Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

ceftaroline 600 mg Pow [HMC]

Facility

$627.90

Service Code	HCPCS J0712
Hospital Charge Code	3807037
Hospital Revenue Code	250
Min. Negotiated Rate	$565.11
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$565.11
Rate for Payer: UnitedHealthcare Commercial	$596.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefTAZidime 1 g Pow [HMC]

Facility

$30.47

Service Code	HCPCS J0713
Hospital Charge Code	3808363
Hospital Revenue Code	259
Min. Negotiated Rate	$27.42
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$27.42
Rate for Payer: UnitedHealthcare Commercial	$28.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefTAZidime 1 g Pow [HMC]

Facility

$30.47

Service Code	HCPCS J0713
Hospital Charge Code	3808363
Hospital Revenue Code	259
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$27.42
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2.50
Rate for Payer: Humana Medicare Advantage	$12.80
Rate for Payer: UnitedHealthcare Commercial	$28.95
Rate for Payer: UnitedHealthcare Medicaid	$1.47
Rate for Payer: WPPA Medicare Advantage	$18.28

cefTRIAXone 1 g Inj ADV [HMC]

Facility

$35.59

Service Code	HCPCS J0696
Hospital Charge Code	3807035
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$33.81
Rate for Payer: Aetna Commercial	$32.03
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Humana Medicare Advantage	$14.95
Rate for Payer: UnitedHealthcare Commercial	$33.81
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: WPPA Medicare Advantage	$21.35

cefTRIAXone 1 g Inj ADV [HMC]

Facility

$35.59

Service Code	HCPCS J0696
Hospital Charge Code	3807035
Hospital Revenue Code	250
Min. Negotiated Rate	$32.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$32.03
Rate for Payer: UnitedHealthcare Commercial	$33.81
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefTRIAXone 1 g Inj [HMC]

Facility

$44.85

Service Code	HCPCS J0696
Hospital Charge Code	3807035
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$42.61
Rate for Payer: Aetna Commercial	$40.37
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Aetna Commercial	$117.47
Rate for Payer: Aetna Commercial	$26.23
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Humana Medicare Advantage	$12.24
Rate for Payer: Humana Medicare Advantage	$18.84
Rate for Payer: Humana Medicare Advantage	$54.82
Rate for Payer: Humana Medicare Advantage	$37.38
Rate for Payer: UnitedHealthcare Commercial	$123.99
Rate for Payer: UnitedHealthcare Commercial	$27.68
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$42.61
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: WPPA Medicare Advantage	$78.31
Rate for Payer: WPPA Medicare Advantage	$26.91
Rate for Payer: WPPA Medicare Advantage	$53.40
Rate for Payer: WPPA Medicare Advantage	$17.48

cefTRIAXone 1 g Inj [HMC]

Facility

$29.14

Service Code	HCPCS J0696
Hospital Charge Code	3807035
Hospital Revenue Code	250
Min. Negotiated Rate	$26.23
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.23
Rate for Payer: Aetna Commercial	$117.47
Rate for Payer: Aetna Commercial	$40.37
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: UnitedHealthcare Commercial	$123.99
Rate for Payer: UnitedHealthcare Commercial	$27.68
Rate for Payer: UnitedHealthcare Commercial	$42.61
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefTRIAXone 2 g Inj [HMC]

Facility

$37.36

Service Code	NDC 00409733520
Hospital Charge Code	3805873
Hospital Revenue Code	250
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$33.62
Rate for Payer: UnitedHealthcare Commercial	$35.49
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefTRIAXone 2 g Inj [HMC]

Facility

$37.36

Service Code	HCPCS J0696
Hospital Charge Code	3805873
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$35.49
Rate for Payer: Aetna Commercial	$33.62
Rate for Payer: Aetna Commercial	$141.40
Rate for Payer: Aetna Commercial	$60.19
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Humana Medicare Advantage	$28.09
Rate for Payer: Humana Medicare Advantage	$65.99
Rate for Payer: Humana Medicare Advantage	$15.69
Rate for Payer: UnitedHealthcare Commercial	$63.54
Rate for Payer: UnitedHealthcare Commercial	$35.49
Rate for Payer: UnitedHealthcare Commercial	$149.25
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: WPPA Medicare Advantage	$22.42
Rate for Payer: WPPA Medicare Advantage	$94.27
Rate for Payer: WPPA Medicare Advantage	$40.13

cefTRIAXone 2 g Inj [HMC]

Facility

$37.36

Service Code	NDC 00409733520
Hospital Charge Code	3805873
Hospital Revenue Code	250
Min. Negotiated Rate	$14.94
Max. Negotiated Rate	$35.49
Rate for Payer: Aetna Commercial	$33.62
Rate for Payer: Humana Medicare Advantage	$15.69
Rate for Payer: UnitedHealthcare Commercial	$35.49
Rate for Payer: UnitedHealthcare Medicaid	$14.94
Rate for Payer: WPPA Medicare Advantage	$22.42

cefTRIAXone 2 g Inj [HMC]

Facility

$37.36

Service Code	HCPCS J0696
Hospital Charge Code	3805873
Hospital Revenue Code	250
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$33.62
Rate for Payer: Aetna Commercial	$141.40
Rate for Payer: Aetna Commercial	$60.19
Rate for Payer: UnitedHealthcare Commercial	$35.49
Rate for Payer: UnitedHealthcare Commercial	$149.25
Rate for Payer: UnitedHealthcare Commercial	$63.54
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefTRIAXone 500 mg Inj [HMC]

Facility

$42.50

Service Code	HCPCS J0696
Hospital Charge Code	3807027
Hospital Revenue Code	250
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna Commercial	$54.30
Rate for Payer: UnitedHealthcare Commercial	$40.38
Rate for Payer: UnitedHealthcare Commercial	$57.31
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefTRIAXone 500 mg Inj [HMC]

Facility

$42.50

Service Code	HCPCS J0696
Hospital Charge Code	3807027
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$40.38
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna Commercial	$54.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.69
Rate for Payer: Humana Medicare Advantage	$17.85
Rate for Payer: Humana Medicare Advantage	$25.34
Rate for Payer: UnitedHealthcare Commercial	$40.38
Rate for Payer: UnitedHealthcare Commercial	$57.31
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: UnitedHealthcare Medicaid	$0.46
Rate for Payer: WPPA Medicare Advantage	$25.50
Rate for Payer: WPPA Medicare Advantage	$36.20

cefuroxime 1.5 g Pow [HMC]

Facility

$31.60

Service Code	HCPCS J0697
Hospital Charge Code	3805898
Hospital Revenue Code	250
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.44
Rate for Payer: Aetna Commercial	$45.29
Rate for Payer: UnitedHealthcare Commercial	$47.80
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cefuroxime 1.5 g Pow [HMC]

Facility

$50.32

Service Code	HCPCS J0697
Hospital Charge Code	3805898
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$47.80
Rate for Payer: Aetna Commercial	$45.29
Rate for Payer: Aetna Commercial	$28.44
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2.86
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2.86
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Humana Medicare Advantage	$21.13
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Commercial	$47.80
Rate for Payer: UnitedHealthcare Medicaid	$2.05
Rate for Payer: UnitedHealthcare Medicaid	$2.05
Rate for Payer: WPPA Medicare Advantage	$30.19
Rate for Payer: WPPA Medicare Advantage	$18.96

celecoxib 200 mg Cap [HMC]

Facility

$12.28

Service Code	NDC 50268016915
Hospital Charge Code	3802291
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.05
Rate for Payer: UnitedHealthcare Commercial	$11.67
Rate for Payer: WPPA Medicare Advantage	$1,200.00

celecoxib 200 mg Cap [HMC]

Facility

$12.28

Service Code	NDC 50268016915
Hospital Charge Code	3802291
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$11.67
Rate for Payer: Aetna Commercial	$11.05
Rate for Payer: Humana Medicare Advantage	$5.16
Rate for Payer: UnitedHealthcare Commercial	$11.67
Rate for Payer: UnitedHealthcare Medicaid	$4.91
Rate for Payer: WPPA Medicare Advantage	$7.37

celecoxib 200 mg Cap [HMC]

Facility

$42.53

Service Code	NDC 00025152534
Hospital Charge Code	3802291
Hospital Revenue Code	250
Min. Negotiated Rate	$17.01
Max. Negotiated Rate	$40.40
Rate for Payer: Aetna Commercial	$38.28
Rate for Payer: Humana Medicare Advantage	$17.86
Rate for Payer: UnitedHealthcare Commercial	$40.40
Rate for Payer: UnitedHealthcare Medicaid	$17.01
Rate for Payer: WPPA Medicare Advantage	$25.52

celecoxib 200 mg Cap [HMC]

Facility

$42.53

Service Code	NDC 00025152534
Hospital Charge Code	3802291
Hospital Revenue Code	250
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$38.28
Rate for Payer: UnitedHealthcare Commercial	$40.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Celiac Disease Comprehensive Panel QST, Child <4yr old QST

Facility

$134.00

Service Code	HCPCS 86364
Hospital Charge Code	3556364
Hospital Revenue Code	300
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$7.49
Rate for Payer: WPPA Medicare Advantage	$80.40

Celiac Disease Comprehensive Panel QST, Child <4yr old QST

Facility

$134.00

Service Code	HCPCS 86364
Hospital Charge Code	3556364
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

Celiac Disease Comprehensive Panel QST PMH

Facility

$186.00

Service Code	HCPCS 86364
Hospital Charge Code	3550178
Hospital Revenue Code	300
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$176.70
Rate for Payer: Aetna Commercial	$167.40
Rate for Payer: Humana Medicare Advantage	$78.12
Rate for Payer: UnitedHealthcare Commercial	$176.70
Rate for Payer: UnitedHealthcare Medicaid	$7.49
Rate for Payer: WPPA Medicare Advantage	$111.60

Celiac Disease Comprehensive Panel QST PMH

Facility

$186.00

Service Code	HCPCS 86364
Hospital Charge Code	3550178
Hospital Revenue Code	300
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$167.40
Rate for Payer: UnitedHealthcare Commercial	$176.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CELLULITIS WITH MCC

Facility

$7,021.17

Service Code	MSDRG 602
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,021.17
Rate for Payer: UnitedHealthcare Medicaid	$7,021.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CELLULITIS WITHOUT MCC

Facility

$4,003.02

Service Code	MSDRG 603
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,003.02
Rate for Payer: UnitedHealthcare Medicaid	$4,003.02
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges