Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

PT Dry Needling, 1-2 Muscles Charges

Facility

$32.00

Service Code	HCPCS 20560 GP
Hospital Charge Code	3957799
Hospital Revenue Code	420
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Dry Needling, 3+ Muscles Assist Unit

Facility

$32.00

Service Code	HCPCS 20561 GP
Hospital Charge Code	3957710
Hospital Revenue Code	420
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Medicaid	$12.80
Rate for Payer: WPPA Medicare Advantage	$19.20

PT Dry Needling, 3+ Muscles Assist Unit

Facility

$32.00

Service Code	HCPCS 20561 GP
Hospital Charge Code	3957710
Hospital Revenue Code	420
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Dry Needling, 3+ Muscles Units

Facility

$32.00

Service Code	HCPCS 20561 GP
Hospital Charge Code	3957710
Hospital Revenue Code	420
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Dry Needling, 3+ Muscles Units

Facility

$32.00

Service Code	HCPCS 20561 GP
Hospital Charge Code	3957710
Hospital Revenue Code	420
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Medicaid	$12.80
Rate for Payer: WPPA Medicare Advantage	$19.20

PT Gait Training Assistant Units

Facility

$112.00

Service Code	HCPCS 97116 GP
Hospital Charge Code	3950135
Hospital Revenue Code	420
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$100.80
Rate for Payer: UnitedHealthcare Commercial	$106.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Gait Training Assistant Units

Facility

$112.00

Service Code	HCPCS 97116 GP
Hospital Charge Code	3950135
Hospital Revenue Code	420
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$106.40
Rate for Payer: Aetna Commercial	$100.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$46.46
Rate for Payer: Humana Medicare Advantage	$47.04
Rate for Payer: UnitedHealthcare Commercial	$106.40
Rate for Payer: UnitedHealthcare Medicaid	$24.24
Rate for Payer: WPPA Medicare Advantage	$67.20

PT High Complex Units

Facility

$270.00

Service Code	HCPCS 97163 GP
Hospital Charge Code	3957163
Hospital Revenue Code	424
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$243.00
Rate for Payer: UnitedHealthcare Commercial	$256.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT High Complex Units

Facility

$270.00

Service Code	HCPCS 97163 GP
Hospital Charge Code	3957163
Hospital Revenue Code	424
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Commercial	$243.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$120.60
Rate for Payer: Humana Medicare Advantage	$113.40
Rate for Payer: UnitedHealthcare Commercial	$256.50
Rate for Payer: UnitedHealthcare Medicaid	$57.45
Rate for Payer: WPPA Medicare Advantage	$162.00

PTH Intact

Facility

$210.00

Service Code	HCPCS 83970
Hospital Charge Code	3556410
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$155.01
Rate for Payer: Humana Medicare Advantage	$88.20
Rate for Payer: UnitedHealthcare Commercial	$199.50
Rate for Payer: UnitedHealthcare Medicaid	$35.09
Rate for Payer: WPPA Medicare Advantage	$126.00

PTH Intact

Facility

$210.00

Service Code	HCPCS 83970
Hospital Charge Code	3556410
Hospital Revenue Code	300
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: UnitedHealthcare Commercial	$199.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PTH, Intact and Calcium QST

Facility

$255.00

Service Code	HCPCS 83970
Hospital Charge Code	3556410
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$242.25
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$155.01
Rate for Payer: Humana Medicare Advantage	$107.10
Rate for Payer: UnitedHealthcare Commercial	$242.25
Rate for Payer: UnitedHealthcare Medicaid	$35.09
Rate for Payer: WPPA Medicare Advantage	$153.00

PTH, Intact and Calcium QST

Facility

$255.00

Service Code	HCPCS 83970
Hospital Charge Code	3556410
Hospital Revenue Code	300
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: UnitedHealthcare Commercial	$242.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PTH, Intact w/o Calcium QST

Facility

$255.00

Service Code	HCPCS 83970
Hospital Charge Code	3556410
Hospital Revenue Code	300
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: UnitedHealthcare Commercial	$242.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PTH, Intact w/o Calcium QST

Facility

$255.00

Service Code	HCPCS 83970
Hospital Charge Code	3556410
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$242.25
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$155.01
Rate for Payer: Humana Medicare Advantage	$107.10
Rate for Payer: UnitedHealthcare Commercial	$242.25
Rate for Payer: UnitedHealthcare Medicaid	$35.09
Rate for Payer: WPPA Medicare Advantage	$153.00

PT Hot, Cold Pack Units

Facility

$26.00

Service Code	HCPCS 97010 GP
Hospital Charge Code	3950085
Hospital Revenue Code	420
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$21.21
Rate for Payer: Humana Medicare Advantage	$10.92
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Medicaid	$15.57
Rate for Payer: WPPA Medicare Advantage	$15.60

PT Hot, Cold Pack Units

Facility

$26.00

Service Code	HCPCS 97010 GP
Hospital Charge Code	3950085
Hospital Revenue Code	420
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PTH RELATED PEPTIDE CPL CPL

Facility

$307.00

Service Code	HCPCS 83519
Hospital Charge Code	3554478
Hospital Revenue Code	300
Min. Negotiated Rate	$276.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$276.30
Rate for Payer: UnitedHealthcare Commercial	$291.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PTH RELATED PEPTIDE CPL CPL

Facility

$307.00

Service Code	HCPCS 83519
Hospital Charge Code	3554478
Hospital Revenue Code	300
Min. Negotiated Rate	$15.64
Max. Negotiated Rate	$291.65
Rate for Payer: Aetna Commercial	$276.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.48
Rate for Payer: Humana Medicare Advantage	$128.94
Rate for Payer: UnitedHealthcare Commercial	$291.65
Rate for Payer: UnitedHealthcare Medicaid	$15.64
Rate for Payer: WPPA Medicare Advantage	$184.20

PT (INR)

Facility

$57.00

Service Code	HCPCS 85610
Hospital Charge Code	3550585
Hospital Revenue Code	300
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$54.15
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$16.08
Rate for Payer: Humana Medicare Advantage	$23.94
Rate for Payer: UnitedHealthcare Commercial	$54.15
Rate for Payer: UnitedHealthcare Medicaid	$4.29
Rate for Payer: WPPA Medicare Advantage	$34.20

PT (INR)

Facility

$57.00

Service Code	HCPCS 85610
Hospital Charge Code	3550585
Hospital Revenue Code	300
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$54.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Iontophhoresis Assistant Units

Facility

$89.00

Service Code	HCPCS 97033 GP
Hospital Charge Code	3950242
Hospital Revenue Code	420
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Iontophhoresis Assistant Units

Facility

$89.00

Service Code	HCPCS 97033 GP
Hospital Charge Code	3950242
Hospital Revenue Code	420
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$84.55
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$38.38
Rate for Payer: Humana Medicare Advantage	$37.38
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: UnitedHealthcare Medicaid	$8.58
Rate for Payer: WPPA Medicare Advantage	$53.40

PT Low Complex Units

Facility

$270.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	3957161
Hospital Revenue Code	424
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$243.00
Rate for Payer: UnitedHealthcare Commercial	$256.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Low Complex Units

Facility

$270.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	3957161
Hospital Revenue Code	424
Min. Negotiated Rate	$71.82
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Commercial	$243.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$138.69
Rate for Payer: Humana Medicare Advantage	$113.40
Rate for Payer: UnitedHealthcare Commercial	$256.50
Rate for Payer: UnitedHealthcare Medicaid	$71.82
Rate for Payer: WPPA Medicare Advantage	$162.00

Know your out-of-pocket cost for care.

All Charges