Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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	$0.60
Max. Negotiated Rate	$39.63
Rate for Payer: Aetna Commercial	$37.55
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.52
Rate for Payer: Humana Medicare Advantage	$17.52
Rate for Payer: UnitedHealthcare Commercial	$39.63
Rate for Payer: UnitedHealthcare Medicaid	$0.60
Rate for Payer: WPPA Medicare Advantage	$25.03

Nephrostomy Drainage Set

Facility

$427.00

Hospital Charge Code	3252152
Hospital Revenue Code	270
Min. Negotiated Rate	$170.80
Max. Negotiated Rate	$405.65
Rate for Payer: Aetna Commercial	$384.30
Rate for Payer: Humana Medicare Advantage	$179.34
Rate for Payer: UnitedHealthcare Commercial	$405.65
Rate for Payer: UnitedHealthcare Medicaid	$170.80
Rate for Payer: WPPA Medicare Advantage	$256.20

Nephrostomy Drainage Set

Facility

$427.00

Hospital Charge Code	3252152
Hospital Revenue Code	270
Min. Negotiated Rate	$384.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$384.30
Rate for Payer: UnitedHealthcare Commercial	$405.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Nerve Locator Vari-Stim lll

Facility

$143.33

Hospital Charge Code	3250233
Hospital Revenue Code	270
Min. Negotiated Rate	$57.33
Max. Negotiated Rate	$136.16
Rate for Payer: Aetna Commercial	$129.00
Rate for Payer: Humana Medicare Advantage	$60.20
Rate for Payer: UnitedHealthcare Commercial	$136.16
Rate for Payer: UnitedHealthcare Medicaid	$57.33
Rate for Payer: WPPA Medicare Advantage	$86.00

Nerve Locator Vari-Stim lll

Facility

$143.33

Hospital Charge Code	3250233
Hospital Revenue Code	270
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$129.00
Rate for Payer: UnitedHealthcare Commercial	$136.16
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$6,894.09

Service Code	MSDRG 054
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,894.09
Rate for Payer: UnitedHealthcare Medicaid	$6,894.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$4,606.65

Service Code	MSDRG 055
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,606.65
Rate for Payer: UnitedHealthcare Medicaid	$4,606.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NEUROLOGICAL EYE DISORDERS

Facility

$2,541.60

Service Code	MSDRG 123
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,541.60
Rate for Payer: UnitedHealthcare Medicaid	$2,541.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Neuromuscular Reeducation Charges

Facility

$132.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	3950531
Hospital Revenue Code	420
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$125.40
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$50.50
Rate for Payer: Humana Medicare Advantage	$55.44
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: UnitedHealthcare Medicaid	$27.18
Rate for Payer: WPPA Medicare Advantage	$79.20

Neuromuscular Reeducation Charges

Facility

$132.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	3950531
Hospital Revenue Code	420
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NEUROSES EXCEPT DEPRESSIVE

Facility

$2,065.05

Service Code	MSDRG 882
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,065.05
Rate for Payer: UnitedHealthcare Medicaid	$2,065.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Newborn Hearing Screening

Facility

$249.00

Service Code	HCPCS 92587 TC
Hospital Charge Code	3114110
Hospital Revenue Code	471
Min. Negotiated Rate	$56.33
Max. Negotiated Rate	$236.55
Rate for Payer: Aetna Commercial	$224.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$56.33
Rate for Payer: Humana Medicare Advantage	$104.58
Rate for Payer: UnitedHealthcare Commercial	$236.55
Rate for Payer: UnitedHealthcare Medicaid	$101.68
Rate for Payer: WPPA Medicare Advantage	$149.40

Newborn Hearing Screening

Facility

$249.00

Service Code	HCPCS 92587 TC
Hospital Charge Code	3114110
Hospital Revenue Code	471
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

Newborn Hearing Screening

Facility

$249.00

Service Code	HCPCS 92587
Hospital Charge Code	3114110
Hospital Revenue Code	471
Min. Negotiated Rate	$56.33
Max. Negotiated Rate	$236.55
Rate for Payer: Aetna Commercial	$224.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$56.33
Rate for Payer: Humana Medicare Advantage	$104.58
Rate for Payer: UnitedHealthcare Commercial	$236.55
Rate for Payer: UnitedHealthcare Medicaid	$101.68
Rate for Payer: WPPA Medicare Advantage	$149.40

Newborn Hearing Screening

Facility

$249.00

Service Code	HCPCS 92587
Hospital Charge Code	3114110
Hospital Revenue Code	471
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

NG Securement Tape

Facility

$7.65

Hospital Charge Code	3255333
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: Humana Medicare Advantage	$3.21
Rate for Payer: UnitedHealthcare Commercial	$7.27
Rate for Payer: UnitedHealthcare Medicaid	$3.06
Rate for Payer: WPPA Medicare Advantage	$4.59

NG Securement Tape

Facility

$7.65

Hospital Charge Code	3255333
Hospital Revenue Code	270
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: UnitedHealthcare Commercial	$7.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NG Tube 10 FR Salem Sump

Facility

$9.00

Hospital Charge Code	3250119
Hospital Revenue Code	270
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.55
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: WPPA Medicare Advantage	$5.40

NG Tube 10 FR Salem Sump

Facility

$9.00

Hospital Charge Code	3250119
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NG Tube 12 FR Salem Sump

Facility

$15.00

Hospital Charge Code	3254454
Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Humana Medicare Advantage	$6.30
Rate for Payer: UnitedHealthcare Commercial	$14.25
Rate for Payer: UnitedHealthcare Medicaid	$6.00
Rate for Payer: WPPA Medicare Advantage	$9.00

NG Tube 12 FR Salem Sump

Facility

$15.00

Hospital Charge Code	3254454
Hospital Revenue Code	270
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: UnitedHealthcare Commercial	$14.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NG Tube 14 FR Salem Sump

Facility

$8.37

Hospital Charge Code	3250721
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.95
Rate for Payer: Aetna Commercial	$7.53
Rate for Payer: Humana Medicare Advantage	$3.52
Rate for Payer: UnitedHealthcare Commercial	$7.95
Rate for Payer: UnitedHealthcare Medicaid	$3.35
Rate for Payer: WPPA Medicare Advantage	$5.02

NG Tube 14 FR Salem Sump

Facility

$8.37

Hospital Charge Code	3250721
Hospital Revenue Code	270
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.53
Rate for Payer: UnitedHealthcare Commercial	$7.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NG Tube 16 FR Salem Sump

Facility

$8.37

Hospital Charge Code	3254443
Hospital Revenue Code	270
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.53
Rate for Payer: UnitedHealthcare Commercial	$7.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NG Tube 16 FR Salem Sump

Facility

$8.37

Hospital Charge Code	3254443
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.95
Rate for Payer: Aetna Commercial	$7.53
Rate for Payer: Humana Medicare Advantage	$3.52
Rate for Payer: UnitedHealthcare Commercial	$7.95
Rate for Payer: UnitedHealthcare Medicaid	$3.35
Rate for Payer: WPPA Medicare Advantage	$5.02

Know your out-of-pocket cost for care.

All Charges