Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC CHARGE

Facility

$2,006.00

Service Code	HCPCS 31575
Hospital Charge Code	3151575
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,905.70
Rate for Payer: Aetna Commercial	$1,805.40
Rate for Payer: UnitedHealthcare Commercial	$1,905.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC CHARGE

Facility

$2,006.00

Service Code	HCPCS 31575
Hospital Charge Code	3151575
Hospital Revenue Code	360
Min. Negotiated Rate	$215.15
Max. Negotiated Rate	$1,905.70
Rate for Payer: Aetna Commercial	$1,805.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$215.15
Rate for Payer: Humana Medicare Advantage	$842.52
Rate for Payer: UnitedHealthcare Commercial	$1,905.70
Rate for Payer: UnitedHealthcare Medicaid	$234.00
Rate for Payer: WPPA Medicare Advantage	$1,203.60

31575 Laryngoscopy, flexible fiberoptic; diagnostic

Facility

$2,106.00

Service Code	HCPCS 31575
Hospital Charge Code	3351575
Hospital Revenue Code	761
Min. Negotiated Rate	$215.15
Max. Negotiated Rate	$2,000.70
Rate for Payer: Aetna Commercial	$1,895.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$215.15
Rate for Payer: Humana Medicare Advantage	$884.52
Rate for Payer: UnitedHealthcare Commercial	$2,000.70
Rate for Payer: UnitedHealthcare Medicaid	$234.00
Rate for Payer: WPPA Medicare Advantage	$1,263.60

31575 Laryngoscopy, flexible fiberoptic; diagnostic

Facility

$2,106.00

Service Code	HCPCS 31575
Hospital Charge Code	3351575
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,000.70
Rate for Payer: Aetna Commercial	$1,895.40
Rate for Payer: UnitedHealthcare Commercial	$2,000.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy

Facility

$2,402.00

Service Code	HCPCS 31579
Hospital Charge Code	3351579
Hospital Revenue Code	761
Min. Negotiated Rate	$371.80
Max. Negotiated Rate	$2,281.90
Rate for Payer: Aetna Commercial	$2,161.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$455.47
Rate for Payer: Humana Medicare Advantage	$1,008.84
Rate for Payer: UnitedHealthcare Commercial	$2,281.90
Rate for Payer: UnitedHealthcare Medicaid	$371.80
Rate for Payer: WPPA Medicare Advantage	$1,441.20

31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy

Facility

$2,402.00

Service Code	HCPCS 31579
Hospital Charge Code	3351579
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,281.90
Rate for Payer: Aetna Commercial	$2,161.80
Rate for Payer: UnitedHealthcare Commercial	$2,281.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31603 Tracheostomy, emergency procedure; transtracheal

Facility

$917.00

Service Code	HCPCS 31603
Hospital Charge Code	3151603
Hospital Revenue Code	360
Min. Negotiated Rate	$825.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$825.30
Rate for Payer: UnitedHealthcare Commercial	$871.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31603 Tracheostomy, emergency procedure; transtracheal

Facility

$917.00

Service Code	HCPCS 31603
Hospital Charge Code	3151603
Hospital Revenue Code	360
Min. Negotiated Rate	$366.80
Max. Negotiated Rate	$871.15
Rate for Payer: Aetna Commercial	$825.30
Rate for Payer: Humana Medicare Advantage	$385.14
Rate for Payer: UnitedHealthcare Commercial	$871.15
Rate for Payer: UnitedHealthcare Medicaid	$366.80
Rate for Payer: WPPA Medicare Advantage	$550.20

31605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE TechFee

Facility

$2,527.00

Service Code	HCPCS 31605
Hospital Charge Code	3301605
Hospital Revenue Code	450
Min. Negotiated Rate	$387.92
Max. Negotiated Rate	$2,400.65
Rate for Payer: Aetna Commercial	$2,274.30
Rate for Payer: Humana Medicare Advantage	$1,061.34
Rate for Payer: UnitedHealthcare Commercial	$2,400.65
Rate for Payer: UnitedHealthcare Medicaid	$387.92
Rate for Payer: WPPA Medicare Advantage	$1,516.20

31605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE TechFee

Facility

$2,527.00

Service Code	HCPCS 31605
Hospital Charge Code	3301605
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,400.65
Rate for Payer: Aetna Commercial	$2,274.30
Rate for Payer: UnitedHealthcare Commercial	$2,400.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31615 Tracheobronchoscopy through established tracheostomy incision

Facility

$1,121.00

Service Code	HCPCS 31615
Hospital Charge Code	3351615
Hospital Revenue Code	761
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,064.95
Rate for Payer: Aetna Commercial	$1,008.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$470.82
Rate for Payer: UnitedHealthcare Commercial	$1,064.95
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$672.60

31615 Tracheobronchoscopy through established tracheostomy incision

Facility

$1,121.00

Service Code	HCPCS 31615
Hospital Charge Code	3351615
Hospital Revenue Code	761
Min. Negotiated Rate	$1,008.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,008.90
Rate for Payer: UnitedHealthcare Commercial	$1,064.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31622 BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX

Facility

$3,343.00

Service Code	HCPCS 31622
Hospital Charge Code	3150406
Hospital Revenue Code	360
Min. Negotiated Rate	$549.83
Max. Negotiated Rate	$3,175.85
Rate for Payer: Aetna Commercial	$3,008.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,461.47
Rate for Payer: Humana Medicare Advantage	$1,404.06
Rate for Payer: UnitedHealthcare Commercial	$3,175.85
Rate for Payer: UnitedHealthcare Medicaid	$549.83
Rate for Payer: WPPA Medicare Advantage	$2,005.80

31622 BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX

Facility

$3,343.00

Service Code	HCPCS 31622
Hospital Charge Code	3150406
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,175.85
Rate for Payer: Aetna Commercial	$3,008.70
Rate for Payer: UnitedHealthcare Commercial	$3,175.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31623 Bronchoscopy, rigid/flexible, w/fluoroscopic guid, w/brushing or protected brushings

Facility

$2,597.00

Service Code	HCPCS 31623
Hospital Charge Code	3150408
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,467.15
Rate for Payer: Aetna Commercial	$2,337.30
Rate for Payer: UnitedHealthcare Commercial	$2,467.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31623 Bronchoscopy, rigid/flexible, w/fluoroscopic guid, w/brushing or protected brushings

Facility

$2,597.00

Service Code	HCPCS 31623
Hospital Charge Code	3150408
Hospital Revenue Code	360
Min. Negotiated Rate	$549.83
Max. Negotiated Rate	$2,467.15
Rate for Payer: Aetna Commercial	$2,337.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,612.97
Rate for Payer: Humana Medicare Advantage	$1,090.74
Rate for Payer: UnitedHealthcare Commercial	$2,467.15
Rate for Payer: UnitedHealthcare Medicaid	$549.83
Rate for Payer: WPPA Medicare Advantage	$1,558.20

31624 Bronchoscopy, rigid or flexible, including fluoroscopic guidance; w/ bronchial alveolar lavage

Facility

$2,247.00

Service Code	HCPCS 31624
Hospital Charge Code	3156243
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,134.65
Rate for Payer: Aetna Commercial	$2,022.30
Rate for Payer: UnitedHealthcare Commercial	$2,134.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31624 Bronchoscopy, rigid or flexible, including fluoroscopic guidance; w/ bronchial alveolar lavage

Facility

$2,247.00

Service Code	HCPCS 31624
Hospital Charge Code	3156243
Hospital Revenue Code	360
Min. Negotiated Rate	$549.83
Max. Negotiated Rate	$2,134.65
Rate for Payer: Aetna Commercial	$2,022.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,334.21
Rate for Payer: Humana Medicare Advantage	$943.74
Rate for Payer: UnitedHealthcare Commercial	$2,134.65
Rate for Payer: UnitedHealthcare Medicaid	$549.83
Rate for Payer: WPPA Medicare Advantage	$1,348.20

31625 Bronchoscopy, rigid or flexible, incld fluoroscopic guidance; w/ biopsy(s), single or multiple

Facility

$2,783.00

Service Code	HCPCS 31625
Hospital Charge Code	3150409
Hospital Revenue Code	360
Min. Negotiated Rate	$549.83
Max. Negotiated Rate	$2,643.85
Rate for Payer: Aetna Commercial	$2,504.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,729.12
Rate for Payer: Humana Medicare Advantage	$1,168.86
Rate for Payer: UnitedHealthcare Commercial	$2,643.85
Rate for Payer: UnitedHealthcare Medicaid	$549.83
Rate for Payer: WPPA Medicare Advantage	$1,669.80

31625 Bronchoscopy, rigid or flexible, incld fluoroscopic guidance; w/ biopsy(s), single or multiple

Facility

$2,783.00

Service Code	HCPCS 31625
Hospital Charge Code	3150409
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,643.85
Rate for Payer: Aetna Commercial	$2,504.70
Rate for Payer: UnitedHealthcare Commercial	$2,643.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31628 Bronchoscopy, rigid/flexible, fluoroscopic guidance; w/ transbronchial lung biopsy single lobe

Facility

$2,734.00

Service Code	HCPCS 31628
Hospital Charge Code	3151628
Hospital Revenue Code	360
Min. Negotiated Rate	$1,148.28
Max. Negotiated Rate	$2,597.30
Rate for Payer: Aetna Commercial	$2,460.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,972.53
Rate for Payer: Humana Medicare Advantage	$1,148.28
Rate for Payer: UnitedHealthcare Commercial	$2,597.30
Rate for Payer: UnitedHealthcare Medicaid	$1,213.14
Rate for Payer: WPPA Medicare Advantage	$1,640.40

31628 Bronchoscopy, rigid/flexible, fluoroscopic guidance; w/ transbronchial lung biopsy single lobe

Facility

$2,734.00

Service Code	HCPCS 31628
Hospital Charge Code	3151628
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,597.30
Rate for Payer: Aetna Commercial	$2,460.60
Rate for Payer: UnitedHealthcare Commercial	$2,597.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31629 Bronchoscopy, rigid/flexible, incld fluoroscopic guidance; w/ transbronchial needle aspiration

Facility

$2,886.00

Service Code	HCPCS 31629
Hospital Charge Code	3151629
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,741.70
Rate for Payer: Aetna Commercial	$2,597.40
Rate for Payer: UnitedHealthcare Commercial	$2,741.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

31629 Bronchoscopy, rigid/flexible, incld fluoroscopic guidance; w/ transbronchial needle aspiration

Facility

$2,886.00

Service Code	HCPCS 31629
Hospital Charge Code	3151629
Hospital Revenue Code	360
Min. Negotiated Rate	$1,212.12
Max. Negotiated Rate	$2,741.70
Rate for Payer: Aetna Commercial	$2,597.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,082.62
Rate for Payer: Humana Medicare Advantage	$1,212.12
Rate for Payer: UnitedHealthcare Commercial	$2,741.70
Rate for Payer: UnitedHealthcare Medicaid	$1,213.14
Rate for Payer: WPPA Medicare Advantage	$1,731.60

32551-Insertion Chest Tube

Facility

$4,317.00

Service Code	HCPCS 32551
Hospital Charge Code	3302551
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,101.15
Rate for Payer: Aetna Commercial	$3,885.30
Rate for Payer: UnitedHealthcare Commercial	$4,101.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges