Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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

88312 AP Bill Special stains group 1

Facility

$384.00

Service Code	HCPCS 88312
Hospital Charge Code	3558312
Hospital Revenue Code	310
Min. Negotiated Rate	$77.68
Max. Negotiated Rate	$364.80
Rate for Payer: Aetna Commercial	$345.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$77.68
Rate for Payer: Humana Medicare Advantage	$161.28
Rate for Payer: UnitedHealthcare Commercial	$364.80
Rate for Payer: UnitedHealthcare Medicaid	$87.00
Rate for Payer: WPPA Medicare Advantage	$230.40

88312 AP Bill Special stains group 1

Facility

$384.00

Service Code	HCPCS 88312
Hospital Charge Code	3558312
Hospital Revenue Code	310
Min. Negotiated Rate	$345.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$345.60
Rate for Payer: UnitedHealthcare Commercial	$364.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88313 AP Bill Special stains group 2

Facility

$118.00

Service Code	HCPCS 88313
Hospital Charge Code	3554045
Hospital Revenue Code	310
Min. Negotiated Rate	$106.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$106.20
Rate for Payer: UnitedHealthcare Commercial	$112.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88313 AP Bill Special stains group 2

Facility

$118.00

Service Code	HCPCS 88313
Hospital Charge Code	3554045
Hospital Revenue Code	310
Min. Negotiated Rate	$49.56
Max. Negotiated Rate	$112.10
Rate for Payer: Aetna Commercial	$106.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$60.30
Rate for Payer: Humana Medicare Advantage	$49.56
Rate for Payer: UnitedHealthcare Commercial	$112.10
Rate for Payer: UnitedHealthcare Medicaid	$62.09
Rate for Payer: WPPA Medicare Advantage	$70.80

88341 Immunocyto 2 AB

Facility

$541.00

Service Code	HCPCS 88341
Hospital Charge Code	3558341
Hospital Revenue Code	310
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$513.95
Rate for Payer: Aetna Commercial	$486.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$287.85
Rate for Payer: Humana Medicare Advantage	$227.22
Rate for Payer: UnitedHealthcare Commercial	$513.95
Rate for Payer: UnitedHealthcare Medicaid	$68.50
Rate for Payer: WPPA Medicare Advantage	$324.60

88341 Immunocyto 2 AB

Facility

$541.00

Service Code	HCPCS 88341
Hospital Charge Code	3558341
Hospital Revenue Code	310
Min. Negotiated Rate	$486.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$486.90
Rate for Payer: UnitedHealthcare Commercial	$513.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88342 Immunocyto 1 AB

Facility

$429.00

Service Code	HCPCS 88342
Hospital Charge Code	3558342
Hospital Revenue Code	310
Min. Negotiated Rate	$78.34
Max. Negotiated Rate	$407.55
Rate for Payer: Aetna Commercial	$386.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$287.85
Rate for Payer: Humana Medicare Advantage	$180.18
Rate for Payer: UnitedHealthcare Commercial	$407.55
Rate for Payer: UnitedHealthcare Medicaid	$78.34
Rate for Payer: WPPA Medicare Advantage	$257.40

88342 Immunocyto 1 AB

Facility

$429.00

Service Code	HCPCS 88342
Hospital Charge Code	3558342
Hospital Revenue Code	310
Min. Negotiated Rate	$386.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$386.10
Rate for Payer: UnitedHealthcare Commercial	$407.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88342 Lynch IHC W/ iNTERPR

Facility

$1,020.00

Service Code	HCPCS 88342
Hospital Charge Code	3551482
Hospital Revenue Code	310
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$918.00
Rate for Payer: UnitedHealthcare Commercial	$969.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

88342 Lynch IHC W/ iNTERPR

Facility

$1,020.00

Service Code	HCPCS 88342
Hospital Charge Code	3551482
Hospital Revenue Code	310
Min. Negotiated Rate	$78.34
Max. Negotiated Rate	$969.00
Rate for Payer: Aetna Commercial	$918.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$287.85
Rate for Payer: Humana Medicare Advantage	$428.40
Rate for Payer: UnitedHealthcare Commercial	$969.00
Rate for Payer: UnitedHealthcare Medicaid	$78.34
Rate for Payer: WPPA Medicare Advantage	$612.00

90471 ADM FEE INFLUENZA CHARGE

Facility

$40.00

Service Code	HCPCS 90471
Hospital Charge Code	3300471
Hospital Revenue Code	771
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

90471 ADM FEE INFLUENZA CHARGE

Facility

$40.00

Service Code	HCPCS 90471
Hospital Charge Code	3300471
Hospital Revenue Code	771
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$38.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.08
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: UnitedHealthcare Medicaid	$14.72
Rate for Payer: WPPA Medicare Advantage	$24.00

90471-Vaccine Administration

Facility

$35.00

Service Code	HCPCS 90471
Hospital Charge Code	3300471
Hospital Revenue Code	771
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$33.25
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.08
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: UnitedHealthcare Commercial	$33.25
Rate for Payer: UnitedHealthcare Medicaid	$14.72
Rate for Payer: WPPA Medicare Advantage	$21.00

90471-Vaccine Administration

Facility

$35.00

Service Code	HCPCS 90471
Hospital Charge Code	3300471
Hospital Revenue Code	771
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

90707 PH Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use

Facility

$138.00

Service Code	HCPCS 90707
Hospital Charge Code	3800115
Hospital Revenue Code	636
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$131.54
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$131.54
Rate for Payer: Humana Medicare Advantage	$57.96
Rate for Payer: UnitedHealthcare Commercial	$131.10
Rate for Payer: UnitedHealthcare Medicaid	$70.92
Rate for Payer: WPPA Medicare Advantage	$82.80

90707 PH Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use

Facility

$138.00

Service Code	HCPCS 90707
Hospital Charge Code	3800115
Hospital Revenue Code	636
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: UnitedHealthcare Commercial	$131.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

90833 PSYTX W PT W E/M 30 MIN FAC TechFee

Facility

$86.00

Service Code	HCPCS 90833
Hospital Charge Code	3300833
Hospital Revenue Code	450
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$77.40
Rate for Payer: UnitedHealthcare Commercial	$81.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

90833 PSYTX W PT W E/M 30 MIN FAC TechFee

Facility

$86.00

Service Code	HCPCS 90833
Hospital Charge Code	3300833
Hospital Revenue Code	450
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$87.52
Rate for Payer: Aetna Commercial	$77.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$87.52
Rate for Payer: Humana Medicare Advantage	$36.12
Rate for Payer: UnitedHealthcare Commercial	$81.70
Rate for Payer: UnitedHealthcare Medicaid	$34.40
Rate for Payer: WPPA Medicare Advantage	$51.60

90836 PSYTX W PT W E/M 45 MIN FAC TechFee

Facility

$110.00

Service Code	HCPCS 90836
Hospital Charge Code	3300836
Hospital Revenue Code	450
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: UnitedHealthcare Commercial	$104.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

90836 PSYTX W PT W E/M 45 MIN FAC TechFee

Facility

$110.00

Service Code	HCPCS 90836
Hospital Charge Code	3300836
Hospital Revenue Code	450
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$104.50
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$98.90
Rate for Payer: Humana Medicare Advantage	$46.20
Rate for Payer: UnitedHealthcare Commercial	$104.50
Rate for Payer: UnitedHealthcare Medicaid	$44.00
Rate for Payer: WPPA Medicare Advantage	$66.00

90838 PSYTX W PT W E/M 60 MIN FAC TechFee

Facility

$145.00

Service Code	HCPCS 90838
Hospital Charge Code	3300838
Hospital Revenue Code	450
Min. Negotiated Rate	$130.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$130.50
Rate for Payer: UnitedHealthcare Commercial	$137.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

90838 PSYTX W PT W E/M 60 MIN FAC TechFee

Facility

$145.00

Service Code	HCPCS 90838
Hospital Charge Code	3300838
Hospital Revenue Code	450
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$137.75
Rate for Payer: Aetna Commercial	$130.50
Rate for Payer: Humana Medicare Advantage	$60.90
Rate for Payer: UnitedHealthcare Commercial	$137.75
Rate for Payer: UnitedHealthcare Medicaid	$58.00
Rate for Payer: WPPA Medicare Advantage	$87.00

92502 Otolaryngologic examination under general anesthesia

Facility

$307.00

Service Code	HCPCS 92502
Hospital Charge Code	3152502
Hospital Revenue Code	360
Min. Negotiated Rate	$276.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$276.30
Rate for Payer: UnitedHealthcare Commercial	$291.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

92502 Otolaryngologic examination under general anesthesia

Facility

$307.00

Service Code	HCPCS 92502
Hospital Charge Code	3152502
Hospital Revenue Code	360
Min. Negotiated Rate	$128.94
Max. Negotiated Rate	$291.65
Rate for Payer: Aetna Commercial	$276.30
Rate for Payer: Humana Medicare Advantage	$128.94
Rate for Payer: UnitedHealthcare Commercial	$291.65
Rate for Payer: UnitedHealthcare Medicaid	$178.24
Rate for Payer: WPPA Medicare Advantage	$184.20

Know your out-of-pocket cost for care.

All Charges