Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

candesartan 4 mg Tab [HMC]

Facility

$14.52

Service Code	NDC 49884065809
Hospital Charge Code	3800025
Hospital Revenue Code	250
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$13.79
Rate for Payer: Aetna Commercial	$13.07
Rate for Payer: Humana Medicare Advantage	$6.10
Rate for Payer: UnitedHealthcare Commercial	$13.79
Rate for Payer: UnitedHealthcare Medicaid	$5.81
Rate for Payer: WPPA Medicare Advantage	$8.71

candesartan 4 mg Tab [HMC]

Facility

$14.52

Service Code	NDC 49884065809
Hospital Charge Code	3800025
Hospital Revenue Code	250
Min. Negotiated Rate	$13.07
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.07
Rate for Payer: UnitedHealthcare Commercial	$13.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

candida albicans extract - Sol [HMC]

Facility

$489.52

Service Code	NDC 59584013801
Hospital Charge Code	3800878
Hospital Revenue Code	259
Min. Negotiated Rate	$440.57
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$440.57
Rate for Payer: UnitedHealthcare Commercial	$465.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

candida albicans extract - Sol [HMC]

Facility

$489.52

Service Code	NDC 59584013801
Hospital Charge Code	3800878
Hospital Revenue Code	259
Min. Negotiated Rate	$195.81
Max. Negotiated Rate	$465.04
Rate for Payer: Aetna Commercial	$440.57
Rate for Payer: Humana Medicare Advantage	$205.60
Rate for Payer: UnitedHealthcare Commercial	$465.04
Rate for Payer: UnitedHealthcare Medicaid	$195.81
Rate for Payer: WPPA Medicare Advantage	$293.71

CANN PROFILE DRILL 2.5MM

Facility

$592.20

Hospital Charge Code	3258133
Hospital Revenue Code	270
Min. Negotiated Rate	$532.98
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$532.98
Rate for Payer: UnitedHealthcare Commercial	$562.59
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CANN PROFILE DRILL 2.5MM

Facility

$592.20

Hospital Charge Code	3258133
Hospital Revenue Code	270
Min. Negotiated Rate	$236.88
Max. Negotiated Rate	$562.59
Rate for Payer: Aetna Commercial	$532.98
Rate for Payer: Humana Medicare Advantage	$248.72
Rate for Payer: UnitedHealthcare Commercial	$562.59
Rate for Payer: UnitedHealthcare Medicaid	$236.88
Rate for Payer: WPPA Medicare Advantage	$355.32

Cannula 14' w/Ear Cushion

Facility

$6.44

Hospital Charge Code	3250516
Hospital Revenue Code	270
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.80
Rate for Payer: UnitedHealthcare Commercial	$6.12
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula 14' w/Ear Cushion

Facility

$6.44

Hospital Charge Code	3250516
Hospital Revenue Code	270
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$6.12
Rate for Payer: Aetna Commercial	$5.80
Rate for Payer: Humana Medicare Advantage	$2.70
Rate for Payer: UnitedHealthcare Commercial	$6.12
Rate for Payer: UnitedHealthcare Medicaid	$2.58
Rate for Payer: WPPA Medicare Advantage	$3.86

Cannula 7' Bi-Flo O2 Delivery & CO2 Sampling w/Male Luer Connector

Facility

$9.86

Hospital Charge Code	3250520
Hospital Revenue Code	270
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$9.37
Rate for Payer: Aetna Commercial	$8.87
Rate for Payer: Humana Medicare Advantage	$4.14
Rate for Payer: UnitedHealthcare Commercial	$9.37
Rate for Payer: UnitedHealthcare Medicaid	$3.94
Rate for Payer: WPPA Medicare Advantage	$5.92

Cannula 7' Bi-Flo O2 Delivery & CO2 Sampling w/Male Luer Connector

Facility

$9.86

Hospital Charge Code	3250520
Hospital Revenue Code	270
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.87
Rate for Payer: UnitedHealthcare Commercial	$9.37
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula 7' Nonflare Tips

Facility

$2.50

Hospital Charge Code	3250508
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula 7' Nonflare Tips

Facility

$2.50

Hospital Charge Code	3250508
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Cannula Adult Long Vapotherm

Facility

$68.00

Hospital Charge Code	3250563
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula Adult Long Vapotherm

Facility

$68.00

Hospital Charge Code	3250563
Hospital Revenue Code	270
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$64.60
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Humana Medicare Advantage	$28.56
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: UnitedHealthcare Medicaid	$27.20
Rate for Payer: WPPA Medicare Advantage	$40.80

Cannula Adult Vapotherm

Facility

$72.90

Hospital Charge Code	3250561
Hospital Revenue Code	270
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$69.25
Rate for Payer: Aetna Commercial	$65.61
Rate for Payer: Humana Medicare Advantage	$30.62
Rate for Payer: UnitedHealthcare Commercial	$69.25
Rate for Payer: UnitedHealthcare Medicaid	$29.16
Rate for Payer: WPPA Medicare Advantage	$43.74

Cannula Adult Vapotherm

Facility

$72.90

Hospital Charge Code	3250561
Hospital Revenue Code	270
Min. Negotiated Rate	$65.61
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$65.61
Rate for Payer: UnitedHealthcare Commercial	$69.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula Infant

Facility

$5.40

Hospital Charge Code	3255747
Hospital Revenue Code	270
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$5.13
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: Humana Medicare Advantage	$2.27
Rate for Payer: UnitedHealthcare Commercial	$5.13
Rate for Payer: UnitedHealthcare Medicaid	$2.16
Rate for Payer: WPPA Medicare Advantage	$3.24

Cannula Infant

Facility

$5.40

Hospital Charge Code	3255747
Hospital Revenue Code	270
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: UnitedHealthcare Commercial	$5.13
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula Intermediate Infant Vapotherm ProSoft

Facility

$73.00

Hospital Charge Code	3250569
Hospital Revenue Code	270
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$65.70
Rate for Payer: UnitedHealthcare Commercial	$69.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula Intermediate Infant Vapotherm ProSoft

Facility

$73.00

Hospital Charge Code	3250569
Hospital Revenue Code	270
Min. Negotiated Rate	$29.20
Max. Negotiated Rate	$69.35
Rate for Payer: Aetna Commercial	$65.70
Rate for Payer: Humana Medicare Advantage	$30.66
Rate for Payer: UnitedHealthcare Commercial	$69.35
Rate for Payer: UnitedHealthcare Medicaid	$29.20
Rate for Payer: WPPA Medicare Advantage	$43.80

Cannula Neonate Vapotherm

Facility

$68.00

Hospital Charge Code	3250568
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula Neonate Vapotherm

Facility

$68.00

Hospital Charge Code	3250568
Hospital Revenue Code	270
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$64.60
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Humana Medicare Advantage	$28.56
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: UnitedHealthcare Medicaid	$27.20
Rate for Payer: WPPA Medicare Advantage	$40.80

Cannula Newborn RAM for use with low/high flow humidified oxygen

Facility

$58.00

Hospital Charge Code	3255745
Hospital Revenue Code	270
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$55.10
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Humana Medicare Advantage	$24.36
Rate for Payer: UnitedHealthcare Commercial	$55.10
Rate for Payer: UnitedHealthcare Medicaid	$23.20
Rate for Payer: WPPA Medicare Advantage	$34.80

Cannula Newborn RAM for use with low/high flow humidified oxygen

Facility

$58.00

Hospital Charge Code	3255745
Hospital Revenue Code	270
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: UnitedHealthcare Commercial	$55.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cannula O2 Hi-Flo Adult

Facility

$4.55

Hospital Charge Code	3251574
Hospital Revenue Code	270
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Humana Medicare Advantage	$1.91
Rate for Payer: UnitedHealthcare Commercial	$4.32
Rate for Payer: UnitedHealthcare Medicaid	$1.82
Rate for Payer: WPPA Medicare Advantage	$2.73

Know your out-of-pocket cost for care.

All Charges