Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Cortisol, Total QST

Facility

$102.00

Service Code	HCPCS 82533
Hospital Charge Code	3551914
Hospital Revenue Code	300
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$96.90
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$60.54
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$96.90
Rate for Payer: UnitedHealthcare Medicaid	$16.30
Rate for Payer: WPPA Medicare Advantage	$61.20

cosyntropin 0.25 mg Inj [HMC]

Facility

$164.36

Service Code	HCPCS J0834
Hospital Charge Code	3800178
Hospital Revenue Code	250
Min. Negotiated Rate	$147.92
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$147.92
Rate for Payer: Aetna Commercial	$190.66
Rate for Payer: UnitedHealthcare Commercial	$201.25
Rate for Payer: UnitedHealthcare Commercial	$156.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cosyntropin 0.25 mg Inj [HMC]

Facility

$164.36

Service Code	HCPCS J0834
Hospital Charge Code	3800178
Hospital Revenue Code	250
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$156.14
Rate for Payer: Aetna Commercial	$147.92
Rate for Payer: Aetna Commercial	$190.66
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.78
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.78
Rate for Payer: Humana Medicare Advantage	$88.97
Rate for Payer: Humana Medicare Advantage	$69.03
Rate for Payer: UnitedHealthcare Commercial	$201.25
Rate for Payer: UnitedHealthcare Commercial	$156.14
Rate for Payer: UnitedHealthcare Medicaid	$20.65
Rate for Payer: UnitedHealthcare Medicaid	$20.65
Rate for Payer: WPPA Medicare Advantage	$127.10
Rate for Payer: WPPA Medicare Advantage	$98.62

Cottonwood (T14) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1008
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

Cottonwood (T14) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1008
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

cough drop/sugar free loz [HMC]

Facility

$5.32

Service Code	NDC 36602019210
Hospital Charge Code	3801389
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$5.05
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: Humana Medicare Advantage	$2.23
Rate for Payer: UnitedHealthcare Commercial	$5.05
Rate for Payer: UnitedHealthcare Medicaid	$2.13
Rate for Payer: WPPA Medicare Advantage	$3.19

cough drop/sugar free loz [HMC]

Facility

$5.32

Service Code	NDC 36602019210
Hospital Charge Code	3801389
Hospital Revenue Code	250
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: UnitedHealthcare Commercial	$5.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cough drop/sugar free loz [HMC]

Facility

$5.48

Service Code	NDC 12546062213
Hospital Charge Code	3801389
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$5.21
Rate for Payer: Aetna Commercial	$4.93
Rate for Payer: Humana Medicare Advantage	$2.30
Rate for Payer: UnitedHealthcare Commercial	$5.21
Rate for Payer: UnitedHealthcare Medicaid	$2.19
Rate for Payer: WPPA Medicare Advantage	$3.29

cough drop/sugar free loz [HMC]

Facility

$5.48

Service Code	NDC 12546062213
Hospital Charge Code	3801389
Hospital Revenue Code	250
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.93
Rate for Payer: UnitedHealthcare Commercial	$5.21
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Countersink 2.8mm Cannulated

Facility

$698.00

Hospital Charge Code	3258598
Hospital Revenue Code	270
Min. Negotiated Rate	$628.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$628.20
Rate for Payer: UnitedHealthcare Commercial	$663.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Countersink 2.8mm Cannulated

Facility

$698.00

Hospital Charge Code	3258598
Hospital Revenue Code	270
Min. Negotiated Rate	$279.20
Max. Negotiated Rate	$663.10
Rate for Payer: Aetna Commercial	$628.20
Rate for Payer: Humana Medicare Advantage	$293.16
Rate for Payer: UnitedHealthcare Commercial	$663.10
Rate for Payer: UnitedHealthcare Medicaid	$279.20
Rate for Payer: WPPA Medicare Advantage	$418.80

Countersink 3.0mm Headless

Facility

$774.00

Hospital Charge Code	3258317
Hospital Revenue Code	270
Min. Negotiated Rate	$696.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$696.60
Rate for Payer: UnitedHealthcare Commercial	$735.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Countersink 3.0mm Headless

Facility

$774.00

Hospital Charge Code	3258317
Hospital Revenue Code	270
Min. Negotiated Rate	$309.60
Max. Negotiated Rate	$735.30
Rate for Payer: Aetna Commercial	$696.60
Rate for Payer: Humana Medicare Advantage	$325.08
Rate for Payer: UnitedHealthcare Commercial	$735.30
Rate for Payer: UnitedHealthcare Medicaid	$309.60
Rate for Payer: WPPA Medicare Advantage	$464.40

Cow's Milk (F2) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3550802
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$19.95
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$8.82
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$12.60

Cow's Milk (F2) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3550802
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Coxsackie A Abs QST

Facility

$198.00

Service Code	HCPCS 86658
Hospital Charge Code	3557477
Hospital Revenue Code	300
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$178.20
Rate for Payer: UnitedHealthcare Commercial	$188.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Coxsackie A Abs QST

Facility

$198.00

Service Code	HCPCS 86658
Hospital Charge Code	3557477
Hospital Revenue Code	300
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$178.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$74.45
Rate for Payer: Humana Medicare Advantage	$83.16
Rate for Payer: UnitedHealthcare Commercial	$188.10
Rate for Payer: UnitedHealthcare Medicaid	$11.08
Rate for Payer: WPPA Medicare Advantage	$118.80

C-Peptide QST

Facility

$110.00

Service Code	HCPCS 84681
Hospital Charge Code	3558468
Hospital Revenue Code	300
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$104.50
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$66.63
Rate for Payer: Humana Medicare Advantage	$46.20
Rate for Payer: UnitedHealthcare Commercial	$104.50
Rate for Payer: UnitedHealthcare Medicaid	$17.69
Rate for Payer: WPPA Medicare Advantage	$66.00

C-Peptide QST

Facility

$110.00

Service Code	HCPCS 84681
Hospital Charge Code	3558468
Hospital Revenue Code	300
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: UnitedHealthcare Commercial	$104.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CPR

Facility

$678.00

Service Code	HCPCS 92950
Hospital Charge Code	3152950
Hospital Revenue Code	360
Min. Negotiated Rate	$114.74
Max. Negotiated Rate	$644.10
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$309.49
Rate for Payer: Humana Medicare Advantage	$284.76
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: UnitedHealthcare Medicaid	$114.74
Rate for Payer: WPPA Medicare Advantage	$406.80

CPR

Facility

$678.00

Service Code	HCPCS 92950
Hospital Charge Code	3152950
Hospital Revenue Code	360
Min. Negotiated Rate	$610.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CPR Mini Scorpion DX

Facility

$3,287.00

Hospital Charge Code	3258523
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,122.65
Rate for Payer: Aetna Commercial	$2,958.30
Rate for Payer: UnitedHealthcare Commercial	$3,122.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CPR Mini Scorpion DX

Facility

$3,287.00

Hospital Charge Code	3258523
Hospital Revenue Code	270
Min. Negotiated Rate	$1,314.80
Max. Negotiated Rate	$3,122.65
Rate for Payer: Aetna Commercial	$2,958.30
Rate for Payer: Humana Medicare Advantage	$1,380.54
Rate for Payer: UnitedHealthcare Commercial	$3,122.65
Rate for Payer: UnitedHealthcare Medicaid	$1,314.80
Rate for Payer: WPPA Medicare Advantage	$1,972.20

cranberry 425 mg Cap [HMC]

Facility

$5.11

Service Code	NDC 43292055812
Hospital Charge Code	3800214
Hospital Revenue Code	250
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.60
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cranberry 425 mg Cap [HMC]

Facility

$5.11

Service Code	NDC 43292055812
Hospital Charge Code	3800214
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$4.85
Rate for Payer: Aetna Commercial	$4.60
Rate for Payer: Humana Medicare Advantage	$2.15
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: UnitedHealthcare Medicaid	$2.04
Rate for Payer: WPPA Medicare Advantage	$3.07

Know your out-of-pocket cost for care.

All Charges