Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

55513-0710-01 - denosumab 60 mg/mL [HMC]

Facility

$2,414.00

Hospital Charge Code	3852210
Hospital Revenue Code	636
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,293.30
Rate for Payer: Aetna Commercial	$2,172.60
Rate for Payer: UnitedHealthcare Commercial	$2,293.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

55513-0710-01 - denosumab 60 mg/mL [HMC]

Facility

$2,414.00

Hospital Charge Code	3852210
Hospital Revenue Code	636
Min. Negotiated Rate	$965.60
Max. Negotiated Rate	$2,293.30
Rate for Payer: Aetna Commercial	$2,172.60
Rate for Payer: Humana Medicare Advantage	$1,013.88
Rate for Payer: UnitedHealthcare Commercial	$2,293.30
Rate for Payer: UnitedHealthcare Medicaid	$965.60
Rate for Payer: WPPA Medicare Advantage	$1,448.40

55540-Excision of varicocele or ligation of spermatic veins for varicocele; with hernia repair

Facility

$5,375.00

Service Code	HCPCS 55540
Hospital Charge Code	3155540
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,106.25
Rate for Payer: Aetna Commercial	$4,837.50
Rate for Payer: UnitedHealthcare Commercial	$5,106.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

55540-Excision of varicocele or ligation of spermatic veins for varicocele; with hernia repair

Facility

$5,375.00

Service Code	HCPCS 55540
Hospital Charge Code	3155540
Hospital Revenue Code	360
Min. Negotiated Rate	$1,120.76
Max. Negotiated Rate	$5,106.25
Rate for Payer: Aetna Commercial	$4,837.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,157.36
Rate for Payer: Humana Medicare Advantage	$2,257.50
Rate for Payer: UnitedHealthcare Commercial	$5,106.25
Rate for Payer: UnitedHealthcare Medicaid	$1,120.76
Rate for Payer: WPPA Medicare Advantage	$3,225.00

56420-I&D Bartholin Abscess

Facility

$234.00

Service Code	HCPCS 56420
Hospital Charge Code	3306420
Hospital Revenue Code	450
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: Humana Medicare Advantage	$98.28
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$140.40

56420-I&D Bartholin Abscess

Facility

$234.00

Service Code	HCPCS 56420
Hospital Charge Code	3306420
Hospital Revenue Code	450
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

56605 Biopsy of vulva or perineum (separate procedure); 1 lesion

Facility

$274.00

Service Code	HCPCS 56605
Hospital Charge Code	3156605
Hospital Revenue Code	360
Min. Negotiated Rate	$115.08
Max. Negotiated Rate	$260.43
Rate for Payer: Aetna Commercial	$246.60
Rate for Payer: Humana Medicare Advantage	$115.08
Rate for Payer: UnitedHealthcare Commercial	$260.30
Rate for Payer: UnitedHealthcare Medicaid	$260.43
Rate for Payer: WPPA Medicare Advantage	$164.40

56605 Biopsy of vulva or perineum (separate procedure); 1 lesion

Facility

$274.00

Service Code	HCPCS 56605
Hospital Charge Code	3156605
Hospital Revenue Code	360
Min. Negotiated Rate	$246.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$246.60
Rate for Payer: UnitedHealthcare Commercial	$260.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

56620 Vulvectomy simple; partial

Facility

$2,183.00

Service Code	HCPCS 56620
Hospital Charge Code	3156620
Hospital Revenue Code	360
Min. Negotiated Rate	$916.86
Max. Negotiated Rate	$2,073.85
Rate for Payer: Aetna Commercial	$1,964.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,370.56
Rate for Payer: Humana Medicare Advantage	$916.86
Rate for Payer: UnitedHealthcare Commercial	$2,073.85
Rate for Payer: UnitedHealthcare Medicaid	$1,012.78
Rate for Payer: WPPA Medicare Advantage	$1,309.80

56620 Vulvectomy simple; partial

Facility

$2,183.00

Service Code	HCPCS 56620
Hospital Charge Code	3156620
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,073.85
Rate for Payer: Aetna Commercial	$1,964.70
Rate for Payer: UnitedHealthcare Commercial	$2,073.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

57160 FITTING AND INSERTING DEVIC-ER SERV PROC

Facility

$276.00

Service Code	HCPCS 57160
Hospital Charge Code	3357160
Hospital Revenue Code	761
Min. Negotiated Rate	$248.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$248.40
Rate for Payer: UnitedHealthcare Commercial	$262.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

57160 FITTING AND INSERTING DEVIC-ER SERV PROC

Facility

$276.00

Service Code	HCPCS 57160
Hospital Charge Code	3357160
Hospital Revenue Code	761
Min. Negotiated Rate	$110.40
Max. Negotiated Rate	$262.20
Rate for Payer: Aetna Commercial	$248.40
Rate for Payer: Humana Medicare Advantage	$115.92
Rate for Payer: UnitedHealthcare Commercial	$262.20
Rate for Payer: UnitedHealthcare Medicaid	$110.40
Rate for Payer: WPPA Medicare Advantage	$165.60

57456 Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage-Tech Fee

Facility

$2,259.00

Service Code	HCPCS 57456
Hospital Charge Code	3157456
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,146.05
Rate for Payer: Aetna Commercial	$2,033.10
Rate for Payer: UnitedHealthcare Commercial	$2,146.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

57456 Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage-Tech Fee

Facility

$2,259.00

Service Code	HCPCS 57456
Hospital Charge Code	3157456
Hospital Revenue Code	360
Min. Negotiated Rate	$258.26
Max. Negotiated Rate	$2,146.05
Rate for Payer: Aetna Commercial	$2,033.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$358.34
Rate for Payer: Humana Medicare Advantage	$948.78
Rate for Payer: UnitedHealthcare Commercial	$2,146.05
Rate for Payer: UnitedHealthcare Medicaid	$258.26
Rate for Payer: WPPA Medicare Advantage	$1,355.40

57460 Colposcopy of the cervix incl. upper vagina; with loop electrode biopsy(s) of the cervix

Facility

$3,877.00

Service Code	HCPCS 57460
Hospital Charge Code	3307460
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,683.15
Rate for Payer: Aetna Commercial	$3,489.30
Rate for Payer: UnitedHealthcare Commercial	$3,683.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

57460 Colposcopy of the cervix incl. upper vagina; with loop electrode biopsy(s) of the cervix

Facility

$3,877.00

Service Code	HCPCS 57460
Hospital Charge Code	3307460
Hospital Revenue Code	360
Min. Negotiated Rate	$1,012.78
Max. Negotiated Rate	$3,683.15
Rate for Payer: Aetna Commercial	$3,489.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,796.69
Rate for Payer: Humana Medicare Advantage	$1,628.34
Rate for Payer: UnitedHealthcare Commercial	$3,683.15
Rate for Payer: UnitedHealthcare Medicaid	$1,012.78
Rate for Payer: WPPA Medicare Advantage	$2,326.20

57522 Conization of cervix, LEEP

Facility

$7,029.00

Service Code	HCPCS 57522
Hospital Charge Code	3150336
Hospital Revenue Code	360
Min. Negotiated Rate	$1,012.78
Max. Negotiated Rate	$6,677.55
Rate for Payer: Aetna Commercial	$6,326.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,747.10
Rate for Payer: Humana Medicare Advantage	$2,952.18
Rate for Payer: UnitedHealthcare Commercial	$6,677.55
Rate for Payer: UnitedHealthcare Medicaid	$1,012.78
Rate for Payer: WPPA Medicare Advantage	$4,217.40

57522 Conization of cervix, LEEP

Facility

$7,029.00

Service Code	HCPCS 57522
Hospital Charge Code	3150336
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,677.55
Rate for Payer: Aetna Commercial	$6,326.10
Rate for Payer: UnitedHealthcare Commercial	$6,677.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)-PF

Facility

$3,239.00

Service Code	HCPCS 58120
Hospital Charge Code	3150301
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,077.05
Rate for Payer: Aetna Commercial	$2,915.10
Rate for Payer: UnitedHealthcare Commercial	$3,077.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)-PF

Facility

$3,239.00

Service Code	HCPCS 58120
Hospital Charge Code	3150301
Hospital Revenue Code	360
Min. Negotiated Rate	$1,012.78
Max. Negotiated Rate	$3,077.05
Rate for Payer: Aetna Commercial	$2,915.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,906.88
Rate for Payer: Humana Medicare Advantage	$1,360.38
Rate for Payer: UnitedHealthcare Commercial	$3,077.05
Rate for Payer: UnitedHealthcare Medicaid	$1,012.78
Rate for Payer: WPPA Medicare Advantage	$1,943.40

58300 Insertion of intrauterine device (IUD).

Facility

$993.00

Service Code	HCPCS 58300
Hospital Charge Code	3158300
Hospital Revenue Code	360
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$943.35
Rate for Payer: Aetna Commercial	$893.70
Rate for Payer: Humana Medicare Advantage	$417.06
Rate for Payer: UnitedHealthcare Commercial	$943.35
Rate for Payer: UnitedHealthcare Medicaid	$156.00
Rate for Payer: WPPA Medicare Advantage	$595.80

58300 Insertion of intrauterine device (IUD).

Facility

$993.00

Service Code	HCPCS 58300
Hospital Charge Code	3158300
Hospital Revenue Code	360
Min. Negotiated Rate	$893.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$893.70
Rate for Payer: UnitedHealthcare Commercial	$943.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

58301 Removal of intrauterine device (IUD).

Facility

$740.00

Service Code	HCPCS 58301
Hospital Charge Code	3158301
Hospital Revenue Code	360
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$703.00
Rate for Payer: Aetna Commercial	$666.00
Rate for Payer: Humana Medicare Advantage	$310.80
Rate for Payer: UnitedHealthcare Commercial	$703.00
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$444.00

58301 Removal of intrauterine device (IUD).

Facility

$740.00

Service Code	HCPCS 58301
Hospital Charge Code	3158301
Hospital Revenue Code	360
Min. Negotiated Rate	$666.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$666.00
Rate for Payer: UnitedHealthcare Commercial	$703.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

58661 Laparoscopy, Surgical Removal of Adnexal structures

Facility

$9,635.00

Service Code	HCPCS 58661
Hospital Charge Code	3158661
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,153.25
Rate for Payer: Aetna Commercial	$8,671.50
Rate for Payer: UnitedHealthcare Commercial	$9,153.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges