Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Aldolase QST

Facility

$64.00

Service Code	HCPCS 82085
Hospital Charge Code	3552085
Hospital Revenue Code	300
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: UnitedHealthcare Commercial	$60.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Aldosterone, LC/MS/MS QST

Facility

$202.00

Service Code	HCPCS 82088
Hospital Charge Code	3558208
Hospital Revenue Code	300
Min. Negotiated Rate	$34.64
Max. Negotiated Rate	$191.90
Rate for Payer: Aetna Commercial	$181.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$123.20
Rate for Payer: Humana Medicare Advantage	$84.84
Rate for Payer: UnitedHealthcare Commercial	$191.90
Rate for Payer: UnitedHealthcare Medicaid	$34.64
Rate for Payer: WPPA Medicare Advantage	$121.20

Aldosterone, LC/MS/MS QST

Facility

$202.00

Service Code	HCPCS 82088
Hospital Charge Code	3558208
Hospital Revenue Code	300
Min. Negotiated Rate	$181.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$181.80
Rate for Payer: UnitedHealthcare Commercial	$191.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Aldosterone/Plasma Renin Activity Ratio,LC/MS/MS QST

Facility

$202.00

Service Code	HCPCS 82088
Hospital Charge Code	3558208
Hospital Revenue Code	300
Min. Negotiated Rate	$181.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$181.80
Rate for Payer: UnitedHealthcare Commercial	$191.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Aldosterone/Plasma Renin Activity Ratio,LC/MS/MS QST

Facility

$202.00

Service Code	HCPCS 82088
Hospital Charge Code	3558208
Hospital Revenue Code	300
Min. Negotiated Rate	$34.64
Max. Negotiated Rate	$191.90
Rate for Payer: Aetna Commercial	$181.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$123.20
Rate for Payer: Humana Medicare Advantage	$84.84
Rate for Payer: UnitedHealthcare Commercial	$191.90
Rate for Payer: UnitedHealthcare Medicaid	$34.64
Rate for Payer: WPPA Medicare Advantage	$121.20

alendronate 70 mg Tab [HMC]

Facility

$25.49

Service Code	NDC 69097022476
Hospital Charge Code	3800560
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$24.22
Rate for Payer: Aetna Commercial	$22.94
Rate for Payer: Humana Medicare Advantage	$10.71
Rate for Payer: UnitedHealthcare Commercial	$24.22
Rate for Payer: UnitedHealthcare Medicaid	$10.20
Rate for Payer: WPPA Medicare Advantage	$15.29

alendronate 70 mg Tab [HMC]

Facility

$25.49

Service Code	NDC 69097022476
Hospital Charge Code	3800560
Hospital Revenue Code	250
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.94
Rate for Payer: UnitedHealthcare Commercial	$24.22
Rate for Payer: WPPA Medicare Advantage	$1,200.00

alendronate 70 mg Tab [HMC]

Facility

$25.49

Service Code	NDC 69543013120
Hospital Charge Code	3800560
Hospital Revenue Code	250
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.94
Rate for Payer: UnitedHealthcare Commercial	$24.22
Rate for Payer: WPPA Medicare Advantage	$1,200.00

alendronate 70 mg Tab [HMC]

Facility

$25.49

Service Code	NDC 69543013120
Hospital Charge Code	3800560
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$24.22
Rate for Payer: Aetna Commercial	$22.94
Rate for Payer: Humana Medicare Advantage	$10.71
Rate for Payer: UnitedHealthcare Commercial	$24.22
Rate for Payer: UnitedHealthcare Medicaid	$10.20
Rate for Payer: WPPA Medicare Advantage	$15.29

ALEXIS O MEDIUM WOUND PROTECTOR/RETRACTOR, 5-9CM

Facility

$206.50

Hospital Charge Code	3250761
Hospital Revenue Code	270
Min. Negotiated Rate	$185.85
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$185.85
Rate for Payer: UnitedHealthcare Commercial	$196.18
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ALEXIS O MEDIUM WOUND PROTECTOR/RETRACTOR, 5-9CM

Facility

$206.50

Hospital Charge Code	3250761
Hospital Revenue Code	270
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$196.18
Rate for Payer: Aetna Commercial	$185.85
Rate for Payer: Humana Medicare Advantage	$86.73
Rate for Payer: UnitedHealthcare Commercial	$196.18
Rate for Payer: UnitedHealthcare Medicaid	$82.60
Rate for Payer: WPPA Medicare Advantage	$123.90

