Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Protein Level 24 Hour Urine

Facility

$66.00

Service Code	HCPCS 84156
Hospital Charge Code	3551765
Hospital Revenue Code	300
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$62.70
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$18.82
Rate for Payer: Humana Medicare Advantage	$27.72
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: UnitedHealthcare Medicaid	$3.67
Rate for Payer: WPPA Medicare Advantage	$39.60

Protein Level 24 Hour Urine

Facility

$66.00

Service Code	HCPCS 84156
Hospital Charge Code	3551765
Hospital Revenue Code	300
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein S

Facility

$170.00

Service Code	HCPCS 85305
Hospital Charge Code	3552493
Hospital Revenue Code	300
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$161.50
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$30.27
Rate for Payer: Humana Medicare Advantage	$71.40
Rate for Payer: UnitedHealthcare Commercial	$161.50
Rate for Payer: UnitedHealthcare Medicaid	$11.61
Rate for Payer: WPPA Medicare Advantage	$102.00

Protein S

Facility

$170.00

Service Code	HCPCS 85305
Hospital Charge Code	3552493
Hospital Revenue Code	300
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: UnitedHealthcare Commercial	$161.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein S Ag, Total QST

Facility

$34.00

Service Code	HCPCS 85305
Hospital Charge Code	3555505
Hospital Revenue Code	300
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$32.30
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$30.27
Rate for Payer: Humana Medicare Advantage	$14.28
Rate for Payer: UnitedHealthcare Commercial	$32.30
Rate for Payer: UnitedHealthcare Medicaid	$11.61
Rate for Payer: WPPA Medicare Advantage	$20.40

Protein S Ag, Total QST

Facility

$34.00

Service Code	HCPCS 85305
Hospital Charge Code	3555505
Hospital Revenue Code	300
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: UnitedHealthcare Commercial	$32.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein S Antigen, Free QST

Facility

$326.00

Service Code	HCPCS 85306
Hospital Charge Code	3555506
Hospital Revenue Code	300
Min. Negotiated Rate	$293.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$293.40
Rate for Payer: UnitedHealthcare Commercial	$309.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein S Antigen, Free QST

Facility

$326.00

Service Code	HCPCS 85306
Hospital Charge Code	3555506
Hospital Revenue Code	300
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$309.70
Rate for Payer: Aetna Commercial	$293.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$108.26
Rate for Payer: Humana Medicare Advantage	$136.92
Rate for Payer: UnitedHealthcare Commercial	$309.70
Rate for Payer: UnitedHealthcare Medicaid	$15.32
Rate for Payer: WPPA Medicare Advantage	$195.60

Protein Total

Facility

$66.00

Service Code	HCPCS 84155
Hospital Charge Code	3550668
Hospital Revenue Code	300
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein Total

Facility

$66.00

Service Code	HCPCS 84155
Hospital Charge Code	3550668
Hospital Revenue Code	300
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$62.70
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8.64
Rate for Payer: Humana Medicare Advantage	$27.72
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: UnitedHealthcare Medicaid	$3.67
Rate for Payer: WPPA Medicare Advantage	$39.60

Protein Total & Electro U Interp QST

Facility

$167.00

Service Code	HCPCS 80327
Hospital Charge Code	3550327
Hospital Revenue Code	300
Min. Negotiated Rate	$150.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$150.30
Rate for Payer: UnitedHealthcare Commercial	$158.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein Total & Electro U Interp QST

Facility

$47.00

Service Code	HCPCS 84166
Hospital Charge Code	LAB0011
Hospital Revenue Code	300
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein Total & Electro U Interp QST

Facility

$167.00

Service Code	HCPCS 80327
Hospital Charge Code	3550327
Hospital Revenue Code	300
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$158.65
Rate for Payer: Aetna Commercial	$150.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$88.99
Rate for Payer: Humana Medicare Advantage	$70.14
Rate for Payer: UnitedHealthcare Commercial	$158.65
Rate for Payer: UnitedHealthcare Medicaid	$15.50
Rate for Payer: WPPA Medicare Advantage	$100.20

Protein Total & Electro U Interp QST

Facility

$47.00

Service Code	HCPCS 84166
Hospital Charge Code	LAB0011
Hospital Revenue Code	300
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$44.65
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$38.52
Rate for Payer: Humana Medicare Advantage	$19.74
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: UnitedHealthcare Medicaid	$17.83
Rate for Payer: WPPA Medicare Advantage	$28.20

Protein, Total & Protein Electroph QST

Facility

$137.00

Service Code	HCPCS 84165
Hospital Charge Code	3551872
Hospital Revenue Code	300
Min. Negotiated Rate	$123.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$123.30
Rate for Payer: UnitedHealthcare Commercial	$130.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein, Total & Protein Electroph QST

Facility

$137.00

Service Code	HCPCS 84165
Hospital Charge Code	3551872
Hospital Revenue Code	300
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$130.15
Rate for Payer: Aetna Commercial	$123.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$40.29
Rate for Payer: Humana Medicare Advantage	$57.54
Rate for Payer: UnitedHealthcare Commercial	$130.15
Rate for Payer: UnitedHealthcare Medicaid	$10.74
Rate for Payer: WPPA Medicare Advantage	$82.20

Protein, Total & Protein Electro, U24 QST

Facility

$219.00

Hospital Charge Code	LAB0008
Hospital Revenue Code	300
Min. Negotiated Rate	$197.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$197.10
Rate for Payer: UnitedHealthcare Commercial	$208.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein, Total & Protein Electro, U24 QST

Facility

$219.00

Hospital Charge Code	LAB0008
Hospital Revenue Code	300
Min. Negotiated Rate	$87.60
Max. Negotiated Rate	$208.05
Rate for Payer: Aetna Commercial	$197.10
Rate for Payer: Humana Medicare Advantage	$91.98
Rate for Payer: UnitedHealthcare Commercial	$208.05
Rate for Payer: UnitedHealthcare Medicaid	$87.60
Rate for Payer: WPPA Medicare Advantage	$131.40

Protein, Total, U24 QST

Facility

$66.00

Service Code	HCPCS 84156
Hospital Charge Code	LAB0009
Hospital Revenue Code	300
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein, Total, U24 QST

Facility

$66.00

Service Code	HCPCS 84156
Hospital Charge Code	LAB0009
Hospital Revenue Code	300
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$62.70
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$18.82
Rate for Payer: Humana Medicare Advantage	$27.72
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: UnitedHealthcare Medicaid	$3.67
Rate for Payer: WPPA Medicare Advantage	$39.60

Protein, Ttl And Protein Electro. w/ Immunofix QST

Facility

$137.00

Service Code	HCPCS 84165
Hospital Charge Code	3551872
Hospital Revenue Code	300
Min. Negotiated Rate	$123.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$123.30
Rate for Payer: UnitedHealthcare Commercial	$130.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein, Ttl And Protein Electro. w/ Immunofix QST

Facility

$137.00

Service Code	HCPCS 84165
Hospital Charge Code	3551872
Hospital Revenue Code	300
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$130.15
Rate for Payer: Aetna Commercial	$123.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$40.29
Rate for Payer: Humana Medicare Advantage	$57.54
Rate for Payer: UnitedHealthcare Commercial	$130.15
Rate for Payer: UnitedHealthcare Medicaid	$10.74
Rate for Payer: WPPA Medicare Advantage	$82.20

Protein Ttl, Pleural Fl QST

Facility

$38.00

Service Code	HCPCS 84157
Hospital Charge Code	3558181
Hospital Revenue Code	300
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Protein Ttl, Pleural Fl QST

Facility

$38.00

Service Code	HCPCS 84157
Hospital Charge Code	3558181
Hospital Revenue Code	300
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$36.10
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$18.82
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: WPPA Medicare Advantage	$22.80

Protein Urine

Facility

$66.00

Service Code	HCPCS 84156
Hospital Charge Code	3552546
Hospital Revenue Code	300
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges