Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

propranolol 10 mg Tab [HMC]

Facility

$6.22

Service Code	NDC 69238207701
Hospital Charge Code	3808173
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$5.91
Rate for Payer: Aetna Commercial	$5.60
Rate for Payer: Humana Medicare Advantage	$2.61
Rate for Payer: UnitedHealthcare Commercial	$5.91
Rate for Payer: UnitedHealthcare Medicaid	$2.49
Rate for Payer: WPPA Medicare Advantage	$3.73

propranolol 10 mg Tab [HMC]

Facility

$5.61

Service Code	NDC 51079027720
Hospital Charge Code	3808173
Hospital Revenue Code	250
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.05
Rate for Payer: UnitedHealthcare Commercial	$5.33
Rate for Payer: WPPA Medicare Advantage	$1,200.00

propranolol 40 mg Tab [HMC]

Facility

$7.15

Service Code	NDC 00603548421
Hospital Charge Code	3806888
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.43
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

propranolol 40 mg Tab [HMC]

Facility

$7.15

Service Code	NDC 00603548421
Hospital Charge Code	3806888
Hospital Revenue Code	250
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$6.79
Rate for Payer: Aetna Commercial	$6.43
Rate for Payer: Humana Medicare Advantage	$3.00
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: UnitedHealthcare Medicaid	$2.86
Rate for Payer: WPPA Medicare Advantage	$4.29

propranolol 40 mg Tab [HMC]

Facility

$7.01

Service Code	NDC 60687060901
Hospital Charge Code	3806888
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.66
Rate for Payer: Aetna Commercial	$6.31
Rate for Payer: Humana Medicare Advantage	$2.94
Rate for Payer: UnitedHealthcare Commercial	$6.66
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: WPPA Medicare Advantage	$4.21

propranolol 40 mg Tab [HMC]

Facility

$7.01

Service Code	NDC 60687060901
Hospital Charge Code	3806888
Hospital Revenue Code	250
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.31
Rate for Payer: UnitedHealthcare Commercial	$6.66
Rate for Payer: WPPA Medicare Advantage	$1,200.00

propranolol 80 mg ERCap [HMC]

Facility

$12.22

Service Code	NDC 00228277911
Hospital Charge Code	3805823
Hospital Revenue Code	250
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$11.61
Rate for Payer: Aetna Commercial	$11.00
Rate for Payer: Humana Medicare Advantage	$5.13
Rate for Payer: UnitedHealthcare Commercial	$11.61
Rate for Payer: UnitedHealthcare Medicaid	$4.89
Rate for Payer: WPPA Medicare Advantage	$7.33

propranolol 80 mg ERCap [HMC]

Facility

$12.22

Service Code	NDC 00228277911
Hospital Charge Code	3805823
Hospital Revenue Code	250
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.00
Rate for Payer: UnitedHealthcare Commercial	$11.61
Rate for Payer: WPPA Medicare Advantage	$1,200.00

propranolol 80 mg ERCap [HMC]

Facility

$12.22

Service Code	NDC 00527411737
Hospital Charge Code	3805823
Hospital Revenue Code	250
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$11.61
Rate for Payer: Aetna Commercial	$11.00
Rate for Payer: Humana Medicare Advantage	$5.13
Rate for Payer: UnitedHealthcare Commercial	$11.61
Rate for Payer: UnitedHealthcare Medicaid	$4.89
Rate for Payer: WPPA Medicare Advantage	$7.33

propranolol 80 mg ERCap [HMC]

Facility

$12.22

Service Code	NDC 00527411737
Hospital Charge Code	3805823
Hospital Revenue Code	250
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.00
Rate for Payer: UnitedHealthcare Commercial	$11.61
Rate for Payer: WPPA Medicare Advantage	$1,200.00

propylthiouracil 50 mg Tab [HMC]

Facility

$7.70

Service Code	NDC 00228234810
Hospital Charge Code	3807846
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.93
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: WPPA Medicare Advantage	$1,200.00

propylthiouracil 50 mg Tab [HMC]

Facility

$7.70

Service Code	NDC 67253065110
Hospital Charge Code	3807846
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.93
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: WPPA Medicare Advantage	$1,200.00

propylthiouracil 50 mg Tab [HMC]

Facility

$7.70

Service Code	NDC 00228234810
Hospital Charge Code	3807846
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$7.32
Rate for Payer: Aetna Commercial	$6.93
Rate for Payer: Humana Medicare Advantage	$3.23
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: UnitedHealthcare Medicaid	$3.08
Rate for Payer: WPPA Medicare Advantage	$4.62

propylthiouracil 50 mg Tab [HMC]

Facility

$7.70

Service Code	NDC 67253065110
Hospital Charge Code	3807846
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$7.32
Rate for Payer: Aetna Commercial	$6.93
Rate for Payer: Humana Medicare Advantage	$3.23
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: UnitedHealthcare Medicaid	$3.08
Rate for Payer: WPPA Medicare Advantage	$4.62

ProSigna PAM50

Facility

$5,738.00

Service Code	HCPCS 81520
Hospital Charge Code	3551520
Hospital Revenue Code	300
Min. Negotiated Rate	$2,295.20
Max. Negotiated Rate	$5,451.10
Rate for Payer: Aetna Commercial	$5,164.20
Rate for Payer: Humana Medicare Advantage	$2,409.96
Rate for Payer: UnitedHealthcare Commercial	$5,451.10
Rate for Payer: UnitedHealthcare Medicaid	$2,295.20
Rate for Payer: WPPA Medicare Advantage	$3,442.80

ProSigna PAM50

Facility

$5,738.00

Service Code	HCPCS 81520
Hospital Charge Code	3551520
Hospital Revenue Code	300
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,451.10
Rate for Payer: Aetna Commercial	$5,164.20
Rate for Payer: UnitedHealthcare Commercial	$5,451.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Prostaglandin D2 (PGD2) MAYO

Facility

$298.00

Service Code	HCPCS 84150
Hospital Charge Code	3554150
Hospital Revenue Code	300
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$283.10
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$113.14
Rate for Payer: Humana Medicare Advantage	$125.16
Rate for Payer: UnitedHealthcare Commercial	$283.10
Rate for Payer: UnitedHealthcare Medicaid	$35.50
Rate for Payer: WPPA Medicare Advantage	$178.80

Prostaglandin D2 (PGD2) MAYO

Facility

$298.00

Service Code	HCPCS 84150
Hospital Charge Code	3554150
Hospital Revenue Code	300
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: UnitedHealthcare Commercial	$283.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PROSTATECTOMY WITH CC

Facility

$5,909.22

Service Code	MSDRG 666
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,909.22
Rate for Payer: UnitedHealthcare Medicaid	$5,909.22
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PROSTATECTOMY WITH MCC

Facility

$10,515.87

Service Code	MSDRG 665
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,515.87
Rate for Payer: UnitedHealthcare Medicaid	$10,515.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PROSTATECTOMY WITHOUT CC/MCC

Facility

$3,717.09

Service Code	MSDRG 667
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,717.09
Rate for Payer: UnitedHealthcare Medicaid	$3,717.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

protamine 10 mg/mL Inj Sol [HMC]

Facility

$115.24

Service Code	HCPCS J2720
Hospital Charge Code	3806912
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$109.48
Rate for Payer: Aetna Commercial	$103.72
Rate for Payer: Aetna Commercial	$77.71
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2.74
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2.74
Rate for Payer: Humana Medicare Advantage	$36.26
Rate for Payer: Humana Medicare Advantage	$48.40
Rate for Payer: UnitedHealthcare Commercial	$82.02
Rate for Payer: UnitedHealthcare Commercial	$109.48
Rate for Payer: UnitedHealthcare Medicaid	$1.57
Rate for Payer: UnitedHealthcare Medicaid	$1.57
Rate for Payer: WPPA Medicare Advantage	$69.14
Rate for Payer: WPPA Medicare Advantage	$51.80

protamine 10 mg/mL Inj Sol [HMC]

Facility

$115.24

Service Code	HCPCS J2720
Hospital Charge Code	3806912
Hospital Revenue Code	250
Min. Negotiated Rate	$103.72
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$103.72
Rate for Payer: Aetna Commercial	$77.71
Rate for Payer: UnitedHealthcare Commercial	$82.02
Rate for Payer: UnitedHealthcare Commercial	$109.48
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein C and S Activity w/Reflex to Ag QST

Facility

$134.00

Service Code	HCPCS 85303
Hospital Charge Code	3552492
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

Protein C and S Activity w/Reflex to Ag QST

Facility

$134.00

Service Code	HCPCS 85303
Hospital Charge Code	3552492
Hospital Revenue Code	300
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$127.30
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$85.69
Rate for Payer: Humana Medicare Advantage	$56.28
Rate for Payer: UnitedHealthcare Commercial	$127.30
Rate for Payer: UnitedHealthcare Medicaid	$13.84
Rate for Payer: WPPA Medicare Advantage	$80.40

Know your out-of-pocket cost for care.

All Charges