Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

36592- Blood Central/Peripheral Cath

Facility

$490.00

Service Code	HCPCS 36592
Hospital Charge Code	3306592
Hospital Revenue Code	450
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$441.00
Rate for Payer: UnitedHealthcare Commercial	$465.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36592- Blood Central/Peripheral Cath

Facility

$490.00

Service Code	HCPCS 36592
Hospital Charge Code	3306592
Hospital Revenue Code	450
Min. Negotiated Rate	$71.01
Max. Negotiated Rate	$465.50
Rate for Payer: Aetna Commercial	$441.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$205.80
Rate for Payer: UnitedHealthcare Commercial	$465.50
Rate for Payer: UnitedHealthcare Medicaid	$71.01
Rate for Payer: WPPA Medicare Advantage	$294.00

36592 BLOOD DRAW FROM PICC LINE CHARGE

Facility

$53.00

Service Code	HCPCS 36592
Hospital Charge Code	3316592
Hospital Revenue Code	760
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$144.89
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$22.26
Rate for Payer: UnitedHealthcare Commercial	$50.35
Rate for Payer: UnitedHealthcare Medicaid	$71.01
Rate for Payer: WPPA Medicare Advantage	$31.80

36592 BLOOD DRAW FROM PICC LINE CHARGE

Facility

$53.00

Service Code	HCPCS 36592
Hospital Charge Code	3316592
Hospital Revenue Code	760
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: UnitedHealthcare Commercial	$50.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36592 COLLECT BLOOD FROM PICC Charge

Facility

$234.00

Service Code	HCPCS 36592
Hospital Charge Code	3296592
Hospital Revenue Code	761
Min. Negotiated Rate	$210.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36592 COLLECT BLOOD FROM PICC Charge

Facility

$234.00

Service Code	HCPCS 36592
Hospital Charge Code	3296592
Hospital Revenue Code	761
Min. Negotiated Rate	$71.01
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$98.28
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: UnitedHealthcare Medicaid	$71.01
Rate for Payer: WPPA Medicare Advantage	$140.40

36593 DECLOT BY THROMBOLYTIC AGENT IMPLANT DEV CHARGE

Facility

$307.00

Service Code	HCPCS 36593
Hospital Charge Code	3296593
Hospital Revenue Code	761
Min. Negotiated Rate	$27.40
Max. Negotiated Rate	$291.65
Rate for Payer: Aetna Commercial	$276.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$41.00
Rate for Payer: Humana Medicare Advantage	$128.94
Rate for Payer: UnitedHealthcare Commercial	$291.65
Rate for Payer: UnitedHealthcare Medicaid	$27.40
Rate for Payer: WPPA Medicare Advantage	$184.20

36593 DECLOT BY THROMBOLYTIC AGENT IMPLANT DEV CHARGE

Facility

$307.00

Service Code	HCPCS 36593
Hospital Charge Code	3296593
Hospital Revenue Code	761
Min. Negotiated Rate	$276.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$276.30
Rate for Payer: UnitedHealthcare Commercial	$291.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36593 Declotting by thrombolytic agent of implanted vascular access device or catheter

Facility

$307.00

Service Code	HCPCS 36593
Hospital Charge Code	3296593
Hospital Revenue Code	761
Min. Negotiated Rate	$27.40
Max. Negotiated Rate	$291.65
Rate for Payer: Aetna Commercial	$276.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$41.00
Rate for Payer: Humana Medicare Advantage	$128.94
Rate for Payer: UnitedHealthcare Commercial	$291.65
Rate for Payer: UnitedHealthcare Medicaid	$27.40
Rate for Payer: WPPA Medicare Advantage	$184.20

36593 Declotting by thrombolytic agent of implanted vascular access device or catheter

Facility

$307.00

Service Code	HCPCS 36593
Hospital Charge Code	3296593
Hospital Revenue Code	761
Min. Negotiated Rate	$276.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$276.30
Rate for Payer: UnitedHealthcare Commercial	$291.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36600 ART-BLD GAS DRAW CHARGE

Facility

$188.00

Service Code	HCPCS 36600
Hospital Charge Code	3900630
Hospital Revenue Code	300
Min. Negotiated Rate	$169.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$169.20
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36600 ART-BLD GAS DRAW CHARGE

Facility

$188.00

Service Code	HCPCS 36600
Hospital Charge Code	3900630
Hospital Revenue Code	300
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$178.60
Rate for Payer: Aetna Commercial	$169.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.67
Rate for Payer: Humana Medicare Advantage	$78.96
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$112.80

36680-Place Needle Intraosseous Infusion

Facility

$269.00

Service Code	HCPCS 36680
Hospital Charge Code	3304705
Hospital Revenue Code	450
Min. Negotiated Rate	$107.60
Max. Negotiated Rate	$255.55
Rate for Payer: Aetna Commercial	$242.10
Rate for Payer: Humana Medicare Advantage	$112.98
Rate for Payer: UnitedHealthcare Commercial	$255.55
Rate for Payer: UnitedHealthcare Medicaid	$107.60
Rate for Payer: WPPA Medicare Advantage	$161.40

36680-Place Needle Intraosseous Infusion

Facility

$269.00

Service Code	HCPCS 36680
Hospital Charge Code	3304705
Hospital Revenue Code	450
Min. Negotiated Rate	$242.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$242.10
Rate for Payer: UnitedHealthcare Commercial	$255.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36821 Arteriovenous anastomosis, open; direct, any site

Facility

$3,882.00

Service Code	HCPCS 36821
Hospital Charge Code	3156821
Hospital Revenue Code	360
Min. Negotiated Rate	$1,032.58
Max. Negotiated Rate	$3,687.90
Rate for Payer: Aetna Commercial	$3,493.80
Rate for Payer: Humana Medicare Advantage	$1,630.44
Rate for Payer: UnitedHealthcare Commercial	$3,687.90
Rate for Payer: UnitedHealthcare Medicaid	$1,032.58
Rate for Payer: WPPA Medicare Advantage	$2,329.20

36821 Arteriovenous anastomosis, open; direct, any site

Facility

$3,882.00

Service Code	HCPCS 36821
Hospital Charge Code	3156821
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,687.90
Rate for Payer: Aetna Commercial	$3,493.80
Rate for Payer: UnitedHealthcare Commercial	$3,687.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36830 Creation of arteriovenous fistula; non-direct arteriovenous anastomosis; nonautogenous graft

Facility

$6,642.00

Service Code	HCPCS 36830
Hospital Charge Code	3156830
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,309.90
Rate for Payer: Aetna Commercial	$5,977.80
Rate for Payer: UnitedHealthcare Commercial	$6,309.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

36830 Creation of arteriovenous fistula; non-direct arteriovenous anastomosis; nonautogenous graft

Facility

$6,642.00

Service Code	HCPCS 36830
Hospital Charge Code	3156830
Hospital Revenue Code	360
Min. Negotiated Rate	$1,780.21
Max. Negotiated Rate	$6,309.90
Rate for Payer: Aetna Commercial	$5,977.80
Rate for Payer: Humana Medicare Advantage	$2,789.64
Rate for Payer: UnitedHealthcare Commercial	$6,309.90
Rate for Payer: UnitedHealthcare Medicaid	$1,780.21
Rate for Payer: WPPA Medicare Advantage	$3,985.20

37609 LIGATE OR BX TEMPORAL ARTERY CHARGE

Facility

$2,015.00

Service Code	HCPCS 37609
Hospital Charge Code	3157609
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$1,914.25
Rate for Payer: Aetna Commercial	$1,813.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$801.00
Rate for Payer: Humana Medicare Advantage	$846.30
Rate for Payer: UnitedHealthcare Commercial	$1,914.25
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,209.00

37609 LIGATE OR BX TEMPORAL ARTERY CHARGE

Facility

$2,015.00

Service Code	HCPCS 37609
Hospital Charge Code	3157609
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,914.25
Rate for Payer: Aetna Commercial	$1,813.50
Rate for Payer: UnitedHealthcare Commercial	$1,914.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

37618 LIGATION MAJOR ARTERY EXTREMITY CHARGE

Facility

$1,965.00

Service Code	HCPCS 37618
Hospital Charge Code	3157618
Hospital Revenue Code	360
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,866.75
Rate for Payer: Aetna Commercial	$1,768.50
Rate for Payer: Humana Medicare Advantage	$825.30
Rate for Payer: UnitedHealthcare Commercial	$1,866.75
Rate for Payer: UnitedHealthcare Medicaid	$364.00
Rate for Payer: WPPA Medicare Advantage	$1,179.00

37618 LIGATION MAJOR ARTERY EXTREMITY CHARGE

Facility

$1,965.00

Service Code	HCPCS 37618
Hospital Charge Code	3157618
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,866.75
Rate for Payer: Aetna Commercial	$1,768.50
Rate for Payer: UnitedHealthcare Commercial	$1,866.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

37785 Ligation, division, and/or excision of varicose vein cluster(s), 1 leg

Facility

$5,156.00

Service Code	HCPCS 37785
Hospital Charge Code	3357785
Hospital Revenue Code	450
Min. Negotiated Rate	$1,032.58
Max. Negotiated Rate	$4,898.20
Rate for Payer: Aetna Commercial	$4,640.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,719.83
Rate for Payer: Humana Medicare Advantage	$2,165.52
Rate for Payer: UnitedHealthcare Commercial	$4,898.20
Rate for Payer: UnitedHealthcare Medicaid	$1,032.58
Rate for Payer: WPPA Medicare Advantage	$3,093.60

37785 Ligation, division, and/or excision of varicose vein cluster(s), 1 leg

Facility

$5,156.00

Service Code	HCPCS 37785
Hospital Charge Code	3357785
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,898.20
Rate for Payer: Aetna Commercial	$4,640.40
Rate for Payer: UnitedHealthcare Commercial	$4,898.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38120 Laparoscopy, surgical, splenectomy

Facility

$15,500.00

Service Code	HCPCS 38120
Hospital Charge Code	3158120
Hospital Revenue Code	360
Min. Negotiated Rate	$3,334.64
Max. Negotiated Rate	$14,725.00
Rate for Payer: Aetna Commercial	$13,950.00
Rate for Payer: Humana Medicare Advantage	$6,510.00
Rate for Payer: UnitedHealthcare Commercial	$14,725.00
Rate for Payer: UnitedHealthcare Medicaid	$3,334.64
Rate for Payer: WPPA Medicare Advantage	$9,300.00

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All Charges