Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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

93304 Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study

Facility

$1,278.00

Service Code	HCPCS 93304
Hospital Charge Code	3623304
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

93304 Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study

Facility

$1,278.00

Service Code	HCPCS 93304
Hospital Charge Code	3623304
Hospital Revenue Code	480
Min. Negotiated Rate	$178.71
Max. Negotiated Rate	$1,214.10
Rate for Payer: Aetna Commercial	$1,150.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$579.74
Rate for Payer: Humana Medicare Advantage	$536.76
Rate for Payer: UnitedHealthcare Commercial	$1,214.10
Rate for Payer: UnitedHealthcare Medicaid	$180.50
Rate for Payer: WPPA Medicare Advantage	$766.80

93307 Echo, transthoracic, real-time with image, includes M-mode, w/o spectral or color Doppler

Facility

$1,274.00

Service Code	HCPCS 93307
Hospital Charge Code	3623307
Hospital Revenue Code	480
Min. Negotiated Rate	$1,146.60
Max. Negotiated Rate	$1,210.30
Rate for Payer: Aetna Commercial	$1,146.60
Rate for Payer: UnitedHealthcare Commercial	$1,210.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93307 Echo, transthoracic, real-time with image, includes M-mode, w/o spectral or color Doppler

Facility

$1,274.00

Service Code	HCPCS 93307
Hospital Charge Code	3623307
Hospital Revenue Code	480
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$1,210.30
Rate for Payer: Aetna Commercial	$1,146.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$575.70
Rate for Payer: Humana Medicare Advantage	$535.08
Rate for Payer: UnitedHealthcare Commercial	$1,210.30
Rate for Payer: UnitedHealthcare Medicaid	$509.60
Rate for Payer: WPPA Medicare Advantage	$764.40

93320 Doppler Echo

Facility

$824.00

Service Code	HCPCS 93320
Hospital Charge Code	3623320
Hospital Revenue Code	480
Min. Negotiated Rate	$50.46
Max. Negotiated Rate	$782.80
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$480.76
Rate for Payer: Humana Medicare Advantage	$346.08
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: UnitedHealthcare Medicaid	$88.09
Rate for Payer: WPPA Medicare Advantage	$494.40

93320 Doppler Echo

Facility

$824.00

Service Code	HCPCS 93320
Hospital Charge Code	3623320
Hospital Revenue Code	480
Min. Negotiated Rate	$741.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93321 Doppler echo, pulsed wave and/or cont wave with spectral display; follow-up or limited study

Facility

$824.00

Service Code	HCPCS 93321
Hospital Charge Code	3623321
Hospital Revenue Code	480
Min. Negotiated Rate	$741.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93321 Doppler echo, pulsed wave and/or cont wave with spectral display; follow-up or limited study

Facility

$824.00

Service Code	HCPCS 93321
Hospital Charge Code	3623321
Hospital Revenue Code	480
Min. Negotiated Rate	$39.81
Max. Negotiated Rate	$782.80
Rate for Payer: Aetna Commercial	$741.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$480.76
Rate for Payer: Humana Medicare Advantage	$346.08
Rate for Payer: UnitedHealthcare Commercial	$782.80
Rate for Payer: UnitedHealthcare Medicaid	$54.45
Rate for Payer: WPPA Medicare Advantage	$494.40

93668 CR Pad Per Session Charge

Facility

$76.00

Service Code	HCPCS 93668
Hospital Charge Code	3923668
Hospital Revenue Code	943
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: UnitedHealthcare Commercial	$72.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93668 CR Pad Per Session Charge

Facility

$76.00

Service Code	HCPCS 93668
Hospital Charge Code	3923668
Hospital Revenue Code	943
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$72.20
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Humana Medicare Advantage	$31.92
Rate for Payer: UnitedHealthcare Commercial	$72.20
Rate for Payer: UnitedHealthcare Medicaid	$30.40
Rate for Payer: WPPA Medicare Advantage	$45.60

93797 CARDIAC REHAB W/O CONT ECG MONITOR CHARGE

Facility

$159.00

Service Code	HCPCS 93797
Hospital Charge Code	3860105
Hospital Revenue Code	943
Min. Negotiated Rate	$143.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$143.10
Rate for Payer: UnitedHealthcare Commercial	$151.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93797 CARDIAC REHAB W/O CONT ECG MONITOR CHARGE

Facility

$159.00

Service Code	HCPCS 93797
Hospital Charge Code	3860105
Hospital Revenue Code	943
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$151.05
Rate for Payer: Aetna Commercial	$143.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$90.22
Rate for Payer: Humana Medicare Advantage	$66.78
Rate for Payer: UnitedHealthcare Commercial	$151.05
Rate for Payer: UnitedHealthcare Medicaid	$63.60
Rate for Payer: WPPA Medicare Advantage	$95.40

93798 CARDIAC REHAB W/ CONT ECG MONITOR CHARGE

Facility

$286.00

Service Code	HCPCS 93798
Hospital Charge Code	3860110
Hospital Revenue Code	943
Min. Negotiated Rate	$42.81
Max. Negotiated Rate	$271.70
Rate for Payer: Aetna Commercial	$257.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$130.41
Rate for Payer: Humana Medicare Advantage	$120.12
Rate for Payer: UnitedHealthcare Commercial	$271.70
Rate for Payer: UnitedHealthcare Medicaid	$42.81
Rate for Payer: WPPA Medicare Advantage	$171.60

93798 CARDIAC REHAB W/ CONT ECG MONITOR CHARGE

Facility

$286.00

Service Code	HCPCS 93798
Hospital Charge Code	3860110
Hospital Revenue Code	943
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$257.40
Rate for Payer: UnitedHealthcare Commercial	$271.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93978 US Aorta IVC Iliac Duplex Complete

Facility

$764.00

Service Code	HCPCS 93978 TC
Hospital Charge Code	3733978
Hospital Revenue Code	402
Min. Negotiated Rate	$687.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

93978 US Aorta IVC Iliac Duplex Complete

Facility

$764.00

Service Code	HCPCS 93978 TC
Hospital Charge Code	3733978
Hospital Revenue Code	402
Min. Negotiated Rate	$79.38
Max. Negotiated Rate	$725.80
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$480.76
Rate for Payer: Humana Medicare Advantage	$320.88
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: UnitedHealthcare Medicaid	$79.38
Rate for Payer: WPPA Medicare Advantage	$458.40

93979 US Aorta IVC Iliac Duplex Limited

Facility

$764.00

Service Code	HCPCS 93979 TC
Hospital Charge Code	3733979
Hospital Revenue Code	402
Min. Negotiated Rate	$35.62
Max. Negotiated Rate	$725.80
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$480.76
Rate for Payer: Humana Medicare Advantage	$320.88
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: UnitedHealthcare Medicaid	$35.62
Rate for Payer: WPPA Medicare Advantage	$458.40

93979 US Aorta IVC Iliac Duplex Limited

Facility

$764.00

Service Code	HCPCS 93979 TC
Hospital Charge Code	3733979
Hospital Revenue Code	402
Min. Negotiated Rate	$687.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

94010 Spirometry, w/ graphic record, total/timed vital capacity, expiratory flow rate measurement(s)

Facility

$665.00

Service Code	HCPCS 94010
Hospital Charge Code	3354010
Hospital Revenue Code	761
Min. Negotiated Rate	$598.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: UnitedHealthcare Commercial	$631.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

94010 Spirometry, w/ graphic record, total/timed vital capacity, expiratory flow rate measurement(s)

Facility

$665.00

Service Code	HCPCS 94010
Hospital Charge Code	3354010
Hospital Revenue Code	761
Min. Negotiated Rate	$50.60
Max. Negotiated Rate	$631.75
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$300.98
Rate for Payer: Humana Medicare Advantage	$279.30
Rate for Payer: UnitedHealthcare Commercial	$631.75
Rate for Payer: UnitedHealthcare Medicaid	$50.60
Rate for Payer: WPPA Medicare Advantage	$399.00

94060 Bronchodilation responsiveness, spirometry pre and post interp

Facility

$443.00

Service Code	HCPCS 94060
Hospital Charge Code	3354060
Hospital Revenue Code	761
Min. Negotiated Rate	$101.68
Max. Negotiated Rate	$420.85
Rate for Payer: Aetna Commercial	$398.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$373.83
Rate for Payer: Humana Medicare Advantage	$186.06
Rate for Payer: UnitedHealthcare Commercial	$420.85
Rate for Payer: UnitedHealthcare Medicaid	$101.68
Rate for Payer: WPPA Medicare Advantage	$265.80

94060 Bronchodilation responsiveness, spirometry pre and post interp

Facility

$443.00

Service Code	HCPCS 94060
Hospital Charge Code	3354060
Hospital Revenue Code	761
Min. Negotiated Rate	$398.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$398.70
Rate for Payer: UnitedHealthcare Commercial	$420.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

94625 PULMONARY REHAB W/O CONT ECG MONITOR CHARGE

Facility

$693.00

Service Code	HCPCS 94625
Hospital Charge Code	3864625
Hospital Revenue Code	948
Min. Negotiated Rate	$43.22
Max. Negotiated Rate	$658.35
Rate for Payer: Aetna Commercial	$623.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$374.06
Rate for Payer: Humana Medicare Advantage	$291.06
Rate for Payer: UnitedHealthcare Commercial	$658.35
Rate for Payer: UnitedHealthcare Medicaid	$43.22
Rate for Payer: WPPA Medicare Advantage	$415.80

94625 PULMONARY REHAB W/O CONT ECG MONITOR CHARGE

Facility

$693.00

Service Code	HCPCS 94625
Hospital Charge Code	3864625
Hospital Revenue Code	948
Min. Negotiated Rate	$623.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$623.70
Rate for Payer: UnitedHealthcare Commercial	$658.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges