Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

86580 TB SKIN TEST CHARGE

Facility

$64.00

Service Code	HCPCS 86580
Hospital Charge Code	3290320
Hospital Revenue Code	761
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$60.80
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$18.35
Rate for Payer: Humana Medicare Advantage	$26.88
Rate for Payer: UnitedHealthcare Commercial	$60.80
Rate for Payer: UnitedHealthcare Medicaid	$7.91
Rate for Payer: WPPA Medicare Advantage	$38.40

86580 TB SKIN TEST CHARGE

Facility

$64.00

Service Code	HCPCS 86580
Hospital Charge Code	3290320
Hospital Revenue Code	761
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: UnitedHealthcare Commercial	$60.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

87045

Facility

$97.00

Service Code	HCPCS 87045
Hospital Charge Code	3550338
Hospital Revenue Code	300
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$92.15
Rate for Payer: Aetna Commercial	$87.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$29.62
Rate for Payer: Humana Medicare Advantage	$40.74
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: UnitedHealthcare Medicaid	$9.44
Rate for Payer: WPPA Medicare Advantage	$58.20

87045

Facility

$97.00

Service Code	HCPCS 87045
Hospital Charge Code	3550338
Hospital Revenue Code	300
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$87.30
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

87088 Bill Presumptive ID REF

Facility

$69.00

Service Code	HCPCS 87088
Hospital Charge Code	3553030
Hospital Revenue Code	300
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: UnitedHealthcare Commercial	$65.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

87088 Bill Presumptive ID REF

Facility

$69.00

Service Code	HCPCS 87088
Hospital Charge Code	3553030
Hospital Revenue Code	300
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$26.20
Rate for Payer: Humana Medicare Advantage	$28.98
Rate for Payer: UnitedHealthcare Commercial	$65.55
Rate for Payer: UnitedHealthcare Medicaid	$8.09
Rate for Payer: WPPA Medicare Advantage	$41.40

87340 Hep B contact

Facility

$35.00

Service Code	HCPCS 87340
Hospital Charge Code	3557340
Hospital Revenue Code	300
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$33.25
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$24.62
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: UnitedHealthcare Commercial	$33.25
Rate for Payer: UnitedHealthcare Medicaid	$10.33
Rate for Payer: WPPA Medicare Advantage	$21.00

87340 Hep B contact

Facility

$35.00

Service Code	HCPCS 87340
Hospital Charge Code	3557340
Hospital Revenue Code	300
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: UnitedHealthcare Commercial	$33.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

87449

Facility

$93.00

Service Code	HCPCS 87449
Hospital Charge Code	3557449
Hospital Revenue Code	300
Min. Negotiated Rate	$83.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$83.70
Rate for Payer: UnitedHealthcare Commercial	$88.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

87449

Facility

$93.00

Service Code	HCPCS 87449
Hospital Charge Code	3557449
Hospital Revenue Code	300
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$88.35
Rate for Payer: Aetna Commercial	$83.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$54.84
Rate for Payer: Humana Medicare Advantage	$39.06
Rate for Payer: UnitedHealthcare Commercial	$88.35
Rate for Payer: UnitedHealthcare Medicaid	$11.98
Rate for Payer: WPPA Medicare Advantage	$55.80

88185

Facility

$126.00

Service Code	HCPCS 88185
Hospital Charge Code	3559051
Hospital Revenue Code	300
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna Commercial	$113.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$89.45
Rate for Payer: Humana Medicare Advantage	$52.92
Rate for Payer: UnitedHealthcare Commercial	$119.70
Rate for Payer: UnitedHealthcare Medicaid	$19.52
Rate for Payer: WPPA Medicare Advantage	$75.60

88185

Facility

$126.00

Service Code	HCPCS 88185
Hospital Charge Code	3559051
Hospital Revenue Code	300
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$113.40
Rate for Payer: UnitedHealthcare Commercial	$119.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88189

Facility

$469.00

Service Code	HCPCS 88189
Hospital Charge Code	3558189
Hospital Revenue Code	300
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$445.55
Rate for Payer: Aetna Commercial	$422.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$265.30
Rate for Payer: Humana Medicare Advantage	$196.98
Rate for Payer: UnitedHealthcare Commercial	$445.55
Rate for Payer: UnitedHealthcare Medicaid	$78.33
Rate for Payer: WPPA Medicare Advantage	$281.40

88189

Facility

$469.00

Service Code	HCPCS 88189
Hospital Charge Code	3558189
Hospital Revenue Code	300
Min. Negotiated Rate	$422.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$422.10
Rate for Payer: UnitedHealthcare Commercial	$445.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88300 AP Bill Surg Level I

Facility

$68.00

Service Code	HCPCS 88300
Hospital Charge Code	3558300
Hospital Revenue Code	310
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88300 AP Bill Surg Level I

Facility

$68.00

Service Code	HCPCS 88300
Hospital Charge Code	3558300
Hospital Revenue Code	310
Min. Negotiated Rate	$13.67
Max. Negotiated Rate	$64.60
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$31.82
Rate for Payer: Humana Medicare Advantage	$28.56
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: UnitedHealthcare Medicaid	$13.67
Rate for Payer: WPPA Medicare Advantage	$40.80

88302 AP Bill Surg Level II

Facility

$124.00

Service Code	HCPCS 88302
Hospital Charge Code	3554010
Hospital Revenue Code	310
Min. Negotiated Rate	$28.47
Max. Negotiated Rate	$117.80
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$80.57
Rate for Payer: Humana Medicare Advantage	$52.08
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: UnitedHealthcare Medicaid	$28.47
Rate for Payer: WPPA Medicare Advantage	$74.40

88302 AP Bill Surg Level II

Facility

$124.00

Service Code	HCPCS 88302
Hospital Charge Code	3554010
Hospital Revenue Code	310
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88304 AP Bill Surg Level III

Facility

$180.00

Service Code	HCPCS 88304
Hospital Charge Code	3558304
Hospital Revenue Code	310
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

88304 AP Bill Surg Level III

Facility

$180.00

Service Code	HCPCS 88304
Hospital Charge Code	3558304
Hospital Revenue Code	310
Min. Negotiated Rate	$37.60
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$116.28
Rate for Payer: Humana Medicare Advantage	$75.60
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: UnitedHealthcare Medicaid	$37.60
Rate for Payer: WPPA Medicare Advantage	$108.00

88305 Surgical pathology, gross and microscopic examination

Facility

$302.00

Service Code	HCPCS 88305
Hospital Charge Code	3558305
Hospital Revenue Code	310
Min. Negotiated Rate	$271.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$271.80
Rate for Payer: UnitedHealthcare Commercial	$286.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88305 Surgical pathology, gross and microscopic examination

Facility

$302.00

Service Code	HCPCS 88305
Hospital Charge Code	3558305
Hospital Revenue Code	310
Min. Negotiated Rate	$65.47
Max. Negotiated Rate	$286.90
Rate for Payer: Aetna Commercial	$271.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$195.61
Rate for Payer: Humana Medicare Advantage	$126.84
Rate for Payer: UnitedHealthcare Commercial	$286.90
Rate for Payer: UnitedHealthcare Medicaid	$65.47
Rate for Payer: WPPA Medicare Advantage	$181.20

88307 AP Bill Surg Level V

Facility

$419.00

Service Code	HCPCS 88307
Hospital Charge Code	3554025
Hospital Revenue Code	310
Min. Negotiated Rate	$377.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$377.10
Rate for Payer: UnitedHealthcare Commercial	$398.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88307 AP Bill Surg Level V

Facility

$419.00

Service Code	HCPCS 88307
Hospital Charge Code	3554025
Hospital Revenue Code	310
Min. Negotiated Rate	$175.98
Max. Negotiated Rate	$398.05
Rate for Payer: Aetna Commercial	$377.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$271.81
Rate for Payer: Humana Medicare Advantage	$175.98
Rate for Payer: UnitedHealthcare Commercial	$398.05
Rate for Payer: UnitedHealthcare Medicaid	$220.97
Rate for Payer: WPPA Medicare Advantage	$251.40

88309 AP Bill Surg Level VI

Facility

$566.00

Service Code	HCPCS 88309
Hospital Charge Code	3554030
Hospital Revenue Code	310
Min. Negotiated Rate	$237.72
Max. Negotiated Rate	$537.70
Rate for Payer: Aetna Commercial	$509.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$366.84
Rate for Payer: Humana Medicare Advantage	$237.72
Rate for Payer: UnitedHealthcare Commercial	$537.70
Rate for Payer: UnitedHealthcare Medicaid	$337.08
Rate for Payer: WPPA Medicare Advantage	$339.60

Know your out-of-pocket cost for care.

All Charges