Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Cast Shoe X-Large Navy

Facility

$81.63

Hospital Charge Code	3255465
Hospital Revenue Code	270
Min. Negotiated Rate	$32.65
Max. Negotiated Rate	$77.55
Rate for Payer: Aetna Commercial	$73.47
Rate for Payer: Humana Medicare Advantage	$34.28
Rate for Payer: UnitedHealthcare Commercial	$77.55
Rate for Payer: UnitedHealthcare Medicaid	$32.65
Rate for Payer: WPPA Medicare Advantage	$48.98

Cast Shoe X-Large Navy

Facility

$81.63

Hospital Charge Code	3255465
Hospital Revenue Code	270
Min. Negotiated Rate	$73.47
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$73.47
Rate for Payer: UnitedHealthcare Commercial	$77.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Shoe X-Small Navy

Facility

$115.00

Hospital Charge Code	3255459
Hospital Revenue Code	270
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$103.50
Rate for Payer: UnitedHealthcare Commercial	$109.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Shoe X-Small Navy

Facility

$115.00

Hospital Charge Code	3255459
Hospital Revenue Code	270
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$109.25
Rate for Payer: Aetna Commercial	$103.50
Rate for Payer: Humana Medicare Advantage	$48.30
Rate for Payer: UnitedHealthcare Commercial	$109.25
Rate for Payer: UnitedHealthcare Medicaid	$46.00
Rate for Payer: WPPA Medicare Advantage	$69.00

Cat Dander (E1) IgE QST

Facility

$98.00

Service Code	HCPCS 86008
Hospital Charge Code	3556008
Hospital Revenue Code	300
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$93.10
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$40.26
Rate for Payer: Humana Medicare Advantage	$41.16
Rate for Payer: UnitedHealthcare Commercial	$93.10
Rate for Payer: UnitedHealthcare Medicaid	$17.93
Rate for Payer: WPPA Medicare Advantage	$58.80

Cat Dander (E1) IgE QST

Facility

$98.00

Service Code	HCPCS 86008
Hospital Charge Code	3556008
Hospital Revenue Code	300
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: UnitedHealthcare Commercial	$93.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cat Dander (E1) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1004
Hospital Revenue Code	300
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cat Dander (E1) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1004
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$11.34
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$16.20

Catecholamines, Frac, U24 w/o Creat QST

Facility

$65.00

Service Code	HCPCS 82384
Hospital Charge Code	3559627
Hospital Revenue Code	300
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$115.99
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$115.99
Rate for Payer: Humana Medicare Advantage	$27.30
Rate for Payer: UnitedHealthcare Commercial	$61.75
Rate for Payer: UnitedHealthcare Medicaid	$25.25
Rate for Payer: WPPA Medicare Advantage	$39.00

Catecholamines, Frac, U24 w/o Creat QST

Facility

$65.00

Service Code	HCPCS 82384
Hospital Charge Code	3559627
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: UnitedHealthcare Commercial	$61.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter AngioCath 14G X 5-1/4

Facility

$67.50

Hospital Charge Code	3252160
Hospital Revenue Code	270
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$64.12
Rate for Payer: Aetna Commercial	$60.75
Rate for Payer: Humana Medicare Advantage	$28.35
Rate for Payer: UnitedHealthcare Commercial	$64.12
Rate for Payer: UnitedHealthcare Medicaid	$27.00
Rate for Payer: WPPA Medicare Advantage	$40.50

Catheter AngioCath 14G X 5-1/4

Facility

$67.50

Hospital Charge Code	3252160
Hospital Revenue Code	270
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$60.75
Rate for Payer: UnitedHealthcare Commercial	$64.12
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Caudal Epidural Brevi-Kath

Facility

$223.00

Hospital Charge Code	3253549
Hospital Revenue Code	270
Min. Negotiated Rate	$89.20
Max. Negotiated Rate	$211.85
Rate for Payer: Aetna Commercial	$200.70
Rate for Payer: Humana Medicare Advantage	$93.66
Rate for Payer: UnitedHealthcare Commercial	$211.85
Rate for Payer: UnitedHealthcare Medicaid	$89.20
Rate for Payer: WPPA Medicare Advantage	$133.80

Catheter Caudal Epidural Brevi-Kath

Facility

$223.00

Hospital Charge Code	3253549
Hospital Revenue Code	270
Min. Negotiated Rate	$200.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$200.70
Rate for Payer: UnitedHealthcare Commercial	$211.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex 18fr 30cc Balloon Coude Tip

Facility

$62.00

Hospital Charge Code	3258063
Hospital Revenue Code	270
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$58.90
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Humana Medicare Advantage	$26.04
Rate for Payer: UnitedHealthcare Commercial	$58.90
Rate for Payer: UnitedHealthcare Medicaid	$24.80
Rate for Payer: WPPA Medicare Advantage	$37.20

Catheter Foley Latex 18fr 30cc Balloon Coude Tip

Facility

$62.00

Hospital Charge Code	3258063
Hospital Revenue Code	270
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: UnitedHealthcare Commercial	$58.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 08FR 3CC Balloon 2Way

Facility

$17.42

Hospital Charge Code	3258500
Hospital Revenue Code	270
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$16.55
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Humana Medicare Advantage	$7.32
Rate for Payer: UnitedHealthcare Commercial	$16.55
Rate for Payer: UnitedHealthcare Medicaid	$6.97
Rate for Payer: WPPA Medicare Advantage	$10.45

Catheter Foley Latex-Free 08FR 3CC Balloon 2Way

Facility

$17.42

Hospital Charge Code	3258500
Hospital Revenue Code	270
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: UnitedHealthcare Commercial	$16.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 10FR 3CC Balloon 2Way

Facility

$17.42

Hospital Charge Code	3258502
Hospital Revenue Code	270
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: UnitedHealthcare Commercial	$16.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 10FR 3CC Balloon 2Way

Facility

$17.42

Hospital Charge Code	3258502
Hospital Revenue Code	270
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$16.55
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Humana Medicare Advantage	$7.32
Rate for Payer: UnitedHealthcare Commercial	$16.55
Rate for Payer: UnitedHealthcare Medicaid	$6.97
Rate for Payer: WPPA Medicare Advantage	$10.45

Catheter Foley Latex-Free 12FR 5CC Balloon 2Way

Facility

$16.65

Hospital Charge Code	3258504
Hospital Revenue Code	270
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.98
Rate for Payer: UnitedHealthcare Commercial	$15.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 12FR 5CC Balloon 2Way

Facility

$16.65

Hospital Charge Code	3258504
Hospital Revenue Code	270
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$15.82
Rate for Payer: Aetna Commercial	$14.98
Rate for Payer: Humana Medicare Advantage	$6.99
Rate for Payer: UnitedHealthcare Commercial	$15.82
Rate for Payer: UnitedHealthcare Medicaid	$6.66
Rate for Payer: WPPA Medicare Advantage	$9.99

Catheter Foley Latex-Free 14FR 5CC Balloon 2Way

Facility

$16.43

Hospital Charge Code	3258066
Hospital Revenue Code	270
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$15.61
Rate for Payer: Aetna Commercial	$14.79
Rate for Payer: Humana Medicare Advantage	$6.90
Rate for Payer: UnitedHealthcare Commercial	$15.61
Rate for Payer: UnitedHealthcare Medicaid	$6.57
Rate for Payer: WPPA Medicare Advantage	$9.86

Catheter Foley Latex-Free 14FR 5CC Balloon 2Way

Facility

$16.43

Hospital Charge Code	3258066
Hospital Revenue Code	270
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.79
Rate for Payer: UnitedHealthcare Commercial	$15.61
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 16FR 30CC Balloon 2Way

Facility

$13.95

Hospital Charge Code	3258517
Hospital Revenue Code	270
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$13.25
Rate for Payer: Aetna Commercial	$12.55
Rate for Payer: Humana Medicare Advantage	$5.86
Rate for Payer: UnitedHealthcare Commercial	$13.25
Rate for Payer: UnitedHealthcare Medicaid	$5.58
Rate for Payer: WPPA Medicare Advantage	$8.37

Know your out-of-pocket cost for care.

All Charges