Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

ARIPiprazole 5 mg Tab [HMC]

Facility

$28.35

Service Code	NDC 59148000713
Hospital Charge Code	3800233
Hospital Revenue Code	250
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$26.93
Rate for Payer: Aetna Commercial	$25.52
Rate for Payer: Humana Medicare Advantage	$11.91
Rate for Payer: UnitedHealthcare Commercial	$26.93
Rate for Payer: UnitedHealthcare Medicaid	$11.34
Rate for Payer: WPPA Medicare Advantage	$17.01

Arthroscopy Knee

Facility

$8,216.00

Service Code	HCPCS 29870
Hospital Charge Code	3150620
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$7,805.20
Rate for Payer: Aetna Commercial	$7,394.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,289.57
Rate for Payer: Humana Medicare Advantage	$3,450.72
Rate for Payer: UnitedHealthcare Commercial	$7,805.20
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$4,929.60

Arthroscopy Knee

Facility

$8,216.00

Service Code	HCPCS 29870
Hospital Charge Code	3150620
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,805.20
Rate for Payer: Aetna Commercial	$7,394.40
Rate for Payer: UnitedHealthcare Commercial	$7,805.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Artisan Port Closure Suture Grasper Device

Facility

$147.00

Hospital Charge Code	3257435
Hospital Revenue Code	270
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Artisan Port Closure Suture Grasper Device

Facility

$147.00

Hospital Charge Code	3257435
Hospital Revenue Code	270
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$139.65
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: Humana Medicare Advantage	$61.74
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: UnitedHealthcare Medicaid	$58.80
Rate for Payer: WPPA Medicare Advantage	$88.20

ascorbic acid 500 mg Tab

Facility

$5.71

Service Code	NDC 68094011361
Hospital Charge Code	3805451
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$5.42
Rate for Payer: Aetna Commercial	$5.14
Rate for Payer: Humana Medicare Advantage	$2.40
Rate for Payer: UnitedHealthcare Commercial	$5.42
Rate for Payer: UnitedHealthcare Medicaid	$2.28
Rate for Payer: WPPA Medicare Advantage	$3.43

ascorbic acid 500 mg Tab

Facility

$5.71

Service Code	NDC 68094011361
Hospital Charge Code	3805451
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.14
Rate for Payer: UnitedHealthcare Commercial	$5.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ascorbic acid 500 mg Tab [HMC]

Facility

$5.20

Service Code	NDC 00904052361
Hospital Charge Code	3805451
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.68
Rate for Payer: UnitedHealthcare Commercial	$4.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ascorbic acid 500 mg Tab [HMC]

Facility

$5.20

Service Code	NDC 00904052361
Hospital Charge Code	3805451
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna Commercial	$4.68
Rate for Payer: Humana Medicare Advantage	$2.18
Rate for Payer: UnitedHealthcare Commercial	$4.94
Rate for Payer: UnitedHealthcare Medicaid	$2.08
Rate for Payer: WPPA Medicare Advantage	$3.12

Aspartate Aminotransferase

Facility

$74.00

Service Code	HCPCS 84450
Hospital Charge Code	3550726
Hospital Revenue Code	300
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Aspartate Aminotransferase

Facility

$74.00

Service Code	HCPCS 84450
Hospital Charge Code	3550726
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$11.11
Rate for Payer: Humana Medicare Advantage	$31.08
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: UnitedHealthcare Medicaid	$5.18
Rate for Payer: WPPA Medicare Advantage	$44.40

Aspergillus Abs,ID QST

Facility

$162.00

Service Code	HCPCS 86606
Hospital Charge Code	3556606
Hospital Revenue Code	300
Min. Negotiated Rate	$12.79
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna Commercial	$145.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$57.98
Rate for Payer: Humana Medicare Advantage	$68.04
Rate for Payer: UnitedHealthcare Commercial	$153.90
Rate for Payer: UnitedHealthcare Medicaid	$12.79
Rate for Payer: WPPA Medicare Advantage	$97.20

Aspergillus Abs,ID QST

Facility

$162.00

Service Code	HCPCS 86606
Hospital Charge Code	3556606
Hospital Revenue Code	300
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$145.80
Rate for Payer: UnitedHealthcare Commercial	$153.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Aspergillus Ag, EIA QST

Facility

$205.00

Service Code	HCPCS 87305
Hospital Charge Code	3557305
Hospital Revenue Code	300
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$194.75
Rate for Payer: Aetna Commercial	$184.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$25.74
Rate for Payer: Humana Medicare Advantage	$86.10
Rate for Payer: UnitedHealthcare Commercial	$194.75
Rate for Payer: UnitedHealthcare Medicaid	$11.98
Rate for Payer: WPPA Medicare Advantage	$123.00

Aspergillus Ag, EIA QST

Facility

$205.00

Service Code	HCPCS 87305
Hospital Charge Code	3557305
Hospital Revenue Code	300
Min. Negotiated Rate	$184.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$184.50
Rate for Payer: UnitedHealthcare Commercial	$194.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Aspergillus fumigatus (M3) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1002
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

Aspergillus fumigatus (M3) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1002
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

aspirin 325 mg Oral EC Tab [HMC]

Facility

$5.08

Service Code	NDC 00536123201
Hospital Charge Code	3804453
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$4.57
Rate for Payer: Humana Medicare Advantage	$2.13
Rate for Payer: UnitedHealthcare Commercial	$4.83
Rate for Payer: UnitedHealthcare Medicaid	$2.03
Rate for Payer: WPPA Medicare Advantage	$3.05

aspirin 325 mg Oral EC Tab [HMC]

Facility

$5.07

Service Code	NDC 57896092101
Hospital Charge Code	3804453
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 325 mg Oral EC Tab [HMC]

Facility

$5.08

Service Code	NDC 00536123201
Hospital Charge Code	3804453
Hospital Revenue Code	250
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.57
Rate for Payer: UnitedHealthcare Commercial	$4.83
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 325 mg Oral EC Tab [HMC]

Facility

$5.07

Service Code	NDC 57896092101
Hospital Charge Code	3804453
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Humana Medicare Advantage	$2.13
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: UnitedHealthcare Medicaid	$2.03
Rate for Payer: WPPA Medicare Advantage	$3.04

aspirin 325 mg Tab [HMC]

Facility

$5.05

Service Code	NDC 00536105429
Hospital Charge Code	3800346
Hospital Revenue Code	250
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.54
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 325 mg Tab [HMC]

Facility

$5.05

Service Code	NDC 00536105429
Hospital Charge Code	3800346
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna Commercial	$4.54
Rate for Payer: Humana Medicare Advantage	$2.12
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Medicaid	$2.02
Rate for Payer: WPPA Medicare Advantage	$3.03

aspirin 325 mg Tab [HMC]

Facility

$5.27

Service Code	NDC 66553000101
Hospital Charge Code	3800346
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$5.01
Rate for Payer: Aetna Commercial	$4.74
Rate for Payer: Humana Medicare Advantage	$2.21
Rate for Payer: UnitedHealthcare Commercial	$5.01
Rate for Payer: UnitedHealthcare Medicaid	$2.11
Rate for Payer: WPPA Medicare Advantage	$3.16

aspirin 325 mg Tab [HMC]

Facility

$5.27

Service Code	NDC 66553000101
Hospital Charge Code	3800346
Hospital Revenue Code	250
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.74
Rate for Payer: UnitedHealthcare Commercial	$5.01
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges