Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Needle Spinal 17G X 5 Tuohy/Weiss Epidural

Facility

$85.00

Hospital Charge Code	3259758
Hospital Revenue Code	270
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Spinal 17G X 5 Tuohy/Weiss Epidural

Facility

$85.00

Hospital Charge Code	3259758
Hospital Revenue Code	270
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$80.75
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Humana Medicare Advantage	$35.70
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: UnitedHealthcare Medicaid	$34.00
Rate for Payer: WPPA Medicare Advantage	$51.00

Needle Spinal 18G X 6 Tuohy/Weiss Epidural

Facility

$46.00

Hospital Charge Code	3257985
Hospital Revenue Code	270
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$41.40
Rate for Payer: UnitedHealthcare Commercial	$43.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Spinal 18G X 6 Tuohy/Weiss Epidural

Facility

$46.00

Hospital Charge Code	3257985
Hospital Revenue Code	270
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$43.70
Rate for Payer: Aetna Commercial	$41.40
Rate for Payer: Humana Medicare Advantage	$19.32
Rate for Payer: UnitedHealthcare Commercial	$43.70
Rate for Payer: UnitedHealthcare Medicaid	$18.40
Rate for Payer: WPPA Medicare Advantage	$27.60

Needlestick Exposure Titer

Facility

$53.00

Hospital Charge Code	3554444
Hospital Revenue Code	300
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: UnitedHealthcare Commercial	$50.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needlestick Exposure Titer

Facility

$53.00

Hospital Charge Code	3554444
Hospital Revenue Code	300
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$50.35
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: Humana Medicare Advantage	$22.26
Rate for Payer: UnitedHealthcare Commercial	$50.35
Rate for Payer: UnitedHealthcare Medicaid	$21.20
Rate for Payer: WPPA Medicare Advantage	$31.80

Needle Veress Insufflation 14g X 15cm

Facility

$59.00

Hospital Charge Code	3257530
Hospital Revenue Code	270
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$53.10
Rate for Payer: UnitedHealthcare Commercial	$56.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Veress Insufflation 14g X 15cm

Facility

$59.00

Hospital Charge Code	3257530
Hospital Revenue Code	270
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$56.05
Rate for Payer: Aetna Commercial	$53.10
Rate for Payer: Humana Medicare Advantage	$24.78
Rate for Payer: UnitedHealthcare Commercial	$56.05
Rate for Payer: UnitedHealthcare Medicaid	$23.60
Rate for Payer: WPPA Medicare Advantage	$35.40

Negative pressure wound therapy (NPWT) - Incision, Wound Dressing:

Facility

$209.00

Hospital Charge Code	3250300
Hospital Revenue Code	272
Min. Negotiated Rate	$188.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: UnitedHealthcare Commercial	$198.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Negative pressure wound therapy (NPWT) - Incision, Wound Dressing:

Facility

$209.00

Hospital Charge Code	3250300
Hospital Revenue Code	272
Min. Negotiated Rate	$83.60
Max. Negotiated Rate	$198.55
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Humana Medicare Advantage	$87.78
Rate for Payer: UnitedHealthcare Commercial	$198.55
Rate for Payer: UnitedHealthcare Medicaid	$83.60
Rate for Payer: WPPA Medicare Advantage	$125.40

Neisseria gonorrhoeae DNA -GeneXpert

Facility

$249.00

Service Code	HCPCS 87591
Hospital Charge Code	3551732
Hospital Revenue Code	300
Min. Negotiated Rate	$224.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$224.10
Rate for Payer: UnitedHealthcare Commercial	$236.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Neisseria gonorrhoeae DNA -GeneXpert

Facility

$249.00

Service Code	HCPCS 87591
Hospital Charge Code	3551732
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$236.55
Rate for Payer: Aetna Commercial	$224.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$75.32
Rate for Payer: Humana Medicare Advantage	$104.58
Rate for Payer: UnitedHealthcare Commercial	$236.55
Rate for Payer: UnitedHealthcare Medicaid	$35.09
Rate for Payer: WPPA Medicare Advantage	$149.40

neomycin 500 mg Tab [HMC]

