Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$1,588.50

Service Code	MSDRG 761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,588.50
Rate for Payer: UnitedHealthcare Medicaid	$1,588.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

menthol topical 4% Gel [HMC]

Facility

$32.53

Service Code	NDC 31124000006
Hospital Charge Code	3800796
Hospital Revenue Code	250
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$30.90
Rate for Payer: Aetna Commercial	$29.28
Rate for Payer: Humana Medicare Advantage	$13.66
Rate for Payer: UnitedHealthcare Commercial	$30.90
Rate for Payer: UnitedHealthcare Medicaid	$13.01
Rate for Payer: WPPA Medicare Advantage	$19.52

menthol topical 4% Gel [HMC]

Facility

$32.53

Service Code	NDC 31124000006
Hospital Charge Code	3800796
Hospital Revenue Code	250
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.28
Rate for Payer: UnitedHealthcare Commercial	$30.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

menthol-zinc oxide topical 0.44%-20.6% Oin [HMC]

Facility

$32.25

Service Code	NDC 00799000102
Hospital Charge Code	3800975
Hospital Revenue Code	259
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$30.64
Rate for Payer: Aetna Commercial	$29.02
Rate for Payer: Humana Medicare Advantage	$13.54
Rate for Payer: UnitedHealthcare Commercial	$30.64
Rate for Payer: UnitedHealthcare Medicaid	$12.90
Rate for Payer: WPPA Medicare Advantage	$19.35

menthol-zinc oxide topical 0.44%-20.6% Oin [HMC]

Facility

$32.25

Service Code	NDC 00799000102
Hospital Charge Code	3800975
Hospital Revenue Code	259
Min. Negotiated Rate	$29.02
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.02
Rate for Payer: UnitedHealthcare Commercial	$30.64
Rate for Payer: WPPA Medicare Advantage	$1,200.00

meperidine 50 mg/mL Inj Sol [HMC]

Facility

$38.60

Service Code	HCPCS J2175
Hospital Charge Code	3805211
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$36.67
Rate for Payer: Aetna Commercial	$34.74
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.88
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.88
Rate for Payer: Humana Medicare Advantage	$16.21
Rate for Payer: Humana Medicare Advantage	$12.92
Rate for Payer: UnitedHealthcare Commercial	$29.23
Rate for Payer: UnitedHealthcare Commercial	$36.67
Rate for Payer: UnitedHealthcare Medicaid	$8.15
Rate for Payer: UnitedHealthcare Medicaid	$8.15
Rate for Payer: WPPA Medicare Advantage	$23.16
Rate for Payer: WPPA Medicare Advantage	$18.46

meperidine 50 mg/mL Inj Sol [HMC]

Facility

$30.77

Service Code	HCPCS J2175
Hospital Charge Code	3805211
Hospital Revenue Code	250
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Commercial	$34.74
Rate for Payer: UnitedHealthcare Commercial	$36.67
Rate for Payer: UnitedHealthcare Commercial	$29.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

mepolizumab 100 mg/mL [HMC]

Facility

$6,659.88

Service Code	HCPCS J2182
Hospital Charge Code	3850100
Hospital Revenue Code	250
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,326.89
Rate for Payer: Aetna Commercial	$5,993.89
Rate for Payer: UnitedHealthcare Commercial	$6,326.89
Rate for Payer: WPPA Medicare Advantage	$1,200.00

mepolizumab 100 mg/mL [HMC]

Facility

$6,659.88

Service Code	HCPCS J2182
Hospital Charge Code	3850100
Hospital Revenue Code	250
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$6,326.89
Rate for Payer: Aetna Commercial	$5,993.89
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$38.95
Rate for Payer: Humana Medicare Advantage	$2,797.15
Rate for Payer: UnitedHealthcare Commercial	$6,326.89
Rate for Payer: UnitedHealthcare Medicaid	$31.89
Rate for Payer: WPPA Medicare Advantage	$3,995.93

meropenem 1000 mg Pow

Facility

$38.32

Service Code	HCPCS J2185
Hospital Charge Code	3852220
Hospital Revenue Code	250
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: UnitedHealthcare Commercial	$36.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

meropenem 1000 mg Pow

Facility

$38.32

Service Code	HCPCS J2185
Hospital Charge Code	3852220
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$36.40
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.58
Rate for Payer: Humana Medicare Advantage	$16.09
Rate for Payer: UnitedHealthcare Commercial	$36.40
Rate for Payer: UnitedHealthcare Medicaid	$0.38
Rate for Payer: WPPA Medicare Advantage	$22.99

meropenem 1 g IV Inj [HMC]

Facility

$171.06

Service Code	HCPCS J2185
Hospital Charge Code	3852220
Hospital Revenue Code	250
Min. Negotiated Rate	$153.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$153.95
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: UnitedHealthcare Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$162.51
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

meropenem 1 g IV Inj [HMC]

Facility

$54.00

Service Code	HCPCS J2185
Hospital Charge Code	3852220
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Aetna Commercial	$153.95
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.58
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.58
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.58
Rate for Payer: Humana Medicare Advantage	$22.68
Rate for Payer: Humana Medicare Advantage	$71.85
Rate for Payer: Humana Medicare Advantage	$24.36
Rate for Payer: UnitedHealthcare Commercial	$162.51
Rate for Payer: UnitedHealthcare Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$55.10
Rate for Payer: UnitedHealthcare Medicaid	$0.38
Rate for Payer: UnitedHealthcare Medicaid	$0.38
Rate for Payer: UnitedHealthcare Medicaid	$0.38
Rate for Payer: WPPA Medicare Advantage	$34.80
Rate for Payer: WPPA Medicare Advantage	$32.40
Rate for Payer: WPPA Medicare Advantage	$102.64

mesalamine 400 mg Cap [HMC]

Facility

$25.82

Service Code	NDC 60687055632
Hospital Charge Code	3800820
Hospital Revenue Code	250
Min. Negotiated Rate	$23.24
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.24
Rate for Payer: UnitedHealthcare Commercial	$24.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

mesalamine 400 mg Cap [HMC]

Facility

$25.82

Service Code	NDC 60687055632
Hospital Charge Code	3800820
Hospital Revenue Code	250
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$24.53
Rate for Payer: Aetna Commercial	$23.24
Rate for Payer: Humana Medicare Advantage	$10.84
Rate for Payer: UnitedHealthcare Commercial	$24.53
Rate for Payer: UnitedHealthcare Medicaid	$10.33
Rate for Payer: WPPA Medicare Advantage	$15.49

Mesh 3DMax Large Left

Facility

$300.00

Hospital Charge Code	3253865
Hospital Revenue Code	270
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$270.00
Rate for Payer: UnitedHealthcare Commercial	$285.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh 3DMax Large Left

Facility

$300.00

Hospital Charge Code	3253865
Hospital Revenue Code	270
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$285.00
Rate for Payer: Aetna Commercial	$270.00
Rate for Payer: Humana Medicare Advantage	$126.00
Rate for Payer: UnitedHealthcare Commercial	$285.00
Rate for Payer: UnitedHealthcare Medicaid	$120.00
Rate for Payer: WPPA Medicare Advantage	$180.00

Mesh 3DMax Large Right

Facility

$504.00

Hospital Charge Code	3253866
Hospital Revenue Code	270
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna Commercial	$453.60
Rate for Payer: Humana Medicare Advantage	$211.68
Rate for Payer: UnitedHealthcare Commercial	$478.80
Rate for Payer: UnitedHealthcare Medicaid	$201.60
Rate for Payer: WPPA Medicare Advantage	$302.40

Mesh 3DMax Large Right

Facility

$504.00

Hospital Charge Code	3253866
Hospital Revenue Code	270
Min. Negotiated Rate	$453.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$453.60
Rate for Payer: UnitedHealthcare Commercial	$478.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh 3DMax Light Large Left

Facility

$555.00

Hospital Charge Code	3253867
Hospital Revenue Code	270
Min. Negotiated Rate	$499.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$499.50
Rate for Payer: UnitedHealthcare Commercial	$527.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh 3DMax Light Large Left

Facility

$555.00

Hospital Charge Code	3253867
Hospital Revenue Code	270
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$527.25
Rate for Payer: Aetna Commercial	$499.50
Rate for Payer: Humana Medicare Advantage	$233.10
Rate for Payer: UnitedHealthcare Commercial	$527.25
Rate for Payer: UnitedHealthcare Medicaid	$222.00
Rate for Payer: WPPA Medicare Advantage	$333.00

Mesh 3DMax Light Large Right

Facility

$465.00

Hospital Charge Code	3256868
Hospital Revenue Code	270
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$441.75
Rate for Payer: Aetna Commercial	$418.50
Rate for Payer: Humana Medicare Advantage	$195.30
Rate for Payer: UnitedHealthcare Commercial	$441.75
Rate for Payer: UnitedHealthcare Medicaid	$186.00
Rate for Payer: WPPA Medicare Advantage	$279.00

Mesh 3DMax Light Large Right

Facility

$465.00

Hospital Charge Code	3256868
Hospital Revenue Code	270
Min. Negotiated Rate	$418.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$418.50
Rate for Payer: UnitedHealthcare Commercial	$441.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh Fixation Device Absorbable Strap25 SecureStrap

Facility

$1,060.36

Hospital Charge Code	3258970
Hospital Revenue Code	270
Min. Negotiated Rate	$424.14
Max. Negotiated Rate	$1,007.34
Rate for Payer: Aetna Commercial	$954.32
Rate for Payer: Humana Medicare Advantage	$445.35
Rate for Payer: UnitedHealthcare Commercial	$1,007.34
Rate for Payer: UnitedHealthcare Medicaid	$424.14
Rate for Payer: WPPA Medicare Advantage	$636.22

Mesh Fixation Device Absorbable Strap25 SecureStrap

Facility

$1,060.36

Hospital Charge Code	3258970
Hospital Revenue Code	270
Min. Negotiated Rate	$954.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$954.32
Rate for Payer: UnitedHealthcare Commercial	$1,007.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges