Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Hepatitis B Core Antibody IgM

Facility

$49.00

Service Code	HCPCS 86705
Hospital Charge Code	3552063
Hospital Revenue Code	300
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$44.10
Rate for Payer: UnitedHealthcare Commercial	$46.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatitis B Core Antibody IgM

Facility

$49.00

Service Code	HCPCS 86705
Hospital Charge Code	3552063
Hospital Revenue Code	300
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$46.55
Rate for Payer: Aetna Commercial	$44.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$34.09
Rate for Payer: Humana Medicare Advantage	$20.58
Rate for Payer: UnitedHealthcare Commercial	$46.55
Rate for Payer: UnitedHealthcare Medicaid	$11.77
Rate for Payer: WPPA Medicare Advantage	$29.40

Hepatitis Be Antigen

Facility

$65.00

Service Code	HCPCS 87350
Hospital Charge Code	3550555
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: UnitedHealthcare Commercial	$61.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatitis Be Antigen

Facility

$65.00

Service Code	HCPCS 87350
Hospital Charge Code	3550555
Hospital Revenue Code	300
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$61.75
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$43.38
Rate for Payer: Humana Medicare Advantage	$27.30
Rate for Payer: UnitedHealthcare Commercial	$61.75
Rate for Payer: UnitedHealthcare Medicaid	$10.00
Rate for Payer: WPPA Medicare Advantage	$39.00

hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [HMC]

Facility

$69.81

Service Code	NDC 58160082052
Hospital Charge Code	3256620
Hospital Revenue Code	259
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$66.32
Rate for Payer: Aetna Commercial	$62.83
Rate for Payer: Humana Medicare Advantage	$29.32
Rate for Payer: UnitedHealthcare Commercial	$66.32
Rate for Payer: UnitedHealthcare Medicaid	$27.92
Rate for Payer: WPPA Medicare Advantage	$41.89

hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [HMC]

Facility

$69.81

Service Code	NDC 58160082052
Hospital Charge Code	3256620
Hospital Revenue Code	259
Min. Negotiated Rate	$62.83
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$62.83
Rate for Payer: UnitedHealthcare Commercial	$66.32
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hepatitis B pediatric vaccine 5 mcg/0.5 mL Sus [HMC]

Facility

$120.47

Service Code	NDC 00006498100
Hospital Charge Code	3256620
Hospital Revenue Code	250
Min. Negotiated Rate	$108.42
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$108.42
Rate for Payer: UnitedHealthcare Commercial	$114.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hepatitis B pediatric vaccine 5 mcg/0.5 mL Sus [HMC]

Facility

$120.47

Service Code	NDC 00006498100
Hospital Charge Code	3256620
Hospital Revenue Code	250
Min. Negotiated Rate	$48.19
Max. Negotiated Rate	$114.45
Rate for Payer: Aetna Commercial	$108.42
Rate for Payer: Humana Medicare Advantage	$50.60
Rate for Payer: UnitedHealthcare Commercial	$114.45
Rate for Payer: UnitedHealthcare Medicaid	$48.19
Rate for Payer: WPPA Medicare Advantage	$72.28

Hepatitis B Surface Antibody

Facility

$79.00

Service Code	HCPCS 86706
Hospital Charge Code	3551799
Hospital Revenue Code	300
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$75.05
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$46.36
Rate for Payer: Humana Medicare Advantage	$33.18
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: UnitedHealthcare Medicaid	$10.74
Rate for Payer: WPPA Medicare Advantage	$47.40

Hepatitis B Surface Antibody

Facility

$79.00

Service Code	HCPCS 86706
Hospital Charge Code	3551799
Hospital Revenue Code	300
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatitis B Surface Antigen

Facility

$40.00

Service Code	HCPCS 87340
Hospital Charge Code	3551807
Hospital Revenue Code	300
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$38.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$24.62
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: UnitedHealthcare Medicaid	$10.33
Rate for Payer: WPPA Medicare Advantage	$24.00

Hepatitis B Surface Antigen

Facility

$40.00

Service Code	HCPCS 87340
Hospital Charge Code	3551807
Hospital Revenue Code	300
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatitis B Titer

Facility

$79.00

Service Code	HCPCS 86706
Hospital Charge Code	3551799
Hospital Revenue Code	300
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hepatitis B Titer

Facility

$79.00

Service Code	HCPCS 86706
Hospital Charge Code	3551799
Hospital Revenue Code	300
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$75.05
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$46.36
Rate for Payer: Humana Medicare Advantage	$33.18
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: UnitedHealthcare Medicaid	$10.74
Rate for Payer: WPPA Medicare Advantage	$47.40

Hepatitis C Antibody

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

Hepatitis C Antibody

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

Hepatitis Panel QST

Facility

$343.00

Service Code	HCPCS 80074
Hospital Charge Code	3550478
Hospital Revenue Code	300
Min. Negotiated Rate	$40.49
Max. Negotiated Rate	$325.85
Rate for Payer: Aetna Commercial	$308.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$137.99
Rate for Payer: Humana Medicare Advantage	$144.06
Rate for Payer: UnitedHealthcare Commercial	$325.85
Rate for Payer: UnitedHealthcare Medicaid	$40.49
Rate for Payer: WPPA Medicare Advantage	$205.80

Hepatitis Panel QST

Facility

$343.00

Service Code	HCPCS 80074
Hospital Charge Code	3550478
Hospital Revenue Code	300
Min. Negotiated Rate	$308.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$308.70
Rate for Payer: UnitedHealthcare Commercial	$325.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$5,591.52

Service Code	MSDRG 421
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,591.52
Rate for Payer: UnitedHealthcare Medicaid	$5,591.52
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$10,960.65

Service Code	MSDRG 420
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,960.65
Rate for Payer: UnitedHealthcare Medicaid	$10,960.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$4,511.34

Service Code	MSDRG 422
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,511.34
Rate for Payer: UnitedHealthcare Medicaid	$4,511.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hep B Core Ab Total QST

Facility

$70.00

Service Code	HCPCS 86704
Hospital Charge Code	3552011
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$66.50
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$44.24
Rate for Payer: Humana Medicare Advantage	$29.40
Rate for Payer: UnitedHealthcare Commercial	$66.50
Rate for Payer: UnitedHealthcare Medicaid	$12.05
Rate for Payer: WPPA Medicare Advantage	$42.00

Hep B Core Ab Total QST

Facility

$70.00

Service Code	HCPCS 86704
Hospital Charge Code	3552011
Hospital Revenue Code	300
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: UnitedHealthcare Commercial	$66.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hep Be Ag QST

Facility

$65.00

Service Code	HCPCS 87350
Hospital Charge Code	3557350
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: UnitedHealthcare Commercial	$61.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hep Be Ag QST

Facility

$65.00

Service Code	HCPCS 87350
Hospital Charge Code	3557350
Hospital Revenue Code	300
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$61.75
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$43.38
Rate for Payer: Humana Medicare Advantage	$27.30
Rate for Payer: UnitedHealthcare Commercial	$61.75
Rate for Payer: UnitedHealthcare Medicaid	$10.00
Rate for Payer: WPPA Medicare Advantage	$39.00

Know your out-of-pocket cost for care.

All Charges