Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$4,161.87

Service Code	MSDRG 060
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,161.87
Rate for Payer: UnitedHealthcare Medicaid	$4,161.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Multiple Vitamins IV Sol 5 mL [HMC]

Facility

$218.45

Service Code	NDC 54643564901
Hospital Charge Code	3802706
Hospital Revenue Code	250
Min. Negotiated Rate	$196.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$196.60
Rate for Payer: UnitedHealthcare Commercial	$207.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Multiple Vitamins IV Sol 5 mL [HMC]

Facility

$218.45

Service Code	NDC 54643564901
Hospital Charge Code	3802706
Hospital Revenue Code	250
Min. Negotiated Rate	$87.38
Max. Negotiated Rate	$207.53
Rate for Payer: Aetna Commercial	$196.60
Rate for Payer: Humana Medicare Advantage	$91.75
Rate for Payer: UnitedHealthcare Commercial	$207.53
Rate for Payer: UnitedHealthcare Medicaid	$87.38
Rate for Payer: WPPA Medicare Advantage	$131.07

Multiple Vitamins Tab [HMC]

Facility

$5.18

Service Code	NDC 00904053061
Hospital Charge Code	3806292
Hospital Revenue Code	250
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.66
Rate for Payer: UnitedHealthcare Commercial	$4.92
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Multiple Vitamins Tab [HMC]

Facility

$5.04

Service Code	NDC 80681002000
Hospital Charge Code	3806292
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$4.79
Rate for Payer: Aetna Commercial	$4.54
Rate for Payer: Humana Medicare Advantage	$2.12
Rate for Payer: UnitedHealthcare Commercial	$4.79
Rate for Payer: UnitedHealthcare Medicaid	$2.02
Rate for Payer: WPPA Medicare Advantage	$3.02

Multiple Vitamins Tab [HMC]

Facility

$5.18

Service Code	NDC 00904053061
Hospital Charge Code	3806292
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$4.92
Rate for Payer: Aetna Commercial	$4.66
Rate for Payer: Humana Medicare Advantage	$2.18
Rate for Payer: UnitedHealthcare Commercial	$4.92
Rate for Payer: UnitedHealthcare Medicaid	$2.07
Rate for Payer: WPPA Medicare Advantage	$3.11

Multiple Vitamins Tab [HMC]

Facility

$5.04

Service Code	NDC 80681002000
Hospital Charge Code	3806292
Hospital Revenue Code	250
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.54
Rate for Payer: UnitedHealthcare Commercial	$4.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Multiple Vitamins with Iron Tab [HMC]

Facility

$5.07

Service Code	NDC 80681012400
Hospital Charge Code	3809742
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Multiple Vitamins with Iron Tab [HMC]

Facility

$5.07

Service Code	NDC 80681012400
Hospital Charge Code	3809742
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Humana Medicare Advantage	$2.13
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: UnitedHealthcare Medicaid	$2.03
Rate for Payer: WPPA Medicare Advantage	$3.04

Multiple Vitamins with Iron Tab [HMC]

Facility

$5.10

Service Code	NDC 00904053160
Hospital Charge Code	3809742
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$4.84
Rate for Payer: Aetna Commercial	$4.59
Rate for Payer: Humana Medicare Advantage	$2.14
Rate for Payer: UnitedHealthcare Commercial	$4.84
Rate for Payer: UnitedHealthcare Medicaid	$2.04
Rate for Payer: WPPA Medicare Advantage	$3.06

Multiple Vitamins with Iron Tab [HMC]

Facility

$5.10

Service Code	NDC 00904053160
Hospital Charge Code	3809742
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.59
Rate for Payer: UnitedHealthcare Commercial	$4.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

multivitamin with iron Vitamin B12 with Folic Acid and Iron Cap UD [HMC]

Facility

$5.47

Service Code	NDC 51991019811
Hospital Charge Code	3808231
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: Humana Medicare Advantage	$2.30
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Medicaid	$2.19
Rate for Payer: WPPA Medicare Advantage	$3.28

multivitamin with iron Vitamin B12 with Folic Acid and Iron Cap UD [HMC]

Facility

$5.79

Service Code	NDC 60258018601
Hospital Charge Code	3808231
Hospital Revenue Code	250
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$5.21
Rate for Payer: Humana Medicare Advantage	$2.43
Rate for Payer: UnitedHealthcare Commercial	$5.50
Rate for Payer: UnitedHealthcare Medicaid	$2.32
Rate for Payer: WPPA Medicare Advantage	$3.47

multivitamin with iron Vitamin B12 with Folic Acid and Iron Cap UD [HMC]

Facility

$5.47

Service Code	NDC 51991019811
Hospital Charge Code	3808231
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

multivitamin with iron Vitamin B12 with Folic Acid and Iron Cap UD [HMC]

Facility

$5.79

Service Code	NDC 60258018601
Hospital Charge Code	3808231
Hospital Revenue Code	250
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.21
Rate for Payer: UnitedHealthcare Commercial	$5.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mumps Virus Ab (IgG) QST

Facility

$107.00

Service Code	HCPCS 86735
Hospital Charge Code	3552102
Hospital Revenue Code	300
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$96.30
Rate for Payer: UnitedHealthcare Commercial	$101.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mumps Virus Ab (IgG) QST

Facility

$107.00

Service Code	HCPCS 86735
Hospital Charge Code	3552102
Hospital Revenue Code	300
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$101.65
Rate for Payer: Aetna Commercial	$96.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$64.95
Rate for Payer: Humana Medicare Advantage	$44.94
Rate for Payer: UnitedHealthcare Commercial	$101.65
Rate for Payer: UnitedHealthcare Medicaid	$11.09
Rate for Payer: WPPA Medicare Advantage	$64.20

Mumps Virus Ab (IgM) QST

Facility

$107.00

Service Code	HCPCS 86735
Hospital Charge Code	3552102
Hospital Revenue Code	300
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$96.30
Rate for Payer: UnitedHealthcare Commercial	$101.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mumps Virus Ab (IgM) QST

Facility

$107.00

Service Code	HCPCS 86735
Hospital Charge Code	3552102
Hospital Revenue Code	300
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$101.65
Rate for Payer: Aetna Commercial	$96.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$64.95
Rate for Payer: Humana Medicare Advantage	$44.94
Rate for Payer: UnitedHealthcare Commercial	$101.65
Rate for Payer: UnitedHealthcare Medicaid	$11.09
Rate for Payer: WPPA Medicare Advantage	$64.20

Mumps Virus Abs IgG TC

Facility

$107.00

Service Code	HCPCS 86735
Hospital Charge Code	3552102
Hospital Revenue Code	300
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$101.65
Rate for Payer: Aetna Commercial	$96.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$64.95
Rate for Payer: Humana Medicare Advantage	$44.94
Rate for Payer: UnitedHealthcare Commercial	$101.65
Rate for Payer: UnitedHealthcare Medicaid	$11.09
Rate for Payer: WPPA Medicare Advantage	$64.20

Mumps Virus Abs IgG TC

Facility

$107.00

Service Code	HCPCS 86735
Hospital Charge Code	3552102
Hospital Revenue Code	300
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$96.30
Rate for Payer: UnitedHealthcare Commercial	$101.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mumps Virus RNA, Ql Real Time PCR QST

Facility

$647.00

Service Code	HCPCS 87798
Hospital Charge Code	3559887
Hospital Revenue Code	300
Min. Negotiated Rate	$582.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$582.30
Rate for Payer: UnitedHealthcare Commercial	$614.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mumps Virus RNA, Ql Real Time PCR QST

Facility

$647.00

Service Code	HCPCS 87798
Hospital Charge Code	3559887
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$614.65
Rate for Payer: Aetna Commercial	$582.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$185.64
Rate for Payer: Humana Medicare Advantage	$271.74
Rate for Payer: UnitedHealthcare Commercial	$614.65
Rate for Payer: UnitedHealthcare Medicaid	$35.09
Rate for Payer: WPPA Medicare Advantage	$388.20

mupirocin Top 2% Oint [HMC]

Facility

$37.17

Service Code	NDC 45802011222
Hospital Charge Code	3803547
Hospital Revenue Code	250
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$35.31
Rate for Payer: Aetna Commercial	$33.45
Rate for Payer: Humana Medicare Advantage	$15.61
Rate for Payer: UnitedHealthcare Commercial	$35.31
Rate for Payer: UnitedHealthcare Medicaid	$14.87
Rate for Payer: WPPA Medicare Advantage	$22.30

mupirocin Top 2% Oint [HMC]

Facility

$53.75

Service Code	NDC 51672131200
Hospital Charge Code	3803547
Hospital Revenue Code	250
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$51.06
Rate for Payer: Aetna Commercial	$48.38
Rate for Payer: Humana Medicare Advantage	$22.57
Rate for Payer: UnitedHealthcare Commercial	$51.06
Rate for Payer: UnitedHealthcare Medicaid	$21.50
Rate for Payer: WPPA Medicare Advantage	$32.25

Know your out-of-pocket cost for care.

All Charges