Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)

Facility

$200.00

Service Code	HCPCS 20550
Hospital Charge Code	3290550
Hospital Revenue Code	761
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: UnitedHealthcare Commercial	$190.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)

Facility

$200.00

Service Code	HCPCS 20550
Hospital Charge Code	3290550
Hospital Revenue Code	761
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$192.19
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$142.41
Rate for Payer: Humana Medicare Advantage	$84.00
Rate for Payer: UnitedHealthcare Commercial	$190.00
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$120.00

20550 INJ TENDON/LIG/CYST CHARGE

Facility

$281.00

Service Code	HCPCS 20550
Hospital Charge Code	3350315
Hospital Revenue Code	761
Min. Negotiated Rate	$252.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: UnitedHealthcare Commercial	$266.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20550 INJ TENDON/LIG/CYST CHARGE

Facility

$281.00

Service Code	HCPCS 20550
Hospital Charge Code	3350315
Hospital Revenue Code	761
Min. Negotiated Rate	$118.02
Max. Negotiated Rate	$266.95
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$142.41
Rate for Payer: Humana Medicare Advantage	$118.02
Rate for Payer: UnitedHealthcare Commercial	$266.95
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$168.60

20550 INJ TENDON SHEATH/LIGAMENT

Facility

$281.00

Service Code	HCPCS 20550
Hospital Charge Code	3152550
Hospital Revenue Code	360
Min. Negotiated Rate	$252.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: UnitedHealthcare Commercial	$266.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20550 INJ TENDON SHEATH/LIGAMENT

Facility

$281.00

Service Code	HCPCS 20550
Hospital Charge Code	3152550
Hospital Revenue Code	360
Min. Negotiated Rate	$118.02
Max. Negotiated Rate	$266.95
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$142.41
Rate for Payer: Humana Medicare Advantage	$118.02
Rate for Payer: UnitedHealthcare Commercial	$266.95
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$168.60

20551 Injection(s) single tendon origin/insertion

Facility

$281.00

Service Code	HCPCS 20551
Hospital Charge Code	3350320
Hospital Revenue Code	761
Min. Negotiated Rate	$118.02
Max. Negotiated Rate	$266.95
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$142.41
Rate for Payer: Humana Medicare Advantage	$118.02
Rate for Payer: UnitedHealthcare Commercial	$266.95
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$168.60

20551 Injection(s) single tendon origin/insertion

Facility

$281.00

Service Code	HCPCS 20551
Hospital Charge Code	3350320
Hospital Revenue Code	761
Min. Negotiated Rate	$252.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: UnitedHealthcare Commercial	$266.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20552-Inject Trigger Point 1-2 Muscles TechFee

Facility

$458.00

Service Code	HCPCS 20552
Hospital Charge Code	3300552
Hospital Revenue Code	450
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$435.10
Rate for Payer: Aetna Commercial	$412.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$192.36
Rate for Payer: UnitedHealthcare Commercial	$435.10
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$274.80

20552-Inject Trigger Point 1-2 Muscles TechFee

Facility

$458.00

Service Code	HCPCS 20552
Hospital Charge Code	3300552
Hospital Revenue Code	450
Min. Negotiated Rate	$412.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$412.20
Rate for Payer: UnitedHealthcare Commercial	$435.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20552 TRIGGER POINT INJECTION

Facility

$458.00

Service Code	HCPCS 20552
Hospital Charge Code	3150730
Hospital Revenue Code	360
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$435.10
Rate for Payer: Aetna Commercial	$412.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$192.36
Rate for Payer: UnitedHealthcare Commercial	$435.10
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$274.80

20552 TRIGGER POINT INJECTION

Facility

$458.00

Service Code	HCPCS 20552
Hospital Charge Code	3150730
Hospital Revenue Code	360
Min. Negotiated Rate	$412.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$412.20
Rate for Payer: UnitedHealthcare Commercial	$435.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes)

Facility

$605.00

Service Code	HCPCS 20600
Hospital Charge Code	3350230
Hospital Revenue Code	761
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$574.75
Rate for Payer: Aetna Commercial	$544.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$254.10
Rate for Payer: UnitedHealthcare Commercial	$574.75
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$363.00

20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes)

Facility

$605.00

Service Code	HCPCS 20600
Hospital Charge Code	3350230
Hospital Revenue Code	761
Min. Negotiated Rate	$544.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$544.50
Rate for Payer: UnitedHealthcare Commercial	$574.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20600-Small Joint Aspirate/Inject w/o US

Facility

$754.00

Service Code	HCPCS 20600
Hospital Charge Code	3300600
Hospital Revenue Code	450
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$716.30
Rate for Payer: Aetna Commercial	$678.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$316.68
Rate for Payer: UnitedHealthcare Commercial	$716.30
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$452.40

20600-Small Joint Aspirate/Inject w/o US

Facility

$754.00

Service Code	HCPCS 20600
Hospital Charge Code	3300600
Hospital Revenue Code	450
Min. Negotiated Rate	$678.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$678.60
Rate for Payer: UnitedHealthcare Commercial	$716.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa

Facility

$754.00

Service Code	HCPCS 20605
Hospital Charge Code	3350140
Hospital Revenue Code	761
Min. Negotiated Rate	$678.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$678.60
Rate for Payer: UnitedHealthcare Commercial	$716.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa

Facility

$754.00

Service Code	HCPCS 20605
Hospital Charge Code	3350140
Hospital Revenue Code	761
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$716.30
Rate for Payer: Aetna Commercial	$678.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$316.68
Rate for Payer: UnitedHealthcare Commercial	$716.30
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$452.40

20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa, w/o ultrasound guida

Facility

$458.00

Service Code	HCPCS 20605
Hospital Charge Code	3290605
Hospital Revenue Code	761
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$435.10
Rate for Payer: Aetna Commercial	$412.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$192.36
Rate for Payer: UnitedHealthcare Commercial	$435.10
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$274.80

20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa, w/o ultrasound guida

Facility

$458.00

Service Code	HCPCS 20605
Hospital Charge Code	3290605
Hospital Revenue Code	761
Min. Negotiated Rate	$412.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$412.20
Rate for Payer: UnitedHealthcare Commercial	$435.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20605 ARTHROCENTESIS INTERMED JOINT BURSA CHARGE

Facility

$718.00

Service Code	HCPCS 20605
Hospital Charge Code	3156050
Hospital Revenue Code	360
Min. Negotiated Rate	$646.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$646.20
Rate for Payer: UnitedHealthcare Commercial	$682.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20605 ARTHROCENTESIS INTERMED JOINT BURSA CHARGE

Facility

$718.00

Service Code	HCPCS 20605
Hospital Charge Code	3156050
Hospital Revenue Code	360
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$682.10
Rate for Payer: Aetna Commercial	$646.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$301.56
Rate for Payer: UnitedHealthcare Commercial	$682.10
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$430.80

20605-Intermediate Aspiration/Inj w/o US

Facility

$242.00

Service Code	HCPCS 20605
Hospital Charge Code	3304760
Hospital Revenue Code	450
Min. Negotiated Rate	$217.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$217.80
Rate for Payer: UnitedHealthcare Commercial	$229.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

20605-Intermediate Aspiration/Inj w/o US

Facility

$242.00

Service Code	HCPCS 20605
Hospital Charge Code	3304760
Hospital Revenue Code	450
Min. Negotiated Rate	$101.64
Max. Negotiated Rate	$330.53
Rate for Payer: Aetna Commercial	$217.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$101.64
Rate for Payer: UnitedHealthcare Commercial	$229.90
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$145.20

20610 Arthrocentesis aspiration and/or injection major joint or bursa without ultrasound guidance

Facility

$1,130.00

Service Code	HCPCS 20610
Hospital Charge Code	3290046
Hospital Revenue Code	761
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,073.50
Rate for Payer: Aetna Commercial	$1,017.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$474.60
Rate for Payer: UnitedHealthcare Commercial	$1,073.50
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$678.00

Know your out-of-pocket cost for care.

All Charges