Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

92612 Flexible endoscopic evaluation of swallowing by cine or video recording.

Facility

$384.00

Service Code	HCPCS 92612
Hospital Charge Code	4052612
Hospital Revenue Code	444
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

92950-Cardiopulmonary Resuscitation

Facility

$125.00

Service Code	HCPCS 92950
Hospital Charge Code	3304650
Hospital Revenue Code	450
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: UnitedHealthcare Commercial	$118.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

92950-Cardiopulmonary Resuscitation

Facility

$125.00

Service Code	HCPCS 92950
Hospital Charge Code	3304650
Hospital Revenue Code	450
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$309.49
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$309.49
Rate for Payer: Humana Medicare Advantage	$52.50
Rate for Payer: UnitedHealthcare Commercial	$118.75
Rate for Payer: UnitedHealthcare Medicaid	$114.74
Rate for Payer: WPPA Medicare Advantage	$75.00

92950 CARDIOPULMONARY RESUSCITATION TechFee

Facility

$678.00

Service Code	HCPCS 92950
Hospital Charge Code	3304650
Hospital Revenue Code	450
Min. Negotiated Rate	$610.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

92950 CARDIOPULMONARY RESUSCITATION TechFee

Facility

$678.00

Service Code	HCPCS 92950
Hospital Charge Code	3304650
Hospital Revenue Code	450
Min. Negotiated Rate	$114.74
Max. Negotiated Rate	$644.10
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$309.49
Rate for Payer: Humana Medicare Advantage	$284.76
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: UnitedHealthcare Medicaid	$114.74
Rate for Payer: WPPA Medicare Advantage	$406.80

92950 CPR CHARGE

Facility

$678.00

Service Code	HCPCS 92950
Hospital Charge Code	3900599
Hospital Revenue Code	410
Min. Negotiated Rate	$114.74
Max. Negotiated Rate	$644.10
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$309.49
Rate for Payer: Humana Medicare Advantage	$284.76
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: UnitedHealthcare Medicaid	$114.74
Rate for Payer: WPPA Medicare Advantage	$406.80

92950 CPR CHARGE

Facility

$678.00

Service Code	HCPCS 92950
Hospital Charge Code	3900599
Hospital Revenue Code	410
Min. Negotiated Rate	$610.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

92950 CPR - ER SERV PROCEDURE

Facility

$678.00

Service Code	HCPCS 92950
Hospital Charge Code	3152950
Hospital Revenue Code	360
Min. Negotiated Rate	$114.74
Max. Negotiated Rate	$644.10
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$309.49
Rate for Payer: Humana Medicare Advantage	$284.76
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: UnitedHealthcare Medicaid	$114.74
Rate for Payer: WPPA Medicare Advantage	$406.80

92950 CPR - ER SERV PROCEDURE

Facility

$678.00

Service Code	HCPCS 92950
Hospital Charge Code	3152950
Hospital Revenue Code	360
Min. Negotiated Rate	$610.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

92960 CARDIOVERSION - ER SERV PROCEDURE

Facility

$1,088.00

Service Code	HCPCS 92960
Hospital Charge Code	3152960
Hospital Revenue Code	360
Min. Negotiated Rate	$979.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$979.20
Rate for Payer: UnitedHealthcare Commercial	$1,033.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

92960 CARDIOVERSION - ER SERV PROCEDURE

Facility

$1,088.00

Service Code	HCPCS 92960
Hospital Charge Code	3152960
Hospital Revenue Code	360
Min. Negotiated Rate	$210.83
Max. Negotiated Rate	$1,033.60
Rate for Payer: Aetna Commercial	$979.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$481.93
Rate for Payer: Humana Medicare Advantage	$456.96
Rate for Payer: UnitedHealthcare Commercial	$1,033.60
Rate for Payer: UnitedHealthcare Medicaid	$210.83
Rate for Payer: WPPA Medicare Advantage	$652.80

92960 CARDIOVERSION - OP CHARGE

Facility

$1,088.00

Service Code	HCPCS 92960
Hospital Charge Code	3300240
Hospital Revenue Code	450
Min. Negotiated Rate	$979.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$979.20
Rate for Payer: UnitedHealthcare Commercial	$1,033.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

92960 CARDIOVERSION - OP CHARGE

Facility

$1,088.00

Service Code	HCPCS 92960
Hospital Charge Code	3300240
Hospital Revenue Code	450
Min. Negotiated Rate	$210.83
Max. Negotiated Rate	$1,033.60
Rate for Payer: Aetna Commercial	$979.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$481.93
Rate for Payer: Humana Medicare Advantage	$456.96
Rate for Payer: UnitedHealthcare Commercial	$1,033.60
Rate for Payer: UnitedHealthcare Medicaid	$210.83
Rate for Payer: WPPA Medicare Advantage	$652.80

93016 CARDIAC DR FEE/NUC CHARGE

Facility

$134.00

Service Code	HCPCS 93016
Hospital Charge Code	3360140
Hospital Revenue Code	943
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93016 CARDIAC DR FEE/NUC CHARGE

Facility

$134.00

Service Code	HCPCS 93016
Hospital Charge Code	3360140
Hospital Revenue Code	943
Min. Negotiated Rate	$30.54
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$30.54
Rate for Payer: WPPA Medicare Advantage	$80.40

93017 STRESS EKG WO/INT/GXT CHARGE

Facility

$721.00

Service Code	HCPCS 93017
Hospital Charge Code	3860155
Hospital Revenue Code	482
Min. Negotiated Rate	$648.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$648.90
Rate for Payer: UnitedHealthcare Commercial	$684.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93017 STRESS EKG WO/INT/GXT CHARGE

Facility

$721.00

Service Code	HCPCS 93017
Hospital Charge Code	3860155
Hospital Revenue Code	482
Min. Negotiated Rate	$101.68
Max. Negotiated Rate	$684.95
Rate for Payer: Aetna Commercial	$648.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$356.37
Rate for Payer: Humana Medicare Advantage	$302.82
Rate for Payer: UnitedHealthcare Commercial	$684.95
Rate for Payer: UnitedHealthcare Medicaid	$101.68
Rate for Payer: WPPA Medicare Advantage	$432.60

93017 STRESS TEST/TREADMILL

Facility

$721.00

Service Code	HCPCS 93017
Hospital Charge Code	3860155
Hospital Revenue Code	482
Min. Negotiated Rate	$648.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$648.90
Rate for Payer: UnitedHealthcare Commercial	$684.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93017 STRESS TEST/TREADMILL

Facility

$721.00

Service Code	HCPCS 93017
Hospital Charge Code	3860155
Hospital Revenue Code	482
Min. Negotiated Rate	$101.68
Max. Negotiated Rate	$684.95
Rate for Payer: Aetna Commercial	$648.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$356.37
Rate for Payer: Humana Medicare Advantage	$302.82
Rate for Payer: UnitedHealthcare Commercial	$684.95
Rate for Payer: UnitedHealthcare Medicaid	$101.68
Rate for Payer: WPPA Medicare Advantage	$432.60

93018 STRESS EKG INTERP/REPORT ONLY CHARGE

Facility

$133.00

Service Code	HCPCS 93018
Hospital Charge Code	3860180
Hospital Revenue Code	960
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$119.70
Rate for Payer: UnitedHealthcare Commercial	$126.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93018 STRESS EKG INTERP/REPORT ONLY CHARGE

Facility

$133.00

Service Code	HCPCS 93018
Hospital Charge Code	3860180
Hospital Revenue Code	960
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$126.35
Rate for Payer: Aetna Commercial	$119.70
Rate for Payer: Humana Medicare Advantage	$55.86
Rate for Payer: UnitedHealthcare Commercial	$126.35
Rate for Payer: UnitedHealthcare Medicaid	$34.65
Rate for Payer: WPPA Medicare Advantage	$79.80

93225 HOLTER MONITOR UP TO 48HRS CHARGE

Facility

$417.00

Service Code	HCPCS 93225
Hospital Charge Code	3600105
Hospital Revenue Code	731
Min. Negotiated Rate	$43.85
Max. Negotiated Rate	$396.15
Rate for Payer: Aetna Commercial	$375.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$188.27
Rate for Payer: Humana Medicare Advantage	$175.14
Rate for Payer: UnitedHealthcare Commercial	$396.15
Rate for Payer: UnitedHealthcare Medicaid	$43.85
Rate for Payer: WPPA Medicare Advantage	$250.20

93225 HOLTER MONITOR UP TO 48HRS CHARGE

Facility

$417.00

Service Code	HCPCS 93225
Hospital Charge Code	3600105
Hospital Revenue Code	731
Min. Negotiated Rate	$375.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$375.30
Rate for Payer: UnitedHealthcare Commercial	$396.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93226 MONITOR SCANNING ANALYSIS REPORT CHARGE

Facility

$412.00

Service Code	HCPCS 93226
Hospital Charge Code	3600110
Hospital Revenue Code	731
Min. Negotiated Rate	$370.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$370.80
Rate for Payer: UnitedHealthcare Commercial	$391.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93226 MONITOR SCANNING ANALYSIS REPORT CHARGE

Facility

$412.00

Service Code	HCPCS 93226
Hospital Charge Code	3600110
Hospital Revenue Code	731
Min. Negotiated Rate	$58.28
Max. Negotiated Rate	$391.40
Rate for Payer: Aetna Commercial	$370.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$185.72
Rate for Payer: Humana Medicare Advantage	$173.04
Rate for Payer: UnitedHealthcare Commercial	$391.40
Rate for Payer: UnitedHealthcare Medicaid	$58.28
Rate for Payer: WPPA Medicare Advantage	$247.20

Know your out-of-pocket cost for care.

All Charges