Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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	$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

49594 Repair anterior abdominal hernia,(epigastric, incisional, ventral,

Facility

$5,432.00

Service Code	HCPCS 49594
Hospital Charge Code	3150428
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

49594 Repair anterior abdominal hernia,(epigastric, incisional, ventral,

Facility

$5,432.00

Service Code	HCPCS 49594
Hospital Charge Code	3150428
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

49595 RPR AA HERNIA 1ST > 10 CM REDUCIBLE Tech Charge

Facility

$5,284.00

Service Code	HCPCS 49595
Hospital Charge Code	3409585
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

49595 RPR AA HERNIA 1ST > 10 CM REDUCIBLE Tech Charge

Facility

$5,284.00

Service Code	HCPCS 49595
Hospital Charge Code	3409585
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

49596 RPR OF ANTERIOR ABD HERN(S), ANY APPR,INITIAL,MESH OR OTHR, > 3CM INCARCERATE/STRANGULATED

Facility

$5,432.00

Service Code	HCPCS 49596
Hospital Charge Code	3159572
Hospital Revenue Code	360
Min. Negotiated Rate	$2,172.80
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	$2,172.80
Rate for Payer: WPPA Medicare Advantage	$3,259.20

49596 RPR OF ANTERIOR ABD HERN(S), ANY APPR,INITIAL,MESH OR OTHR, > 3CM INCARCERATE/STRANGULATED

Facility

$5,432.00

Service Code	HCPCS 49596
Hospital Charge Code	3159572
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

49613 HERNIA<3CMREDRECPRO [HGHO]

Facility

$6,216.00

Service Code	HCPCS 49613
Hospital Charge Code	3369613
Hospital Revenue Code	360
Min. Negotiated Rate	$2,302.25
Max. Negotiated Rate	$5,905.20
Rate for Payer: Aetna Commercial	$5,594.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,485.41
Rate for Payer: Humana Medicare Advantage	$2,610.72
Rate for Payer: UnitedHealthcare Commercial	$5,905.20
Rate for Payer: UnitedHealthcare Medicaid	$2,302.25
Rate for Payer: WPPA Medicare Advantage	$3,729.60

49613 HERNIA<3CMREDRECPRO [HGHO]

Facility

$6,216.00

Service Code	HCPCS 49613
Hospital Charge Code	3369613
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,905.20
Rate for Payer: Aetna Commercial	$5,594.40
Rate for Payer: UnitedHealthcare Commercial	$5,905.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49650 Laparoscopy, surgical; repair initial inguinal hernica Surg pro fee

Facility

$11,093.00

Service Code	HCPCS 49650
Hospital Charge Code	3150589
Hospital Revenue Code	360
Min. Negotiated Rate	$1,869.18
Max. Negotiated Rate	$10,538.35
Rate for Payer: Aetna Commercial	$9,983.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$7,195.24
Rate for Payer: Humana Medicare Advantage	$4,659.06
Rate for Payer: UnitedHealthcare Commercial	$10,538.35
Rate for Payer: UnitedHealthcare Medicaid	$1,869.18
Rate for Payer: WPPA Medicare Advantage	$6,655.80

49650 Laparoscopy, surgical; repair initial inguinal hernica Surg pro fee

Facility

$11,093.00

Service Code	HCPCS 49650
Hospital Charge Code	3150589
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,538.35
Rate for Payer: Aetna Commercial	$9,983.70
Rate for Payer: UnitedHealthcare Commercial	$10,538.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49651 LAPARO HERNIA REPAIR RECUR

Facility

$13,133.00

Service Code	HCPCS 49651
Hospital Charge Code	3159651
Hospital Revenue Code	360
Min. Negotiated Rate	$1,869.18
Max. Negotiated Rate	$12,476.35
Rate for Payer: Aetna Commercial	$11,819.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$9,475.82
Rate for Payer: Humana Medicare Advantage	$5,515.86
Rate for Payer: UnitedHealthcare Commercial	$12,476.35
Rate for Payer: UnitedHealthcare Medicaid	$1,869.18
Rate for Payer: WPPA Medicare Advantage	$7,879.80

49651 LAPARO HERNIA REPAIR RECUR

Facility

$13,133.00

Service Code	HCPCS 49651
Hospital Charge Code	3159651
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$12,476.35
Rate for Payer: Aetna Commercial	$11,819.70
Rate for Payer: UnitedHealthcare Commercial	$12,476.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49651 Laparoscopy, surgical repair recurrent inguinal hernia

Facility

$13,133.00

Service Code	HCPCS 49651
Hospital Charge Code	3159651
Hospital Revenue Code	360
Min. Negotiated Rate	$1,869.18
Max. Negotiated Rate	$12,476.35
Rate for Payer: Aetna Commercial	$11,819.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$9,475.82
Rate for Payer: Humana Medicare Advantage	$5,515.86
Rate for Payer: UnitedHealthcare Commercial	$12,476.35
Rate for Payer: UnitedHealthcare Medicaid	$1,869.18
Rate for Payer: WPPA Medicare Advantage	$7,879.80

49651 Laparoscopy, surgical repair recurrent inguinal hernia

Facility

$13,133.00

Service Code	HCPCS 49651
Hospital Charge Code	3159651
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$12,476.35
Rate for Payer: Aetna Commercial	$11,819.70
Rate for Payer: UnitedHealthcare Commercial	$12,476.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49653 LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INC ProFee

Facility

$2,427.00

Service Code	HCPCS 49653
Hospital Charge Code	3369653
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,305.65
Rate for Payer: Aetna Commercial	$2,184.30
Rate for Payer: UnitedHealthcare Commercial	$2,305.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

49653 LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INC ProFee

Facility

$2,427.00

Service Code	HCPCS 49653
Hospital Charge Code	3369653
Hospital Revenue Code	360
Min. Negotiated Rate	$970.80
Max. Negotiated Rate	$2,305.65
Rate for Payer: Aetna Commercial	$2,184.30
Rate for Payer: Humana Medicare Advantage	$1,019.34
Rate for Payer: UnitedHealthcare Commercial	$2,305.65
Rate for Payer: UnitedHealthcare Medicaid	$970.80
Rate for Payer: WPPA Medicare Advantage	$1,456.20

49905 Surgical Procedures on the Omental Flap

Facility

$1,103.00

Service Code	HCPCS 49905
Hospital Charge Code	3159905
Hospital Revenue Code	360
Min. Negotiated Rate	$441.20
Max. Negotiated Rate	$1,047.85
Rate for Payer: Aetna Commercial	$992.70
Rate for Payer: Humana Medicare Advantage	$463.26
Rate for Payer: UnitedHealthcare Commercial	$1,047.85
Rate for Payer: UnitedHealthcare Medicaid	$441.20
Rate for Payer: WPPA Medicare Advantage	$661.80

49905 Surgical Procedures on the Omental Flap

Facility

$1,103.00

Service Code	HCPCS 49905
Hospital Charge Code	3159905
Hospital Revenue Code	360
Min. Negotiated Rate	$992.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$992.70
Rate for Payer: UnitedHealthcare Commercial	$1,047.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

50432 PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AN ProFee

Facility

$4,419.00

Service Code	HCPCS 50432
Hospital Charge Code	3150432
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,198.05
Rate for Payer: Aetna Commercial	$3,977.10
Rate for Payer: UnitedHealthcare Commercial	$4,198.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

50432 PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AN ProFee

Facility

$4,419.00

Service Code	HCPCS 50432
Hospital Charge Code	3150432
Hospital Revenue Code	360
Min. Negotiated Rate	$310.07
Max. Negotiated Rate	$4,198.05
Rate for Payer: Aetna Commercial	$3,977.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$310.07
Rate for Payer: Humana Medicare Advantage	$1,855.98
Rate for Payer: UnitedHealthcare Commercial	$4,198.05
Rate for Payer: UnitedHealthcare Medicaid	$1,018.34
Rate for Payer: WPPA Medicare Advantage	$2,651.40

50435 Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or uretero

Facility

$3,114.00

Service Code	HCPCS 50435
Hospital Charge Code	3154350
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,958.30
Rate for Payer: Aetna Commercial	$2,802.60
Rate for Payer: UnitedHealthcare Commercial	$2,958.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

50435 Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or uretero

Facility

$3,114.00

Service Code	HCPCS 50435
Hospital Charge Code	3154350
Hospital Revenue Code	360
Min. Negotiated Rate	$354.55
Max. Negotiated Rate	$2,958.30
Rate for Payer: Aetna Commercial	$2,802.60
Rate for Payer: Humana Medicare Advantage	$1,307.88
Rate for Payer: UnitedHealthcare Commercial	$2,958.30
Rate for Payer: UnitedHealthcare Medicaid	$354.55
Rate for Payer: WPPA Medicare Advantage	$1,868.40

51700 BLADDER IRRIGATION

Facility

$277.00

Service Code	HCPCS 51700
Hospital Charge Code	3290035
Hospital Revenue Code	761
Min. Negotiated Rate	$249.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$249.30
Rate for Payer: UnitedHealthcare Commercial	$263.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51700 BLADDER IRRIGATION

Facility

$277.00

Service Code	HCPCS 51700
Hospital Charge Code	3290035
Hospital Revenue Code	761
Min. Negotiated Rate	$116.34
Max. Negotiated Rate	$312.17
Rate for Payer: Aetna Commercial	$249.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$312.17
Rate for Payer: Humana Medicare Advantage	$116.34
Rate for Payer: UnitedHealthcare Commercial	$263.15
Rate for Payer: UnitedHealthcare Medicaid	$171.60
Rate for Payer: WPPA Medicare Advantage	$166.20

Know your out-of-pocket cost for care.

All Charges