOMOS Essential $144.85
Service Code HCPCS 77073 TC
Min. Negotiated Rate $104.48
Max. Negotiated Rate $104.48
Rate for Payer: Cash Price $38.35
Rate for Payer: SOMOS CHP/HARP/Medicaid $104.48
Rate for Payer: SOMOS Essential $104.48
Service Code HCPCS 77073 26
Min. Negotiated Rate $40.40
Max. Negotiated Rate $40.40
Rate for Payer: Cash Price $14.64
Rate for Payer: SOMOS CHP/HARP/Medicaid $40.40
Rate for Payer: SOMOS Essential $40.40
Service Code HCPCS 77084
Min. Negotiated Rate $978.13
Max. Negotiated Rate $978.13
Rate for Payer: Cash Price $379.77
Rate for Payer: SOMOS CHP/HARP/Medicaid $978.13
Rate for Payer: SOMOS Essential $978.13
Service Code HCPCS 77084 TC
Min. Negotiated Rate $747.81
Max. Negotiated Rate $747.81
Rate for Payer: Cash Price $296.58
Rate for Payer: SOMOS CHP/HARP/Medicaid $747.81
Rate for Payer: SOMOS Essential $747.81
Service Code HCPCS 77084 26
Min. Negotiated Rate $230.32
Max. Negotiated Rate $230.32
Rate for Payer: Cash Price $83.20
Rate for Payer: SOMOS CHP/HARP/Medicaid $230.32
Rate for Payer: SOMOS Essential $230.32
Service Code HCPCS 78102
Min. Negotiated Rate $522.20
Max. Negotiated Rate $522.20
Rate for Payer: Cash Price $187.97
Rate for Payer: SOMOS CHP/HARP/Medicaid $522.20
Rate for Payer: SOMOS Essential $522.20
Service Code HCPCS 78102 TC
Min. Negotiated Rate $448.09
Max. Negotiated Rate $448.09
Rate for Payer: Cash Price $161.25
Rate for Payer: SOMOS CHP/HARP/Medicaid $448.09
Rate for Payer: SOMOS Essential $448.09
Service Code HCPCS 78102 26
Min. Negotiated Rate $74.11
Max. Negotiated Rate $74.11
Rate for Payer: Cash Price $26.72
Rate for Payer: SOMOS CHP/HARP/Medicaid $74.11
Rate for Payer: SOMOS Essential $74.11
Service Code HCPCS 78103
Min. Negotiated Rate $557.24
Max. Negotiated Rate $557.24
Rate for Payer: Cash Price $199.42
Rate for Payer: SOMOS CHP/HARP/Medicaid $557.24
Rate for Payer: SOMOS Essential $557.24
Service Code HCPCS 78103 TC
Min. Negotiated Rate $471.80
Max. Negotiated Rate $471.80
Rate for Payer: Cash Price $167.93
Rate for Payer: SOMOS CHP/HARP/Medicaid $471.80
Rate for Payer: SOMOS Essential $471.80
Service Code HCPCS 78103 26
Min. Negotiated Rate $85.45
Max. Negotiated Rate $85.45
Rate for Payer: Cash Price $31.50
Rate for Payer: SOMOS CHP/HARP/Medicaid $85.45
Rate for Payer: SOMOS Essential $85.45
Service Code HCPCS 78104 26
Min. Negotiated Rate $111.38
Max. Negotiated Rate $111.38
Rate for Payer: Cash Price $39.60
Rate for Payer: SOMOS CHP/HARP/Medicaid $111.38
Rate for Payer: SOMOS Essential $111.38
Service Code HCPCS 78104
Min. Negotiated Rate $753.53
Max. Negotiated Rate $753.53
Rate for Payer: Cash Price $269.06
Rate for Payer: SOMOS CHP/HARP/Medicaid $753.53
Rate for Payer: SOMOS Essential $753.53
Service Code HCPCS 78104 TC
Min. Negotiated Rate $642.16
Max. Negotiated Rate $642.16
Rate for Payer: Cash Price $229.46
Rate for Payer: SOMOS CHP/HARP/Medicaid $642.16
Rate for Payer: SOMOS Essential $642.16
Service Code HCPCS 85097
Min. Negotiated Rate $142.88
Max. Negotiated Rate $142.88
Rate for Payer: Cash Price $52.41
Rate for Payer: SOMOS CHP/HARP/Medicaid $142.88
Rate for Payer: SOMOS Essential $142.88
Service Code HCPCS 77318 26
Min. Negotiated Rate $458.74
Max. Negotiated Rate $458.74
Rate for Payer: Cash Price $167.58
Rate for Payer: SOMOS CHP/HARP/Medicaid $458.74
Rate for Payer: SOMOS Essential $458.74