Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Specialty Bed - Pressure Reducing Device for Bed

Facility

$101.00

Hospital Charge Code	3258115
Hospital Revenue Code	270
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$90.90
Rate for Payer: Humana Medicare Advantage	$42.42
Rate for Payer: UnitedHealthcare Commercial	$95.95
Rate for Payer: UnitedHealthcare Medicaid	$40.40
Rate for Payer: WPPA Medicare Advantage	$60.60

Specialty Bed - Pressure Reducing Device for Bed

Facility

$101.00

Hospital Charge Code	3258115
Hospital Revenue Code	270
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$90.90
Rate for Payer: UnitedHealthcare Commercial	$95.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Specimen Sock Specimen Collection-Retainer with Male Port accepting up to 3/8 Tubing

Facility

$9.14

Hospital Charge Code	3258289
Hospital Revenue Code	270
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.23
Rate for Payer: UnitedHealthcare Commercial	$8.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Specimen Sock Specimen Collection-Retainer with Male Port accepting up to 3/8 Tubing

Facility

$9.14

Hospital Charge Code	3258289
Hospital Revenue Code	270
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$8.68
Rate for Payer: Aetna Commercial	$8.23
Rate for Payer: Humana Medicare Advantage	$3.84
Rate for Payer: UnitedHealthcare Commercial	$8.68
Rate for Payer: UnitedHealthcare Medicaid	$3.66
Rate for Payer: WPPA Medicare Advantage	$5.48

Speech Fluency Eval Charge

Facility

$257.00

Service Code	HCPCS 92521 GN
Hospital Charge Code	4051095
Hospital Revenue Code	444
Min. Negotiated Rate	$80.95
Max. Negotiated Rate	$244.15
Rate for Payer: Aetna Commercial	$231.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$116.15
Rate for Payer: Humana Medicare Advantage	$107.94
Rate for Payer: UnitedHealthcare Commercial	$244.15
Rate for Payer: UnitedHealthcare Medicaid	$80.95
Rate for Payer: WPPA Medicare Advantage	$154.20

Speech Fluency Eval Charge

Facility

$257.00

Service Code	HCPCS 92521 GN
Hospital Charge Code	4051095
Hospital Revenue Code	444
Min. Negotiated Rate	$231.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$231.30
Rate for Payer: UnitedHealthcare Commercial	$244.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Speech Generating Device Evaluation 1st hr Charge

Facility

$192.00

Service Code	HCPCS 92607 GN
Hospital Charge Code	4052607
Hospital Revenue Code	444
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$182.40
Rate for Payer: Aetna Commercial	$172.80
Rate for Payer: Humana Medicare Advantage	$80.64
Rate for Payer: UnitedHealthcare Commercial	$182.40
Rate for Payer: UnitedHealthcare Medicaid	$76.80
Rate for Payer: WPPA Medicare Advantage	$115.20

Speech Generating Device Evaluation 1st hr Charge

Facility

$192.00

Service Code	HCPCS 92607 GN
Hospital Charge Code	4052607
Hospital Revenue Code	444
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$172.80
Rate for Payer: UnitedHealthcare Commercial	$182.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Speech Generating Device Service Charge

Facility

$81.00

Service Code	HCPCS 92608 GN
Hospital Charge Code	4052608
Hospital Revenue Code	444
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$72.90
Rate for Payer: UnitedHealthcare Commercial	$76.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Speech Generating Device Service Charge

Facility

$81.00

Service Code	HCPCS 92608 GN
Hospital Charge Code	4052608
Hospital Revenue Code	444
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$76.95
Rate for Payer: Aetna Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$34.02
Rate for Payer: UnitedHealthcare Commercial	$76.95
Rate for Payer: UnitedHealthcare Medicaid	$32.40
Rate for Payer: WPPA Medicare Advantage	$48.60

Speech Language Pathology Evaluation and Treatment Acute

Facility

$433.00

Service Code	HCPCS 92523 GN
Hospital Charge Code	4051105
Hospital Revenue Code	444
Min. Negotiated Rate	$389.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$389.70
Rate for Payer: UnitedHealthcare Commercial	$411.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Speech Language Pathology Evaluation and Treatment Acute

Facility

$433.00

Service Code	HCPCS 92523 GN
Hospital Charge Code	4051105
Hospital Revenue Code	444
Min. Negotiated Rate	$116.15
Max. Negotiated Rate	$411.35
Rate for Payer: Aetna Commercial	$389.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$116.15
Rate for Payer: Humana Medicare Advantage	$181.86
Rate for Payer: UnitedHealthcare Commercial	$411.35
Rate for Payer: UnitedHealthcare Medicaid	$182.72
Rate for Payer: WPPA Medicare Advantage	$259.80

Speech Sound Production Eval Charge

Facility

$257.00

Service Code	HCPCS 92522 GN
Hospital Charge Code	4051100
Hospital Revenue Code	444
Min. Negotiated Rate	$67.70
Max. Negotiated Rate	$244.15
Rate for Payer: Aetna Commercial	$231.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$116.15
Rate for Payer: Humana Medicare Advantage	$107.94
Rate for Payer: UnitedHealthcare Commercial	$244.15
Rate for Payer: UnitedHealthcare Medicaid	$67.70
Rate for Payer: WPPA Medicare Advantage	$154.20

Speech Sound Production Eval Charge

Facility

$257.00

Service Code	HCPCS 92522 GN
Hospital Charge Code	4051100
Hospital Revenue Code	444
Min. Negotiated Rate	$231.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$231.30
Rate for Payer: UnitedHealthcare Commercial	$244.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Speech Sound Prod w/ Language Charge

Facility

$433.00

Service Code	HCPCS 92523 GN
Hospital Charge Code	4051105
Hospital Revenue Code	444
Min. Negotiated Rate	$116.15
Max. Negotiated Rate	$411.35
Rate for Payer: Aetna Commercial	$389.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$116.15
Rate for Payer: Humana Medicare Advantage	$181.86
Rate for Payer: UnitedHealthcare Commercial	$411.35
Rate for Payer: UnitedHealthcare Medicaid	$182.72
Rate for Payer: WPPA Medicare Advantage	$259.80

Speech Sound Prod w/ Language Charge

Facility

$433.00

Service Code	HCPCS 92523 GN
Hospital Charge Code	4051105
Hospital Revenue Code	444
Min. Negotiated Rate	$389.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$389.70
Rate for Payer: UnitedHealthcare Commercial	$411.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SphenoCath Occipital Nerve Block Catheter for Migraine and Headache Management

Facility

$294.00

Hospital Charge Code	3253550
Hospital Revenue Code	270
Min. Negotiated Rate	$264.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$264.60
Rate for Payer: UnitedHealthcare Commercial	$279.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SphenoCath Occipital Nerve Block Catheter for Migraine and Headache Management

Facility

$294.00

Hospital Charge Code	3253550
Hospital Revenue Code	270
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$279.30
Rate for Payer: Aetna Commercial	$264.60
Rate for Payer: Humana Medicare Advantage	$123.48
Rate for Payer: UnitedHealthcare Commercial	$279.30
Rate for Payer: UnitedHealthcare Medicaid	$117.60
Rate for Payer: WPPA Medicare Advantage	$176.40

Sphincterotomy Anal

Facility

$3,515.00

Service Code	HCPCS 46080
Hospital Charge Code	3406080
Hospital Revenue Code	360
Min. Negotiated Rate	$909.58
Max. Negotiated Rate	$3,339.25
Rate for Payer: Aetna Commercial	$3,163.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,235.23
Rate for Payer: Humana Medicare Advantage	$1,476.30
Rate for Payer: UnitedHealthcare Commercial	$3,339.25
Rate for Payer: UnitedHealthcare Medicaid	$909.58
Rate for Payer: WPPA Medicare Advantage	$2,109.00

Sphincterotomy Anal

Facility

$3,515.00

Service Code	HCPCS 46080
Hospital Charge Code	3406080
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,339.25
Rate for Payer: Aetna Commercial	$3,163.50
Rate for Payer: UnitedHealthcare Commercial	$3,339.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Spinal Anesthesia Tray 25G

Facility

$60.12

Hospital Charge Code	3255168
Hospital Revenue Code	270
Min. Negotiated Rate	$54.11
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.11
Rate for Payer: UnitedHealthcare Commercial	$57.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Spinal Anesthesia Tray 25G

Facility

$60.12

Hospital Charge Code	3255168
Hospital Revenue Code	270
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$57.11
Rate for Payer: Aetna Commercial	$54.11
Rate for Payer: Humana Medicare Advantage	$25.25
Rate for Payer: UnitedHealthcare Commercial	$57.11
Rate for Payer: UnitedHealthcare Medicaid	$24.05
Rate for Payer: WPPA Medicare Advantage	$36.07

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$8,196.66

Service Code	MSDRG 052
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$8,196.66
Rate for Payer: UnitedHealthcare Medicaid	$8,196.66
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$4,416.03

Service Code	MSDRG 053
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,416.03
Rate for Payer: UnitedHealthcare Medicaid	$4,416.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$20,269.26

Service Code	MSDRG 457
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$20,269.26
Rate for Payer: UnitedHealthcare Medicaid	$20,269.26
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges