Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

calcium carbonate 750 mg Chew Tab [HMC]

Facility

$5.48

Service Code	NDC 00135045603
Hospital Charge Code	3809271
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$5.21
Rate for Payer: Aetna Commercial	$4.93
Rate for Payer: Humana Medicare Advantage	$2.30
Rate for Payer: UnitedHealthcare Commercial	$5.21
Rate for Payer: UnitedHealthcare Medicaid	$2.19
Rate for Payer: WPPA Medicare Advantage	$3.29

calcium carbonate-magnesium chloride 119 mg-71.5 mg Tab [HMC]

Facility

$5.51

Service Code	NDC 67618010760
Hospital Charge Code	3808141
Hospital Revenue Code	250
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna Commercial	$4.96
Rate for Payer: Humana Medicare Advantage	$2.31
Rate for Payer: UnitedHealthcare Commercial	$5.23
Rate for Payer: UnitedHealthcare Medicaid	$2.20
Rate for Payer: WPPA Medicare Advantage	$3.31

calcium carbonate-magnesium chloride 119 mg-71.5 mg Tab [HMC]

Facility

$5.51

Service Code	NDC 67618010760
Hospital Charge Code	3808141
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.96
Rate for Payer: UnitedHealthcare Commercial	$5.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

calcium chloride 100 mg/mL Inj Sol [HMC]

Facility

$44.00

Service Code	NDC 64253090091
Hospital Charge Code	3808042
Hospital Revenue Code	250
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

calcium chloride 100 mg/mL Inj Sol [HMC]

Facility

$54.78

Service Code	NDC 00517271025
Hospital Charge Code	3808042
Hospital Revenue Code	250
Min. Negotiated Rate	$21.91
Max. Negotiated Rate	$52.04
Rate for Payer: Aetna Commercial	$49.30
Rate for Payer: Humana Medicare Advantage	$23.01
Rate for Payer: UnitedHealthcare Commercial	$52.04
Rate for Payer: UnitedHealthcare Medicaid	$21.91
Rate for Payer: WPPA Medicare Advantage	$32.87

calcium chloride 100 mg/mL Inj Sol [HMC]

Facility

$44.00

Service Code	NDC 64253090091
Hospital Charge Code	3808042
Hospital Revenue Code	250
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

calcium chloride 100 mg/mL Inj Sol [HMC]

Facility

$54.78

Service Code	NDC 00517271025
Hospital Charge Code	3808042
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$49.30
Rate for Payer: UnitedHealthcare Commercial	$52.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

calcium gluconate 100 mg/mL Inj Sol [HMC]

Facility

$39.44

Service Code	HCPCS J0612
Hospital Charge Code	3809072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$37.47
Rate for Payer: Aetna Commercial	$35.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.06
Rate for Payer: Humana Medicare Advantage	$16.56
Rate for Payer: UnitedHealthcare Commercial	$37.47
Rate for Payer: UnitedHealthcare Medicaid	$15.78
Rate for Payer: WPPA Medicare Advantage	$23.66

calcium gluconate 100 mg/mL Inj Sol [HMC]

Facility

$39.44

Service Code	HCPCS J0612
Hospital Charge Code	3809072
Hospital Revenue Code	250
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$35.50
Rate for Payer: UnitedHealthcare Commercial	$37.47
Rate for Payer: WPPA Medicare Advantage	$1,200.00

calcium gluconate 100 mg/mL Sol 10 ml [HMC]

Facility

$44.05

Service Code	HCPCS J0612
Hospital Charge Code	3809072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$41.85
Rate for Payer: Aetna Commercial	$39.65
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.06
Rate for Payer: Humana Medicare Advantage	$18.50
Rate for Payer: UnitedHealthcare Commercial	$41.85
Rate for Payer: UnitedHealthcare Medicaid	$17.62
Rate for Payer: WPPA Medicare Advantage	$26.43

calcium gluconate 100 mg/mL Sol 10 ml [HMC]

Facility

$44.05

Service Code	HCPCS J0612
Hospital Charge Code	3809072
Hospital Revenue Code	250
Min. Negotiated Rate	$39.65
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.65
Rate for Payer: UnitedHealthcare Commercial	$41.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Calcium, Ionized QST

Facility

$79.00

Service Code	HCPCS 82330
Hospital Charge Code	3552599
Hospital Revenue Code	300
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$75.05
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$46.45
Rate for Payer: Humana Medicare Advantage	$33.18
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: UnitedHealthcare Medicaid	$11.63
Rate for Payer: WPPA Medicare Advantage	$47.40

Calcium, Ionized QST

Facility

$79.00

Service Code	HCPCS 82330
Hospital Charge Code	3552599
Hospital Revenue Code	300
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Calcium Level Total

Facility

$61.00

Service Code	HCPCS 82310
Hospital Charge Code	3550205
Hospital Revenue Code	300
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$57.95
Rate for Payer: Aetna Commercial	$54.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$11.06
Rate for Payer: Humana Medicare Advantage	$25.62
Rate for Payer: UnitedHealthcare Commercial	$57.95
Rate for Payer: UnitedHealthcare Medicaid	$5.16
Rate for Payer: WPPA Medicare Advantage	$36.60

Calcium Level Total

Facility

$61.00

Service Code	HCPCS 82310
Hospital Charge Code	3550205
Hospital Revenue Code	300
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.90
Rate for Payer: UnitedHealthcare Commercial	$57.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

calcium-vitamin D 500 mg-200 intl units Tab [HMC]

Facility

$5.13

Service Code	NDC 00904546092
Hospital Charge Code	3800405
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: UnitedHealthcare Commercial	$4.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

calcium-vitamin D 500 mg-200 intl units Tab [HMC]

Facility

$5.17

Service Code	NDC 10006070038
Hospital Charge Code	3800405
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$4.91
Rate for Payer: Aetna Commercial	$4.65
Rate for Payer: Humana Medicare Advantage	$2.17
Rate for Payer: UnitedHealthcare Commercial	$4.91
Rate for Payer: UnitedHealthcare Medicaid	$2.07
Rate for Payer: WPPA Medicare Advantage	$3.10

calcium-vitamin D 500 mg-200 intl units Tab [HMC]

Facility

$5.13

Service Code	NDC 00904546092
Hospital Charge Code	3800405
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$4.87
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Humana Medicare Advantage	$2.15
Rate for Payer: UnitedHealthcare Commercial	$4.87
Rate for Payer: UnitedHealthcare Medicaid	$2.05
Rate for Payer: WPPA Medicare Advantage	$3.08

calcium-vitamin D 500 mg-200 intl units Tab [HMC]

Facility

$5.17

Service Code	NDC 10006070038
Hospital Charge Code	3800405
Hospital Revenue Code	250
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.65
Rate for Payer: UnitedHealthcare Commercial	$4.91
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Calprotectin, Stool QST

Facility

$349.00

Service Code	HCPCS 83993
Hospital Charge Code	3553993
Hospital Revenue Code	300
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$331.55
Rate for Payer: Aetna Commercial	$314.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$24.56
Rate for Payer: Humana Medicare Advantage	$146.58
Rate for Payer: UnitedHealthcare Commercial	$331.55
Rate for Payer: UnitedHealthcare Medicaid	$19.63
Rate for Payer: WPPA Medicare Advantage	$209.40

Calprotectin, Stool QST

Facility

$349.00

Service Code	HCPCS 83993
Hospital Charge Code	3553993
Hospital Revenue Code	300
Min. Negotiated Rate	$314.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$314.10
Rate for Payer: UnitedHealthcare Commercial	$331.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

candesartan 16 mg Tab [HMC]

Facility

$14.53

Service Code	NDC 49884066009
Hospital Charge Code	3803091
Hospital Revenue Code	250
Min. Negotiated Rate	$13.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: UnitedHealthcare Commercial	$13.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

candesartan 16 mg Tab [HMC]

Facility

$14.17

Service Code	NDC 33342011607
Hospital Charge Code	3803091
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$13.46
Rate for Payer: Aetna Commercial	$12.75
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Medicaid	$5.67
Rate for Payer: WPPA Medicare Advantage	$8.50

candesartan 16 mg Tab [HMC]

Facility

$14.17

Service Code	NDC 33342011607
Hospital Charge Code	3803091
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.75
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

candesartan 16 mg Tab [HMC]

Facility

$14.53

Service Code	NDC 49884066009
Hospital Charge Code	3803091
Hospital Revenue Code	250
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Humana Medicare Advantage	$6.10
Rate for Payer: UnitedHealthcare Commercial	$13.80
Rate for Payer: UnitedHealthcare Medicaid	$5.81
Rate for Payer: WPPA Medicare Advantage	$8.72

Know your out-of-pocket cost for care.

All Charges