Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

heparin 1000 units/mL Inj Sol [HMC]

Facility

$46.17

Service Code	HCPCS J1644
Hospital Charge Code	3801840
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$43.86
Rate for Payer: Aetna Commercial	$41.55
Rate for Payer: Aetna Commercial	$42.53
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	$19.85
Rate for Payer: Humana Medicare Advantage	$19.39
Rate for Payer: UnitedHealthcare Commercial	$44.90
Rate for Payer: UnitedHealthcare Commercial	$43.86
Rate for Payer: UnitedHealthcare Medicaid	$0.18
Rate for Payer: UnitedHealthcare Medicaid	$0.18
Rate for Payer: WPPA Medicare Advantage	$27.70
Rate for Payer: WPPA Medicare Advantage	$28.36

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	$18.90
Max. Negotiated Rate	$44.90
Rate for Payer: Aetna Commercial	$42.53
Rate for Payer: Humana Medicare Advantage	$19.85
Rate for Payer: UnitedHealthcare Commercial	$44.90
Rate for Payer: UnitedHealthcare Medicaid	$18.90
Rate for Payer: WPPA Medicare Advantage	$28.36

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

heparin 100 units/mL-D5% Sol 250 ml [HMC]

Facility

$45.41

Service Code	HCPCS J1644
Hospital Charge Code	3808661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$43.14
Rate for Payer: Aetna Commercial	$40.87
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.35
Rate for Payer: Humana Medicare Advantage	$19.07
Rate for Payer: UnitedHealthcare Commercial	$43.14
Rate for Payer: UnitedHealthcare Medicaid	$0.18
Rate for Payer: WPPA Medicare Advantage	$27.25

heparin 100 units/mL-D5% Sol 250 ml [HMC]

Facility

$45.41

Service Code	HCPCS J1644
Hospital Charge Code	3808661
Hospital Revenue Code	250
Min. Negotiated Rate	$40.87
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$40.87
Rate for Payer: UnitedHealthcare Commercial	$43.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

heparin 5000 units/mL Inj Sol [HMC]

Facility

$32.12

Service Code	HCPCS J1644
Hospital Charge Code	3801831
Hospital Revenue Code	250
Min. Negotiated Rate	$28.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.91
Rate for Payer: UnitedHealthcare Commercial	$30.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00

heparin 5000 units/mL Inj Sol [HMC]

Facility

$32.12

Service Code	HCPCS J1644
Hospital Charge Code	3801831
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$30.51
Rate for Payer: Aetna Commercial	$28.91
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.35
Rate for Payer: Humana Medicare Advantage	$13.49
Rate for Payer: UnitedHealthcare Commercial	$30.51
Rate for Payer: UnitedHealthcare Medicaid	$0.18
Rate for Payer: WPPA Medicare Advantage	$19.27

Heparin, Anti Xa QST

Facility

$219.00

Service Code	HCPCS 85520
Hospital Charge Code	3555797
Hospital Revenue Code	300
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$208.05
Rate for Payer: Aetna Commercial	$197.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$58.15
Rate for Payer: Humana Medicare Advantage	$91.98
Rate for Payer: UnitedHealthcare Commercial	$208.05
Rate for Payer: UnitedHealthcare Medicaid	$13.09
Rate for Payer: WPPA Medicare Advantage	$131.40

Heparin, Anti Xa QST

Facility

$219.00

Service Code	HCPCS 85520
Hospital Charge Code	3555797
Hospital Revenue Code	300
Min. Negotiated Rate	$197.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$197.10
Rate for Payer: UnitedHealthcare Commercial	$208.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

heparin flush 100 units/mL [HMC]

Facility

$38.55

Service Code	HCPCS J1642
Hospital Charge Code	3804801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$36.62
Rate for Payer: Aetna Commercial	$34.70
Rate for Payer: Aetna Commercial	$21.73
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.02
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.02
Rate for Payer: Humana Medicare Advantage	$16.19
Rate for Payer: Humana Medicare Advantage	$10.14
Rate for Payer: UnitedHealthcare Commercial	$22.93
Rate for Payer: UnitedHealthcare Commercial	$36.62
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: WPPA Medicare Advantage	$23.13
Rate for Payer: WPPA Medicare Advantage	$14.48

heparin flush 100 units/mL [HMC]

Facility

$24.14

Service Code	HCPCS J1642
Hospital Charge Code	3804801
Hospital Revenue Code	250
Min. Negotiated Rate	$21.73
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$21.73
Rate for Payer: Aetna Commercial	$34.70
Rate for Payer: UnitedHealthcare Commercial	$36.62
Rate for Payer: UnitedHealthcare Commercial	$22.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatic Function Panel

Facility

$109.00

Service Code	HCPCS 80076
Hospital Charge Code	3550536
Hospital Revenue Code	300
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$103.55
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$31.88
Rate for Payer: Humana Medicare Advantage	$45.78
Rate for Payer: UnitedHealthcare Commercial	$103.55
Rate for Payer: UnitedHealthcare Medicaid	$8.17
Rate for Payer: WPPA Medicare Advantage	$65.40

Hepatic Function Panel

Facility

$109.00

Service Code	HCPCS 80076
Hospital Charge Code	3550536
Hospital Revenue Code	300
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: UnitedHealthcare Commercial	$103.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatic Function Panel QST

Facility

$114.00

Service Code	HCPCS 80076
Hospital Charge Code	3550536
Hospital Revenue Code	300
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$108.30
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$31.88
Rate for Payer: Humana Medicare Advantage	$47.88
Rate for Payer: UnitedHealthcare Commercial	$108.30
Rate for Payer: UnitedHealthcare Medicaid	$8.17
Rate for Payer: WPPA Medicare Advantage	$68.40

Hepatic Function Panel QST

Facility

$114.00

Service Code	HCPCS 80076
Hospital Charge Code	3550536
Hospital Revenue Code	300
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$108.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hepatitis A adult vaccine 50 units/mL IM Sol [HMC]

Facility

$166.37

Service Code	NDC 00006484141
Hospital Charge Code	3800124
Hospital Revenue Code	250
Min. Negotiated Rate	$149.73
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$149.73
Rate for Payer: UnitedHealthcare Commercial	$158.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hepatitis A adult vaccine 50 units/mL IM Sol [HMC]

Facility

$166.37

Service Code	NDC 00006484141
Hospital Charge Code	3800124
Hospital Revenue Code	250
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$158.05
Rate for Payer: Aetna Commercial	$149.73
Rate for Payer: Humana Medicare Advantage	$69.88
Rate for Payer: UnitedHealthcare Commercial	$158.05
Rate for Payer: UnitedHealthcare Medicaid	$66.55
Rate for Payer: WPPA Medicare Advantage	$99.82

Hepatitis A Antibody IgM

Facility

$83.00

Service Code	HCPCS 86709
Hospital Charge Code	3552045
Hospital Revenue Code	300
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$74.70
Rate for Payer: UnitedHealthcare Commercial	$78.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatitis A Antibody IgM

Facility

$83.00

Service Code	HCPCS 86709
Hospital Charge Code	3552045
Hospital Revenue Code	300
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$78.85
Rate for Payer: Aetna Commercial	$74.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$49.95
Rate for Payer: Humana Medicare Advantage	$34.86
Rate for Payer: UnitedHealthcare Commercial	$78.85
Rate for Payer: UnitedHealthcare Medicaid	$11.26
Rate for Payer: WPPA Medicare Advantage	$49.80

hepatitis A pediatric vaccine 720 units/0.5 mL preservative free Sus [HMC]

Facility

$87.07

Service Code	NDC 58160082552
Hospital Charge Code	3800124
Hospital Revenue Code	259
Min. Negotiated Rate	$34.83
Max. Negotiated Rate	$82.72
Rate for Payer: Aetna Commercial	$78.36
Rate for Payer: Humana Medicare Advantage	$36.57
Rate for Payer: UnitedHealthcare Commercial	$82.72
Rate for Payer: UnitedHealthcare Medicaid	$34.83
Rate for Payer: WPPA Medicare Advantage	$52.24

hepatitis A pediatric vaccine 720 units/0.5 mL preservative free Sus [HMC]

Facility

$87.07

Service Code	NDC 58160082552
Hospital Charge Code	3800124
Hospital Revenue Code	259
Min. Negotiated Rate	$78.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$78.36
Rate for Payer: UnitedHealthcare Commercial	$82.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatitis B

Facility

$126.00

Service Code	HCPCS 90746
Hospital Charge Code	3252293
Hospital Revenue Code	636
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$113.40
Rate for Payer: UnitedHealthcare Commercial	$119.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatitis B

Facility

$126.00

Service Code	HCPCS 90746
Hospital Charge Code	3252293
Hospital Revenue Code	636
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna Commercial	$113.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$95.25
Rate for Payer: Humana Medicare Advantage	$52.92
Rate for Payer: UnitedHealthcare Commercial	$119.70
Rate for Payer: UnitedHealthcare Medicaid	$75.15
Rate for Payer: WPPA Medicare Advantage	$75.60

hepatitis B adult vaccine 20 mcg/mL Sus [HMC]

Facility

$143.73

Service Code	NDC 58160082152
Hospital Charge Code	3800340
Hospital Revenue Code	250
Min. Negotiated Rate	$129.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$129.36
Rate for Payer: UnitedHealthcare Commercial	$136.54
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hepatitis B adult vaccine 20 mcg/mL Sus [HMC]

Facility

$143.73

Service Code	NDC 58160082152
Hospital Charge Code	3800340
Hospital Revenue Code	250
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$136.54
Rate for Payer: Aetna Commercial	$129.36
Rate for Payer: Humana Medicare Advantage	$60.37
Rate for Payer: UnitedHealthcare Commercial	$136.54
Rate for Payer: UnitedHealthcare Medicaid	$57.49
Rate for Payer: WPPA Medicare Advantage	$86.24

Know your out-of-pocket cost for care.

All Charges