Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

PT/MAINTAINCE/DAY

Facility

$3.00

Hospital Charge Code	3950845
Hospital Revenue Code	420
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Humana Medicare Advantage	$1.26
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: WPPA Medicare Advantage	$1.80

PT/MAINTAINCE/DAY

Facility

$3.00

Hospital Charge Code	3950845
Hospital Revenue Code	420
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Manual Therapy Assistant Units

Facility

$122.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	3950572
Hospital Revenue Code	420
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$109.80
Rate for Payer: UnitedHealthcare Commercial	$115.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Manual Therapy Assistant Units

Facility

$122.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	3950572
Hospital Revenue Code	420
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$115.90
Rate for Payer: Aetna Commercial	$109.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$58.08
Rate for Payer: Humana Medicare Advantage	$51.24
Rate for Payer: UnitedHealthcare Commercial	$115.90
Rate for Payer: UnitedHealthcare Medicaid	$22.37
Rate for Payer: WPPA Medicare Advantage	$73.20

PT Manual Traction Assistant units

Facility

$88.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	3950127
Hospital Revenue Code	420
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$83.60
Rate for Payer: Aetna Commercial	$79.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.36
Rate for Payer: Humana Medicare Advantage	$36.96
Rate for Payer: UnitedHealthcare Commercial	$83.60
Rate for Payer: UnitedHealthcare Medicaid	$14.77
Rate for Payer: WPPA Medicare Advantage	$52.80

PT Manual Traction Assistant units

Facility

$88.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	3950127
Hospital Revenue Code	420
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$79.20
Rate for Payer: UnitedHealthcare Commercial	$83.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Massage Assistant Units

Facility

$110.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	3957124
Hospital Revenue Code	420
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$104.50
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$42.42
Rate for Payer: Humana Medicare Advantage	$46.20
Rate for Payer: UnitedHealthcare Commercial	$104.50
Rate for Payer: UnitedHealthcare Medicaid	$11.41
Rate for Payer: WPPA Medicare Advantage	$66.00

PT Massage Assistant Units

Facility

$110.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	3957124
Hospital Revenue Code	420
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: UnitedHealthcare Commercial	$104.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Mechanical Traction Units

Facility

$88.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	3950127
Hospital Revenue Code	420
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$79.20
Rate for Payer: UnitedHealthcare Commercial	$83.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Mechanical Traction Units

Facility

$88.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	3950127
Hospital Revenue Code	420
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$83.60
Rate for Payer: Aetna Commercial	$79.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.36
Rate for Payer: Humana Medicare Advantage	$36.96
Rate for Payer: UnitedHealthcare Commercial	$83.60
Rate for Payer: UnitedHealthcare Medicaid	$14.77
Rate for Payer: WPPA Medicare Advantage	$52.80

PT Moderate Complex Units

Facility

$270.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	3957162
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	$120.60
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

PT Moderate Complex Units

Facility

$270.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	3957162
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 Neuromuscular Reeducation Assist Unit

Facility

$132.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	3950531
Hospital Revenue Code	420
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Neuromuscular Reeducation Assist Unit

Facility

$132.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	3950531
Hospital Revenue Code	420
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$125.40
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$50.50
Rate for Payer: Humana Medicare Advantage	$55.44
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: UnitedHealthcare Medicaid	$27.18
Rate for Payer: WPPA Medicare Advantage	$79.20

PT Orthotic Mgmt, Train Assistant Units

Facility

$134.00

Service Code	HCPCS 97760 GP
Hospital Charge Code	3950507
Hospital Revenue Code	420
Min. Negotiated Rate	$39.64
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$39.64
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$53.60
Rate for Payer: WPPA Medicare Advantage	$80.40

PT Orthotic Mgmt, Train Assistant Units

Facility

$134.00

Service Code	HCPCS 97760 GP
Hospital Charge Code	3950507
Hospital Revenue Code	420
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Other Thermal Assitant 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

PT Other Thermal Assitant 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 OUTSOURCING ASSISTANT

Facility

$9.00

Hospital Charge Code	5575728
Hospital Revenue Code	422
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.55
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: WPPA Medicare Advantage	$5.40

PT OUTSOURCING ASSISTANT

Facility

$9.00

Hospital Charge Code	5575728
Hospital Revenue Code	422
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Paraffin Assistant Units

Facility

$67.00

Service Code	HCPCS 97018 GP
Hospital Charge Code	3950150
Hospital Revenue Code	420
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Paraffin Assistant Units

Facility

$67.00

Service Code	HCPCS 97018 GP
Hospital Charge Code	3950150
Hospital Revenue Code	420
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$63.65
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.23
Rate for Payer: Humana Medicare Advantage	$28.14
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: UnitedHealthcare Medicaid	$13.96
Rate for Payer: WPPA Medicare Advantage	$40.20

PT Paraffin Units

Facility

$67.00

Service Code	HCPCS 97018 GP
Hospital Charge Code	3950150
Hospital Revenue Code	420
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$63.65
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.23
Rate for Payer: Humana Medicare Advantage	$28.14
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: UnitedHealthcare Medicaid	$13.96
Rate for Payer: WPPA Medicare Advantage	$40.20

PT Paraffin Units

Facility

$67.00

Service Code	HCPCS 97018 GP
Hospital Charge Code	3950150
Hospital Revenue Code	420
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PT Physical PerFormance Assistant Test

Facility

$95.00

Service Code	HCPCS 97750 GP
Hospital Charge Code	3957750
Hospital Revenue Code	420
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$90.25
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$53.53
Rate for Payer: Humana Medicare Advantage	$39.90
Rate for Payer: UnitedHealthcare Commercial	$90.25
Rate for Payer: UnitedHealthcare Medicaid	$17.56
Rate for Payer: WPPA Medicare Advantage	$57.00

Know your out-of-pocket cost for care.

All Charges