Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

mupirocin Top 2% Oint [HMC]

Facility

$37.17

Service Code	NDC 45802011222
Hospital Charge Code	3803547
Hospital Revenue Code	250
Min. Negotiated Rate	$33.45
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$33.45
Rate for Payer: UnitedHealthcare Commercial	$35.31
Rate for Payer: WPPA Medicare Advantage	$1,200.00

mupirocin Top 2% Oint [HMC]

Facility

$53.75

Service Code	NDC 51672131200
Hospital Charge Code	3803547
Hospital Revenue Code	250
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$48.38
Rate for Payer: UnitedHealthcare Commercial	$51.06
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Musk Ab Test QST

Facility

$1,600.00

Service Code	HCPCS 86366
Hospital Charge Code	3551598
Hospital Revenue Code	300
Min. Negotiated Rate	$15.64
Max. Negotiated Rate	$1,520.00
Rate for Payer: Aetna Commercial	$1,440.00
Rate for Payer: Humana Medicare Advantage	$672.00
Rate for Payer: UnitedHealthcare Commercial	$1,520.00
Rate for Payer: UnitedHealthcare Medicaid	$15.64
Rate for Payer: WPPA Medicare Advantage	$960.00

Musk Ab Test QST

Facility

$1,600.00

Service Code	HCPCS 86366
Hospital Charge Code	3551598
Hospital Revenue Code	300
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,520.00
Rate for Payer: Aetna Commercial	$1,440.00
Rate for Payer: UnitedHealthcare Commercial	$1,520.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Myasthenia Gravis Panel 2 w Rfx to MuSK Ab QST

Facility

$792.00

Service Code	HCPCS 83519
Hospital Charge Code	3555198
Hospital Revenue Code	300
Min. Negotiated Rate	$712.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$712.80
Rate for Payer: UnitedHealthcare Commercial	$752.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Myasthenia Gravis Panel 2 w Rfx to MuSK Ab QST

Facility

$792.00

Service Code	HCPCS 83519
Hospital Charge Code	3555198
Hospital Revenue Code	300
Min. Negotiated Rate	$15.64
Max. Negotiated Rate	$752.40
Rate for Payer: Aetna Commercial	$712.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.48
Rate for Payer: Humana Medicare Advantage	$332.64
Rate for Payer: UnitedHealthcare Commercial	$752.40
Rate for Payer: UnitedHealthcare Medicaid	$15.64
Rate for Payer: WPPA Medicare Advantage	$475.20

Mycophenolic Acid LC/MS/MS QST

Facility

$279.00

Service Code	HCPCS 80180
Hospital Charge Code	3550662
Hospital Revenue Code	300
Min. Negotiated Rate	$251.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$251.10
Rate for Payer: UnitedHealthcare Commercial	$265.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mycophenolic Acid LC/MS/MS QST

Facility

$279.00

Service Code	HCPCS 80180
Hospital Charge Code	3550662
Hospital Revenue Code	300
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$265.05
Rate for Payer: Aetna Commercial	$251.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.75
Rate for Payer: Humana Medicare Advantage	$117.18
Rate for Payer: UnitedHealthcare Commercial	$265.05
Rate for Payer: UnitedHealthcare Medicaid	$111.60
Rate for Payer: WPPA Medicare Advantage	$167.40

Myelin Oligodendrocyte Glycoprotein (MOG) Antibody w/Rflx to Titer, Serum QST

Facility

$980.00

Service Code	HCPCS 86362
Hospital Charge Code	3556362
Hospital Revenue Code	300
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$931.00
Rate for Payer: Aetna Commercial	$882.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$22.59
Rate for Payer: Humana Medicare Advantage	$411.60
Rate for Payer: UnitedHealthcare Commercial	$931.00
Rate for Payer: UnitedHealthcare Medicaid	$7.83
Rate for Payer: WPPA Medicare Advantage	$588.00

Myelin Oligodendrocyte Glycoprotein (MOG) Antibody w/Rflx to Titer, Serum QST

Facility

$980.00

Service Code	HCPCS 86362
Hospital Charge Code	3556362
Hospital Revenue Code	300
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$882.00
Rate for Payer: UnitedHealthcare Commercial	$931.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Myeloperoxidase Ab QST

Facility

$119.00

Service Code	HCPCS 86376
Hospital Charge Code	3552474
Hospital Revenue Code	300
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: UnitedHealthcare Commercial	$113.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Myeloperoxidase Ab QST

Facility

$119.00

Service Code	HCPCS 86376
Hospital Charge Code	3552474
Hospital Revenue Code	300
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$113.05
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$50.96
Rate for Payer: Humana Medicare Advantage	$49.98
Rate for Payer: UnitedHealthcare Commercial	$113.05
Rate for Payer: UnitedHealthcare Medicaid	$14.55
Rate for Payer: WPPA Medicare Advantage	$71.40

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$8,101.35

Service Code	MSDRG 827
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$8,101.35
Rate for Payer: UnitedHealthcare Medicaid	$8,101.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$16,393.32

Service Code	MSDRG 826
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$16,393.32
Rate for Payer: UnitedHealthcare Medicaid	$16,393.32
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$5,972.76

Service Code	MSDRG 828
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,972.76
Rate for Payer: UnitedHealthcare Medicaid	$5,972.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$11,087.73

Service Code	MSDRG 829
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$11,087.73
Rate for Payer: UnitedHealthcare Medicaid	$11,087.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$5,273.82

Service Code	MSDRG 830
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,273.82
Rate for Payer: UnitedHealthcare Medicaid	$5,273.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Myositis Specific 11 Ab Panel QST

Facility

$1,933.00

Service Code	HCPCS 84182
Hospital Charge Code	3554777
Hospital Revenue Code	300
Min. Negotiated Rate	$86.54
Max. Negotiated Rate	$1,836.35
Rate for Payer: Aetna Commercial	$1,739.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$86.54
Rate for Payer: Humana Medicare Advantage	$811.86
Rate for Payer: UnitedHealthcare Commercial	$1,836.35
Rate for Payer: UnitedHealthcare Medicaid	$773.20
Rate for Payer: WPPA Medicare Advantage	$1,159.80

Myositis Specific 11 Ab Panel QST

Facility

$1,933.00

Service Code	HCPCS 84182
Hospital Charge Code	3554777
Hospital Revenue Code	300
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,836.35
Rate for Payer: Aetna Commercial	$1,739.70
Rate for Payer: UnitedHealthcare Commercial	$1,836.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Myringotomy Blade Down Cut Lance (Pediatric)

Facility

$36.77

Hospital Charge Code	3256965
Hospital Revenue Code	270
Min. Negotiated Rate	$33.09
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$33.09
Rate for Payer: UnitedHealthcare Commercial	$34.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Myringotomy Blade Down Cut Lance (Pediatric)

Facility

$36.77

Hospital Charge Code	3256965
Hospital Revenue Code	270
Min. Negotiated Rate	$14.71
Max. Negotiated Rate	$34.93
Rate for Payer: Aetna Commercial	$33.09
Rate for Payer: Humana Medicare Advantage	$15.44
Rate for Payer: UnitedHealthcare Commercial	$34.93
Rate for Payer: UnitedHealthcare Medicaid	$14.71
Rate for Payer: WPPA Medicare Advantage	$22.06

nafcillin 2 g Inj [HMC]

Facility

$76.03

Service Code	NDC 00781312992
Hospital Charge Code	3809519
Hospital Revenue Code	250
Min. Negotiated Rate	$30.41
Max. Negotiated Rate	$72.23
Rate for Payer: Aetna Commercial	$68.43
Rate for Payer: Humana Medicare Advantage	$31.93
Rate for Payer: UnitedHealthcare Commercial	$72.23
Rate for Payer: UnitedHealthcare Medicaid	$30.41
Rate for Payer: WPPA Medicare Advantage	$45.62

nafcillin 2 g Inj [HMC]

Facility

$76.03

Service Code	NDC 00781312992
Hospital Charge Code	3809519
Hospital Revenue Code	250
Min. Negotiated Rate	$68.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$68.43
Rate for Payer: UnitedHealthcare Commercial	$72.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nalbuphine 10 mg/mL Sol Inj [HMC]

Facility

$35.91

Service Code	HCPCS J2300
Hospital Charge Code	3852070
Hospital Revenue Code	250
Min. Negotiated Rate	$32.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$32.32
Rate for Payer: UnitedHealthcare Commercial	$34.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nalbuphine 10 mg/mL Sol Inj [HMC]

Facility

$35.91

Service Code	HCPCS J2300
Hospital Charge Code	3852070
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$34.11
Rate for Payer: Aetna Commercial	$32.32
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3.57
Rate for Payer: Humana Medicare Advantage	$15.08
Rate for Payer: UnitedHealthcare Commercial	$34.11
Rate for Payer: UnitedHealthcare Medicaid	$3.45
Rate for Payer: WPPA Medicare Advantage	$21.55

Know your out-of-pocket cost for care.

All Charges