Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$4,416.03

Service Code	MSDRG 352
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,416.03
Rate for Payer: UnitedHealthcare Medicaid	$4,416.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Injection Joint

Facility

$578.00

Service Code	HCPCS 20600
Hospital Charge Code	3150600
Hospital Revenue Code	360
Min. Negotiated Rate	$520.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$520.20
Rate for Payer: UnitedHealthcare Commercial	$549.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Injection Joint

Facility

$578.00

Service Code	HCPCS 20600
Hospital Charge Code	3150600
Hospital Revenue Code	360
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$549.10
Rate for Payer: Aetna Commercial	$520.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$242.76
Rate for Payer: UnitedHealthcare Commercial	$549.10
Rate for Payer: UnitedHealthcare Medicaid	$192.19
Rate for Payer: WPPA Medicare Advantage	$346.80

Injection Large Joint US Guided

Facility

$896.00

Service Code	HCPCS 20611
Hospital Charge Code	3152061
Hospital Revenue Code	360
Min. Negotiated Rate	$806.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$806.40
Rate for Payer: UnitedHealthcare Commercial	$851.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Injection Large Joint US Guided

Facility

$896.00

Service Code	HCPCS 20611
Hospital Charge Code	3152061
Hospital Revenue Code	360
Min. Negotiated Rate	$142.73
Max. Negotiated Rate	$851.20
Rate for Payer: Aetna Commercial	$806.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$330.53
Rate for Payer: Humana Medicare Advantage	$376.32
Rate for Payer: UnitedHealthcare Commercial	$851.20
Rate for Payer: UnitedHealthcare Medicaid	$142.73
Rate for Payer: WPPA Medicare Advantage	$537.60

Injection Medication Intramuscular

Facility

$167.00

Service Code	HCPCS 96372
Hospital Charge Code	3196372
Hospital Revenue Code	360
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$158.65
Rate for Payer: Aetna Commercial	$150.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$83.90
Rate for Payer: Humana Medicare Advantage	$70.14
Rate for Payer: UnitedHealthcare Commercial	$158.65
Rate for Payer: UnitedHealthcare Medicaid	$16.83
Rate for Payer: WPPA Medicare Advantage	$100.20

Injection Medication Intramuscular

Facility

$167.00

Service Code	HCPCS 96372
Hospital Charge Code	3196372
Hospital Revenue Code	360
Min. Negotiated Rate	$150.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$150.30
Rate for Payer: UnitedHealthcare Commercial	$158.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Injection Sacroiliac Joint

Facility

$1,274.00

Service Code	HCPCS 27096
Hospital Charge Code	3150716
Hospital Revenue Code	360
Min. Negotiated Rate	$1,146.60
Max. Negotiated Rate	$1,210.30
Rate for Payer: Aetna Commercial	$1,146.60
Rate for Payer: UnitedHealthcare Commercial	$1,210.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Injection Sacroiliac Joint

Facility

$1,274.00

Service Code	HCPCS 27096
Hospital Charge Code	3150716
Hospital Revenue Code	360
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$1,210.30
Rate for Payer: Aetna Commercial	$1,146.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$675.69
Rate for Payer: Humana Medicare Advantage	$535.08
Rate for Payer: UnitedHealthcare Commercial	$1,210.30
Rate for Payer: UnitedHealthcare Medicaid	$104.00
Rate for Payer: WPPA Medicare Advantage	$764.40

Injection Therapeutic Agent Epidural Thoracic

Facility

$1,262.00

Service Code	HCPCS 64479
Hospital Charge Code	3150750
Hospital Revenue Code	360
Min. Negotiated Rate	$1,135.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,135.80
Rate for Payer: UnitedHealthcare Commercial	$1,198.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Injection Therapeutic Agent Epidural Thoracic

Facility

$1,262.00

Service Code	HCPCS 64479
Hospital Charge Code	3150750
Hospital Revenue Code	360
Min. Negotiated Rate	$295.27
Max. Negotiated Rate	$1,198.90
Rate for Payer: Aetna Commercial	$1,135.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$726.81
Rate for Payer: Humana Medicare Advantage	$530.04
Rate for Payer: UnitedHealthcare Commercial	$1,198.90
Rate for Payer: UnitedHealthcare Medicaid	$295.27
Rate for Payer: WPPA Medicare Advantage	$757.20

Injection Therapeutic Agent Tendon Sheath Upper Extremity

Facility

$281.00

Service Code	HCPCS 20551
Hospital Charge Code	3150551
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

Injection Therapeutic Agent Tendon Sheath Upper Extremity

Facility

$281.00

Service Code	HCPCS 20551
Hospital Charge Code	3150551
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

Injection Trigger Point Multiple Muscles

Facility

$458.00

Service Code	HCPCS 20553
Hospital Charge Code	3150736
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

Injection Trigger Point Multiple Muscles

Facility

$458.00

Service Code	HCPCS 20553
Hospital Charge Code	3150736
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

Insertion Central Venous Line

Facility

$4,317.00

Service Code	HCPCS 36556
Hospital Charge Code	3150526
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,101.15
Rate for Payer: Aetna Commercial	$3,885.30
Rate for Payer: UnitedHealthcare Commercial	$4,101.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Insertion Central Venous Line

Facility

$4,317.00

Service Code	HCPCS 36556
Hospital Charge Code	3150526
Hospital Revenue Code	360
Min. Negotiated Rate	$382.20
Max. Negotiated Rate	$4,101.15
Rate for Payer: Aetna Commercial	$3,885.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,666.40
Rate for Payer: Humana Medicare Advantage	$1,813.14
Rate for Payer: UnitedHealthcare Commercial	$4,101.15
Rate for Payer: UnitedHealthcare Medicaid	$382.20
Rate for Payer: WPPA Medicare Advantage	$2,590.20

Insertion Dialysis Catheter

Facility

$5,712.00

Service Code	HCPCS 49418
Hospital Charge Code	3156556
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,426.40
Rate for Payer: Aetna Commercial	$5,140.80
Rate for Payer: UnitedHealthcare Commercial	$5,426.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Insertion Dialysis Catheter

Facility

$5,712.00

Service Code	HCPCS 49418
Hospital Charge Code	3156556
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.38
Max. Negotiated Rate	$5,426.40
Rate for Payer: Aetna Commercial	$5,140.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,120.43
Rate for Payer: Humana Medicare Advantage	$2,399.04
Rate for Payer: UnitedHealthcare Commercial	$5,426.40
Rate for Payer: UnitedHealthcare Medicaid	$1,147.38
Rate for Payer: WPPA Medicare Advantage	$3,427.20

INSERTION OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF

Facility

$5,486.93

Service Code	CPT 32550
Hospital Revenue Code	360
Min. Negotiated Rate	$1,322.27
Max. Negotiated Rate	$5,486.93
Rate for Payer: UnitedHealthcare Medicaid	$1,322.27
Rate for Payer: WPPA Medicare Advantage	$5,486.93

Inspire

Facility

$78,750.00

Service Code	HCPCS 64582
Hospital Charge Code	3154582
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$74,812.50
Rate for Payer: Aetna Commercial	$70,875.00
Rate for Payer: UnitedHealthcare Commercial	$74,812.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Inspire

Facility

$78,750.00

Service Code	HCPCS 64582
Hospital Charge Code	3154582
Hospital Revenue Code	360
Min. Negotiated Rate	$19,541.26
Max. Negotiated Rate	$74,812.50
Rate for Payer: Aetna Commercial	$70,875.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36,982.86
Rate for Payer: Humana Medicare Advantage	$33,075.00
Rate for Payer: UnitedHealthcare Commercial	$74,812.50
Rate for Payer: UnitedHealthcare Medicaid	$19,541.26
Rate for Payer: WPPA Medicare Advantage	$47,250.00

Inspire Implantable Pulse Generator IV (replaced with V)

Facility

$38,273.00

Service Code	HCPCS C1767
Hospital Charge Code	3257110
Hospital Revenue Code	278
Min. Negotiated Rate	$15,309.20
Max. Negotiated Rate	$36,359.35
Rate for Payer: Aetna Commercial	$34,445.70
Rate for Payer: Humana Medicare Advantage	$16,074.66
Rate for Payer: UnitedHealthcare Commercial	$36,359.35
Rate for Payer: UnitedHealthcare Medicaid	$15,309.20
Rate for Payer: WPPA Medicare Advantage	$22,963.80

Inspire Implantable Pulse Generator IV (replaced with V)

Facility

$38,273.00

Service Code	HCPCS C1767
Hospital Charge Code	3257110
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$36,359.35
Rate for Payer: Aetna Commercial	$34,445.70
Rate for Payer: UnitedHealthcare Commercial	$36,359.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Inspire Implantable Pulse Generator V with Built-in Respiratory Sensing Lead (Replaces System IV Gen

Facility

$43,200.00

Service Code	HCPCS C1767
Hospital Charge Code	3257115
Hospital Revenue Code	278
Min. Negotiated Rate	$17,280.00
Max. Negotiated Rate	$41,040.00
Rate for Payer: Aetna Commercial	$38,880.00
Rate for Payer: Humana Medicare Advantage	$18,144.00
Rate for Payer: UnitedHealthcare Commercial	$41,040.00
Rate for Payer: UnitedHealthcare Medicaid	$17,280.00
Rate for Payer: WPPA Medicare Advantage	$25,920.00

Know your out-of-pocket cost for care.

All Charges