Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

methotrexate 2.5 mg Tab [HMC]

Facility

$20.59

Service Code	HCPCS J8610
Hospital Charge Code	3859552
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$19.56
Rate for Payer: Aetna Commercial	$18.53
Rate for Payer: Aetna Commercial	$14.12
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.35
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.35
Rate for Payer: Humana Medicare Advantage	$6.59
Rate for Payer: Humana Medicare Advantage	$8.65
Rate for Payer: UnitedHealthcare Commercial	$14.91
Rate for Payer: UnitedHealthcare Commercial	$19.56
Rate for Payer: UnitedHealthcare Medicaid	$8.24
Rate for Payer: UnitedHealthcare Medicaid	$6.28
Rate for Payer: WPPA Medicare Advantage	$9.41
Rate for Payer: WPPA Medicare Advantage	$12.35

methylcellulose 500 mg Tab [HMC]

Facility

$5.78

Service Code	NDC 00135019902
Hospital Charge Code	3809049
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$5.49
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: Humana Medicare Advantage	$2.43
Rate for Payer: UnitedHealthcare Commercial	$5.49
Rate for Payer: UnitedHealthcare Medicaid	$2.31
Rate for Payer: WPPA Medicare Advantage	$3.47

methylcellulose 500 mg Tab [HMC]

Facility

$5.78

Service Code	NDC 00135019902
Hospital Charge Code	3809049
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: UnitedHealthcare Commercial	$5.49
Rate for Payer: WPPA Medicare Advantage	$1,200.00

methyldopa 250 mg Tab [HMC]

Facility

$6.12

Service Code	NDC 16729003001
Hospital Charge Code	3807150
Hospital Revenue Code	250
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: UnitedHealthcare Commercial	$5.81
Rate for Payer: WPPA Medicare Advantage	$1,200.00

methyldopa 250 mg Tab [HMC]

Facility

$6.12

Service Code	NDC 16729003001
Hospital Charge Code	3807150
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.81
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: Humana Medicare Advantage	$2.57
Rate for Payer: UnitedHealthcare Commercial	$5.81
Rate for Payer: UnitedHealthcare Medicaid	$2.45
Rate for Payer: WPPA Medicare Advantage	$3.67

methylene blue 5 mg/mL [HMC]

Facility

$635.03

Service Code	HCPCS Q9968
Hospital Charge Code	3170223
Hospital Revenue Code	250
Min. Negotiated Rate	$254.01
Max. Negotiated Rate	$603.28
Rate for Payer: Aetna Commercial	$571.53
Rate for Payer: Humana Medicare Advantage	$266.71
Rate for Payer: UnitedHealthcare Commercial	$603.28
Rate for Payer: UnitedHealthcare Medicaid	$254.01
Rate for Payer: WPPA Medicare Advantage	$381.02

methylene blue 5 mg/mL [HMC]

Facility

$635.03

Service Code	HCPCS Q9968
Hospital Charge Code	3170223
Hospital Revenue Code	250
Min. Negotiated Rate	$571.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$571.53
Rate for Payer: UnitedHealthcare Commercial	$603.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00

methylergonovine 0.2 mg/mL Inj Sol [HMC]

Facility

$74.67

Service Code	HCPCS J2210
Hospital Charge Code	3803756
Hospital Revenue Code	250
Min. Negotiated Rate	$21.36
Max. Negotiated Rate	$70.94
Rate for Payer: Aetna Commercial	$67.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$26.85
Rate for Payer: Humana Medicare Advantage	$31.36
Rate for Payer: UnitedHealthcare Commercial	$70.94
Rate for Payer: UnitedHealthcare Medicaid	$21.36
Rate for Payer: WPPA Medicare Advantage	$44.80

methylergonovine 0.2 mg/mL Inj Sol [HMC]

Facility

$74.67

Service Code	HCPCS J2210
Hospital Charge Code	3803756
Hospital Revenue Code	250
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$67.20
Rate for Payer: UnitedHealthcare Commercial	$70.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Methylmalonic Acid QST

Facility

$370.00

Service Code	HCPCS 83921
Hospital Charge Code	3552111
Hospital Revenue Code	300
Min. Negotiated Rate	$333.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$333.00
Rate for Payer: UnitedHealthcare Commercial	$351.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Methylmalonic Acid QST

Facility

$370.00

Service Code	HCPCS 83921
Hospital Charge Code	3552111
Hospital Revenue Code	300
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$351.50
Rate for Payer: Aetna Commercial	$333.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$42.99
Rate for Payer: Humana Medicare Advantage	$155.40
Rate for Payer: UnitedHealthcare Commercial	$351.50
Rate for Payer: UnitedHealthcare Medicaid	$19.34
Rate for Payer: WPPA Medicare Advantage	$222.00

methylPREDNISolone 125 mg Pow [HMC]

Facility

$43.26

Service Code	HCPCS J2919
Hospital Charge Code	3803894
Hospital Revenue Code	636
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$38.93
Rate for Payer: Aetna Commercial	$42.62
Rate for Payer: UnitedHealthcare Commercial	$44.99
Rate for Payer: UnitedHealthcare Commercial	$41.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

methylPREDNISolone 125 mg Pow [HMC]

Facility

$43.26

Service Code	HCPCS J2919
Hospital Charge Code	3803894
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$41.10
Rate for Payer: Aetna Commercial	$38.93
Rate for Payer: Aetna Commercial	$42.62
Rate for Payer: Humana Medicare Advantage	$18.17
Rate for Payer: Humana Medicare Advantage	$19.89
Rate for Payer: UnitedHealthcare Commercial	$44.99
Rate for Payer: UnitedHealthcare Commercial	$41.10
Rate for Payer: UnitedHealthcare Medicaid	$0.26
Rate for Payer: UnitedHealthcare Medicaid	$0.26
Rate for Payer: WPPA Medicare Advantage	$25.96
Rate for Payer: WPPA Medicare Advantage	$28.42

methylPREDNISolone 125 mg preservative-free Pow [HMC]

Facility

$45.00

Service Code	HCPCS J2930
Hospital Charge Code	3803894
Hospital Revenue Code	250
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Humana Medicare Advantage	$18.90
Rate for Payer: UnitedHealthcare Commercial	$42.75
Rate for Payer: UnitedHealthcare Medicaid	$18.00
Rate for Payer: WPPA Medicare Advantage	$27.00

methylPREDNISolone 125 mg preservative-free Pow [HMC]

Facility

$45.00

Service Code	NDC 00009004726
Hospital Charge Code	3803894
Hospital Revenue Code	250
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Humana Medicare Advantage	$18.90
Rate for Payer: UnitedHealthcare Commercial	$42.75
Rate for Payer: UnitedHealthcare Medicaid	$18.00
Rate for Payer: WPPA Medicare Advantage	$27.00

methylPREDNISolone 125 mg preservative-free Pow [HMC]

Facility

$45.00

Service Code	NDC 00009004726
Hospital Charge Code	3803894
Hospital Revenue Code	250
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: UnitedHealthcare Commercial	$42.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

methylPREDNISolone 125 mg preservative-free Pow [HMC]

Facility

$45.00

Service Code	HCPCS J2930
Hospital Charge Code	3803894
Hospital Revenue Code	250
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: UnitedHealthcare Commercial	$42.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

methylPREDNISolone 1 g Inj [HMC]

Facility

$81.59

Service Code	HCPCS J2919
Hospital Charge Code	3803936
Hospital Revenue Code	250
Min. Negotiated Rate	$73.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$73.43
Rate for Payer: Aetna Commercial	$89.24
Rate for Payer: UnitedHealthcare Commercial	$94.20
Rate for Payer: UnitedHealthcare Commercial	$77.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

methylPREDNISolone 1 g Inj [HMC]

Facility

$99.16

Service Code	HCPCS J2919
Hospital Charge Code	3803936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$94.20
Rate for Payer: Aetna Commercial	$89.24
Rate for Payer: Aetna Commercial	$73.43
Rate for Payer: Humana Medicare Advantage	$34.27
Rate for Payer: Humana Medicare Advantage	$41.65
Rate for Payer: UnitedHealthcare Commercial	$94.20
Rate for Payer: UnitedHealthcare Commercial	$77.51
Rate for Payer: UnitedHealthcare Medicaid	$0.26
Rate for Payer: UnitedHealthcare Medicaid	$0.26
Rate for Payer: WPPA Medicare Advantage	$48.95
Rate for Payer: WPPA Medicare Advantage	$59.50

methylPREDNISolone 1 g preservative-free Pow [HMC]

Facility

$144.06

Service Code	HCPCS J2919
Hospital Charge Code	3803936
Hospital Revenue Code	250
Min. Negotiated Rate	$129.65
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$129.65
Rate for Payer: UnitedHealthcare Commercial	$136.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

methylPREDNISolone 1 g preservative-free Pow [HMC]

Facility

$144.06

Service Code	HCPCS J2919
Hospital Charge Code	3803936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$136.86
Rate for Payer: Aetna Commercial	$129.65
Rate for Payer: Humana Medicare Advantage	$60.51
Rate for Payer: UnitedHealthcare Commercial	$136.86
Rate for Payer: UnitedHealthcare Medicaid	$0.26
Rate for Payer: WPPA Medicare Advantage	$86.44

methylPREDNISolone 40 mg/mL Inj Susp [HMC]

Facility

$46.64

Service Code	HCPCS J1010
Hospital Charge Code	3805237
Hospital Revenue Code	250
Min. Negotiated Rate	$41.98
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$41.98
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Commercial	$40.95
Rate for Payer: UnitedHealthcare Commercial	$43.23
Rate for Payer: UnitedHealthcare Commercial	$40.96
Rate for Payer: UnitedHealthcare Commercial	$44.31
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

methylPREDNISolone 40 mg/mL Inj Susp [HMC]

Facility

$45.50

Service Code	HCPCS J1010
Hospital Charge Code	3805237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$43.23
Rate for Payer: Aetna Commercial	$40.95
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Commercial	$41.98
Rate for Payer: Humana Medicare Advantage	$19.11
Rate for Payer: Humana Medicare Advantage	$18.11
Rate for Payer: Humana Medicare Advantage	$19.59
Rate for Payer: UnitedHealthcare Commercial	$44.31
Rate for Payer: UnitedHealthcare Commercial	$40.96
Rate for Payer: UnitedHealthcare Commercial	$43.23
Rate for Payer: UnitedHealthcare Medicaid	$0.12
Rate for Payer: UnitedHealthcare Medicaid	$0.12
Rate for Payer: UnitedHealthcare Medicaid	$0.12
Rate for Payer: WPPA Medicare Advantage	$27.30
Rate for Payer: WPPA Medicare Advantage	$25.87
Rate for Payer: WPPA Medicare Advantage	$27.98

methylPREDNISolone 80 mg/mL Inj Susp [HMC]

Facility

$59.16

Service Code	HCPCS J1010
Hospital Charge Code	3807135
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$56.20
Rate for Payer: Aetna Commercial	$53.24
Rate for Payer: Aetna Commercial	$53.25
Rate for Payer: Aetna Commercial	$49.95
Rate for Payer: Humana Medicare Advantage	$24.85
Rate for Payer: Humana Medicare Advantage	$24.85
Rate for Payer: Humana Medicare Advantage	$23.31
Rate for Payer: UnitedHealthcare Commercial	$56.20
Rate for Payer: UnitedHealthcare Commercial	$52.73
Rate for Payer: UnitedHealthcare Commercial	$56.21
Rate for Payer: UnitedHealthcare Medicaid	$0.12
Rate for Payer: UnitedHealthcare Medicaid	$0.12
Rate for Payer: UnitedHealthcare Medicaid	$0.12
Rate for Payer: WPPA Medicare Advantage	$35.50
Rate for Payer: WPPA Medicare Advantage	$33.30
Rate for Payer: WPPA Medicare Advantage	$35.50

methylPREDNISolone 80 mg/mL Inj Susp [HMC]

Facility

$59.17

Service Code	HCPCS J1010
Hospital Charge Code	3807135
Hospital Revenue Code	250
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$53.25
Rate for Payer: Aetna Commercial	$49.95
Rate for Payer: Aetna Commercial	$53.24
Rate for Payer: UnitedHealthcare Commercial	$52.73
Rate for Payer: UnitedHealthcare Commercial	$56.20
Rate for Payer: UnitedHealthcare Commercial	$56.21
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

Know your out-of-pocket cost for care.

All Charges