Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$25,543.08

Service Code	MSDRG 275
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$25,543.08
Rate for Payer: UnitedHealthcare Medicaid	$25,543.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$21,540.06

Service Code	MSDRG 276
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$21,540.06
Rate for Payer: UnitedHealthcare Medicaid	$21,540.06
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$16,329.78

Service Code	MSDRG 277
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$16,329.78
Rate for Payer: UnitedHealthcare Medicaid	$16,329.78
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cardiac Event Monitor

Facility

$320.00

Service Code	HCPCS 93270
Hospital Charge Code	3600072
Hospital Revenue Code	731
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$288.00
Rate for Payer: UnitedHealthcare Commercial	$304.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cardiac Event Monitor

Facility

$320.00

Service Code	HCPCS 93270
Hospital Charge Code	3600072
Hospital Revenue Code	731
Min. Negotiated Rate	$32.63
Max. Negotiated Rate	$304.00
Rate for Payer: Aetna Commercial	$288.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$119.92
Rate for Payer: Humana Medicare Advantage	$134.40
Rate for Payer: UnitedHealthcare Commercial	$304.00
Rate for Payer: UnitedHealthcare Medicaid	$32.63
Rate for Payer: WPPA Medicare Advantage	$192.00

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$11,246.58

Service Code	MSDRG 258
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$11,246.58
Rate for Payer: UnitedHealthcare Medicaid	$11,246.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$7,243.56

Service Code	MSDRG 259
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,243.56
Rate for Payer: UnitedHealthcare Medicaid	$7,243.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$6,767.01

Service Code	MSDRG 261
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,767.01
Rate for Payer: UnitedHealthcare Medicaid	$6,767.01
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$11,659.59

Service Code	MSDRG 260
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$11,659.59
Rate for Payer: UnitedHealthcare Medicaid	$11,659.59
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$5,845.68

Service Code	MSDRG 262
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,845.68
Rate for Payer: UnitedHealthcare Medicaid	$5,845.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC REHAB MAINT/NEW CHARGE

Facility

$4.00

Hospital Charge Code	3860068
Hospital Revenue Code	943
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC REHAB MAINT/NEW CHARGE

Facility

$4.00

Hospital Charge Code	3860068
Hospital Revenue Code	943
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.80
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Humana Medicare Advantage	$1.68
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Medicaid	$1.60
Rate for Payer: WPPA Medicare Advantage	$2.40

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$33,390.27

Service Code	MSDRG 217
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$33,390.27
Rate for Payer: UnitedHealthcare Medicaid	$33,390.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$35,074.08

Service Code	MSDRG 216
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$35,074.08
Rate for Payer: UnitedHealthcare Medicaid	$35,074.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$31,801.77

Service Code	MSDRG 218
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$31,801.77
Rate for Payer: UnitedHealthcare Medicaid	$31,801.77
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$21,349.44

Service Code	MSDRG 220
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$21,349.44
Rate for Payer: UnitedHealthcare Medicaid	$21,349.44
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$27,512.82

Service Code	MSDRG 219
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$27,512.82
Rate for Payer: UnitedHealthcare Medicaid	$27,512.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$18,077.13

Service Code	MSDRG 221
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$18,077.13
Rate for Payer: UnitedHealthcare Medicaid	$18,077.13
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cardio IQ(R) Apolipoprotein B QST

Facility

$112.00

Service Code	HCPCS 82172
Hospital Charge Code	3552565
Hospital Revenue Code	300
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$100.80
Rate for Payer: UnitedHealthcare Commercial	$106.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cardio IQ(R) Apolipoprotein B QST

Facility

$112.00

Service Code	HCPCS 82172
Hospital Charge Code	3552565
Hospital Revenue Code	300
Min. Negotiated Rate	$33.26
Max. Negotiated Rate	$106.40
Rate for Payer: Aetna Commercial	$100.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$33.26
Rate for Payer: Humana Medicare Advantage	$47.04
Rate for Payer: UnitedHealthcare Commercial	$106.40
Rate for Payer: UnitedHealthcare Medicaid	$44.80
Rate for Payer: WPPA Medicare Advantage	$67.20

Cardio IQ(R) Cholesterol, Total QST

Facility

$54.00

Service Code	HCPCS 82465
Hospital Charge Code	3550247
Hospital Revenue Code	300
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$10.87
Rate for Payer: Humana Medicare Advantage	$22.68
Rate for Payer: UnitedHealthcare Commercial	$51.30
Rate for Payer: UnitedHealthcare Medicaid	$4.35
Rate for Payer: WPPA Medicare Advantage	$32.40

Cardio IQ(R) Cholesterol, Total QST

Facility

$54.00

Service Code	HCPCS 82465
Hospital Charge Code	3550247
Hospital Revenue Code	300
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: UnitedHealthcare Commercial	$51.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cardio IQ(R) HDL Cholesterol QST

Facility

$54.00

Service Code	HCPCS 82465
Hospital Charge Code	3550247
Hospital Revenue Code	300
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: UnitedHealthcare Commercial	$51.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cardio IQ(R) HDL Cholesterol QST

Facility

$54.00

Service Code	HCPCS 82465
Hospital Charge Code	3550247
Hospital Revenue Code	300
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$10.87
Rate for Payer: Humana Medicare Advantage	$22.68
Rate for Payer: UnitedHealthcare Commercial	$51.30
Rate for Payer: UnitedHealthcare Medicaid	$4.35
Rate for Payer: WPPA Medicare Advantage	$32.40

Cardio IQ(R) HS CRP QST

Facility

$102.00

Service Code	HCPCS 86141
Hospital Charge Code	3552470
Hospital Revenue Code	300
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$96.90
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$61.27
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$96.90
Rate for Payer: UnitedHealthcare Medicaid	$11.01
Rate for Payer: WPPA Medicare Advantage	$61.20

Know your out-of-pocket cost for care.

All Charges