Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

COLLECTION: COVID-19

Facility

$32.00

Service Code	HCPCS C9803
Hospital Charge Code	3552023
Hospital Revenue Code	300
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Medicaid	$12.80
Rate for Payer: WPPA Medicare Advantage	$19.20

COLLECTION: COVID-19

Facility

$32.00

Service Code	HCPCS C9803
Hospital Charge Code	3552023
Hospital Revenue Code	300
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

COLLECTION: Venous Draw

Facility

$47.00

Service Code	HCPCS 36415
Hospital Charge Code	3550890
Hospital Revenue Code	300
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

COLLECTION: Venous Draw

Facility

$47.00

Service Code	HCPCS 36415
Hospital Charge Code	3550890
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$44.65
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$12.05
Rate for Payer: Humana Medicare Advantage	$19.74
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: UnitedHealthcare Medicaid	$18.80
Rate for Payer: WPPA Medicare Advantage	$28.20

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX

Facility

$4,960.86

Service Code	CPT 57461
Hospital Revenue Code	360
Min. Negotiated Rate	$1,012.78
Max. Negotiated Rate	$4,960.86
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,538.23
Rate for Payer: UnitedHealthcare Medicaid	$1,012.78
Rate for Payer: WPPA Medicare Advantage	$4,960.86

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$34,120.98

Service Code	MSDRG 429
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$34,120.98
Rate for Payer: UnitedHealthcare Medicaid	$34,120.98
Rate for Payer: WPPA Medicare Advantage	$1,200.00

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$21,825.99

Service Code	MSDRG 430
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$21,825.99
Rate for Payer: UnitedHealthcare Medicaid	$21,825.99
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Combitube Rollup 41fr

Facility

$198.00

Hospital Charge Code	3256230
Hospital Revenue Code	270
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$178.20
Rate for Payer: Humana Medicare Advantage	$83.16
Rate for Payer: UnitedHealthcare Commercial	$188.10
Rate for Payer: UnitedHealthcare Medicaid	$79.20
Rate for Payer: WPPA Medicare Advantage	$118.80

Combitube Rollup 41fr

Facility

$198.00

Hospital Charge Code	3256230
Hospital Revenue Code	270
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$178.20
Rate for Payer: UnitedHealthcare Commercial	$188.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Comfy Boot w/fleece w/o amb pad size adult for plantar flexion contracture

Facility

$187.00

Hospital Charge Code	3251825
Hospital Revenue Code	270
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$177.65
Rate for Payer: Aetna Commercial	$168.30
Rate for Payer: Humana Medicare Advantage	$78.54
Rate for Payer: UnitedHealthcare Commercial	$177.65
Rate for Payer: UnitedHealthcare Medicaid	$74.80
Rate for Payer: WPPA Medicare Advantage	$112.20

Comfy Boot w/fleece w/o amb pad size adult for plantar flexion contracture

Facility

$187.00

Hospital Charge Code	3251825
Hospital Revenue Code	270
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$168.30
Rate for Payer: UnitedHealthcare Commercial	$177.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Common Ragweed (Short) (W1) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1007
Hospital Revenue Code	300
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Common Ragweed (Short) (W1) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1007
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$11.34
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$16.20

Compatible - Serological Immediate Spin

Facility

$91.00

Service Code	HCPCS 86920
Hospital Charge Code	3560149
Hospital Revenue Code	300
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: UnitedHealthcare Commercial	$86.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Compatible - Serological Immediate Spin

Facility

$91.00

Service Code	HCPCS 86920
Hospital Charge Code	3560149
Hospital Revenue Code	300
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$86.45
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$46.33
Rate for Payer: Humana Medicare Advantage	$38.22
Rate for Payer: UnitedHealthcare Commercial	$86.45
Rate for Payer: UnitedHealthcare Medicaid	$36.40
Rate for Payer: WPPA Medicare Advantage	$54.60

Compatible - XM AHG Gel Interp

Facility

$113.00

Service Code	HCPCS 86922
Hospital Charge Code	3560164
Hospital Revenue Code	300
Min. Negotiated Rate	$42.03
Max. Negotiated Rate	$107.35
Rate for Payer: Aetna Commercial	$101.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$42.03
Rate for Payer: Humana Medicare Advantage	$47.46
Rate for Payer: UnitedHealthcare Commercial	$107.35
Rate for Payer: UnitedHealthcare Medicaid	$45.20
Rate for Payer: WPPA Medicare Advantage	$67.80

Compatible - XM AHG Gel Interp

Facility

$113.00

Service Code	HCPCS 86922
Hospital Charge Code	3560164
Hospital Revenue Code	300
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$101.70
Rate for Payer: UnitedHealthcare Commercial	$107.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Compatible - XM AHG Tube Interp

Facility

$113.00

Service Code	HCPCS 86922
Hospital Charge Code	3560164
Hospital Revenue Code	300
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$101.70
Rate for Payer: UnitedHealthcare Commercial	$107.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Compatible - XM AHG Tube Interp

Facility

$113.00

Service Code	HCPCS 86922
Hospital Charge Code	3560164
Hospital Revenue Code	300
Min. Negotiated Rate	$42.03
Max. Negotiated Rate	$107.35
Rate for Payer: Aetna Commercial	$101.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$42.03
Rate for Payer: Humana Medicare Advantage	$47.46
Rate for Payer: UnitedHealthcare Commercial	$107.35
Rate for Payer: UnitedHealthcare Medicaid	$45.20
Rate for Payer: WPPA Medicare Advantage	$67.80

Complement Component C1Q QST

Facility

$135.00

Service Code	HCPCS 86160
Hospital Charge Code	3555861
Hospital Revenue Code	300
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: UnitedHealthcare Commercial	$128.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Complement Component C1Q QST

Facility

$135.00

Service Code	HCPCS 86160
Hospital Charge Code	3555861
Hospital Revenue Code	300
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$128.25
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$55.68
Rate for Payer: Humana Medicare Advantage	$56.70
Rate for Payer: UnitedHealthcare Commercial	$128.25
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: WPPA Medicare Advantage	$81.00

Complement Component C3C QST

Facility

$91.00

Service Code	HCPCS 86160
Hospital Charge Code	3556160
Hospital Revenue Code	300
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$86.45
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$55.68
Rate for Payer: Humana Medicare Advantage	$38.22
Rate for Payer: UnitedHealthcare Commercial	$86.45
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: WPPA Medicare Advantage	$54.60

Complement Component C3C QST

Facility

$91.00

Service Code	HCPCS 86160
Hospital Charge Code	3556160
Hospital Revenue Code	300
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: UnitedHealthcare Commercial	$86.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Complement Component C4C QST

Facility

$91.00

Service Code	HCPCS 86160
Hospital Charge Code	3551600
Hospital Revenue Code	300
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: UnitedHealthcare Commercial	$86.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Complement Component C4C QST

Facility

$91.00

Service Code	HCPCS 86160
Hospital Charge Code	3551600
Hospital Revenue Code	300
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$86.45
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$55.68
Rate for Payer: Humana Medicare Advantage	$38.22
Rate for Payer: UnitedHealthcare Commercial	$86.45
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: WPPA Medicare Advantage	$54.60

Know your out-of-pocket cost for care.

All Charges