Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

93242 HOLTER RECORDING CONNECT >48HR <7 DAYS CHARGE

Facility

$459.00

Service Code	HCPCS 93242
Hospital Charge Code	3603242
Hospital Revenue Code	731
Min. Negotiated Rate	$413.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: UnitedHealthcare Commercial	$436.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93242 HOLTER RECORDING CONNECT >48HR <7 DAYS CHARGE

Facility

$459.00

Service Code	HCPCS 93242
Hospital Charge Code	3603242
Hospital Revenue Code	731
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$436.05
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$188.27
Rate for Payer: Humana Medicare Advantage	$192.78
Rate for Payer: UnitedHealthcare Commercial	$436.05
Rate for Payer: UnitedHealthcare Medicaid	$22.00
Rate for Payer: WPPA Medicare Advantage	$275.40

93243 HOLTER RECORDING ANALYSIS >48HRS <7 DAYS CHARGE

Facility

$455.00

Service Code	HCPCS 93243
Hospital Charge Code	3863243
Hospital Revenue Code	731
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$432.25
Rate for Payer: Aetna Commercial	$409.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$185.72
Rate for Payer: Humana Medicare Advantage	$191.10
Rate for Payer: UnitedHealthcare Commercial	$432.25
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$273.00

93243 HOLTER RECORDING ANALYSIS >48HRS <7 DAYS CHARGE

Facility

$455.00

Service Code	HCPCS 93243
Hospital Charge Code	3863243
Hospital Revenue Code	731
Min. Negotiated Rate	$409.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$409.50
Rate for Payer: UnitedHealthcare Commercial	$432.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93246 CARDIAC MONITOR >7 DAYS AND <15 DAYS CHARGE

Facility

$417.00

Service Code	HCPCS 93246
Hospital Charge Code	3603246
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

93246 CARDIAC MONITOR >7 DAYS AND <15 DAYS CHARGE

Facility

$417.00

Service Code	HCPCS 93246
Hospital Charge Code	3603246
Hospital Revenue Code	731
Min. Negotiated Rate	$36.18
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	$36.18
Rate for Payer: WPPA Medicare Advantage	$250.20

93246 HOLTER CARDIAC MONITOR >7 DAYS AND <15 DAYS CHARGE.

Facility

$417.00

Service Code	HCPCS 93246
Hospital Charge Code	3603246
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

93246 HOLTER CARDIAC MONITOR >7 DAYS AND <15 DAYS CHARGE.

Facility

$417.00

Service Code	HCPCS 93246
Hospital Charge Code	3603246
Hospital Revenue Code	731
Min. Negotiated Rate	$36.18
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	$36.18
Rate for Payer: WPPA Medicare Advantage	$250.20

93247 Holter Novi Patch- Analysis 7days-14days.

Facility

$412.00

Service Code	HCPCS 93247
Hospital Charge Code	3603247
Hospital Revenue Code	731
Min. Negotiated Rate	$72.77
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	$72.77
Rate for Payer: WPPA Medicare Advantage	$247.20

93247 Holter Novi Patch- Analysis 7days-14days.

Facility

$412.00

Service Code	HCPCS 93247
Hospital Charge Code	3603247
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

93247 Novi Patch- Analysis 7days-14days

Facility

$412.00

Service Code	HCPCS 93247
Hospital Charge Code	3603247
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

93247 Novi Patch- Analysis 7days-14days

Facility

$412.00

Service Code	HCPCS 93247
Hospital Charge Code	3603247
Hospital Revenue Code	731
Min. Negotiated Rate	$72.77
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	$72.77
Rate for Payer: WPPA Medicare Advantage	$247.20

93270 EVENT MONITORING HOOK UP CHARGE

Facility

$320.00

Service Code	HCPCS 93270
Hospital Charge Code	3600072
Hospital Revenue Code	731
Min. Negotiated Rate	$32.63
Max. Negotiated Rate	$304.00
Rate for Payer: Aetna Commercial	$288.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$119.92
Rate for Payer: Humana Medicare Advantage	$134.40
Rate for Payer: UnitedHealthcare Commercial	$304.00
Rate for Payer: UnitedHealthcare Medicaid	$32.63
Rate for Payer: WPPA Medicare Advantage	$192.00

93270 EVENT MONITORING HOOK UP CHARGE

Facility

$320.00

Service Code	HCPCS 93270
Hospital Charge Code	3600072
Hospital Revenue Code	731
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$288.00
Rate for Payer: UnitedHealthcare Commercial	$304.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93271 CARDIAC EV MON ANALYS FULL </= 30 DYS CHARGE

Facility

$475.00

Service Code	HCPCS 93271
Hospital Charge Code	3603271
Hospital Revenue Code	731
Min. Negotiated Rate	$139.89
Max. Negotiated Rate	$451.25
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$202.99
Rate for Payer: Humana Medicare Advantage	$199.50
Rate for Payer: UnitedHealthcare Commercial	$451.25
Rate for Payer: UnitedHealthcare Medicaid	$139.89
Rate for Payer: WPPA Medicare Advantage	$285.00

93271 CARDIAC EV MON ANALYS FULL </= 30 DYS CHARGE

Facility

$475.00

Service Code	HCPCS 93271
Hospital Charge Code	3603271
Hospital Revenue Code	731
Min. Negotiated Rate	$427.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: UnitedHealthcare Commercial	$451.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93272 EVENT MONITORING INTERPRETATION CHARGE

Facility

$60.00

Service Code	HCPCS 93272
Hospital Charge Code	3603272
Hospital Revenue Code	731
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: UnitedHealthcare Commercial	$57.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93272 EVENT MONITORING INTERPRETATION CHARGE

Facility

$60.00

Service Code	HCPCS 93272
Hospital Charge Code	3603272
Hospital Revenue Code	731
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: Humana Medicare Advantage	$25.20
Rate for Payer: UnitedHealthcare Commercial	$57.00
Rate for Payer: UnitedHealthcare Medicaid	$24.00
Rate for Payer: WPPA Medicare Advantage	$36.00

93288 PACEMAKER CHECK- PCMH DOCTOR READ CHARGE

Facility

$85.00

Service Code	HCPCS 93288
Hospital Charge Code	3603288
Hospital Revenue Code	731
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93288 PACEMAKER CHECK- PCMH DOCTOR READ CHARGE

Facility

$85.00

Service Code	HCPCS 93288
Hospital Charge Code	3603288
Hospital Revenue Code	731
Min. Negotiated Rate	$33.10
Max. Negotiated Rate	$80.75
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Humana Medicare Advantage	$35.70
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: UnitedHealthcare Medicaid	$33.10
Rate for Payer: WPPA Medicare Advantage	$51.00

93297 REMOTE ICM INTERROGATION CHARGE

Facility

$85.00

Service Code	HCPCS 93297
Hospital Charge Code	3603297
Hospital Revenue Code	731
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93297 REMOTE ICM INTERROGATION CHARGE

Facility

$85.00

Service Code	HCPCS 93297
Hospital Charge Code	3603297
Hospital Revenue Code	731
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$80.75
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Humana Medicare Advantage	$35.70
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: WPPA Medicare Advantage	$51.00

93298 Interrogation device eval, (remote) up to 30 days; implant loop recorder, heart rhythm data

Facility

$183.00

Service Code	HCPCS 93298
Hospital Charge Code	3603298
Hospital Revenue Code	731
Min. Negotiated Rate	$164.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$164.70
Rate for Payer: UnitedHealthcare Commercial	$173.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93298 Interrogation device eval, (remote) up to 30 days; implant loop recorder, heart rhythm data

Facility

$183.00

Service Code	HCPCS 93298
Hospital Charge Code	3603298
Hospital Revenue Code	731
Min. Negotiated Rate	$76.86
Max. Negotiated Rate	$173.85
Rate for Payer: Aetna Commercial	$164.70
Rate for Payer: Humana Medicare Advantage	$76.86
Rate for Payer: UnitedHealthcare Commercial	$173.85
Rate for Payer: WPPA Medicare Advantage	$109.80

93303 Transthoracic echocardiography for congenital cardiac anomalies

Facility

$1,278.00

Service Code	HCPCS 93303
Hospital Charge Code	3623303
Hospital Revenue Code	480
Min. Negotiated Rate	$1,150.20
Max. Negotiated Rate	$1,214.10
Rate for Payer: Aetna Commercial	$1,150.20
Rate for Payer: UnitedHealthcare Commercial	$1,214.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges