Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Sodium Chloride 0.9% IV Sol 100 mL [HMC]

Facility

$25.29

Service Code	NDC 00409798437
Hospital Charge Code	3254047
Hospital Revenue Code	250
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.76
Rate for Payer: UnitedHealthcare Commercial	$24.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Sodium Chloride 0.9% IV Sol 100 mL [HMC]

Facility

$25.29

Service Code	NDC 00409798437
Hospital Charge Code	3254047
Hospital Revenue Code	250
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$24.03
Rate for Payer: Aetna Commercial	$22.76
Rate for Payer: Humana Medicare Advantage	$10.62
Rate for Payer: UnitedHealthcare Commercial	$24.03
Rate for Payer: UnitedHealthcare Medicaid	$10.12
Rate for Payer: WPPA Medicare Advantage	$15.17

Sodium Chloride 0.9% IV Sol 100 mL [HMC]

Facility

$28.75

Service Code	HCPCS J7040
Hospital Charge Code	3254047
Hospital Revenue Code	250
Min. Negotiated Rate	$25.88
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.88
Rate for Payer: Aetna Commercial	$22.76
Rate for Payer: Aetna Commercial	$25.95
Rate for Payer: UnitedHealthcare Commercial	$27.31
Rate for Payer: UnitedHealthcare Commercial	$24.03
Rate for Payer: UnitedHealthcare Commercial	$27.39
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

Sodium Chloride 0.9% IV Sol 100 mL [HMC]

Facility

$28.75

Service Code	HCPCS J7040
Hospital Charge Code	3254047
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$27.31
Rate for Payer: Aetna Commercial	$25.88
Rate for Payer: Aetna Commercial	$22.76
Rate for Payer: Aetna Commercial	$25.95
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Humana Medicare Advantage	$12.11
Rate for Payer: Humana Medicare Advantage	$10.62
Rate for Payer: Humana Medicare Advantage	$12.07
Rate for Payer: UnitedHealthcare Commercial	$27.39
Rate for Payer: UnitedHealthcare Commercial	$27.31
Rate for Payer: UnitedHealthcare Commercial	$24.03
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: WPPA Medicare Advantage	$17.25
Rate for Payer: WPPA Medicare Advantage	$15.17
Rate for Payer: WPPA Medicare Advantage	$17.30

Sodium Chloride 0.9% IV Sol 250 mL [HMC]

Facility

$35.51

Service Code	HCPCS J7040
Hospital Charge Code	3256919
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$33.73
Rate for Payer: Aetna Commercial	$31.96
Rate for Payer: Aetna Commercial	$35.71
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Humana Medicare Advantage	$14.91
Rate for Payer: UnitedHealthcare Commercial	$33.73
Rate for Payer: UnitedHealthcare Commercial	$37.70
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: WPPA Medicare Advantage	$23.81
Rate for Payer: WPPA Medicare Advantage	$21.31

Sodium Chloride 0.9% IV Sol 250 mL [HMC]

Facility

$35.51

Service Code	HCPCS J7040
Hospital Charge Code	3256919
Hospital Revenue Code	250
Min. Negotiated Rate	$31.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.96
Rate for Payer: Aetna Commercial	$35.71
Rate for Payer: UnitedHealthcare Commercial	$37.70
Rate for Payer: UnitedHealthcare Commercial	$33.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Sodium Chloride 0.9% IV Sol 500 mL [HMC]

Facility

$40.40

Service Code	HCPCS J7040
Hospital Charge Code	3253999
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$38.38
Rate for Payer: Aetna Commercial	$36.36
Rate for Payer: Aetna Commercial	$38.59
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Humana Medicare Advantage	$18.01
Rate for Payer: Humana Medicare Advantage	$16.97
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: UnitedHealthcare Commercial	$38.38
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: WPPA Medicare Advantage	$24.24
Rate for Payer: WPPA Medicare Advantage	$25.73

Sodium Chloride 0.9% IV Sol 500 mL [HMC]

Facility

$40.40

Service Code	HCPCS J7040
Hospital Charge Code	3253999
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.36
Rate for Payer: Aetna Commercial	$38.59
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: UnitedHealthcare Commercial	$38.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Sodium Chloride 0.9% IV Sol ADV 100 mL [HMC]

Facility

$29.96

Service Code	HCPCS J7040
Hospital Charge Code	3254047
Hospital Revenue Code	250
Min. Negotiated Rate	$26.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.96
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: UnitedHealthcare Commercial	$34.40
Rate for Payer: UnitedHealthcare Commercial	$28.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Sodium Chloride 0.9% IV Sol ADV 100 mL [HMC]

Facility

$36.21

Service Code	HCPCS J7040
Hospital Charge Code	3254047
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$34.40
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Commercial	$26.96
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Humana Medicare Advantage	$15.21
Rate for Payer: Humana Medicare Advantage	$12.58
Rate for Payer: UnitedHealthcare Commercial	$28.46
Rate for Payer: UnitedHealthcare Commercial	$34.40
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: WPPA Medicare Advantage	$21.73
Rate for Payer: WPPA Medicare Advantage	$17.98

Sodium Chloride 0.9% IV Sol ADV 250 mL [HMC]

Facility

$42.32

Service Code	HCPCS J7040
Hospital Charge Code	3256919
Hospital Revenue Code	250
Min. Negotiated Rate	$38.09
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$38.09
Rate for Payer: UnitedHealthcare Commercial	$40.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Sodium Chloride 0.9% IV Sol ADV 250 mL [HMC]

Facility

$42.32

Service Code	HCPCS J7040
Hospital Charge Code	3256919
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$40.20
Rate for Payer: Aetna Commercial	$38.09
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.68
Rate for Payer: Humana Medicare Advantage	$17.77
Rate for Payer: UnitedHealthcare Commercial	$40.20
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: WPPA Medicare Advantage	$25.39

sodium chloride 0.9% Sol Inh [HMC]

Facility

$21.72

Service Code	NDC 70756066199
Hospital Charge Code	3807209
Hospital Revenue Code	259
Min. Negotiated Rate	$8.69
Max. Negotiated Rate	$20.63
Rate for Payer: Aetna Commercial	$19.55
Rate for Payer: Humana Medicare Advantage	$9.12
Rate for Payer: UnitedHealthcare Commercial	$20.63
Rate for Payer: UnitedHealthcare Medicaid	$8.69
Rate for Payer: WPPA Medicare Advantage	$13.03

sodium chloride 0.9% Sol Inh [HMC]

Facility

$21.72

Service Code	NDC 70756066199
Hospital Charge Code	3807209
Hospital Revenue Code	259
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$19.55
Rate for Payer: UnitedHealthcare Commercial	$20.63
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sodium chloride 1 g Tab [HMC]

Facility

$5.82

Service Code	NDC 00904723961
Hospital Charge Code	3802915
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$5.53
Rate for Payer: Aetna Commercial	$5.24
Rate for Payer: Humana Medicare Advantage	$2.44
Rate for Payer: UnitedHealthcare Commercial	$5.53
Rate for Payer: UnitedHealthcare Medicaid	$2.33
Rate for Payer: WPPA Medicare Advantage	$3.49

sodium chloride 1 g Tab [HMC]

Facility

$5.82

Service Code	NDC 00904723961
Hospital Charge Code	3802915
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.24
Rate for Payer: UnitedHealthcare Commercial	$5.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sodium chloride 1 g Tab [HMC]

Facility

$5.86

Service Code	NDC 77333083510
Hospital Charge Code	3802915
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.57
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Humana Medicare Advantage	$2.46
Rate for Payer: UnitedHealthcare Commercial	$5.57
Rate for Payer: UnitedHealthcare Medicaid	$2.34
Rate for Payer: WPPA Medicare Advantage	$3.52

sodium chloride 1 g Tab [HMC]

Facility

$5.86

Service Code	NDC 77333083510
Hospital Charge Code	3802915
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: UnitedHealthcare Commercial	$5.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sodium chloride 1 g Tab [HMC]

Facility

$5.24

Service Code	NDC 00223176001
Hospital Charge Code	3802915
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.98
Rate for Payer: Aetna Commercial	$4.72
Rate for Payer: Humana Medicare Advantage	$2.20
Rate for Payer: UnitedHealthcare Commercial	$4.98
Rate for Payer: UnitedHealthcare Medicaid	$2.10
Rate for Payer: WPPA Medicare Advantage	$3.14

sodium chloride 1 g Tab [HMC]

Facility

$5.24

Service Code	NDC 00223176001
Hospital Charge Code	3802915
Hospital Revenue Code	250
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.72
Rate for Payer: UnitedHealthcare Commercial	$4.98
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sodium chloride 3% Inh Sol 15 mL [HMC]

Facility

$11.83

Service Code	NDC 00378699789
Hospital Charge Code	3802728
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.65
Rate for Payer: UnitedHealthcare Commercial	$11.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sodium chloride 3% Inh Sol 15 mL [HMC]

Facility

$11.83

Service Code	NDC 00378699789
Hospital Charge Code	3802728
Hospital Revenue Code	250
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$11.24
Rate for Payer: Aetna Commercial	$10.65
Rate for Payer: Humana Medicare Advantage	$4.97
Rate for Payer: UnitedHealthcare Commercial	$11.24
Rate for Payer: UnitedHealthcare Medicaid	$4.73
Rate for Payer: WPPA Medicare Advantage	$7.10

Sodium Chloride 3% IV Sol 500 mL [HMC]

Facility

$34.28

Service Code	HCPCS J7131
Hospital Charge Code	3250144
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$32.57
Rate for Payer: Aetna Commercial	$30.85
Rate for Payer: Aetna Commercial	$37.76
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	$14.40
Rate for Payer: Humana Medicare Advantage	$17.62
Rate for Payer: UnitedHealthcare Commercial	$32.57
Rate for Payer: UnitedHealthcare Commercial	$39.85
Rate for Payer: UnitedHealthcare Medicaid	$0.15
Rate for Payer: UnitedHealthcare Medicaid	$0.15
Rate for Payer: WPPA Medicare Advantage	$20.57
Rate for Payer: WPPA Medicare Advantage	$25.17

Sodium Chloride 3% IV Sol 500 mL [HMC]

Facility

$34.28

Service Code	HCPCS J7131
Hospital Charge Code	3250144
Hospital Revenue Code	250
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$30.85
Rate for Payer: Aetna Commercial	$37.76
Rate for Payer: UnitedHealthcare Commercial	$32.57
Rate for Payer: UnitedHealthcare Commercial	$39.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sodium chloride 7% Inh Sol 4 ml [HMC]

Facility

$11.68

Service Code	NDC 70756066460
Hospital Charge Code	3800515
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$11.10
Rate for Payer: Aetna Commercial	$10.51
Rate for Payer: Humana Medicare Advantage	$4.91
Rate for Payer: UnitedHealthcare Commercial	$11.10
Rate for Payer: UnitedHealthcare Medicaid	$4.67
Rate for Payer: WPPA Medicare Advantage	$7.01

Know your out-of-pocket cost for care.

All Charges