Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$7,243.56

Service Code	MSDRG 073
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

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$4,670.19

Service Code	MSDRG 074
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,670.19
Rate for Payer: UnitedHealthcare Medicaid	$4,670.19
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$10,515.87

Service Code	MSDRG 026
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,515.87
Rate for Payer: UnitedHealthcare Medicaid	$10,515.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$17,600.58

Service Code	MSDRG 025
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$17,600.58
Rate for Payer: UnitedHealthcare Medicaid	$17,600.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$9,181.53

Service Code	MSDRG 027
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,181.53
Rate for Payer: UnitedHealthcare Medicaid	$9,181.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$12,326.76

Service Code	MSDRG 955
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$12,326.76
Rate for Payer: UnitedHealthcare Medicaid	$12,326.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$19,919.79

Service Code	MSDRG 023
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$19,919.79
Rate for Payer: UnitedHealthcare Medicaid	$19,919.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$14,232.96

Service Code	MSDRG 024
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$14,232.96
Rate for Payer: UnitedHealthcare Medicaid	$14,232.96
Rate for Payer: WPPA Medicare Advantage	$1,200.00

C-Reactive Protein

Facility

$91.00

Service Code	HCPCS 86140
Hospital Charge Code	3552151
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$86.45
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$26.14
Rate for Payer: Humana Medicare Advantage	$38.22
Rate for Payer: UnitedHealthcare Commercial	$86.45
Rate for Payer: UnitedHealthcare Medicaid	$5.18
Rate for Payer: WPPA Medicare Advantage	$54.60

C-Reactive Protein

Facility

$91.00

Service Code	HCPCS 86140
Hospital Charge Code	3552151
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

Creatine Kinase

Facility

$74.00

Service Code	HCPCS 82550
Hospital Charge Code	3553550
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

Creatine Kinase

Facility

$74.00

Service Code	HCPCS 82550
Hospital Charge Code	3553550
Hospital Revenue Code	300
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.11
Rate for Payer: Humana Medicare Advantage	$31.08
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: UnitedHealthcare Medicaid	$6.51
Rate for Payer: WPPA Medicare Advantage	$44.40

Creatine Kinase

Facility

$229.00

Service Code	HCPCS 84484
Hospital Charge Code	3552508
Hospital Revenue Code	300
Min. Negotiated Rate	$206.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Creatine Kinase

Facility

$229.00

Service Code	HCPCS 84484
Hospital Charge Code	3552508
Hospital Revenue Code	300
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$217.55
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$68.59
Rate for Payer: Humana Medicare Advantage	$96.18
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: UnitedHealthcare Medicaid	$12.47
Rate for Payer: WPPA Medicare Advantage	$137.40

Creatinine

Facility

$64.00

Service Code	HCPCS 82565
Hospital Charge Code	3550296
Hospital Revenue Code	300
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: UnitedHealthcare Commercial	$60.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Creatinine

Facility

$64.00

Service Code	HCPCS 82565
Hospital Charge Code	3550296
Hospital Revenue Code	300
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$60.80
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$11.00
Rate for Payer: Humana Medicare Advantage	$26.88
Rate for Payer: UnitedHealthcare Commercial	$60.80
Rate for Payer: UnitedHealthcare Medicaid	$5.12
Rate for Payer: WPPA Medicare Advantage	$38.40

Creatinine Clearance

Facility

$116.00

Service Code	HCPCS 82575
Hospital Charge Code	3550304
Hospital Revenue Code	300
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$104.40
Rate for Payer: UnitedHealthcare Commercial	$110.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Creatinine Clearance

Facility

$116.00

Service Code	HCPCS 82575
Hospital Charge Code	3550304
Hospital Revenue Code	300
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$110.20
Rate for Payer: Aetna Commercial	$104.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$35.11
Rate for Payer: Humana Medicare Advantage	$48.72
Rate for Payer: UnitedHealthcare Commercial	$110.20
Rate for Payer: UnitedHealthcare Medicaid	$9.46
Rate for Payer: WPPA Medicare Advantage	$69.60

Creatinine Level 24 Hour Urine

Facility

$74.00

Service Code	HCPCS 82570
Hospital Charge Code	3551773
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$21.53
Rate for Payer: Humana Medicare Advantage	$31.08
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: UnitedHealthcare Medicaid	$5.18
Rate for Payer: WPPA Medicare Advantage	$44.40

Creatinine Level 24 Hour Urine

Facility

$74.00

Service Code	HCPCS 82570
Hospital Charge Code	3551773
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

Creatinine U24 QST

Facility

$74.00

Service Code	HCPCS 82570
Hospital Charge Code	LAB0010
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

Creatinine U24 QST

Facility

$74.00

Service Code	HCPCS 82570
Hospital Charge Code	LAB0010
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$21.53
Rate for Payer: Humana Medicare Advantage	$31.08
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: UnitedHealthcare Medicaid	$5.18
Rate for Payer: WPPA Medicare Advantage	$44.40

Creatinine Urine

Facility

$74.00

Service Code	HCPCS 82570
Hospital Charge Code	3551774
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

Creatinine Urine

Facility

$74.00

Service Code	HCPCS 82570
Hospital Charge Code	3551774
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$21.53
Rate for Payer: Humana Medicare Advantage	$31.08
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: UnitedHealthcare Medicaid	$5.18
Rate for Payer: WPPA Medicare Advantage	$44.40

Critical Care Ill/Injured Patient Addl 30 Min 99292

Facility

$541.00

Service Code	HCPCS 99292
Hospital Charge Code	3300200
Hospital Revenue Code	450
Min. Negotiated Rate	$486.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$486.90
Rate for Payer: UnitedHealthcare Commercial	$513.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges