Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

ropivacaine 0.2% Sol 10 mL [HMC]

Facility

$38.34

Service Code	HCPCS J2795
Hospital Charge Code	3170490
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$34.51
Rate for Payer: Aetna Commercial	$35.88
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	$16.10
Rate for Payer: Humana Medicare Advantage	$16.75
Rate for Payer: UnitedHealthcare Commercial	$36.42
Rate for Payer: UnitedHealthcare Commercial	$37.88
Rate for Payer: UnitedHealthcare Medicaid	$15.34
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: WPPA Medicare Advantage	$23.92
Rate for Payer: WPPA Medicare Advantage	$23.00

ropivacaine 0.2% Sol 10 mL [HMC]

Facility

$39.87

Service Code	HCPCS J2795
Hospital Charge Code	3170490
Hospital Revenue Code	250
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Commercial	$34.51
Rate for Payer: UnitedHealthcare Commercial	$36.42
Rate for Payer: UnitedHealthcare Commercial	$37.88
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ropivacaine 0.5% Inj Sol 30 mL [HMC]

Facility

$70.80

Service Code	HCPCS J2795
Hospital Charge Code	3170495
Hospital Revenue Code	250
Min. Negotiated Rate	$63.72
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$63.72
Rate for Payer: UnitedHealthcare Commercial	$67.26
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ropivacaine 0.5% Inj Sol 30 mL [HMC]

Facility

$70.80

Service Code	HCPCS J2795
Hospital Charge Code	3170495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$67.26
Rate for Payer: Aetna Commercial	$63.72
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.11
Rate for Payer: Humana Medicare Advantage	$29.74
Rate for Payer: UnitedHealthcare Commercial	$67.26
Rate for Payer: UnitedHealthcare Medicaid	$28.32
Rate for Payer: WPPA Medicare Advantage	$42.48

ropivacaine 1% Inj Sol 20 mL [HMC]

Facility

$49.48

Service Code	HCPCS J2795
Hospital Charge Code	3170383
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$47.01
Rate for Payer: Aetna Commercial	$44.53
Rate for Payer: Aetna Commercial	$71.46
Rate for Payer: Aetna Commercial	$54.77
Rate for Payer: Aetna Commercial	$39.61
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: 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	$20.78
Rate for Payer: Humana Medicare Advantage	$18.48
Rate for Payer: Humana Medicare Advantage	$33.35
Rate for Payer: Humana Medicare Advantage	$25.56
Rate for Payer: UnitedHealthcare Commercial	$75.43
Rate for Payer: UnitedHealthcare Commercial	$47.01
Rate for Payer: UnitedHealthcare Commercial	$41.81
Rate for Payer: UnitedHealthcare Commercial	$57.82
Rate for Payer: UnitedHealthcare Medicaid	$24.34
Rate for Payer: UnitedHealthcare Medicaid	$17.60
Rate for Payer: UnitedHealthcare Medicaid	$19.79
Rate for Payer: UnitedHealthcare Medicaid	$31.76
Rate for Payer: WPPA Medicare Advantage	$29.69
Rate for Payer: WPPA Medicare Advantage	$26.41
Rate for Payer: WPPA Medicare Advantage	$47.64
Rate for Payer: WPPA Medicare Advantage	$36.52

ropivacaine 1% Inj Sol 20 mL [HMC]

Facility

$49.48

Service Code	HCPCS J2795
Hospital Charge Code	3170383
Hospital Revenue Code	250
Min. Negotiated Rate	$44.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$44.53
Rate for Payer: Aetna Commercial	$39.61
Rate for Payer: Aetna Commercial	$54.77
Rate for Payer: Aetna Commercial	$71.46
Rate for Payer: UnitedHealthcare Commercial	$47.01
Rate for Payer: UnitedHealthcare Commercial	$75.43
Rate for Payer: UnitedHealthcare Commercial	$57.82
Rate for Payer: UnitedHealthcare Commercial	$41.81
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rosuvastatin 10 mg Tab [HMC]

Facility

$9.94

Service Code	NDC 00904677961
Hospital Charge Code	3800545
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$9.44
Rate for Payer: Aetna Commercial	$8.95
Rate for Payer: Humana Medicare Advantage	$4.17
Rate for Payer: UnitedHealthcare Commercial	$9.44
Rate for Payer: UnitedHealthcare Medicaid	$3.98
Rate for Payer: WPPA Medicare Advantage	$5.96

rosuvastatin 10 mg Tab [HMC]

Facility

$9.12

Service Code	NDC 50268070915
Hospital Charge Code	3800545
Hospital Revenue Code	250
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.21
Rate for Payer: UnitedHealthcare Commercial	$8.66
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rosuvastatin 10 mg Tab [HMC]

Facility

$22.86

Service Code	NDC 60687024501
Hospital Charge Code	3800545
Hospital Revenue Code	250
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$21.72
Rate for Payer: Aetna Commercial	$20.57
Rate for Payer: Humana Medicare Advantage	$9.60
Rate for Payer: UnitedHealthcare Commercial	$21.72
Rate for Payer: UnitedHealthcare Medicaid	$9.14
Rate for Payer: WPPA Medicare Advantage	$13.72

rosuvastatin 10 mg Tab [HMC]

Facility

$22.86

Service Code	NDC 60687024501
Hospital Charge Code	3800545
Hospital Revenue Code	250
Min. Negotiated Rate	$20.57
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$20.57
Rate for Payer: UnitedHealthcare Commercial	$21.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rosuvastatin 10 mg Tab [HMC]

Facility

$9.12

Service Code	NDC 50268070915
Hospital Charge Code	3800545
Hospital Revenue Code	250
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$8.66
Rate for Payer: Aetna Commercial	$8.21
Rate for Payer: Humana Medicare Advantage	$3.83
Rate for Payer: UnitedHealthcare Commercial	$8.66
Rate for Payer: UnitedHealthcare Medicaid	$3.65
Rate for Payer: WPPA Medicare Advantage	$5.47

rosuvastatin 10 mg Tab [HMC]

Facility

$9.94

Service Code	NDC 00904677961
Hospital Charge Code	3800545
Hospital Revenue Code	250
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.95
Rate for Payer: UnitedHealthcare Commercial	$9.44
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Rough Marsh Elder (W16) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1020
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$11.34
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$16.20

Rough Marsh Elder (W16) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1020
Hospital Revenue Code	300
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Rough Pigweed (W14) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1021
Hospital Revenue Code	300
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Rough Pigweed (W14) IgE QST

Facility

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1021
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$11.34
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$16.20

RPR (Dx) w/ Rfx Titer And Confirmatory Testing QST

Facility

$53.00

Service Code	HCPCS 86592
Hospital Charge Code	3550874
Hospital Revenue Code	300
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$50.35
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$16.26
Rate for Payer: Humana Medicare Advantage	$22.26
Rate for Payer: UnitedHealthcare Commercial	$50.35
Rate for Payer: UnitedHealthcare Medicaid	$4.27
Rate for Payer: WPPA Medicare Advantage	$31.80

RPR (Dx) w/ Rfx Titer And Confirmatory Testing QST

Facility

$53.00

Service Code	HCPCS 86592
Hospital Charge Code	3550874
Hospital Revenue Code	300
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: UnitedHealthcare Commercial	$50.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RPR (Monitor) w/ Rfx To Titer QST

Facility

$132.00

Service Code	HCPCS 86780
Hospital Charge Code	3556780
Hospital Revenue Code	300
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$125.40
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$53.11
Rate for Payer: Humana Medicare Advantage	$55.44
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: UnitedHealthcare Medicaid	$13.24
Rate for Payer: WPPA Medicare Advantage	$79.20

RPR (Monitor) w/ Rfx To Titer QST

Facility

$132.00

Service Code	HCPCS 86780
Hospital Charge Code	3556780
Hospital Revenue Code	300
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: UnitedHealthcare Commercial	$125.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

.RPR Titer QST

Facility

$40.00

Service Code	HCPCS 86593
Hospital Charge Code	3556593
Hospital Revenue Code	300
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$38.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$22.56
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: UnitedHealthcare Medicaid	$4.40
Rate for Payer: WPPA Medicare Advantage	$24.00

.RPR Titer QST

Facility

$40.00

Service Code	HCPCS 86593
Hospital Charge Code	3556593
Hospital Revenue Code	300
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RSV (ID NOW)

Facility

$218.00

Service Code	HCPCS 87634
Hospital Charge Code	3552169
Hospital Revenue Code	300
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$207.10
Rate for Payer: Aetna Commercial	$196.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$157.55
Rate for Payer: Humana Medicare Advantage	$91.56
Rate for Payer: UnitedHealthcare Commercial	$207.10
Rate for Payer: UnitedHealthcare Medicaid	$70.20
Rate for Payer: WPPA Medicare Advantage	$130.80

RSV (ID NOW)

Facility

$218.00

Service Code	HCPCS 87634
Hospital Charge Code	3552169
Hospital Revenue Code	300
Min. Negotiated Rate	$196.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$196.20
Rate for Payer: UnitedHealthcare Commercial	$207.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RSV RNA QST

Facility

$462.00

Service Code	HCPCS 87634
Hospital Charge Code	3556047
Hospital Revenue Code	300
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$438.90
Rate for Payer: Aetna Commercial	$415.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$157.55
Rate for Payer: Humana Medicare Advantage	$194.04
Rate for Payer: UnitedHealthcare Commercial	$438.90
Rate for Payer: UnitedHealthcare Medicaid	$70.20
Rate for Payer: WPPA Medicare Advantage	$277.20

Know your out-of-pocket cost for care.

All Charges