Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

King Airway LTS-D Yellow Size #3

Facility

$173.00

Hospital Charge Code	3257705
Hospital Revenue Code	541
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$155.70
Rate for Payer: UnitedHealthcare Commercial	$164.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

King Airway LTS-D Yellow Size #3

Facility

$173.00

Hospital Charge Code	3257705
Hospital Revenue Code	541
Min. Negotiated Rate	$69.20
Max. Negotiated Rate	$164.35
Rate for Payer: Aetna Commercial	$155.70
Rate for Payer: Humana Medicare Advantage	$72.66
Rate for Payer: UnitedHealthcare Commercial	$164.35
Rate for Payer: UnitedHealthcare Medicaid	$69.20
Rate for Payer: WPPA Medicare Advantage	$103.80

King Vision Video Laryngoscope Size 2 Disposable Cover for Reusable Blades

Facility

$51.00

Hospital Charge Code	3257632
Hospital Revenue Code	270
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$48.45
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$21.42
Rate for Payer: UnitedHealthcare Commercial	$48.45
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: WPPA Medicare Advantage	$30.60

King Vision Video Laryngoscope Size 2 Disposable Cover for Reusable Blades

Facility

$51.00

Hospital Charge Code	3257632
Hospital Revenue Code	270
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: UnitedHealthcare Commercial	$48.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

King Vision Video Laryngoscope Size 3 Disposable Cover for Reusable Blades

Facility

$51.00

Hospital Charge Code	3257633
Hospital Revenue Code	270
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$48.45
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$21.42
Rate for Payer: UnitedHealthcare Commercial	$48.45
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: WPPA Medicare Advantage	$30.60

King Vision Video Laryngoscope Size 3 Disposable Cover for Reusable Blades

Facility

$51.00

Hospital Charge Code	3257633
Hospital Revenue Code	270
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: UnitedHealthcare Commercial	$48.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Kirschner Pin Ball .065(2mm) Wire Size W-Series Color Coded

Facility

$33.00

Hospital Charge Code	3251305
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.35
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: WPPA Medicare Advantage	$19.80

Kirschner Pin Ball .065(2mm) Wire Size W-Series Color Coded

Facility

$33.00

Hospital Charge Code	3251305
Hospital Revenue Code	270
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Kirschner Pin Ball .094(2.5mm) Wire Size W-Series White Colored

Facility

$33.00

Hospital Charge Code	3251306
Hospital Revenue Code	270
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Kirschner Pin Ball .094(2.5mm) Wire Size W-Series White Colored

Facility

$33.00

Hospital Charge Code	3251306
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.35
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: WPPA Medicare Advantage	$19.80

KIRSCHNER WIRE #1 1.1X152

Facility

$28.00

Hospital Charge Code	3251285
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

KIRSCHNER WIRE #1 1.1X152

Facility

$28.00

Hospital Charge Code	3251285
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Humana Medicare Advantage	$11.76
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: UnitedHealthcare Medicaid	$11.20
Rate for Payer: WPPA Medicare Advantage	$16.80

KIRSCHNER WIRE #1 1.6X152

Facility

$28.00

Hospital Charge Code	3251290
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Humana Medicare Advantage	$11.76
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: UnitedHealthcare Medicaid	$11.20
Rate for Payer: WPPA Medicare Advantage	$16.80

KIRSCHNER WIRE #1 1.6X152

Facility

$28.00

Hospital Charge Code	3251290
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

KIRSCHNER WIRE #7 1.1X102

Facility

$28.00

Hospital Charge Code	3251286
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

KIRSCHNER WIRE #7 1.1X102

Facility

$28.00

Hospital Charge Code	3251286
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Humana Medicare Advantage	$11.76
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: UnitedHealthcare Medicaid	$11.20
Rate for Payer: WPPA Medicare Advantage	$16.80

KIRSCHNER WIRE #7 1.66X10

Facility

$28.00

Hospital Charge Code	3251284
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Humana Medicare Advantage	$11.76
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: UnitedHealthcare Medicaid	$11.20
Rate for Payer: WPPA Medicare Advantage	$16.80

KIRSCHNER WIRE #7 1.66X10

Facility

$28.00

Hospital Charge Code	3251284
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

KIRSCHNER WIRE #7 .99X76

Facility

$29.00

Hospital Charge Code	3251287
Hospital Revenue Code	270
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: UnitedHealthcare Commercial	$27.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

KIRSCHNER WIRE #7 .99X76

Facility

$29.00

Hospital Charge Code	3251287
Hospital Revenue Code	270
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$27.55
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: Humana Medicare Advantage	$12.18
Rate for Payer: UnitedHealthcare Commercial	$27.55
Rate for Payer: UnitedHealthcare Medicaid	$11.60
Rate for Payer: WPPA Medicare Advantage	$17.40

KIRSCHNER WIRE #7 .9X102

Facility

$25.00

Hospital Charge Code	3251288
Hospital Revenue Code	270
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: UnitedHealthcare Commercial	$23.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

KIRSCHNER WIRE #7 .9X102

Facility

$25.00

Hospital Charge Code	3251288
Hospital Revenue Code	270
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Humana Medicare Advantage	$10.50
Rate for Payer: UnitedHealthcare Commercial	$23.75
Rate for Payer: UnitedHealthcare Medicaid	$10.00
Rate for Payer: WPPA Medicare Advantage	$15.00

KIT D816 Mutation Analysis (Mastocytosis) QST

Facility

$789.00

Service Code	HCPCS 81273
Hospital Charge Code	3551772
Hospital Revenue Code	300
Min. Negotiated Rate	$315.60
Max. Negotiated Rate	$749.55
Rate for Payer: Aetna Commercial	$710.10
Rate for Payer: Humana Medicare Advantage	$331.38
Rate for Payer: UnitedHealthcare Commercial	$749.55
Rate for Payer: UnitedHealthcare Medicaid	$315.60
Rate for Payer: WPPA Medicare Advantage	$473.40

KIT D816 Mutation Analysis (Mastocytosis) QST

Facility

$789.00

Service Code	HCPCS 81273
Hospital Charge Code	3551772
Hospital Revenue Code	300
Min. Negotiated Rate	$710.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$710.10
Rate for Payer: UnitedHealthcare Commercial	$749.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Kiwi IgE UNMC

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	3552884
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

Know your out-of-pocket cost for care.

All Charges