Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Place of Pickup: Scene (A0427)

Facility

$746.00

Service Code	HCPCS A0427
Hospital Charge Code	4550148
Hospital Revenue Code	540
Min. Negotiated Rate	$671.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$671.40
Rate for Payer: UnitedHealthcare Commercial	$708.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Place of Pickup: Scene (A0428)

Facility

$377.00

Service Code	HCPCS A0428 QN
Hospital Charge Code	4550080
Hospital Revenue Code	540
Min. Negotiated Rate	$150.80
Max. Negotiated Rate	$367.67
Rate for Payer: Aetna Commercial	$339.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$367.67
Rate for Payer: Humana Medicare Advantage	$158.34
Rate for Payer: UnitedHealthcare Commercial	$358.15
Rate for Payer: UnitedHealthcare Medicaid	$150.80
Rate for Payer: WPPA Medicare Advantage	$226.20

Place of Pickup: Scene (A0428)

Facility

$377.00

Service Code	HCPCS A0428 QN
Hospital Charge Code	4550080
Hospital Revenue Code	540
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$339.30
Rate for Payer: UnitedHealthcare Commercial	$358.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Place of Pickup: Scene (A0429)

Facility

$825.00

Service Code	HCPCS A0429 QN
Hospital Charge Code	4550106
Hospital Revenue Code	540
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$783.75
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$450.09
Rate for Payer: Humana Medicare Advantage	$346.50
Rate for Payer: UnitedHealthcare Commercial	$783.75
Rate for Payer: UnitedHealthcare Medicaid	$330.00
Rate for Payer: WPPA Medicare Advantage	$495.00

Place of Pickup: Scene (A0429)

Facility

$825.00

Service Code	HCPCS A0429 QN
Hospital Charge Code	4550106
Hospital Revenue Code	540
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

Place of Pickup: Scene (A0434)

Facility

$1,832.00

Service Code	HCPCS A0434
Hospital Charge Code	4550163
Hospital Revenue Code	540
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,740.40
Rate for Payer: Aetna Commercial	$1,648.80
Rate for Payer: UnitedHealthcare Commercial	$1,740.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Place of Pickup: Scene (A0434)

Facility

$1,832.00

Service Code	HCPCS A0434
Hospital Charge Code	4550163
Hospital Revenue Code	540
Min. Negotiated Rate	$732.80
Max. Negotiated Rate	$1,740.40
Rate for Payer: Aetna Commercial	$1,648.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$942.91
Rate for Payer: Humana Medicare Advantage	$769.44
Rate for Payer: UnitedHealthcare Commercial	$1,740.40
Rate for Payer: UnitedHealthcare Medicaid	$732.80
Rate for Payer: WPPA Medicare Advantage	$1,099.20

Place of Pickup: Skilled Nursing Facility (A0426)

Facility

$469.00

Service Code	HCPCS A0427 QN
Hospital Charge Code	4550122
Hospital Revenue Code	540
Min. Negotiated Rate	$422.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$422.10
Rate for Payer: UnitedHealthcare Commercial	$445.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Place of Pickup: Skilled Nursing Facility (A0426)

Facility

$469.00

Service Code	HCPCS A0427 QN
Hospital Charge Code	4550122
Hospital Revenue Code	540
Min. Negotiated Rate	$187.60
Max. Negotiated Rate	$585.68
Rate for Payer: Aetna Commercial	$422.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$585.68
Rate for Payer: Humana Medicare Advantage	$196.98
Rate for Payer: UnitedHealthcare Commercial	$445.55
Rate for Payer: UnitedHealthcare Medicaid	$187.60
Rate for Payer: WPPA Medicare Advantage	$281.40

Place of Pickup: Skilled Nursing Facility (A0427)

Facility

$746.00

Service Code	HCPCS A0427
Hospital Charge Code	4550148
Hospital Revenue Code	540
Min. Negotiated Rate	$671.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$671.40
Rate for Payer: UnitedHealthcare Commercial	$708.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Place of Pickup: Skilled Nursing Facility (A0427)

Facility

$746.00

Service Code	HCPCS A0427
Hospital Charge Code	4550148
Hospital Revenue Code	540
Min. Negotiated Rate	$298.40
Max. Negotiated Rate	$708.70
Rate for Payer: Aetna Commercial	$671.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$585.68
Rate for Payer: Humana Medicare Advantage	$313.32
Rate for Payer: UnitedHealthcare Commercial	$708.70
Rate for Payer: UnitedHealthcare Medicaid	$298.40
Rate for Payer: WPPA Medicare Advantage	$447.60

Place of Pickup: Skilled Nursing Facility (A0428)

Facility

$377.00

Service Code	HCPCS A0428 QN
Hospital Charge Code	4550080
Hospital Revenue Code	540
Min. Negotiated Rate	$150.80
Max. Negotiated Rate	$367.67
Rate for Payer: Aetna Commercial	$339.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$367.67
Rate for Payer: Humana Medicare Advantage	$158.34
Rate for Payer: UnitedHealthcare Commercial	$358.15
Rate for Payer: UnitedHealthcare Medicaid	$150.80
Rate for Payer: WPPA Medicare Advantage	$226.20

Place of Pickup: Skilled Nursing Facility (A0428)

Facility

$377.00

Service Code	HCPCS A0428 QN
Hospital Charge Code	4550080
Hospital Revenue Code	540
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$339.30
Rate for Payer: UnitedHealthcare Commercial	$358.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Place of Pickup: Skilled Nursing Facility (A0429)

Facility

$825.00

Service Code	HCPCS A0429 QN
Hospital Charge Code	4550106
Hospital Revenue Code	540
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$783.75
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$450.09
Rate for Payer: Humana Medicare Advantage	$346.50
Rate for Payer: UnitedHealthcare Commercial	$783.75
Rate for Payer: UnitedHealthcare Medicaid	$330.00
Rate for Payer: WPPA Medicare Advantage	$495.00

Place of Pickup: Skilled Nursing Facility (A0429)

Facility

$825.00

Service Code	HCPCS A0429 QN
Hospital Charge Code	4550106
Hospital Revenue Code	540
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

Place of Pickup: Skilled Nursing Facility (A0434)

Facility

$1,832.00

Service Code	HCPCS A0434
Hospital Charge Code	4550163
Hospital Revenue Code	540
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,740.40
Rate for Payer: Aetna Commercial	$1,648.80
Rate for Payer: UnitedHealthcare Commercial	$1,740.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Place of Pickup: Skilled Nursing Facility (A0434)

Facility

$1,832.00

Service Code	HCPCS A0434
Hospital Charge Code	4550163
Hospital Revenue Code	540
Min. Negotiated Rate	$732.80
Max. Negotiated Rate	$1,740.40
Rate for Payer: Aetna Commercial	$1,648.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$942.91
Rate for Payer: Humana Medicare Advantage	$769.44
Rate for Payer: UnitedHealthcare Commercial	$1,740.40
Rate for Payer: UnitedHealthcare Medicaid	$732.80
Rate for Payer: WPPA Medicare Advantage	$1,099.20

Plasma Renin Activity, LC/MS/MS QST

Facility

$152.00

Service Code	HCPCS 84244
Hospital Charge Code	3558424
Hospital Revenue Code	300
Min. Negotiated Rate	$136.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: UnitedHealthcare Commercial	$144.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Plasma Renin Activity, LC/MS/MS QST

Facility

$152.00

Service Code	HCPCS 84244
Hospital Charge Code	3558424
Hospital Revenue Code	300
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$144.40
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$80.38
Rate for Payer: Humana Medicare Advantage	$63.84
Rate for Payer: UnitedHealthcare Commercial	$144.40
Rate for Payer: UnitedHealthcare Medicaid	$21.99
Rate for Payer: WPPA Medicare Advantage	$91.20

Platelet Count

Facility

$53.00

Service Code	HCPCS 85049
Hospital Charge Code	3550627
Hospital Revenue Code	300
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$50.35
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$22.26
Rate for Payer: UnitedHealthcare Commercial	$50.35
Rate for Payer: UnitedHealthcare Medicaid	$4.48
Rate for Payer: WPPA Medicare Advantage	$31.80

Platelet Count

Facility

$53.00

Service Code	HCPCS 85049
Hospital Charge Code	3550627
Hospital Revenue Code	300
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: UnitedHealthcare Commercial	$50.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PLEURAL EFFUSION WITH CC

Facility

$3,812.40

Service Code	MSDRG 187
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,812.40
Rate for Payer: UnitedHealthcare Medicaid	$3,812.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PLEURAL EFFUSION WITH MCC

Facility

$6,004.53

Service Code	MSDRG 186
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

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$2,763.99

Service Code	MSDRG 188
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,763.99
Rate for Payer: UnitedHealthcare Medicaid	$2,763.99
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PleurX Drainage Bottle 1000ml w/Procedure Pack

Facility

$200.03

Service Code	HCPCS C1729
Hospital Charge Code	3252062
Hospital Revenue Code	278
Min. Negotiated Rate	$80.01
Max. Negotiated Rate	$190.03
Rate for Payer: Aetna Commercial	$180.03
Rate for Payer: Humana Medicare Advantage	$84.01
Rate for Payer: UnitedHealthcare Commercial	$190.03
Rate for Payer: UnitedHealthcare Medicaid	$80.01
Rate for Payer: WPPA Medicare Advantage	$120.02

Know your out-of-pocket cost for care.

All Charges