Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

bisoprolol 5 mg Tab [HMC]

Facility

$11.76

Service Code	NDC 70954045520
Hospital Charge Code	3809515
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$11.17
Rate for Payer: Aetna Commercial	$10.58
Rate for Payer: Humana Medicare Advantage	$4.94
Rate for Payer: UnitedHealthcare Commercial	$11.17
Rate for Payer: UnitedHealthcare Medicaid	$4.70
Rate for Payer: WPPA Medicare Advantage	$7.06

bisoprolol 5 mg Tab [HMC]

Facility

$11.76

Service Code	NDC 70954045510
Hospital Charge Code	3809515
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$11.17
Rate for Payer: Aetna Commercial	$10.58
Rate for Payer: Humana Medicare Advantage	$4.94
Rate for Payer: UnitedHealthcare Commercial	$11.17
Rate for Payer: UnitedHealthcare Medicaid	$4.70
Rate for Payer: WPPA Medicare Advantage	$7.06

bisoprolol 5 mg Tab [HMC]

Facility

$11.76

Service Code	NDC 70954045520
Hospital Charge Code	3809515
Hospital Revenue Code	250
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.58
Rate for Payer: UnitedHealthcare Commercial	$11.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bisoprolol 5 mg Tab [HMC]

Facility

$11.76

Service Code	NDC 70954045510
Hospital Charge Code	3809515
Hospital Revenue Code	250
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.58
Rate for Payer: UnitedHealthcare Commercial	$11.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bisoprolol 5 mg Tab [HMC]

Facility

$9.21

Service Code	NDC 29300012613
Hospital Charge Code	3809515
Hospital Revenue Code	250
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$8.75
Rate for Payer: Aetna Commercial	$8.29
Rate for Payer: Humana Medicare Advantage	$3.87
Rate for Payer: UnitedHealthcare Commercial	$8.75
Rate for Payer: UnitedHealthcare Medicaid	$3.68
Rate for Payer: WPPA Medicare Advantage	$5.53

bisoprolol 5 mg Tab [HMC]

Facility

$9.27

Service Code	NDC 50268012715
Hospital Charge Code	3809515
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna Commercial	$8.34
Rate for Payer: Humana Medicare Advantage	$3.89
Rate for Payer: UnitedHealthcare Commercial	$8.81
Rate for Payer: UnitedHealthcare Medicaid	$3.71
Rate for Payer: WPPA Medicare Advantage	$5.56

bisoprolol 5 mg Tab [HMC]

Facility

$9.27

Service Code	NDC 50268012715
Hospital Charge Code	3809515
Hospital Revenue Code	250
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.34
Rate for Payer: UnitedHealthcare Commercial	$8.81
Rate for Payer: WPPA Medicare Advantage	$1,200.00

BK Virus DNA, Qn Real Time PCR, P QST

Facility

$692.00

Service Code	HCPCS 87799
Hospital Charge Code	3552450
Hospital Revenue Code	300
Min. Negotiated Rate	$36.41
Max. Negotiated Rate	$657.40
Rate for Payer: Aetna Commercial	$622.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$251.58
Rate for Payer: Humana Medicare Advantage	$290.64
Rate for Payer: UnitedHealthcare Commercial	$657.40
Rate for Payer: UnitedHealthcare Medicaid	$36.41
Rate for Payer: WPPA Medicare Advantage	$415.20

BK Virus DNA, Qn Real Time PCR, P QST

Facility

$692.00

Service Code	HCPCS 87799
Hospital Charge Code	3552450
Hospital Revenue Code	300
Min. Negotiated Rate	$622.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$622.80
Rate for Payer: UnitedHealthcare Commercial	$657.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Blade Bone Saw Wire Olivecrona Gigli 30cm

Facility

$53.69

Hospital Charge Code	3256013
Hospital Revenue Code	270
Min. Negotiated Rate	$48.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$48.32
Rate for Payer: UnitedHealthcare Commercial	$51.01
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Blade Bone Saw Wire Olivecrona Gigli 30cm

Facility

$53.69

Hospital Charge Code	3256013
Hospital Revenue Code	270
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$51.01
Rate for Payer: Aetna Commercial	$48.32
Rate for Payer: Humana Medicare Advantage	$22.55
Rate for Payer: UnitedHealthcare Commercial	$51.01
Rate for Payer: UnitedHealthcare Medicaid	$21.48
Rate for Payer: WPPA Medicare Advantage	$32.21

Blade Microdebrider Inferior Turbinate Blade 2.0 mm for Septo/SMR Procedures

Facility

$654.00

Hospital Charge Code	3256015
Hospital Revenue Code	270
Min. Negotiated Rate	$261.60
Max. Negotiated Rate	$621.30
Rate for Payer: Aetna Commercial	$588.60
Rate for Payer: Humana Medicare Advantage	$274.68
Rate for Payer: UnitedHealthcare Commercial	$621.30
Rate for Payer: UnitedHealthcare Medicaid	$261.60
Rate for Payer: WPPA Medicare Advantage	$392.40

Blade Microdebrider Inferior Turbinate Blade 2.0 mm for Septo/SMR Procedures

Facility

$654.00

Hospital Charge Code	3256015
Hospital Revenue Code	270
Min. Negotiated Rate	$588.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$588.60
Rate for Payer: UnitedHealthcare Commercial	$621.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Blade Oscillating Bone Saw Fine Straight 10mm Wide X 18.5mm Length X 0.4mm Thick

Facility

$44.00

Hospital Charge Code	3256010
Hospital Revenue Code	270
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Blade Oscillating Bone Saw Fine Straight 10mm Wide X 18.5mm Length X 0.4mm Thick

Facility

$44.00

Hospital Charge Code	3256010
Hospital Revenue Code	270
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$41.80
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: Humana Medicare Advantage	$18.48
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Medicaid	$17.60
Rate for Payer: WPPA Medicare Advantage	$26.40

Blade Oscillating Bone Saw Fine Straight 5.5mm Wide x 18.5mm Length x 0.4mm Thic

Facility

$44.00

Hospital Charge Code	3250350
Hospital Revenue Code	270
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Blade Oscillating Bone Saw Fine Straight 5.5mm Wide x 18.5mm Length x 0.4mm Thic

Facility

$44.00

Hospital Charge Code	3250350
Hospital Revenue Code	270
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$41.80
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: Humana Medicare Advantage	$18.48
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Medicaid	$17.60
Rate for Payer: WPPA Medicare Advantage	$26.40

Blade Rem-B Bone Saw 5.5mm x 18mm x 0.38mm for Stryker Sagittal & Oscillating

Facility

$108.00

Hospital Charge Code	3256021
Hospital Revenue Code	270
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Humana Medicare Advantage	$45.36
Rate for Payer: UnitedHealthcare Commercial	$102.60
Rate for Payer: UnitedHealthcare Medicaid	$43.20
Rate for Payer: WPPA Medicare Advantage	$64.80

Blade Rem-B Bone Saw 5.5mm x 18mm x 0.38mm for Stryker Sagittal & Oscillating

Facility

$108.00

Hospital Charge Code	3256021
Hospital Revenue Code	270
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: UnitedHealthcare Commercial	$102.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Blade Rem-B Bone Saw 9mm x 25mm x 0.38mm for Stryker Sagittal & Oscillating Saws

Facility

$108.00

Hospital Charge Code	3256020
Hospital Revenue Code	270
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: UnitedHealthcare Commercial	$102.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Blade Rem-B Bone Saw 9mm x 25mm x 0.38mm for Stryker Sagittal & Oscillating Saws

Facility

$108.00

Hospital Charge Code	3256020
Hospital Revenue Code	270
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Humana Medicare Advantage	$45.36
Rate for Payer: UnitedHealthcare Commercial	$102.60
Rate for Payer: UnitedHealthcare Medicaid	$43.20
Rate for Payer: WPPA Medicare Advantage	$64.80

Blastomyces Ab Panel, CF and ID QST

Facility

$139.00

Service Code	HCPCS 86612
Hospital Charge Code	3556612
Hospital Revenue Code	300
Min. Negotiated Rate	$125.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$125.10
Rate for Payer: UnitedHealthcare Commercial	$132.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Blastomyces Ab Panel, CF and ID QST

Facility

$139.00

Service Code	HCPCS 86612
Hospital Charge Code	3556612
Hospital Revenue Code	300
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$132.05
Rate for Payer: Aetna Commercial	$125.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$13.48
Rate for Payer: Humana Medicare Advantage	$58.38
Rate for Payer: UnitedHealthcare Commercial	$132.05
Rate for Payer: UnitedHealthcare Medicaid	$10.97
Rate for Payer: WPPA Medicare Advantage	$83.40

Bleeding Control Kit Advanced BCD Single Vacuum Sealed

Facility

$268.00

Hospital Charge Code	3259497
Hospital Revenue Code	270
Min. Negotiated Rate	$107.20
Max. Negotiated Rate	$254.60
Rate for Payer: Aetna Commercial	$241.20
Rate for Payer: Humana Medicare Advantage	$112.56
Rate for Payer: UnitedHealthcare Commercial	$254.60
Rate for Payer: UnitedHealthcare Medicaid	$107.20
Rate for Payer: WPPA Medicare Advantage	$160.80

Bleeding Control Kit Advanced BCD Single Vacuum Sealed

Facility

$268.00

Hospital Charge Code	3259497
Hospital Revenue Code	270
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$241.20
Rate for Payer: UnitedHealthcare Commercial	$254.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges