Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

45338 Sigmoidoscopy, flexible; w/ removal of tumor(s), polyp(s), or other lesion(s) by snare technqe

Facility

$1,580.00

Service Code	HCPCS 45338
Hospital Charge Code	3155338
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,501.00
Rate for Payer: Aetna Commercial	$1,422.00
Rate for Payer: UnitedHealthcare Commercial	$1,501.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45338 Sigmoidoscopy, flexible; w/ removal of tumor(s), polyp(s), or other lesion(s) by snare technqe

Facility

$1,580.00

Service Code	HCPCS 45338
Hospital Charge Code	3155338
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$1,501.00
Rate for Payer: Aetna Commercial	$1,422.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,140.29
Rate for Payer: Humana Medicare Advantage	$663.60
Rate for Payer: UnitedHealthcare Commercial	$1,501.00
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$948.00

45340 Sigmoidoscopy, flexible; with transendoscopic balloon dilation

Facility

$1,120.00

Service Code	HCPCS 45340
Hospital Charge Code	3155340
Hospital Revenue Code	360
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,008.00
Rate for Payer: UnitedHealthcare Commercial	$1,064.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45340 Sigmoidoscopy, flexible; with transendoscopic balloon dilation

Facility

$1,120.00

Service Code	HCPCS 45340
Hospital Charge Code	3155340
Hospital Revenue Code	360
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$1,064.00
Rate for Payer: Aetna Commercial	$1,008.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$808.00
Rate for Payer: Humana Medicare Advantage	$470.40
Rate for Payer: UnitedHealthcare Commercial	$1,064.00
Rate for Payer: UnitedHealthcare Medicaid	$448.00
Rate for Payer: WPPA Medicare Advantage	$672.00

45378 COLONOSCOPY Charges

Facility

$2,517.00

Service Code	HCPCS 45378
Hospital Charge Code	3150286
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,391.15
Rate for Payer: Aetna Commercial	$2,265.30
Rate for Payer: UnitedHealthcare Commercial	$2,391.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45378 COLONOSCOPY Charges

Facility

$2,517.00

Service Code	HCPCS 45378
Hospital Charge Code	3150286
Hospital Revenue Code	360
Min. Negotiated Rate	$296.08
Max. Negotiated Rate	$2,391.15
Rate for Payer: Aetna Commercial	$2,265.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,321.08
Rate for Payer: Humana Medicare Advantage	$1,057.14
Rate for Payer: UnitedHealthcare Commercial	$2,391.15
Rate for Payer: UnitedHealthcare Medicaid	$296.08
Rate for Payer: WPPA Medicare Advantage	$1,510.20

45380 COLONOSCOPY AND BIOPSY

Facility

$2,517.00

Service Code	HCPCS 45380
Hospital Charge Code	3150287
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,391.15
Rate for Payer: Aetna Commercial	$2,265.30
Rate for Payer: UnitedHealthcare Commercial	$2,391.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45380 COLONOSCOPY AND BIOPSY

Facility

$2,517.00

Service Code	HCPCS 45380
Hospital Charge Code	3150287
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$2,391.15
Rate for Payer: Aetna Commercial	$2,265.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,363.50
Rate for Payer: Humana Medicare Advantage	$1,057.14
Rate for Payer: UnitedHealthcare Commercial	$2,391.15
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$1,510.20

45381 COLONOSCOPE, SUBMUCOUS INJ

Facility

$2,517.00

Service Code	HCPCS 45381
Hospital Charge Code	3150291
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,391.15
Rate for Payer: Aetna Commercial	$2,265.30
Rate for Payer: UnitedHealthcare Commercial	$2,391.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45381 COLONOSCOPE, SUBMUCOUS INJ

Facility

$2,517.00

Service Code	HCPCS 45381
Hospital Charge Code	3150291
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$2,391.15
Rate for Payer: Aetna Commercial	$2,265.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,321.08
Rate for Payer: Humana Medicare Advantage	$1,057.14
Rate for Payer: UnitedHealthcare Commercial	$2,391.15
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$1,510.20

45384 Colonoscopy, flexible; w/ removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forc

Facility

$2,517.00

Service Code	HCPCS 45384
Hospital Charge Code	3150288
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$2,391.15
Rate for Payer: Aetna Commercial	$2,265.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,321.08
Rate for Payer: Humana Medicare Advantage	$1,057.14
Rate for Payer: UnitedHealthcare Commercial	$2,391.15
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$1,510.20

45384 Colonoscopy, flexible; w/ removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forc

Facility

$2,517.00

Service Code	HCPCS 45384
Hospital Charge Code	3150288
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,391.15
Rate for Payer: Aetna Commercial	$2,265.30
Rate for Payer: UnitedHealthcare Commercial	$2,391.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45385 COLON WITH REMOVAL BY SNARE/ANESTHESIA

Facility

$2,729.00

Service Code	HCPCS 45385
Hospital Charge Code	3150289
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$2,592.55
Rate for Payer: Aetna Commercial	$2,456.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,486.72
Rate for Payer: Humana Medicare Advantage	$1,146.18
Rate for Payer: UnitedHealthcare Commercial	$2,592.55
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$1,637.40

45385 COLON WITH REMOVAL BY SNARE/ANESTHESIA

Facility

$2,729.00

Service Code	HCPCS 45385
Hospital Charge Code	3150289
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,592.55
Rate for Payer: Aetna Commercial	$2,456.10
Rate for Payer: UnitedHealthcare Commercial	$2,592.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45386 COCLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT

Facility

$2,432.00

Service Code	HCPCS 45386
Hospital Charge Code	3155386
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$2,310.40
Rate for Payer: Aetna Commercial	$2,188.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,454.40
Rate for Payer: Humana Medicare Advantage	$1,021.44
Rate for Payer: UnitedHealthcare Commercial	$2,310.40
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$1,459.20

45386 COCLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT

Facility

$2,432.00

Service Code	HCPCS 45386
Hospital Charge Code	3155386
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,310.40
Rate for Payer: Aetna Commercial	$2,188.80
Rate for Payer: UnitedHealthcare Commercial	$2,310.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s)

Facility

$2,732.00

Service Code	HCPCS 45388
Hospital Charge Code	3155388
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,595.40
Rate for Payer: Aetna Commercial	$2,458.80
Rate for Payer: UnitedHealthcare Commercial	$2,595.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s)

Facility

$2,732.00

Service Code	HCPCS 45388
Hospital Charge Code	3155388
Hospital Revenue Code	360
Min. Negotiated Rate	$559.12
Max. Negotiated Rate	$2,595.40
Rate for Payer: Aetna Commercial	$2,458.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,454.40
Rate for Payer: Humana Medicare Advantage	$1,147.44
Rate for Payer: UnitedHealthcare Commercial	$2,595.40
Rate for Payer: UnitedHealthcare Medicaid	$559.12
Rate for Payer: WPPA Medicare Advantage	$1,639.20

45905 Dilation of anal sphincter (separate procedure) under anesthesia other than local

Facility

$1,263.00

Service Code	HCPCS 45905
Hospital Charge Code	3155905
Hospital Revenue Code	360
Min. Negotiated Rate	$1,136.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,136.70
Rate for Payer: UnitedHealthcare Commercial	$1,199.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

45905 Dilation of anal sphincter (separate procedure) under anesthesia other than local

Facility

$1,263.00

Service Code	HCPCS 45905
Hospital Charge Code	3155905
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$1,199.85
Rate for Payer: Aetna Commercial	$1,136.70
Rate for Payer: Humana Medicare Advantage	$530.46
Rate for Payer: UnitedHealthcare Commercial	$1,199.85
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$757.80

45915 Removal of fecal impaction or foreign body (separate procedure) under anesthesia

Facility

$1,278.00

Service Code	HCPCS 45915
Hospital Charge Code	3155915
Hospital Revenue Code	360
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

45915 Removal of fecal impaction or foreign body (separate procedure) under anesthesia

Facility

$1,278.00

Service Code	HCPCS 45915
Hospital Charge Code	3155915
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$1,214.10
Rate for Payer: Aetna Commercial	$1,150.20
Rate for Payer: Humana Medicare Advantage	$536.76
Rate for Payer: UnitedHealthcare Commercial	$1,214.10
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$766.80

45990 Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic

Facility

$397.00

Service Code	HCPCS 45990
Hospital Charge Code	3405990
Hospital Revenue Code	360
Min. Negotiated Rate	$85.64
Max. Negotiated Rate	$377.15
Rate for Payer: Aetna Commercial	$357.30
Rate for Payer: Humana Medicare Advantage	$166.74
Rate for Payer: UnitedHealthcare Commercial	$377.15
Rate for Payer: UnitedHealthcare Medicaid	$85.64
Rate for Payer: WPPA Medicare Advantage	$238.20

45990 Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic

Facility

$397.00

Service Code	HCPCS 45990
Hospital Charge Code	3405990
Hospital Revenue Code	360
Min. Negotiated Rate	$357.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$357.30
Rate for Payer: UnitedHealthcare Commercial	$377.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46050-I&D Perianal Abscess Superficial

Facility

$234.00

Service Code	HCPCS 46050
Hospital Charge Code	3306050
Hospital Revenue Code	450
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$919.10
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$919.10
Rate for Payer: Humana Medicare Advantage	$98.28
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: UnitedHealthcare Medicaid	$296.08
Rate for Payer: WPPA Medicare Advantage	$140.40

Know your out-of-pocket cost for care.

All Charges