Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

49000 EXPLORATION OF ABDOMEN

Facility

$5,114.00

Service Code	HCPCS 49000
Hospital Charge Code	3150310
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,858.30
Rate for Payer: Aetna Commercial	$4,602.60
Rate for Payer: UnitedHealthcare Commercial	$4,858.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49010 Laparoscopic exploration behind abdomen

Facility

$2,135.00

Service Code	HCPCS 49010
Hospital Charge Code	3159010
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,028.25
Rate for Payer: Aetna Commercial	$1,921.50
Rate for Payer: UnitedHealthcare Commercial	$2,028.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49010 Laparoscopic exploration behind abdomen

Facility

$2,135.00

Service Code	HCPCS 49010
Hospital Charge Code	3159010
Hospital Revenue Code	360
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,028.25
Rate for Payer: Aetna Commercial	$1,921.50
Rate for Payer: Humana Medicare Advantage	$896.70
Rate for Payer: UnitedHealthcare Commercial	$2,028.25
Rate for Payer: UnitedHealthcare Medicaid	$520.00
Rate for Payer: WPPA Medicare Advantage	$1,281.00

49020 Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, ope

Facility

$6,899.00

Service Code	HCPCS 49020
Hospital Charge Code	3159020
Hospital Revenue Code	360
Min. Negotiated Rate	$416.00
Max. Negotiated Rate	$6,554.05
Rate for Payer: Aetna Commercial	$6,209.10
Rate for Payer: Humana Medicare Advantage	$2,897.58
Rate for Payer: UnitedHealthcare Commercial	$6,554.05
Rate for Payer: UnitedHealthcare Medicaid	$416.00
Rate for Payer: WPPA Medicare Advantage	$4,139.40

49020 Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, ope

Facility

$6,899.00

Service Code	HCPCS 49020
Hospital Charge Code	3159020
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,554.05
Rate for Payer: Aetna Commercial	$6,209.10
Rate for Payer: UnitedHealthcare Commercial	$6,554.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

Facility

$1,496.00

Service Code	HCPCS 49082
Hospital Charge Code	3159082
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,421.20
Rate for Payer: Aetna Commercial	$1,346.40
Rate for Payer: UnitedHealthcare Commercial	$1,421.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

Facility

$1,496.00

Service Code	HCPCS 49082
Hospital Charge Code	3159082
Hospital Revenue Code	761
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$1,421.20
Rate for Payer: Aetna Commercial	$1,346.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,079.61
Rate for Payer: Humana Medicare Advantage	$628.32
Rate for Payer: UnitedHealthcare Commercial	$1,421.20
Rate for Payer: UnitedHealthcare Medicaid	$260.47
Rate for Payer: WPPA Medicare Advantage	$897.60

49083 Abdominal paracentesis with imaging guidance; (diagnostic or therapeutic) CCMC

Facility

$1,116.00

Service Code	HCPCS 49083
Hospital Charge Code	3299083
Hospital Revenue Code	761
Min. Negotiated Rate	$1,004.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,004.40
Rate for Payer: UnitedHealthcare Commercial	$1,060.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49083 Abdominal paracentesis with imaging guidance; (diagnostic or therapeutic) CCMC

Facility

$1,116.00

Service Code	HCPCS 49083
Hospital Charge Code	3299083
Hospital Revenue Code	761
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$1,079.61
Rate for Payer: Aetna Commercial	$1,004.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,079.61
Rate for Payer: Humana Medicare Advantage	$468.72
Rate for Payer: UnitedHealthcare Commercial	$1,060.20
Rate for Payer: UnitedHealthcare Medicaid	$260.47
Rate for Payer: WPPA Medicare Advantage	$669.60

49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE Tech Charge

Facility

$1,116.00

Service Code	HCPCS 49083
Hospital Charge Code	3150430
Hospital Revenue Code	360
Min. Negotiated Rate	$1,004.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,004.40
Rate for Payer: UnitedHealthcare Commercial	$1,060.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE Tech Charge

Facility

$1,116.00

Service Code	HCPCS 49083
Hospital Charge Code	3150430
Hospital Revenue Code	360
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$1,079.61
Rate for Payer: Aetna Commercial	$1,004.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,079.61
Rate for Payer: Humana Medicare Advantage	$468.72
Rate for Payer: UnitedHealthcare Commercial	$1,060.20
Rate for Payer: UnitedHealthcare Medicaid	$260.47
Rate for Payer: WPPA Medicare Advantage	$669.60

49083 - PARACENTESIS W/GUIDANCE CHARGE

Facility

$1,116.00

Service Code	HCPCS 49083
Hospital Charge Code	3739083
Hospital Revenue Code	761
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$1,079.61
Rate for Payer: Aetna Commercial	$1,004.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,079.61
Rate for Payer: Humana Medicare Advantage	$468.72
Rate for Payer: UnitedHealthcare Commercial	$1,060.20
Rate for Payer: UnitedHealthcare Medicaid	$260.47
Rate for Payer: WPPA Medicare Advantage	$669.60

49083 - PARACENTESIS W/GUIDANCE CHARGE

Facility

$1,116.00

Service Code	HCPCS 49083
Hospital Charge Code	3739083
Hospital Revenue Code	761
Min. Negotiated Rate	$1,004.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,004.40
Rate for Payer: UnitedHealthcare Commercial	$1,060.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of spec

Facility

$9,525.00

Service Code	HCPCS 49320
Hospital Charge Code	3150330
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,048.75
Rate for Payer: Aetna Commercial	$8,572.50
Rate for Payer: UnitedHealthcare Commercial	$9,048.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of spec

Facility

$9,525.00

Service Code	HCPCS 49320
Hospital Charge Code	3150330
Hospital Revenue Code	360
Min. Negotiated Rate	$1,869.18
Max. Negotiated Rate	$9,048.75
Rate for Payer: Aetna Commercial	$8,572.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$6,871.99
Rate for Payer: Humana Medicare Advantage	$4,000.50
Rate for Payer: UnitedHealthcare Commercial	$9,048.75
Rate for Payer: UnitedHealthcare Medicaid	$1,869.18
Rate for Payer: WPPA Medicare Advantage	$5,715.00

49322 Laparoscopy, surgical

Facility

$9,525.00

Service Code	HCPCS 49322
Hospital Charge Code	3159322
Hospital Revenue Code	360
Min. Negotiated Rate	$1,869.18
Max. Negotiated Rate	$9,048.75
Rate for Payer: Aetna Commercial	$8,572.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$6,871.99
Rate for Payer: Humana Medicare Advantage	$4,000.50
Rate for Payer: UnitedHealthcare Commercial	$9,048.75
Rate for Payer: UnitedHealthcare Medicaid	$1,869.18
Rate for Payer: WPPA Medicare Advantage	$5,715.00

49322 Laparoscopy, surgical

Facility

$9,525.00

Service Code	HCPCS 49322
Hospital Charge Code	3159322
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,048.75
Rate for Payer: Aetna Commercial	$8,572.50
Rate for Payer: UnitedHealthcare Commercial	$9,048.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49324 Laparoscopy, surgical

Facility

$9,702.00

Service Code	HCPCS 49324
Hospital Charge Code	3159324
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,216.90
Rate for Payer: Aetna Commercial	$8,731.80
Rate for Payer: UnitedHealthcare Commercial	$9,216.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49324 Laparoscopy, surgical

Facility

$9,702.00

Service Code	HCPCS 49324
Hospital Charge Code	3159324
Hospital Revenue Code	360
Min. Negotiated Rate	$1,334.83
Max. Negotiated Rate	$9,216.90
Rate for Payer: Aetna Commercial	$8,731.80
Rate for Payer: Humana Medicare Advantage	$4,074.84
Rate for Payer: UnitedHealthcare Commercial	$9,216.90
Rate for Payer: UnitedHealthcare Medicaid	$1,334.83
Rate for Payer: WPPA Medicare Advantage	$5,821.20

49329 Laparoscopic Procedures on the Abdomen, Peritoneum, and Omentum

Facility

$5,326.00

Service Code	HCPCS 49329
Hospital Charge Code	3159329
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,059.70
Rate for Payer: Aetna Commercial	$4,793.40
Rate for Payer: UnitedHealthcare Commercial	$5,059.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49329 Laparoscopic Procedures on the Abdomen, Peritoneum, and Omentum

Facility

$5,326.00

Service Code	HCPCS 49329
Hospital Charge Code	3159329
Hospital Revenue Code	360
Min. Negotiated Rate	$2,236.92
Max. Negotiated Rate	$5,059.70
Rate for Payer: Aetna Commercial	$4,793.40
Rate for Payer: Humana Medicare Advantage	$2,236.92
Rate for Payer: UnitedHealthcare Commercial	$5,059.70
Rate for Payer: UnitedHealthcare Medicaid	$2,975.26
Rate for Payer: WPPA Medicare Advantage	$3,195.60

49422 Removal of tunneled intraperitoneal catheter

Facility

$5,262.00

Service Code	HCPCS 49422
Hospital Charge Code	3159422
Hospital Revenue Code	360
Min. Negotiated Rate	$2,104.80
Max. Negotiated Rate	$4,998.90
Rate for Payer: Aetna Commercial	$4,735.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,796.26
Rate for Payer: Humana Medicare Advantage	$2,210.04
Rate for Payer: UnitedHealthcare Commercial	$4,998.90
Rate for Payer: UnitedHealthcare Medicaid	$2,104.80
Rate for Payer: WPPA Medicare Advantage	$3,157.20

49422 Removal of tunneled intraperitoneal catheter

Facility

$5,262.00

Service Code	HCPCS 49422
Hospital Charge Code	3159422
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,998.90
Rate for Payer: Aetna Commercial	$4,735.80
Rate for Payer: UnitedHealthcare Commercial	$4,998.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49440 Insertion of gastrostomy tube, percutaneous

Facility

$2,949.00

Service Code	HCPCS 49440
Hospital Charge Code	3159440
Hospital Revenue Code	360
Min. Negotiated Rate	$616.42
Max. Negotiated Rate	$2,801.55
Rate for Payer: Aetna Commercial	$2,654.10
Rate for Payer: Humana Medicare Advantage	$1,238.58
Rate for Payer: UnitedHealthcare Commercial	$2,801.55
Rate for Payer: UnitedHealthcare Medicaid	$616.42
Rate for Payer: WPPA Medicare Advantage	$1,769.40

49440 Insertion of gastrostomy tube, percutaneous

Facility

$2,949.00

Service Code	HCPCS 49440
Hospital Charge Code	3159440
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,801.55
Rate for Payer: Aetna Commercial	$2,654.10
Rate for Payer: UnitedHealthcare Commercial	$2,801.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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All Charges