Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

31231 Nasal endoscopy, diagnostic, unilateral or bilateral

Facility

$2,477.00

Service Code	HCPCS 31231
Hospital Charge Code	3351231
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,353.15
Rate for Payer: Aetna Commercial	$2,229.30
Rate for Payer: UnitedHealthcare Commercial	$2,353.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31231 Nasal endoscopy, diagnostic, unilateral or bilateral

Facility

$2,477.00

Service Code	HCPCS 31231
Hospital Charge Code	3351231
Hospital Revenue Code	761
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$2,353.15
Rate for Payer: Aetna Commercial	$2,229.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$215.15
Rate for Payer: Humana Medicare Advantage	$1,040.34
Rate for Payer: UnitedHealthcare Commercial	$2,353.15
Rate for Payer: UnitedHealthcare Medicaid	$114.40
Rate for Payer: WPPA Medicare Advantage	$1,486.20

31231 NASAL ENDOSCOPY DX

Facility

$525.00

Service Code	HCPCS 31231
Hospital Charge Code	3151231
Hospital Revenue Code	360
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$472.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$215.15
Rate for Payer: Humana Medicare Advantage	$220.50
Rate for Payer: UnitedHealthcare Commercial	$498.75
Rate for Payer: UnitedHealthcare Medicaid	$114.40
Rate for Payer: WPPA Medicare Advantage	$315.00

31231 NASAL ENDOSCOPY DX

Facility

$525.00

Service Code	HCPCS 31231
Hospital Charge Code	3151231
Hospital Revenue Code	360
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$472.50
Rate for Payer: UnitedHealthcare Commercial	$498.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31237 NASAL/SINUS ENDOSCOPY SURG

Facility

$3,150.00

Service Code	HCPCS 31237
Hospital Charge Code	3151237
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,992.50
Rate for Payer: Aetna Commercial	$2,835.00
Rate for Payer: UnitedHealthcare Commercial	$2,992.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31237 NASAL/SINUS ENDOSCOPY SURG

Facility

$3,150.00

Service Code	HCPCS 31237
Hospital Charge Code	3151237
Hospital Revenue Code	360
Min. Negotiated Rate	$549.83
Max. Negotiated Rate	$2,992.50
Rate for Payer: Aetna Commercial	$2,835.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,918.05
Rate for Payer: Humana Medicare Advantage	$1,323.00
Rate for Payer: UnitedHealthcare Commercial	$2,992.50
Rate for Payer: UnitedHealthcare Medicaid	$549.83
Rate for Payer: WPPA Medicare Advantage	$1,890.00

31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement

Facility

$5,546.00

Service Code	HCPCS 31237
Hospital Charge Code	3351237
Hospital Revenue Code	761
Min. Negotiated Rate	$549.83
Max. Negotiated Rate	$5,268.70
Rate for Payer: Aetna Commercial	$4,991.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,918.05
Rate for Payer: Humana Medicare Advantage	$2,329.32
Rate for Payer: UnitedHealthcare Commercial	$5,268.70
Rate for Payer: UnitedHealthcare Medicaid	$549.83
Rate for Payer: WPPA Medicare Advantage	$3,327.60

31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement

Facility

$5,546.00

Service Code	HCPCS 31237
Hospital Charge Code	3351237
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,268.70
Rate for Payer: Aetna Commercial	$4,991.40
Rate for Payer: UnitedHealthcare Commercial	$5,268.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31238 CONTROL POST. NASAL HEMORRAGE-ER SERV PR

Facility

$6,742.00

Service Code	HCPCS 31238
Hospital Charge Code	3351238
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,404.90
Rate for Payer: Aetna Commercial	$6,067.80
Rate for Payer: UnitedHealthcare Commercial	$6,404.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31238 CONTROL POST. NASAL HEMORRAGE-ER SERV PR

Facility

$6,742.00

Service Code	HCPCS 31238
Hospital Charge Code	3351238
Hospital Revenue Code	761
Min. Negotiated Rate	$549.83
Max. Negotiated Rate	$6,404.90
Rate for Payer: Aetna Commercial	$6,067.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,632.87
Rate for Payer: Humana Medicare Advantage	$2,831.64
Rate for Payer: UnitedHealthcare Commercial	$6,404.90
Rate for Payer: UnitedHealthcare Medicaid	$549.83
Rate for Payer: WPPA Medicare Advantage	$4,045.20

31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection

Facility

$6,421.00

Service Code	HCPCS 31240
Hospital Charge Code	3151240
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,099.95
Rate for Payer: Aetna Commercial	$5,778.90
Rate for Payer: UnitedHealthcare Commercial	$6,099.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection

Facility

$6,421.00

Service Code	HCPCS 31240
Hospital Charge Code	3151240
Hospital Revenue Code	360
Min. Negotiated Rate	$549.83
Max. Negotiated Rate	$6,099.95
Rate for Payer: Aetna Commercial	$5,778.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,632.87
Rate for Payer: Humana Medicare Advantage	$2,696.82
Rate for Payer: UnitedHealthcare Commercial	$6,099.95
Rate for Payer: UnitedHealthcare Medicaid	$549.83
Rate for Payer: WPPA Medicare Advantage	$3,852.60

31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including

Facility

$4,262.00

Service Code	HCPCS 31253
Hospital Charge Code	3151253
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,048.90
Rate for Payer: Aetna Commercial	$3,835.80
Rate for Payer: UnitedHealthcare Commercial	$4,048.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including

Facility

$4,262.00

Service Code	HCPCS 31253
Hospital Charge Code	3151253
Hospital Revenue Code	360
Min. Negotiated Rate	$1,790.04
Max. Negotiated Rate	$4,048.90
Rate for Payer: Aetna Commercial	$3,835.80
Rate for Payer: Humana Medicare Advantage	$1,790.04
Rate for Payer: UnitedHealthcare Commercial	$4,048.90
Rate for Payer: UnitedHealthcare Medicaid	$3,288.18
Rate for Payer: WPPA Medicare Advantage	$2,557.20

31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)

Facility

$10,335.00

Service Code	HCPCS 31254
Hospital Charge Code	3151254
Hospital Revenue Code	360
Min. Negotiated Rate	$2,217.20
Max. Negotiated Rate	$9,818.25
Rate for Payer: Aetna Commercial	$9,301.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$7,456.55
Rate for Payer: Humana Medicare Advantage	$4,340.70
Rate for Payer: UnitedHealthcare Commercial	$9,818.25
Rate for Payer: UnitedHealthcare Medicaid	$2,217.20
Rate for Payer: WPPA Medicare Advantage	$6,201.00

31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)

Facility

$10,335.00

Service Code	HCPCS 31254
Hospital Charge Code	3151254
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,818.25
Rate for Payer: Aetna Commercial	$9,301.50
Rate for Payer: UnitedHealthcare Commercial	$9,818.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31255 NSL/SINS NDSC W/TOT ETHMDCT

Facility

$6,876.00

Service Code	HCPCS 31255
Hospital Charge Code	3151255
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,532.20
Rate for Payer: Aetna Commercial	$6,188.40
Rate for Payer: UnitedHealthcare Commercial	$6,532.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31255 NSL/SINS NDSC W/TOT ETHMDCT

Facility

$6,876.00

Service Code	HCPCS 31255
Hospital Charge Code	3151255
Hospital Revenue Code	360
Min. Negotiated Rate	$2,217.20
Max. Negotiated Rate	$7,456.55
Rate for Payer: Aetna Commercial	$6,188.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$7,456.55
Rate for Payer: Humana Medicare Advantage	$2,887.92
Rate for Payer: UnitedHealthcare Commercial	$6,532.20
Rate for Payer: UnitedHealthcare Medicaid	$2,217.20
Rate for Payer: WPPA Medicare Advantage	$4,125.60

31256 EXPLORATION MAXILLARY SINUS

Facility

$5,572.00

Service Code	HCPCS 31256
Hospital Charge Code	3151256
Hospital Revenue Code	360
Min. Negotiated Rate	$1,213.14
Max. Negotiated Rate	$5,293.40
Rate for Payer: Aetna Commercial	$5,014.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,020.08
Rate for Payer: Humana Medicare Advantage	$2,340.24
Rate for Payer: UnitedHealthcare Commercial	$5,293.40
Rate for Payer: UnitedHealthcare Medicaid	$1,213.14
Rate for Payer: WPPA Medicare Advantage	$3,343.20

31256 EXPLORATION MAXILLARY SINUS

Facility

$5,572.00

Service Code	HCPCS 31256
Hospital Charge Code	3151256
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,293.40
Rate for Payer: Aetna Commercial	$5,014.80
Rate for Payer: UnitedHealthcare Commercial	$5,293.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy

Facility

$5,572.00

Service Code	HCPCS 31256
Hospital Charge Code	3151256
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,293.40
Rate for Payer: Aetna Commercial	$5,014.80
Rate for Payer: UnitedHealthcare Commercial	$5,293.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy

Facility

$5,572.00

Service Code	HCPCS 31256
Hospital Charge Code	3151256
Hospital Revenue Code	360
Min. Negotiated Rate	$1,213.14
Max. Negotiated Rate	$5,293.40
Rate for Payer: Aetna Commercial	$5,014.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,020.08
Rate for Payer: Humana Medicare Advantage	$2,340.24
Rate for Payer: UnitedHealthcare Commercial	$5,293.40
Rate for Payer: UnitedHealthcare Medicaid	$1,213.14
Rate for Payer: WPPA Medicare Advantage	$3,343.20

31257 NASAL SINUS ENDO TOAL ANTERIOR/POST/SPHENOID

Facility

$11,969.00

Service Code	HCPCS 31257
Hospital Charge Code	3361257
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$11,370.55
Rate for Payer: Aetna Commercial	$10,772.10
Rate for Payer: UnitedHealthcare Commercial	$11,370.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31257 NASAL SINUS ENDO TOAL ANTERIOR/POST/SPHENOID

Facility

$11,969.00

Service Code	HCPCS 31257
Hospital Charge Code	3361257
Hospital Revenue Code	360
Min. Negotiated Rate	$3,288.18
Max. Negotiated Rate	$11,370.55
Rate for Payer: Aetna Commercial	$10,772.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$7,456.55
Rate for Payer: Humana Medicare Advantage	$5,026.98
Rate for Payer: UnitedHealthcare Commercial	$11,370.55
Rate for Payer: UnitedHealthcare Medicaid	$3,288.18
Rate for Payer: WPPA Medicare Advantage	$7,181.40

31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including

Facility

$10,335.00

Service Code	HCPCS 31259
Hospital Charge Code	3151259
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,818.25
Rate for Payer: Aetna Commercial	$9,301.50
Rate for Payer: UnitedHealthcare Commercial	$9,818.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges