Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

29580 Strapping Unna boot

Facility

$547.00

Service Code	HCPCS 29580
Hospital Charge Code	3299580
Hospital Revenue Code	761
Min. Negotiated Rate	$492.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$492.30
Rate for Payer: UnitedHealthcare Commercial	$519.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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

29580 Strapping; Unna boot

Facility

$547.00

Service Code	HCPCS 29580
Hospital Charge Code	3299580
Hospital Revenue Code	761
Min. Negotiated Rate	$492.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$492.30
Rate for Payer: UnitedHealthcare Commercial	$519.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29580 STRAPPING UNNA BOOT CHARGE

Facility

$547.00

Service Code	HCPCS 29580
Hospital Charge Code	3299580
Hospital Revenue Code	761
Min. Negotiated Rate	$492.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$492.30
Rate for Payer: UnitedHealthcare Commercial	$519.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29580 STRAPPING UNNA BOOT CHARGE

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

29581 Application Multilayer Compression System; Below Knee

Facility

$702.00

Service Code	HCPCS 29581
Hospital Charge Code	3292958
Hospital Revenue Code	761
Min. Negotiated Rate	$38.17
Max. Negotiated Rate	$666.90
Rate for Payer: Aetna Commercial	$631.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$277.75
Rate for Payer: Humana Medicare Advantage	$294.84
Rate for Payer: UnitedHealthcare Commercial	$666.90
Rate for Payer: UnitedHealthcare Medicaid	$38.17
Rate for Payer: WPPA Medicare Advantage	$421.20

29581 Application Multilayer Compression System; Below Knee

Facility

$702.00

Service Code	HCPCS 29581
Hospital Charge Code	3292958
Hospital Revenue Code	761
Min. Negotiated Rate	$631.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$631.80
Rate for Payer: UnitedHealthcare Commercial	$666.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29581 APPL MULTI LAYER COMPRESSION SYSTEM CHARGE

Facility

$702.00

Service Code	HCPCS 29581
Hospital Charge Code	3292958
Hospital Revenue Code	761
Min. Negotiated Rate	$38.17
Max. Negotiated Rate	$666.90
Rate for Payer: Aetna Commercial	$631.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$277.75
Rate for Payer: Humana Medicare Advantage	$294.84
Rate for Payer: UnitedHealthcare Commercial	$666.90
Rate for Payer: UnitedHealthcare Medicaid	$38.17
Rate for Payer: WPPA Medicare Advantage	$421.20

29581 APPL MULTI LAYER COMPRESSION SYSTEM CHARGE

Facility

$702.00

Service Code	HCPCS 29581
Hospital Charge Code	3292958
Hospital Revenue Code	761
Min. Negotiated Rate	$631.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$631.80
Rate for Payer: UnitedHealthcare Commercial	$666.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body

Facility

$4,616.00

Service Code	HCPCS 29874
Hospital Charge Code	3159874
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,385.20
Rate for Payer: Aetna Commercial	$4,154.40
Rate for Payer: UnitedHealthcare Commercial	$4,385.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body

Facility

$4,616.00

Service Code	HCPCS 29874
Hospital Charge Code	3159874
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$4,385.20
Rate for Payer: Aetna Commercial	$4,154.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,851.23
Rate for Payer: Humana Medicare Advantage	$1,938.72
Rate for Payer: UnitedHealthcare Commercial	$4,385.20
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$2,769.60

29875 Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection)

Facility

$3,750.00

Service Code	HCPCS 29875
Hospital Charge Code	3159875
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$3,375.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,315.93
Rate for Payer: Humana Medicare Advantage	$1,575.00
Rate for Payer: UnitedHealthcare Commercial	$3,562.50
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$2,250.00

29875 Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection)

Facility

$3,750.00

Service Code	HCPCS 29875
Hospital Charge Code	3159875
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$3,375.00
Rate for Payer: UnitedHealthcare Commercial	$3,562.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)

Facility

$5,919.00

Service Code	HCPCS 29877
Hospital Charge Code	3159877
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,623.05
Rate for Payer: Aetna Commercial	$5,327.10
Rate for Payer: UnitedHealthcare Commercial	$5,623.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)

Facility

$5,919.00

Service Code	HCPCS 29877
Hospital Charge Code	3159877
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$5,623.05
Rate for Payer: Aetna Commercial	$5,327.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,839.01
Rate for Payer: Humana Medicare Advantage	$2,485.98
Rate for Payer: UnitedHealthcare Commercial	$5,623.05
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$3,551.40

29879 Arthroscopy, knee, surgical; abrasion arthroplasty or multiple drilling or microfracture

Facility

$6,214.00

Service Code	HCPCS 29879
Hospital Charge Code	3159879
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,903.30
Rate for Payer: Aetna Commercial	$5,592.60
Rate for Payer: UnitedHealthcare Commercial	$5,903.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29879 Arthroscopy, knee, surgical; abrasion arthroplasty or multiple drilling or microfracture

Facility

$6,214.00

Service Code	HCPCS 29879
Hospital Charge Code	3159879
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$5,903.30
Rate for Payer: Aetna Commercial	$5,592.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,839.01
Rate for Payer: Humana Medicare Advantage	$2,609.88
Rate for Payer: UnitedHealthcare Commercial	$5,903.30
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$3,728.40

29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral) including chondroplasty

Facility

$6,214.00

Service Code	HCPCS 29880
Hospital Charge Code	3159880
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$5,903.30
Rate for Payer: Aetna Commercial	$5,592.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,839.01
Rate for Payer: Humana Medicare Advantage	$2,609.88
Rate for Payer: UnitedHealthcare Commercial	$5,903.30
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$3,728.40

29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral) including chondroplasty

Facility

$6,214.00

Service Code	HCPCS 29880
Hospital Charge Code	3159880
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,903.30
Rate for Payer: Aetna Commercial	$5,592.60
Rate for Payer: UnitedHealthcare Commercial	$5,903.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

29881 Arthroscopy, knee, surgical with meniscectomy including debridement/shaving

Facility

$6,214.00

Service Code	HCPCS 29881
Hospital Charge Code	3159881
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$5,903.30
Rate for Payer: Aetna Commercial	$5,592.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,595.00
Rate for Payer: Humana Medicare Advantage	$2,609.88
Rate for Payer: UnitedHealthcare Commercial	$5,903.30
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$3,728.40

29881 Arthroscopy, knee, surgical with meniscectomy including debridement/shaving

Facility

$6,214.00

Service Code	HCPCS 29881
Hospital Charge Code	3159881
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,903.30
Rate for Payer: Aetna Commercial	$5,592.60
Rate for Payer: UnitedHealthcare Commercial	$5,903.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30100 Biopsy, intranasal

Facility

$431.00

Service Code	HCPCS 30100
Hospital Charge Code	3350100
Hospital Revenue Code	761
Min. Negotiated Rate	$181.02
Max. Negotiated Rate	$494.04
Rate for Payer: Aetna Commercial	$387.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$310.07
Rate for Payer: Humana Medicare Advantage	$181.02
Rate for Payer: UnitedHealthcare Commercial	$409.45
Rate for Payer: UnitedHealthcare Medicaid	$494.04
Rate for Payer: WPPA Medicare Advantage	$258.60

30100 Biopsy, intranasal

Facility

$431.00

Service Code	HCPCS 30100
Hospital Charge Code	3350100
Hospital Revenue Code	761
Min. Negotiated Rate	$387.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$387.90
Rate for Payer: UnitedHealthcare Commercial	$409.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30130 Excision inferior turbinate, partial or complete, any method

Facility

$2,655.00

Service Code	HCPCS 30130
Hospital Charge Code	3150130
Hospital Revenue Code	360
Min. Negotiated Rate	$1,042.99
Max. Negotiated Rate	$2,522.25
Rate for Payer: Aetna Commercial	$2,389.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,915.97
Rate for Payer: Humana Medicare Advantage	$1,115.10
Rate for Payer: UnitedHealthcare Commercial	$2,522.25
Rate for Payer: UnitedHealthcare Medicaid	$1,042.99
Rate for Payer: WPPA Medicare Advantage	$1,593.00

30130 Excision inferior turbinate, partial or complete, any method

Facility

$2,655.00

Service Code	HCPCS 30130
Hospital Charge Code	3150130
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,522.25
Rate for Payer: Aetna Commercial	$2,389.50
Rate for Payer: UnitedHealthcare Commercial	$2,522.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges