Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

UNIVERS APEX STEM SZ 11MM

Facility

$20,038.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,605.04
Max. Negotiated Rate	$19,237.20
Rate for Payer: Aetna Commercial	$15,429.84
Rate for Payer: Anthem Medicaid	$6,891.33
Rate for Payer: Anthem POS/PPO/Traditional	$15,630.22
Rate for Payer: Cash Price	$10,019.38
Rate for Payer: Cigna Commercial	$16,632.16
Rate for Payer: First Health Commercial	$19,036.81
Rate for Payer: Humana Commercial	$17,032.94
Rate for Payer: Humana KY Medicaid	$6,891.33
Rate for Payer: Kentucky WC Medicaid	$6,961.46
Rate for Payer: Medical Mutual Of Ohio HMO	$16,431.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$14,788.60
Rate for Payer: Molina Healthcare Benefit Exchange	$6,011.62
Rate for Payer: Molina Healthcare Medicaid	$7,029.59
Rate for Payer: Ohio Health Choice Commercial	$17,634.10
Rate for Payer: Ohio Health Group HMO	$15,029.06
Rate for Payer: Ohio Health Group PPO Differential	$4,007.75
Rate for Payer: Ohio Health Group PPO No Differential	$2,605.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,212.01
Rate for Payer: PHCS Commercial	$19,237.20
Rate for Payer: United Healthcare All Payer	$17,634.10

UNIVERS APEX STEM SZ 11MM

Facility

$20,038.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,605.04
Max. Negotiated Rate	$19,237.20
Rate for Payer: Aetna Commercial	$15,429.84
Rate for Payer: Anthem POS/PPO/Traditional	$15,630.22
Rate for Payer: Cash Price	$10,019.38
Rate for Payer: Cigna Commercial	$16,632.16
Rate for Payer: First Health Commercial	$19,036.81
Rate for Payer: Humana Commercial	$17,032.94
Rate for Payer: Medical Mutual Of Ohio HMO	$16,431.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$14,788.60
Rate for Payer: Molina Healthcare Benefit Exchange	$6,011.62
Rate for Payer: Ohio Health Choice Commercial	$17,634.10
Rate for Payer: Ohio Health Group HMO	$15,029.06
Rate for Payer: Ohio Health Group PPO Differential	$4,007.75
Rate for Payer: Ohio Health Group PPO No Differential	$2,605.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,212.01
Rate for Payer: PHCS Commercial	$19,237.20
Rate for Payer: United Healthcare All Payer	$17,634.10

UNIVERS APEX STEM SZ 13MM

Facility

$20,038.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,605.04
Max. Negotiated Rate	$19,237.20
Rate for Payer: Aetna Commercial	$15,429.84
Rate for Payer: Anthem Medicaid	$6,891.33
Rate for Payer: Anthem POS/PPO/Traditional	$15,630.22
Rate for Payer: Cash Price	$10,019.38
Rate for Payer: Cigna Commercial	$16,632.16
Rate for Payer: First Health Commercial	$19,036.81
Rate for Payer: Humana Commercial	$17,032.94
Rate for Payer: Humana KY Medicaid	$6,891.33
Rate for Payer: Kentucky WC Medicaid	$6,961.46
Rate for Payer: Medical Mutual Of Ohio HMO	$16,431.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$14,788.60
Rate for Payer: Molina Healthcare Benefit Exchange	$6,011.62
Rate for Payer: Molina Healthcare Medicaid	$7,029.59
Rate for Payer: Ohio Health Choice Commercial	$17,634.10
Rate for Payer: Ohio Health Group HMO	$15,029.06
Rate for Payer: Ohio Health Group PPO Differential	$4,007.75
Rate for Payer: Ohio Health Group PPO No Differential	$2,605.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,212.01
Rate for Payer: PHCS Commercial	$19,237.20
Rate for Payer: United Healthcare All Payer	$17,634.10

UNIVERS APEX STEM SZ 13MM

Facility

$20,038.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,605.04
Max. Negotiated Rate	$19,237.20
Rate for Payer: Aetna Commercial	$15,429.84
Rate for Payer: Anthem POS/PPO/Traditional	$15,630.22
Rate for Payer: Cash Price	$10,019.38
Rate for Payer: Cigna Commercial	$16,632.16
Rate for Payer: First Health Commercial	$19,036.81
Rate for Payer: Humana Commercial	$17,032.94
Rate for Payer: Medical Mutual Of Ohio HMO	$16,431.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$14,788.60
Rate for Payer: Molina Healthcare Benefit Exchange	$6,011.62
Rate for Payer: Ohio Health Choice Commercial	$17,634.10
Rate for Payer: Ohio Health Group HMO	$15,029.06
Rate for Payer: Ohio Health Group PPO Differential	$4,007.75
Rate for Payer: Ohio Health Group PPO No Differential	$2,605.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,212.01
Rate for Payer: PHCS Commercial	$19,237.20
Rate for Payer: United Healthcare All Payer	$17,634.10

UNIVERS APEX STEM SZ 8MM

Facility

$20,038.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,605.04
Max. Negotiated Rate	$19,237.20
Rate for Payer: Aetna Commercial	$15,429.84
Rate for Payer: Anthem POS/PPO/Traditional	$15,630.22
Rate for Payer: Cash Price	$10,019.38
Rate for Payer: Cigna Commercial	$16,632.16
Rate for Payer: First Health Commercial	$19,036.81
Rate for Payer: Humana Commercial	$17,032.94
Rate for Payer: Medical Mutual Of Ohio HMO	$16,431.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$14,788.60
Rate for Payer: Molina Healthcare Benefit Exchange	$6,011.62
Rate for Payer: Ohio Health Choice Commercial	$17,634.10
Rate for Payer: Ohio Health Group HMO	$15,029.06
Rate for Payer: Ohio Health Group PPO Differential	$4,007.75
Rate for Payer: Ohio Health Group PPO No Differential	$2,605.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,212.01
Rate for Payer: PHCS Commercial	$19,237.20
Rate for Payer: United Healthcare All Payer	$17,634.10

UNIVERS APEX STEM SZ 8MM

Facility

$20,038.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,605.04
Max. Negotiated Rate	$19,237.20
Rate for Payer: Aetna Commercial	$15,429.84
Rate for Payer: Anthem Medicaid	$6,891.33
Rate for Payer: Anthem POS/PPO/Traditional	$15,630.22
Rate for Payer: Cash Price	$10,019.38
Rate for Payer: Cigna Commercial	$16,632.16
Rate for Payer: First Health Commercial	$19,036.81
Rate for Payer: Humana Commercial	$17,032.94
Rate for Payer: Humana KY Medicaid	$6,891.33
Rate for Payer: Kentucky WC Medicaid	$6,961.46
Rate for Payer: Medical Mutual Of Ohio HMO	$16,431.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$14,788.60
Rate for Payer: Molina Healthcare Benefit Exchange	$6,011.62
Rate for Payer: Molina Healthcare Medicaid	$7,029.59
Rate for Payer: Ohio Health Choice Commercial	$17,634.10
Rate for Payer: Ohio Health Group HMO	$15,029.06
Rate for Payer: Ohio Health Group PPO Differential	$4,007.75
Rate for Payer: Ohio Health Group PPO No Differential	$2,605.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,212.01
Rate for Payer: PHCS Commercial	$19,237.20
Rate for Payer: United Healthcare All Payer	$17,634.10

UNIVERS APEX STEM SZ 9MM

Facility

$20,038.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,605.04
Max. Negotiated Rate	$19,237.20
Rate for Payer: Aetna Commercial	$15,429.84
Rate for Payer: Anthem POS/PPO/Traditional	$15,630.22
Rate for Payer: Cash Price	$10,019.38
Rate for Payer: Cigna Commercial	$16,632.16
Rate for Payer: First Health Commercial	$19,036.81
Rate for Payer: Humana Commercial	$17,032.94
Rate for Payer: Medical Mutual Of Ohio HMO	$16,431.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$14,788.60
Rate for Payer: Molina Healthcare Benefit Exchange	$6,011.62
Rate for Payer: Ohio Health Choice Commercial	$17,634.10
Rate for Payer: Ohio Health Group HMO	$15,029.06
Rate for Payer: Ohio Health Group PPO Differential	$4,007.75
Rate for Payer: Ohio Health Group PPO No Differential	$2,605.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,212.01
Rate for Payer: PHCS Commercial	$19,237.20
Rate for Payer: United Healthcare All Payer	$17,634.10

UNIVERS APEX STEM SZ 9MM

Facility

$20,038.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,605.04
Max. Negotiated Rate	$19,237.20
Rate for Payer: Aetna Commercial	$15,429.84
Rate for Payer: Anthem Medicaid	$6,891.33
Rate for Payer: Anthem POS/PPO/Traditional	$15,630.22
Rate for Payer: Cash Price	$10,019.38
Rate for Payer: Cigna Commercial	$16,632.16
Rate for Payer: First Health Commercial	$19,036.81
Rate for Payer: Humana Commercial	$17,032.94
Rate for Payer: Humana KY Medicaid	$6,891.33
Rate for Payer: Kentucky WC Medicaid	$6,961.46
Rate for Payer: Medical Mutual Of Ohio HMO	$16,431.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$14,788.60
Rate for Payer: Molina Healthcare Benefit Exchange	$6,011.62
Rate for Payer: Molina Healthcare Medicaid	$7,029.59
Rate for Payer: Ohio Health Choice Commercial	$17,634.10
Rate for Payer: Ohio Health Group HMO	$15,029.06
Rate for Payer: Ohio Health Group PPO Differential	$4,007.75
Rate for Payer: Ohio Health Group PPO No Differential	$2,605.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,212.01
Rate for Payer: PHCS Commercial	$19,237.20
Rate for Payer: United Healthcare All Payer	$17,634.10

UNIVERSA URET STENT 6*22-32

Facility

$1,108.43

Service Code	HCPCS C2617
Hospital Charge Code	27000129
Hospital Revenue Code	272
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$1,064.09
Rate for Payer: Aetna Commercial	$853.49
Rate for Payer: Anthem POS/PPO/Traditional	$864.58
Rate for Payer: Cash Price	$554.22
Rate for Payer: Cigna Commercial	$920.00
Rate for Payer: First Health Commercial	$1,053.01
Rate for Payer: Humana Commercial	$942.17
Rate for Payer: Medical Mutual Of Ohio HMO	$908.91
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$818.02
Rate for Payer: Molina Healthcare Benefit Exchange	$332.53
Rate for Payer: Ohio Health Choice Commercial	$975.42
Rate for Payer: Ohio Health Group HMO	$831.32
Rate for Payer: Ohio Health Group PPO Differential	$221.69
Rate for Payer: Ohio Health Group PPO No Differential	$144.10
Rate for Payer: Ohio Health Group PPO SOMC Employees	$343.61
Rate for Payer: PHCS Commercial	$1,064.09
Rate for Payer: United Healthcare All Payer	$975.42

UNIVERSA URET STENT 6*22-32

Facility

$1,108.43

Service Code	HCPCS C2617
Hospital Charge Code	27000129
Hospital Revenue Code	272
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$1,064.09
Rate for Payer: Aetna Commercial	$853.49
Rate for Payer: Anthem Medicaid	$381.19
Rate for Payer: Anthem POS/PPO/Traditional	$864.58
Rate for Payer: Cash Price	$554.22
Rate for Payer: Cigna Commercial	$920.00
Rate for Payer: First Health Commercial	$1,053.01
Rate for Payer: Humana Commercial	$942.17
Rate for Payer: Humana KY Medicaid	$381.19
Rate for Payer: Kentucky WC Medicaid	$385.07
Rate for Payer: Medical Mutual Of Ohio HMO	$908.91
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$818.02
Rate for Payer: Molina Healthcare Benefit Exchange	$332.53
Rate for Payer: Molina Healthcare Medicaid	$388.84
Rate for Payer: Ohio Health Choice Commercial	$975.42
Rate for Payer: Ohio Health Group HMO	$831.32
Rate for Payer: Ohio Health Group PPO Differential	$221.69
Rate for Payer: Ohio Health Group PPO No Differential	$144.10
Rate for Payer: Ohio Health Group PPO SOMC Employees	$343.61
Rate for Payer: PHCS Commercial	$1,064.09
Rate for Payer: United Healthcare All Payer	$975.42

UNLISTED LAPAROSCOPIC PROCEDURE, LIVER

Facility

$6,985.45

Service Code	CPT 47379
Hospital Revenue Code	360
Min. Negotiated Rate	$4,989.61
Max. Negotiated Rate	$6,985.45
Rate for Payer: Anthem Medicare Advantage/PPO	$4,989.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,985.45
Rate for Payer: CareSource Just4Me Medicare	$6,735.97
Rate for Payer: Humana Medicare Advantage	$4,989.61
Rate for Payer: Molina Healthcare Benefit Exchange	$5,987.53

UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM

Facility

$6,985.45

Service Code	CPT 49329
Hospital Revenue Code	360
Min. Negotiated Rate	$4,989.61
Max. Negotiated Rate	$6,985.45
Rate for Payer: Anthem Medicare Advantage/PPO	$4,989.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,985.45
Rate for Payer: CareSource Just4Me Medicare	$6,735.97
Rate for Payer: Humana Medicare Advantage	$4,989.61
Rate for Payer: Molina Healthcare Benefit Exchange	$5,987.53

UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY

Facility

$6,985.45

Service Code	CPT 49659
Hospital Revenue Code	360
Min. Negotiated Rate	$4,989.61
Max. Negotiated Rate	$6,985.45
Rate for Payer: Anthem Medicare Advantage/PPO	$4,989.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,985.45
Rate for Payer: CareSource Just4Me Medicare	$6,735.97
Rate for Payer: Humana Medicare Advantage	$4,989.61
Rate for Payer: Molina Healthcare Benefit Exchange	$5,987.53

UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY

Facility

$6,985.45

Service Code	CPT 58679
Hospital Revenue Code	360
Min. Negotiated Rate	$4,989.61
Max. Negotiated Rate	$6,985.45
Rate for Payer: Anthem Medicare Advantage/PPO	$4,989.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,985.45
Rate for Payer: CareSource Just4Me Medicare	$6,735.97
Rate for Payer: Humana Medicare Advantage	$4,989.61
Rate for Payer: Molina Healthcare Benefit Exchange	$5,987.53

UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD

Facility

$6,985.45

Service Code	CPT 55559
Hospital Revenue Code	360
Min. Negotiated Rate	$4,989.61
Max. Negotiated Rate	$6,985.45
Rate for Payer: Anthem Medicare Advantage/PPO	$4,989.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,985.45
Rate for Payer: CareSource Just4Me Medicare	$6,735.97
Rate for Payer: Humana Medicare Advantage	$4,989.61
Rate for Payer: Molina Healthcare Benefit Exchange	$5,987.53

UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN

Facility

$6,985.45

Service Code	CPT 38129
Hospital Revenue Code	360
Min. Negotiated Rate	$4,989.61
Max. Negotiated Rate	$6,985.45
Rate for Payer: Anthem Medicare Advantage/PPO	$4,989.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,985.45
Rate for Payer: CareSource Just4Me Medicare	$6,735.97
Rate for Payer: Humana Medicare Advantage	$4,989.61
Rate for Payer: Molina Healthcare Benefit Exchange	$5,987.53

UNLISTED PROCEDURE, BREAST

Facility

$4,614.69

Service Code	CPT 19499
Hospital Charge Code	76102664
Hospital Revenue Code	360
Min. Negotiated Rate	$3,296.21
Max. Negotiated Rate	$4,614.69
Rate for Payer: Anthem Medicare Advantage/PPO	$3,296.21
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,614.69
Rate for Payer: CareSource Just4Me Medicare	$4,449.88
Rate for Payer: Humana Medicare Advantage	$3,296.21
Rate for Payer: Molina Healthcare Benefit Exchange	$3,955.45

UNLISTED PROCEDURE, BREAST

Facility

$4,614.69

Service Code	CPT 19499
Hospital Revenue Code	360
Min. Negotiated Rate	$3,296.21
Max. Negotiated Rate	$4,614.69
Rate for Payer: Anthem Medicare Advantage/PPO	$3,296.21
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,614.69
Rate for Payer: CareSource Just4Me Medicare	$4,449.88
Rate for Payer: Humana Medicare Advantage	$3,296.21
Rate for Payer: Molina Healthcare Benefit Exchange	$3,955.45

UNLISTED PROCEDURE, BREAST

Professional

Both

$3,000.00

Service Code	HCPCS 19499
Hospital Charge Code	76102664
Hospital Revenue Code	761
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Anthem Medicaid	$250.00
Rate for Payer: Buckeye Medicare Advantage	$3,000.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Humana Medicaid	$250.00
Rate for Payer: Molina Healthcare CHIP/Medicaid	$255.00
Rate for Payer: Molina Healthcare Passport	$250.00
Rate for Payer: Multiplan PHCS	$1,800.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$2,100.00
Rate for Payer: UHCCP Medicaid	$1,050.00
Rate for Payer: Wellcare CHIP/Medicaid	$252.50

UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)

Facility

$241.25

Service Code	CPT 58999
Hospital Revenue Code	360
Min. Negotiated Rate	$172.32
Max. Negotiated Rate	$241.25
Rate for Payer: Anthem Medicare Advantage/PPO	$172.32
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$241.25
Rate for Payer: CareSource Just4Me Medicare	$232.63
Rate for Payer: Humana Medicare Advantage	$172.32
Rate for Payer: Molina Healthcare Benefit Exchange	$206.78

UNLISTED PROCEDURE, FEMUR OR KNEE

Facility

$285.50

Service Code	CPT 27599
Hospital Revenue Code	360
Min. Negotiated Rate	$203.93
Max. Negotiated Rate	$285.50
Rate for Payer: Anthem Medicare Advantage/PPO	$203.93
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$285.50
Rate for Payer: CareSource Just4Me Medicare	$275.31
Rate for Payer: Humana Medicare Advantage	$203.93
Rate for Payer: Molina Healthcare Benefit Exchange	$244.72

UNLISTED PROCEDURE, FOOT OR TOES

Facility

$285.50

Service Code	CPT 28899
Hospital Revenue Code	360
Min. Negotiated Rate	$203.93
Max. Negotiated Rate	$285.50
Rate for Payer: Anthem Medicare Advantage/PPO	$203.93
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$285.50
Rate for Payer: CareSource Just4Me Medicare	$275.31
Rate for Payer: Humana Medicare Advantage	$203.93
Rate for Payer: Molina Healthcare Benefit Exchange	$244.72

UNLISTED PROCEDURE, LARYNX

Professional

Both

$70.00

Service Code	HCPCS 31599
Hospital Charge Code	41000027
Hospital Revenue Code	410
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$361.59
Rate for Payer: Anthem Medicaid	$354.50
Rate for Payer: Buckeye Medicare Advantage	$70.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Humana Medicaid	$354.50
Rate for Payer: Molina Healthcare CHIP/Medicaid	$361.59
Rate for Payer: Molina Healthcare Passport	$354.50
Rate for Payer: Multiplan PHCS	$42.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$49.00
Rate for Payer: UHCCP Medicaid	$24.50
Rate for Payer: Wellcare CHIP/Medicaid	$358.04

UNLISTED PROCEDURE, LARYNX(P

Professional

Both

$70.00

Service Code	HCPCS 31599
Hospital Charge Code	410P0027
Hospital Revenue Code	410
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$361.59
Rate for Payer: Anthem Medicaid	$354.50
Rate for Payer: Buckeye Medicare Advantage	$70.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Humana Medicaid	$354.50
Rate for Payer: Molina Healthcare CHIP/Medicaid	$361.59
Rate for Payer: Molina Healthcare Passport	$354.50
Rate for Payer: Multiplan PHCS	$42.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$49.00
Rate for Payer: UHCCP Medicaid	$24.50
Rate for Payer: Wellcare CHIP/Medicaid	$358.04

UNLISTED PROCEDURE, LUNGS AND PLEURA

Facility

$760.54

Service Code	CPT 32999
Hospital Revenue Code	360
Min. Negotiated Rate	$543.24
Max. Negotiated Rate	$760.54
Rate for Payer: Anthem Medicare Advantage/PPO	$543.24
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$760.54
Rate for Payer: CareSource Just4Me Medicare	$733.37
Rate for Payer: Humana Medicare Advantage	$543.24
Rate for Payer: Molina Healthcare Benefit Exchange	$651.89

Know your out-of-pocket cost for care.

All Charges