Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

desflurane 100% Liq [HMC]

Facility

$360.49

Service Code	NDC 00781617286
Hospital Charge Code	3170325
Hospital Revenue Code	370
Min. Negotiated Rate	$144.20
Max. Negotiated Rate	$342.47
Rate for Payer: Aetna Commercial	$324.44
Rate for Payer: Humana Medicare Advantage	$151.41
Rate for Payer: UnitedHealthcare Commercial	$342.47
Rate for Payer: UnitedHealthcare Medicaid	$144.20
Rate for Payer: WPPA Medicare Advantage	$216.29

desflurane 100% Liq [HMC]

Facility

$384.53

Service Code	NDC 10019064434
Hospital Charge Code	3170325
Hospital Revenue Code	370
Min. Negotiated Rate	$153.81
Max. Negotiated Rate	$365.30
Rate for Payer: Aetna Commercial	$346.08
Rate for Payer: Humana Medicare Advantage	$161.50
Rate for Payer: UnitedHealthcare Commercial	$365.30
Rate for Payer: UnitedHealthcare Medicaid	$153.81
Rate for Payer: WPPA Medicare Advantage	$230.72

desmopressin 4 mcg/mL IV Sol [HMC]

Facility

$125.83

Service Code	HCPCS J2597
Hospital Charge Code	3800883
Hospital Revenue Code	250
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$119.54
Rate for Payer: Aetna Commercial	$113.25
Rate for Payer: Aetna Commercial	$103.05
Rate for Payer: Aetna Commercial	$79.56
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.14
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.14
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.14
Rate for Payer: Humana Medicare Advantage	$52.85
Rate for Payer: Humana Medicare Advantage	$48.09
Rate for Payer: Humana Medicare Advantage	$37.13
Rate for Payer: UnitedHealthcare Commercial	$108.78
Rate for Payer: UnitedHealthcare Commercial	$119.54
Rate for Payer: UnitedHealthcare Commercial	$83.98
Rate for Payer: UnitedHealthcare Medicaid	$3.41
Rate for Payer: UnitedHealthcare Medicaid	$3.41
Rate for Payer: UnitedHealthcare Medicaid	$3.41
Rate for Payer: WPPA Medicare Advantage	$53.04
Rate for Payer: WPPA Medicare Advantage	$75.50
Rate for Payer: WPPA Medicare Advantage	$68.70

desmopressin 4 mcg/mL IV Sol [HMC]

Facility

$114.50

Service Code	HCPCS J2597
Hospital Charge Code	3800883
Hospital Revenue Code	250
Min. Negotiated Rate	$103.05
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$103.05
Rate for Payer: Aetna Commercial	$113.25
Rate for Payer: Aetna Commercial	$79.56
Rate for Payer: UnitedHealthcare Commercial	$83.98
Rate for Payer: UnitedHealthcare Commercial	$108.78
Rate for Payer: UnitedHealthcare Commercial	$119.54
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

desvenlafaxine 50 mg [HMC]

Facility

$27.02

Service Code	NDC 70436001204
Hospital Charge Code	3807055
Hospital Revenue Code	250
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$25.67
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Humana Medicare Advantage	$11.35
Rate for Payer: UnitedHealthcare Commercial	$25.67
Rate for Payer: UnitedHealthcare Medicaid	$10.81
Rate for Payer: WPPA Medicare Advantage	$16.21

desvenlafaxine 50 mg [HMC]

Facility

$40.04

Service Code	NDC 00008121130
Hospital Charge Code	3807055
Hospital Revenue Code	250
Min. Negotiated Rate	$36.04
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: UnitedHealthcare Commercial	$38.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

desvenlafaxine 50 mg [HMC]

Facility

$27.02

Service Code	NDC 70436001204
Hospital Charge Code	3807055
Hospital Revenue Code	250
Min. Negotiated Rate	$24.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: UnitedHealthcare Commercial	$25.67
Rate for Payer: WPPA Medicare Advantage	$1,200.00

desvenlafaxine 50 mg [HMC]

Facility

$40.04

Service Code	NDC 00008121130
Hospital Charge Code	3807055
Hospital Revenue Code	250
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$38.04
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Humana Medicare Advantage	$16.82
Rate for Payer: UnitedHealthcare Commercial	$38.04
Rate for Payer: UnitedHealthcare Medicaid	$16.02
Rate for Payer: WPPA Medicare Advantage	$24.02

desvenlafaxine 50 mg [HMC]

Facility

$12.71

Service Code	NDC 60687060721
Hospital Charge Code	3807055
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$12.07
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: UnitedHealthcare Commercial	$12.07
Rate for Payer: UnitedHealthcare Medicaid	$5.08
Rate for Payer: WPPA Medicare Advantage	$7.63

desvenlafaxine 50 mg [HMC]

Facility

$12.71

Service Code	NDC 60687060721
Hospital Charge Code	3807055
Hospital Revenue Code	250
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: UnitedHealthcare Commercial	$12.07
Rate for Payer: WPPA Medicare Advantage	$1,200.00

dexamethasone 10 mg/mL Inj Sol 100mg/10ml [HMC]

Facility

$54.29

Service Code	HCPCS J1100
Hospital Charge Code	3808710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$51.58
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna Commercial	$39.59
Rate for Payer: Aetna Commercial	$51.46
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Humana Medicare Advantage	$22.80
Rate for Payer: Humana Medicare Advantage	$18.48
Rate for Payer: Humana Medicare Advantage	$24.02
Rate for Payer: UnitedHealthcare Commercial	$41.79
Rate for Payer: UnitedHealthcare Commercial	$51.58
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: WPPA Medicare Advantage	$34.31
Rate for Payer: WPPA Medicare Advantage	$32.57
Rate for Payer: WPPA Medicare Advantage	$26.39

dexamethasone 10 mg/mL Inj Sol 100mg/10ml [HMC]

Facility

$43.99

Service Code	HCPCS J1100
Hospital Charge Code	3808710
Hospital Revenue Code	250
Min. Negotiated Rate	$39.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.59
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna Commercial	$51.46
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: UnitedHealthcare Commercial	$41.79
Rate for Payer: UnitedHealthcare Commercial	$51.58
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

dexamethasone 10 mg/mL Inj Sol 100mg/10ml [HMC]

Facility

$43.99

Service Code	NDC 67457042010
Hospital Charge Code	3808710
Hospital Revenue Code	250
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$41.79
Rate for Payer: Aetna Commercial	$39.59
Rate for Payer: Humana Medicare Advantage	$18.48
Rate for Payer: UnitedHealthcare Commercial	$41.79
Rate for Payer: UnitedHealthcare Medicaid	$17.60
Rate for Payer: WPPA Medicare Advantage	$26.39

dexamethasone 10 mg/mL Inj Sol 100mg/10ml [HMC]

Facility

$43.99

Service Code	NDC 67457042010
Hospital Charge Code	3808710
Hospital Revenue Code	250
Min. Negotiated Rate	$39.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.59
Rate for Payer: UnitedHealthcare Commercial	$41.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

dexamethasone 10 mg/mL preservative-free [HMC]

Facility

$47.00

Service Code	HCPCS J1100
Hospital Charge Code	3800348
Hospital Revenue Code	250
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Aetna Commercial	$32.26
Rate for Payer: Aetna Commercial	$34.97
Rate for Payer: UnitedHealthcare Commercial	$34.05
Rate for Payer: UnitedHealthcare Commercial	$36.92
Rate for Payer: UnitedHealthcare Commercial	$44.65
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

dexamethasone 10 mg/mL preservative-free [HMC]

Facility

$38.86

Service Code	HCPCS J1100
Hospital Charge Code	3800348
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$36.92
Rate for Payer: Aetna Commercial	$34.97
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Aetna Commercial	$32.26
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Humana Medicare Advantage	$19.74
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: Humana Medicare Advantage	$16.32
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: UnitedHealthcare Commercial	$36.92
Rate for Payer: UnitedHealthcare Commercial	$34.05
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: WPPA Medicare Advantage	$28.20
Rate for Payer: WPPA Medicare Advantage	$21.50
Rate for Payer: WPPA Medicare Advantage	$23.32

dexamethasone 1 mg/mL Oral Conc [HMC]

Facility

$19.38

Service Code	HCPCS J8540
Hospital Charge Code	3800826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$18.41
Rate for Payer: Aetna Commercial	$17.44
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Humana Medicare Advantage	$8.14
Rate for Payer: UnitedHealthcare Commercial	$18.41
Rate for Payer: UnitedHealthcare Medicaid	$7.75
Rate for Payer: WPPA Medicare Advantage	$11.63

dexamethasone 1 mg/mL Oral Conc [HMC]

Facility

$19.38

Service Code	HCPCS J8540
Hospital Charge Code	3800826
Hospital Revenue Code	250
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.44
Rate for Payer: UnitedHealthcare Commercial	$18.41
Rate for Payer: WPPA Medicare Advantage	$1,200.00

dexamethasone 4 mg/mL Inj Sol [HMC]

Facility

$24.95

Service Code	HCPCS J1100
Hospital Charge Code	3804933
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$23.70
Rate for Payer: Aetna Commercial	$22.45
Rate for Payer: Aetna Commercial	$23.32
Rate for Payer: Aetna Commercial	$22.19
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Humana Medicare Advantage	$10.88
Rate for Payer: Humana Medicare Advantage	$10.36
Rate for Payer: Humana Medicare Advantage	$10.48
Rate for Payer: UnitedHealthcare Commercial	$24.61
Rate for Payer: UnitedHealthcare Commercial	$23.70
Rate for Payer: UnitedHealthcare Commercial	$23.43
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: WPPA Medicare Advantage	$15.55
Rate for Payer: WPPA Medicare Advantage	$14.80
Rate for Payer: WPPA Medicare Advantage	$14.97

dexamethasone 4 mg/mL Inj Sol [HMC]

Facility

$24.95

Service Code	HCPCS J1100
Hospital Charge Code	3804933
Hospital Revenue Code	250
Min. Negotiated Rate	$22.45
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.45
Rate for Payer: Aetna Commercial	$22.19
Rate for Payer: Aetna Commercial	$23.32
Rate for Payer: UnitedHealthcare Commercial	$23.70
Rate for Payer: UnitedHealthcare Commercial	$23.43
Rate for Payer: UnitedHealthcare Commercial	$24.61
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

dexamethasone 4 mg Tab [HMC]

Facility

$8.61

Service Code	HCPCS J8540
Hospital Charge Code	3805294
Hospital Revenue Code	250
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.75
Rate for Payer: Aetna Commercial	$7.88
Rate for Payer: UnitedHealthcare Commercial	$8.18
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

dexamethasone 4 mg Tab [HMC]

Facility

$8.61

Service Code	HCPCS J8540
Hospital Charge Code	3805294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$8.18
Rate for Payer: Aetna Commercial	$7.75
Rate for Payer: Aetna Commercial	$7.88
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Humana Medicare Advantage	$3.68
Rate for Payer: Humana Medicare Advantage	$3.62
Rate for Payer: UnitedHealthcare Commercial	$8.18
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Medicaid	$3.44
Rate for Payer: UnitedHealthcare Medicaid	$3.50
Rate for Payer: WPPA Medicare Advantage	$5.17
Rate for Payer: WPPA Medicare Advantage	$5.26

dexamethasone 6 mg Tab [HMC]

Facility

$10.69

Service Code	HCPCS J8540
Hospital Charge Code	3803572
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$10.16
Rate for Payer: Aetna Commercial	$9.62
Rate for Payer: Aetna Commercial	$10.30
Rate for Payer: Aetna Commercial	$9.31
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Humana Medicare Advantage	$4.49
Rate for Payer: Humana Medicare Advantage	$4.35
Rate for Payer: Humana Medicare Advantage	$4.81
Rate for Payer: UnitedHealthcare Commercial	$10.16
Rate for Payer: UnitedHealthcare Commercial	$9.83
Rate for Payer: UnitedHealthcare Commercial	$10.88
Rate for Payer: UnitedHealthcare Medicaid	$4.28
Rate for Payer: UnitedHealthcare Medicaid	$4.58
Rate for Payer: UnitedHealthcare Medicaid	$4.14
Rate for Payer: WPPA Medicare Advantage	$6.41
Rate for Payer: WPPA Medicare Advantage	$6.21
Rate for Payer: WPPA Medicare Advantage	$6.87

dexamethasone 6 mg Tab [HMC]

Facility

$10.69

Service Code	HCPCS J8540
Hospital Charge Code	3803572
Hospital Revenue Code	259
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.62
Rate for Payer: Aetna Commercial	$9.31
Rate for Payer: Aetna Commercial	$10.30
Rate for Payer: UnitedHealthcare Commercial	$9.83
Rate for Payer: UnitedHealthcare Commercial	$10.16
Rate for Payer: UnitedHealthcare Commercial	$10.88
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

Dexamethasone Bill only

Facility

$132.00

Service Code	HCPCS 80299
Hospital Charge Code	3552990
Hospital Revenue Code	300
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$125.40
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$65.71
Rate for Payer: Humana Medicare Advantage	$55.44
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: UnitedHealthcare Medicaid	$18.64
Rate for Payer: WPPA Medicare Advantage	$79.20

Know your out-of-pocket cost for care.

All Charges