Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

HEADACHES WITH MCC

Facility

$5,083.20

Service Code	MSDRG 102
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,083.20
Rate for Payer: UnitedHealthcare Medicaid	$5,083.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEADACHES WITHOUT MCC

Facility

$3,113.46

Service Code	MSDRG 103
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,113.46
Rate for Payer: UnitedHealthcare Medicaid	$3,113.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Headless Screw 3.0mm X 20mm

Facility

$1,171.00

Hospital Charge Code	3258596
Hospital Revenue Code	270
Min. Negotiated Rate	$1,053.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,053.90
Rate for Payer: UnitedHealthcare Commercial	$1,112.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Headless Screw 3.0mm X 20mm

Facility

$1,171.00

Hospital Charge Code	3258596
Hospital Revenue Code	270
Min. Negotiated Rate	$468.40
Max. Negotiated Rate	$1,112.45
Rate for Payer: Aetna Commercial	$1,053.90
Rate for Payer: Humana Medicare Advantage	$491.82
Rate for Payer: UnitedHealthcare Commercial	$1,112.45
Rate for Payer: UnitedHealthcare Medicaid	$468.40
Rate for Payer: WPPA Medicare Advantage	$702.60

Headless Screw 3.0 X 26mm

Facility

$1,171.00

Hospital Charge Code	3258599
Hospital Revenue Code	270
Min. Negotiated Rate	$1,053.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,053.90
Rate for Payer: UnitedHealthcare Commercial	$1,112.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Headless Screw 3.0 X 26mm

Facility

$1,171.00

Hospital Charge Code	3258599
Hospital Revenue Code	270
Min. Negotiated Rate	$468.40
Max. Negotiated Rate	$1,112.45
Rate for Payer: Aetna Commercial	$1,053.90
Rate for Payer: Humana Medicare Advantage	$491.82
Rate for Payer: UnitedHealthcare Commercial	$1,112.45
Rate for Payer: UnitedHealthcare Medicaid	$468.40
Rate for Payer: WPPA Medicare Advantage	$702.60

Head Screw 3.0mm X 22mm

Facility

$877.00

Hospital Charge Code	3258583
Hospital Revenue Code	270
Min. Negotiated Rate	$789.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$789.30
Rate for Payer: UnitedHealthcare Commercial	$833.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Head Screw 3.0mm X 22mm

Facility

$877.00

Hospital Charge Code	3258583
Hospital Revenue Code	270
Min. Negotiated Rate	$350.80
Max. Negotiated Rate	$833.15
Rate for Payer: Aetna Commercial	$789.30
Rate for Payer: Humana Medicare Advantage	$368.34
Rate for Payer: UnitedHealthcare Commercial	$833.15
Rate for Payer: UnitedHealthcare Medicaid	$350.80
Rate for Payer: WPPA Medicare Advantage	$526.20

HEART FAILURE AND SHOCK WITH CC

Facility

$4,670.19

Service Code	MSDRG 292
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

HEART FAILURE AND SHOCK WITH MCC

Facility

$5,813.91

Service Code	MSDRG 291
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,813.91
Rate for Payer: UnitedHealthcare Medicaid	$5,813.91
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$2,668.68

Service Code	MSDRG 293
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,668.68
Rate for Payer: UnitedHealthcare Medicaid	$2,668.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HeartStart Smart Pads II for FRX AED

Facility

$132.00

Hospital Charge Code	3253604
Hospital Revenue Code	270
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$125.40
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: Humana Medicare Advantage	$55.44
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: UnitedHealthcare Medicaid	$52.80
Rate for Payer: WPPA Medicare Advantage	$79.20

HeartStart Smart Pads II for FRX AED

Facility

$132.00

Hospital Charge Code	3253604
Hospital Revenue Code	270
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$74,055.87

Service Code	MSDRG 001
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$74,055.87
Rate for Payer: UnitedHealthcare Medicaid	$74,055.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$29,959.11

Service Code	MSDRG 002
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$29,959.11
Rate for Payer: UnitedHealthcare Medicaid	$29,959.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Heat Therapy Blanket Hyperthermia Duo Therm 24 X 60 K-Blanket

Facility

$45.32

Hospital Charge Code	3257487
Hospital Revenue Code	270
Min. Negotiated Rate	$18.13
Max. Negotiated Rate	$43.05
Rate for Payer: Aetna Commercial	$40.79
Rate for Payer: Humana Medicare Advantage	$19.03
Rate for Payer: UnitedHealthcare Commercial	$43.05
Rate for Payer: UnitedHealthcare Medicaid	$18.13
Rate for Payer: WPPA Medicare Advantage	$27.19

Heat Therapy Blanket Hyperthermia Duo Therm 24 X 60 K-Blanket

Facility

$45.32

Hospital Charge Code	3257487
Hospital Revenue Code	270
Min. Negotiated Rate	$40.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$40.79
Rate for Payer: UnitedHealthcare Commercial	$43.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Heat Therapy Pad Hyperthermia Duo Therm 14 X 20 K-Pad

Facility

$16.61

Hospital Charge Code	3250888
Hospital Revenue Code	270
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$15.78
Rate for Payer: Aetna Commercial	$14.95
Rate for Payer: Humana Medicare Advantage	$6.98
Rate for Payer: UnitedHealthcare Commercial	$15.78
Rate for Payer: UnitedHealthcare Medicaid	$6.64
Rate for Payer: WPPA Medicare Advantage	$9.97

Heat Therapy Pad Hyperthermia Duo Therm 14 X 20 K-Pad

Facility

$16.61

Hospital Charge Code	3250888
Hospital Revenue Code	270
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.95
Rate for Payer: UnitedHealthcare Commercial	$15.78
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Heavy Metals Panel QST

Facility

$179.00

Service Code	HCPCS 83018
Hospital Charge Code	3553018
Hospital Revenue Code	300
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$170.05
Rate for Payer: Aetna Commercial	$161.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$45.97
Rate for Payer: Humana Medicare Advantage	$75.18
Rate for Payer: UnitedHealthcare Commercial	$170.05
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: WPPA Medicare Advantage	$107.40

Heavy Metals Panel QST

Facility

$179.00

Service Code	HCPCS 83018
Hospital Charge Code	3553018
Hospital Revenue Code	300
Min. Negotiated Rate	$161.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$161.10
Rate for Payer: UnitedHealthcare Commercial	$170.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEEL/ELBOW MED/SM

Facility

$14.67

Hospital Charge Code	3251100
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: UnitedHealthcare Commercial	$13.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEEL/ELBOW MED/SM

Facility

$14.67

Hospital Charge Code	3251100
Hospital Revenue Code	270
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$13.94
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Humana Medicare Advantage	$6.16
Rate for Payer: UnitedHealthcare Commercial	$13.94
Rate for Payer: UnitedHealthcare Medicaid	$5.87
Rate for Payer: WPPA Medicare Advantage	$8.80

Heel Lift Adjust-A-Lift Large

Facility

$18.00

Hospital Charge Code	3250593
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Humana Medicare Advantage	$7.56
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: WPPA Medicare Advantage	$10.80

Heel Lift Adjust-A-Lift Large

Facility

$18.00

Hospital Charge Code	3250593
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges