Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

atenolol 25 mg Tab [HMC]

Facility

$5.93

Service Code	NDC 60687060501
Hospital Charge Code	3800166
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$5.63
Rate for Payer: Aetna Commercial	$5.34
Rate for Payer: Humana Medicare Advantage	$2.49
Rate for Payer: UnitedHealthcare Commercial	$5.63
Rate for Payer: UnitedHealthcare Medicaid	$2.37
Rate for Payer: WPPA Medicare Advantage	$3.56

ATHEROSCLEROSIS WITH MCC

Facility

$5,242.05

Service Code	MSDRG 302
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,242.05
Rate for Payer: UnitedHealthcare Medicaid	$5,242.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ATHEROSCLEROSIS WITHOUT MCC

Facility

$2,954.61

Service Code	MSDRG 303
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,954.61
Rate for Payer: UnitedHealthcare Medicaid	$2,954.61
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Athletic Support Large Suspensory w/ Leg Straps used in Hernia Procedure

Facility

$45.00

Hospital Charge Code	3251415
Hospital Revenue Code	270
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: UnitedHealthcare Commercial	$42.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Athletic Support Large Suspensory w/ Leg Straps used in Hernia Procedure

Facility

$45.00

Hospital Charge Code	3251415
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Humana Medicare Advantage	$18.90
Rate for Payer: UnitedHealthcare Commercial	$42.75
Rate for Payer: UnitedHealthcare Medicaid	$18.00
Rate for Payer: WPPA Medicare Advantage	$27.00

atorvastatin 10 mg Tab [HMC]

Facility

$6.50

Service Code	NDC 00904629061
Hospital Charge Code	3800758
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$6.17
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Humana Medicare Advantage	$2.73
Rate for Payer: UnitedHealthcare Commercial	$6.17
Rate for Payer: UnitedHealthcare Medicaid	$2.60
Rate for Payer: WPPA Medicare Advantage	$3.90

atorvastatin 10 mg Tab [HMC]

Facility

$6.10

Service Code	NDC 51079020820
Hospital Charge Code	3800758
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.79
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: Humana Medicare Advantage	$2.56
Rate for Payer: UnitedHealthcare Commercial	$5.79
Rate for Payer: UnitedHealthcare Medicaid	$2.44
Rate for Payer: WPPA Medicare Advantage	$3.66

atorvastatin 10 mg Tab [HMC]

Facility

$6.10

Service Code	NDC 51079020820
Hospital Charge Code	3800758
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: UnitedHealthcare Commercial	$5.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atorvastatin 10 mg Tab [HMC]

Facility

$6.50

Service Code	NDC 00904629061
Hospital Charge Code	3800758
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: UnitedHealthcare Commercial	$6.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atorvastatin 40 mg Tab [HMC]

Facility

$7.07

Service Code	NDC 00904629261
Hospital Charge Code	3800538
Hospital Revenue Code	250
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.36
Rate for Payer: UnitedHealthcare Commercial	$6.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atorvastatin 40 mg Tab [HMC]

Facility

$7.07

Service Code	NDC 00904629261
Hospital Charge Code	3800538
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna Commercial	$6.36
Rate for Payer: Humana Medicare Advantage	$2.97
Rate for Payer: UnitedHealthcare Commercial	$6.72
Rate for Payer: UnitedHealthcare Medicaid	$2.83
Rate for Payer: WPPA Medicare Advantage	$4.24

atorvastatin 40 mg Tab [HMC]

Facility

$6.57

Service Code	NDC 50268009515
Hospital Charge Code	3800538
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$6.24
Rate for Payer: Aetna Commercial	$5.91
Rate for Payer: Humana Medicare Advantage	$2.76
Rate for Payer: UnitedHealthcare Commercial	$6.24
Rate for Payer: UnitedHealthcare Medicaid	$2.63
Rate for Payer: WPPA Medicare Advantage	$3.94

atorvastatin 40 mg Tab [HMC]

Facility

$6.57

Service Code	NDC 50268009515
Hospital Charge Code	3800538
Hospital Revenue Code	250
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.91
Rate for Payer: UnitedHealthcare Commercial	$6.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atracurium 10 mg/mL IV Sol [HMC]

Facility

$48.80

Service Code	NDC 25021065905
Hospital Charge Code	3800366
Hospital Revenue Code	250
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$46.36
Rate for Payer: Aetna Commercial	$43.92
Rate for Payer: Humana Medicare Advantage	$20.50
Rate for Payer: UnitedHealthcare Commercial	$46.36
Rate for Payer: UnitedHealthcare Medicaid	$19.52
Rate for Payer: WPPA Medicare Advantage	$29.28

atracurium 10 mg/mL IV Sol [HMC]

Facility

$48.80

Service Code	NDC 25021065905
Hospital Charge Code	3800366
Hospital Revenue Code	250
Min. Negotiated Rate	$43.92
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$43.92
Rate for Payer: UnitedHealthcare Commercial	$46.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atropine 0.1 mg/mL [HMC]

Facility

$51.22

Service Code	HCPCS J0461
Hospital Charge Code	3804487
Hospital Revenue Code	250
Min. Negotiated Rate	$46.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$46.10
Rate for Payer: Aetna Commercial	$48.87
Rate for Payer: UnitedHealthcare Commercial	$48.66
Rate for Payer: UnitedHealthcare Commercial	$51.59
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atropine 0.1 mg/mL [HMC]

Facility

$54.30

Service Code	HCPCS J0461
Hospital Charge Code	3804487
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$51.59
Rate for Payer: Aetna Commercial	$48.87
Rate for Payer: Aetna Commercial	$46.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.10
Rate for Payer: Humana Medicare Advantage	$21.51
Rate for Payer: Humana Medicare Advantage	$22.81
Rate for Payer: UnitedHealthcare Commercial	$48.66
Rate for Payer: UnitedHealthcare Commercial	$51.59
Rate for Payer: UnitedHealthcare Medicaid	$21.72
Rate for Payer: UnitedHealthcare Medicaid	$20.49
Rate for Payer: WPPA Medicare Advantage	$30.73
Rate for Payer: WPPA Medicare Advantage	$32.58

atropine 0.4 mg/mL Inj Sol [HMC]

Facility

$48.80

Service Code	HCPCS J0461
Hospital Charge Code	3800486
Hospital Revenue Code	250
Min. Negotiated Rate	$43.92
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$43.92
Rate for Payer: UnitedHealthcare Commercial	$46.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atropine 0.4 mg/mL Inj Sol [HMC]

Facility

$48.80

Service Code	HCPCS J0461
Hospital Charge Code	3800486
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$46.36
Rate for Payer: Aetna Commercial	$43.92
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.10
Rate for Payer: Humana Medicare Advantage	$20.50
Rate for Payer: UnitedHealthcare Commercial	$46.36
Rate for Payer: UnitedHealthcare Medicaid	$19.52
Rate for Payer: WPPA Medicare Advantage	$29.28

atropine 1 mg/mL Inj Sol [HMC]

Facility

$50.14

Service Code	HCPCS J0461
Hospital Charge Code	3806871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$47.63
Rate for Payer: Aetna Commercial	$45.13
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.10
Rate for Payer: Humana Medicare Advantage	$21.06
Rate for Payer: UnitedHealthcare Commercial	$47.63
Rate for Payer: UnitedHealthcare Medicaid	$20.06
Rate for Payer: WPPA Medicare Advantage	$30.08

atropine 1 mg/mL Inj Sol [HMC]

Facility

$50.14

Service Code	HCPCS J0461
Hospital Charge Code	3806871
Hospital Revenue Code	250
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.13
Rate for Payer: UnitedHealthcare Commercial	$47.63
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atropine 1 mg/mL Sol [HMC]

Facility

$50.53

Service Code	HCPCS J0461
Hospital Charge Code	3806871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna Commercial	$45.48
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.10
Rate for Payer: Humana Medicare Advantage	$21.22
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: UnitedHealthcare Medicaid	$20.21
Rate for Payer: WPPA Medicare Advantage	$30.32

atropine 1 mg/mL Sol [HMC]

Facility

$50.53

Service Code	HCPCS J0461
Hospital Charge Code	3806871
Hospital Revenue Code	250
Min. Negotiated Rate	$45.48
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.48
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atropine-diphenoxylate 0.025 mg-2.5 mg Tab

Facility

$6.67

Service Code	NDC 69315091001
Hospital Charge Code	3806078
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: UnitedHealthcare Commercial	$6.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atropine-diphenoxylate 0.025 mg-2.5 mg Tab

Facility

$6.67

Service Code	NDC 69315091001
Hospital Charge Code	3806078
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$6.34
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: Humana Medicare Advantage	$2.80
Rate for Payer: UnitedHealthcare Commercial	$6.34
Rate for Payer: UnitedHealthcare Medicaid	$2.67
Rate for Payer: WPPA Medicare Advantage	$4.00

Know your out-of-pocket cost for care.

All Charges