Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Bill Only ABO

Facility

$46.00

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	$41.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$210.75
Rate for Payer: Humana Medicare Advantage	$19.32
Rate for Payer: UnitedHealthcare Commercial	$43.70
Rate for Payer: UnitedHealthcare Medicaid	$2.99
Rate for Payer: WPPA Medicare Advantage	$27.60

Bill Only ABO/Rh

Facility

$38.00

Service Code	HCPCS 86901
Hospital Charge Code	3560198
Hospital Revenue Code	300
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only ABO/Rh

Facility

$38.00

Service Code	HCPCS 86901
Hospital Charge Code	3560198
Hospital Revenue Code	300
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$61.64
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$61.64
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: UnitedHealthcare Medicaid	$2.99
Rate for Payer: WPPA Medicare Advantage	$22.80

Bill Only ABSC

Facility

$79.00

Service Code	HCPCS 86850
Hospital Charge Code	3560073
Hospital Revenue Code	300
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only ABSC

Facility

$79.00

Service Code	HCPCS 86850
Hospital Charge Code	3560073
Hospital Revenue Code	300
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$91.28
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$91.28
Rate for Payer: Humana Medicare Advantage	$33.18
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: UnitedHealthcare Medicaid	$8.30
Rate for Payer: WPPA Medicare Advantage	$47.40

Bill Only Alloadsorption

Facility

$184.00

Service Code	HCPCS 86978
Hospital Charge Code	3556978
Hospital Revenue Code	300
Min. Negotiated Rate	$54.27
Max. Negotiated Rate	$174.80
Rate for Payer: Aetna Commercial	$165.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$54.27
Rate for Payer: Humana Medicare Advantage	$77.28
Rate for Payer: UnitedHealthcare Commercial	$174.80
Rate for Payer: UnitedHealthcare Medicaid	$73.60
Rate for Payer: WPPA Medicare Advantage	$110.40

Bill Only Alloadsorption

Facility

$184.00

Service Code	HCPCS 86978
Hospital Charge Code	3556978
Hospital Revenue Code	300
Min. Negotiated Rate	$165.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$165.60
Rate for Payer: UnitedHealthcare Commercial	$174.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only Anaerobe ID

Facility

$100.00

Service Code	HCPCS 87076
Hospital Charge Code	3550941
Hospital Revenue Code	300
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only Anaerobe ID

Facility

$100.00

Service Code	HCPCS 87076
Hospital Charge Code	3550941
Hospital Revenue Code	300
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$30.65
Rate for Payer: Humana Medicare Advantage	$42.00
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Medicaid	$8.08
Rate for Payer: WPPA Medicare Advantage	$60.00

Bill Only ANA titer and pattern

Facility

$74.00

Service Code	HCPCS 86039
Hospital Charge Code	3556039
Hospital Revenue Code	300
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$41.77
Rate for Payer: Humana Medicare Advantage	$31.08
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: WPPA Medicare Advantage	$44.40

Bill Only ANA titer and pattern

Facility

$74.00

Service Code	HCPCS 86039
Hospital Charge Code	3556039
Hospital Revenue Code	300
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill only Androstenedione LC/MS/MS QST

Facility

$212.00

Service Code	HCPCS 82157
Hospital Charge Code	3552157
Hospital Revenue Code	300
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: UnitedHealthcare Commercial	$201.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill only Androstenedione LC/MS/MS QST

Facility

$212.00

Service Code	HCPCS 82157
Hospital Charge Code	3552157
Hospital Revenue Code	300
Min. Negotiated Rate	$24.89
Max. Negotiated Rate	$201.40
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$119.11
Rate for Payer: Humana Medicare Advantage	$89.04
Rate for Payer: UnitedHealthcare Commercial	$201.40
Rate for Payer: UnitedHealthcare Medicaid	$24.89
Rate for Payer: WPPA Medicare Advantage	$127.20

Bill Only Antibody Titer

Facility

$138.00

Service Code	HCPCS 86886
Hospital Charge Code	3556886
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$131.10
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$29.18
Rate for Payer: Humana Medicare Advantage	$57.96
Rate for Payer: UnitedHealthcare Commercial	$131.10
Rate for Payer: UnitedHealthcare Medicaid	$5.18
Rate for Payer: WPPA Medicare Advantage	$82.80

Bill Only Antibody Titer

Facility

$138.00

Service Code	HCPCS 86886
Hospital Charge Code	3556886
Hospital Revenue Code	300
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: UnitedHealthcare Commercial	$131.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only Antigen Typing

Facility

$75.00

Service Code	HCPCS 86902
Hospital Charge Code	3556905
Hospital Revenue Code	300
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$14.90
Rate for Payer: Humana Medicare Advantage	$31.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: WPPA Medicare Advantage	$45.00

Bill Only Antigen Typing

Facility

$75.00

Service Code	HCPCS 86902
Hospital Charge Code	3556905
Hospital Revenue Code	300
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only AP 88361 Tumor Comp Analysis

Facility

$3,570.00

Service Code	HCPCS 81459
Hospital Charge Code	3554159
Hospital Revenue Code	300
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$3,391.50
Rate for Payer: Aetna Commercial	$3,213.00
Rate for Payer: Humana Medicare Advantage	$1,499.40
Rate for Payer: UnitedHealthcare Commercial	$3,391.50
Rate for Payer: UnitedHealthcare Medicaid	$1,428.00
Rate for Payer: WPPA Medicare Advantage	$2,142.00

Bill Only AP 88361 Tumor Comp Analysis

Facility

$3,570.00

Service Code	HCPCS 81459
Hospital Charge Code	3554159
Hospital Revenue Code	300
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,391.50
Rate for Payer: Aetna Commercial	$3,213.00
Rate for Payer: UnitedHealthcare Commercial	$3,391.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only Cell Separation

Facility

$210.00

Service Code	HCPCS 86972
Hospital Charge Code	3556972
Hospital Revenue Code	300
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: UnitedHealthcare Commercial	$199.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only Cell Separation

Facility

$210.00

Service Code	HCPCS 86972
Hospital Charge Code	3556972
Hospital Revenue Code	300
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: Humana Medicare Advantage	$88.20
Rate for Payer: UnitedHealthcare Commercial	$199.50
Rate for Payer: UnitedHealthcare Medicaid	$84.00
Rate for Payer: WPPA Medicare Advantage	$126.00

Bill Only Cold Agglutinin

Facility

$90.00

Service Code	HCPCS 86156
Hospital Charge Code	3556971
Hospital Revenue Code	300
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: UnitedHealthcare Commercial	$85.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Bill Only Cold Agglutinin

Facility

$90.00

Service Code	HCPCS 86156
Hospital Charge Code	3556971
Hospital Revenue Code	300
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$39.99
Rate for Payer: Humana Medicare Advantage	$37.80
Rate for Payer: UnitedHealthcare Commercial	$85.50
Rate for Payer: UnitedHealthcare Medicaid	$7.50
Rate for Payer: WPPA Medicare Advantage	$54.00

Bill Only Cold Blood Elution

Facility

$138.00

Service Code	HCPCS 86860
Hospital Charge Code	3560289
Hospital Revenue Code	300
Min. Negotiated Rate	$19.23
Max. Negotiated Rate	$131.10
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$19.23
Rate for Payer: Humana Medicare Advantage	$57.96
Rate for Payer: UnitedHealthcare Commercial	$131.10
Rate for Payer: UnitedHealthcare Medicaid	$129.47
Rate for Payer: WPPA Medicare Advantage	$82.80

Bill Only Cold Blood Elution

Facility

$138.00

Service Code	HCPCS 86860
Hospital Charge Code	3560289
Hospital Revenue Code	300
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: UnitedHealthcare Commercial	$131.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges