Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

ROOM/BED: Semi Private Peds

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

ROOM/BED: Semi Private Swing Bed

Facility

$948.00

Hospital Charge Code	3000001
Hospital Revenue Code	120
Min. Negotiated Rate	$853.20
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$853.20
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$900.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ROOM/BED: SNF Semi-Private

Facility

$948.00

Hospital Charge Code	3000003
Hospital Revenue Code	120
Min. Negotiated Rate	$853.20
Max. Negotiated Rate	$4,466.00
Rate for Payer: Aetna Commercial	$853.20
Rate for Payer: Humana Medicare Advantage	$4,466.00
Rate for Payer: UnitedHealthcare Commercial	$900.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ropinirole 0.25 mg Tab [HMC]

Facility

$12.50

Service Code	NDC 43547026810
Hospital Charge Code	3804829
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$11.88
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: Humana Medicare Advantage	$5.25
Rate for Payer: UnitedHealthcare Commercial	$11.88
Rate for Payer: UnitedHealthcare Medicaid	$5.00
Rate for Payer: WPPA Medicare Advantage	$7.50

ropinirole 0.25 mg Tab [HMC]

Facility

$6.77

Service Code	NDC 00904637361
Hospital Charge Code	3804829
Hospital Revenue Code	250
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.09
Rate for Payer: UnitedHealthcare Commercial	$6.43
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ropinirole 0.25 mg Tab [HMC]

Facility

$6.77

Service Code	NDC 50268074115
Hospital Charge Code	3804829
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$6.43
Rate for Payer: Aetna Commercial	$6.09
Rate for Payer: Humana Medicare Advantage	$2.84
Rate for Payer: UnitedHealthcare Commercial	$6.43
Rate for Payer: UnitedHealthcare Medicaid	$2.71
Rate for Payer: WPPA Medicare Advantage	$4.06

ropinirole 0.25 mg Tab [HMC]

Facility

$7.44

Service Code	NDC 68084030501
Hospital Charge Code	3804829
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: Humana Medicare Advantage	$3.12
Rate for Payer: UnitedHealthcare Commercial	$7.07
Rate for Payer: UnitedHealthcare Medicaid	$2.98
Rate for Payer: WPPA Medicare Advantage	$4.46

ropinirole 0.25 mg Tab [HMC]

Facility

$7.44

Service Code	NDC 68084030501
Hospital Charge Code	3804829
Hospital Revenue Code	250
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: UnitedHealthcare Commercial	$7.07
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ropinirole 0.25 mg Tab [HMC]

Facility

$6.77

Service Code	NDC 50268074115
Hospital Charge Code	3804829
Hospital Revenue Code	250
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.09
Rate for Payer: UnitedHealthcare Commercial	$6.43
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ropinirole 0.25 mg Tab [HMC]

Facility

$6.77

Service Code	NDC 00904637361
Hospital Charge Code	3804829
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$6.43
Rate for Payer: Aetna Commercial	$6.09
Rate for Payer: Humana Medicare Advantage	$2.84
Rate for Payer: UnitedHealthcare Commercial	$6.43
Rate for Payer: UnitedHealthcare Medicaid	$2.71
Rate for Payer: WPPA Medicare Advantage	$4.06

ropinirole 0.25 mg Tab [HMC]

Facility

$12.50

Service Code	NDC 43547026810
Hospital Charge Code	3804829
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: UnitedHealthcare Commercial	$11.88
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rOPINIRole 1 mg Tab [HMC]

Facility

$12.52

Service Code	NDC 68462025501
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$11.89
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Humana Medicare Advantage	$5.26
Rate for Payer: UnitedHealthcare Commercial	$11.89
Rate for Payer: UnitedHealthcare Medicaid	$5.01
Rate for Payer: WPPA Medicare Advantage	$7.51

rOPINIRole 1 mg Tab [HMC]

Facility

$7.04

Service Code	NDC 00904637461
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: UnitedHealthcare Commercial	$6.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rOPINIRole 1 mg Tab [HMC]

Facility

$7.04

Service Code	NDC 50268074315
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: UnitedHealthcare Commercial	$6.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rOPINIRole 1 mg Tab [HMC]

Facility

$12.50

Service Code	NDC 43547027010
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: UnitedHealthcare Commercial	$11.88
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rOPINIRole 1 mg Tab [HMC]

Facility

$12.52

Service Code	NDC 68462025501
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: UnitedHealthcare Commercial	$11.89
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rOPINIRole 1 mg Tab [HMC]

Facility

$7.09

Service Code	NDC 60687058801
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$6.74
Rate for Payer: Aetna Commercial	$6.38
Rate for Payer: Humana Medicare Advantage	$2.98
Rate for Payer: UnitedHealthcare Commercial	$6.74
Rate for Payer: UnitedHealthcare Medicaid	$2.84
Rate for Payer: WPPA Medicare Advantage	$4.25

rOPINIRole 1 mg Tab [HMC]

Facility

$7.09

Service Code	NDC 60687058801
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.38
Rate for Payer: UnitedHealthcare Commercial	$6.74
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rOPINIRole 1 mg Tab [HMC]

Facility

$12.50

Service Code	NDC 43547027010
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$11.88
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: Humana Medicare Advantage	$5.25
Rate for Payer: UnitedHealthcare Commercial	$11.88
Rate for Payer: UnitedHealthcare Medicaid	$5.00
Rate for Payer: WPPA Medicare Advantage	$7.50

rOPINIRole 1 mg Tab [HMC]

Facility

$7.04

Service Code	NDC 50268074315
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$6.69
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Humana Medicare Advantage	$2.96
Rate for Payer: UnitedHealthcare Commercial	$6.69
Rate for Payer: UnitedHealthcare Medicaid	$2.82
Rate for Payer: WPPA Medicare Advantage	$4.22

rOPINIRole 1 mg Tab [HMC]

Facility

$7.04

Service Code	NDC 00904637461
Hospital Charge Code	3808626
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$6.69
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Humana Medicare Advantage	$2.96
Rate for Payer: UnitedHealthcare Commercial	$6.69
Rate for Payer: UnitedHealthcare Medicaid	$2.82
Rate for Payer: WPPA Medicare Advantage	$4.22

ropivacaine 0.2% Inj Sol 200 mL [HMC]

Facility

$159.05

Service Code	HCPCS J2795
Hospital Charge Code	3170020
Hospital Revenue Code	250
Min. Negotiated Rate	$143.15
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$143.15
Rate for Payer: Aetna Commercial	$62.19
Rate for Payer: UnitedHealthcare Commercial	$65.64
Rate for Payer: UnitedHealthcare Commercial	$151.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ropivacaine 0.2% Inj Sol 200 mL [HMC]

Facility

$159.05

Service Code	NDC 25021067187
Hospital Charge Code	3170020
Hospital Revenue Code	250
Min. Negotiated Rate	$63.62
Max. Negotiated Rate	$151.10
Rate for Payer: Aetna Commercial	$143.15
Rate for Payer: Humana Medicare Advantage	$66.80
Rate for Payer: UnitedHealthcare Commercial	$151.10
Rate for Payer: UnitedHealthcare Medicaid	$63.62
Rate for Payer: WPPA Medicare Advantage	$95.43

ropivacaine 0.2% Inj Sol 200 mL [HMC]

Facility

$69.10

Service Code	HCPCS J2795
Hospital Charge Code	3170020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$65.64
Rate for Payer: Aetna Commercial	$62.19
Rate for Payer: Aetna Commercial	$143.15
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Humana Medicare Advantage	$66.80
Rate for Payer: Humana Medicare Advantage	$29.02
Rate for Payer: UnitedHealthcare Commercial	$151.10
Rate for Payer: UnitedHealthcare Commercial	$65.64
Rate for Payer: UnitedHealthcare Medicaid	$63.62
Rate for Payer: UnitedHealthcare Medicaid	$27.64
Rate for Payer: WPPA Medicare Advantage	$95.43
Rate for Payer: WPPA Medicare Advantage	$41.46

ropivacaine 0.2% Inj Sol 200 mL [HMC]

Facility

$159.05

Service Code	NDC 25021067187
Hospital Charge Code	3170020
Hospital Revenue Code	250
Min. Negotiated Rate	$143.15
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$143.15
Rate for Payer: UnitedHealthcare Commercial	$151.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges