Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

US Echo 2D Complete

Facility

$3,387.00

Service Code	HCPCS 93306 TC
Hospital Charge Code	3620025
Hospital Revenue Code	480
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,217.65
Rate for Payer: Aetna Commercial	$3,048.30
Rate for Payer: UnitedHealthcare Commercial	$3,217.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo 2D Limited

Facility

$1,274.00

Service Code	HCPCS 93308 TC
Hospital Charge Code	3620033
Hospital Revenue Code	480
Min. Negotiated Rate	$79.38
Max. Negotiated Rate	$1,210.30
Rate for Payer: Aetna Commercial	$1,146.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$575.70
Rate for Payer: Humana Medicare Advantage	$535.08
Rate for Payer: UnitedHealthcare Commercial	$1,210.30
Rate for Payer: UnitedHealthcare Medicaid	$79.38
Rate for Payer: WPPA Medicare Advantage	$764.40

US Echo 2D Limited

Facility

$1,274.00

Service Code	HCPCS 93308 TC
Hospital Charge Code	3620033
Hospital Revenue Code	480
Min. Negotiated Rate	$1,146.60
Max. Negotiated Rate	$1,210.30
Rate for Payer: Aetna Commercial	$1,146.60
Rate for Payer: UnitedHealthcare Commercial	$1,210.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo Color Flow Mapping

Facility

$824.00

Service Code	HCPCS 93325 TC
Hospital Charge Code	3613325
Hospital Revenue Code	480
Min. Negotiated Rate	$56.93
Max. Negotiated Rate	$782.80
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$480.76
Rate for Payer: Humana Medicare Advantage	$346.08
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: UnitedHealthcare Medicaid	$56.93
Rate for Payer: WPPA Medicare Advantage	$494.40

US Echo Color Flow Mapping

Facility

$824.00

Service Code	HCPCS 93325 TC
Hospital Charge Code	3613325
Hospital Revenue Code	480
Min. Negotiated Rate	$741.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo Congenital Complete

Facility

$1,278.00

Service Code	HCPCS 93303 TC
Hospital Charge Code	3623303
Hospital Revenue Code	480
Min. Negotiated Rate	$1,150.20
Max. Negotiated Rate	$1,214.10
Rate for Payer: Aetna Commercial	$1,150.20
Rate for Payer: UnitedHealthcare Commercial	$1,214.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo Congenital Complete

Facility

$1,278.00

Service Code	HCPCS 93303 TC
Hospital Charge Code	3623303
Hospital Revenue Code	480
Min. Negotiated Rate	$178.71
Max. Negotiated Rate	$1,214.10
Rate for Payer: Aetna Commercial	$1,150.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$579.74
Rate for Payer: Humana Medicare Advantage	$536.76
Rate for Payer: UnitedHealthcare Commercial	$1,214.10
Rate for Payer: UnitedHealthcare Medicaid	$178.71
Rate for Payer: WPPA Medicare Advantage	$766.80

US Echo Congenital Limited

Facility

$1,278.00

Service Code	HCPCS 93304 TC
Hospital Charge Code	3623304
Hospital Revenue Code	480
Min. Negotiated Rate	$178.71
Max. Negotiated Rate	$1,214.10
Rate for Payer: Aetna Commercial	$1,150.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$579.74
Rate for Payer: Humana Medicare Advantage	$536.76
Rate for Payer: UnitedHealthcare Commercial	$1,214.10
Rate for Payer: UnitedHealthcare Medicaid	$178.71
Rate for Payer: WPPA Medicare Advantage	$766.80

US Echo Congenital Limited

Facility

$1,278.00

Service Code	HCPCS 93304 TC
Hospital Charge Code	3623304
Hospital Revenue Code	480
Min. Negotiated Rate	$1,150.20
Max. Negotiated Rate	$1,214.10
Rate for Payer: Aetna Commercial	$1,150.20
Rate for Payer: UnitedHealthcare Commercial	$1,214.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo Doppler Complete

Facility

$824.00

Service Code	HCPCS 93320 TC
Hospital Charge Code	3623320
Hospital Revenue Code	480
Min. Negotiated Rate	$50.46
Max. Negotiated Rate	$782.80
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$480.76
Rate for Payer: Humana Medicare Advantage	$346.08
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: UnitedHealthcare Medicaid	$50.46
Rate for Payer: WPPA Medicare Advantage	$494.40

US Echo Doppler Complete

Facility

$824.00

Service Code	HCPCS 93320 TC
Hospital Charge Code	3623320
Hospital Revenue Code	480
Min. Negotiated Rate	$741.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo Doppler Fetal Complete

Facility

$279.00

Service Code	HCPCS 76827 TC
Hospital Charge Code	3626827
Hospital Revenue Code	480
Min. Negotiated Rate	$251.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$251.10
Rate for Payer: UnitedHealthcare Commercial	$265.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo Doppler Fetal Complete

Facility

$279.00

Service Code	HCPCS 76827 TC
Hospital Charge Code	3626827
Hospital Revenue Code	480
Min. Negotiated Rate	$59.96
Max. Negotiated Rate	$265.05
Rate for Payer: Aetna Commercial	$251.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$90.90
Rate for Payer: Humana Medicare Advantage	$117.18
Rate for Payer: UnitedHealthcare Commercial	$265.05
Rate for Payer: UnitedHealthcare Medicaid	$59.96
Rate for Payer: WPPA Medicare Advantage	$167.40

US Echo Doppler Fetal Follow-Up

Facility

$213.00

Service Code	HCPCS 76828 TC
Hospital Charge Code	3626828
Hospital Revenue Code	402
Min. Negotiated Rate	$59.96
Max. Negotiated Rate	$202.35
Rate for Payer: Aetna Commercial	$191.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$70.70
Rate for Payer: Humana Medicare Advantage	$89.46
Rate for Payer: UnitedHealthcare Commercial	$202.35
Rate for Payer: UnitedHealthcare Medicaid	$59.96
Rate for Payer: WPPA Medicare Advantage	$127.80

US Echo Doppler Fetal Follow-Up

Facility

$213.00

Service Code	HCPCS 76828 TC
Hospital Charge Code	3626828
Hospital Revenue Code	402
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$191.70
Rate for Payer: UnitedHealthcare Commercial	$202.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo Doppler Limited

Facility

$824.00

Service Code	HCPCS 93321 TC
Hospital Charge Code	3623321
Hospital Revenue Code	480
Min. Negotiated Rate	$741.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo Doppler Limited

Facility

$824.00

Service Code	HCPCS 93321 TC
Hospital Charge Code	3623321
Hospital Revenue Code	480
Min. Negotiated Rate	$39.81
Max. Negotiated Rate	$782.80
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$480.76
Rate for Payer: Humana Medicare Advantage	$346.08
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: UnitedHealthcare Medicaid	$39.81
Rate for Payer: WPPA Medicare Advantage	$494.40

US Echo w/o Doppler

Facility

$1,274.00

Service Code	HCPCS 93307 TC
Hospital Charge Code	36323307
Hospital Revenue Code	480
Min. Negotiated Rate	$1,146.60
Max. Negotiated Rate	$1,210.30
Rate for Payer: Aetna Commercial	$1,146.60
Rate for Payer: UnitedHealthcare Commercial	$1,210.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Echo w/o Doppler

Facility

$1,274.00

Service Code	HCPCS 93307 TC
Hospital Charge Code	36323307
Hospital Revenue Code	480
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$1,210.30
Rate for Payer: Aetna Commercial	$1,146.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$575.70
Rate for Payer: Humana Medicare Advantage	$535.08
Rate for Payer: UnitedHealthcare Commercial	$1,210.30
Rate for Payer: UnitedHealthcare Medicaid	$509.60
Rate for Payer: WPPA Medicare Advantage	$764.40

US Elastography First Target Lesion

Facility

$764.00

Service Code	HCPCS 76982 TC
Hospital Charge Code	3736982
Hospital Revenue Code	402
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$725.80
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: Humana Medicare Advantage	$320.88
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: UnitedHealthcare Medicaid	$90.85
Rate for Payer: WPPA Medicare Advantage	$458.40

US Elastography First Target Lesion

Facility

$764.00

Service Code	HCPCS 76982 TC
Hospital Charge Code	3736982
Hospital Revenue Code	402
Min. Negotiated Rate	$687.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Elastography Parenchyma

Facility

$764.00

Service Code	HCPCS 76981 TC
Hospital Charge Code	3736981
Hospital Revenue Code	402
Min. Negotiated Rate	$687.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Elastography Parenchyma

Facility

$764.00

Service Code	HCPCS 76981 TC
Hospital Charge Code	3736981
Hospital Revenue Code	402
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$725.80
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: Humana Medicare Advantage	$320.88
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: UnitedHealthcare Medicaid	$90.85
Rate for Payer: WPPA Medicare Advantage	$458.40

US Encephalogram

Facility

$1,063.00

Service Code	HCPCS 76506 TC
Hospital Charge Code	3730376
Hospital Revenue Code	402
Min. Negotiated Rate	$956.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$956.70
Rate for Payer: UnitedHealthcare Commercial	$1,009.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

US Encephalogram

Facility

$1,063.00

Service Code	HCPCS 76506 TC
Hospital Charge Code	3730376
Hospital Revenue Code	402
Min. Negotiated Rate	$59.96
Max. Negotiated Rate	$1,009.85
Rate for Payer: Aetna Commercial	$956.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$480.76
Rate for Payer: Humana Medicare Advantage	$446.46
Rate for Payer: UnitedHealthcare Commercial	$1,009.85
Rate for Payer: UnitedHealthcare Medicaid	$59.96
Rate for Payer: WPPA Medicare Advantage	$637.80

Know your out-of-pocket cost for care.

All Charges