Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

rocuronium 10 mg/mL IV Sol 5 mL [HMC]

Facility

$36.88

Service Code	NDC 39822420002
Hospital Charge Code	3170179
Hospital Revenue Code	250
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$35.04
Rate for Payer: Aetna Commercial	$33.19
Rate for Payer: Humana Medicare Advantage	$15.49
Rate for Payer: UnitedHealthcare Commercial	$35.04
Rate for Payer: UnitedHealthcare Medicaid	$14.75
Rate for Payer: WPPA Medicare Advantage	$22.13

rocuronium 10 mg/mL IV Sol 5 mL [HMC]

Facility

$36.88

Service Code	NDC 39822420002
Hospital Charge Code	3170179
Hospital Revenue Code	250
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$33.19
Rate for Payer: UnitedHealthcare Commercial	$35.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rocuronium 10 mg/mL IV Sol 5 mL [HMC]

Facility

$41.15

Service Code	NDC 72611075610
Hospital Charge Code	3170179
Hospital Revenue Code	250
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$39.09
Rate for Payer: Aetna Commercial	$37.03
Rate for Payer: Humana Medicare Advantage	$17.28
Rate for Payer: UnitedHealthcare Commercial	$39.09
Rate for Payer: UnitedHealthcare Medicaid	$16.46
Rate for Payer: WPPA Medicare Advantage	$24.69

rocuronium 10 mg/mL IV Sol [HMC]

Facility

$42.12

Service Code	NDC 00409140310
Hospital Charge Code	3170180
Hospital Revenue Code	250
Min. Negotiated Rate	$37.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$37.91
Rate for Payer: UnitedHealthcare Commercial	$40.01
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rocuronium 10 mg/mL IV Sol [HMC]

Facility

$42.12

Service Code	NDC 00409955849
Hospital Charge Code	3170180
Hospital Revenue Code	250
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$40.01
Rate for Payer: Aetna Commercial	$37.91
Rate for Payer: Humana Medicare Advantage	$17.69
Rate for Payer: UnitedHealthcare Commercial	$40.01
Rate for Payer: UnitedHealthcare Medicaid	$16.85
Rate for Payer: WPPA Medicare Advantage	$25.27

rocuronium 10 mg/mL IV Sol [HMC]

Facility

$42.12

Service Code	NDC 00409955849
Hospital Charge Code	3170180
Hospital Revenue Code	250
Min. Negotiated Rate	$37.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$37.91
Rate for Payer: UnitedHealthcare Commercial	$40.01
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rocuronium 10 mg/mL IV Sol [HMC]

Facility

$42.12

Service Code	NDC 00409140310
Hospital Charge Code	3170180
Hospital Revenue Code	250
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$40.01
Rate for Payer: Aetna Commercial	$37.91
Rate for Payer: Humana Medicare Advantage	$17.69
Rate for Payer: UnitedHealthcare Commercial	$40.01
Rate for Payer: UnitedHealthcare Medicaid	$16.85
Rate for Payer: WPPA Medicare Advantage	$25.27

ROM POCT

Facility

$212.00

Service Code	HCPCS 84112
Hospital Charge Code	3304112
Hospital Revenue Code	729
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: UnitedHealthcare Commercial	$201.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROM POCT

Facility

$212.00

Service Code	HCPCS 84112
Hospital Charge Code	3304112
Hospital Revenue Code	729
Min. Negotiated Rate	$83.39
Max. Negotiated Rate	$201.40
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$124.11
Rate for Payer: Humana Medicare Advantage	$89.04
Rate for Payer: UnitedHealthcare Commercial	$201.40
Rate for Payer: UnitedHealthcare Medicaid	$83.39
Rate for Payer: WPPA Medicare Advantage	$127.20

ROOM/BED: Inpatient

Facility

$1,533.00

Hospital Charge Code	3000010
Hospital Revenue Code	112
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,379.70
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,456.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Inpatient

Facility

$1,477.00

Hospital Charge Code	3000004
Hospital Revenue Code	120
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,329.30
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,403.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Isolation

Facility

$1,499.00

Hospital Charge Code	3000006
Hospital Revenue Code	110
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,349.10
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,424.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Newborn Level 1

Facility

$1,281.00

Hospital Charge Code	3110052
Hospital Revenue Code	170
Min. Negotiated Rate	$1,152.90
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,152.90
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,216.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Nursery

Facility

$1,345.00

Hospital Charge Code	3110053
Hospital Revenue Code	170
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,210.50
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,277.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Nursery Level 1

Facility

$1,345.00

Hospital Charge Code	3110055
Hospital Revenue Code	170
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,210.50
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,277.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Nursery Level 2

Facility

$1,820.00

Hospital Charge Code	3110065
Hospital Revenue Code	172
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,638.00
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,729.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Nursery Level 3

Facility

$2,403.00

Hospital Charge Code	3110080
Hospital Revenue Code	173
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$2,162.70
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$2,282.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: OB

Facility

$1,533.00

Hospital Charge Code	3000007
Hospital Revenue Code	112
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,379.70
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,456.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Observation

Facility

$84.00

Service Code	HCPCS G0378
Hospital Charge Code	3310036
Hospital Revenue Code	762
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$79.80
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: Humana Medicare Advantage	$35.28
Rate for Payer: UnitedHealthcare Commercial	$79.80
Rate for Payer: UnitedHealthcare Medicaid	$5.20
Rate for Payer: WPPA Medicare Advantage	$50.40

ROOM/BED: Observation

Facility

$84.00

Service Code	HCPCS G0378
Hospital Charge Code	3310036
Hospital Revenue Code	762
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: UnitedHealthcare Commercial	$79.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Private

Facility

$1,533.00

Hospital Charge Code	3000005
Hospital Revenue Code	110
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,379.70
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,456.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Private

Facility

$1,533.00

Hospital Charge Code	3000009
Hospital Revenue Code	110
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,379.70
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,456.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Private - PEDs

Facility

$1,533.00

Hospital Charge Code	3000009
Hospital Revenue Code	110
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,379.70
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,456.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Private Swing Bed

Facility

$1,058.00

Hospital Charge Code	3000002
Hospital Revenue Code	110
Min. Negotiated Rate	$952.20
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$952.20
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,005.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: Semi-Private

Facility

$1,477.00

Hospital Charge Code	3000008
Hospital Revenue Code	120
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$1,329.30
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$1,403.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges