Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Cath Tray Intermittent w/ Latex 15fr Foley - Uretheral Straight Catheter Tray

Facility

$7.00

Hospital Charge Code	3250972
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Tray Quick Cath Female Urine Specimen 8fr

Facility

$7.29

Hospital Charge Code	3250602
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.56
Rate for Payer: UnitedHealthcare Commercial	$6.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Tray Quick Cath Female Urine Specimen 8fr

Facility

$7.29

Hospital Charge Code	3250602
Hospital Revenue Code	270
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.93
Rate for Payer: Aetna Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.06
Rate for Payer: UnitedHealthcare Commercial	$6.93
Rate for Payer: UnitedHealthcare Medicaid	$2.92
Rate for Payer: WPPA Medicare Advantage	$4.37

Cath Tray Residual

Facility

$13.19

Hospital Charge Code	3254997
Hospital Revenue Code	270
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$12.53
Rate for Payer: Aetna Commercial	$11.87
Rate for Payer: Humana Medicare Advantage	$5.54
Rate for Payer: UnitedHealthcare Commercial	$12.53
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: WPPA Medicare Advantage	$7.91

Cath Tray Residual

Facility

$13.19

Hospital Charge Code	3254997
Hospital Revenue Code	270
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.87
Rate for Payer: UnitedHealthcare Commercial	$12.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Umbilical 3.5

Facility

$89.96

Hospital Charge Code	3250192
Hospital Revenue Code	270
Min. Negotiated Rate	$35.98
Max. Negotiated Rate	$85.46
Rate for Payer: Aetna Commercial	$80.96
Rate for Payer: Humana Medicare Advantage	$37.78
Rate for Payer: UnitedHealthcare Commercial	$85.46
Rate for Payer: UnitedHealthcare Medicaid	$35.98
Rate for Payer: WPPA Medicare Advantage	$53.98

Cath Umbilical 3.5

Facility

$89.96

Hospital Charge Code	3250192
Hospital Revenue Code	270
Min. Negotiated Rate	$80.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$80.96
Rate for Payer: UnitedHealthcare Commercial	$85.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Umbilical 5.0

Facility

$89.10

Hospital Charge Code	3250200
Hospital Revenue Code	270
Min. Negotiated Rate	$80.19
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$80.19
Rate for Payer: UnitedHealthcare Commercial	$84.64
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Umbilical 5.0

Facility

$89.10

Hospital Charge Code	3250200
Hospital Revenue Code	270
Min. Negotiated Rate	$35.64
Max. Negotiated Rate	$84.64
Rate for Payer: Aetna Commercial	$80.19
Rate for Payer: Humana Medicare Advantage	$37.42
Rate for Payer: UnitedHealthcare Commercial	$84.64
Rate for Payer: UnitedHealthcare Medicaid	$35.64
Rate for Payer: WPPA Medicare Advantage	$53.46

Cautery Handheld Fine Tip

Facility

$43.29

Hospital Charge Code	3258006
Hospital Revenue Code	270
Min. Negotiated Rate	$38.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$38.96
Rate for Payer: UnitedHealthcare Commercial	$41.13
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cautery Handheld Fine Tip

Facility

$43.29

Hospital Charge Code	3258006
Hospital Revenue Code	270
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$41.13
Rate for Payer: Aetna Commercial	$38.96
Rate for Payer: Humana Medicare Advantage	$18.18
Rate for Payer: UnitedHealthcare Commercial	$41.13
Rate for Payer: UnitedHealthcare Medicaid	$17.32
Rate for Payer: WPPA Medicare Advantage	$25.97

CBC w/ Differential

Facility

$75.00

Service Code	HCPCS 85025
Hospital Charge Code	3550122
Hospital Revenue Code	300
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$13.36
Rate for Payer: Humana Medicare Advantage	$31.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: UnitedHealthcare Medicaid	$6.60
Rate for Payer: WPPA Medicare Advantage	$45.00

CBC w/ Differential

Facility

$75.00

Service Code	HCPCS 85025
Hospital Charge Code	3550122
Hospital Revenue Code	300
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CBC without Differential

Facility

$66.00

Service Code	HCPCS 85027
Hospital Charge Code	3550130
Hospital Revenue Code	300
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CBC without Differential

Facility

$66.00

Service Code	HCPCS 85027
Hospital Charge Code	3550130
Hospital Revenue Code	300
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$62.70
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$13.90
Rate for Payer: Humana Medicare Advantage	$27.72
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: UnitedHealthcare Medicaid	$6.47
Rate for Payer: WPPA Medicare Advantage	$39.60

C-Collar Adult Flat Hard

Facility

$24.93

Hospital Charge Code	3250286
Hospital Revenue Code	270
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$22.44
Rate for Payer: Humana Medicare Advantage	$10.47
Rate for Payer: UnitedHealthcare Commercial	$23.68
Rate for Payer: UnitedHealthcare Medicaid	$9.97
Rate for Payer: WPPA Medicare Advantage	$14.96

C-Collar Adult Flat Hard

Facility

$24.93

Hospital Charge Code	3250286
Hospital Revenue Code	270
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.44
Rate for Payer: UnitedHealthcare Commercial	$23.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

C-Collar Adult X-Short Extendable Wear Post-Op

Facility

$183.00

Hospital Charge Code	3254670
Hospital Revenue Code	270
Min. Negotiated Rate	$164.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$164.70
Rate for Payer: UnitedHealthcare Commercial	$173.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

C-Collar Adult X-Short Extendable Wear Post-Op

Facility

$183.00

Hospital Charge Code	3254670
Hospital Revenue Code	270
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$173.85
Rate for Payer: Aetna Commercial	$164.70
Rate for Payer: Humana Medicare Advantage	$76.86
Rate for Payer: UnitedHealthcare Commercial	$173.85
Rate for Payer: UnitedHealthcare Medicaid	$73.20
Rate for Payer: WPPA Medicare Advantage	$109.80

C-Collar Pedi Flat Hard

Facility

$24.71

Hospital Charge Code	3250288
Hospital Revenue Code	270
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$23.47
Rate for Payer: Aetna Commercial	$22.24
Rate for Payer: Humana Medicare Advantage	$10.38
Rate for Payer: UnitedHealthcare Commercial	$23.47
Rate for Payer: UnitedHealthcare Medicaid	$9.88
Rate for Payer: WPPA Medicare Advantage	$14.83

C-Collar Pedi Flat Hard

Facility

$24.71

Hospital Charge Code	3250288
Hospital Revenue Code	270
Min. Negotiated Rate	$22.24
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.24
Rate for Payer: UnitedHealthcare Commercial	$23.47
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CCP Ab (IgG) QST

Facility

$134.00

Service Code	HCPCS 86200
Hospital Charge Code	3551164
Hospital Revenue Code	300
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$27.79
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$12.95
Rate for Payer: WPPA Medicare Advantage	$80.40

CCP Ab (IgG) QST

Facility

$134.00

Service Code	HCPCS 86200
Hospital Charge Code	3551164
Hospital Revenue Code	300
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefadroxil 500 mg Cap [HMC]

Facility

$16.16

Service Code	NDC 68180018008
Hospital Charge Code	3804743
Hospital Revenue Code	250
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$15.35
Rate for Payer: Aetna Commercial	$14.54
Rate for Payer: Humana Medicare Advantage	$6.79
Rate for Payer: UnitedHealthcare Commercial	$15.35
Rate for Payer: UnitedHealthcare Medicaid	$6.46
Rate for Payer: WPPA Medicare Advantage	$9.70

cefadroxil 500 mg Cap [HMC]

Facility

$16.16

Service Code	NDC 68180018008
Hospital Charge Code	3804743
Hospital Revenue Code	250
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.54
Rate for Payer: UnitedHealthcare Commercial	$15.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges