Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

IVF D5 250 LC

Facility

$10.22

Hospital Charge Code	3250102
Hospital Revenue Code	258
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$9.71
Rate for Payer: Aetna Commercial	$9.20
Rate for Payer: Humana Medicare Advantage	$4.29
Rate for Payer: UnitedHealthcare Commercial	$9.71
Rate for Payer: UnitedHealthcare Medicaid	$4.09
Rate for Payer: WPPA Medicare Advantage	$6.13

IVF D5 250 LC

Facility

$10.22

Hospital Charge Code	3250102
Hospital Revenue Code	258
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.20
Rate for Payer: UnitedHealthcare Commercial	$9.71
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF D5 500 LC

Facility

$14.00

Service Code	HCPCS J7060
Hospital Charge Code	3250110
Hospital Revenue Code	636
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$13.30
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2.32
Rate for Payer: Humana Medicare Advantage	$5.88
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: UnitedHealthcare Medicaid	$1.75
Rate for Payer: WPPA Medicare Advantage	$8.40

IVF D5 500 LC

Facility

$14.00

Service Code	HCPCS J7060
Hospital Charge Code	3250110
Hospital Revenue Code	636
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF D5LR 1000 LC

Facility

$13.55

Service Code	HCPCS J7121
Hospital Charge Code	3253916
Hospital Revenue Code	636
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.20
Rate for Payer: UnitedHealthcare Commercial	$12.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF D5LR 1000 LC

Facility

$13.55

Service Code	HCPCS J7121
Hospital Charge Code	3253916
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$12.87
Rate for Payer: Aetna Commercial	$12.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$9.39
Rate for Payer: Humana Medicare Advantage	$5.69
Rate for Payer: UnitedHealthcare Commercial	$12.87
Rate for Payer: UnitedHealthcare Medicaid	$5.25
Rate for Payer: WPPA Medicare Advantage	$8.13

IVF D5NS 1000 LC

Facility

$13.19

Hospital Charge Code	3254013
Hospital Revenue Code	258
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.87
Rate for Payer: UnitedHealthcare Commercial	$12.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF D5NS 1000 LC

Facility

$13.19

Hospital Charge Code	3254013
Hospital Revenue Code	258
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$12.53
Rate for Payer: Aetna Commercial	$11.87
Rate for Payer: Humana Medicare Advantage	$5.54
Rate for Payer: UnitedHealthcare Commercial	$12.53
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: WPPA Medicare Advantage	$7.91

IVF D5NS 500

Facility

$4.00

Hospital Charge Code	3255242
Hospital Revenue Code	258
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.80
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Humana Medicare Advantage	$1.68
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Medicaid	$1.60
Rate for Payer: WPPA Medicare Advantage	$2.40

IVF D5NS 500

Facility

$4.00

Hospital Charge Code	3255242
Hospital Revenue Code	258
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF LR 1000 LC

Facility

$11.88

Service Code	HCPCS J7120
Hospital Charge Code	3254054
Hospital Revenue Code	636
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.69
Rate for Payer: UnitedHealthcare Commercial	$11.29
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF LR 1000 LC

Facility

$11.88

Service Code	HCPCS J7120
Hospital Charge Code	3254054
Hospital Revenue Code	636
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$11.29
Rate for Payer: Aetna Commercial	$10.69
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3.12
Rate for Payer: Humana Medicare Advantage	$4.99
Rate for Payer: UnitedHealthcare Commercial	$11.29
Rate for Payer: UnitedHealthcare Medicaid	$2.38
Rate for Payer: WPPA Medicare Advantage	$7.13

IVF LR 250 LC

Facility

$14.00

Hospital Charge Code	3257520
Hospital Revenue Code	258
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF LR 250 LC

Facility

$14.00

Hospital Charge Code	3257520
Hospital Revenue Code	258
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$13.30
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Humana Medicare Advantage	$5.88
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: UnitedHealthcare Medicaid	$5.60
Rate for Payer: WPPA Medicare Advantage	$8.40

IVF LR 500 CC

Facility

$12.06

Hospital Charge Code	3256943
Hospital Revenue Code	258
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: UnitedHealthcare Commercial	$11.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF LR 500 CC

Facility

$12.06

Hospital Charge Code	3256943
Hospital Revenue Code	258
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$11.46
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Humana Medicare Advantage	$5.07
Rate for Payer: UnitedHealthcare Commercial	$11.46
Rate for Payer: UnitedHealthcare Medicaid	$4.82
Rate for Payer: WPPA Medicare Advantage	$7.24

IVF NS 1000 LC

Facility

$11.84

Service Code	HCPCS J7030
Hospital Charge Code	3253973
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$10.66
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3.39
Rate for Payer: Humana Medicare Advantage	$4.97
Rate for Payer: UnitedHealthcare Commercial	$11.25
Rate for Payer: UnitedHealthcare Medicaid	$1.99
Rate for Payer: WPPA Medicare Advantage	$7.10

IVF NS 1000 LC

Facility

$11.84

Service Code	HCPCS J7030
Hospital Charge Code	3253973
Hospital Revenue Code	636
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.66
Rate for Payer: UnitedHealthcare Commercial	$11.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF NS 100 ADV

Facility

$9.99

Hospital Charge Code	3254047
Hospital Revenue Code	258
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$9.49
Rate for Payer: Aetna Commercial	$8.99
Rate for Payer: Humana Medicare Advantage	$4.20
Rate for Payer: UnitedHealthcare Commercial	$9.49
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: WPPA Medicare Advantage	$5.99

IVF NS 100 ADV

Facility

$9.99

Hospital Charge Code	3254047
Hospital Revenue Code	258
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.99
Rate for Payer: UnitedHealthcare Commercial	$9.49
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF NS 100 LC

Facility

$8.06

Hospital Charge Code	3255374
Hospital Revenue Code	258
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.25
Rate for Payer: UnitedHealthcare Commercial	$7.66
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF NS 100 LC

Facility

$8.06

Hospital Charge Code	3255374
Hospital Revenue Code	258
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$7.66
Rate for Payer: Aetna Commercial	$7.25
Rate for Payer: Humana Medicare Advantage	$3.39
Rate for Payer: UnitedHealthcare Commercial	$7.66
Rate for Payer: UnitedHealthcare Medicaid	$3.22
Rate for Payer: WPPA Medicare Advantage	$4.84

IVF NS 1/2 1000 LC

Facility

$12.42

Hospital Charge Code	3254005
Hospital Revenue Code	258
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.18
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

IVF NS 1/2 1000 LC

Facility

$12.42

Hospital Charge Code	3254005
Hospital Revenue Code	258
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$11.80
Rate for Payer: Aetna Commercial	$11.18
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: UnitedHealthcare Medicaid	$4.97
Rate for Payer: WPPA Medicare Advantage	$7.45

IVF NS 250 ADV

Facility

$15.66

Service Code	HCPCS J7030
Hospital Charge Code	3256919
Hospital Revenue Code	636
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: UnitedHealthcare Commercial	$14.88
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges