Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Abdominal Binder XXL 50-56

Facility

$51.62

Hospital Charge Code	3259814
Hospital Revenue Code	270
Min. Negotiated Rate	$46.46
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$46.46
Rate for Payer: UnitedHealthcare Commercial	$49.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Abdominal Binder XXL 50-56

Facility

$51.62

Hospital Charge Code	3259814
Hospital Revenue Code	270
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$49.04
Rate for Payer: Aetna Commercial	$46.46
Rate for Payer: Humana Medicare Advantage	$21.68
Rate for Payer: UnitedHealthcare Commercial	$49.04
Rate for Payer: UnitedHealthcare Medicaid	$20.65
Rate for Payer: WPPA Medicare Advantage	$30.97

ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE

Facility

$1,389.94

Service Code	CPT 49082
Hospital Revenue Code	360
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$1,389.94
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,079.61
Rate for Payer: UnitedHealthcare Medicaid	$260.47
Rate for Payer: WPPA Medicare Advantage	$1,389.94

ABD Pad 5 X 9 Surgipad

Facility

$3.00

Hospital Charge Code	3252070
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ABD Pad 5 X 9 Surgipad

Facility

$3.00

Hospital Charge Code	3252070
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Humana Medicare Advantage	$1.26
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: WPPA Medicare Advantage	$1.80

ABD Pad 8 X 10 Surgipad

Facility

$2.50

Hospital Charge Code	3252090
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ABD Pad 8 X 10 Surgipad

Facility

$2.50

Hospital Charge Code	3252090
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Ablation Endometrium

Facility

$7,756.00

Service Code	HCPCS 58353
Hospital Charge Code	3150516
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,368.20
Rate for Payer: Aetna Commercial	$6,980.40
Rate for Payer: UnitedHealthcare Commercial	$7,368.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Ablation Endometrium

Facility

$7,756.00

Service Code	HCPCS 58353
Hospital Charge Code	3150516
Hospital Revenue Code	360
Min. Negotiated Rate	$1,611.29
Max. Negotiated Rate	$7,368.20
Rate for Payer: Aetna Commercial	$6,980.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5,596.23
Rate for Payer: Humana Medicare Advantage	$3,257.52
Rate for Payer: UnitedHealthcare Commercial	$7,368.20
Rate for Payer: UnitedHealthcare Medicaid	$1,611.29
Rate for Payer: WPPA Medicare Advantage	$4,653.60

Ablation; nerve

Facility

$918.00

Service Code	HCPCS 64640
Hospital Charge Code	3154640
Hospital Revenue Code	360
Min. Negotiated Rate	$215.70
Max. Negotiated Rate	$872.10
Rate for Payer: Aetna Commercial	$826.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$215.70
Rate for Payer: Humana Medicare Advantage	$385.56
Rate for Payer: UnitedHealthcare Commercial	$872.10
Rate for Payer: UnitedHealthcare Medicaid	$295.27
Rate for Payer: WPPA Medicare Advantage	$550.80

Ablation; nerve

Facility

$918.00

Service Code	HCPCS 64640
Hospital Charge Code	3154640
Hospital Revenue Code	360
Min. Negotiated Rate	$826.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$826.20
Rate for Payer: UnitedHealthcare Commercial	$872.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Ablation Probe Aspirating Cool Cut 90

Facility

$551.00

Hospital Charge Code	3255620
Hospital Revenue Code	270
Min. Negotiated Rate	$495.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$495.90
Rate for Payer: UnitedHealthcare Commercial	$523.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Ablation Probe Aspirating Cool Cut 90

Facility

$551.00

Hospital Charge Code	3255620
Hospital Revenue Code	270
Min. Negotiated Rate	$220.40
Max. Negotiated Rate	$523.45
Rate for Payer: Aetna Commercial	$495.90
Rate for Payer: Humana Medicare Advantage	$231.42
Rate for Payer: UnitedHealthcare Commercial	$523.45
Rate for Payer: UnitedHealthcare Medicaid	$220.40
Rate for Payer: WPPA Medicare Advantage	$330.60

Abl Kinase Domain Mutation QST

Facility

$707.00

Service Code	HCPCS 81170
Hospital Charge Code	3551170
Hospital Revenue Code	300
Min. Negotiated Rate	$636.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$636.30
Rate for Payer: UnitedHealthcare Commercial	$671.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Abl Kinase Domain Mutation QST

Facility

$707.00

Service Code	HCPCS 81170
Hospital Charge Code	3551170
Hospital Revenue Code	300
Min. Negotiated Rate	$282.80
Max. Negotiated Rate	$671.65
Rate for Payer: Aetna Commercial	$636.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$454.50
Rate for Payer: Humana Medicare Advantage	$296.94
Rate for Payer: UnitedHealthcare Commercial	$671.65
Rate for Payer: UnitedHealthcare Medicaid	$282.80
Rate for Payer: WPPA Medicare Advantage	$424.20

ABO/Rh

Facility

$63.00

Service Code	HCPCS 86900
Hospital Charge Code	3560081
Hospital Revenue Code	300
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$210.75
Rate for Payer: Aetna Commercial	$56.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$210.75
Rate for Payer: Humana Medicare Advantage	$26.46
Rate for Payer: UnitedHealthcare Commercial	$59.85
Rate for Payer: UnitedHealthcare Medicaid	$2.99
Rate for Payer: WPPA Medicare Advantage	$37.80

ABO/Rh

Facility

$63.00

Service Code	HCPCS 86900
Hospital Charge Code	3560081
Hospital Revenue Code	300
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$56.70
Rate for Payer: UnitedHealthcare Commercial	$59.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,827.53

Service Code	MSDRG 770
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,827.53
Rate for Payer: UnitedHealthcare Medicaid	$2,827.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ABORTION WITHOUT D&C

Facility

$3,208.77

Service Code	MSDRG 779
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,208.77
Rate for Payer: UnitedHealthcare Medicaid	$3,208.77
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Ace Bandage 2 X 5 yd

Facility

$2.50

Hospital Charge Code	3250185
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Ace Bandage 2 X 5 yd

Facility

$2.50

Hospital Charge Code	3250185
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Ace Bandage 3 X 5 yd

Facility

$2.50

Hospital Charge Code	3250193
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Ace Bandage 3 X 5 yd

Facility

$2.50

Hospital Charge Code	3250193
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Ace Bandage 4 X 10 yd

Facility

$8.00

Hospital Charge Code	3250202
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Humana Medicare Advantage	$3.36
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Medicaid	$3.20
Rate for Payer: WPPA Medicare Advantage	$4.80

Ace Bandage 4 X 10 yd

Facility

$8.00

Hospital Charge Code	3250202
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges