Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

XR Femur 2 Views Right

Facility

$229.00

Service Code	HCPCS 73552 RT
Hospital Charge Code	3700185
Hospital Revenue Code	320
Min. Negotiated Rate	$206.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR Femur 2 Views Right

Facility

$229.00

Service Code	HCPCS 73552 RT
Hospital Charge Code	3700185
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$217.55
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: Humana Medicare Advantage	$96.18
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$137.40

XR Finger(s) 2+ Views Left

Facility

$234.00

Service Code	HCPCS 73140 LT
Hospital Charge Code	3700193
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$105.93
Rate for Payer: Humana Medicare Advantage	$98.28
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$140.40

XR Finger(s) 2+ Views Left

Facility

$234.00

Service Code	HCPCS 73140 LT
Hospital Charge Code	3700193
Hospital Revenue Code	320
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

XR Finger(s) 2+ Views Right

Facility

$234.00

Service Code	HCPCS 73140 TC
Hospital Charge Code	3700193
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$105.93
Rate for Payer: Humana Medicare Advantage	$98.28
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$140.40

XR Finger(s) 2+ Views Right

Facility

$234.00

Service Code	HCPCS 73140 RT
Hospital Charge Code	3700193
Hospital Revenue Code	320
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

XR Finger(s) 2+ Views Right

Facility

$234.00

Service Code	HCPCS 73140 TC
Hospital Charge Code	3700193
Hospital Revenue Code	320
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

XR Finger(s) 2+ Views Right

Facility

$234.00

Service Code	HCPCS 73140 RT
Hospital Charge Code	3700193
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$105.93
Rate for Payer: Humana Medicare Advantage	$98.28
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$140.40

XR Fluoro Guidance Needle Placement

Facility

$823.00

Service Code	HCPCS 77002 TC
Hospital Charge Code	3700205
Hospital Revenue Code	320
Min. Negotiated Rate	$740.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$740.70
Rate for Payer: UnitedHealthcare Commercial	$781.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR Fluoro Guidance Needle Placement

Facility

$823.00

Service Code	HCPCS 77002 TC
Hospital Charge Code	3700205
Hospital Revenue Code	320
Min. Negotiated Rate	$35.92
Max. Negotiated Rate	$781.85
Rate for Payer: Aetna Commercial	$740.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$372.61
Rate for Payer: Humana Medicare Advantage	$345.66
Rate for Payer: UnitedHealthcare Commercial	$781.85
Rate for Payer: UnitedHealthcare Medicaid	$35.92
Rate for Payer: WPPA Medicare Advantage	$493.80

XR Fluoro Guide CVA Placement

Facility

$423.00

Service Code	HCPCS 77001 TC
Hospital Charge Code	3700012
Hospital Revenue Code	320
Min. Negotiated Rate	$380.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$380.70
Rate for Payer: UnitedHealthcare Commercial	$401.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR Fluoro Guide CVA Placement

Facility

$423.00

Service Code	HCPCS 77001 TC
Hospital Charge Code	3700012
Hospital Revenue Code	320
Min. Negotiated Rate	$58.56
Max. Negotiated Rate	$401.85
Rate for Payer: Aetna Commercial	$380.70
Rate for Payer: Humana Medicare Advantage	$177.66
Rate for Payer: UnitedHealthcare Commercial	$401.85
Rate for Payer: UnitedHealthcare Medicaid	$58.56
Rate for Payer: WPPA Medicare Advantage	$253.80

XR Fluoroscopy Under 1 Hour

Facility

$534.00

Service Code	HCPCS 76000 TC
Hospital Charge Code	3700201
Hospital Revenue Code	320
Min. Negotiated Rate	$480.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$480.60
Rate for Payer: UnitedHealthcare Commercial	$507.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR Fluoroscopy Under 1 Hour

Facility

$534.00

Service Code	HCPCS 76000 TC
Hospital Charge Code	3700201
Hospital Revenue Code	320
Min. Negotiated Rate	$131.00
Max. Negotiated Rate	$507.30
Rate for Payer: Aetna Commercial	$480.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$234.16
Rate for Payer: Humana Medicare Advantage	$224.28
Rate for Payer: UnitedHealthcare Commercial	$507.30
Rate for Payer: UnitedHealthcare Medicaid	$131.00
Rate for Payer: WPPA Medicare Advantage	$320.40

XR FOOT 2 VIEW Add-On

Facility

$229.00

Service Code	HCPCS 73620 TC
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$206.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR FOOT 2 VIEW Add-On

Facility

$229.00

Service Code	HCPCS 73620 TC
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$217.55
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$94.78
Rate for Payer: Humana Medicare Advantage	$96.18
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$137.40

XR Foot 2 Views Bilateral

Facility

$229.00

Service Code	HCPCS 73620 RT
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$206.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR Foot 2 Views Bilateral

Facility

$229.00

Service Code	HCPCS 73620 TC
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$206.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR Foot 2 Views Bilateral

Facility

$229.00

Service Code	HCPCS 73620 TC
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$217.55
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$94.78
Rate for Payer: Humana Medicare Advantage	$96.18
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$137.40

XR Foot 2 Views Bilateral

Facility

$229.00

Service Code	HCPCS 73620 RT
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$217.55
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$94.78
Rate for Payer: Humana Medicare Advantage	$96.18
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$137.40

XR Foot 2 Views Left

Facility

$229.00

Service Code	HCPCS 73620 LT
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$206.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR Foot 2 Views Left

Facility

$229.00

Service Code	HCPCS 73620 LT
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$217.55
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$94.78
Rate for Payer: Humana Medicare Advantage	$96.18
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$137.40

XR Foot 2 Views Left Add-On

Facility

$229.00

Service Code	HCPCS 73620 TC
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$206.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

XR Foot 2 Views Left Add-On

Facility

$229.00

Service Code	HCPCS 73620 TC
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$217.55
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$94.78
Rate for Payer: Humana Medicare Advantage	$96.18
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$137.40

XR Foot 2 Views Left Add-On

Facility

$229.00

Service Code	HCPCS 73620 LT
Hospital Charge Code	3700847
Hospital Revenue Code	320
Min. Negotiated Rate	$48.74
Max. Negotiated Rate	$217.55
Rate for Payer: Aetna Commercial	$206.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$94.78
Rate for Payer: Humana Medicare Advantage	$96.18
Rate for Payer: UnitedHealthcare Commercial	$217.55
Rate for Payer: UnitedHealthcare Medicaid	$48.74
Rate for Payer: WPPA Medicare Advantage	$137.40

Know your out-of-pocket cost for care.

All Charges