Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Heel Lift Adjust-A-Lift Medium

Facility

$18.00

Hospital Charge Code	3250592
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Heel Lift Adjust-A-Lift Medium

Facility

$18.00

Hospital Charge Code	3250592
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Humana Medicare Advantage	$7.56
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: WPPA Medicare Advantage	$10.80

Heel Lift Adjust-A-Lift Small

Facility

$18.00

Hospital Charge Code	3250591
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Humana Medicare Advantage	$7.56
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: WPPA Medicare Advantage	$10.80

Heel Lift Adjust-A-Lift Small

Facility

$18.00

Hospital Charge Code	3250591
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEEL PILLOW PROTECTOR

Facility

$51.08

Hospital Charge Code	3259236
Hospital Revenue Code	270
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$48.53
Rate for Payer: Aetna Commercial	$45.97
Rate for Payer: Humana Medicare Advantage	$21.45
Rate for Payer: UnitedHealthcare Commercial	$48.53
Rate for Payer: UnitedHealthcare Medicaid	$20.43
Rate for Payer: WPPA Medicare Advantage	$30.65

HEEL PILLOW PROTECTOR

Facility

$51.08

Hospital Charge Code	3259236
Hospital Revenue Code	270
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.97
Rate for Payer: UnitedHealthcare Commercial	$48.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hematocrit

Facility

$38.00

Service Code	HCPCS 85014
Hospital Charge Code	3550155
Hospital Revenue Code	300
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hematocrit

Facility

$38.00

Service Code	HCPCS 85014
Hospital Charge Code	3550155
Hospital Revenue Code	300
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$36.10
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.91
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: UnitedHealthcare Medicaid	$2.01
Rate for Payer: WPPA Medicare Advantage	$22.80

Hemoglobin

Facility

$38.00

Service Code	HCPCS 85018
Hospital Charge Code	3550148
Hospital Revenue Code	300
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$36.10
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$9.75
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: UnitedHealthcare Medicaid	$2.01
Rate for Payer: WPPA Medicare Advantage	$22.80

Hemoglobin

Facility

$38.00

Service Code	HCPCS 85018
Hospital Charge Code	3550148
Hospital Revenue Code	300
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hemoglobin A1c

Facility

$122.00

Service Code	HCPCS 83036
Hospital Charge Code	3551401
Hospital Revenue Code	300
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$109.80
Rate for Payer: UnitedHealthcare Commercial	$115.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hemoglobin A1c

Facility

$122.00

Service Code	HCPCS 83036
Hospital Charge Code	3551401
Hospital Revenue Code	300
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$115.90
Rate for Payer: Aetna Commercial	$109.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$51.24
Rate for Payer: UnitedHealthcare Commercial	$115.90
Rate for Payer: UnitedHealthcare Medicaid	$9.71
Rate for Payer: WPPA Medicare Advantage	$73.20

Hemoglobinopathy Evaluation QST

Facility

$100.00

Service Code	HCPCS 83021
Hospital Charge Code	3553021
Hospital Revenue Code	300
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$49.92
Rate for Payer: Humana Medicare Advantage	$42.00
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Medicaid	$17.80
Rate for Payer: WPPA Medicare Advantage	$60.00

Hemoglobinopathy Evaluation QST

Facility

$100.00

Service Code	HCPCS 83021
Hospital Charge Code	3553021
Hospital Revenue Code	300
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hemorrhoid Anoscope Multi-Band Ligator ShortShot

Facility

$176.00

Hospital Charge Code	3250630
Hospital Revenue Code	270
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$167.20
Rate for Payer: Aetna Commercial	$158.40
Rate for Payer: Humana Medicare Advantage	$73.92
Rate for Payer: UnitedHealthcare Commercial	$167.20
Rate for Payer: UnitedHealthcare Medicaid	$70.40
Rate for Payer: WPPA Medicare Advantage	$105.60

Hemorrhoid Anoscope Multi-Band Ligator ShortShot

Facility

$176.00

Hospital Charge Code	3250630
Hospital Revenue Code	270
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$158.40
Rate for Payer: UnitedHealthcare Commercial	$167.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hemostat Surgicel 4X8

Facility

$401.64

Hospital Charge Code	3250054
Hospital Revenue Code	270
Min. Negotiated Rate	$160.66
Max. Negotiated Rate	$381.56
Rate for Payer: Aetna Commercial	$361.48
Rate for Payer: Humana Medicare Advantage	$168.69
Rate for Payer: UnitedHealthcare Commercial	$381.56
Rate for Payer: UnitedHealthcare Medicaid	$160.66
Rate for Payer: WPPA Medicare Advantage	$240.98

Hemostat Surgicel 4X8

Facility

$401.64

Hospital Charge Code	3250054
Hospital Revenue Code	270
Min. Negotiated Rate	$361.48
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$361.48
Rate for Payer: UnitedHealthcare Commercial	$381.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hep A Ab, Total QST

Facility

$74.00

Service Code	HCPCS 86708
Hospital Charge Code	3552037
Hospital Revenue Code	300
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hep A Ab, Total QST

Facility

$74.00

Service Code	HCPCS 86708
Hospital Charge Code	3552037
Hospital Revenue Code	300
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$45.93
Rate for Payer: Humana Medicare Advantage	$31.08
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: UnitedHealthcare Medicaid	$12.39
Rate for Payer: WPPA Medicare Advantage	$44.40

heparin 10,000 units/100 mL-NaCl 0.45% IV Sol 250 mL [HMC]

Facility

$54.14

Service Code	NDC 00409765062
Hospital Charge Code	3808661
Hospital Revenue Code	250
Min. Negotiated Rate	$48.73
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$48.73
Rate for Payer: UnitedHealthcare Commercial	$51.43
Rate for Payer: WPPA Medicare Advantage	$1,200.00

heparin 10,000 units/100 mL-NaCl 0.45% IV Sol 250 mL [HMC]

Facility

$54.14

Service Code	HCPCS J1644
Hospital Charge Code	3808661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$51.43
Rate for Payer: Aetna Commercial	$48.73
Rate for Payer: Aetna Commercial	$388.53
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.35
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.35
Rate for Payer: Humana Medicare Advantage	$22.74
Rate for Payer: Humana Medicare Advantage	$181.31
Rate for Payer: UnitedHealthcare Commercial	$410.12
Rate for Payer: UnitedHealthcare Commercial	$51.43
Rate for Payer: UnitedHealthcare Medicaid	$0.18
Rate for Payer: UnitedHealthcare Medicaid	$0.18
Rate for Payer: WPPA Medicare Advantage	$259.02
Rate for Payer: WPPA Medicare Advantage	$32.48

heparin 10,000 units/100 mL-NaCl 0.45% IV Sol 250 mL [HMC]

Facility

$54.14

Service Code	NDC 00409765062
Hospital Charge Code	3808661
Hospital Revenue Code	250
Min. Negotiated Rate	$21.66
Max. Negotiated Rate	$51.43
Rate for Payer: Aetna Commercial	$48.73
Rate for Payer: Humana Medicare Advantage	$22.74
Rate for Payer: UnitedHealthcare Commercial	$51.43
Rate for Payer: UnitedHealthcare Medicaid	$21.66
Rate for Payer: WPPA Medicare Advantage	$32.48

heparin 10,000 units/100 mL-NaCl 0.45% IV Sol 250 mL [HMC]

Facility

$431.70

Service Code	HCPCS J1644
Hospital Charge Code	3808661
Hospital Revenue Code	250
Min. Negotiated Rate	$388.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$388.53
Rate for Payer: Aetna Commercial	$48.73
Rate for Payer: UnitedHealthcare Commercial	$51.43
Rate for Payer: UnitedHealthcare Commercial	$410.12
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

heparin 1000 units/mL Inj Sol [HMC]

Facility

$47.26

Service Code	NDC 63323054067
Hospital Charge Code	3801840
Hospital Revenue Code	250
Min. Negotiated Rate	$42.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$42.53
Rate for Payer: UnitedHealthcare Commercial	$44.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges