Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

haloperidol 5 mg Tab [HMC]

Facility

$8.07

Service Code	NDC 00378032701
Hospital Charge Code	3808090
Hospital Revenue Code	250
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: UnitedHealthcare Commercial	$7.67
Rate for Payer: WPPA Medicare Advantage	$1,200.00

haloperidol 5 mg Tab [HMC]

Facility

$7.72

Service Code	NDC 00904678261
Hospital Charge Code	3808090
Hospital Revenue Code	250
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: UnitedHealthcare Commercial	$7.33
Rate for Payer: WPPA Medicare Advantage	$1,200.00

haloperidol 5 mg Tab [HMC]

Facility

$7.72

Service Code	NDC 00904678261
Hospital Charge Code	3808090
Hospital Revenue Code	250
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$7.33
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: Humana Medicare Advantage	$3.24
Rate for Payer: UnitedHealthcare Commercial	$7.33
Rate for Payer: UnitedHealthcare Medicaid	$3.09
Rate for Payer: WPPA Medicare Advantage	$4.63

haloperidol 5 mg Tab [HMC]

Facility

$8.28

Service Code	NDC 60687016101
Hospital Charge Code	3808090
Hospital Revenue Code	250
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$7.87
Rate for Payer: Aetna Commercial	$7.45
Rate for Payer: Humana Medicare Advantage	$3.48
Rate for Payer: UnitedHealthcare Commercial	$7.87
Rate for Payer: UnitedHealthcare Medicaid	$3.31
Rate for Payer: WPPA Medicare Advantage	$4.97

haloperidol 5 mg Tab [HMC]

Facility

$8.28

Service Code	NDC 60687016101
Hospital Charge Code	3808090
Hospital Revenue Code	250
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.45
Rate for Payer: UnitedHealthcare Commercial	$7.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

haloperidol 5 mg Tab [HMC]

Facility

$8.07

Service Code	NDC 00378032701
Hospital Charge Code	3808090
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$7.67
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: Humana Medicare Advantage	$3.39
Rate for Payer: UnitedHealthcare Commercial	$7.67
Rate for Payer: UnitedHealthcare Medicaid	$3.23
Rate for Payer: WPPA Medicare Advantage	$4.84

Hammertube Implant 2.75mm 0 Cannulated

Facility

$3,980.00

Service Code	HCPCS C1781
Hospital Charge Code	3258595
Hospital Revenue Code	278
Min. Negotiated Rate	$1,592.00
Max. Negotiated Rate	$3,781.00
Rate for Payer: Aetna Commercial	$3,582.00
Rate for Payer: Humana Medicare Advantage	$1,671.60
Rate for Payer: UnitedHealthcare Commercial	$3,781.00
Rate for Payer: UnitedHealthcare Medicaid	$1,592.00
Rate for Payer: WPPA Medicare Advantage	$2,388.00

Hammertube Implant 2.75mm 0 Cannulated

Facility

$3,980.00

Service Code	HCPCS C1781
Hospital Charge Code	3258595
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,781.00
Rate for Payer: Aetna Commercial	$3,582.00
Rate for Payer: UnitedHealthcare Commercial	$3,781.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility

$5,972.76

Service Code	MSDRG 513
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,972.76
Rate for Payer: UnitedHealthcare Medicaid	$5,972.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$3,875.94

Service Code	MSDRG 514
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,875.94
Rate for Payer: UnitedHealthcare Medicaid	$3,875.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HAND PROCEDURES FOR INJURIES

Facility

$6,894.09

Service Code	MSDRG 906
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,894.09
Rate for Payer: UnitedHealthcare Medicaid	$6,894.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hantavirus Ab (IgG,IgM) QST

Facility

$227.00

Service Code	HCPCS 86790
Hospital Charge Code	3556790
Hospital Revenue Code	300
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$215.65
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$33.65
Rate for Payer: Humana Medicare Advantage	$95.34
Rate for Payer: UnitedHealthcare Commercial	$215.65
Rate for Payer: UnitedHealthcare Medicaid	$10.95
Rate for Payer: WPPA Medicare Advantage	$136.20

Hantavirus Ab (IgG,IgM) QST

Facility

$227.00

Service Code	HCPCS 86790
Hospital Charge Code	3556790
Hospital Revenue Code	300
Min. Negotiated Rate	$204.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: UnitedHealthcare Commercial	$215.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Haptoglobin QST

Facility

$85.00

Service Code	HCPCS 83010
Hospital Charge Code	3551518
Hospital Revenue Code	300
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$80.75
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$52.09
Rate for Payer: Humana Medicare Advantage	$35.70
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: UnitedHealthcare Medicaid	$12.58
Rate for Payer: WPPA Medicare Advantage	$51.00

Haptoglobin QST

Facility

$85.00

Service Code	HCPCS 83010
Hospital Charge Code	3551518
Hospital Revenue Code	300
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hazelnut (F17) IgE QST

Facility

$26.00

Service Code	HCPCS 86003
Hospital Charge Code	3552817
Hospital Revenue Code	300
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hazelnut (F17) IgE QST

Facility

$26.00

Service Code	HCPCS 86003
Hospital Charge Code	3552817
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$10.92
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$15.60

HCV RNA, Qn PCR w/Rfx to Gt, LiPA(R) QST

Facility

$725.00

Service Code	HCPCS 86803
Hospital Charge Code	3552029
Hospital Revenue Code	300
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$688.75
Rate for Payer: Aetna Commercial	$652.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$45.09
Rate for Payer: Humana Medicare Advantage	$304.50
Rate for Payer: UnitedHealthcare Commercial	$688.75
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: WPPA Medicare Advantage	$435.00

HCV RNA, Qn PCR w/Rfx to Gt, LiPA(R) QST

Facility

$725.00

Service Code	HCPCS 86803
Hospital Charge Code	3552029
Hospital Revenue Code	300
Min. Negotiated Rate	$652.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$652.50
Rate for Payer: UnitedHealthcare Commercial	$688.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HCV RNA, Quantitative Real Time PCR QST

Facility

$218.00

Service Code	HCPCS 87522
Hospital Charge Code	3556425
Hospital Revenue Code	300
Min. Negotiated Rate	$36.41
Max. Negotiated Rate	$207.10
Rate for Payer: Aetna Commercial	$196.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$91.91
Rate for Payer: Humana Medicare Advantage	$91.56
Rate for Payer: UnitedHealthcare Commercial	$207.10
Rate for Payer: UnitedHealthcare Medicaid	$36.41
Rate for Payer: WPPA Medicare Advantage	$130.80

HCV RNA, Quantitative Real Time PCR QST

Facility

$218.00

Service Code	HCPCS 87522
Hospital Charge Code	3556425
Hospital Revenue Code	300
Min. Negotiated Rate	$196.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$196.20
Rate for Payer: UnitedHealthcare Commercial	$207.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

.HCV RNA, Quant Real Time PCR QST

Facility

$75.00

Service Code	HCPCS 86803
Hospital Charge Code	3552029
Hospital Revenue Code	300
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$45.09
Rate for Payer: Humana Medicare Advantage	$31.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: WPPA Medicare Advantage	$45.00

.HCV RNA, Quant Real Time PCR QST

Facility

$75.00

Service Code	HCPCS 86803
Hospital Charge Code	3552029
Hospital Revenue Code	300
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: UnitedHealthcare Commercial	$71.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HDL Cholesterol

Facility

$34.00

Service Code	HCPCS 83718
Hospital Charge Code	3551369
Hospital Revenue Code	300
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$32.30
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$17.57
Rate for Payer: Humana Medicare Advantage	$14.28
Rate for Payer: UnitedHealthcare Commercial	$32.30
Rate for Payer: UnitedHealthcare Medicaid	$8.19
Rate for Payer: WPPA Medicare Advantage	$20.40

HDL Cholesterol

Facility

$34.00

Service Code	HCPCS 83718
Hospital Charge Code	3551369
Hospital Revenue Code	300
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: UnitedHealthcare Commercial	$32.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges