Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$5,972.76

Service Code	MSDRG 565
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,972.76
Rate for Payer: UnitedHealthcare Medicaid	$5,972.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$9,467.46

Service Code	MSDRG 564
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,467.46
Rate for Payer: UnitedHealthcare Medicaid	$9,467.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$4,606.65

Service Code	MSDRG 566
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,606.65
Rate for Payer: UnitedHealthcare Medicaid	$4,606.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$7,974.27

Service Code	MSDRG 516
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,974.27
Rate for Payer: UnitedHealthcare Medicaid	$7,974.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$12,072.60

Service Code	MSDRG 515
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$12,072.60
Rate for Payer: UnitedHealthcare Medicaid	$12,072.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$5,813.91

Service Code	MSDRG 517
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

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$3,653.55

Service Code	MSDRG 844
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

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$6,004.53

Service Code	MSDRG 843
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,004.53
Rate for Payer: UnitedHealthcare Medicaid	$6,004.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$2,573.37

Service Code	MSDRG 845
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,573.37
Rate for Payer: UnitedHealthcare Medicaid	$2,573.37
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$6,989.40

Service Code	MSDRG 908
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,989.40
Rate for Payer: UnitedHealthcare Medicaid	$6,989.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$13,470.48

Service Code	MSDRG 907
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$13,470.48
Rate for Payer: UnitedHealthcare Medicaid	$13,470.48
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$4,606.65

Service Code	MSDRG 909
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,606.65
Rate for Payer: UnitedHealthcare Medicaid	$4,606.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$7,720.11

Service Code	MSDRG 958
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,720.11
Rate for Payer: UnitedHealthcare Medicaid	$7,720.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$13,978.80

Service Code	MSDRG 957
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$13,978.80
Rate for Payer: UnitedHealthcare Medicaid	$13,978.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$5,400.90

Service Code	MSDRG 959
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,400.90
Rate for Payer: UnitedHealthcare Medicaid	$5,400.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$6,512.85

Service Code	MSDRG 803
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,512.85
Rate for Payer: UnitedHealthcare Medicaid	$6,512.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$13,978.80

Service Code	MSDRG 802
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$13,978.80
Rate for Payer: UnitedHealthcare Medicaid	$13,978.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$4,765.50

Service Code	MSDRG 804
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,765.50
Rate for Payer: UnitedHealthcare Medicaid	$4,765.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$7,084.71

Service Code	MSDRG 205
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,084.71
Rate for Payer: UnitedHealthcare Medicaid	$7,084.71
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$3,621.78

Service Code	MSDRG 206
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,621.78
Rate for Payer: UnitedHealthcare Medicaid	$3,621.78
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$6,322.23

Service Code	MSDRG 167
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,322.23
Rate for Payer: UnitedHealthcare Medicaid	$6,322.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$13,089.24

Service Code	MSDRG 166
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$13,089.24
Rate for Payer: UnitedHealthcare Medicaid	$13,089.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$4,797.27

Service Code	MSDRG 168
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,797.27
Rate for Payer: UnitedHealthcare Medicaid	$4,797.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$5,623.29

Service Code	MSDRG 580
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

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$10,579.41

Service Code	MSDRG 579
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,579.41
Rate for Payer: UnitedHealthcare Medicaid	$10,579.41
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges