Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility

$6,290.46

Service Code	MSDRG 543
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,290.46
Rate for Payer: UnitedHealthcare Medicaid	$6,290.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC

Facility

$10,833.57

Service Code	MSDRG 542
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,833.57
Rate for Payer: UnitedHealthcare Medicaid	$10,833.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC

Facility

$4,638.42

Service Code	MSDRG 544
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,638.42
Rate for Payer: UnitedHealthcare Medicaid	$4,638.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Path Review of Peripheral Smear QST

Facility

$131.00

Service Code	HCPCS 85060
Hospital Charge Code	3550935
Hospital Revenue Code	300
Min. Negotiated Rate	$19.08
Max. Negotiated Rate	$124.45
Rate for Payer: Aetna Commercial	$117.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$78.98
Rate for Payer: Humana Medicare Advantage	$55.02
Rate for Payer: UnitedHealthcare Commercial	$124.45
Rate for Payer: UnitedHealthcare Medicaid	$19.08
Rate for Payer: WPPA Medicare Advantage	$78.60

Path Review of Peripheral Smear QST

Facility

$131.00

Service Code	HCPCS 85060
Hospital Charge Code	3550935
Hospital Revenue Code	300
Min. Negotiated Rate	$117.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$117.90
Rate for Payer: UnitedHealthcare Commercial	$124.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

patiromer 16.8 g Pow [HMC]

Facility

$45.99

Service Code	NDC 53436016830
Hospital Charge Code	3800829
Hospital Revenue Code	250
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$43.69
Rate for Payer: Aetna Commercial	$41.39
Rate for Payer: Humana Medicare Advantage	$19.32
Rate for Payer: UnitedHealthcare Commercial	$43.69
Rate for Payer: UnitedHealthcare Medicaid	$18.40
Rate for Payer: WPPA Medicare Advantage	$27.59

patiromer 16.8 g Pow [HMC]

Facility

$45.99

Service Code	NDC 53436016830
Hospital Charge Code	3800829
Hospital Revenue Code	250
Min. Negotiated Rate	$41.39
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$41.39
Rate for Payer: UnitedHealthcare Commercial	$43.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pea IgE UNMC

Facility

$25.00

Service Code	HCPCS 86003
Hospital Charge Code	3552812
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$10.50
Rate for Payer: UnitedHealthcare Commercial	$23.75
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$15.00

Pea IgE UNMC

Facility

$25.00

Service Code	HCPCS 86003
Hospital Charge Code	3552812
Hospital Revenue Code	300
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: UnitedHealthcare Commercial	$23.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Peak Flow Meter Full Range

Facility

$39.00

Hospital Charge Code	3252030
Hospital Revenue Code	270
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$35.10
Rate for Payer: UnitedHealthcare Commercial	$37.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Peak Flow Meter Full Range

Facility

$39.00

Hospital Charge Code	3252030
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$37.05
Rate for Payer: Aetna Commercial	$35.10
Rate for Payer: Humana Medicare Advantage	$16.38
Rate for Payer: UnitedHealthcare Commercial	$37.05
Rate for Payer: UnitedHealthcare Medicaid	$15.60
Rate for Payer: WPPA Medicare Advantage	$23.40

Peak Flow Meter Low Range

Facility

$71.00

Hospital Charge Code	3252031
Hospital Revenue Code	270
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$67.45
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: Humana Medicare Advantage	$29.82
Rate for Payer: UnitedHealthcare Commercial	$67.45
Rate for Payer: UnitedHealthcare Medicaid	$28.40
Rate for Payer: WPPA Medicare Advantage	$42.60

Peak Flow Meter Low Range

Facility

$71.00

Hospital Charge Code	3252031
Hospital Revenue Code	270
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: UnitedHealthcare Commercial	$67.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Peanut Component Panel QST

Facility

$134.00

Service Code	HCPCS 86003
Hospital Charge Code	3550281
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$80.40

Peanut Component Panel QST

Facility

$134.00

Service Code	HCPCS 86003
Hospital Charge Code	3550281
Hospital Revenue Code	300
Min. Negotiated Rate	$120.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Peanut (F13) IgE QST

Facility

$26.00

Service Code	HCPCS 86003
Hospital Charge Code	3550281
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$10.92
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$15.60

Peanut (F13) IgE QST

Facility

$26.00

Service Code	HCPCS 86003
Hospital Charge Code	3550281
Hospital Revenue Code	300
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pecan Nut (F201) IgE QST

Facility

$26.00

Service Code	HCPCS 86003
Hospital Charge Code	3556003
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$10.92
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$15.60

Pecan Nut (F201) IgE QST

Facility

$26.00

Service Code	HCPCS 86003
Hospital Charge Code	3556003
Hospital Revenue Code	300
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pegfilgrastim 6 mg/0.6 mL SubQ Inj [HMC]

Facility

$11,572.38

Service Code	HCPCS J2506
Hospital Charge Code	3850560
Hospital Revenue Code	250
Min. Negotiated Rate	$122.84
Max. Negotiated Rate	$10,993.76
Rate for Payer: Aetna Commercial	$10,415.14
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$135.05
Rate for Payer: Humana Medicare Advantage	$4,860.40
Rate for Payer: UnitedHealthcare Commercial	$10,993.76
Rate for Payer: UnitedHealthcare Medicaid	$122.84
Rate for Payer: WPPA Medicare Advantage	$6,943.43

pegfilgrastim 6 mg/0.6 mL SubQ Inj [HMC]

Facility

$11,572.38

Service Code	HCPCS J2506
Hospital Charge Code	3850560
Hospital Revenue Code	250
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,993.76
Rate for Payer: Aetna Commercial	$10,415.14
Rate for Payer: UnitedHealthcare Commercial	$10,993.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pegfilgrastim jmdb 6 mg/0.6 mL Fulphila Sol [HMC]

Facility

$7,535.00

Service Code	HCPCS Q5108
Hospital Charge Code	3850561
Hospital Revenue Code	250
Min. Negotiated Rate	$98.87
Max. Negotiated Rate	$7,158.25
Rate for Payer: Aetna Commercial	$6,781.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$220.19
Rate for Payer: Humana Medicare Advantage	$3,164.70
Rate for Payer: UnitedHealthcare Commercial	$7,158.25
Rate for Payer: UnitedHealthcare Medicaid	$98.87
Rate for Payer: WPPA Medicare Advantage	$4,521.00

pegfilgrastim jmdb 6 mg/0.6 mL Fulphila Sol [HMC]

Facility

$7,535.00

Service Code	HCPCS Q5108
Hospital Charge Code	3850561
Hospital Revenue Code	250
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,158.25
Rate for Payer: Aetna Commercial	$6,781.50
Rate for Payer: UnitedHealthcare Commercial	$7,158.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Peg Gastro 24fr Push

Facility

$415.00

Hospital Charge Code	3256042
Hospital Revenue Code	270
Min. Negotiated Rate	$373.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$373.50
Rate for Payer: UnitedHealthcare Commercial	$394.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Peg Gastro 24fr Push

Facility

$415.00

Hospital Charge Code	3256042
Hospital Revenue Code	270
Min. Negotiated Rate	$166.00
Max. Negotiated Rate	$394.25
Rate for Payer: Aetna Commercial	$373.50
Rate for Payer: Humana Medicare Advantage	$174.30
Rate for Payer: UnitedHealthcare Commercial	$394.25
Rate for Payer: UnitedHealthcare Medicaid	$166.00
Rate for Payer: WPPA Medicare Advantage	$249.00

Know your out-of-pocket cost for care.

All Charges