Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Linear Cutter Open Proximate Stapler 55-3.81mm

Facility

$347.00

Hospital Charge Code	3251011
Hospital Revenue Code	270
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$312.30
Rate for Payer: UnitedHealthcare Commercial	$329.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Linear Cutter Open Proximate Stapler 75mm w/Blue Staple Reloads

Facility

$532.05

Hospital Charge Code	3251001
Hospital Revenue Code	270
Min. Negotiated Rate	$212.82
Max. Negotiated Rate	$505.45
Rate for Payer: Aetna Commercial	$478.85
Rate for Payer: Humana Medicare Advantage	$223.46
Rate for Payer: UnitedHealthcare Commercial	$505.45
Rate for Payer: UnitedHealthcare Medicaid	$212.82
Rate for Payer: WPPA Medicare Advantage	$319.23

Linear Cutter Open Proximate Stapler 75mm w/Blue Staple Reloads

Facility

$532.05

Hospital Charge Code	3251001
Hospital Revenue Code	270
Min. Negotiated Rate	$478.85
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$478.85
Rate for Payer: UnitedHealthcare Commercial	$505.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Linear Cutter Open Proximate Stapler 75mm w/Green Staple Reloads

Facility

$85.50

Hospital Charge Code	3251003
Hospital Revenue Code	270
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$81.22
Rate for Payer: Aetna Commercial	$76.95
Rate for Payer: Humana Medicare Advantage	$35.91
Rate for Payer: UnitedHealthcare Commercial	$81.22
Rate for Payer: UnitedHealthcare Medicaid	$34.20
Rate for Payer: WPPA Medicare Advantage	$51.30

Linear Cutter Open Proximate Stapler 75mm w/Green Staple Reloads

Facility

$85.50

Hospital Charge Code	3251003
Hospital Revenue Code	270
Min. Negotiated Rate	$76.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$81.22
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Linear Cutter Open Proximate Stapler Reloads 55-3.81mm

Facility

$186.00

Hospital Charge Code	3251013
Hospital Revenue Code	270
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$176.70
Rate for Payer: Aetna Commercial	$167.40
Rate for Payer: Humana Medicare Advantage	$78.12
Rate for Payer: UnitedHealthcare Commercial	$176.70
Rate for Payer: UnitedHealthcare Medicaid	$74.40
Rate for Payer: WPPA Medicare Advantage	$111.60

Linear Cutter Open Proximate Stapler Reloads 55-3.81mm

Facility

$186.00

Hospital Charge Code	3251013
Hospital Revenue Code	270
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$167.40
Rate for Payer: UnitedHealthcare Commercial	$176.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

linezolid 100 mg/5 mL Pow [HMC]

Facility

$56.90

Service Code	NDC 59762130801
Hospital Charge Code	3800343
Hospital Revenue Code	259
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$54.05
Rate for Payer: Aetna Commercial	$51.21
Rate for Payer: Humana Medicare Advantage	$23.90
Rate for Payer: UnitedHealthcare Commercial	$54.05
Rate for Payer: UnitedHealthcare Medicaid	$22.76
Rate for Payer: WPPA Medicare Advantage	$34.14

linezolid 100 mg/5 mL Pow [HMC]

Facility

$56.90

Service Code	NDC 59762130801
Hospital Charge Code	3800343
Hospital Revenue Code	259
Min. Negotiated Rate	$51.21
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$51.21
Rate for Payer: UnitedHealthcare Commercial	$54.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

linezolid 2 mg/mL-D5% 300 ml Sol [HMC]

Facility

$166.26

Service Code	HCPCS J2020
Hospital Charge Code	3800116
Hospital Revenue Code	250
Min. Negotiated Rate	$149.63
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$149.63
Rate for Payer: UnitedHealthcare Commercial	$157.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

linezolid 2 mg/mL-D5% 300 ml Sol [HMC]

Facility

$166.26

Service Code	HCPCS J2020
Hospital Charge Code	3800116
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$157.95
Rate for Payer: Aetna Commercial	$149.63
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5.47
Rate for Payer: Humana Medicare Advantage	$69.83
Rate for Payer: UnitedHealthcare Commercial	$157.95
Rate for Payer: UnitedHealthcare Medicaid	$2.74
Rate for Payer: WPPA Medicare Advantage	$99.76

linezolid 2 mg/mL IV Sol [HMC]

Facility

$94.00

Service Code	HCPCS J2020
Hospital Charge Code	3800116
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: Aetna Commercial	$166.09
Rate for Payer: Aetna Commercial	$47.88
Rate for Payer: UnitedHealthcare Commercial	$50.54
Rate for Payer: UnitedHealthcare Commercial	$175.31
Rate for Payer: UnitedHealthcare Commercial	$89.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

linezolid 2 mg/mL IV Sol [HMC]

Facility

$53.20

Service Code	HCPCS J2020
Hospital Charge Code	3800116
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$50.54
Rate for Payer: Aetna Commercial	$47.88
Rate for Payer: Aetna Commercial	$166.09
Rate for Payer: Aetna Commercial	$84.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5.47
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5.47
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5.47
Rate for Payer: Humana Medicare Advantage	$22.34
Rate for Payer: Humana Medicare Advantage	$77.51
Rate for Payer: Humana Medicare Advantage	$39.48
Rate for Payer: UnitedHealthcare Commercial	$175.31
Rate for Payer: UnitedHealthcare Commercial	$50.54
Rate for Payer: UnitedHealthcare Commercial	$89.30
Rate for Payer: UnitedHealthcare Medicaid	$2.74
Rate for Payer: UnitedHealthcare Medicaid	$2.74
Rate for Payer: UnitedHealthcare Medicaid	$2.74
Rate for Payer: WPPA Medicare Advantage	$31.92
Rate for Payer: WPPA Medicare Advantage	$56.40
Rate for Payer: WPPA Medicare Advantage	$110.72

linezolid 2 mg/mL IV Sol [HMC]

Facility

$184.54

Service Code	NDC 66794023663
Hospital Charge Code	3800116
Hospital Revenue Code	250
Min. Negotiated Rate	$73.82
Max. Negotiated Rate	$175.31
Rate for Payer: Aetna Commercial	$166.09
Rate for Payer: Humana Medicare Advantage	$77.51
Rate for Payer: UnitedHealthcare Commercial	$175.31
Rate for Payer: UnitedHealthcare Medicaid	$73.82
Rate for Payer: WPPA Medicare Advantage	$110.72

linezolid 2 mg/mL IV Sol [HMC]

Facility

$184.54

Service Code	NDC 66794023663
Hospital Charge Code	3800116
Hospital Revenue Code	250
Min. Negotiated Rate	$166.09
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$166.09
Rate for Payer: UnitedHealthcare Commercial	$175.31
Rate for Payer: WPPA Medicare Advantage	$1,200.00

linezolid 600 mg Tab [HMC]

Facility

$188.66

Service Code	NDC 67877041920
Hospital Charge Code	3800173
Hospital Revenue Code	250
Min. Negotiated Rate	$169.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: UnitedHealthcare Commercial	$179.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

linezolid 600 mg Tab [HMC]

Facility

$188.67

Service Code	NDC 50268047112
Hospital Charge Code	3800173
Hospital Revenue Code	250
Min. Negotiated Rate	$169.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$169.80
Rate for Payer: UnitedHealthcare Commercial	$179.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

linezolid 600 mg Tab [HMC]

Facility

$188.66

Service Code	NDC 67877041984
Hospital Charge Code	3800173
Hospital Revenue Code	250
Min. Negotiated Rate	$75.46
Max. Negotiated Rate	$179.23
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: Humana Medicare Advantage	$79.24
Rate for Payer: UnitedHealthcare Commercial	$179.23
Rate for Payer: UnitedHealthcare Medicaid	$75.46
Rate for Payer: WPPA Medicare Advantage	$113.20

linezolid 600 mg Tab [HMC]

Facility

$188.00

Service Code	NDC 00904655304
Hospital Charge Code	3800173
Hospital Revenue Code	250
Min. Negotiated Rate	$75.20
Max. Negotiated Rate	$178.60
Rate for Payer: Aetna Commercial	$169.20
Rate for Payer: Humana Medicare Advantage	$78.96
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: UnitedHealthcare Medicaid	$75.20
Rate for Payer: WPPA Medicare Advantage	$112.80

linezolid 600 mg Tab [HMC]

Facility

$188.66

Service Code	NDC 67877041920
Hospital Charge Code	3800173
Hospital Revenue Code	250
Min. Negotiated Rate	$75.46
Max. Negotiated Rate	$179.23
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: Humana Medicare Advantage	$79.24
Rate for Payer: UnitedHealthcare Commercial	$179.23
Rate for Payer: UnitedHealthcare Medicaid	$75.46
Rate for Payer: WPPA Medicare Advantage	$113.20

linezolid 600 mg Tab [HMC]

Facility

$188.67

Service Code	NDC 50268047112
Hospital Charge Code	3800173
Hospital Revenue Code	250
Min. Negotiated Rate	$75.47
Max. Negotiated Rate	$179.24
Rate for Payer: Aetna Commercial	$169.80
Rate for Payer: Humana Medicare Advantage	$79.24
Rate for Payer: UnitedHealthcare Commercial	$179.24
Rate for Payer: UnitedHealthcare Medicaid	$75.47
Rate for Payer: WPPA Medicare Advantage	$113.20

linezolid 600 mg Tab [HMC]

Facility

$188.66

Service Code	NDC 67877041984
Hospital Charge Code	3800173
Hospital Revenue Code	250
Min. Negotiated Rate	$169.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: UnitedHealthcare Commercial	$179.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

linezolid 600 mg Tab [HMC]

Facility

$188.00

Service Code	NDC 00904655304
Hospital Charge Code	3800173
Hospital Revenue Code	250
Min. Negotiated Rate	$169.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$169.20
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Lipase Level

Facility

$97.00

Service Code	HCPCS 83690
Hospital Charge Code	3551575
Hospital Revenue Code	300
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$92.15
Rate for Payer: Aetna Commercial	$87.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$27.78
Rate for Payer: Humana Medicare Advantage	$40.74
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: UnitedHealthcare Medicaid	$6.89
Rate for Payer: WPPA Medicare Advantage	$58.20

Lipase Level

Facility

$97.00

Service Code	HCPCS 83690
Hospital Charge Code	3551575
Hospital Revenue Code	300
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$87.30
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges