Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

OT OUTSOURCING ASSISTANT

Facility

$9.00

Hospital Charge Code	5576409
Hospital Revenue Code	432
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.55
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: WPPA Medicare Advantage	$5.40

OT OUTSOURCING THERAPIST

Facility

$22.00

Hospital Charge Code	5616409
Hospital Revenue Code	432
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: UnitedHealthcare Commercial	$20.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT OUTSOURCING THERAPIST

Facility

$22.00

Hospital Charge Code	5616409
Hospital Revenue Code	432
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$20.90
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Humana Medicare Advantage	$9.24
Rate for Payer: UnitedHealthcare Commercial	$20.90
Rate for Payer: UnitedHealthcare Medicaid	$8.80
Rate for Payer: WPPA Medicare Advantage	$13.20

OT Paraffin Bath Assistant Units

Facility

$67.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	3970175
Hospital Revenue Code	430
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$63.65
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.23
Rate for Payer: Humana Medicare Advantage	$28.14
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: UnitedHealthcare Medicaid	$13.96
Rate for Payer: WPPA Medicare Advantage	$40.20

OT Paraffin Bath Assistant Units

Facility

$67.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	3970175
Hospital Revenue Code	430
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Paraffin Bath Units

Facility

$67.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	3970175
Hospital Revenue Code	430
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Paraffin Bath Units

Facility

$67.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	3970175
Hospital Revenue Code	430
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$63.65
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.23
Rate for Payer: Humana Medicare Advantage	$28.14
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: UnitedHealthcare Medicaid	$13.96
Rate for Payer: WPPA Medicare Advantage	$40.20

OT ReEval Units

Facility

$182.00

Service Code	HCPCS 97168 GO
Hospital Charge Code	3970105
Hospital Revenue Code	434
Min. Negotiated Rate	$56.56
Max. Negotiated Rate	$172.90
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$77.42
Rate for Payer: Humana Medicare Advantage	$76.44
Rate for Payer: UnitedHealthcare Commercial	$172.90
Rate for Payer: UnitedHealthcare Medicaid	$56.56
Rate for Payer: WPPA Medicare Advantage	$109.20

OT ReEval Units

Facility

$182.00

Service Code	HCPCS 97168 GO
Hospital Charge Code	3970105
Hospital Revenue Code	434
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: UnitedHealthcare Commercial	$172.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Therapeutic Activities Assistant Units

Facility

$134.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	3970150
Hospital Revenue Code	430
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$56.91
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$28.44
Rate for Payer: WPPA Medicare Advantage	$80.40

OT Therapeutic Activities Assistant Units

Facility

$134.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	3970150
Hospital Revenue Code	430
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Therapeutic Activities Charges

Facility

$134.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	3970150
Hospital Revenue Code	430
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$56.91
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$28.44
Rate for Payer: WPPA Medicare Advantage	$80.40

OT Therapeutic Activities Charges

Facility

$134.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	3970150
Hospital Revenue Code	430
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Therapeutic Exercise Assistant units

Facility

$134.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	3970110
Hospital Revenue Code	430
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$56.91
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$28.04
Rate for Payer: WPPA Medicare Advantage	$80.40

OT Therapeutic Exercise Assistant units

Facility

$134.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	3970110
Hospital Revenue Code	430
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Therapeutic Exercise Charges

Facility

$134.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	3970110
Hospital Revenue Code	430
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$56.91
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$28.04
Rate for Payer: WPPA Medicare Advantage	$80.40

OT Therapeutic Exercise Charges

Facility

$134.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	3970110
Hospital Revenue Code	430
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Ultrasound Assistant Units

Facility

$78.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	3970125
Hospital Revenue Code	430
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: UnitedHealthcare Commercial	$74.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Ultrasound Assistant Units

Facility

$78.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	3970125
Hospital Revenue Code	430
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$74.10
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$29.29
Rate for Payer: Humana Medicare Advantage	$32.76
Rate for Payer: UnitedHealthcare Commercial	$74.10
Rate for Payer: UnitedHealthcare Medicaid	$12.33
Rate for Payer: WPPA Medicare Advantage	$46.80

OT Unattended E-stim Assistant Units

Facility

$84.00

Service Code	HCPCS 97014 GO
Hospital Charge Code	3970115
Hospital Revenue Code	430
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$79.80
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$31.31
Rate for Payer: Humana Medicare Advantage	$35.28
Rate for Payer: UnitedHealthcare Commercial	$79.80
Rate for Payer: UnitedHealthcare Medicaid	$14.75
Rate for Payer: WPPA Medicare Advantage	$50.40

OT Unattended E-stim Assistant Units

Facility

$84.00

Service Code	HCPCS 97014 GO
Hospital Charge Code	3970115
Hospital Revenue Code	430
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: UnitedHealthcare Commercial	$79.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Vasopneumatic Devices Assistant Units

Facility

$197.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	3977016
Hospital Revenue Code	430
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$187.15
Rate for Payer: Aetna Commercial	$177.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$33.33
Rate for Payer: Humana Medicare Advantage	$82.74
Rate for Payer: UnitedHealthcare Commercial	$187.15
Rate for Payer: UnitedHealthcare Medicaid	$16.50
Rate for Payer: WPPA Medicare Advantage	$118.20

OT Vasopneumatic Devices Assistant Units

Facility

$197.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	3977016
Hospital Revenue Code	430
Min. Negotiated Rate	$177.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$177.30
Rate for Payer: UnitedHealthcare Commercial	$187.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Vasopneumatic Devices Units

Facility

$197.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	3977016
Hospital Revenue Code	430
Min. Negotiated Rate	$177.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$177.30
Rate for Payer: UnitedHealthcare Commercial	$187.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

OT Vasopneumatic Devices Units

Facility

$197.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	3977016
Hospital Revenue Code	430
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$187.15
Rate for Payer: Aetna Commercial	$177.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$33.33
Rate for Payer: Humana Medicare Advantage	$82.74
Rate for Payer: UnitedHealthcare Commercial	$187.15
Rate for Payer: UnitedHealthcare Medicaid	$16.50
Rate for Payer: WPPA Medicare Advantage	$118.20

Know your out-of-pocket cost for care.

All Charges