Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

99205 Office Visit New Pt Level 5

Facility

$495.00

Service Code	HCPCS 99205
Hospital Charge Code	3270080
Hospital Revenue Code	761
Min. Negotiated Rate	$168.67
Max. Negotiated Rate	$470.25
Rate for Payer: Aetna Commercial	$445.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$168.67
Rate for Payer: Humana Medicare Advantage	$207.90
Rate for Payer: UnitedHealthcare Commercial	$470.25
Rate for Payer: UnitedHealthcare Medicaid	$198.00
Rate for Payer: WPPA Medicare Advantage	$297.00

99211 EST 5-10 MIN NURSING CHARGE

Facility

$75.00

Service Code	HCPCS 99211
Hospital Charge Code	3350705
Hospital Revenue Code	761
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$42.50
Rate for Payer: Humana Medicare Advantage	$31.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: UnitedHealthcare Medicaid	$24.12
Rate for Payer: WPPA Medicare Advantage	$45.00

99211 EST 5-10 MIN NURSING CHARGE

Facility

$75.00

Service Code	HCPCS 99211
Hospital Charge Code	3359211
Hospital Revenue Code	761
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$42.50
Rate for Payer: Humana Medicare Advantage	$31.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: UnitedHealthcare Medicaid	$24.12
Rate for Payer: WPPA Medicare Advantage	$45.00

99211 EST 5-10 MIN NURSING CHARGE

Facility

$75.00

Service Code	HCPCS 99211
Hospital Charge Code	3350705
Hospital Revenue Code	761
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99211 EST 5-10 MIN NURSING CHARGE

Facility

$75.00

Service Code	HCPCS 99211
Hospital Charge Code	3359211
Hospital Revenue Code	761
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99211 INITIAL CLINIC VISIT/LACTATION CONSULT CHARGE

Facility

$75.00

Service Code	HCPCS 99211
Hospital Charge Code	3359211
Hospital Revenue Code	761
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99211 INITIAL CLINIC VISIT/LACTATION CONSULT CHARGE

Facility

$75.00

Service Code	HCPCS 99211
Hospital Charge Code	3359211
Hospital Revenue Code	761
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$42.50
Rate for Payer: Humana Medicare Advantage	$31.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: UnitedHealthcare Medicaid	$24.12
Rate for Payer: WPPA Medicare Advantage	$45.00

99211 Nurse Office Visit Established Pt Level 1

Facility

$75.00

Service Code	HCPCS 99211
Hospital Charge Code	3350705
Hospital Revenue Code	761
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$42.50
Rate for Payer: Humana Medicare Advantage	$31.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: UnitedHealthcare Medicaid	$24.12
Rate for Payer: WPPA Medicare Advantage	$45.00

99211 Nurse Office Visit Established Pt Level 1

Facility

$75.00

Service Code	HCPCS 99211
Hospital Charge Code	3350705
Hospital Revenue Code	761
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99212 CRNA-ESTABLISHED OF99212 CRNA-ESTABLISHED OFFICE/OUTPNT, LEV 2, STRAIGHTFORWARD MDM, 10-19 MIN

Facility

$119.00

Service Code	HCPCS 99212
Hospital Charge Code	3189212
Hospital Revenue Code	761
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$113.05
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$49.98
Rate for Payer: UnitedHealthcare Commercial	$113.05
Rate for Payer: UnitedHealthcare Medicaid	$47.60
Rate for Payer: WPPA Medicare Advantage	$71.40

99212 CRNA-ESTABLISHED OF99212 CRNA-ESTABLISHED OFFICE/OUTPNT, LEV 2, STRAIGHTFORWARD MDM, 10-19 MIN

Facility

$119.00

Service Code	HCPCS 99212
Hospital Charge Code	3189212
Hospital Revenue Code	761
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: UnitedHealthcare Commercial	$113.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99212 EST 15-20 MIN NURSING CHARGE

Facility

$119.00

Service Code	HCPCS 99212
Hospital Charge Code	3291500
Hospital Revenue Code	761
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$113.05
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$49.98
Rate for Payer: UnitedHealthcare Commercial	$113.05
Rate for Payer: UnitedHealthcare Medicaid	$47.60
Rate for Payer: WPPA Medicare Advantage	$71.40

99212 EST 15-20 MIN NURSING CHARGE

Facility

$119.00

Service Code	HCPCS 99212
Hospital Charge Code	3291500
Hospital Revenue Code	761
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: UnitedHealthcare Commercial	$113.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99212 Office Visit Established Pt Level 2

Facility

$119.00

Service Code	HCPCS 99212
Hospital Charge Code	3291500
Hospital Revenue Code	761
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$113.05
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$49.98
Rate for Payer: UnitedHealthcare Commercial	$113.05
Rate for Payer: UnitedHealthcare Medicaid	$47.60
Rate for Payer: WPPA Medicare Advantage	$71.40

99212 Office Visit Established Pt Level 2

Facility

$119.00

Service Code	HCPCS 99212
Hospital Charge Code	3291500
Hospital Revenue Code	761
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: UnitedHealthcare Commercial	$113.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99212 Office Visit Established Pt. Level 2 (SP Pro)

Facility

$89.00

Service Code	HCPCS 99212
Hospital Charge Code	SCC99212SP
Hospital Revenue Code	521
Min. Negotiated Rate	$35.60
Max. Negotiated Rate	$85.38
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$37.38
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: UnitedHealthcare Medicaid	$35.60
Rate for Payer: WPPA Medicare Advantage	$53.40

99212 Office Visit Established Pt. Level 2 (SP Pro)

Facility

$89.00

Service Code	HCPCS 99212
Hospital Charge Code	SCC99212SP
Hospital Revenue Code	521
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99213 CRNA-ESTABLISHED OFFICE/OUTPNT, LEV 3, LOW MDM, 20+ MIN

Facility

$185.00

Service Code	HCPCS 99213
Hospital Charge Code	3189213
Hospital Revenue Code	761
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$166.50
Rate for Payer: UnitedHealthcare Commercial	$175.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99213 CRNA-ESTABLISHED OFFICE/OUTPNT, LEV 3, LOW MDM, 20+ MIN

Facility

$185.00

Service Code	HCPCS 99213
Hospital Charge Code	3189213
Hospital Revenue Code	761
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$175.75
Rate for Payer: Aetna Commercial	$166.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$133.49
Rate for Payer: Humana Medicare Advantage	$77.70
Rate for Payer: UnitedHealthcare Commercial	$175.75
Rate for Payer: UnitedHealthcare Medicaid	$74.00
Rate for Payer: WPPA Medicare Advantage	$111.00

99213 EST 25-35 MIN NURSING CHARGE

Facility

$204.00

Service Code	HCPCS 99213
Hospital Charge Code	3290110
Hospital Revenue Code	761
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: UnitedHealthcare Commercial	$193.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99213 EST 25-35 MIN NURSING CHARGE

Facility

$204.00

Service Code	HCPCS 99213
Hospital Charge Code	3290110
Hospital Revenue Code	761
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$193.80
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$133.49
Rate for Payer: Humana Medicare Advantage	$85.68
Rate for Payer: UnitedHealthcare Commercial	$193.80
Rate for Payer: UnitedHealthcare Medicaid	$81.60
Rate for Payer: WPPA Medicare Advantage	$122.40

99213 Office Visit Established Pt Level 3

Facility

$185.00

Service Code	HCPCS 99213
Hospital Charge Code	3290110
Hospital Revenue Code	761
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$175.75
Rate for Payer: Aetna Commercial	$166.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$133.49
Rate for Payer: Humana Medicare Advantage	$77.70
Rate for Payer: UnitedHealthcare Commercial	$175.75
Rate for Payer: UnitedHealthcare Medicaid	$74.00
Rate for Payer: WPPA Medicare Advantage	$111.00

99213 Office Visit Established Pt Level 3

Facility

$185.00

Service Code	HCPCS 99213
Hospital Charge Code	3290110
Hospital Revenue Code	761
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$166.50
Rate for Payer: UnitedHealthcare Commercial	$175.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

99213 Office Visit Established Pt. Level 3

Facility

$138.00

Service Code	HCPCS 99213
Hospital Charge Code	SCC99213SP
Hospital Revenue Code	521
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

99213 Office Visit Established Pt. Level 3

Facility

$138.00

Service Code	HCPCS 99213
Hospital Charge Code	SCC99213SP
Hospital Revenue Code	521
Min. Negotiated Rate	$55.20
Max. Negotiated Rate	$133.49
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$133.49
Rate for Payer: Humana Medicare Advantage	$57.96
Rate for Payer: UnitedHealthcare Commercial	$131.10
Rate for Payer: UnitedHealthcare Medicaid	$55.20
Rate for Payer: WPPA Medicare Advantage	$82.80

Know your out-of-pocket cost for care.

All Charges