Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

49450 REPLACE GASTRO/CECOSTOMY TUBE-ER SERV P

Facility

$2,292.00

Service Code	HCPCS 49450
Hospital Charge Code	3159450
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,177.40
Rate for Payer: Aetna Commercial	$2,062.80
Rate for Payer: UnitedHealthcare Commercial	$2,177.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49450 REPLACE GASTRO/CECOSTOMY TUBE-ER SERV P

Facility

$2,292.00

Service Code	HCPCS 49450
Hospital Charge Code	3159450
Hospital Revenue Code	360
Min. Negotiated Rate	$139.43
Max. Negotiated Rate	$2,177.40
Rate for Payer: Aetna Commercial	$2,062.80
Rate for Payer: Humana Medicare Advantage	$962.64
Rate for Payer: UnitedHealthcare Commercial	$2,177.40
Rate for Payer: UnitedHealthcare Medicaid	$139.43
Rate for Payer: WPPA Medicare Advantage	$1,375.20

49505 INGUINAL HERNIA

Facility

$6,135.00

Service Code	HCPCS 49505
Hospital Charge Code	3150326
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,828.25
Rate for Payer: Aetna Commercial	$5,521.50
Rate for Payer: UnitedHealthcare Commercial	$5,828.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49505 INGUINAL HERNIA

Facility

$6,135.00

Service Code	HCPCS 49505
Hospital Charge Code	3150326
Hospital Revenue Code	360
Min. Negotiated Rate	$1,120.76
Max. Negotiated Rate	$5,828.25
Rate for Payer: Aetna Commercial	$5,521.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,120.43
Rate for Payer: Humana Medicare Advantage	$2,576.70
Rate for Payer: UnitedHealthcare Commercial	$5,828.25
Rate for Payer: UnitedHealthcare Medicaid	$1,120.76
Rate for Payer: WPPA Medicare Advantage	$3,681.00

49507 Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated

Facility

$6,344.00

Service Code	HCPCS 49507
Hospital Charge Code	3150331
Hospital Revenue Code	360
Min. Negotiated Rate	$1,120.76
Max. Negotiated Rate	$6,026.80
Rate for Payer: Aetna Commercial	$5,709.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,120.43
Rate for Payer: Humana Medicare Advantage	$2,664.48
Rate for Payer: UnitedHealthcare Commercial	$6,026.80
Rate for Payer: UnitedHealthcare Medicaid	$1,120.76
Rate for Payer: WPPA Medicare Advantage	$3,806.40

49507 Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated

Facility

$6,344.00

Service Code	HCPCS 49507
Hospital Charge Code	3150331
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,026.80
Rate for Payer: Aetna Commercial	$5,709.60
Rate for Payer: UnitedHealthcare Commercial	$6,026.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49507 Repair initial inguinal hernia incarcerated or strangulated >5 yr

Facility

$6,344.00

Service Code	HCPCS 49507
Hospital Charge Code	3150331
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,026.80
Rate for Payer: Aetna Commercial	$5,709.60
Rate for Payer: UnitedHealthcare Commercial	$6,026.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49507 Repair initial inguinal hernia incarcerated or strangulated >5 yr

Facility

$6,344.00

Service Code	HCPCS 49507
Hospital Charge Code	3150331
Hospital Revenue Code	360
Min. Negotiated Rate	$1,120.76
Max. Negotiated Rate	$6,026.80
Rate for Payer: Aetna Commercial	$5,709.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,120.43
Rate for Payer: Humana Medicare Advantage	$2,664.48
Rate for Payer: UnitedHealthcare Commercial	$6,026.80
Rate for Payer: UnitedHealthcare Medicaid	$1,120.76
Rate for Payer: WPPA Medicare Advantage	$3,806.40

49520 Repair recurrent inguinal hernia, any age, reducible

Facility

$7,554.00

Service Code	HCPCS 49520
Hospital Charge Code	3150329
Hospital Revenue Code	360
Min. Negotiated Rate	$1,120.76
Max. Negotiated Rate	$7,176.30
Rate for Payer: Aetna Commercial	$6,798.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,120.43
Rate for Payer: Humana Medicare Advantage	$3,172.68
Rate for Payer: UnitedHealthcare Commercial	$7,176.30
Rate for Payer: UnitedHealthcare Medicaid	$1,120.76
Rate for Payer: WPPA Medicare Advantage	$4,532.40

49520 Repair recurrent inguinal hernia, any age, reducible

Facility

$7,554.00

Service Code	HCPCS 49520
Hospital Charge Code	3150329
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,176.30
Rate for Payer: Aetna Commercial	$6,798.60
Rate for Payer: UnitedHealthcare Commercial	$7,176.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49540 Hernioplasty, Herniorrhaphy, Herniotomy Procedures

Facility

$9,525.00

Service Code	HCPCS 49540
Hospital Charge Code	3159540
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

49540 Hernioplasty, Herniorrhaphy, Herniotomy Procedures

Facility

$9,525.00

Service Code	HCPCS 49540
Hospital Charge Code	3159540
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

49550 Repair initial femoral hernia, any age; reducible SURG

Facility

$7,053.00

Service Code	HCPCS 49550
Hospital Charge Code	3159550
Hospital Revenue Code	360
Min. Negotiated Rate	$1,120.76
Max. Negotiated Rate	$6,700.35
Rate for Payer: Aetna Commercial	$6,347.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,120.43
Rate for Payer: Humana Medicare Advantage	$2,962.26
Rate for Payer: UnitedHealthcare Commercial	$6,700.35
Rate for Payer: UnitedHealthcare Medicaid	$1,120.76
Rate for Payer: WPPA Medicare Advantage	$4,231.80

49550 Repair initial femoral hernia, any age; reducible SURG

Facility

$7,053.00

Service Code	HCPCS 49550
Hospital Charge Code	3159550
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,700.35
Rate for Payer: Aetna Commercial	$6,347.70
Rate for Payer: UnitedHealthcare Commercial	$6,700.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49560 Repair Initial Incisional or Ventral Hernia; Reducible.

Facility

$4,089.00

Service Code	HCPCS 49560
Hospital Charge Code	3150588
Hospital Revenue Code	360
Min. Negotiated Rate	$1,635.60
Max. Negotiated Rate	$3,884.55
Rate for Payer: Aetna Commercial	$3,680.10
Rate for Payer: Humana Medicare Advantage	$1,717.38
Rate for Payer: UnitedHealthcare Commercial	$3,884.55
Rate for Payer: UnitedHealthcare Medicaid	$1,635.60
Rate for Payer: WPPA Medicare Advantage	$2,453.40

49560 Repair Initial Incisional or Ventral Hernia; Reducible.

Facility

$4,089.00

Service Code	HCPCS 49560
Hospital Charge Code	3150588
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,884.55
Rate for Payer: Aetna Commercial	$3,680.10
Rate for Payer: UnitedHealthcare Commercial	$3,884.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49561 Repair initial incisional or ventral hernia

Facility

$5,258.00

Service Code	HCPCS 49561
Hospital Charge Code	3150586
Hospital Revenue Code	360
Min. Negotiated Rate	$2,103.20
Max. Negotiated Rate	$4,995.10
Rate for Payer: Aetna Commercial	$4,732.20
Rate for Payer: Humana Medicare Advantage	$2,208.36
Rate for Payer: UnitedHealthcare Commercial	$4,995.10
Rate for Payer: UnitedHealthcare Medicaid	$2,103.20
Rate for Payer: WPPA Medicare Advantage	$3,154.80

49561 Repair initial incisional or ventral hernia

Facility

$5,258.00

Service Code	HCPCS 49561
Hospital Charge Code	3150586
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,995.10
Rate for Payer: Aetna Commercial	$4,732.20
Rate for Payer: UnitedHealthcare Commercial	$4,995.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49568 HERNIA INC/VENTRAL MESH IMPLANTATION

Facility

$6,539.00

Service Code	HCPCS 49568
Hospital Charge Code	3150605
Hospital Revenue Code	360
Min. Negotiated Rate	$2,615.60
Max. Negotiated Rate	$6,212.05
Rate for Payer: Aetna Commercial	$5,885.10
Rate for Payer: Humana Medicare Advantage	$2,746.38
Rate for Payer: UnitedHealthcare Commercial	$6,212.05
Rate for Payer: UnitedHealthcare Medicaid	$2,615.60
Rate for Payer: WPPA Medicare Advantage	$3,923.40

49568 HERNIA INC/VENTRAL MESH IMPLANTATION

Facility

$6,539.00

Service Code	HCPCS 49568
Hospital Charge Code	3150605
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,212.05
Rate for Payer: Aetna Commercial	$5,885.10
Rate for Payer: UnitedHealthcare Commercial	$6,212.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49591 RPR AA HERNIA 1ST < 3 CM REDUCIBLE Tech Charge

Facility

$5,284.00

Service Code	HCPCS 49591
Hospital Charge Code	3150427
Hospital Revenue Code	360
Min. Negotiated Rate	$2,219.28
Max. Negotiated Rate	$5,019.80
Rate for Payer: Aetna Commercial	$4,755.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,811.74
Rate for Payer: Humana Medicare Advantage	$2,219.28
Rate for Payer: UnitedHealthcare Commercial	$5,019.80
Rate for Payer: UnitedHealthcare Medicaid	$2,302.25
Rate for Payer: WPPA Medicare Advantage	$3,170.40

49591 RPR AA HERNIA 1ST < 3 CM REDUCIBLE Tech Charge

Facility

$5,284.00

Service Code	HCPCS 49591
Hospital Charge Code	3150427
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,019.80
Rate for Payer: Aetna Commercial	$4,755.60
Rate for Payer: UnitedHealthcare Commercial	$5,019.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49592 RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED Tech Charge

Facility

$5,432.00

Service Code	HCPCS 49592
Hospital Charge Code	3159653
Hospital Revenue Code	360
Min. Negotiated Rate	$2,281.44
Max. Negotiated Rate	$5,160.40
Rate for Payer: Aetna Commercial	$4,888.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,918.80
Rate for Payer: Humana Medicare Advantage	$2,281.44
Rate for Payer: UnitedHealthcare Commercial	$5,160.40
Rate for Payer: UnitedHealthcare Medicaid	$3,387.90
Rate for Payer: WPPA Medicare Advantage	$3,259.20

49592 RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED Tech Charge

Facility

$5,432.00

Service Code	HCPCS 49592
Hospital Charge Code	3159653
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: Aetna Commercial	$4,888.80
Rate for Payer: UnitedHealthcare Commercial	$5,160.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49593 RPR AA HERNIA 1ST 3-10 CM REDUCIBLE Tech Charge

Facility

$5,284.00

Service Code	HCPCS 49593
Hospital Charge Code	3150587
Hospital Revenue Code	360
Min. Negotiated Rate	$2,219.28
Max. Negotiated Rate	$5,019.80
Rate for Payer: Aetna Commercial	$4,755.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,811.74
Rate for Payer: Humana Medicare Advantage	$2,219.28
Rate for Payer: UnitedHealthcare Commercial	$5,019.80
Rate for Payer: UnitedHealthcare Medicaid	$2,302.25
Rate for Payer: WPPA Medicare Advantage	$3,170.40

Know your out-of-pocket cost for care.

All Charges