Alfalfa IgE UNMC

Facility

$67.00

Service Code	HCPCS 86003
Hospital Charge Code	3558263
Hospital Revenue Code	300
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Alfalfa IgE UNMC

Facility

$67.00

Service Code	HCPCS 86003
Hospital Charge Code	3558263
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$63.65
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$28.14
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$40.20

alfentanil 0.5 mg/mL 2mL Inj Sol [HMC]

Facility

$32.89

Service Code	NDC 17478006702
Hospital Charge Code	3170222
Hospital Revenue Code	259
Min. Negotiated Rate	$13.16
Max. Negotiated Rate	$31.25
Rate for Payer: Aetna Commercial	$29.60
Rate for Payer: Humana Medicare Advantage	$13.81
Rate for Payer: UnitedHealthcare Commercial	$31.25
Rate for Payer: UnitedHealthcare Medicaid	$13.16
Rate for Payer: WPPA Medicare Advantage	$19.73

alfentanil 0.5 mg/mL 2mL Inj Sol [HMC]

Facility

$32.89

Service Code	NDC 17478006702
Hospital Charge Code	3170222
Hospital Revenue Code	259
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.60
Rate for Payer: UnitedHealthcare Commercial	$31.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Al hydroxide/Mg hydroxide/simethicone 400 mg-400 mg-40 mg/5 mL Oral Susp 30 mL [HMC]

Facility

$29.08

Service Code	NDC 00121176230
Hospital Charge Code	3802730
Hospital Revenue Code	250
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$27.63
Rate for Payer: Aetna Commercial	$26.17
Rate for Payer: Humana Medicare Advantage	$12.21
Rate for Payer: UnitedHealthcare Commercial	$27.63
Rate for Payer: UnitedHealthcare Medicaid	$11.63
Rate for Payer: WPPA Medicare Advantage	$17.45

Al hydroxide/Mg hydroxide/simethicone 400 mg-400 mg-40 mg/5 mL Oral Susp 30 mL [HMC]

Facility

$29.08

Service Code	NDC 00121176230
Hospital Charge Code	3802730
Hospital Revenue Code	250
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.17
Rate for Payer: UnitedHealthcare Commercial	$27.63
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Al hydroxide/Mg hydroxide/simethicone 400 mg-400 mg-40 mg/5 mL Oral Susp 360 mL [HMC]

Facility

$27.60

Service Code	NDC 00904000514
Hospital Charge Code	3802730
Hospital Revenue Code	250
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$26.22
Rate for Payer: Aetna Commercial	$24.84
Rate for Payer: Humana Medicare Advantage	$11.59
Rate for Payer: UnitedHealthcare Commercial	$26.22
Rate for Payer: UnitedHealthcare Medicaid	$11.04
Rate for Payer: WPPA Medicare Advantage	$16.56

Al hydroxide/Mg hydroxide/simethicone 400 mg-400 mg-40 mg/5 mL Oral Susp 360 mL [HMC]

Facility

$27.60

Service Code	NDC 00904000514
Hospital Charge Code	3802730
Hospital Revenue Code	250
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.84
Rate for Payer: UnitedHealthcare Commercial	$26.22
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Alkaline Phosphatase

Facility

$72.00

Service Code	HCPCS 84075
Hospital Charge Code	3551005
Hospital Revenue Code	300
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$64.80
Rate for Payer: UnitedHealthcare Commercial	$68.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Alkaline Phosphatase

Facility

$72.00

Service Code	HCPCS 84075
Hospital Charge Code	3551005
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna Commercial	$64.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$11.11
Rate for Payer: Humana Medicare Advantage	$30.24
Rate for Payer: UnitedHealthcare Commercial	$68.40
Rate for Payer: UnitedHealthcare Medicaid	$5.18
Rate for Payer: WPPA Medicare Advantage	$43.20

Allergen IgE Aspergillus terreus QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	3556103
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$11.34
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$16.20

Allergen IgE Aspergillus terreus QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	3556103
Hospital Revenue Code	300
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ALLERGIC REACTIONS WITH MCC

Facility

$5,083.20

Service Code	MSDRG 915
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,083.20
Rate for Payer: UnitedHealthcare Medicaid	$5,083.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ALLERGIC REACTIONS WITHOUT MCC

Facility

$2,033.28

Service Code	MSDRG 916
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,033.28
Rate for Payer: UnitedHealthcare Medicaid	$2,033.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges