Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

carvedilol 25 mg Tab [HMC]

Facility

$11.30

Service Code	NDC 00904630361
Hospital Charge Code	3802101
Hospital Revenue Code	250
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.17
Rate for Payer: UnitedHealthcare Commercial	$10.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carvedilol 25 mg Tab [HMC]

Facility

$11.40

Service Code	NDC 51079093220
Hospital Charge Code	3802101
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$10.83
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Humana Medicare Advantage	$4.79
Rate for Payer: UnitedHealthcare Commercial	$10.83
Rate for Payer: UnitedHealthcare Medicaid	$4.56
Rate for Payer: WPPA Medicare Advantage	$6.84

carvedilol 25 mg Tab [HMC]

Facility

$11.40

Service Code	NDC 51079093220
Hospital Charge Code	3802101
Hospital Revenue Code	250
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: UnitedHealthcare Commercial	$10.83
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carvedilol 3.125 mg Tab [HMC]

Facility

$11.40

Service Code	NDC 51079077120
Hospital Charge Code	3802010
Hospital Revenue Code	250
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: UnitedHealthcare Commercial	$10.83
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carvedilol 3.125 mg Tab [HMC]

Facility

$5.33

Service Code	NDC 00904730561
Hospital Charge Code	3802010
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: UnitedHealthcare Commercial	$5.06
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carvedilol 3.125 mg Tab [HMC]

Facility

$11.41

Service Code	NDC 68382009201
Hospital Charge Code	3802010
Hospital Revenue Code	250
Min. Negotiated Rate	$10.27
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.27
Rate for Payer: UnitedHealthcare Commercial	$10.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carvedilol 3.125 mg Tab [HMC]

Facility

$5.33

Service Code	NDC 00904730561
Hospital Charge Code	3802010
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Humana Medicare Advantage	$2.24
Rate for Payer: UnitedHealthcare Commercial	$5.06
Rate for Payer: UnitedHealthcare Medicaid	$2.13
Rate for Payer: WPPA Medicare Advantage	$3.20

carvedilol 3.125 mg Tab [HMC]

Facility

$11.41

Service Code	NDC 68382009201
Hospital Charge Code	3802010
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna Commercial	$10.27
Rate for Payer: Humana Medicare Advantage	$4.79
Rate for Payer: UnitedHealthcare Commercial	$10.84
Rate for Payer: UnitedHealthcare Medicaid	$4.56
Rate for Payer: WPPA Medicare Advantage	$6.85

carvedilol 3.125 mg Tab [HMC]

Facility

$11.30

Service Code	NDC 00904630061
Hospital Charge Code	3802010
Hospital Revenue Code	250
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.17
Rate for Payer: UnitedHealthcare Commercial	$10.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carvedilol 3.125 mg Tab [HMC]

Facility

$11.30

Service Code	NDC 00904630061
Hospital Charge Code	3802010
Hospital Revenue Code	250
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$10.73
Rate for Payer: Aetna Commercial	$10.17
Rate for Payer: Humana Medicare Advantage	$4.75
Rate for Payer: UnitedHealthcare Commercial	$10.73
Rate for Payer: UnitedHealthcare Medicaid	$4.52
Rate for Payer: WPPA Medicare Advantage	$6.78

carvedilol 3.125 mg Tab [HMC]

Facility

$11.40

Service Code	NDC 51079077120
Hospital Charge Code	3802010
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$10.83
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Humana Medicare Advantage	$4.79
Rate for Payer: UnitedHealthcare Commercial	$10.83
Rate for Payer: UnitedHealthcare Medicaid	$4.56
Rate for Payer: WPPA Medicare Advantage	$6.84

Cashew Nut (F202) IgE QST

Facility

$26.00

Service Code	HCPCS 86003
Hospital Charge Code	3552608
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$10.92
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$15.60

Cashew Nut (F202) IgE QST

Facility

$26.00

Service Code	HCPCS 86003
Hospital Charge Code	3552608
Hospital Revenue Code	300
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 2 Dark Blue

Facility

$7.65

Hospital Charge Code	3250872
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: Humana Medicare Advantage	$3.21
Rate for Payer: UnitedHealthcare Commercial	$7.27
Rate for Payer: UnitedHealthcare Medicaid	$3.06
Rate for Payer: WPPA Medicare Advantage	$4.59

Casting Tape 2 Dark Blue

Facility

$7.65

Hospital Charge Code	3250872
Hospital Revenue Code	270
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: UnitedHealthcare Commercial	$7.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 2 Green

Facility

$9.00

Hospital Charge Code	3250871
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 2 Green

Facility

$9.00

Hospital Charge Code	3250871
Hospital Revenue Code	270
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.55
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: WPPA Medicare Advantage	$5.40

Casting Tape 2 Mixed

Facility

$10.00

Hospital Charge Code	3250865
Hospital Revenue Code	270
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Humana Medicare Advantage	$4.20
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: WPPA Medicare Advantage	$6.00

Casting Tape 2 Mixed

Facility

$10.00

Hospital Charge Code	3250865
Hospital Revenue Code	270
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 2 Purple

Facility

$7.65

Hospital Charge Code	3250863
Hospital Revenue Code	270
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: UnitedHealthcare Commercial	$7.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 2 Purple

Facility

$7.65

Hospital Charge Code	3250863
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: Humana Medicare Advantage	$3.21
Rate for Payer: UnitedHealthcare Commercial	$7.27
Rate for Payer: UnitedHealthcare Medicaid	$3.06
Rate for Payer: WPPA Medicare Advantage	$4.59

Casting Tape 2 White

Facility

$7.65

Hospital Charge Code	3250864
Hospital Revenue Code	270
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: UnitedHealthcare Commercial	$7.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 2 White

Facility

$7.65

Hospital Charge Code	3250864
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: Humana Medicare Advantage	$3.21
Rate for Payer: UnitedHealthcare Commercial	$7.27
Rate for Payer: UnitedHealthcare Medicaid	$3.06
Rate for Payer: WPPA Medicare Advantage	$4.59

Casting Tape 3 Dark Blue

Facility

$8.33

Hospital Charge Code	3250876
Hospital Revenue Code	270
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$7.91
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Humana Medicare Advantage	$3.50
Rate for Payer: UnitedHealthcare Commercial	$7.91
Rate for Payer: UnitedHealthcare Medicaid	$3.33
Rate for Payer: WPPA Medicare Advantage	$5.00

Casting Tape 3 Dark Blue

Facility

$8.33

Hospital Charge Code	3250876
Hospital Revenue Code	270
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: UnitedHealthcare Commercial	$7.91
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges