Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

3.5MM CORT LOCK SCR 16MM NS

Facility

$364.50

Hospital Charge Code	3258144
Hospital Revenue Code	270
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$346.27
Rate for Payer: Aetna Commercial	$328.05
Rate for Payer: Humana Medicare Advantage	$153.09
Rate for Payer: UnitedHealthcare Commercial	$346.27
Rate for Payer: UnitedHealthcare Medicaid	$145.80
Rate for Payer: WPPA Medicare Advantage	$218.70

3.5MM CORT LOCK SCR 16MM NS

Facility

$364.50

Hospital Charge Code	3258144
Hospital Revenue Code	270
Min. Negotiated Rate	$328.05
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$328.05
Rate for Payer: UnitedHealthcare Commercial	$346.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

3.5MM LOW PROFILE CORT16 MM

Facility

$204.75

Hospital Charge Code	3258140
Hospital Revenue Code	270
Min. Negotiated Rate	$184.28
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$184.28
Rate for Payer: UnitedHealthcare Commercial	$194.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00

3.5MM LOW PROFILE CORT16 MM

Facility

$204.75

Hospital Charge Code	3258140
Hospital Revenue Code	270
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$194.51
Rate for Payer: Aetna Commercial	$184.28
Rate for Payer: Humana Medicare Advantage	$86.00
Rate for Payer: UnitedHealthcare Commercial	$194.51
Rate for Payer: UnitedHealthcare Medicaid	$81.90
Rate for Payer: WPPA Medicare Advantage	$122.85

3.5MM LOW PROFILE CORT 20 MM

Facility

$204.75

Hospital Charge Code	3258141
Hospital Revenue Code	270
Min. Negotiated Rate	$184.28
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$184.28
Rate for Payer: UnitedHealthcare Commercial	$194.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00

3.5MM LOW PROFILE CORT 20 MM

Facility

$204.75

Hospital Charge Code	3258141
Hospital Revenue Code	270
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$194.51
Rate for Payer: Aetna Commercial	$184.28
Rate for Payer: Humana Medicare Advantage	$86.00
Rate for Payer: UnitedHealthcare Commercial	$194.51
Rate for Payer: UnitedHealthcare Medicaid	$81.90
Rate for Payer: WPPA Medicare Advantage	$122.85

36000-Introduction Needle/Intracath Vein

Facility

$2,602.00

Service Code	HCPCS 36000
Hospital Charge Code	3304755
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,471.90
Rate for Payer: Aetna Commercial	$2,341.80
Rate for Payer: UnitedHealthcare Commercial	$2,471.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36000-Introduction Needle/Intracath Vein

Facility

$2,602.00

Service Code	HCPCS 36000
Hospital Charge Code	3304755
Hospital Revenue Code	450
Min. Negotiated Rate	$67.67
Max. Negotiated Rate	$2,471.90
Rate for Payer: Aetna Commercial	$2,341.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.67
Rate for Payer: Humana Medicare Advantage	$1,092.84
Rate for Payer: UnitedHealthcare Commercial	$2,471.90
Rate for Payer: UnitedHealthcare Medicaid	$234.00
Rate for Payer: WPPA Medicare Advantage	$1,561.20

36000 INTRO OF NEEDLE/INTRACATHETER VEIN CHARGE

Facility

$135.00

Service Code	HCPCS 36000
Hospital Charge Code	3186000
Hospital Revenue Code	360
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: UnitedHealthcare Commercial	$128.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36000 INTRO OF NEEDLE/INTRACATHETER VEIN CHARGE

Facility

$135.00

Service Code	HCPCS 36000
Hospital Charge Code	3186000
Hospital Revenue Code	360
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.67
Rate for Payer: Humana Medicare Advantage	$56.70
Rate for Payer: UnitedHealthcare Commercial	$128.25
Rate for Payer: UnitedHealthcare Medicaid	$234.00
Rate for Payer: WPPA Medicare Advantage	$81.00

36410 IV Start, over age 3, (Difficult Requiring MD/CRNA Skill)

Facility

$888.00

Service Code	HCPCS 36410
Hospital Charge Code	3186410
Hospital Revenue Code	360
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$843.60
Rate for Payer: Aetna Commercial	$799.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$277.75
Rate for Payer: Humana Medicare Advantage	$372.96
Rate for Payer: UnitedHealthcare Commercial	$843.60
Rate for Payer: UnitedHealthcare Medicaid	$13.52
Rate for Payer: WPPA Medicare Advantage	$532.80

36410 IV Start, over age 3, (Difficult Requiring MD/CRNA Skill)

Facility

$888.00

Service Code	HCPCS 36410
Hospital Charge Code	3186410
Hospital Revenue Code	360
Min. Negotiated Rate	$799.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$799.20
Rate for Payer: UnitedHealthcare Commercial	$843.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36430 BLOOD TRANSFUSION 1-8 HOURS CHARGE

Facility

$1,253.00

Service Code	HCPCS 36430
Hospital Charge Code	3290167
Hospital Revenue Code	391
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,190.35
Rate for Payer: Aetna Commercial	$1,127.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$515.69
Rate for Payer: Humana Medicare Advantage	$526.26
Rate for Payer: UnitedHealthcare Commercial	$1,190.35
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$751.80

36430 BLOOD TRANSFUSION 1-8 HOURS CHARGE

Facility

$1,253.00

Service Code	HCPCS 36430
Hospital Charge Code	3290167
Hospital Revenue Code	391
Min. Negotiated Rate	$1,127.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,127.70
Rate for Payer: UnitedHealthcare Commercial	$1,190.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36475 BIOPSY LYMPH NODE SF NEEDLE CHARGE

Facility

$982.00

Service Code	HCPCS 38505
Hospital Charge Code	3358505
Hospital Revenue Code	761
Min. Negotiated Rate	$412.44
Max. Negotiated Rate	$932.90
Rate for Payer: Aetna Commercial	$883.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$668.62
Rate for Payer: Humana Medicare Advantage	$412.44
Rate for Payer: UnitedHealthcare Commercial	$932.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$589.20

36475 BIOPSY LYMPH NODE SF NEEDLE CHARGE

Facility

$982.00

Service Code	HCPCS 38505
Hospital Charge Code	3358505
Hospital Revenue Code	761
Min. Negotiated Rate	$883.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$883.80
Rate for Payer: UnitedHealthcare Commercial	$932.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> TechFee

Facility

$4,111.00

Service Code	HCPCS 36556
Hospital Charge Code	3304002
Hospital Revenue Code	450
Min. Negotiated Rate	$382.20
Max. Negotiated Rate	$3,905.45
Rate for Payer: Aetna Commercial	$3,699.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,666.40
Rate for Payer: Humana Medicare Advantage	$1,726.62
Rate for Payer: UnitedHealthcare Commercial	$3,905.45
Rate for Payer: UnitedHealthcare Medicaid	$382.20
Rate for Payer: WPPA Medicare Advantage	$2,466.60

36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> TechFee

Facility

$4,111.00

Service Code	HCPCS 36556
Hospital Charge Code	3304002
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,905.45
Rate for Payer: Aetna Commercial	$3,699.90
Rate for Payer: UnitedHealthcare Commercial	$3,905.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36558 INSERT TUNNELED CV CATH CHARGE

Facility

$4,251.00

Service Code	HCPCS 36558
Hospital Charge Code	3156558
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,038.45
Rate for Payer: Aetna Commercial	$3,825.90
Rate for Payer: UnitedHealthcare Commercial	$4,038.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36558 INSERT TUNNELED CV CATH CHARGE

Facility

$4,251.00

Service Code	HCPCS 36558
Hospital Charge Code	3156558
Hospital Revenue Code	360
Min. Negotiated Rate	$382.20
Max. Negotiated Rate	$4,038.45
Rate for Payer: Aetna Commercial	$3,825.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,067.37
Rate for Payer: Humana Medicare Advantage	$1,785.42
Rate for Payer: UnitedHealthcare Commercial	$4,038.45
Rate for Payer: UnitedHealthcare Medicaid	$382.20
Rate for Payer: WPPA Medicare Advantage	$2,550.60

36561 INSERT PORT-A-CATH

Facility

$4,970.00

Service Code	HCPCS 36561
Hospital Charge Code	3150356
Hospital Revenue Code	360
Min. Negotiated Rate	$945.83
Max. Negotiated Rate	$4,721.50
Rate for Payer: Aetna Commercial	$4,473.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,585.46
Rate for Payer: Humana Medicare Advantage	$2,087.40
Rate for Payer: UnitedHealthcare Commercial	$4,721.50
Rate for Payer: UnitedHealthcare Medicaid	$945.83
Rate for Payer: WPPA Medicare Advantage	$2,982.00

36561 INSERT PORT-A-CATH

Facility

$4,970.00

Service Code	HCPCS 36561
Hospital Charge Code	3150356
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,721.50
Rate for Payer: Aetna Commercial	$4,473.00
Rate for Payer: UnitedHealthcare Commercial	$4,721.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36569 PICC Line Placement Age 5+ w/o Imaging

Facility

$5,053.00

Hospital Charge Code	3180655
Hospital Revenue Code	370
Min. Negotiated Rate	$2,021.20
Max. Negotiated Rate	$4,800.35
Rate for Payer: Aetna Commercial	$4,547.70
Rate for Payer: Humana Medicare Advantage	$2,122.26
Rate for Payer: UnitedHealthcare Commercial	$4,800.35
Rate for Payer: UnitedHealthcare Medicaid	$2,021.20
Rate for Payer: WPPA Medicare Advantage	$3,031.80

36569 PICC Line Placement Age 5+ w/o Imaging

Facility

$5,053.00

Hospital Charge Code	3180655
Hospital Revenue Code	370
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,800.35
Rate for Payer: Aetna Commercial	$4,547.70
Rate for Payer: UnitedHealthcare Commercial	$4,800.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36570 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS POR ProFee

Facility

$1,831.00

Service Code	HCPCS 36570
Hospital Charge Code	3366570
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,739.45
Rate for Payer: Aetna Commercial	$1,647.90
Rate for Payer: UnitedHealthcare Commercial	$1,739.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges