Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$10,293.48

Service Code	MSDRG 085
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,293.48
Rate for Payer: UnitedHealthcare Medicaid	$10,293.48
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$10,325.25

Service Code	MSDRG 082
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,325.25
Rate for Payer: UnitedHealthcare Medicaid	$10,325.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$1,683.81

Service Code	MSDRG 087
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,683.81
Rate for Payer: UnitedHealthcare Medicaid	$1,683.81
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$4,320.72

Service Code	MSDRG 084
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,320.72
Rate for Payer: UnitedHealthcare Medicaid	$4,320.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$6,894.09

Service Code	MSDRG 604
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,894.09
Rate for Payer: UnitedHealthcare Medicaid	$6,894.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$4,288.95

Service Code	MSDRG 605
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,288.95
Rate for Payer: UnitedHealthcare Medicaid	$4,288.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

traZODone 50 mg Tab [HMC]

Facility

$6.31

Service Code	NDC 00904399061
Hospital Charge Code	3807506
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.99
Rate for Payer: Aetna Commercial	$5.68
Rate for Payer: Humana Medicare Advantage	$2.65
Rate for Payer: UnitedHealthcare Commercial	$5.99
Rate for Payer: UnitedHealthcare Medicaid	$2.52
Rate for Payer: WPPA Medicare Advantage	$3.79

traZODone 50 mg Tab [HMC]

Facility

$5.47

Service Code	NDC 60687044301
Hospital Charge Code	3807506
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

traZODone 50 mg Tab [HMC]

Facility

$6.31

Service Code	NDC 00904399061
Hospital Charge Code	3807506
Hospital Revenue Code	250
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.68
Rate for Payer: UnitedHealthcare Commercial	$5.99
Rate for Payer: WPPA Medicare Advantage	$1,200.00

traZODone 50 mg Tab [HMC]

Facility

$5.47

Service Code	NDC 60687044301
Hospital Charge Code	3807506
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: Humana Medicare Advantage	$2.30
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Medicaid	$2.19
Rate for Payer: WPPA Medicare Advantage	$3.28

traZODone 50 mg Tab [HMC]

Facility

$5.44

Service Code	NDC 00904686861
Hospital Charge Code	3807506
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$5.17
Rate for Payer: Aetna Commercial	$4.90
Rate for Payer: Humana Medicare Advantage	$2.28
Rate for Payer: UnitedHealthcare Commercial	$5.17
Rate for Payer: UnitedHealthcare Medicaid	$2.18
Rate for Payer: WPPA Medicare Advantage	$3.26

traZODone 50 mg Tab [HMC]

Facility

$5.44

Service Code	NDC 00904686861
Hospital Charge Code	3807506
Hospital Revenue Code	250
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.90
Rate for Payer: UnitedHealthcare Commercial	$5.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Treatment of Swallowing Dysfunction Charge

Facility

$248.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	4050214
Hospital Revenue Code	441
Min. Negotiated Rate	$65.44
Max. Negotiated Rate	$235.60
Rate for Payer: Aetna Commercial	$223.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$65.44
Rate for Payer: Humana Medicare Advantage	$104.16
Rate for Payer: UnitedHealthcare Commercial	$235.60
Rate for Payer: UnitedHealthcare Medicaid	$70.82
Rate for Payer: WPPA Medicare Advantage	$148.80

Treatment of Swallowing Dysfunction Charge

Facility

$248.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	4050214
Hospital Revenue Code	441
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$223.20
Rate for Payer: UnitedHealthcare Commercial	$235.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Treat Spinal Canal Lesion

Facility

$552.00

Service Code	HCPCS 62282
Hospital Charge Code	3150503
Hospital Revenue Code	360
Min. Negotiated Rate	$496.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$496.80
Rate for Payer: UnitedHealthcare Commercial	$524.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Treat Spinal Canal Lesion

Facility

$552.00

Service Code	HCPCS 62282
Hospital Charge Code	3150503
Hospital Revenue Code	360
Min. Negotiated Rate	$231.84
Max. Negotiated Rate	$524.40
Rate for Payer: Aetna Commercial	$496.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$278.76
Rate for Payer: Humana Medicare Advantage	$231.84
Rate for Payer: UnitedHealthcare Commercial	$524.40
Rate for Payer: UnitedHealthcare Medicaid	$295.27
Rate for Payer: WPPA Medicare Advantage	$331.20

triamcinolone acetonide 40 mg/mL Inj Susp 1 ml [HMC]

Facility

$40.60

Service Code	HCPCS J3301
Hospital Charge Code	3804715
Hospital Revenue Code	250
Min. Negotiated Rate	$36.54
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.54
Rate for Payer: UnitedHealthcare Commercial	$38.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triamcinolone acetonide 40 mg/mL Inj Susp 1 ml [HMC]

Facility

$40.60

Service Code	HCPCS J3301
Hospital Charge Code	3804715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$38.57
Rate for Payer: Aetna Commercial	$36.54
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.39
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: UnitedHealthcare Commercial	$38.57
Rate for Payer: UnitedHealthcare Medicaid	$0.74
Rate for Payer: WPPA Medicare Advantage	$24.36

triamcinolone acetonide 40 mg/mL Inj Susp 1 mL [HMC]

Facility

$40.60

Service Code	NDC 70121165101
Hospital Charge Code	3804715
Hospital Revenue Code	250
Min. Negotiated Rate	$16.24
Max. Negotiated Rate	$38.57
Rate for Payer: Aetna Commercial	$36.54
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: UnitedHealthcare Commercial	$38.57
Rate for Payer: UnitedHealthcare Medicaid	$16.24
Rate for Payer: WPPA Medicare Advantage	$24.36

triamcinolone acetonide 40 mg/mL Inj Susp 1 mL [HMC]

Facility

$40.60

Service Code	NDC 70121165101
Hospital Charge Code	3804715
Hospital Revenue Code	250
Min. Negotiated Rate	$36.54
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.54
Rate for Payer: UnitedHealthcare Commercial	$38.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triamcinolone acetonide 40 mg/mL Inj Susp 1 mL [HMC]

Facility

$43.69

Service Code	HCPCS J3301
Hospital Charge Code	3804715
Hospital Revenue Code	250
Min. Negotiated Rate	$39.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.32
Rate for Payer: Aetna Commercial	$43.96
Rate for Payer: UnitedHealthcare Commercial	$46.40
Rate for Payer: UnitedHealthcare Commercial	$41.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triamcinolone acetonide 40 mg/mL Inj Susp 1 mL [HMC]

Facility

$43.69

Service Code	HCPCS J3301
Hospital Charge Code	3804715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$41.51
Rate for Payer: Aetna Commercial	$39.32
Rate for Payer: Aetna Commercial	$43.96
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.39
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.39
Rate for Payer: Humana Medicare Advantage	$20.51
Rate for Payer: Humana Medicare Advantage	$18.35
Rate for Payer: UnitedHealthcare Commercial	$41.51
Rate for Payer: UnitedHealthcare Commercial	$46.40
Rate for Payer: UnitedHealthcare Medicaid	$0.74
Rate for Payer: UnitedHealthcare Medicaid	$0.74
Rate for Payer: WPPA Medicare Advantage	$29.30
Rate for Payer: WPPA Medicare Advantage	$26.21

triamcinolone acetonide 40 mg/mL Inj Susp [HMC]

Facility

$136.55

Service Code	HCPCS J3301
Hospital Charge Code	3800308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$129.72
Rate for Payer: Aetna Commercial	$122.89
Rate for Payer: Aetna Commercial	$117.32
Rate for Payer: Aetna Commercial	$132.96
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.39
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.39
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.39
Rate for Payer: Humana Medicare Advantage	$62.05
Rate for Payer: Humana Medicare Advantage	$54.75
Rate for Payer: Humana Medicare Advantage	$57.35
Rate for Payer: UnitedHealthcare Commercial	$140.34
Rate for Payer: UnitedHealthcare Commercial	$129.72
Rate for Payer: UnitedHealthcare Commercial	$123.84
Rate for Payer: UnitedHealthcare Medicaid	$0.74
Rate for Payer: UnitedHealthcare Medicaid	$0.74
Rate for Payer: UnitedHealthcare Medicaid	$0.74
Rate for Payer: WPPA Medicare Advantage	$81.93
Rate for Payer: WPPA Medicare Advantage	$78.22
Rate for Payer: WPPA Medicare Advantage	$88.64

triamcinolone acetonide 40 mg/mL Inj Susp [HMC]

Facility

$136.55

Service Code	NDC 70121165301
Hospital Charge Code	3800308
Hospital Revenue Code	250
Min. Negotiated Rate	$54.62
Max. Negotiated Rate	$129.72
Rate for Payer: Aetna Commercial	$122.89
Rate for Payer: Humana Medicare Advantage	$57.35
Rate for Payer: UnitedHealthcare Commercial	$129.72
Rate for Payer: UnitedHealthcare Medicaid	$54.62
Rate for Payer: WPPA Medicare Advantage	$81.93

triamcinolone acetonide 40 mg/mL Inj Susp [HMC]

Facility

$136.55

Service Code	NDC 70121165301
Hospital Charge Code	3800308
Hospital Revenue Code	250
Min. Negotiated Rate	$122.89
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$122.89
Rate for Payer: UnitedHealthcare Commercial	$129.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges