Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

zinc oxide Top 20% Oint [HMC]

Facility

$84.80

Service Code	NDC 00168006216
Hospital Charge Code	3800575
Hospital Revenue Code	250
Min. Negotiated Rate	$76.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$76.32
Rate for Payer: UnitedHealthcare Commercial	$80.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

zinc oxide Top 20% Oint [HMC]

Facility

$84.80

Service Code	NDC 00168006216
Hospital Charge Code	3800575
Hospital Revenue Code	250
Min. Negotiated Rate	$33.92
Max. Negotiated Rate	$80.56
Rate for Payer: Aetna Commercial	$76.32
Rate for Payer: Humana Medicare Advantage	$35.62
Rate for Payer: UnitedHealthcare Commercial	$80.56
Rate for Payer: UnitedHealthcare Medicaid	$33.92
Rate for Payer: WPPA Medicare Advantage	$50.88

zinc oxide Top 40% Oint [HMC]

Facility

$25.18

Service Code	NDC 74300000700
Hospital Charge Code	3808422
Hospital Revenue Code	250
Min. Negotiated Rate	$22.66
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.66
Rate for Payer: UnitedHealthcare Commercial	$23.92
Rate for Payer: WPPA Medicare Advantage	$1,200.00

zinc oxide Top 40% Oint [HMC]

Facility

$25.18

Service Code	NDC 74300000700
Hospital Charge Code	3808422
Hospital Revenue Code	250
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$23.92
Rate for Payer: Aetna Commercial	$22.66
Rate for Payer: Humana Medicare Advantage	$10.58
Rate for Payer: UnitedHealthcare Commercial	$23.92
Rate for Payer: UnitedHealthcare Medicaid	$10.07
Rate for Payer: WPPA Medicare Advantage	$15.11

zinc oxide topical 16% Ointment 2 oz [HMC]

Facility

$29.98

Service Code	NDC 62103033302
Hospital Charge Code	3800575
Hospital Revenue Code	257
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: UnitedHealthcare Commercial	$28.48
Rate for Payer: WPPA Medicare Advantage	$1,200.00

zinc oxide topical 16% Ointment 2 oz [HMC]

Facility

$29.98

Service Code	NDC 62103033302
Hospital Charge Code	3800575
Hospital Revenue Code	257
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$28.48
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Humana Medicare Advantage	$12.59
Rate for Payer: UnitedHealthcare Commercial	$28.48
Rate for Payer: UnitedHealthcare Medicaid	$11.99
Rate for Payer: WPPA Medicare Advantage	$17.99

zinc oxide topical 40% Oint [HMC]

Facility

$24.38

Service Code	NDC 74300000071
Hospital Charge Code	3808422
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$23.16
Rate for Payer: Aetna Commercial	$21.94
Rate for Payer: Humana Medicare Advantage	$10.24
Rate for Payer: UnitedHealthcare Commercial	$23.16
Rate for Payer: UnitedHealthcare Medicaid	$9.75
Rate for Payer: WPPA Medicare Advantage	$14.63

zinc oxide topical 40% Oint [HMC]

Facility

$24.38

Service Code	NDC 74300000071
Hospital Charge Code	3808422
Hospital Revenue Code	250
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$21.94
Rate for Payer: UnitedHealthcare Commercial	$23.16
Rate for Payer: WPPA Medicare Advantage	$1,200.00

zinc oxide topical 40% Pas [HMC]

Facility

$28.38

Service Code	NDC 74300000070
Hospital Charge Code	3808422
Hospital Revenue Code	250
Min. Negotiated Rate	$25.54
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.54
Rate for Payer: UnitedHealthcare Commercial	$26.96
Rate for Payer: WPPA Medicare Advantage	$1,200.00

zinc oxide topical 40% Pas [HMC]

Facility

$28.38

Service Code	NDC 74300000070
Hospital Charge Code	3808422
Hospital Revenue Code	250
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$26.96
Rate for Payer: Aetna Commercial	$25.54
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: UnitedHealthcare Commercial	$26.96
Rate for Payer: UnitedHealthcare Medicaid	$11.35
Rate for Payer: WPPA Medicare Advantage	$17.03

Zinc QST

Facility

$50.00

Service Code	HCPCS 84630
Hospital Charge Code	3554630
Hospital Revenue Code	300
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: UnitedHealthcare Commercial	$47.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Zinc QST

Facility

$50.00

Service Code	HCPCS 84630
Hospital Charge Code	3554630
Hospital Revenue Code	300
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$28.85
Rate for Payer: Humana Medicare Advantage	$21.00
Rate for Payer: UnitedHealthcare Commercial	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$11.39
Rate for Payer: WPPA Medicare Advantage	$30.00

zinc sulfate 220 mg Cap [HMC]

Facility

$5.70

Service Code	NDC 77333098310
Hospital Charge Code	3800840
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$5.42
Rate for Payer: Aetna Commercial	$5.13
Rate for Payer: Humana Medicare Advantage	$2.39
Rate for Payer: UnitedHealthcare Commercial	$5.42
Rate for Payer: UnitedHealthcare Medicaid	$2.28
Rate for Payer: WPPA Medicare Advantage	$3.42

zinc sulfate 220 mg Cap [HMC]

Facility

$5.67

Service Code	NDC 20555004000
Hospital Charge Code	3800840
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: UnitedHealthcare Commercial	$5.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00

zinc sulfate 220 mg Cap [HMC]

Facility

$5.70

Service Code	NDC 77333098310
Hospital Charge Code	3800840
Hospital Revenue Code	250
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.13
Rate for Payer: UnitedHealthcare Commercial	$5.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

zinc sulfate 220 mg Cap [HMC]

Facility

$5.36

Service Code	NDC 00731040106
Hospital Charge Code	3800840
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$5.09
Rate for Payer: Aetna Commercial	$4.82
Rate for Payer: Humana Medicare Advantage	$2.25
Rate for Payer: UnitedHealthcare Commercial	$5.09
Rate for Payer: UnitedHealthcare Medicaid	$2.14
Rate for Payer: WPPA Medicare Advantage	$3.22

zinc sulfate 220 mg Cap [HMC]

Facility

$5.67

Service Code	NDC 20555004000
Hospital Charge Code	3800840
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Humana Medicare Advantage	$2.38
Rate for Payer: UnitedHealthcare Commercial	$5.39
Rate for Payer: UnitedHealthcare Medicaid	$2.27
Rate for Payer: WPPA Medicare Advantage	$3.40

zinc sulfate 220 mg Cap [HMC]

Facility

$5.36

Service Code	NDC 00731040106
Hospital Charge Code	3800840
Hospital Revenue Code	250
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.82
Rate for Payer: UnitedHealthcare Commercial	$5.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Zinc Transporter 8 (ZnT8) Antibody QST

Facility

$293.00

Service Code	HCPCS 86341
Hospital Charge Code	3553022
Hospital Revenue Code	300
Min. Negotiated Rate	$79.87
Max. Negotiated Rate	$278.35
Rate for Payer: Aetna Commercial	$263.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$79.87
Rate for Payer: Humana Medicare Advantage	$123.06
Rate for Payer: UnitedHealthcare Commercial	$278.35
Rate for Payer: UnitedHealthcare Medicaid	$117.20
Rate for Payer: WPPA Medicare Advantage	$175.80

Zinc Transporter 8 (ZnT8) Antibody QST

Facility

$293.00

Service Code	HCPCS 86341
Hospital Charge Code	3553022
Hospital Revenue Code	300
Min. Negotiated Rate	$263.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$263.70
Rate for Payer: UnitedHealthcare Commercial	$278.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ziprasidone 20 mg Cap [HMC]

Facility

$6.80

Service Code	NDC 55111025660
Hospital Charge Code	3800607
Hospital Revenue Code	250
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.12
Rate for Payer: UnitedHealthcare Commercial	$6.46
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ziprasidone 20 mg Cap [HMC]

Facility

$6.80

Service Code	NDC 55111025660
Hospital Charge Code	3800607
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$6.46
Rate for Payer: Aetna Commercial	$6.12
Rate for Payer: Humana Medicare Advantage	$2.86
Rate for Payer: UnitedHealthcare Commercial	$6.46
Rate for Payer: UnitedHealthcare Medicaid	$2.72
Rate for Payer: WPPA Medicare Advantage	$4.08

ziprasidone 20 mg Cap [HMC]

Facility

$27.41

Service Code	NDC 68180033107
Hospital Charge Code	3800607
Hospital Revenue Code	250
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$26.04
Rate for Payer: Aetna Commercial	$24.67
Rate for Payer: Humana Medicare Advantage	$11.51
Rate for Payer: UnitedHealthcare Commercial	$26.04
Rate for Payer: UnitedHealthcare Medicaid	$10.96
Rate for Payer: WPPA Medicare Advantage	$16.45

ziprasidone 20 mg Cap [HMC]

Facility

$27.41

Service Code	NDC 68180033107
Hospital Charge Code	3800607
Hospital Revenue Code	250
Min. Negotiated Rate	$24.67
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.67
Rate for Payer: UnitedHealthcare Commercial	$26.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ziprasidone 20 mg Cap [HMC]

Facility

$27.41

Service Code	NDC 00904626908
Hospital Charge Code	3800607
Hospital Revenue Code	250
Min. Negotiated Rate	$24.67
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.67
Rate for Payer: UnitedHealthcare Commercial	$26.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges