Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

29125-Short Arm

Facility

$739.00

Service Code	HCPCS 29125
Hospital Charge Code	3304743
Hospital Revenue Code	450
Min. Negotiated Rate	$665.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$665.10
Rate for Payer: UnitedHealthcare Commercial	$702.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29125-Short Arm

Facility

$739.00

Service Code	HCPCS 29125
Hospital Charge Code	3304743
Hospital Revenue Code	450
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$702.05
Rate for Payer: Aetna Commercial	$665.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$310.38
Rate for Payer: UnitedHealthcare Commercial	$702.05
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$443.40

29130 APPLICATION FINGER SPLINT STATIC

Facility

$584.00

Service Code	HCPCS 29130
Hospital Charge Code	3304740
Hospital Revenue Code	450
Min. Negotiated Rate	$525.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$525.60
Rate for Payer: UnitedHealthcare Commercial	$554.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29130 APPLICATION FINGER SPLINT STATIC

Facility

$584.00

Service Code	HCPCS 29130
Hospital Charge Code	3304740
Hospital Revenue Code	450
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$554.80
Rate for Payer: Aetna Commercial	$525.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$245.28
Rate for Payer: UnitedHealthcare Commercial	$554.80
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$350.40

29130-Finger

Facility

$739.00

Service Code	HCPCS 29130
Hospital Charge Code	3304740
Hospital Revenue Code	450
Min. Negotiated Rate	$665.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$665.10
Rate for Payer: UnitedHealthcare Commercial	$702.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29130-Finger

Facility

$739.00

Service Code	HCPCS 29130
Hospital Charge Code	3304740
Hospital Revenue Code	450
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$702.05
Rate for Payer: Aetna Commercial	$665.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$310.38
Rate for Payer: UnitedHealthcare Commercial	$702.05
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$443.40

29130 OT APPL FINGER SPLINT/STA

Facility

$613.00

Service Code	HCPCS 29130 GO
Hospital Charge Code	3970245
Hospital Revenue Code	430
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$582.35
Rate for Payer: Aetna Commercial	$551.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$257.46
Rate for Payer: UnitedHealthcare Commercial	$582.35
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$367.80

29130 OT APPL FINGER SPLINT/STA

Facility

$613.00

Service Code	HCPCS 29130 GO
Hospital Charge Code	3970245
Hospital Revenue Code	430
Min. Negotiated Rate	$551.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$551.70
Rate for Payer: UnitedHealthcare Commercial	$582.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29345-Application of long leg cast thigh to toes

Facility

$739.00

Service Code	HCPCS 29345
Hospital Charge Code	3304620
Hospital Revenue Code	450
Min. Negotiated Rate	$228.80
Max. Negotiated Rate	$702.05
Rate for Payer: Aetna Commercial	$665.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$277.75
Rate for Payer: Humana Medicare Advantage	$310.38
Rate for Payer: UnitedHealthcare Commercial	$702.05
Rate for Payer: UnitedHealthcare Medicaid	$228.80
Rate for Payer: WPPA Medicare Advantage	$443.40

29345-Application of long leg cast thigh to toes

Facility

$739.00

Service Code	HCPCS 29345
Hospital Charge Code	3304620
Hospital Revenue Code	450
Min. Negotiated Rate	$665.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$665.10
Rate for Payer: UnitedHealthcare Commercial	$702.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29405 Application of short leg cast (below knee to toes)

Facility

$739.00

Service Code	HCPCS 29405
Hospital Charge Code	3359405
Hospital Revenue Code	761
Min. Negotiated Rate	$228.80
Max. Negotiated Rate	$702.05
Rate for Payer: Aetna Commercial	$665.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$277.75
Rate for Payer: Humana Medicare Advantage	$310.38
Rate for Payer: UnitedHealthcare Commercial	$702.05
Rate for Payer: UnitedHealthcare Medicaid	$228.80
Rate for Payer: WPPA Medicare Advantage	$443.40

29405 Application of short leg cast (below knee to toes)

Facility

$739.00

Service Code	HCPCS 29405
Hospital Charge Code	3359405
Hospital Revenue Code	761
Min. Negotiated Rate	$665.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$665.10
Rate for Payer: UnitedHealthcare Commercial	$702.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29405-App of Short Leg Cast (below knee to toes)

Facility

$456.00

Service Code	HCPCS 29405
Hospital Charge Code	3304630
Hospital Revenue Code	450
Min. Negotiated Rate	$410.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: UnitedHealthcare Commercial	$433.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29405-App of Short Leg Cast (below knee to toes)

Facility

$456.00

Service Code	HCPCS 29405
Hospital Charge Code	3304630
Hospital Revenue Code	450
Min. Negotiated Rate	$191.52
Max. Negotiated Rate	$433.20
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$277.75
Rate for Payer: Humana Medicare Advantage	$191.52
Rate for Payer: UnitedHealthcare Commercial	$433.20
Rate for Payer: UnitedHealthcare Medicaid	$228.80
Rate for Payer: WPPA Medicare Advantage	$273.60

29425 - Application Short Leg Cast

Facility

$456.00

Service Code	HCPCS 29425
Hospital Charge Code	3304635
Hospital Revenue Code	450
Min. Negotiated Rate	$410.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: UnitedHealthcare Commercial	$433.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29425 - Application Short Leg Cast

Facility

$456.00

Service Code	HCPCS 29425
Hospital Charge Code	3304635
Hospital Revenue Code	450
Min. Negotiated Rate	$191.52
Max. Negotiated Rate	$433.20
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$277.75
Rate for Payer: Humana Medicare Advantage	$191.52
Rate for Payer: UnitedHealthcare Commercial	$433.20
Rate for Payer: UnitedHealthcare Medicaid	$228.80
Rate for Payer: WPPA Medicare Advantage	$273.60

29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee

Facility

$434.00

Service Code	HCPCS 29505
Hospital Charge Code	3309505
Hospital Revenue Code	450
Min. Negotiated Rate	$390.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$390.60
Rate for Payer: UnitedHealthcare Commercial	$412.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee

Facility

$434.00

Service Code	HCPCS 29505
Hospital Charge Code	3309505
Hospital Revenue Code	450
Min. Negotiated Rate	$182.28
Max. Negotiated Rate	$412.30
Rate for Payer: Aetna Commercial	$390.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$182.28
Rate for Payer: UnitedHealthcare Commercial	$412.30
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$260.40

29505-Long Leg

Facility

$1,594.00

Service Code	HCPCS 29505
Hospital Charge Code	3309505
Hospital Revenue Code	450
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$1,514.30
Rate for Payer: Aetna Commercial	$1,434.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$669.48
Rate for Payer: UnitedHealthcare Commercial	$1,514.30
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$956.40

29505-Long Leg

Facility

$1,594.00

Service Code	HCPCS 29505
Hospital Charge Code	3309505
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,514.30
Rate for Payer: Aetna Commercial	$1,434.60
Rate for Payer: UnitedHealthcare Commercial	$1,514.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee

Facility

$825.00

Service Code	HCPCS 29515
Hospital Charge Code	3302951
Hospital Revenue Code	450
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$783.75
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$346.50
Rate for Payer: UnitedHealthcare Commercial	$783.75
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$495.00

29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee

Facility

$825.00

Service Code	HCPCS 29515
Hospital Charge Code	3302951
Hospital Revenue Code	450
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: UnitedHealthcare Commercial	$783.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29515-Short Leg

Facility

$825.00

Service Code	HCPCS 29515
Hospital Charge Code	3302951
Hospital Revenue Code	450
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: UnitedHealthcare Commercial	$783.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29515-Short Leg

Facility

$825.00

Service Code	HCPCS 29515
Hospital Charge Code	3302951
Hospital Revenue Code	450
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$783.75
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$346.50
Rate for Payer: UnitedHealthcare Commercial	$783.75
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$495.00

29580 Strapping Unna boot

Facility

$547.00

Service Code	HCPCS 29580
Hospital Charge Code	3299580
Hospital Revenue Code	761
Min. Negotiated Rate	$57.20
Max. Negotiated Rate	$519.65
Rate for Payer: Aetna Commercial	$492.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$277.75
Rate for Payer: Humana Medicare Advantage	$229.74
Rate for Payer: UnitedHealthcare Commercial	$519.65
Rate for Payer: UnitedHealthcare Medicaid	$57.20
Rate for Payer: WPPA Medicare Advantage	$328.20

Know your out-of-pocket cost for care.

All Charges