Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

insulin glargine 300 units/mL [HMC]

Facility

$277.14

Service Code	HCPCS J1815
Hospital Charge Code	3800283
Hospital Revenue Code	250
Min. Negotiated Rate	$249.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$249.43
Rate for Payer: UnitedHealthcare Commercial	$263.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00

insulin glargine 300 units/mL [HMC]

Facility

$277.14

Service Code	HCPCS J1815
Hospital Charge Code	3800283
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$263.28
Rate for Payer: Aetna Commercial	$249.43
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Humana Medicare Advantage	$116.40
Rate for Payer: UnitedHealthcare Commercial	$263.28
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: WPPA Medicare Advantage	$166.28

insulin isophane human recombinant 100 units/mL SubQ Inj [HMC]

Facility

$100.29

Service Code	HCPCS J1815
Hospital Charge Code	3805609
Hospital Revenue Code	250
Min. Negotiated Rate	$90.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$90.26
Rate for Payer: Aetna Commercial	$47.51
Rate for Payer: UnitedHealthcare Commercial	$50.15
Rate for Payer: UnitedHealthcare Commercial	$95.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

insulin isophane human recombinant 100 units/mL SubQ Inj [HMC]

Facility

$100.29

Service Code	HCPCS J1815
Hospital Charge Code	3805609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$95.28
Rate for Payer: Aetna Commercial	$90.26
Rate for Payer: Aetna Commercial	$47.51
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Humana Medicare Advantage	$42.12
Rate for Payer: Humana Medicare Advantage	$22.17
Rate for Payer: UnitedHealthcare Commercial	$50.15
Rate for Payer: UnitedHealthcare Commercial	$95.28
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: WPPA Medicare Advantage	$31.67
Rate for Payer: WPPA Medicare Advantage	$60.17

insulin isophane-insulin regular human recombinant 70 units-30 units/mL SubQ Inj 10 mL [HMC]

Facility

$189.67

Service Code	HCPCS J1815
Hospital Charge Code	3805591
Hospital Revenue Code	250
Min. Negotiated Rate	$170.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$170.70
Rate for Payer: UnitedHealthcare Commercial	$180.19
Rate for Payer: WPPA Medicare Advantage	$1,200.00

insulin isophane-insulin regular human recombinant 70 units-30 units/mL SubQ Inj 10 mL [HMC]

Facility

$189.67

Service Code	HCPCS J1815
Hospital Charge Code	3805591
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$180.19
Rate for Payer: Aetna Commercial	$170.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Humana Medicare Advantage	$79.66
Rate for Payer: UnitedHealthcare Commercial	$180.19
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: WPPA Medicare Advantage	$113.80

insulin lispro 100 units/mL [HMC]

Facility

$168.33

Service Code	NDC 00002753301
Hospital Charge Code	3808629
Hospital Revenue Code	250
Min. Negotiated Rate	$151.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$151.50
Rate for Payer: UnitedHealthcare Commercial	$159.91
Rate for Payer: WPPA Medicare Advantage	$1,200.00

insulin lispro 100 units/mL [HMC]

Facility

$168.33

Service Code	NDC 00002753301
Hospital Charge Code	3808629
Hospital Revenue Code	250
Min. Negotiated Rate	$67.33
Max. Negotiated Rate	$159.91
Rate for Payer: Aetna Commercial	$151.50
Rate for Payer: Humana Medicare Advantage	$70.70
Rate for Payer: UnitedHealthcare Commercial	$159.91
Rate for Payer: UnitedHealthcare Medicaid	$67.33
Rate for Payer: WPPA Medicare Advantage	$101.00

insulin lispro 100 units/mL [HMC]

Facility

$168.33

Service Code	HCPCS J1815
Hospital Charge Code	3808629
Hospital Revenue Code	250
Min. Negotiated Rate	$151.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$151.50
Rate for Payer: Aetna Commercial	$69.55
Rate for Payer: UnitedHealthcare Commercial	$73.42
Rate for Payer: UnitedHealthcare Commercial	$159.91
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

insulin lispro 100 units/mL [HMC]

Facility

$168.33

Service Code	HCPCS J1815
Hospital Charge Code	3808629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$159.91
Rate for Payer: Aetna Commercial	$151.50
Rate for Payer: Aetna Commercial	$69.55
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Humana Medicare Advantage	$32.46
Rate for Payer: Humana Medicare Advantage	$70.70
Rate for Payer: UnitedHealthcare Commercial	$73.42
Rate for Payer: UnitedHealthcare Commercial	$159.91
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: WPPA Medicare Advantage	$46.37
Rate for Payer: WPPA Medicare Advantage	$101.00

insulin lispro-insulin lispro protamine 25 units-75 units/mL SubQ Susp 10 mL [HMC]

Facility

$532.46

Service Code	HCPCS J1815
Hospital Charge Code	3808843
Hospital Revenue Code	250
Min. Negotiated Rate	$479.21
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$479.21
Rate for Payer: UnitedHealthcare Commercial	$505.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

insulin lispro-insulin lispro protamine 25 units-75 units/mL SubQ Susp 10 mL [HMC]

Facility

$532.46

Service Code	HCPCS J1815
Hospital Charge Code	3808843
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$505.84
Rate for Payer: Aetna Commercial	$479.21
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Humana Medicare Advantage	$223.63
Rate for Payer: UnitedHealthcare Commercial	$505.84
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: WPPA Medicare Advantage	$319.48

Insulin QST

Facility

$102.00

Service Code	HCPCS 83525
Hospital Charge Code	3553525
Hospital Revenue Code	300
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: UnitedHealthcare Commercial	$96.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Insulin QST

Facility

$102.00

Service Code	HCPCS 83525
Hospital Charge Code	3553525
Hospital Revenue Code	300
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$96.90
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$50.72
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$96.90
Rate for Payer: UnitedHealthcare Medicaid	$11.43
Rate for Payer: WPPA Medicare Advantage	$61.20

insulin regular human recombinant 100 units/mL Inj Sol 10 mL [HMC]

Facility

$340.48

Service Code	HCPCS J1815
Hospital Charge Code	3805617
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$323.46
Rate for Payer: Aetna Commercial	$306.43
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Humana Medicare Advantage	$143.00
Rate for Payer: UnitedHealthcare Commercial	$323.46
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: WPPA Medicare Advantage	$204.29

insulin regular human recombinant 100 units/mL Inj Sol 10 mL [HMC]

Facility

$340.48

Service Code	HCPCS J1815
Hospital Charge Code	3805617
Hospital Revenue Code	250
Min. Negotiated Rate	$306.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$306.43
Rate for Payer: UnitedHealthcare Commercial	$323.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

insulin regular human recombinant 100 units/mL Inj Sol [HMC]

Facility

$100.30

Service Code	HCPCS J1815
Hospital Charge Code	3805617
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$95.28
Rate for Payer: Aetna Commercial	$90.27
Rate for Payer: Aetna Commercial	$90.26
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.27
Rate for Payer: Humana Medicare Advantage	$42.13
Rate for Payer: Humana Medicare Advantage	$42.12
Rate for Payer: UnitedHealthcare Commercial	$95.28
Rate for Payer: UnitedHealthcare Commercial	$95.28
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: WPPA Medicare Advantage	$60.17
Rate for Payer: WPPA Medicare Advantage	$60.18

insulin regular human recombinant 100 units/mL Inj Sol [HMC]

Facility

$100.29

Service Code	HCPCS J1815
Hospital Charge Code	3805617
Hospital Revenue Code	250
Min. Negotiated Rate	$90.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$90.26
Rate for Payer: Aetna Commercial	$90.27
Rate for Payer: UnitedHealthcare Commercial	$95.28
Rate for Payer: UnitedHealthcare Commercial	$95.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$3,653.55

Service Code	MSDRG 197
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

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$7,275.33

Service Code	MSDRG 196
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,275.33
Rate for Payer: UnitedHealthcare Medicaid	$7,275.33
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$2,763.99

Service Code	MSDRG 198
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,763.99
Rate for Payer: UnitedHealthcare Medicaid	$2,763.99
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$5,877.45

Service Code	MSDRG 065
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,877.45
Rate for Payer: UnitedHealthcare Medicaid	$5,877.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$9,689.85

Service Code	MSDRG 064
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,689.85
Rate for Payer: UnitedHealthcare Medicaid	$9,689.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$3,081.69

Service Code	MSDRG 066
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,081.69
Rate for Payer: UnitedHealthcare Medicaid	$3,081.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$19,252.62

Service Code	MSDRG 021
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$19,252.62
Rate for Payer: UnitedHealthcare Medicaid	$19,252.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges