Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$2,986.38

Service Code	MSDRG 142
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,986.38
Rate for Payer: UnitedHealthcare Medicaid	$2,986.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$5,623.29

Service Code	MSDRG 809
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,623.29
Rate for Payer: UnitedHealthcare Medicaid	$5,623.29
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$9,785.16

Service Code	MSDRG 808
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,785.16
Rate for Payer: UnitedHealthcare Medicaid	$9,785.16
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$4,638.42

Service Code	MSDRG 810
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,638.42
Rate for Payer: UnitedHealthcare Medicaid	$4,638.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$11,468.97

Service Code	MSDRG 469
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$11,468.97
Rate for Payer: UnitedHealthcare Medicaid	$11,468.97
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$10,420.56

Service Code	MSDRG 470
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,420.56
Rate for Payer: UnitedHealthcare Medicaid	$10,420.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$10,484.10

Service Code	MSDRG 483
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,484.10
Rate for Payer: UnitedHealthcare Medicaid	$10,484.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$7,021.17

Service Code	MSDRG 707
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,021.17
Rate for Payer: UnitedHealthcare Medicaid	$7,021.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$5,369.13

Service Code	MSDRG 708
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,369.13
Rate for Payer: UnitedHealthcare Medicaid	$5,369.13
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility

$6,830.55

Service Code	MSDRG 507
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,830.55
Rate for Payer: UnitedHealthcare Medicaid	$6,830.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility

$5,718.60

Service Code	MSDRG 508
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,718.60
Rate for Payer: UnitedHealthcare Medicaid	$5,718.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR SKIN DISORDERS WITH MCC

Facility

$9,944.01

Service Code	MSDRG 595
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,944.01
Rate for Payer: UnitedHealthcare Medicaid	$9,944.01
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$5,083.20

Service Code	MSDRG 596
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

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$8,260.20

Service Code	MSDRG 330
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$8,260.20
Rate for Payer: UnitedHealthcare Medicaid	$8,260.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$19,347.93

Service Code	MSDRG 329
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$19,347.93
Rate for Payer: UnitedHealthcare Medicaid	$19,347.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$5,845.68

Service Code	MSDRG 331
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,845.68
Rate for Payer: UnitedHealthcare Medicaid	$5,845.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MAJOR THUMB OR JOINT PROCEDURES

Facility

$5,114.97

Service Code	MSDRG 506
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,114.97
Rate for Payer: UnitedHealthcare Medicaid	$5,114.97
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Malaria/Babesia/Other Blood Parasites QST

Facility

$189.00

Service Code	HCPCS 87207
Hospital Charge Code	3555207
Hospital Revenue Code	300
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$170.10
Rate for Payer: UnitedHealthcare Commercial	$179.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Malaria/Babesia/Other Blood Parasites QST

Facility

$189.00

Service Code	HCPCS 87207
Hospital Charge Code	3555207
Hospital Revenue Code	300
Min. Negotiated Rate	$36.23
Max. Negotiated Rate	$179.55
Rate for Payer: Aetna Commercial	$170.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.23
Rate for Payer: Humana Medicare Advantage	$79.38
Rate for Payer: UnitedHealthcare Commercial	$179.55
Rate for Payer: UnitedHealthcare Medicaid	$75.60
Rate for Payer: WPPA Medicare Advantage	$113.40

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$3,049.92

Service Code	MSDRG 755
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,049.92
Rate for Payer: UnitedHealthcare Medicaid	$3,049.92
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$5,146.74

Service Code	MSDRG 754
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,146.74
Rate for Payer: UnitedHealthcare Medicaid	$5,146.74
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$2,700.45

Service Code	MSDRG 756
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,700.45
Rate for Payer: UnitedHealthcare Medicaid	$2,700.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility

$3,653.55

Service Code	MSDRG 723
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,653.55
Rate for Payer: UnitedHealthcare Medicaid	$3,653.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$5,782.14

Service Code	MSDRG 722
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,782.14
Rate for Payer: UnitedHealthcare Medicaid	$5,782.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$2,096.82

Service Code	MSDRG 724
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,096.82
Rate for Payer: UnitedHealthcare Medicaid	$2,096.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges