Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$20,110.41

Service Code	MSDRG 853
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$20,110.41
Rate for Payer: UnitedHealthcare Medicaid	$20,110.41
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$6,131.61

Service Code	MSDRG 855
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,131.61
Rate for Payer: UnitedHealthcare Medicaid	$6,131.61
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$4,733.73

Service Code	MSDRG 727
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,733.73
Rate for Payer: UnitedHealthcare Medicaid	$4,733.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$2,605.14

Service Code	MSDRG 728
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,605.14
Rate for Payer: UnitedHealthcare Medicaid	$2,605.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$5,178.51

Service Code	MSDRG 386
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,178.51
Rate for Payer: UnitedHealthcare Medicaid	$5,178.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$7,307.10

Service Code	MSDRG 385
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,307.10
Rate for Payer: UnitedHealthcare Medicaid	$7,307.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$3,145.23

Service Code	MSDRG 387
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,145.23
Rate for Payer: UnitedHealthcare Medicaid	$3,145.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

inFLIXimab 100 mg IV Inj [HMC]

Facility

$2,112.07

Service Code	HCPCS J1745
Hospital Charge Code	3852065
Hospital Revenue Code	250
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,006.47
Rate for Payer: Aetna Commercial	$1,900.86
Rate for Payer: Aetna Commercial	$778.50
Rate for Payer: UnitedHealthcare Commercial	$2,006.47
Rate for Payer: UnitedHealthcare Commercial	$821.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

inFLIXimab 100 mg IV Inj [HMC]

Facility

$2,112.07

Service Code	HCPCS J1745
Hospital Charge Code	3852065
Hospital Revenue Code	250
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$2,006.47
Rate for Payer: Aetna Commercial	$1,900.86
Rate for Payer: Aetna Commercial	$778.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$39.57
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$363.30
Rate for Payer: Humana Medicare Advantage	$887.07
Rate for Payer: UnitedHealthcare Commercial	$821.75
Rate for Payer: UnitedHealthcare Commercial	$2,006.47
Rate for Payer: UnitedHealthcare Medicaid	$32.42
Rate for Payer: UnitedHealthcare Medicaid	$32.42
Rate for Payer: WPPA Medicare Advantage	$1,267.24
Rate for Payer: WPPA Medicare Advantage	$519.00

inFLIXimab dyyb 100 mg Pow [HMC]

Facility

$1,723.31

Service Code	HCPCS Q5103
Hospital Charge Code	3859920
Hospital Revenue Code	250
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,637.14
Rate for Payer: Aetna Commercial	$1,550.98
Rate for Payer: UnitedHealthcare Commercial	$1,637.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

inFLIXimab dyyb 100 mg Pow [HMC]

Facility

$1,723.31

Service Code	HCPCS Q5103
Hospital Charge Code	3859920
Hospital Revenue Code	250
Min. Negotiated Rate	$24.22
Max. Negotiated Rate	$1,637.14
Rate for Payer: Aetna Commercial	$1,550.98
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$44.97
Rate for Payer: Humana Medicare Advantage	$723.79
Rate for Payer: UnitedHealthcare Commercial	$1,637.14
Rate for Payer: UnitedHealthcare Medicaid	$24.22
Rate for Payer: WPPA Medicare Advantage	$1,033.99

Infliximab Level, IBD QST

Facility

$315.00

Service Code	HCPCS 80230
Hospital Charge Code	3556352
Hospital Revenue Code	300
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$299.25
Rate for Payer: Aetna Commercial	$283.50
Rate for Payer: Humana Medicare Advantage	$132.30
Rate for Payer: UnitedHealthcare Commercial	$299.25
Rate for Payer: UnitedHealthcare Medicaid	$32.78
Rate for Payer: WPPA Medicare Advantage	$189.00

Infliximab Level, IBD QST

Facility

$315.00

Service Code	HCPCS 80230
Hospital Charge Code	3556352
Hospital Revenue Code	300
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$283.50
Rate for Payer: UnitedHealthcare Commercial	$299.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Influenza A/B (ID NOW)

Facility

$224.00

Service Code	HCPCS 86710
Hospital Charge Code	3552094
Hospital Revenue Code	300
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$201.60
Rate for Payer: UnitedHealthcare Commercial	$212.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Influenza A/B (ID NOW)

Facility

$224.00

Service Code	HCPCS 86710
Hospital Charge Code	3552094
Hospital Revenue Code	300
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$212.80
Rate for Payer: Aetna Commercial	$201.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$67.89
Rate for Payer: Humana Medicare Advantage	$94.08
Rate for Payer: UnitedHealthcare Commercial	$212.80
Rate for Payer: UnitedHealthcare Medicaid	$11.52
Rate for Payer: WPPA Medicare Advantage	$134.40

influenza virus vaccine, inactivated high-dose preservative-free trivalent Sus [HMC]

Facility

$304.57

Service Code	NDC 49281012565
Hospital Charge Code	3802705
Hospital Revenue Code	250
Min. Negotiated Rate	$274.11
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$274.11
Rate for Payer: UnitedHealthcare Commercial	$289.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

influenza virus vaccine, inactivated high-dose preservative-free trivalent Sus [HMC]

Facility

$283.66

Service Code	NDC 49281012465
Hospital Charge Code	3802705
Hospital Revenue Code	250
Min. Negotiated Rate	$113.46
Max. Negotiated Rate	$269.48
Rate for Payer: Aetna Commercial	$255.29
Rate for Payer: Humana Medicare Advantage	$119.14
Rate for Payer: UnitedHealthcare Commercial	$269.48
Rate for Payer: UnitedHealthcare Medicaid	$113.46
Rate for Payer: WPPA Medicare Advantage	$170.20

influenza virus vaccine, inactivated high-dose preservative-free trivalent Sus [HMC]

Facility

$304.57

Service Code	NDC 49281012565
Hospital Charge Code	3802705
Hospital Revenue Code	250
Min. Negotiated Rate	$121.83
Max. Negotiated Rate	$289.34
Rate for Payer: Aetna Commercial	$274.11
Rate for Payer: Humana Medicare Advantage	$127.92
Rate for Payer: UnitedHealthcare Commercial	$289.34
Rate for Payer: UnitedHealthcare Medicaid	$121.83
Rate for Payer: WPPA Medicare Advantage	$182.74

influenza virus vaccine, inactivated high-dose preservative-free trivalent Sus [HMC]

Facility

$283.66

Service Code	NDC 49281012465
Hospital Charge Code	3802705
Hospital Revenue Code	250
Min. Negotiated Rate	$255.29
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$255.29
Rate for Payer: UnitedHealthcare Commercial	$269.48
Rate for Payer: WPPA Medicare Advantage	$1,200.00

influenza virus vaccine, inactivated preservative-free trivalent Sus [HMC]

Facility

$94.00

Service Code	NDC 49281042450
Hospital Charge Code	3802705
Hospital Revenue Code	250
Min. Negotiated Rate	$84.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$84.60
Rate for Payer: UnitedHealthcare Commercial	$89.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

influenza virus vaccine, inactivated preservative-free trivalent Sus [HMC]

Facility

$94.00

Service Code	NDC 49281042450
Hospital Charge Code	3802705
Hospital Revenue Code	250
Min. Negotiated Rate	$37.60
Max. Negotiated Rate	$89.30
Rate for Payer: Aetna Commercial	$84.60
Rate for Payer: Humana Medicare Advantage	$39.48
Rate for Payer: UnitedHealthcare Commercial	$89.30
Rate for Payer: UnitedHealthcare Medicaid	$37.60
Rate for Payer: WPPA Medicare Advantage	$56.40

influenza virus vaccine, inactivated preservative-free trivalent Sus [HMC]

Facility

$94.71

Service Code	NDC 49281042550
Hospital Charge Code	3802705
Hospital Revenue Code	250
Min. Negotiated Rate	$85.24
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$85.24
Rate for Payer: UnitedHealthcare Commercial	$89.97
Rate for Payer: WPPA Medicare Advantage	$1,200.00

influenza virus vaccine, inactivated preservative-free trivalent Sus [HMC]

Facility

$94.71

Service Code	NDC 49281042550
Hospital Charge Code	3802705
Hospital Revenue Code	250
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$89.97
Rate for Payer: Aetna Commercial	$85.24
Rate for Payer: Humana Medicare Advantage	$39.78
Rate for Payer: UnitedHealthcare Commercial	$89.97
Rate for Payer: UnitedHealthcare Medicaid	$37.88
Rate for Payer: WPPA Medicare Advantage	$56.83

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$5,750.37

Service Code	MSDRG 351
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,750.37
Rate for Payer: UnitedHealthcare Medicaid	$5,750.37
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$9,435.69

Service Code	MSDRG 350
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,435.69
Rate for Payer: UnitedHealthcare Medicaid	$9,435.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges