Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

sterile water for irrigation 1000 mL - Sol [HMC]

Facility

$35.50

Service Code	HCPCS A4217
Hospital Charge Code	3256945
Hospital Revenue Code	272
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.95
Rate for Payer: UnitedHealthcare Commercial	$33.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

STERI-STRIP 1/2

Facility

$3.78

Hospital Charge Code	3253130
Hospital Revenue Code	270
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$3.59
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: Humana Medicare Advantage	$1.59
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Medicaid	$1.51
Rate for Payer: WPPA Medicare Advantage	$2.27

STERI-STRIP 1/2

Facility

$3.78

Hospital Charge Code	3253130
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: WPPA Medicare Advantage	$1,200.00

STERI-STRIP 1/4

Facility

$3.78

Hospital Charge Code	3254195
Hospital Revenue Code	270
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$3.59
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: Humana Medicare Advantage	$1.59
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Medicaid	$1.51
Rate for Payer: WPPA Medicare Advantage	$2.27

STERI-STRIP 1/4

Facility

$3.78

Hospital Charge Code	3254195
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: WPPA Medicare Advantage	$1,200.00

STERI-STRIP 1/8

Facility

$2.50

Hospital Charge Code	3254898
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

STERI-STRIP 1/8

Facility

$2.50

Hospital Charge Code	3254898
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stockinette 4 X 48 Sterile Splint/Cast Liner

Facility

$13.00

Hospital Charge Code	3254155
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$12.35
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Humana Medicare Advantage	$5.46
Rate for Payer: UnitedHealthcare Commercial	$12.35
Rate for Payer: UnitedHealthcare Medicaid	$5.20
Rate for Payer: WPPA Medicare Advantage	$7.80

Stockinette 4 X 48 Sterile Splint/Cast Liner

Facility

$13.00

Hospital Charge Code	3254155
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: UnitedHealthcare Commercial	$12.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stockinette Impervious 9 X 44 Sterile Splint/Cast Liner

Facility

$21.00

Hospital Charge Code	3254156
Hospital Revenue Code	270
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$19.95
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Humana Medicare Advantage	$8.82
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Medicaid	$8.40
Rate for Payer: WPPA Medicare Advantage	$12.60

Stockinette Impervious 9 X 44 Sterile Splint/Cast Liner

Facility

$21.00

Hospital Charge Code	3254156
Hospital Revenue Code	270
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

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$9,245.07

Service Code	MSDRG 327
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,245.07
Rate for Payer: UnitedHealthcare Medicaid	$9,245.07
Rate for Payer: WPPA Medicare Advantage	$1,200.00

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$18,871.38

Service Code	MSDRG 326
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$18,871.38
Rate for Payer: UnitedHealthcare Medicaid	$18,871.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$6,068.07

Service Code	MSDRG 328
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,068.07
Rate for Payer: UnitedHealthcare Medicaid	$6,068.07
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stone Analysis QST

Facility

$89.00

Service Code	HCPCS 82365
Hospital Charge Code	3550213
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

Stone Analysis QST

Facility

$89.00

Service Code	HCPCS 82365
Hospital Charge Code	3550213
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$84.55
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$50.36
Rate for Payer: Humana Medicare Advantage	$37.38
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: UnitedHealthcare Medicaid	$12.60
Rate for Payer: WPPA Medicare Advantage	$53.40

Stopcock 3-Way w/Luer Lock and Swivel

Facility

$2.50

Hospital Charge Code	3255140
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stopcock 3-Way w/Luer Lock and Swivel

Facility

$2.50

Hospital Charge Code	3255140
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Straight Staple Assembly 10mm X 10mm

Facility

$4,610.00

Hospital Charge Code	3258315
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,379.50
Rate for Payer: Aetna Commercial	$4,149.00
Rate for Payer: UnitedHealthcare Commercial	$4,379.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Straight Staple Assembly 10mm X 10mm

Facility

$4,610.00

Hospital Charge Code	3258315
Hospital Revenue Code	270
Min. Negotiated Rate	$1,844.00
Max. Negotiated Rate	$4,379.50
Rate for Payer: Aetna Commercial	$4,149.00
Rate for Payer: Humana Medicare Advantage	$1,936.20
Rate for Payer: UnitedHealthcare Commercial	$4,379.50
Rate for Payer: UnitedHealthcare Medicaid	$1,844.00
Rate for Payer: WPPA Medicare Advantage	$2,766.00

Strawberry (f44) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552824
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

Strawberry (f44) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552824
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

Strep A (ID NOW)

Facility

$98.00

Service Code	HCPCS 87651
Hospital Charge Code	3551385
Hospital Revenue Code	300
Min. Negotiated Rate	$29.83
Max. Negotiated Rate	$93.10
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$75.32
Rate for Payer: Humana Medicare Advantage	$41.16
Rate for Payer: UnitedHealthcare Commercial	$93.10
Rate for Payer: UnitedHealthcare Medicaid	$29.83
Rate for Payer: WPPA Medicare Advantage	$58.80

Strep A (ID NOW)

Facility

$98.00

Service Code	HCPCS 87651
Hospital Charge Code	3551385
Hospital Revenue Code	300
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: UnitedHealthcare Commercial	$93.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Strep Pneumoniae Ab IgG (14 Sero) QST

Facility

$525.00

Service Code	HCPCS 86317
Hospital Charge Code	3552956
Hospital Revenue Code	300
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$472.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$44.56
Rate for Payer: Humana Medicare Advantage	$220.50
Rate for Payer: UnitedHealthcare Commercial	$498.75
Rate for Payer: UnitedHealthcare Medicaid	$12.74
Rate for Payer: WPPA Medicare Advantage	$315.00

Know your out-of-pocket cost for care.

All Charges