Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Hep B Virus DNA, Qn, Real Time PCR QST

Facility

$81.00

Service Code	HCPCS 87517
Hospital Charge Code	3557517
Hospital Revenue Code	300
Min. Negotiated Rate	$34.02
Max. Negotiated Rate	$229.67
Rate for Payer: Aetna Commercial	$72.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$229.67
Rate for Payer: Humana Medicare Advantage	$34.02
Rate for Payer: UnitedHealthcare Commercial	$76.95
Rate for Payer: UnitedHealthcare Medicaid	$36.41
Rate for Payer: WPPA Medicare Advantage	$48.60

Hep B Virus DNA, Qn, Real Time PCR QST

Facility

$81.00

Service Code	HCPCS 87517
Hospital Charge Code	3557517
Hospital Revenue Code	300
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$72.90
Rate for Payer: UnitedHealthcare Commercial	$76.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HER2, IHC, PARAFFIN

Facility

$405.00

Service Code	HCPCS 88360
Hospital Charge Code	3551481
Hospital Revenue Code	310
Min. Negotiated Rate	$364.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$364.50
Rate for Payer: UnitedHealthcare Commercial	$384.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HER2, IHC, PARAFFIN

Facility

$405.00

Service Code	HCPCS 88360
Hospital Charge Code	3551481
Hospital Revenue Code	310
Min. Negotiated Rate	$93.77
Max. Negotiated Rate	$384.75
Rate for Payer: Aetna Commercial	$364.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$131.65
Rate for Payer: Humana Medicare Advantage	$170.10
Rate for Payer: UnitedHealthcare Commercial	$384.75
Rate for Payer: UnitedHealthcare Medicaid	$93.77
Rate for Payer: WPPA Medicare Advantage	$243.00

Hereditary Cancer Single Site(S) QST

Facility

$415.00

Service Code	HCPCS 81215
Hospital Charge Code	3551215
Hospital Revenue Code	300
Min. Negotiated Rate	$166.00
Max. Negotiated Rate	$394.25
Rate for Payer: Aetna Commercial	$373.50
Rate for Payer: Humana Medicare Advantage	$174.30
Rate for Payer: UnitedHealthcare Commercial	$394.25
Rate for Payer: UnitedHealthcare Medicaid	$166.00
Rate for Payer: WPPA Medicare Advantage	$249.00

Hereditary Cancer Single Site(S) QST

Facility

$415.00

Service Code	HCPCS 81215
Hospital Charge Code	3551215
Hospital Revenue Code	300
Min. Negotiated Rate	$373.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$373.50
Rate for Payer: UnitedHealthcare Commercial	$394.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hereditary Hemochromatosis HFE Test, MAYO

Facility

$607.00

Service Code	HCPCS 81256
Hospital Charge Code	3551256
Hospital Revenue Code	300
Min. Negotiated Rate	$546.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$546.30
Rate for Payer: UnitedHealthcare Commercial	$576.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hereditary Hemochromatosis HFE Test, MAYO

Facility

$607.00

Service Code	HCPCS 81256
Hospital Charge Code	3551256
Hospital Revenue Code	300
Min. Negotiated Rate	$242.80
Max. Negotiated Rate	$576.65
Rate for Payer: Aetna Commercial	$546.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$379.30
Rate for Payer: Humana Medicare Advantage	$254.94
Rate for Payer: UnitedHealthcare Commercial	$576.65
Rate for Payer: UnitedHealthcare Medicaid	$242.80
Rate for Payer: WPPA Medicare Advantage	$364.20

Hernia Patch Ventralex ST Large Davol with Sepra Technology

Facility

$1,070.00

Service Code	HCPCS C1781
Hospital Charge Code	3253887
Hospital Revenue Code	278
Min. Negotiated Rate	$963.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$963.00
Rate for Payer: UnitedHealthcare Commercial	$1,016.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hernia Patch Ventralex ST Large Davol with Sepra Technology

Facility

$1,070.00

Service Code	HCPCS C1781
Hospital Charge Code	3253887
Hospital Revenue Code	278
Min. Negotiated Rate	$428.00
Max. Negotiated Rate	$1,016.50
Rate for Payer: Aetna Commercial	$963.00
Rate for Payer: Humana Medicare Advantage	$449.40
Rate for Payer: UnitedHealthcare Commercial	$1,016.50
Rate for Payer: UnitedHealthcare Medicaid	$428.00
Rate for Payer: WPPA Medicare Advantage	$642.00

Hernia Patch Ventralex ST Medium Davol with Sepra Technology

Facility

$1,050.00

Service Code	HCPCS C1781
Hospital Charge Code	3253886
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$997.50
Rate for Payer: Aetna Commercial	$945.00
Rate for Payer: Humana Medicare Advantage	$441.00
Rate for Payer: UnitedHealthcare Commercial	$997.50
Rate for Payer: UnitedHealthcare Medicaid	$420.00
Rate for Payer: WPPA Medicare Advantage	$630.00

Hernia Patch Ventralex ST Medium Davol with Sepra Technology

Facility

$1,050.00

Service Code	HCPCS C1781
Hospital Charge Code	3253886
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$945.00
Rate for Payer: UnitedHealthcare Commercial	$997.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hernia Patch Ventralex ST Small Davol with Sepra Technology 1ea per case

Facility

$873.28

Service Code	HCPCS C1781
Hospital Charge Code	3253885
Hospital Revenue Code	278
Min. Negotiated Rate	$785.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$785.95
Rate for Payer: UnitedHealthcare Commercial	$829.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hernia Patch Ventralex ST Small Davol with Sepra Technology 1ea per case

Facility

$873.28

Service Code	HCPCS C1781
Hospital Charge Code	3253885
Hospital Revenue Code	278
Min. Negotiated Rate	$349.31
Max. Negotiated Rate	$829.62
Rate for Payer: Aetna Commercial	$785.95
Rate for Payer: Humana Medicare Advantage	$366.78
Rate for Payer: UnitedHealthcare Commercial	$829.62
Rate for Payer: UnitedHealthcare Medicaid	$349.31
Rate for Payer: WPPA Medicare Advantage	$523.97

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$6,354.00

Service Code	MSDRG 354
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,354.00
Rate for Payer: UnitedHealthcare Medicaid	$6,354.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$10,960.65

Service Code	MSDRG 353
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

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$5,083.20

Service Code	MSDRG 355
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,083.20
Rate for Payer: UnitedHealthcare Medicaid	$5,083.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hetastarch 60 mg/mL-NS IV Sol [HMC]

Facility

$67.41

Service Code	NDC 00264196510
Hospital Charge Code	3170013
Hospital Revenue Code	250
Min. Negotiated Rate	$26.96
Max. Negotiated Rate	$64.04
Rate for Payer: Aetna Commercial	$60.67
Rate for Payer: Humana Medicare Advantage	$28.31
Rate for Payer: UnitedHealthcare Commercial	$64.04
Rate for Payer: UnitedHealthcare Medicaid	$26.96
Rate for Payer: WPPA Medicare Advantage	$40.45

hetastarch 60 mg/mL-NS IV Sol [HMC]

Facility

$67.41

Service Code	NDC 00264196510
Hospital Charge Code	3170013
Hospital Revenue Code	250
Min. Negotiated Rate	$60.67
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$60.67
Rate for Payer: UnitedHealthcare Commercial	$64.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hickman Power Catheter Kit 9.5fr with Microintroducer

Facility

$1,091.00

Hospital Charge Code	3256672
Hospital Revenue Code	270
Min. Negotiated Rate	$436.40
Max. Negotiated Rate	$1,036.45
Rate for Payer: Aetna Commercial	$981.90
Rate for Payer: Humana Medicare Advantage	$458.22
Rate for Payer: UnitedHealthcare Commercial	$1,036.45
Rate for Payer: UnitedHealthcare Medicaid	$436.40
Rate for Payer: WPPA Medicare Advantage	$654.60

Hickman Power Catheter Kit 9.5fr with Microintroducer

Facility

$1,091.00

Hospital Charge Code	3256672
Hospital Revenue Code	270
Min. Negotiated Rate	$981.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$981.90
Rate for Payer: UnitedHealthcare Commercial	$1,036.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hickory/Pecan Tree (T22) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1013
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$11.34
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$16.20

Hickory/Pecan Tree (T22) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1013
Hospital Revenue Code	300
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$8,387.28

Service Code	MSDRG 481
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$8,387.28
Rate for Payer: UnitedHealthcare Medicaid	$8,387.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$14,232.96

Service Code	MSDRG 480
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$14,232.96
Rate for Payer: UnitedHealthcare Medicaid	$14,232.96
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges