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Charge Type Setting Price  
Service Code HCPCS 88125
Min. Negotiated Rate $88.91
Max. Negotiated Rate $88.91
Rate for Payer: Cash Price $33.11
Rate for Payer: SOMOS CHP/HARP/Medicaid $88.91
Rate for Payer: SOMOS Essential $88.91
Service Code HCPCS 88141
Min. Negotiated Rate $70.70
Max. Negotiated Rate $70.70
Rate for Payer: Cash Price $27.37
Rate for Payer: SOMOS CHP/HARP/Medicaid $70.70
Rate for Payer: SOMOS Essential $70.70
Service Code HCPCS 88108 TC
Min. Negotiated Rate $143.30
Max. Negotiated Rate $143.30
Rate for Payer: Cash Price $55.64
Rate for Payer: SOMOS CHP/HARP/Medicaid $143.30
Rate for Payer: SOMOS Essential $143.30
Service Code HCPCS 88108
Min. Negotiated Rate $208.24
Max. Negotiated Rate $208.24
Rate for Payer: Cash Price $79.46
Rate for Payer: SOMOS CHP/HARP/Medicaid $208.24
Rate for Payer: SOMOS Essential $208.24
Service Code HCPCS 88108 26
Min. Negotiated Rate $64.94
Max. Negotiated Rate $64.94
Rate for Payer: Cash Price $23.83
Rate for Payer: SOMOS CHP/HARP/Medicaid $64.94
Rate for Payer: SOMOS Essential $64.94
Service Code HCPCS 88173
Min. Negotiated Rate $505.13
Max. Negotiated Rate $505.13
Rate for Payer: Cash Price $192.27
Rate for Payer: SOMOS CHP/HARP/Medicaid $505.13
Rate for Payer: SOMOS Essential $505.13
Service Code HCPCS 88173 TC
Min. Negotiated Rate $303.61
Max. Negotiated Rate $303.61
Rate for Payer: Cash Price $118.58
Rate for Payer: SOMOS CHP/HARP/Medicaid $303.61
Rate for Payer: SOMOS Essential $303.61
Service Code HCPCS 88173 26
Min. Negotiated Rate $201.52
Max. Negotiated Rate $201.52
Rate for Payer: Cash Price $73.69
Rate for Payer: SOMOS CHP/HARP/Medicaid $201.52
Rate for Payer: SOMOS Essential $201.52
Service Code HCPCS 88172
Min. Negotiated Rate $170.26
Max. Negotiated Rate $170.26
Rate for Payer: Cash Price $63.03
Rate for Payer: SOMOS CHP/HARP/Medicaid $170.26
Rate for Payer: SOMOS Essential $170.26
Service Code HCPCS 88172 26
Min. Negotiated Rate $102.46
Max. Negotiated Rate $102.46
Rate for Payer: Cash Price $37.26
Rate for Payer: SOMOS CHP/HARP/Medicaid $102.46
Rate for Payer: SOMOS Essential $102.46
Service Code HCPCS 88172 TC
Min. Negotiated Rate $67.83
Max. Negotiated Rate $67.83
Rate for Payer: Cash Price $25.77
Rate for Payer: SOMOS CHP/HARP/Medicaid $67.83
Rate for Payer: SOMOS Essential $67.83
Service Code HCPCS 88177 TC
Min. Negotiated Rate $25.88
Max. Negotiated Rate $25.88
Rate for Payer: Cash Price $9.82
Rate for Payer: SOMOS CHP/HARP/Medicaid $25.88
Rate for Payer: SOMOS Essential $25.88
Service Code HCPCS 88177 26
Min. Negotiated Rate $63.08
Max. Negotiated Rate $63.08
Rate for Payer: Cash Price $23.13
Rate for Payer: SOMOS CHP/HARP/Medicaid $63.08
Rate for Payer: SOMOS Essential $63.08
Service Code HCPCS 88177
Min. Negotiated Rate $88.94
Max. Negotiated Rate $88.94
Rate for Payer: Cash Price $32.95
Rate for Payer: SOMOS CHP/HARP/Medicaid $88.94
Rate for Payer: SOMOS Essential $88.94
Service Code HCPCS 88106
Min. Negotiated Rate $221.06
Max. Negotiated Rate $221.06
Rate for Payer: Cash Price $83.15
Rate for Payer: SOMOS CHP/HARP/Medicaid $221.06
Rate for Payer: SOMOS Essential $221.06
Service Code HCPCS 88106 TC
Min. Negotiated Rate $164.85
Max. Negotiated Rate $164.85
Rate for Payer: Cash Price $62.94
Rate for Payer: SOMOS CHP/HARP/Medicaid $164.85
Rate for Payer: SOMOS Essential $164.85
Service Code HCPCS 88106 26
Min. Negotiated Rate $56.23
Max. Negotiated Rate $56.23
Rate for Payer: Cash Price $20.21
Rate for Payer: SOMOS CHP/HARP/Medicaid $56.23
Rate for Payer: SOMOS Essential $56.23
Service Code HCPCS 88104
Min. Negotiated Rate $217.24
Max. Negotiated Rate $217.24
Rate for Payer: Cash Price $87.42
Rate for Payer: SOMOS CHP/HARP/Medicaid $217.24
Rate for Payer: SOMOS Essential $217.24
Service Code HCPCS 88104 TC
Min. Negotiated Rate $138.86
Max. Negotiated Rate $138.86
Rate for Payer: Cash Price $58.23
Rate for Payer: SOMOS CHP/HARP/Medicaid $138.86
Rate for Payer: SOMOS Essential $138.86
Service Code HCPCS 88104 26
Min. Negotiated Rate $78.38
Max. Negotiated Rate $78.38
Rate for Payer: Cash Price $29.19
Rate for Payer: SOMOS CHP/HARP/Medicaid $78.38
Rate for Payer: SOMOS Essential $78.38
Service Code HCPCS 88120
Min. Negotiated Rate $1,910.40
Max. Negotiated Rate $1,910.40
Rate for Payer: Cash Price $679.17
Rate for Payer: SOMOS CHP/HARP/Medicaid $1,910.40
Rate for Payer: SOMOS Essential $1,910.40
Service Code HCPCS 88120 26
Min. Negotiated Rate $167.50
Max. Negotiated Rate $167.50
Rate for Payer: Cash Price $61.17
Rate for Payer: SOMOS CHP/HARP/Medicaid $167.50
Rate for Payer: SOMOS Essential $167.50
Service Code HCPCS 88120 TC
Min. Negotiated Rate $1,742.90
Max. Negotiated Rate $1,742.90
Rate for Payer: Cash Price $617.99
Rate for Payer: SOMOS CHP/HARP/Medicaid $1,742.90
Rate for Payer: SOMOS Essential $1,742.90
Service Code HCPCS 88121
Min. Negotiated Rate $1,338.86
Max. Negotiated Rate $1,338.86
Rate for Payer: Cash Price $490.82
Rate for Payer: SOMOS CHP/HARP/Medicaid $1,338.86
Rate for Payer: SOMOS Essential $1,338.86
Service Code HCPCS 88121 TC
Min. Negotiated Rate $1,199.84
Max. Negotiated Rate $1,199.84
Rate for Payer: Cash Price $439.76
Rate for Payer: SOMOS CHP/HARP/Medicaid $1,199.84
Rate for Payer: SOMOS Essential $1,199.84