Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

enalapril 20 mg Tab [HMC]

Facility

$7.40

Service Code	NDC 00904731261
Hospital Charge Code	3809197
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$7.03
Rate for Payer: Aetna Commercial	$6.66
Rate for Payer: Humana Medicare Advantage	$3.11
Rate for Payer: UnitedHealthcare Commercial	$7.03
Rate for Payer: UnitedHealthcare Medicaid	$2.96
Rate for Payer: WPPA Medicare Advantage	$4.44

enalapril 20 mg Tab [HMC]

Facility

$7.99

Service Code	NDC 68682071301
Hospital Charge Code	3809197
Hospital Revenue Code	250
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.19
Rate for Payer: UnitedHealthcare Commercial	$7.59
Rate for Payer: WPPA Medicare Advantage	$1,200.00

enalapril 20 mg Tab [HMC]

Facility

$13.30

Service Code	NDC 23155077301
Hospital Charge Code	3809197
Hospital Revenue Code	250
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.97
Rate for Payer: UnitedHealthcare Commercial	$12.63
Rate for Payer: WPPA Medicare Advantage	$1,200.00

enalapril 20 mg Tab [HMC]

Facility

$7.40

Service Code	NDC 00904731261
Hospital Charge Code	3809197
Hospital Revenue Code	250
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.66
Rate for Payer: UnitedHealthcare Commercial	$7.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

enalapril 20 mg Tab [HMC]

Facility

$13.30

Service Code	NDC 23155077301
Hospital Charge Code	3809197
Hospital Revenue Code	250
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$12.63
Rate for Payer: Aetna Commercial	$11.97
Rate for Payer: Humana Medicare Advantage	$5.59
Rate for Payer: UnitedHealthcare Commercial	$12.63
Rate for Payer: UnitedHealthcare Medicaid	$5.32
Rate for Payer: WPPA Medicare Advantage	$7.98

enalapril 20 mg Tab [HMC]

Facility

$7.99

Service Code	NDC 68682071301
Hospital Charge Code	3809197
Hospital Revenue Code	250
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$7.59
Rate for Payer: Aetna Commercial	$7.19
Rate for Payer: Humana Medicare Advantage	$3.36
Rate for Payer: UnitedHealthcare Commercial	$7.59
Rate for Payer: UnitedHealthcare Medicaid	$3.20
Rate for Payer: WPPA Medicare Advantage	$4.79

enalapril 5 mg Tab [HMC]

Facility

$9.63

Service Code	NDC 00904550261
Hospital Charge Code	3803778
Hospital Revenue Code	250
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.67
Rate for Payer: UnitedHealthcare Commercial	$9.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

enalapril 5 mg Tab [HMC]

Facility

$10.55

Service Code	NDC 23155070501
Hospital Charge Code	3803778
Hospital Revenue Code	250
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$10.02
Rate for Payer: Aetna Commercial	$9.49
Rate for Payer: Humana Medicare Advantage	$4.43
Rate for Payer: UnitedHealthcare Commercial	$10.02
Rate for Payer: UnitedHealthcare Medicaid	$4.22
Rate for Payer: WPPA Medicare Advantage	$6.33

enalapril 5 mg Tab [HMC]

Facility

$9.63

Service Code	NDC 00904550261
Hospital Charge Code	3803778
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$9.15
Rate for Payer: Aetna Commercial	$8.67
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: UnitedHealthcare Commercial	$9.15
Rate for Payer: UnitedHealthcare Medicaid	$3.85
Rate for Payer: WPPA Medicare Advantage	$5.78

enalapril 5 mg Tab [HMC]

Facility

$10.55

Service Code	NDC 23155070501
Hospital Charge Code	3803778
Hospital Revenue Code	250
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.49
Rate for Payer: UnitedHealthcare Commercial	$10.02
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Endo Aspiration Needle 21G X 13mm TBNA SmoothShot

Facility

$226.00

Hospital Charge Code	3257551
Hospital Revenue Code	270
Min. Negotiated Rate	$90.40
Max. Negotiated Rate	$214.70
Rate for Payer: Aetna Commercial	$203.40
Rate for Payer: Humana Medicare Advantage	$94.92
Rate for Payer: UnitedHealthcare Commercial	$214.70
Rate for Payer: UnitedHealthcare Medicaid	$90.40
Rate for Payer: WPPA Medicare Advantage	$135.60

Endo Aspiration Needle 21G X 13mm TBNA SmoothShot

Facility

$226.00

Hospital Charge Code	3257551
Hospital Revenue Code	270
Min. Negotiated Rate	$203.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$203.40
Rate for Payer: UnitedHealthcare Commercial	$214.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Endo Carry-On Procedure

Facility

$63.00

Hospital Charge Code	3258875
Hospital Revenue Code	270
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$56.70
Rate for Payer: UnitedHealthcare Commercial	$59.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Endo Carry-On Procedure

Facility

$63.00

Hospital Charge Code	3258875
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$59.85
Rate for Payer: Aetna Commercial	$56.70
Rate for Payer: Humana Medicare Advantage	$26.46
Rate for Payer: UnitedHealthcare Commercial	$59.85
Rate for Payer: UnitedHealthcare Medicaid	$25.20
Rate for Payer: WPPA Medicare Advantage	$37.80

ENDOCRINE DISORDERS WITH CC

Facility

$4,447.80

Service Code	MSDRG 644
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,447.80
Rate for Payer: UnitedHealthcare Medicaid	$4,447.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ENDOCRINE DISORDERS WITH MCC

Facility

$7,148.25

Service Code	MSDRG 643
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,148.25
Rate for Payer: UnitedHealthcare Medicaid	$7,148.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$3,335.85

Service Code	MSDRG 645
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,335.85
Rate for Payer: UnitedHealthcare Medicaid	$3,335.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Endo Foreign Body Grasping Device Raptor 2.4mm Diameter 230cm Length

Facility

$416.00

Hospital Charge Code	3257265
Hospital Revenue Code	270
Min. Negotiated Rate	$166.40
Max. Negotiated Rate	$395.20
Rate for Payer: Aetna Commercial	$374.40
Rate for Payer: Humana Medicare Advantage	$174.72
Rate for Payer: UnitedHealthcare Commercial	$395.20
Rate for Payer: UnitedHealthcare Medicaid	$166.40
Rate for Payer: WPPA Medicare Advantage	$249.60

Endo Foreign Body Grasping Device Raptor 2.4mm Diameter 230cm Length

Facility

$416.00

Hospital Charge Code	3257265
Hospital Revenue Code	270
Min. Negotiated Rate	$374.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$374.40
Rate for Payer: UnitedHealthcare Commercial	$395.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Endo GI Spot Marker Ink

Facility

$140.00

Hospital Charge Code	3257240
Hospital Revenue Code	270
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: UnitedHealthcare Commercial	$133.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Endo GI Spot Marker Ink

Facility

$140.00

Hospital Charge Code	3257240
Hospital Revenue Code	270
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Humana Medicare Advantage	$58.80
Rate for Payer: UnitedHealthcare Commercial	$133.00
Rate for Payer: UnitedHealthcare Medicaid	$56.00
Rate for Payer: WPPA Medicare Advantage	$84.00

Endo Injection Needle 25G X 4mm Therapy Injector/Interject Catheter

Facility

$124.00

Hospital Charge Code	3257550
Hospital Revenue Code	270
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$117.80
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Humana Medicare Advantage	$52.08
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: UnitedHealthcare Medicaid	$49.60
Rate for Payer: WPPA Medicare Advantage	$74.40

Endo Injection Needle 25G X 4mm Therapy Injector/Interject Catheter

Facility

$124.00

Hospital Charge Code	3257550
Hospital Revenue Code	270
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Endometrial Pipelle

Facility

$37.94

Hospital Charge Code	3259145
Hospital Revenue Code	270
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$36.04
Rate for Payer: Aetna Commercial	$34.15
Rate for Payer: Humana Medicare Advantage	$15.93
Rate for Payer: UnitedHealthcare Commercial	$36.04
Rate for Payer: UnitedHealthcare Medicaid	$15.18
Rate for Payer: WPPA Medicare Advantage	$22.76

Endometrial Pipelle

Facility

$37.94

Hospital Charge Code	3259145
Hospital Revenue Code	270
Min. Negotiated Rate	$34.15
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.15
Rate for Payer: UnitedHealthcare Commercial	$36.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges