Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Salmonella and Shigella, Culture QST

Facility

$89.00

Service Code	HCPCS 87427
Hospital Charge Code	3557427
Hospital Revenue Code	300
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Salmon (f41) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552841
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$19.95
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$8.82
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$12.60

Salmon (f41) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552841
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Sal/Shig/Campy, Culture And Shiga Toxin, EIA w/Rfx To E.Coli, 0157 Culture QST

Facility

$89.00

Service Code	HCPCS 87427
Hospital Charge Code	3557427
Hospital Revenue Code	300
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Sal/Shig/Campy, Culture And Shiga Toxin, EIA w/Rfx To E.Coli, 0157 Culture QST

Facility

$89.00

Service Code	HCPCS 87427
Hospital Charge Code	3557427
Hospital Revenue Code	300
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$84.55
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$54.84
Rate for Payer: Humana Medicare Advantage	$37.38
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: UnitedHealthcare Medicaid	$11.98
Rate for Payer: WPPA Medicare Advantage	$53.40

Sam Splint

Facility

$69.00

Hospital Charge Code	3254430
Hospital Revenue Code	541
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: UnitedHealthcare Commercial	$65.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Sam Splint

Facility

$69.00

Hospital Charge Code	3254430
Hospital Revenue Code	541
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: Humana Medicare Advantage	$28.98
Rate for Payer: UnitedHealthcare Commercial	$65.55
Rate for Payer: UnitedHealthcare Medicaid	$27.60
Rate for Payer: WPPA Medicare Advantage	$41.40

SARS-CoV-2 (COVID-19) Antigen

Facility

$85.00

Service Code	HCPCS 87426
Hospital Charge Code	3557426
Hospital Revenue Code	300
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SARS-CoV-2 (COVID-19) Antigen

Facility

$85.00

Service Code	HCPCS 87426
Hospital Charge Code	3557426
Hospital Revenue Code	300
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$80.75
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$54.84
Rate for Payer: Humana Medicare Advantage	$35.70
Rate for Payer: UnitedHealthcare Commercial	$80.75
Rate for Payer: UnitedHealthcare Medicaid	$38.45
Rate for Payer: WPPA Medicare Advantage	$51.00

SARS-CoV-2 (COVID-19) RNA (ID Now)

Facility

$62.00

Service Code	HCPCS 87635
Hospital Charge Code	3558763
Hospital Revenue Code	300
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: UnitedHealthcare Commercial	$58.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SARS-CoV-2 (COVID-19) RNA (ID Now)

Facility

$62.00

Service Code	HCPCS 87635
Hospital Charge Code	3558763
Hospital Revenue Code	300
Min. Negotiated Rate	$26.04
Max. Negotiated Rate	$114.18
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$114.18
Rate for Payer: Humana Medicare Advantage	$26.04
Rate for Payer: UnitedHealthcare Commercial	$58.90
Rate for Payer: UnitedHealthcare Medicaid	$43.61
Rate for Payer: WPPA Medicare Advantage	$37.20

Scallop (F338) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552830
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Scallop (F338) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552830
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$19.95
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$8.82
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$12.60

Scissor Lap Curved 5mm

Facility

$249.83

Hospital Charge Code	3258444
Hospital Revenue Code	270
Min. Negotiated Rate	$99.93
Max. Negotiated Rate	$237.34
Rate for Payer: Aetna Commercial	$224.85
Rate for Payer: Humana Medicare Advantage	$104.93
Rate for Payer: UnitedHealthcare Commercial	$237.34
Rate for Payer: UnitedHealthcare Medicaid	$99.93
Rate for Payer: WPPA Medicare Advantage	$149.90

Scissor Lap Curved 5mm

Facility

$249.83

Hospital Charge Code	3258444
Hospital Revenue Code	270
Min. Negotiated Rate	$224.85
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$224.85
Rate for Payer: UnitedHealthcare Commercial	$237.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SCL-70 Antibody QST

Facility

$64.00

Service Code	HCPCS 86235
Hospital Charge Code	3556403
Hospital Revenue Code	300
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: UnitedHealthcare Commercial	$60.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SCL-70 Antibody QST

Facility

$64.00

Service Code	HCPCS 86235
Hospital Charge Code	3556403
Hospital Revenue Code	300
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$60.80
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$52.26
Rate for Payer: Humana Medicare Advantage	$26.88
Rate for Payer: UnitedHealthcare Commercial	$60.80
Rate for Payer: UnitedHealthcare Medicaid	$17.93
Rate for Payer: WPPA Medicare Advantage	$38.40

scopolamine 1.5 mg/72 hr ER Patch [HMC]

Facility

$27.97

Service Code	NDC 50742050510
Hospital Charge Code	3807068
Hospital Revenue Code	250
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.17
Rate for Payer: UnitedHealthcare Commercial	$26.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

scopolamine 1.5 mg/72 hr ER Patch [HMC]

Facility

$27.97

Service Code	NDC 50742050510
Hospital Charge Code	3807068
Hospital Revenue Code	250
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$26.57
Rate for Payer: Aetna Commercial	$25.17
Rate for Payer: Humana Medicare Advantage	$11.75
Rate for Payer: UnitedHealthcare Commercial	$26.57
Rate for Payer: UnitedHealthcare Medicaid	$11.19
Rate for Payer: WPPA Medicare Advantage	$16.78

scopolamine 1.5 mg/72 hr ER Patch [HMC]

Facility

$30.56

Service Code	NDC 10019055304
Hospital Charge Code	3807068
Hospital Revenue Code	250
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$27.50
Rate for Payer: UnitedHealthcare Commercial	$29.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

scopolamine 1.5 mg/72 hr ER Patch [HMC]

Facility

$30.56

Service Code	NDC 10019055304
Hospital Charge Code	3807068
Hospital Revenue Code	250
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$29.03
Rate for Payer: Aetna Commercial	$27.50
Rate for Payer: Humana Medicare Advantage	$12.84
Rate for Payer: UnitedHealthcare Commercial	$29.03
Rate for Payer: UnitedHealthcare Medicaid	$12.22
Rate for Payer: WPPA Medicare Advantage	$18.34

Securement Device StayFix Drainage Tube Fixation Dressing/Holder 12 Fr - 22 Fr

Facility

$66.00

Hospital Charge Code	3255340
Hospital Revenue Code	270
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$62.70
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: Humana Medicare Advantage	$27.72
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: UnitedHealthcare Medicaid	$26.40
Rate for Payer: WPPA Medicare Advantage	$39.60

Securement Device StayFix Drainage Tube Fixation Dressing/Holder 12 Fr - 22 Fr

Facility

$66.00

Hospital Charge Code	3255340
Hospital Revenue Code	270
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

Sedimentation Rate (ESR)

Facility

$47.00

Service Code	HCPCS 85652
Hospital Charge Code	3550718
Hospital Revenue Code	300
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$44.65
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$12.82
Rate for Payer: Humana Medicare Advantage	$19.74
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: UnitedHealthcare Medicaid	$2.70
Rate for Payer: WPPA Medicare Advantage	$28.20

Sedimentation Rate (ESR)

Facility

$47.00

Service Code	HCPCS 85652
Hospital Charge Code	3550718
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

Know your out-of-pocket cost for care.

All Charges