Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Culture, Mycobacteria w/ Fluorochrome Smear QST

Facility

$80.00

Service Code	HCPCS 87116
Hospital Charge Code	3551229
Hospital Revenue Code	300
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$47.89
Rate for Payer: Humana Medicare Advantage	$33.60
Rate for Payer: UnitedHealthcare Commercial	$76.00
Rate for Payer: UnitedHealthcare Medicaid	$10.50
Rate for Payer: WPPA Medicare Advantage	$48.00

Culture, NP/Nasal QST

Facility

$71.00

Service Code	HCPCS 87070
Hospital Charge Code	3551088
Hospital Revenue Code	300
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: UnitedHealthcare Commercial	$67.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Culture, NP/Nasal QST

Facility

$71.00

Service Code	HCPCS 87070
Hospital Charge Code	3551088
Hospital Revenue Code	300
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$67.45
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$31.88
Rate for Payer: Humana Medicare Advantage	$29.82
Rate for Payer: UnitedHealthcare Commercial	$67.45
Rate for Payer: UnitedHealthcare Medicaid	$7.35
Rate for Payer: WPPA Medicare Advantage	$42.60

Culture, Sputum/Lower Respiratory QST

Facility

$71.00

Service Code	HCPCS 87070
Hospital Charge Code	3551153
Hospital Revenue Code	300
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: UnitedHealthcare Commercial	$67.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Culture, Sputum/Lower Respiratory QST

Facility

$71.00

Service Code	HCPCS 87070
Hospital Charge Code	3551153
Hospital Revenue Code	300
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$67.45
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$31.88
Rate for Payer: Humana Medicare Advantage	$29.82
Rate for Payer: UnitedHealthcare Commercial	$67.45
Rate for Payer: UnitedHealthcare Medicaid	$7.35
Rate for Payer: WPPA Medicare Advantage	$42.60

Culture, Throat QST

Facility

$71.00

Service Code	HCPCS 87070
Hospital Charge Code	3551088
Hospital Revenue Code	300
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: UnitedHealthcare Commercial	$67.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Culture, Throat QST

Facility

$71.00

Service Code	HCPCS 87070
Hospital Charge Code	3551088
Hospital Revenue Code	300
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$67.45
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$31.88
Rate for Payer: Humana Medicare Advantage	$29.82
Rate for Payer: UnitedHealthcare Commercial	$67.45
Rate for Payer: UnitedHealthcare Medicaid	$7.35
Rate for Payer: WPPA Medicare Advantage	$42.60

Culture, Urine Routine QST

Facility

$69.00

Service Code	HCPCS 87086
Hospital Charge Code	3550346
Hospital Revenue Code	300
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: UnitedHealthcare Commercial	$65.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Culture, Urine Routine QST

Facility

$69.00

Service Code	HCPCS 87086
Hospital Charge Code	3550346
Hospital Revenue Code	300
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$30.38
Rate for Payer: Humana Medicare Advantage	$28.98
Rate for Payer: UnitedHealthcare Commercial	$65.55
Rate for Payer: UnitedHealthcare Medicaid	$8.07
Rate for Payer: WPPA Medicare Advantage	$41.40

Culture, Urine Special QST

Facility

$69.00

Service Code	HCPCS 87086
Hospital Charge Code	3550906
Hospital Revenue Code	300
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$30.38
Rate for Payer: Humana Medicare Advantage	$28.98
Rate for Payer: UnitedHealthcare Commercial	$65.55
Rate for Payer: UnitedHealthcare Medicaid	$8.07
Rate for Payer: WPPA Medicare Advantage	$41.40

Culture, Urine Special QST

Facility

$69.00

Service Code	HCPCS 87086
Hospital Charge Code	3550906
Hospital Revenue Code	300
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: UnitedHealthcare Commercial	$65.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Culture, Viral Body Fluids, Tissues QST

Facility

$315.00

Service Code	HCPCS 87252
Hospital Charge Code	3551195
Hospital Revenue Code	300
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$283.50
Rate for Payer: UnitedHealthcare Commercial	$299.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Culture, Viral Body Fluids, Tissues QST

Facility

$315.00

Service Code	HCPCS 87252
Hospital Charge Code	3551195
Hospital Revenue Code	300
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$299.25
Rate for Payer: Aetna Commercial	$283.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$93.01
Rate for Payer: Humana Medicare Advantage	$132.30
Rate for Payer: UnitedHealthcare Commercial	$299.25
Rate for Payer: UnitedHealthcare Medicaid	$26.07
Rate for Payer: WPPA Medicare Advantage	$189.00

Cushion Coccyx Kabooti XL 3-in-1

Facility

$118.00

Hospital Charge Code	3259242
Hospital Revenue Code	270
Min. Negotiated Rate	$106.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$106.20
Rate for Payer: UnitedHealthcare Commercial	$112.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cushion Coccyx Kabooti XL 3-in-1

Facility

$118.00

Hospital Charge Code	3259242
Hospital Revenue Code	270
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$112.10
Rate for Payer: Aetna Commercial	$106.20
Rate for Payer: Humana Medicare Advantage	$49.56
Rate for Payer: UnitedHealthcare Commercial	$112.10
Rate for Payer: UnitedHealthcare Medicaid	$47.20
Rate for Payer: WPPA Medicare Advantage	$70.80

Cushion Gel & Foam 16 X 18 X 3

Facility

$107.48

Hospital Charge Code	3259240
Hospital Revenue Code	270
Min. Negotiated Rate	$42.99
Max. Negotiated Rate	$102.11
Rate for Payer: Aetna Commercial	$96.73
Rate for Payer: Humana Medicare Advantage	$45.14
Rate for Payer: UnitedHealthcare Commercial	$102.11
Rate for Payer: UnitedHealthcare Medicaid	$42.99
Rate for Payer: WPPA Medicare Advantage	$64.49

Cushion Gel & Foam 16 X 18 X 3

Facility

$107.48

Hospital Charge Code	3259240
Hospital Revenue Code	270
Min. Negotiated Rate	$96.73
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$96.73
Rate for Payer: UnitedHealthcare Commercial	$102.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cushion Ring Gel & Foam 9 Diameter

Facility

$125.00

Hospital Charge Code	3250481
Hospital Revenue Code	270
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: UnitedHealthcare Commercial	$118.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cushion Ring Gel & Foam 9 Diameter

Facility

$125.00

Hospital Charge Code	3250481
Hospital Revenue Code	270
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$118.75
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Humana Medicare Advantage	$52.50
Rate for Payer: UnitedHealthcare Commercial	$118.75
Rate for Payer: UnitedHealthcare Medicaid	$50.00
Rate for Payer: WPPA Medicare Advantage	$75.00

Cushion Ring Inflatable PVC 14 Diameter

Facility

$7.00

Hospital Charge Code	3250485
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

Cushion Ring Inflatable PVC 14 Diameter

Facility

$7.00

Hospital Charge Code	3250485
Hospital Revenue Code	270
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.65
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Humana Medicare Advantage	$2.94
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: WPPA Medicare Advantage	$4.20

Cushion Ring Molded Seat 18 Navy

Facility

$61.88

Hospital Charge Code	3259245
Hospital Revenue Code	270
Min. Negotiated Rate	$55.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$55.69
Rate for Payer: UnitedHealthcare Commercial	$58.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cushion Ring Molded Seat 18 Navy

Facility

$61.88

Hospital Charge Code	3259245
Hospital Revenue Code	270
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$58.79
Rate for Payer: Aetna Commercial	$55.69
Rate for Payer: Humana Medicare Advantage	$25.99
Rate for Payer: UnitedHealthcare Commercial	$58.79
Rate for Payer: UnitedHealthcare Medicaid	$24.75
Rate for Payer: WPPA Medicare Advantage	$37.13

cyanocobalamin 1000 mcg/mL Inj Sol [HMC]

Facility

$21.06

Service Code	HCPCS J3420
Hospital Charge Code	3801179
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$20.01
Rate for Payer: Aetna Commercial	$18.95
Rate for Payer: Aetna Commercial	$30.89
Rate for Payer: Aetna Commercial	$33.52
Rate for Payer: Aetna Commercial	$40.46
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.86
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.86
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.86
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.86
Rate for Payer: Humana Medicare Advantage	$18.88
Rate for Payer: Humana Medicare Advantage	$15.64
Rate for Payer: Humana Medicare Advantage	$14.41
Rate for Payer: Humana Medicare Advantage	$8.85
Rate for Payer: UnitedHealthcare Commercial	$42.71
Rate for Payer: UnitedHealthcare Commercial	$32.60
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Commercial	$35.39
Rate for Payer: UnitedHealthcare Medicaid	$0.64
Rate for Payer: UnitedHealthcare Medicaid	$0.64
Rate for Payer: UnitedHealthcare Medicaid	$0.64
Rate for Payer: UnitedHealthcare Medicaid	$0.64
Rate for Payer: WPPA Medicare Advantage	$26.98
Rate for Payer: WPPA Medicare Advantage	$22.35
Rate for Payer: WPPA Medicare Advantage	$20.59
Rate for Payer: WPPA Medicare Advantage	$12.64

cyanocobalamin 1000 mcg/mL Inj Sol [HMC]

Facility

$37.25

Service Code	NDC 70069000510
Hospital Charge Code	3801179
Hospital Revenue Code	250
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$35.39
Rate for Payer: Aetna Commercial	$33.52
Rate for Payer: Humana Medicare Advantage	$15.64
Rate for Payer: UnitedHealthcare Commercial	$35.39
Rate for Payer: UnitedHealthcare Medicaid	$14.90
Rate for Payer: WPPA Medicare Advantage	$22.35

Know your out-of-pocket cost for care.

All Charges