Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

30140 Submucous resection inferior turbinate, partial or complete, any method

Facility

$3,398.00

Service Code	HCPCS 30140
Hospital Charge Code	3151403
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,228.10
Rate for Payer: Aetna Commercial	$3,058.20
Rate for Payer: UnitedHealthcare Commercial	$3,228.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30140 Submucous resection inferior turbinate, partial or complete, any method

Facility

$3,398.00

Service Code	HCPCS 30140
Hospital Charge Code	3151403
Hospital Revenue Code	360
Min. Negotiated Rate	$1,042.99
Max. Negotiated Rate	$3,228.10
Rate for Payer: Aetna Commercial	$3,058.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,451.27
Rate for Payer: Humana Medicare Advantage	$1,427.16
Rate for Payer: UnitedHealthcare Commercial	$3,228.10
Rate for Payer: UnitedHealthcare Medicaid	$1,042.99
Rate for Payer: WPPA Medicare Advantage	$2,038.80

30220 Insertion, nasal septal prosthesis (button)

Facility

$1,105.00

Service Code	HCPCS 30220
Hospital Charge Code	3150220
Hospital Revenue Code	360
Min. Negotiated Rate	$994.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$994.50
Rate for Payer: UnitedHealthcare Commercial	$1,049.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30220 Insertion, nasal septal prosthesis (button)

Facility

$1,105.00

Service Code	HCPCS 30220
Hospital Charge Code	3150220
Hospital Revenue Code	360
Min. Negotiated Rate	$442.00
Max. Negotiated Rate	$1,049.75
Rate for Payer: Aetna Commercial	$994.50
Rate for Payer: Humana Medicare Advantage	$464.10
Rate for Payer: UnitedHealthcare Commercial	$1,049.75
Rate for Payer: UnitedHealthcare Medicaid	$442.00
Rate for Payer: WPPA Medicare Advantage	$663.00

30300-Intranasal

Facility

$1,049.00

Service Code	HCPCS 30300
Hospital Charge Code	3303030
Hospital Revenue Code	450
Min. Negotiated Rate	$944.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$944.10
Rate for Payer: UnitedHealthcare Commercial	$996.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30300-Intranasal

Facility

$1,049.00

Service Code	HCPCS 30300
Hospital Charge Code	3303030
Hospital Revenue Code	450
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$996.55
Rate for Payer: Aetna Commercial	$944.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$938.29
Rate for Payer: Humana Medicare Advantage	$440.58
Rate for Payer: UnitedHealthcare Commercial	$996.55
Rate for Payer: UnitedHealthcare Medicaid	$140.40
Rate for Payer: WPPA Medicare Advantage	$629.40

30300 Removal foreign body, intranasal; office type procedure

Facility

$1,301.00

Service Code	HCPCS 30300
Hospital Charge Code	3290300
Hospital Revenue Code	761
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$1,235.95
Rate for Payer: Aetna Commercial	$1,170.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$938.29
Rate for Payer: Humana Medicare Advantage	$546.42
Rate for Payer: UnitedHealthcare Commercial	$1,235.95
Rate for Payer: UnitedHealthcare Medicaid	$140.40
Rate for Payer: WPPA Medicare Advantage	$780.60

30300 Removal foreign body, intranasal; office type procedure

Facility

$1,301.00

Service Code	HCPCS 30300
Hospital Charge Code	3290300
Hospital Revenue Code	761
Min. Negotiated Rate	$1,170.90
Max. Negotiated Rate	$1,235.95
Rate for Payer: Aetna Commercial	$1,170.90
Rate for Payer: UnitedHealthcare Commercial	$1,235.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30300 REMOVAL NASAL FOREIGN BODY-ER SERV PROCE

Facility

$1,301.00

Service Code	HCPCS 30300
Hospital Charge Code	3300300
Hospital Revenue Code	450
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$1,235.95
Rate for Payer: Aetna Commercial	$1,170.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$938.29
Rate for Payer: Humana Medicare Advantage	$546.42
Rate for Payer: UnitedHealthcare Commercial	$1,235.95
Rate for Payer: UnitedHealthcare Medicaid	$140.40
Rate for Payer: WPPA Medicare Advantage	$780.60

30300 REMOVAL NASAL FOREIGN BODY-ER SERV PROCE

Facility

$1,301.00

Service Code	HCPCS 30300
Hospital Charge Code	3300300
Hospital Revenue Code	450
Min. Negotiated Rate	$1,170.90
Max. Negotiated Rate	$1,235.95
Rate for Payer: Aetna Commercial	$1,170.90
Rate for Payer: UnitedHealthcare Commercial	$1,235.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30310 REMOVE NASAL FOREIGN BODY

Facility

$622.00

Service Code	HCPCS 30310
Hospital Charge Code	3153031
Hospital Revenue Code	360
Min. Negotiated Rate	$559.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$559.80
Rate for Payer: UnitedHealthcare Commercial	$590.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30310 REMOVE NASAL FOREIGN BODY

Facility

$622.00

Service Code	HCPCS 30310
Hospital Charge Code	3153031
Hospital Revenue Code	360
Min. Negotiated Rate	$261.24
Max. Negotiated Rate	$1,042.99
Rate for Payer: Aetna Commercial	$559.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$261.24
Rate for Payer: UnitedHealthcare Commercial	$590.90
Rate for Payer: UnitedHealthcare Medicaid	$1,042.99
Rate for Payer: WPPA Medicare Advantage	$373.20

30468 Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant

Facility

$2,990.00

Service Code	HCPCS 30468
Hospital Charge Code	3150468
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,840.50
Rate for Payer: Aetna Commercial	$2,691.00
Rate for Payer: UnitedHealthcare Commercial	$2,840.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30468 Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant

Facility

$2,990.00

Service Code	HCPCS 30468
Hospital Charge Code	3150468
Hospital Revenue Code	360
Min. Negotiated Rate	$1,255.80
Max. Negotiated Rate	$3,305.93
Rate for Payer: Aetna Commercial	$2,691.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,157.36
Rate for Payer: Humana Medicare Advantage	$1,255.80
Rate for Payer: UnitedHealthcare Commercial	$2,840.50
Rate for Payer: UnitedHealthcare Medicaid	$3,305.93
Rate for Payer: WPPA Medicare Advantage	$1,794.00

30520 Septoplasty or submucous resection, w/ or w/o cartilage scoring/contouring/replcmnt w/ graft

Facility

$5,415.00

Service Code	HCPCS 30520
Hospital Charge Code	3153052
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,144.25
Rate for Payer: Aetna Commercial	$4,873.50
Rate for Payer: UnitedHealthcare Commercial	$5,144.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30520 Septoplasty or submucous resection, w/ or w/o cartilage scoring/contouring/replcmnt w/ graft

Facility

$5,415.00

Service Code	HCPCS 30520
Hospital Charge Code	3153052
Hospital Revenue Code	360
Min. Negotiated Rate	$1,042.99
Max. Negotiated Rate	$5,144.25
Rate for Payer: Aetna Commercial	$4,873.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,439.30
Rate for Payer: Humana Medicare Advantage	$2,274.30
Rate for Payer: UnitedHealthcare Commercial	$5,144.25
Rate for Payer: UnitedHealthcare Medicaid	$1,042.99
Rate for Payer: WPPA Medicare Advantage	$3,249.00

30801 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method; superficial

Facility

$5,773.00

Service Code	HCPCS 30801
Hospital Charge Code	3153080
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,484.35
Rate for Payer: Aetna Commercial	$5,195.70
Rate for Payer: UnitedHealthcare Commercial	$5,484.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30801 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method; superficial

Facility

$5,773.00

Service Code	HCPCS 30801
Hospital Charge Code	3153080
Hospital Revenue Code	360
Min. Negotiated Rate	$494.04
Max. Negotiated Rate	$5,484.35
Rate for Payer: Aetna Commercial	$5,195.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,108.78
Rate for Payer: Humana Medicare Advantage	$2,424.66
Rate for Payer: UnitedHealthcare Commercial	$5,484.35
Rate for Payer: UnitedHealthcare Medicaid	$494.04
Rate for Payer: WPPA Medicare Advantage	$3,463.80

30802 Ablation, soft tissue inferior turbinates, unilateral or bilateral, any method; intramural

Facility

$431.00

Service Code	HCPCS 30802
Hospital Charge Code	3150802
Hospital Revenue Code	360
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

30802 Ablation, soft tissue inferior turbinates, unilateral or bilateral, any method; intramural

Facility

$431.00

Service Code	HCPCS 30802
Hospital Charge Code	3150802
Hospital Revenue Code	360
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

30802 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method; intramural

Facility

$431.00

Service Code	HCPCS 30802
Hospital Charge Code	3150802
Hospital Revenue Code	360
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

30802 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method; intramural

Facility

$431.00

Service Code	HCPCS 30802
Hospital Charge Code	3150802
Hospital Revenue Code	360
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

30901-Anterior Simple

Facility

$620.00

Service Code	HCPCS 30901
Hospital Charge Code	3300315
Hospital Revenue Code	450
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$589.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$488.84
Rate for Payer: Humana Medicare Advantage	$260.40
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: UnitedHealthcare Medicaid	$234.00
Rate for Payer: WPPA Medicare Advantage	$372.00

30901-Anterior Simple

Facility

$620.00

Service Code	HCPCS 30901
Hospital Charge Code	3300315
Hospital Revenue Code	450
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

30901 Control anterior nasal hemorrhage.

Facility

$825.00

Service Code	HCPCS 30901
Hospital Charge Code	3350901
Hospital Revenue Code	761
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

Know your out-of-pocket cost for care.

All Charges