Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Ceruloplasmin QST

Facility

$75.00

Service Code	HCPCS 82390
Hospital Charge Code	3552390
Hospital Revenue Code	300
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$37.33
Rate for Payer: Humana Medicare Advantage	$31.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: WPPA Medicare Advantage	$45.00

Cervical Collar Narrow Large

Facility

$32.99

Hospital Charge Code	3251319
Hospital Revenue Code	270
Min. Negotiated Rate	$29.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: UnitedHealthcare Commercial	$31.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cervical Collar Narrow Large

Facility

$32.99

Hospital Charge Code	3251319
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.34
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: UnitedHealthcare Commercial	$31.34
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: WPPA Medicare Advantage	$19.79

Cervical Collar Narrow Medium

Facility

$32.99

Hospital Charge Code	3251318
Hospital Revenue Code	270
Min. Negotiated Rate	$29.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: UnitedHealthcare Commercial	$31.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cervical Collar Narrow Medium

Facility

$32.99

Hospital Charge Code	3251318
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.34
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: UnitedHealthcare Commercial	$31.34
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: WPPA Medicare Advantage	$19.79

Cervical Collar Narrow Small

Facility

$32.99

Hospital Charge Code	3251317
Hospital Revenue Code	270
Min. Negotiated Rate	$29.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: UnitedHealthcare Commercial	$31.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cervical Collar Narrow Small

Facility

$32.99

Hospital Charge Code	3251317
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.34
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: UnitedHealthcare Commercial	$31.34
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: WPPA Medicare Advantage	$19.79

Cervical Collar Narrow X-Large

Facility

$37.49

Hospital Charge Code	3251325
Hospital Revenue Code	270
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$33.74
Rate for Payer: UnitedHealthcare Commercial	$35.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cervical Collar Narrow X-Large

Facility

$37.49

Hospital Charge Code	3251325
Hospital Revenue Code	270
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$35.62
Rate for Payer: Aetna Commercial	$33.74
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: UnitedHealthcare Commercial	$35.62
Rate for Payer: UnitedHealthcare Medicaid	$15.00
Rate for Payer: WPPA Medicare Advantage	$22.49

Cervical Collar Narrow X-Small

Facility

$32.99

Hospital Charge Code	3251324
Hospital Revenue Code	270
Min. Negotiated Rate	$29.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: UnitedHealthcare Commercial	$31.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cervical Collar Narrow X-Small

Facility

$32.99

Hospital Charge Code	3251324
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.34
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: UnitedHealthcare Commercial	$31.34
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: WPPA Medicare Advantage	$19.79

Cervical Facet/Medial Branch Block #1

Facility

$798.00

Service Code	HCPCS 64490
Hospital Charge Code	3154499
Hospital Revenue Code	360
Min. Negotiated Rate	$260.80
Max. Negotiated Rate	$758.10
Rate for Payer: Aetna Commercial	$718.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$536.11
Rate for Payer: Humana Medicare Advantage	$335.16
Rate for Payer: UnitedHealthcare Commercial	$758.10
Rate for Payer: UnitedHealthcare Medicaid	$260.80
Rate for Payer: WPPA Medicare Advantage	$478.80

Cervical Facet/Medial Branch Block #1

Facility

$798.00

Service Code	HCPCS 64490
Hospital Charge Code	3154499
Hospital Revenue Code	360
Min. Negotiated Rate	$718.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$718.20
Rate for Payer: UnitedHealthcare Commercial	$758.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cervical Facet/Medial Branch Block #2

Facility

$1,353.00

Service Code	HCPCS 64491
Hospital Charge Code	3154491
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,285.35
Rate for Payer: Aetna Commercial	$1,217.70
Rate for Payer: UnitedHealthcare Commercial	$1,285.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cervical Facet/Medial Branch Block #2

Facility

$1,353.00

Service Code	HCPCS 64491
Hospital Charge Code	3154491
Hospital Revenue Code	360
Min. Negotiated Rate	$92.58
Max. Negotiated Rate	$1,285.35
Rate for Payer: Aetna Commercial	$1,217.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$765.58
Rate for Payer: Humana Medicare Advantage	$568.26
Rate for Payer: UnitedHealthcare Commercial	$1,285.35
Rate for Payer: UnitedHealthcare Medicaid	$92.58
Rate for Payer: WPPA Medicare Advantage	$811.80

Cervical Facet/Medial Branch Block #3

Facility

$1,550.00

Service Code	HCPCS 64492
Hospital Charge Code	3154492
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,472.50
Rate for Payer: Aetna Commercial	$1,395.00
Rate for Payer: UnitedHealthcare Commercial	$1,472.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cervical Facet/Medial Branch Block #3

Facility

$1,550.00

Service Code	HCPCS 64492
Hospital Charge Code	3154492
Hospital Revenue Code	360
Min. Negotiated Rate	$92.58
Max. Negotiated Rate	$1,472.50
Rate for Payer: Aetna Commercial	$1,395.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,087.82
Rate for Payer: Humana Medicare Advantage	$651.00
Rate for Payer: UnitedHealthcare Commercial	$1,472.50
Rate for Payer: UnitedHealthcare Medicaid	$92.58
Rate for Payer: WPPA Medicare Advantage	$930.00

CERVICAL SPINAL FUSION WITH CC

Facility

$10,611.18

Service Code	MSDRG 472
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,611.18
Rate for Payer: UnitedHealthcare Medicaid	$10,611.18
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CERVICAL SPINAL FUSION WITH MCC

Facility

$11,119.50

Service Code	MSDRG 471
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$11,119.50
Rate for Payer: UnitedHealthcare Medicaid	$11,119.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$10,102.86

Service Code	MSDRG 473
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,102.86
Rate for Payer: UnitedHealthcare Medicaid	$10,102.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cesarean Section

Facility

$5,588.00

Service Code	HCPCS 59514
Hospital Charge Code	3150290
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,308.60
Rate for Payer: Aetna Commercial	$5,029.20
Rate for Payer: UnitedHealthcare Commercial	$5,308.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cesarean Section

Facility

$5,588.00

Service Code	HCPCS 59514
Hospital Charge Code	3150290
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.95
Max. Negotiated Rate	$5,308.60
Rate for Payer: Aetna Commercial	$5,029.20
Rate for Payer: Humana Medicare Advantage	$2,346.96
Rate for Payer: UnitedHealthcare Commercial	$5,308.60
Rate for Payer: UnitedHealthcare Medicaid	$1,048.95
Rate for Payer: WPPA Medicare Advantage	$3,352.80

Cesarean Section with Bilateral Tubal Ligation

Facility

$4,097.00

Service Code	HCPCS 58611
Hospital Charge Code	3150645
Hospital Revenue Code	360
Min. Negotiated Rate	$1,638.80
Max. Negotiated Rate	$3,892.15
Rate for Payer: Aetna Commercial	$3,687.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,356.33
Rate for Payer: Humana Medicare Advantage	$1,720.74
Rate for Payer: UnitedHealthcare Commercial	$3,892.15
Rate for Payer: UnitedHealthcare Medicaid	$1,638.80
Rate for Payer: WPPA Medicare Advantage	$2,458.20

Cesarean Section with Bilateral Tubal Ligation

Facility

$4,097.00

Service Code	HCPCS 58611
Hospital Charge Code	3150645
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,892.15
Rate for Payer: Aetna Commercial	$3,687.30
Rate for Payer: UnitedHealthcare Commercial	$3,892.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$3,748.86

Service Code	MSDRG 787
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,748.86
Rate for Payer: UnitedHealthcare Medicaid	$3,748.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges