Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Central Line

Facility

$429.69

Hospital Charge Code	3256650
Hospital Revenue Code	270
Min. Negotiated Rate	$386.72
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$386.72
Rate for Payer: UnitedHealthcare Commercial	$408.21
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Central Line

Facility

$429.69

Hospital Charge Code	3256650
Hospital Revenue Code	270
Min. Negotiated Rate	$171.88
Max. Negotiated Rate	$408.21
Rate for Payer: Aetna Commercial	$386.72
Rate for Payer: Humana Medicare Advantage	$180.47
Rate for Payer: UnitedHealthcare Commercial	$408.21
Rate for Payer: UnitedHealthcare Medicaid	$171.88
Rate for Payer: WPPA Medicare Advantage	$257.81

Centromere B Ab QST

Facility

$51.00

Service Code	HCPCS 86235
Hospital Charge Code	3556407
Hospital Revenue Code	300
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: UnitedHealthcare Commercial	$48.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Centromere B Ab QST

Facility

$51.00

Service Code	HCPCS 86235
Hospital Charge Code	3556407
Hospital Revenue Code	300
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$52.26
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$52.26
Rate for Payer: Humana Medicare Advantage	$21.42
Rate for Payer: UnitedHealthcare Commercial	$48.45
Rate for Payer: UnitedHealthcare Medicaid	$17.93
Rate for Payer: WPPA Medicare Advantage	$30.60

cephalexin 250 mg Cap [HMC]

Facility

$7.08

Service Code	NDC 68180012101
Hospital Charge Code	3808041
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$6.73
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: Humana Medicare Advantage	$2.97
Rate for Payer: UnitedHealthcare Commercial	$6.73
Rate for Payer: UnitedHealthcare Medicaid	$2.83
Rate for Payer: WPPA Medicare Advantage	$4.25

cephalexin 250 mg Cap [HMC]

Facility

$7.03

Service Code	NDC 50268015115
Hospital Charge Code	3808041
Hospital Revenue Code	250
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.33
Rate for Payer: UnitedHealthcare Commercial	$6.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 250 mg Cap [HMC]

Facility

$7.08

Service Code	NDC 68180012101
Hospital Charge Code	3808041
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: UnitedHealthcare Commercial	$6.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 250 mg Cap [HMC]

Facility

$6.21

Service Code	NDC 00904733661
Hospital Charge Code	3808041
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.59
Rate for Payer: UnitedHealthcare Commercial	$5.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 250 mg Cap [HMC]

Facility

$7.14

Service Code	NDC 60687015201
Hospital Charge Code	3808041
Hospital Revenue Code	250
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$6.78
Rate for Payer: Aetna Commercial	$6.43
Rate for Payer: Humana Medicare Advantage	$3.00
Rate for Payer: UnitedHealthcare Commercial	$6.78
Rate for Payer: UnitedHealthcare Medicaid	$2.86
Rate for Payer: WPPA Medicare Advantage	$4.28

cephalexin 250 mg Cap [HMC]

Facility

$7.14

Service Code	NDC 60687015201
Hospital Charge Code	3808041
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.43
Rate for Payer: UnitedHealthcare Commercial	$6.78
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 250 mg Cap [HMC]

Facility

$6.21

Service Code	NDC 00904733661
Hospital Charge Code	3808041
Hospital Revenue Code	250
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$5.90
Rate for Payer: Aetna Commercial	$5.59
Rate for Payer: Humana Medicare Advantage	$2.61
Rate for Payer: UnitedHealthcare Commercial	$5.90
Rate for Payer: UnitedHealthcare Medicaid	$2.48
Rate for Payer: WPPA Medicare Advantage	$3.73

cephalexin 250 mg Cap [HMC]

Facility

$7.03

Service Code	NDC 50268015115
Hospital Charge Code	3808041
Hospital Revenue Code	250
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$6.68
Rate for Payer: Aetna Commercial	$6.33
Rate for Payer: Humana Medicare Advantage	$2.95
Rate for Payer: UnitedHealthcare Commercial	$6.68
Rate for Payer: UnitedHealthcare Medicaid	$2.81
Rate for Payer: WPPA Medicare Advantage	$4.22

cephalexin 500 mg Cap [HMC]

Facility

$6.35

Service Code	NDC 00904733761
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.71
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 500 mg Cap [HMC]

Facility

$9.13

Service Code	NDC 68180012201
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$8.22
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.22
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 500 mg Cap [HMC]

Facility

$15.45

Service Code	NDC 62584023601
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$14.68
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: Humana Medicare Advantage	$6.49
Rate for Payer: UnitedHealthcare Commercial	$14.68
Rate for Payer: UnitedHealthcare Medicaid	$6.18
Rate for Payer: WPPA Medicare Advantage	$9.27

cephalexin 500 mg Cap [HMC]

Facility

$6.35

Service Code	NDC 00904733761
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna Commercial	$5.71
Rate for Payer: Humana Medicare Advantage	$2.67
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: UnitedHealthcare Medicaid	$2.54
Rate for Payer: WPPA Medicare Advantage	$3.81

cephalexin 500 mg Cap [HMC]

Facility

$15.45

Service Code	NDC 62584023601
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: UnitedHealthcare Commercial	$14.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 500 mg Cap [HMC]

Facility

$8.67

Service Code	NDC 50268015215
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Humana Medicare Advantage	$3.64
Rate for Payer: UnitedHealthcare Commercial	$8.24
Rate for Payer: UnitedHealthcare Medicaid	$3.47
Rate for Payer: WPPA Medicare Advantage	$5.20

cephalexin 500 mg Cap [HMC]

Facility

$10.91

Service Code	NDC 67877021901
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$10.36
Rate for Payer: Aetna Commercial	$9.82
Rate for Payer: Humana Medicare Advantage	$4.58
Rate for Payer: UnitedHealthcare Commercial	$10.36
Rate for Payer: UnitedHealthcare Medicaid	$4.36
Rate for Payer: WPPA Medicare Advantage	$6.55

cephalexin 500 mg Cap [HMC]

Facility

$10.91

Service Code	NDC 67877021901
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.82
Rate for Payer: UnitedHealthcare Commercial	$10.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 500 mg Cap [HMC]

Facility

$8.67

Service Code	NDC 50268015215
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: UnitedHealthcare Commercial	$8.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cephalexin 500 mg Cap [HMC]

Facility

$9.13

Service Code	NDC 68180012201
Hospital Charge Code	3804800
Hospital Revenue Code	250
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$8.67
Rate for Payer: Aetna Commercial	$8.22
Rate for Payer: Humana Medicare Advantage	$3.83
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicaid	$3.65
Rate for Payer: WPPA Medicare Advantage	$5.48

certolizumab 200 mg/mL Kit [HMC]

Facility

$10,314.54

Service Code	HCPCS J0717
Hospital Charge Code	3852265
Hospital Revenue Code	250
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,798.81
Rate for Payer: Aetna Commercial	$9,283.09
Rate for Payer: UnitedHealthcare Commercial	$9,798.81
Rate for Payer: WPPA Medicare Advantage	$1,200.00

certolizumab 200 mg/mL Kit [HMC]

Facility

$10,314.54

Service Code	HCPCS J0717
Hospital Charge Code	3852265
Hospital Revenue Code	250
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$9,798.81
Rate for Payer: Aetna Commercial	$9,283.09
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5.95
Rate for Payer: Humana Medicare Advantage	$4,332.11
Rate for Payer: UnitedHealthcare Commercial	$9,798.81
Rate for Payer: UnitedHealthcare Medicaid	$3.87
Rate for Payer: WPPA Medicare Advantage	$6,188.72

Ceruloplasmin QST

Facility

$75.00

Service Code	HCPCS 82390
Hospital Charge Code	3552390
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

Know your out-of-pocket cost for care.

All Charges