Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Vicair Adjuster O2 Adjustable Wheelchair Cushion 18x16x4 w/Incotec Cover

Facility

$735.00

Hospital Charge Code	3259244
Hospital Revenue Code	270
Min. Negotiated Rate	$294.00
Max. Negotiated Rate	$698.25
Rate for Payer: Aetna Commercial	$661.50
Rate for Payer: Humana Medicare Advantage	$308.70
Rate for Payer: UnitedHealthcare Commercial	$698.25
Rate for Payer: UnitedHealthcare Medicaid	$294.00
Rate for Payer: WPPA Medicare Advantage	$441.00

vilazodone 20 mg Tab [HMC]

Facility

$32.80

Service Code	NDC 00456112030
Hospital Charge Code	3800185
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$31.16
Rate for Payer: Aetna Commercial	$29.52
Rate for Payer: Humana Medicare Advantage	$13.78
Rate for Payer: UnitedHealthcare Commercial	$31.16
Rate for Payer: UnitedHealthcare Medicaid	$13.12
Rate for Payer: WPPA Medicare Advantage	$19.68

vilazodone 20 mg Tab [HMC]

Facility

$32.80

Service Code	NDC 00456112030
Hospital Charge Code	3800185
Hospital Revenue Code	250
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.52
Rate for Payer: UnitedHealthcare Commercial	$31.16
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vilazodone 40 mg Tab [HMC]

Facility

$32.80

Service Code	NDC 00456114030
Hospital Charge Code	3800185
Hospital Revenue Code	250
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.52
Rate for Payer: UnitedHealthcare Commercial	$31.16
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vilazodone 40 mg Tab [HMC]

Facility

$32.80

Service Code	NDC 00456114030
Hospital Charge Code	3800185
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$31.16
Rate for Payer: Aetna Commercial	$29.52
Rate for Payer: Humana Medicare Advantage	$13.78
Rate for Payer: UnitedHealthcare Commercial	$31.16
Rate for Payer: UnitedHealthcare Medicaid	$13.12
Rate for Payer: WPPA Medicare Advantage	$19.68

vinCRIStine 1 mg/mL IV Sol [HMC]

Facility

$52.60

Service Code	HCPCS J9370
Hospital Charge Code	3850131
Hospital Revenue Code	250
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$47.34
Rate for Payer: UnitedHealthcare Commercial	$49.97
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vinCRIStine 1 mg/mL IV Sol [HMC]

Facility

$52.60

Service Code	HCPCS J9370
Hospital Charge Code	3850131
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$49.97
Rate for Payer: Aetna Commercial	$47.34
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$9.94
Rate for Payer: Humana Medicare Advantage	$22.09
Rate for Payer: UnitedHealthcare Commercial	$49.97
Rate for Payer: UnitedHealthcare Medicaid	$8.15
Rate for Payer: WPPA Medicare Advantage	$31.56

vinorelbine 10 mg/mL IV Sol 1 mL [HMC]

Facility

$74.00

Service Code	HCPCS J9390
Hospital Charge Code	3850045
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$10.94
Rate for Payer: Humana Medicare Advantage	$31.08
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: UnitedHealthcare Medicaid	$5.44
Rate for Payer: WPPA Medicare Advantage	$44.40

vinorelbine 10 mg/mL IV Sol 1 mL [HMC]

Facility

$74.00

Service Code	HCPCS J9390
Hospital Charge Code	3850045
Hospital Revenue Code	250
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: UnitedHealthcare Commercial	$70.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vinorelbine 10 mg/mL IV Sol [HMC]

Facility

$214.00

Service Code	HCPCS J9390
Hospital Charge Code	3850050
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$203.30
Rate for Payer: Aetna Commercial	$192.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$10.94
Rate for Payer: Humana Medicare Advantage	$89.88
Rate for Payer: UnitedHealthcare Commercial	$203.30
Rate for Payer: UnitedHealthcare Medicaid	$5.44
Rate for Payer: WPPA Medicare Advantage	$128.40

vinorelbine 10 mg/mL IV Sol [HMC]

Facility

$214.00

Service Code	HCPCS J9390
Hospital Charge Code	3850050
Hospital Revenue Code	250
Min. Negotiated Rate	$192.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$192.60
Rate for Payer: UnitedHealthcare Commercial	$203.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

VIRAL ILLNESS WITH MCC

Facility

$5,972.76

Service Code	MSDRG 865
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,972.76
Rate for Payer: UnitedHealthcare Medicaid	$5,972.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

VIRAL ILLNESS WITHOUT MCC

Facility

$3,462.93

Service Code	MSDRG 866
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,462.93
Rate for Payer: UnitedHealthcare Medicaid	$3,462.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

VIRAL MENINGITIS WITH CC/MCC

Facility

$8,673.21

Service Code	MSDRG 075
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$8,673.21
Rate for Payer: UnitedHealthcare Medicaid	$8,673.21
Rate for Payer: WPPA Medicare Advantage	$1,200.00

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$3,748.86

Service Code	MSDRG 076
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,748.86
Rate for Payer: UnitedHealthcare Medicaid	$3,748.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Viscosity QST

Facility

$124.00

Service Code	HCPCS 85810
Hospital Charge Code	3558810
Hospital Revenue Code	300
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Viscosity QST

Facility

$124.00

Service Code	HCPCS 85810
Hospital Charge Code	3558810
Hospital Revenue Code	300
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$117.80
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$37.51
Rate for Payer: Humana Medicare Advantage	$52.08
Rate for Payer: UnitedHealthcare Commercial	$117.80
Rate for Payer: UnitedHealthcare Medicaid	$11.60
Rate for Payer: WPPA Medicare Advantage	$74.40

Vitamin A (Retinol) QST

Facility

$213.00

Service Code	HCPCS 84590
Hospital Charge Code	3554590
Hospital Revenue Code	300
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$191.70
Rate for Payer: UnitedHealthcare Commercial	$202.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Vitamin A (Retinol) QST

Facility

$213.00

Service Code	HCPCS 84590
Hospital Charge Code	3554590
Hospital Revenue Code	300
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$202.35
Rate for Payer: Aetna Commercial	$191.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$46.89
Rate for Payer: Humana Medicare Advantage	$89.46
Rate for Payer: UnitedHealthcare Commercial	$202.35
Rate for Payer: UnitedHealthcare Medicaid	$11.61
Rate for Payer: WPPA Medicare Advantage	$127.80

Vitamin B12 Level

Facility

$95.00

Service Code	HCPCS 82607
Hospital Charge Code	3550882
Hospital Revenue Code	300
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$90.25
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$57.41
Rate for Payer: Humana Medicare Advantage	$39.90
Rate for Payer: UnitedHealthcare Commercial	$90.25
Rate for Payer: UnitedHealthcare Medicaid	$15.08
Rate for Payer: WPPA Medicare Advantage	$57.00

Vitamin B12 Level

Facility

$95.00

Service Code	HCPCS 82607
Hospital Charge Code	3550882
Hospital Revenue Code	300
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$90.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Vitamin B1 (Thiamine), S/P, LC/MS/MS QST

Facility

$239.00

Service Code	HCPCS 84425
Hospital Charge Code	3558442
Hospital Revenue Code	300
Min. Negotiated Rate	$21.23
Max. Negotiated Rate	$227.05
Rate for Payer: Aetna Commercial	$215.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$72.57
Rate for Payer: Humana Medicare Advantage	$100.38
Rate for Payer: UnitedHealthcare Commercial	$227.05
Rate for Payer: UnitedHealthcare Medicaid	$21.23
Rate for Payer: WPPA Medicare Advantage	$143.40

Vitamin B1 (Thiamine), S/P, LC/MS/MS QST

Facility

$239.00

Service Code	HCPCS 84425
Hospital Charge Code	3558442
Hospital Revenue Code	300
Min. Negotiated Rate	$215.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$215.10
Rate for Payer: UnitedHealthcare Commercial	$227.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Vitamin B6, P QST

Facility

$274.00

Service Code	HCPCS 84207
Hospital Charge Code	3554207
Hospital Revenue Code	300
Min. Negotiated Rate	$109.60
Max. Negotiated Rate	$260.30
Rate for Payer: Aetna Commercial	$246.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$140.52
Rate for Payer: Humana Medicare Advantage	$115.08
Rate for Payer: UnitedHealthcare Commercial	$260.30
Rate for Payer: UnitedHealthcare Medicaid	$109.60
Rate for Payer: WPPA Medicare Advantage	$164.40

Vitamin B6, P QST

Facility

$274.00

Service Code	HCPCS 84207
Hospital Charge Code	3554207
Hospital Revenue Code	300
Min. Negotiated Rate	$246.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$246.60
Rate for Payer: UnitedHealthcare Commercial	$260.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges