Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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	$769.02
Max. Negotiated Rate	$3,211.00
Rate for Payer: Aetna Commercial	$1,647.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,321.08
Rate for Payer: Humana Medicare Advantage	$769.02
Rate for Payer: UnitedHealthcare Commercial	$1,739.45
Rate for Payer: UnitedHealthcare Medicaid	$3,211.00
Rate for Payer: WPPA Medicare Advantage	$1,098.60

36571 Insertion of peripherally inserted central venous access device, with subcutaneous port

Facility

$5,951.00

Service Code	HCPCS 36571
Hospital Charge Code	3150357
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,653.45
Rate for Payer: Aetna Commercial	$5,355.90
Rate for Payer: UnitedHealthcare Commercial	$5,653.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36571 Insertion of peripherally inserted central venous access device, with subcutaneous port

Facility

$5,951.00

Service Code	HCPCS 36571
Hospital Charge Code	3150357
Hospital Revenue Code	360
Min. Negotiated Rate	$2,499.42
Max. Negotiated Rate	$5,653.45
Rate for Payer: Aetna Commercial	$5,355.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,830.93
Rate for Payer: Humana Medicare Advantage	$2,499.42
Rate for Payer: UnitedHealthcare Commercial	$5,653.45
Rate for Payer: UnitedHealthcare Medicaid	$3,211.00
Rate for Payer: WPPA Medicare Advantage	$3,570.60

36573 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER

Facility

$5,306.00

Service Code	HCPCS 36573
Hospital Charge Code	3156573
Hospital Revenue Code	360
Min. Negotiated Rate	$710.86
Max. Negotiated Rate	$5,040.70
Rate for Payer: Aetna Commercial	$4,775.40
Rate for Payer: Humana Medicare Advantage	$2,228.52
Rate for Payer: UnitedHealthcare Commercial	$5,040.70
Rate for Payer: UnitedHealthcare Medicaid	$710.86
Rate for Payer: WPPA Medicare Advantage	$3,183.60

36573 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER

Facility

$5,306.00

Service Code	HCPCS 36573
Hospital Charge Code	3156573
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,040.70
Rate for Payer: Aetna Commercial	$4,775.40
Rate for Payer: UnitedHealthcare Commercial	$5,040.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36581 Complete Replacement of Central Venous Access Device Through Same Venous Access Site

Facility

$2,139.00

Service Code	HCPCS 36581
Hospital Charge Code	3156581
Hospital Revenue Code	360
Min. Negotiated Rate	$423.81
Max. Negotiated Rate	$2,032.05
Rate for Payer: Aetna Commercial	$1,925.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,321.08
Rate for Payer: Humana Medicare Advantage	$898.38
Rate for Payer: UnitedHealthcare Commercial	$2,032.05
Rate for Payer: UnitedHealthcare Medicaid	$423.81
Rate for Payer: WPPA Medicare Advantage	$1,283.40

36581 Complete Replacement of Central Venous Access Device Through Same Venous Access Site

Facility

$2,139.00

Service Code	HCPCS 36581
Hospital Charge Code	3156581
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,032.05
Rate for Payer: Aetna Commercial	$1,925.10
Rate for Payer: UnitedHealthcare Commercial	$2,032.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36589 CENTRAL LINE REMOVAL CHARGE

Facility

$1,328.00

Service Code	HCPCS 36589
Hospital Charge Code	3156589
Hospital Revenue Code	761
Min. Negotiated Rate	$163.98
Max. Negotiated Rate	$1,261.60
Rate for Payer: Aetna Commercial	$1,195.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$958.49
Rate for Payer: Humana Medicare Advantage	$557.76
Rate for Payer: UnitedHealthcare Commercial	$1,261.60
Rate for Payer: UnitedHealthcare Medicaid	$163.98
Rate for Payer: WPPA Medicare Advantage	$796.80

36589 CENTRAL LINE REMOVAL CHARGE

Facility

$1,328.00

Service Code	HCPCS 36589
Hospital Charge Code	3156589
Hospital Revenue Code	761
Min. Negotiated Rate	$1,195.20
Max. Negotiated Rate	$1,261.60
Rate for Payer: Aetna Commercial	$1,195.20
Rate for Payer: UnitedHealthcare Commercial	$1,261.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36589 PICC REMOVAL

Facility

$1,328.00

Service Code	HCPCS 36589
Hospital Charge Code	3156589
Hospital Revenue Code	360
Min. Negotiated Rate	$1,195.20
Max. Negotiated Rate	$1,261.60
Rate for Payer: Aetna Commercial	$1,195.20
Rate for Payer: UnitedHealthcare Commercial	$1,261.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36589 PICC REMOVAL

Facility

$1,328.00

Service Code	HCPCS 36589
Hospital Charge Code	3156589
Hospital Revenue Code	360
Min. Negotiated Rate	$163.98
Max. Negotiated Rate	$1,261.60
Rate for Payer: Aetna Commercial	$1,195.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$958.49
Rate for Payer: Humana Medicare Advantage	$557.76
Rate for Payer: UnitedHealthcare Commercial	$1,261.60
Rate for Payer: UnitedHealthcare Medicaid	$163.98
Rate for Payer: WPPA Medicare Advantage	$796.80

36590 Removal of Port a Cath

Facility

$3,087.00

Service Code	HCPCS 36590
Hospital Charge Code	3356590
Hospital Revenue Code	761
Min. Negotiated Rate	$275.54
Max. Negotiated Rate	$2,932.65
Rate for Payer: Aetna Commercial	$2,778.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,906.88
Rate for Payer: Humana Medicare Advantage	$1,296.54
Rate for Payer: UnitedHealthcare Commercial	$2,932.65
Rate for Payer: UnitedHealthcare Medicaid	$275.54
Rate for Payer: WPPA Medicare Advantage	$1,852.20

36590 Removal of Port a Cath

Facility

$3,087.00

Service Code	HCPCS 36590
Hospital Charge Code	3356590
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,932.65
Rate for Payer: Aetna Commercial	$2,778.30
Rate for Payer: UnitedHealthcare Commercial	$2,932.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36590-Removal Tunneled CVA Device

Facility

$3,087.00

Service Code	HCPCS 36590
Hospital Charge Code	3306590
Hospital Revenue Code	450
Min. Negotiated Rate	$275.54
Max. Negotiated Rate	$2,932.65
Rate for Payer: Aetna Commercial	$2,778.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,906.88
Rate for Payer: Humana Medicare Advantage	$1,296.54
Rate for Payer: UnitedHealthcare Commercial	$2,932.65
Rate for Payer: UnitedHealthcare Medicaid	$275.54
Rate for Payer: WPPA Medicare Advantage	$1,852.20

36590-Removal Tunneled CVA Device

Facility

$3,087.00

Service Code	HCPCS 36590
Hospital Charge Code	3306590
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,932.65
Rate for Payer: Aetna Commercial	$2,778.30
Rate for Payer: UnitedHealthcare Commercial	$2,932.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36590 REMOVAL TUNNELED CV CATH CHARGE

Facility

$3,087.00

Service Code	HCPCS 36590
Hospital Charge Code	3150360
Hospital Revenue Code	360
Min. Negotiated Rate	$275.54
Max. Negotiated Rate	$2,932.65
Rate for Payer: Aetna Commercial	$2,778.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,906.88
Rate for Payer: Humana Medicare Advantage	$1,296.54
Rate for Payer: UnitedHealthcare Commercial	$2,932.65
Rate for Payer: UnitedHealthcare Medicaid	$275.54
Rate for Payer: WPPA Medicare Advantage	$1,852.20

36590 REMOVAL TUNNELED CV CATH CHARGE

Facility

$3,087.00

Service Code	HCPCS 36590
Hospital Charge Code	3150360
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,932.65
Rate for Payer: Aetna Commercial	$2,778.30
Rate for Payer: UnitedHealthcare Commercial	$2,932.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36591 BLOOD COLLECTION FROM PORT CHARGE

Facility

$124.00

Service Code	HCPCS 36591
Hospital Charge Code	3310205
Hospital Revenue Code	760
Min. Negotiated Rate	$52.08
Max. Negotiated Rate	$126.68
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$126.68
Rate for Payer: Humana Medicare Advantage	$52.08
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: UnitedHealthcare Medicaid	$71.01
Rate for Payer: WPPA Medicare Advantage	$74.40

36591 BLOOD COLLECTION FROM PORT CHARGE

Facility

$124.00

Service Code	HCPCS 36591
Hospital Charge Code	3310205
Hospital Revenue Code	760
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36591-Collect Blood Port/Access Device

Facility

$257.00

Service Code	HCPCS 36591
Hospital Charge Code	3300410
Hospital Revenue Code	450
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

36591-Collect Blood Port/Access Device

Facility

$257.00

Service Code	HCPCS 36591
Hospital Charge Code	3300410
Hospital Revenue Code	450
Min. Negotiated Rate	$71.01
Max. Negotiated Rate	$244.15
Rate for Payer: Aetna Commercial	$231.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$126.68
Rate for Payer: Humana Medicare Advantage	$107.94
Rate for Payer: UnitedHealthcare Commercial	$244.15
Rate for Payer: UnitedHealthcare Medicaid	$71.01
Rate for Payer: WPPA Medicare Advantage	$154.20

36591 Collection of blood specimen from a completely implantable venous access device

Facility

$124.00

Service Code	HCPCS 36591
Hospital Charge Code	3290010
Hospital Revenue Code	761
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36591 Collection of blood specimen from a completely implantable venous access device

Facility

$124.00

Service Code	HCPCS 36591
Hospital Charge Code	3290010
Hospital Revenue Code	761
Min. Negotiated Rate	$52.08
Max. Negotiated Rate	$126.68
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$126.68
Rate for Payer: Humana Medicare Advantage	$52.08
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: UnitedHealthcare Medicaid	$71.01
Rate for Payer: WPPA Medicare Advantage	$74.40

36591 OP BLOOD COLLECTION FROM PORT CHARGE

Facility

$124.00

Service Code	HCPCS 36591
Hospital Charge Code	3290010
Hospital Revenue Code	761
Min. Negotiated Rate	$52.08
Max. Negotiated Rate	$126.68
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$126.68
Rate for Payer: Humana Medicare Advantage	$52.08
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: UnitedHealthcare Medicaid	$71.01
Rate for Payer: WPPA Medicare Advantage	$74.40

36591 OP BLOOD COLLECTION FROM PORT CHARGE

Facility

$124.00

Service Code	HCPCS 36591
Hospital Charge Code	3290010
Hospital Revenue Code	761
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

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