Facility

$9.46

Service Code	NDC 00093117701
Hospital Charge Code	3802839
Hospital Revenue Code	250
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$8.99
Rate for Payer: Aetna Commercial	$8.51
Rate for Payer: Humana Medicare Advantage	$3.97
Rate for Payer: UnitedHealthcare Commercial	$8.99
Rate for Payer: UnitedHealthcare Medicaid	$3.78
Rate for Payer: WPPA Medicare Advantage	$5.68

neomycin 500 mg Tab [HMC]

Facility

$9.46

Service Code	NDC 00093117701
Hospital Charge Code	3802839
Hospital Revenue Code	250
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.51
Rate for Payer: UnitedHealthcare Commercial	$8.99
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$4,257.18

Service Code	MSDRG 789
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,257.18
Rate for Payer: UnitedHealthcare Medicaid	$4,257.18
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$1,239.03

Service Code	MSDRG 794
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,239.03
Rate for Payer: UnitedHealthcare Medicaid	$1,239.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Neopuff Circuit

Facility

$27.72

Hospital Charge Code	3255005
Hospital Revenue Code	270
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$26.33
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Humana Medicare Advantage	$11.64
Rate for Payer: UnitedHealthcare Commercial	$26.33
Rate for Payer: UnitedHealthcare Medicaid	$11.09
Rate for Payer: WPPA Medicare Advantage	$16.63

Neopuff Circuit

Facility

$27.72

Hospital Charge Code	3255005
Hospital Revenue Code	270
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: UnitedHealthcare Commercial	$26.33
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Neopuff Mask 50MM

Facility

$28.00

Hospital Charge Code	3255008
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Neopuff Mask 50MM

Facility

$28.00

Hospital Charge Code	3255008
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Humana Medicare Advantage	$11.76
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: UnitedHealthcare Medicaid	$11.20
Rate for Payer: WPPA Medicare Advantage	$16.80

Neopuff Mask 60MM

Facility

$28.94

Hospital Charge Code	3255012
Hospital Revenue Code	270
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.05
Rate for Payer: UnitedHealthcare Commercial	$27.49
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Neopuff Mask 60MM

Facility

$28.94

Hospital Charge Code	3255012
Hospital Revenue Code	270
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$27.49
Rate for Payer: Aetna Commercial	$26.05
Rate for Payer: Humana Medicare Advantage	$12.15
Rate for Payer: UnitedHealthcare Commercial	$27.49
Rate for Payer: UnitedHealthcare Medicaid	$11.58
Rate for Payer: WPPA Medicare Advantage	$17.36

neostigmine 1 mg/mL 10 mL inj Sol [HMC]

Facility

$49.70

Service Code	HCPCS J2710
Hospital Charge Code	3170178
Hospital Revenue Code	259
Min. Negotiated Rate	$44.73
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$44.73
Rate for Payer: Aetna Commercial	$60.12
Rate for Payer: UnitedHealthcare Commercial	$47.22
Rate for Payer: UnitedHealthcare Commercial	$63.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

neostigmine 1 mg/mL 10 mL inj Sol [HMC]

Facility

$49.70

Service Code	HCPCS J2710
Hospital Charge Code	3170178
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$47.22
Rate for Payer: Aetna Commercial	$44.73
Rate for Payer: Aetna Commercial	$60.12
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.52
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.52
Rate for Payer: Humana Medicare Advantage	$20.87
Rate for Payer: Humana Medicare Advantage	$28.06
Rate for Payer: UnitedHealthcare Commercial	$47.22
Rate for Payer: UnitedHealthcare Commercial	$63.46
Rate for Payer: UnitedHealthcare Medicaid	$0.60
Rate for Payer: UnitedHealthcare Medicaid	$0.60
Rate for Payer: WPPA Medicare Advantage	$29.82
Rate for Payer: WPPA Medicare Advantage	$40.08

neostigmine 1 mg/mL Inj Sol [HMC]

Facility

$41.72

Service Code	HCPCS J2710
Hospital Charge Code	3170178
Hospital Revenue Code	250
Min. Negotiated Rate	$37.55
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$37.55
Rate for Payer: UnitedHealthcare Commercial	$39.63
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges