Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Paracentesis

Facility

$2,335.00

Service Code	HCPCS 58940
Hospital Charge Code	3158943
Hospital Revenue Code	360
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$2,218.25
Rate for Payer: Aetna Commercial	$2,101.50
Rate for Payer: Humana Medicare Advantage	$980.70
Rate for Payer: UnitedHealthcare Commercial	$2,218.25
Rate for Payer: UnitedHealthcare Medicaid	$468.00
Rate for Payer: WPPA Medicare Advantage	$1,401.00

parenteral nutrition solution w/electrolytes Amino Acids 4.25% with 5% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol [HMC]

Facility

$97.49

Service Code	NDC 00338114403
Hospital Charge Code	3801081
Hospital Revenue Code	259
Min. Negotiated Rate	$87.74
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$87.74
Rate for Payer: UnitedHealthcare Commercial	$92.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

parenteral nutrition solution w/electrolytes Amino Acids 4.25% with 5% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol [HMC]

Facility

$97.49

Service Code	NDC 00338114403
Hospital Charge Code	3801081
Hospital Revenue Code	259
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$92.62
Rate for Payer: Aetna Commercial	$87.74
Rate for Payer: Humana Medicare Advantage	$40.95
Rate for Payer: UnitedHealthcare Commercial	$92.62
Rate for Payer: UnitedHealthcare Medicaid	$39.00
Rate for Payer: WPPA Medicare Advantage	$58.49

PARoxetine 20 mg Tab [HMC]

Facility

$13.20

Service Code	NDC 60505008302
Hospital Charge Code	3809081
Hospital Revenue Code	250
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.88
Rate for Payer: UnitedHealthcare Commercial	$12.54
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PARoxetine 20 mg Tab [HMC]

Facility

$13.37

Service Code	NDC 68084004501
Hospital Charge Code	3809081
Hospital Revenue Code	250
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna Commercial	$12.03
Rate for Payer: Humana Medicare Advantage	$5.62
Rate for Payer: UnitedHealthcare Commercial	$12.70
Rate for Payer: UnitedHealthcare Medicaid	$5.35
Rate for Payer: WPPA Medicare Advantage	$8.02

PARoxetine 20 mg Tab [HMC]

Facility

$13.81

Service Code	NDC 00904567761
Hospital Charge Code	3809081
Hospital Revenue Code	250
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$13.12
Rate for Payer: Aetna Commercial	$12.43
Rate for Payer: Humana Medicare Advantage	$5.80
Rate for Payer: UnitedHealthcare Commercial	$13.12
Rate for Payer: UnitedHealthcare Medicaid	$5.52
Rate for Payer: WPPA Medicare Advantage	$8.29

PARoxetine 20 mg Tab [HMC]

Facility

$13.81

Service Code	NDC 00904567761
Hospital Charge Code	3809081
Hospital Revenue Code	250
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.43
Rate for Payer: UnitedHealthcare Commercial	$13.12
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PARoxetine 20 mg Tab [HMC]

Facility

$13.20

Service Code	NDC 60505008302
Hospital Charge Code	3809081
Hospital Revenue Code	250
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$12.54
Rate for Payer: Aetna Commercial	$11.88
Rate for Payer: Humana Medicare Advantage	$5.54
Rate for Payer: UnitedHealthcare Commercial	$12.54
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: WPPA Medicare Advantage	$7.92

PARoxetine 20 mg Tab [HMC]

Facility

$13.37

Service Code	NDC 68084004501
Hospital Charge Code	3809081
Hospital Revenue Code	250
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.03
Rate for Payer: UnitedHealthcare Commercial	$12.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Partial Thromboplastin Time

Facility

$79.00

Service Code	HCPCS 85730
Hospital Charge Code	3550593
Hospital Revenue Code	300
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Partial Thromboplastin Time

Facility

$79.00

Service Code	HCPCS 85730
Hospital Charge Code	3550593
Hospital Revenue Code	301
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Partial Thromboplastin Time

Facility

$79.00

Service Code	HCPCS 85730
Hospital Charge Code	3550593
Hospital Revenue Code	300
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$75.05
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$22.53
Rate for Payer: Humana Medicare Advantage	$33.18
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: UnitedHealthcare Medicaid	$5.25
Rate for Payer: WPPA Medicare Advantage	$47.40

Partial Thromboplastin Time

Facility

$79.00

Service Code	HCPCS 85730
Hospital Charge Code	3550593
Hospital Revenue Code	301
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$75.05
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$22.53
Rate for Payer: Humana Medicare Advantage	$33.18
Rate for Payer: UnitedHealthcare Commercial	$75.05
Rate for Payer: UnitedHealthcare Medicaid	$5.25
Rate for Payer: WPPA Medicare Advantage	$47.40

Parvovirus B19 Ab (IgG) QST

Facility

$260.00

Service Code	HCPCS 86747
Hospital Charge Code	3558674
Hospital Revenue Code	300
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: UnitedHealthcare Commercial	$247.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Parvovirus B19 Ab (IgG) QST

Facility

$260.00

Service Code	HCPCS 86747
Hospital Charge Code	3558674
Hospital Revenue Code	300
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$247.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$79.25
Rate for Payer: Humana Medicare Advantage	$109.20
Rate for Payer: UnitedHealthcare Commercial	$247.00
Rate for Payer: UnitedHealthcare Medicaid	$12.78
Rate for Payer: WPPA Medicare Advantage	$156.00

Parvovirus B19 Ab (IgM) QST

Facility

$260.00

Service Code	HCPCS 86747
Hospital Charge Code	3558674
Hospital Revenue Code	300
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: UnitedHealthcare Commercial	$247.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Parvovirus B19 Ab (IgM) QST

Facility

$260.00

Service Code	HCPCS 86747
Hospital Charge Code	3558674
Hospital Revenue Code	300
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$247.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$79.25
Rate for Payer: Humana Medicare Advantage	$109.20
Rate for Payer: UnitedHealthcare Commercial	$247.00
Rate for Payer: UnitedHealthcare Medicaid	$12.78
Rate for Payer: WPPA Medicare Advantage	$156.00

Parvovirus B19 Abs (IgG, IgM) QST

Facility

$260.00

Service Code	HCPCS 86747
Hospital Charge Code	3558674
Hospital Revenue Code	300
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$247.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$79.25
Rate for Payer: Humana Medicare Advantage	$109.20
Rate for Payer: UnitedHealthcare Commercial	$247.00
Rate for Payer: UnitedHealthcare Medicaid	$12.78
Rate for Payer: WPPA Medicare Advantage	$156.00

Parvovirus B19 Abs (IgG, IgM) QST

Facility

$260.00

Service Code	HCPCS 86747
Hospital Charge Code	3558674
Hospital Revenue Code	300
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: UnitedHealthcare Commercial	$247.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Parvovirus B19 DNA, Qnt PCR, QST

Facility

$616.00

Service Code	HCPCS 87799
Hospital Charge Code	3559724
Hospital Revenue Code	300
Min. Negotiated Rate	$36.41
Max. Negotiated Rate	$585.20
Rate for Payer: Aetna Commercial	$554.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$251.58
Rate for Payer: Humana Medicare Advantage	$258.72
Rate for Payer: UnitedHealthcare Commercial	$585.20
Rate for Payer: UnitedHealthcare Medicaid	$36.41
Rate for Payer: WPPA Medicare Advantage	$369.60

Parvovirus B19 DNA, Qnt PCR, QST

Facility

$616.00

Service Code	HCPCS 87799
Hospital Charge Code	3559724
Hospital Revenue Code	300
Min. Negotiated Rate	$554.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$554.40
Rate for Payer: UnitedHealthcare Commercial	$585.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Patch Iontophoresis Companion 80 Wireless System

Facility

$28.00

Hospital Charge Code	3257320
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

Patch Iontophoresis Companion 80 Wireless System

Facility

$28.00

Hospital Charge Code	3257320
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

Patch Iontophoresis Large Ionto Plus 4.0cc

Facility

$17.00

Hospital Charge Code	3257325
Hospital Revenue Code	270
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: UnitedHealthcare Commercial	$16.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Patch Iontophoresis Large Ionto Plus 4.0cc

Facility

$17.00

Hospital Charge Code	3257325
Hospital Revenue Code	270
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$16.15
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Humana Medicare Advantage	$7.14
Rate for Payer: UnitedHealthcare Commercial	$16.15
Rate for Payer: UnitedHealthcare Medicaid	$6.80
Rate for Payer: WPPA Medicare Advantage	$10.20

Know your out-of-pocket cost for care.

All Charges