Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Respiratory Allergy Profile Region IX QST

Facility

$265.00

Service Code	HCPCS 86003
Hospital Charge Code	3552785
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$251.75
Rate for Payer: Aetna Commercial	$238.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$111.30
Rate for Payer: UnitedHealthcare Commercial	$251.75
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$159.00

Respiratory Allergy Prof Region VIII QST

Facility

$205.00

Service Code	HCPCS 82785
Hospital Charge Code	LAB1000
Hospital Revenue Code	300
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$194.75
Rate for Payer: Aetna Commercial	$184.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$63.27
Rate for Payer: Humana Medicare Advantage	$86.10
Rate for Payer: UnitedHealthcare Commercial	$194.75
Rate for Payer: UnitedHealthcare Medicaid	$13.99
Rate for Payer: WPPA Medicare Advantage	$123.00

Respiratory Allergy Prof Region VIII QST

Facility

$205.00

Service Code	HCPCS 82785
Hospital Charge Code	LAB1000
Hospital Revenue Code	300
Min. Negotiated Rate	$184.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$184.50
Rate for Payer: UnitedHealthcare Commercial	$194.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$3,780.63

Service Code	MSDRG 178
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,780.63
Rate for Payer: UnitedHealthcare Medicaid	$3,780.63
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$6,290.46

Service Code	MSDRG 177
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,290.46
Rate for Payer: UnitedHealthcare Medicaid	$6,290.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$2,922.84

Service Code	MSDRG 179
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,922.84
Rate for Payer: UnitedHealthcare Medicaid	$2,922.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY NEOPLASMS WITH CC

Facility

$3,145.23

Service Code	MSDRG 181
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,145.23
Rate for Payer: UnitedHealthcare Medicaid	$3,145.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY NEOPLASMS WITH MCC

Facility

$7,942.50

Service Code	MSDRG 180
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,942.50
Rate for Payer: UnitedHealthcare Medicaid	$7,942.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$2,922.84

Service Code	MSDRG 182
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,922.84
Rate for Payer: UnitedHealthcare Medicaid	$2,922.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$3,113.46

Service Code	MSDRG 204
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,113.46
Rate for Payer: UnitedHealthcare Medicaid	$3,113.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$7,974.27

Service Code	MSDRG 208
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,974.27
Rate for Payer: UnitedHealthcare Medicaid	$7,974.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$24,240.51

Service Code	MSDRG 207
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$24,240.51
Rate for Payer: UnitedHealthcare Medicaid	$24,240.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Respiratory Viral Panel PCR QST

Facility

$1,182.00

Service Code	HCPCS 87633
Hospital Charge Code	3557633
Hospital Revenue Code	300
Min. Negotiated Rate	$372.39
Max. Negotiated Rate	$1,398.85
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,398.85
Rate for Payer: Humana Medicare Advantage	$496.44
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: UnitedHealthcare Medicaid	$372.39
Rate for Payer: WPPA Medicare Advantage	$709.20

Respiratory Viral Panel PCR QST

Facility

$1,182.00

Service Code	HCPCS 87633
Hospital Charge Code	3557633
Hospital Revenue Code	300
Min. Negotiated Rate	$1,063.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Retic Count Automated

Facility

$66.00

Service Code	HCPCS 85046
Hospital Charge Code	3555046
Hospital Revenue Code	300
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Retic Count Automated

Facility

$66.00

Service Code	HCPCS 85046
Hospital Charge Code	3555046
Hospital Revenue Code	300
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$62.70
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$34.02
Rate for Payer: Humana Medicare Advantage	$27.72
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: UnitedHealthcare Medicaid	$5.57
Rate for Payer: WPPA Medicare Advantage	$39.60

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$4,479.57

Service Code	MSDRG 815
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,479.57
Rate for Payer: UnitedHealthcare Medicaid	$4,479.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$9,435.69

Service Code	MSDRG 814
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,435.69
Rate for Payer: UnitedHealthcare Medicaid	$9,435.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$2,795.76

Service Code	MSDRG 816
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,795.76
Rate for Payer: UnitedHealthcare Medicaid	$2,795.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Retractor Panniculus Traxi

Facility

$238.00

Hospital Charge Code	3256860
Hospital Revenue Code	270
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$226.10
Rate for Payer: Aetna Commercial	$214.20
Rate for Payer: Humana Medicare Advantage	$99.96
Rate for Payer: UnitedHealthcare Commercial	$226.10
Rate for Payer: UnitedHealthcare Medicaid	$95.20
Rate for Payer: WPPA Medicare Advantage	$142.80

Retractor Panniculus Traxi

Facility

$238.00

Hospital Charge Code	3256860
Hospital Revenue Code	270
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$214.20
Rate for Payer: UnitedHealthcare Commercial	$226.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$14,264.73

Service Code	MSDRG 467
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$14,264.73
Rate for Payer: UnitedHealthcare Medicaid	$14,264.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$19,697.40

Service Code	MSDRG 466
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$19,697.40
Rate for Payer: UnitedHealthcare Medicaid	$19,697.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$12,771.54

Service Code	MSDRG 468
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$12,771.54
Rate for Payer: UnitedHealthcare Medicaid	$12,771.54
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RF Abalation 2-Probe w/ 4-Introducers 1-Dual Tube 17G X 50mm 4mm-Active Tip

Facility

$2,713.20

Service Code	HCPCS A4649
Hospital Charge Code	3256670
Hospital Revenue Code	270
Min. Negotiated Rate	$1,085.28
Max. Negotiated Rate	$2,577.54
Rate for Payer: Aetna Commercial	$2,441.88
Rate for Payer: Humana Medicare Advantage	$1,139.54
Rate for Payer: UnitedHealthcare Commercial	$2,577.54
Rate for Payer: UnitedHealthcare Medicaid	$1,085.28
Rate for Payer: WPPA Medicare Advantage	$1,627.92

Know your out-of-pocket cost for care.

All Charges