Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

colchicine 0.6 mg Tab [HMC]

Facility

$19.39

Service Code	NDC 00904712004
Hospital Charge Code	3808752
Hospital Revenue Code	250
Min. Negotiated Rate	$17.45
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.45
Rate for Payer: UnitedHealthcare Commercial	$18.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

colestipol 1 g Tab [HMC]

Facility

$8.79

Service Code	NDC 59762045001
Hospital Charge Code	3806354
Hospital Revenue Code	250
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.91
Rate for Payer: UnitedHealthcare Commercial	$8.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

colestipol 1 g Tab [HMC]

Facility

$17.51

Service Code	NDC 60687071521
Hospital Charge Code	3806354
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$16.63
Rate for Payer: Aetna Commercial	$15.76
Rate for Payer: Humana Medicare Advantage	$7.35
Rate for Payer: UnitedHealthcare Commercial	$16.63
Rate for Payer: UnitedHealthcare Medicaid	$7.00
Rate for Payer: WPPA Medicare Advantage	$10.51

colestipol 1 g Tab [HMC]

Facility

$17.51

Service Code	NDC 60687071521
Hospital Charge Code	3806354
Hospital Revenue Code	250
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.76
Rate for Payer: UnitedHealthcare Commercial	$16.63
Rate for Payer: WPPA Medicare Advantage	$1,200.00

colestipol 1 g Tab [HMC]

Facility

$8.79

Service Code	NDC 59762045001
Hospital Charge Code	3806354
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$8.35
Rate for Payer: Aetna Commercial	$7.91
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: UnitedHealthcare Commercial	$8.35
Rate for Payer: UnitedHealthcare Medicaid	$3.52
Rate for Payer: WPPA Medicare Advantage	$5.27

colestipol 5 g Oral Gran [HMC]

Facility

$16.79

Service Code	NDC 59762026001
Hospital Charge Code	3800104
Hospital Revenue Code	250
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$15.95
Rate for Payer: Aetna Commercial	$15.11
Rate for Payer: Humana Medicare Advantage	$7.05
Rate for Payer: UnitedHealthcare Commercial	$15.95
Rate for Payer: UnitedHealthcare Medicaid	$6.72
Rate for Payer: WPPA Medicare Advantage	$10.07

colestipol 5 g Oral Gran [HMC]

Facility

$16.79

Service Code	NDC 00115521218
Hospital Charge Code	3800104
Hospital Revenue Code	250
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$15.95
Rate for Payer: Aetna Commercial	$15.11
Rate for Payer: Humana Medicare Advantage	$7.05
Rate for Payer: UnitedHealthcare Commercial	$15.95
Rate for Payer: UnitedHealthcare Medicaid	$6.72
Rate for Payer: WPPA Medicare Advantage	$10.07

colestipol 5 g Oral Gran [HMC]

Facility

$16.79

Service Code	NDC 59762026001
Hospital Charge Code	3800104
Hospital Revenue Code	250
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.11
Rate for Payer: UnitedHealthcare Commercial	$15.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

colestipol 5 g Oral Gran [HMC]

Facility

$16.79

Service Code	NDC 00115521218
Hospital Charge Code	3800104
Hospital Revenue Code	250
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.11
Rate for Payer: UnitedHealthcare Commercial	$15.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

collagenase topical 250 units/g Oin [HMC]

Facility

$509.65

Service Code	NDC 50484001030
Hospital Charge Code	3800066
Hospital Revenue Code	250
Min. Negotiated Rate	$458.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$458.69
Rate for Payer: UnitedHealthcare Commercial	$484.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

collagenase topical 250 units/g Oin [HMC]

Facility

$509.65

Service Code	NDC 50484001030
Hospital Charge Code	3800066
Hospital Revenue Code	250
Min. Negotiated Rate	$203.86
Max. Negotiated Rate	$484.17
Rate for Payer: Aetna Commercial	$458.69
Rate for Payer: Humana Medicare Advantage	$214.05
Rate for Payer: UnitedHealthcare Commercial	$484.17
Rate for Payer: UnitedHealthcare Medicaid	$203.86
Rate for Payer: WPPA Medicare Advantage	$305.79

Collagen Cross-Linked N-Telopeptide QST

Facility

$277.00

Service Code	HCPCS 82523
Hospital Charge Code	3558252
Hospital Revenue Code	300
Min. Negotiated Rate	$249.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$249.30
Rate for Payer: UnitedHealthcare Commercial	$263.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Collagen Cross-Linked N-Telopeptide QST

Facility

$277.00

Service Code	HCPCS 82523
Hospital Charge Code	3558252
Hospital Revenue Code	300
Min. Negotiated Rate	$62.35
Max. Negotiated Rate	$263.15
Rate for Payer: Aetna Commercial	$249.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$62.35
Rate for Payer: Humana Medicare Advantage	$116.34
Rate for Payer: UnitedHealthcare Commercial	$263.15
Rate for Payer: UnitedHealthcare Medicaid	$110.80
Rate for Payer: WPPA Medicare Advantage	$166.20

Collar Cervical Large

Facility

$86.00

Hospital Charge Code	3250664
Hospital Revenue Code	270
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$77.40
Rate for Payer: UnitedHealthcare Commercial	$81.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Collar Cervical Large

Facility

$86.00

Hospital Charge Code	3250664
Hospital Revenue Code	270
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$81.70
Rate for Payer: Aetna Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$36.12
Rate for Payer: UnitedHealthcare Commercial	$81.70
Rate for Payer: UnitedHealthcare Medicaid	$34.40
Rate for Payer: WPPA Medicare Advantage	$51.60

Collar Cervical Medium

Facility

$85.00

Hospital Charge Code	3254666
Hospital Revenue Code	270
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Collar Cervical Medium

Facility

$85.00

Hospital Charge Code	3254666
Hospital Revenue Code	270
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$80.75
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Humana Medicare Advantage	$35.70
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: UnitedHealthcare Medicaid	$34.00
Rate for Payer: WPPA Medicare Advantage	$51.00

Collar Cervical Small

Facility

$31.95

Hospital Charge Code	3254658
Hospital Revenue Code	270
Min. Negotiated Rate	$28.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.75
Rate for Payer: UnitedHealthcare Commercial	$30.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Collar Cervical Small

Facility

$31.95

Hospital Charge Code	3254658
Hospital Revenue Code	270
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$30.35
Rate for Payer: Aetna Commercial	$28.75
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: UnitedHealthcare Commercial	$30.35
Rate for Payer: UnitedHealthcare Medicaid	$12.78
Rate for Payer: WPPA Medicare Advantage	$19.17

Collar Cervical X-Large

Facility

$78.00

Hospital Charge Code	3252092
Hospital Revenue Code	270
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: UnitedHealthcare Commercial	$74.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Collar Cervical X-Large

Facility

$78.00

Hospital Charge Code	3252092
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$74.10
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Humana Medicare Advantage	$32.76
Rate for Payer: UnitedHealthcare Commercial	$74.10
Rate for Payer: UnitedHealthcare Medicaid	$31.20
Rate for Payer: WPPA Medicare Advantage	$46.80

COLLECTION: Arterial Draw

Facility

$188.00

Service Code	HCPCS 36600
Hospital Charge Code	3900630
Hospital Revenue Code	300
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$178.60
Rate for Payer: Aetna Commercial	$169.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.67
Rate for Payer: Humana Medicare Advantage	$78.96
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: WPPA Medicare Advantage	$112.80

COLLECTION: Arterial Draw

Facility

$188.00

Service Code	HCPCS 36600
Hospital Charge Code	3900630
Hospital Revenue Code	300
Min. Negotiated Rate	$169.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$169.20
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

COLLECTION: Capillary

Facility

$43.00

Service Code	HCPCS 36416
Hospital Charge Code	3556416
Hospital Revenue Code	300
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$40.85
Rate for Payer: Aetna Commercial	$38.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4.42
Rate for Payer: Humana Medicare Advantage	$18.06
Rate for Payer: UnitedHealthcare Commercial	$40.85
Rate for Payer: UnitedHealthcare Medicaid	$17.20
Rate for Payer: WPPA Medicare Advantage	$25.80

COLLECTION: Capillary

Facility

$43.00

Service Code	HCPCS 36416
Hospital Charge Code	3556416
Hospital Revenue Code	300
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$38.70
Rate for Payer: UnitedHealthcare Commercial	$40.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges