Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

hydrOXYzine hydrochloride 25 mg Tab [HMC]

Facility

$5.91

Service Code	NDC 00904661761
Hospital Charge Code	3804827
Hospital Revenue Code	250
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.61
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Humana Medicare Advantage	$2.48
Rate for Payer: UnitedHealthcare Commercial	$5.61
Rate for Payer: UnitedHealthcare Medicaid	$2.36
Rate for Payer: WPPA Medicare Advantage	$3.55

hydrOXYzine hydrochloride 25 mg Tab [HMC]

Facility

$7.74

Service Code	NDC 00093506101
Hospital Charge Code	3804827
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.97
Rate for Payer: UnitedHealthcare Commercial	$7.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrOXYzine hydrochloride 25 mg Tab [HMC]

Facility

$6.18

Service Code	NDC 60687067501
Hospital Charge Code	3804827
Hospital Revenue Code	250
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.56
Rate for Payer: UnitedHealthcare Commercial	$5.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hylan G-F 20 48 mg/6 mL [HMC]

Facility

$3,699.20

Service Code	HCPCS J7325
Hospital Charge Code	3852175
Hospital Revenue Code	636
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,514.24
Rate for Payer: Aetna Commercial	$3,329.28
Rate for Payer: UnitedHealthcare Commercial	$3,514.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hylan G-F 20 48 mg/6 mL [HMC]

Facility

$3,699.20

Service Code	HCPCS J7325
Hospital Charge Code	3852175
Hospital Revenue Code	636
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$3,514.24
Rate for Payer: Aetna Commercial	$3,329.28
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$11.41
Rate for Payer: Humana Medicare Advantage	$1,553.66
Rate for Payer: UnitedHealthcare Commercial	$3,514.24
Rate for Payer: UnitedHealthcare Medicaid	$7.56
Rate for Payer: WPPA Medicare Advantage	$2,219.52

hylan G-F 20 8 mg/mL intra-articular Sol [HMC]

Facility

$841.77

Service Code	HCPCS J7325
Hospital Charge Code	3809122
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$799.68
Rate for Payer: Aetna Commercial	$757.59
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$11.41
Rate for Payer: Humana Medicare Advantage	$353.54
Rate for Payer: UnitedHealthcare Commercial	$799.68
Rate for Payer: UnitedHealthcare Medicaid	$7.56
Rate for Payer: WPPA Medicare Advantage	$505.06

hylan G-F 20 8 mg/mL intra-articular Sol [HMC]

Facility

$841.77

Service Code	HCPCS J7325
Hospital Charge Code	3809122
Hospital Revenue Code	250
Min. Negotiated Rate	$757.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$757.59
Rate for Payer: UnitedHealthcare Commercial	$799.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hyoscyamine 0.125 mg/mL Oral Sol [HMC]

Facility

$63.99

Service Code	NDC 54838050615
Hospital Charge Code	3803299
Hospital Revenue Code	250
Min. Negotiated Rate	$57.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$57.59
Rate for Payer: UnitedHealthcare Commercial	$60.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hyoscyamine 0.125 mg/mL Oral Sol [HMC]

Facility

$63.99

Service Code	NDC 54838050615
Hospital Charge Code	3803299
Hospital Revenue Code	250
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$60.79
Rate for Payer: Aetna Commercial	$57.59
Rate for Payer: Humana Medicare Advantage	$26.88
Rate for Payer: UnitedHealthcare Commercial	$60.79
Rate for Payer: UnitedHealthcare Medicaid	$25.60
Rate for Payer: WPPA Medicare Advantage	$38.39

hyoscyamine 0.125 mg Tab [HMC]

Facility

$7.55

Service Code	NDC 47781001201
Hospital Charge Code	3803307
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$7.17
Rate for Payer: Aetna Commercial	$6.79
Rate for Payer: Humana Medicare Advantage	$3.17
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: UnitedHealthcare Medicaid	$3.02
Rate for Payer: WPPA Medicare Advantage	$4.53

hyoscyamine 0.125 mg Tab [HMC]

Facility

$7.55

Service Code	NDC 62559042201
Hospital Charge Code	3803307
Hospital Revenue Code	250
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.79
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hyoscyamine 0.125 mg Tab [HMC]

Facility

$7.55

Service Code	NDC 62559042201
Hospital Charge Code	3803307
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$7.17
Rate for Payer: Aetna Commercial	$6.79
Rate for Payer: Humana Medicare Advantage	$3.17
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: UnitedHealthcare Medicaid	$3.02
Rate for Payer: WPPA Medicare Advantage	$4.53

hyoscyamine 0.125 mg Tab [HMC]

Facility

$7.55

Service Code	NDC 47781001201
Hospital Charge Code	3803307
Hospital Revenue Code	250
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.79
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hypersensitivity Pneumonitis Screen QST

Facility

$162.00

Service Code	HCPCS 86606
Hospital Charge Code	3556606
Hospital Revenue Code	300
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$145.80
Rate for Payer: UnitedHealthcare Commercial	$153.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hypersensitivity Pneumonitis Screen QST

Facility

$162.00

Service Code	HCPCS 86606
Hospital Charge Code	3556606
Hospital Revenue Code	300
Min. Negotiated Rate	$12.79
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna Commercial	$145.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$57.98
Rate for Payer: Humana Medicare Advantage	$68.04
Rate for Payer: UnitedHealthcare Commercial	$153.90
Rate for Payer: UnitedHealthcare Medicaid	$12.79
Rate for Payer: WPPA Medicare Advantage	$97.20

HYPERTENSION WITH MCC

Facility

$4,987.89

Service Code	MSDRG 304
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,987.89
Rate for Payer: UnitedHealthcare Medicaid	$4,987.89
Rate for Payer: WPPA Medicare Advantage	$1,200.00

HYPERTENSION WITHOUT MCC

Facility

$3,653.55

Service Code	MSDRG 305
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,653.55
Rate for Payer: UnitedHealthcare Medicaid	$3,653.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hysterectomy

Facility

$3,754.00

Service Code	HCPCS 58150
Hospital Charge Code	3150226
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,566.30
Rate for Payer: Aetna Commercial	$3,378.60
Rate for Payer: UnitedHealthcare Commercial	$3,566.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Hysterectomy

Facility

$3,754.00

Service Code	HCPCS 58150
Hospital Charge Code	3150226
Hospital Revenue Code	360
Min. Negotiated Rate	$1,501.60
Max. Negotiated Rate	$3,566.30
Rate for Payer: Aetna Commercial	$3,378.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,422.00
Rate for Payer: Humana Medicare Advantage	$1,576.68
Rate for Payer: UnitedHealthcare Commercial	$3,566.30
Rate for Payer: UnitedHealthcare Medicaid	$1,501.60
Rate for Payer: WPPA Medicare Advantage	$2,252.40

Hysterectomy Total Vaginal

Facility

$4,914.00

Service Code	HCPCS 58180
Hospital Charge Code	3158180
Hospital Revenue Code	360
Min. Negotiated Rate	$1,965.60
Max. Negotiated Rate	$4,668.30
Rate for Payer: Aetna Commercial	$4,422.60
Rate for Payer: Humana Medicare Advantage	$2,063.88
Rate for Payer: UnitedHealthcare Commercial	$4,668.30
Rate for Payer: UnitedHealthcare Medicaid	$1,965.60
Rate for Payer: WPPA Medicare Advantage	$2,948.40

Hysterectomy Total Vaginal

Facility

$4,914.00

Service Code	HCPCS 58180
Hospital Charge Code	3158180
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,668.30
Rate for Payer: Aetna Commercial	$4,422.60
Rate for Payer: UnitedHealthcare Commercial	$4,668.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Ia-2 Ab QST

Facility

$255.00

Service Code	HCPCS 86341
Hospital Charge Code	3557933
Hospital Revenue Code	300
Min. Negotiated Rate	$79.87
Max. Negotiated Rate	$242.25
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$79.87
Rate for Payer: Humana Medicare Advantage	$107.10
Rate for Payer: UnitedHealthcare Commercial	$242.25
Rate for Payer: UnitedHealthcare Medicaid	$102.00
Rate for Payer: WPPA Medicare Advantage	$153.00

Ia-2 Ab QST

Facility

$255.00

Service Code	HCPCS 86341
Hospital Charge Code	3557933
Hospital Revenue Code	300
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: UnitedHealthcare Commercial	$242.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibandronate 3 mg/3 mL [HMC]

Facility

$959.32

Service Code	HCPCS J1740
Hospital Charge Code	3851150
Hospital Revenue Code	250
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$911.35
Rate for Payer: Aetna Commercial	$863.39
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$402.91
Rate for Payer: UnitedHealthcare Commercial	$911.35
Rate for Payer: UnitedHealthcare Medicaid	$13.14
Rate for Payer: WPPA Medicare Advantage	$575.59

ibandronate 3 mg/3 mL [HMC]

Facility

$959.32

Service Code	HCPCS J1740
Hospital Charge Code	3851150
Hospital Revenue Code	250
Min. Negotiated Rate	$863.39
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$863.39
Rate for Payer: UnitedHealthcare Commercial	$911.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges