Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

51700 Bladder irrigation, simple, lavage and/or instillation.

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, simple, lavage and/or instillation.

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

51701 ER TECH STRAIGHT CATH

Facility

$180.00

Service Code	HCPCS 51701
Hospital Charge Code	3301701
Hospital Revenue Code	450
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51701 ER TECH STRAIGHT CATH

Facility

$180.00

Service Code	HCPCS 51701
Hospital Charge Code	3301701
Hospital Revenue Code	450
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$75.60
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$108.00

51701-Insert Bladder Cath Non-Dwelling

Facility

$180.00

Service Code	HCPCS 51701
Hospital Charge Code	3301701
Hospital Revenue Code	450
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$75.60
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$108.00

51701-Insert Bladder Cath Non-Dwelling

Facility

$180.00

Service Code	HCPCS 51701
Hospital Charge Code	3301701
Hospital Revenue Code	450
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51701 INSERTION OF NON DWELLING BLADDER CATHET

Facility

$1,496.00

Service Code	HCPCS 51701
Hospital Charge Code	3351701
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

51701 INSERTION OF NON DWELLING BLADDER CATHET

Facility

$1,496.00

Service Code	HCPCS 51701
Hospital Charge Code	3351701
Hospital Revenue Code	761
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$1,421.20
Rate for Payer: Aetna Commercial	$1,346.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$628.32
Rate for Payer: UnitedHealthcare Commercial	$1,421.20
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$897.60

51701 INSERT STRAIGHT CATHETER CHARGE

Facility

$146.00

Service Code	HCPCS 51701
Hospital Charge Code	3351701
Hospital Revenue Code	761
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$144.89
Rate for Payer: Aetna Commercial	$131.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$61.32
Rate for Payer: UnitedHealthcare Commercial	$138.70
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$87.60

51701 INSERT STRAIGHT CATHETER CHARGE

Facility

$146.00

Service Code	HCPCS 51701
Hospital Charge Code	3351701
Hospital Revenue Code	761
Min. Negotiated Rate	$131.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$131.40
Rate for Payer: UnitedHealthcare Commercial	$138.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51702 INSERTION FOLEY CATH CHARGE

Facility

$234.00

Service Code	HCPCS 51702
Hospital Charge Code	3290030
Hospital Revenue Code	761
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

51702 INSERTION FOLEY CATH CHARGE

Facility

$234.00

Service Code	HCPCS 51702
Hospital Charge Code	3290030
Hospital Revenue Code	761
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$98.28
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$140.40

51702-Insertion Indwelling Catheter

Facility

$583.00

Service Code	HCPCS 51702
Hospital Charge Code	3306000
Hospital Revenue Code	450
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$553.85
Rate for Payer: Aetna Commercial	$524.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$244.86
Rate for Payer: UnitedHealthcare Commercial	$553.85
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$349.80

51702-Insertion Indwelling Catheter

Facility

$583.00

Service Code	HCPCS 51702
Hospital Charge Code	3306000
Hospital Revenue Code	450
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$524.70
Rate for Payer: UnitedHealthcare Commercial	$553.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51702 INSERT TEMP INDWELLING BLADDER C ER SERV

Facility

$583.00

Service Code	HCPCS 51702
Hospital Charge Code	3306000
Hospital Revenue Code	450
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$553.85
Rate for Payer: Aetna Commercial	$524.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$144.89
Rate for Payer: Humana Medicare Advantage	$244.86
Rate for Payer: UnitedHealthcare Commercial	$553.85
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$349.80

51702 INSERT TEMP INDWELLING BLADDER C ER SERV

Facility

$583.00

Service Code	HCPCS 51702
Hospital Charge Code	3306000
Hospital Revenue Code	450
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$524.70
Rate for Payer: UnitedHealthcare Commercial	$553.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51705 CHANGE OF CYSTOSTOMY TUBE, SIMPLE

Facility

$291.00

Service Code	HCPCS 51705
Hospital Charge Code	3291550
Hospital Revenue Code	761
Min. Negotiated Rate	$67.67
Max. Negotiated Rate	$276.45
Rate for Payer: Aetna Commercial	$261.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.67
Rate for Payer: Humana Medicare Advantage	$122.22
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: UnitedHealthcare Medicaid	$171.60
Rate for Payer: WPPA Medicare Advantage	$174.60

51705 CHANGE OF CYSTOSTOMY TUBE, SIMPLE

Facility

$291.00

Service Code	HCPCS 51705
Hospital Charge Code	3291550
Hospital Revenue Code	761
Min. Negotiated Rate	$261.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$261.90
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51705 SUPRAPUBIC CATHETER CHANGE (CYSTOSTOMY) CHARGE

Facility

$291.00

Service Code	HCPCS 51705
Hospital Charge Code	3291550
Hospital Revenue Code	761
Min. Negotiated Rate	$261.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$261.90
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51705 SUPRAPUBIC CATHETER CHANGE (CYSTOSTOMY) CHARGE

Facility

$291.00

Service Code	HCPCS 51705
Hospital Charge Code	3291550
Hospital Revenue Code	761
Min. Negotiated Rate	$67.67
Max. Negotiated Rate	$276.45
Rate for Payer: Aetna Commercial	$261.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.67
Rate for Payer: Humana Medicare Advantage	$122.22
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: UnitedHealthcare Medicaid	$171.60
Rate for Payer: WPPA Medicare Advantage	$174.60

51798 BLADDER SCAN CHARGE

Facility

$180.00

Service Code	HCPCS 51798
Hospital Charge Code	3351798
Hospital Revenue Code	761
Min. Negotiated Rate	$67.67
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.67
Rate for Payer: Humana Medicare Advantage	$75.60
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: UnitedHealthcare Medicaid	$156.00
Rate for Payer: WPPA Medicare Advantage	$108.00

51798 BLADDER SCAN CHARGE

Facility

$180.00

Service Code	HCPCS 51798
Hospital Charge Code	3351798
Hospital Revenue Code	761
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging

Facility

$180.00

Service Code	HCPCS 51798
Hospital Charge Code	3351798
Hospital Revenue Code	761
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging

Facility

$180.00

Service Code	HCPCS 51798
Hospital Charge Code	3351798
Hospital Revenue Code	761
Min. Negotiated Rate	$67.67
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.67
Rate for Payer: Humana Medicare Advantage	$75.60
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: UnitedHealthcare Medicaid	$156.00
Rate for Payer: WPPA Medicare Advantage	$108.00

51798 MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON- TechFee

Facility

$180.00

Service Code	HCPCS 51798
Hospital Charge Code	3451998
Hospital Revenue Code	450
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges