Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

enoxaparin 60 mg/0.6 mL SC Sol [HMC]

Facility

$109.41

Service Code	HCPCS J1650
Hospital Charge Code	3809734
Hospital Revenue Code	250
Min. Negotiated Rate	$98.47
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$98.47
Rate for Payer: Aetna Commercial	$48.18
Rate for Payer: Aetna Commercial	$36.69
Rate for Payer: Aetna Commercial	$37.44
Rate for Payer: UnitedHealthcare Commercial	$38.73
Rate for Payer: UnitedHealthcare Commercial	$50.85
Rate for Payer: UnitedHealthcare Commercial	$103.94
Rate for Payer: UnitedHealthcare Commercial	$39.52
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
Rate for Payer: WPPA Medicare Advantage	$1,200.00

enoxaparin 60 mg/0.6 mL SC Sol [HMC]

Facility

$109.41

Service Code	HCPCS J1650
Hospital Charge Code	3809734
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$103.94
Rate for Payer: Aetna Commercial	$98.47
Rate for Payer: Aetna Commercial	$36.69
Rate for Payer: Aetna Commercial	$37.44
Rate for Payer: Aetna Commercial	$48.18
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.80
Rate for Payer: Humana Medicare Advantage	$22.48
Rate for Payer: Humana Medicare Advantage	$17.47
Rate for Payer: Humana Medicare Advantage	$17.12
Rate for Payer: Humana Medicare Advantage	$45.95
Rate for Payer: UnitedHealthcare Commercial	$50.85
Rate for Payer: UnitedHealthcare Commercial	$38.73
Rate for Payer: UnitedHealthcare Commercial	$103.94
Rate for Payer: UnitedHealthcare Commercial	$39.52
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: WPPA Medicare Advantage	$32.12
Rate for Payer: WPPA Medicare Advantage	$24.96
Rate for Payer: WPPA Medicare Advantage	$24.46
Rate for Payer: WPPA Medicare Advantage	$65.65

enoxaparin 80 mg/0.8 mL Sol [HMC]

Facility

$53.53

Service Code	HCPCS J1650
Hospital Charge Code	3809099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$50.85
Rate for Payer: Aetna Commercial	$48.18
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.80
Rate for Payer: Humana Medicare Advantage	$22.48
Rate for Payer: UnitedHealthcare Commercial	$50.85
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: WPPA Medicare Advantage	$32.12

enoxaparin 80 mg/0.8 mL Sol [HMC]

Facility

$53.53

Service Code	HCPCS J1650
Hospital Charge Code	3809099
Hospital Revenue Code	250
Min. Negotiated Rate	$48.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$48.18
Rate for Payer: UnitedHealthcare Commercial	$50.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Entamoeba Histolytica Ag, EIA QST

Facility

$190.00

Service Code	HCPCS 87337
Hospital Charge Code	3557337
Hospital Revenue Code	300
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$180.50
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$60.95
Rate for Payer: Humana Medicare Advantage	$79.80
Rate for Payer: UnitedHealthcare Commercial	$180.50
Rate for Payer: UnitedHealthcare Medicaid	$11.98
Rate for Payer: WPPA Medicare Advantage	$114.00

Entamoeba Histolytica Ag, EIA QST

Facility

$190.00

Service Code	HCPCS 87337
Hospital Charge Code	3557337
Hospital Revenue Code	300
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$180.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Enterovirus RNA, Ql Real Time PCR QST

Facility

$401.00

Service Code	HCPCS 87498
Hospital Charge Code	3557498
Hospital Revenue Code	300
Min. Negotiated Rate	$360.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$360.90
Rate for Payer: UnitedHealthcare Commercial	$380.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Enterovirus RNA, Ql Real Time PCR QST

Facility

$401.00

Service Code	HCPCS 87498
Hospital Charge Code	3557498
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$380.95
Rate for Payer: Aetna Commercial	$360.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$76.59
Rate for Payer: Humana Medicare Advantage	$168.42
Rate for Payer: UnitedHealthcare Commercial	$380.95
Rate for Payer: UnitedHealthcare Medicaid	$35.09
Rate for Payer: WPPA Medicare Advantage	$240.60

ENT SE Inflation Device for Sinus & Aera Eustachian Dialation Tubes

Facility

$274.00

Hospital Charge Code	3259972
Hospital Revenue Code	270
Min. Negotiated Rate	$109.60
Max. Negotiated Rate	$260.30
Rate for Payer: Aetna Commercial	$246.60
Rate for Payer: Humana Medicare Advantage	$115.08
Rate for Payer: UnitedHealthcare Commercial	$260.30
Rate for Payer: UnitedHealthcare Medicaid	$109.60
Rate for Payer: WPPA Medicare Advantage	$164.40

ENT SE Inflation Device for Sinus & Aera Eustachian Dialation Tubes

Facility

$274.00

Hospital Charge Code	3259972
Hospital Revenue Code	270
Min. Negotiated Rate	$246.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$246.60
Rate for Payer: UnitedHealthcare Commercial	$260.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Eosinophil Count, Nasal QST

Facility

$41.30

Service Code	HCPCS 89190
Hospital Charge Code	3559190
Hospital Revenue Code	300
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$39.23
Rate for Payer: Aetna Commercial	$37.17
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$27.23
Rate for Payer: Humana Medicare Advantage	$17.35
Rate for Payer: UnitedHealthcare Commercial	$39.23
Rate for Payer: UnitedHealthcare Medicaid	$4.92
Rate for Payer: WPPA Medicare Advantage	$24.78

Eosinophil Count, Nasal QST

Facility

$41.30

Service Code	HCPCS 89190
Hospital Charge Code	3559190
Hospital Revenue Code	300
Min. Negotiated Rate	$37.17
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$37.17
Rate for Payer: UnitedHealthcare Commercial	$39.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ePHEDrine 50 mg/5 mL-NS IV Sol [HMC]

Facility

$48.50

Service Code	NDC 61553030870
Hospital Charge Code	3170181
Hospital Revenue Code	250
Min. Negotiated Rate	$19.40
Max. Negotiated Rate	$46.08
Rate for Payer: Aetna Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$20.37
Rate for Payer: UnitedHealthcare Commercial	$46.08
Rate for Payer: UnitedHealthcare Medicaid	$19.40
Rate for Payer: WPPA Medicare Advantage	$29.10

ePHEDrine 50 mg/5 mL-NS IV Sol [HMC]

Facility

$48.50

Service Code	NDC 61553030870
Hospital Charge Code	3170181
Hospital Revenue Code	250
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$43.65
Rate for Payer: UnitedHealthcare Commercial	$46.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ePHEDrine 50 mg/mL [HMC]

Facility

$105.12

Service Code	NDC 17478051701
Hospital Charge Code	3801534
Hospital Revenue Code	250
Min. Negotiated Rate	$94.61
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$94.61
Rate for Payer: UnitedHealthcare Commercial	$99.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ePHEDrine 50 mg/mL [HMC]

Facility

$56.96

Service Code	NDC 43598072525
Hospital Charge Code	3801534
Hospital Revenue Code	250
Min. Negotiated Rate	$22.78
Max. Negotiated Rate	$54.11
Rate for Payer: Aetna Commercial	$51.26
Rate for Payer: Humana Medicare Advantage	$23.92
Rate for Payer: UnitedHealthcare Commercial	$54.11
Rate for Payer: UnitedHealthcare Medicaid	$22.78
Rate for Payer: WPPA Medicare Advantage	$34.18

ePHEDrine 50 mg/mL [HMC]

Facility

$105.12

Service Code	NDC 17478095510
Hospital Charge Code	3801534
Hospital Revenue Code	250
Min. Negotiated Rate	$94.61
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$94.61
Rate for Payer: UnitedHealthcare Commercial	$99.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ePHEDrine 50 mg/mL [HMC]

Facility

$105.12

Service Code	NDC 17478095510
Hospital Charge Code	3801534
Hospital Revenue Code	250
Min. Negotiated Rate	$42.05
Max. Negotiated Rate	$99.86
Rate for Payer: Aetna Commercial	$94.61
Rate for Payer: Humana Medicare Advantage	$44.15
Rate for Payer: UnitedHealthcare Commercial	$99.86
Rate for Payer: UnitedHealthcare Medicaid	$42.05
Rate for Payer: WPPA Medicare Advantage	$63.07

ePHEDrine 50 mg/mL [HMC]

Facility

$65.02

Service Code	NDC 70756061125
Hospital Charge Code	3801534
Hospital Revenue Code	250
Min. Negotiated Rate	$26.01
Max. Negotiated Rate	$61.77
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Humana Medicare Advantage	$27.31
Rate for Payer: UnitedHealthcare Commercial	$61.77
Rate for Payer: UnitedHealthcare Medicaid	$26.01
Rate for Payer: WPPA Medicare Advantage	$39.01

ePHEDrine 50 mg/mL [HMC]

Facility

$56.96

Service Code	NDC 43598072525
Hospital Charge Code	3801534
Hospital Revenue Code	250
Min. Negotiated Rate	$51.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$51.26
Rate for Payer: UnitedHealthcare Commercial	$54.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ePHEDrine 50 mg/mL [HMC]

Facility

$65.02

Service Code	NDC 70756061125
Hospital Charge Code	3801534
Hospital Revenue Code	250
Min. Negotiated Rate	$58.52
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: UnitedHealthcare Commercial	$61.77
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ePHEDrine 50 mg/mL [HMC]

Facility

$105.12

Service Code	NDC 17478051701
Hospital Charge Code	3801534
Hospital Revenue Code	250
Min. Negotiated Rate	$42.05
Max. Negotiated Rate	$99.86
Rate for Payer: Aetna Commercial	$94.61
Rate for Payer: Humana Medicare Advantage	$44.15
Rate for Payer: UnitedHealthcare Commercial	$99.86
Rate for Payer: UnitedHealthcare Medicaid	$42.05
Rate for Payer: WPPA Medicare Advantage	$63.07

Epic Pump 2ML/HR/100ML

Facility

$56.30

Hospital Charge Code	3253597
Hospital Revenue Code	270
Min. Negotiated Rate	$22.52
Max. Negotiated Rate	$53.48
Rate for Payer: Aetna Commercial	$50.67
Rate for Payer: Humana Medicare Advantage	$23.65
Rate for Payer: UnitedHealthcare Commercial	$53.48
Rate for Payer: UnitedHealthcare Medicaid	$22.52
Rate for Payer: WPPA Medicare Advantage	$33.78

Epic Pump 2ML/HR/100ML

Facility

$56.30

Hospital Charge Code	3253597
Hospital Revenue Code	270
Min. Negotiated Rate	$50.67
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$50.67
Rate for Payer: UnitedHealthcare Commercial	$53.48
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Epic Pump 5ML/HR/270ML

Facility

$65.25

Hospital Charge Code	3253598
Hospital Revenue Code	270
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$61.99
Rate for Payer: Aetna Commercial	$58.73
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: UnitedHealthcare Commercial	$61.99
Rate for Payer: UnitedHealthcare Medicaid	$26.10
Rate for Payer: WPPA Medicare Advantage	$39.15

Know your out-of-pocket cost for care.

All Charges