Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

MORGAN LENS

Facility

$165.38

Hospital Charge Code	3256158
Hospital Revenue Code	270
Min. Negotiated Rate	$66.15
Max. Negotiated Rate	$157.11
Rate for Payer: Aetna Commercial	$148.84
Rate for Payer: Humana Medicare Advantage	$69.46
Rate for Payer: UnitedHealthcare Commercial	$157.11
Rate for Payer: UnitedHealthcare Medicaid	$66.15
Rate for Payer: WPPA Medicare Advantage	$99.23

MORGAN LENS

Facility

$165.38

Hospital Charge Code	3256158
Hospital Revenue Code	270
Min. Negotiated Rate	$148.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$148.84
Rate for Payer: UnitedHealthcare Commercial	$157.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MORGAN LENS TUBING

Facility

$59.22

Hospital Charge Code	3256166
Hospital Revenue Code	270
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$56.26
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Humana Medicare Advantage	$24.87
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: UnitedHealthcare Medicaid	$23.69
Rate for Payer: WPPA Medicare Advantage	$35.53

MORGAN LENS TUBING

Facility

$59.22

Hospital Charge Code	3256166
Hospital Revenue Code	270
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 10 mg/mL preservative-free [HMC]

Facility

$30.29

Service Code	HCPCS J2270
Hospital Charge Code	3802664
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$28.78
Rate for Payer: Aetna Commercial	$27.26
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5.74
Rate for Payer: Humana Medicare Advantage	$12.72
Rate for Payer: UnitedHealthcare Commercial	$28.78
Rate for Payer: UnitedHealthcare Medicaid	$3.04
Rate for Payer: WPPA Medicare Advantage	$18.17

morphine 10 mg/mL preservative-free [HMC]

Facility

$30.29

Service Code	HCPCS J2270
Hospital Charge Code	3802664
Hospital Revenue Code	250
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$27.26
Rate for Payer: UnitedHealthcare Commercial	$28.78
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 10 mg/mL preservative-free Sol [HMC]

Facility

$32.32

Service Code	HCPCS J2274
Hospital Charge Code	3802664
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$30.70
Rate for Payer: Aetna Commercial	$29.09
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$18.56
Rate for Payer: Humana Medicare Advantage	$13.57
Rate for Payer: UnitedHealthcare Commercial	$30.70
Rate for Payer: UnitedHealthcare Medicaid	$13.50
Rate for Payer: WPPA Medicare Advantage	$19.39

morphine 10 mg/mL preservative-free Sol [HMC]

Facility

$32.32

Service Code	HCPCS J2274
Hospital Charge Code	3802664
Hospital Revenue Code	250
Min. Negotiated Rate	$29.09
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.09
Rate for Payer: UnitedHealthcare Commercial	$30.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 15 mg ER tabs [HMC]

Facility

$10.53

Service Code	NDC 68084040301
Hospital Charge Code	3807803
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$9.48
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Medicaid	$4.21
Rate for Payer: WPPA Medicare Advantage	$6.32

morphine 15 mg ER tabs [HMC]

Facility

$10.53

Service Code	NDC 68084040301
Hospital Charge Code	3807803
Hospital Revenue Code	250
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.48
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 15 mg ER tabs [HMC]

Facility

$9.12

Service Code	NDC 00904655761
Hospital Charge Code	3807803
Hospital Revenue Code	250
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.21
Rate for Payer: UnitedHealthcare Commercial	$8.66
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 15 mg ER tabs [HMC]

Facility

$9.12

Service Code	NDC 00904655761
Hospital Charge Code	3807803
Hospital Revenue Code	250
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$8.66
Rate for Payer: Aetna Commercial	$8.21
Rate for Payer: Humana Medicare Advantage	$3.83
Rate for Payer: UnitedHealthcare Commercial	$8.66
Rate for Payer: UnitedHealthcare Medicaid	$3.65
Rate for Payer: WPPA Medicare Advantage	$5.47

morphine 1 mg/mL-NaCl 0.9% preservative-free Sol 30mL [HMC]

Facility

$145.17

Service Code	HCPCS J2274
Hospital Charge Code	3805915
Hospital Revenue Code	636
Min. Negotiated Rate	$130.65
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$130.65
Rate for Payer: UnitedHealthcare Commercial	$137.91
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 1 mg/mL-NaCl 0.9% preservative-free Sol 30mL [HMC]

Facility

$145.17

Service Code	HCPCS J2274
Hospital Charge Code	3805915
Hospital Revenue Code	636
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$137.91
Rate for Payer: Aetna Commercial	$130.65
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$18.56
Rate for Payer: Humana Medicare Advantage	$60.97
Rate for Payer: UnitedHealthcare Commercial	$137.91
Rate for Payer: UnitedHealthcare Medicaid	$13.50
Rate for Payer: WPPA Medicare Advantage	$87.10

morphine 1 mg/mL-NaCl 0.9% preservative-free Sol [HMC]

Facility

$59.30

Service Code	HCPCS J2274
Hospital Charge Code	3802657
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$56.34
Rate for Payer: Aetna Commercial	$53.37
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$18.56
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: UnitedHealthcare Commercial	$56.34
Rate for Payer: UnitedHealthcare Medicaid	$13.50
Rate for Payer: WPPA Medicare Advantage	$35.58

morphine 1 mg/mL-NaCl 0.9% preservative-free Sol [HMC]

Facility

$59.30

Service Code	HCPCS J2274
Hospital Charge Code	3802657
Hospital Revenue Code	250
Min. Negotiated Rate	$53.37
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$53.37
Rate for Payer: UnitedHealthcare Commercial	$56.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 1 mg/mL preservative-free Inj Sol [HMC]

Facility

$77.13

Service Code	HCPCS J2274
Hospital Charge Code	3802950
Hospital Revenue Code	250
Min. Negotiated Rate	$69.42
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$69.42
Rate for Payer: UnitedHealthcare Commercial	$73.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 1 mg/mL preservative-free Inj Sol [HMC]

Facility

$77.13

Service Code	HCPCS J2274
Hospital Charge Code	3802950
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$73.27
Rate for Payer: Aetna Commercial	$69.42
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$18.56
Rate for Payer: Humana Medicare Advantage	$32.39
Rate for Payer: UnitedHealthcare Commercial	$73.27
Rate for Payer: UnitedHealthcare Medicaid	$13.50
Rate for Payer: WPPA Medicare Advantage	$46.28

morphine 20 mg/mL Oral Conc [HMC]

Facility

$15.84

Service Code	NDC 00054051741
Hospital Charge Code	3800110
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$14.26
Rate for Payer: Humana Medicare Advantage	$6.65
Rate for Payer: UnitedHealthcare Commercial	$15.05
Rate for Payer: UnitedHealthcare Medicaid	$6.34
Rate for Payer: WPPA Medicare Advantage	$9.50

morphine 20 mg/mL Oral Conc [HMC]

Facility

$15.75

Service Code	NDC 00406800315
Hospital Charge Code	3800110
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.96
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: Humana Medicare Advantage	$6.62
Rate for Payer: UnitedHealthcare Commercial	$14.96
Rate for Payer: UnitedHealthcare Medicaid	$6.30
Rate for Payer: WPPA Medicare Advantage	$9.45

morphine 20 mg/mL Oral Conc [HMC]

Facility

$15.75

Service Code	NDC 00406800315
Hospital Charge Code	3800110
Hospital Revenue Code	250
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: UnitedHealthcare Commercial	$14.96
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 20 mg/mL Oral Conc [HMC]

Facility

$15.84

Service Code	NDC 00054051741
Hospital Charge Code	3800110
Hospital Revenue Code	250
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.26
Rate for Payer: UnitedHealthcare Commercial	$15.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 2 mg/mL preservative-free [HMC]

Facility

$27.78

Service Code	HCPCS J2270
Hospital Charge Code	3802656
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$26.39
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5.74
Rate for Payer: Humana Medicare Advantage	$11.67
Rate for Payer: UnitedHealthcare Commercial	$26.39
Rate for Payer: UnitedHealthcare Medicaid	$3.04
Rate for Payer: WPPA Medicare Advantage	$16.67

morphine 2 mg/mL preservative-free [HMC]

Facility

$27.78

Service Code	HCPCS J2270
Hospital Charge Code	3802656
Hospital Revenue Code	250
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: UnitedHealthcare Commercial	$26.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00

morphine 2 mg/mL preservative-free Sol [HMC]

Facility

$30.57

Service Code	HCPCS J2270
Hospital Charge Code	3802656
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$29.04
Rate for Payer: Aetna Commercial	$27.51
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5.74
Rate for Payer: Humana Medicare Advantage	$12.84
Rate for Payer: UnitedHealthcare Commercial	$29.04
Rate for Payer: UnitedHealthcare Medicaid	$3.04
Rate for Payer: WPPA Medicare Advantage	$18.34

Know your out-of-pocket cost for care.

All Charges