Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

THUMB SPICA 8 Right LG.

Facility

$34.92

Hospital Charge Code	3259915
Hospital Revenue Code	270
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$33.17
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: Humana Medicare Advantage	$14.67
Rate for Payer: UnitedHealthcare Commercial	$33.17
Rate for Payer: UnitedHealthcare Medicaid	$13.97
Rate for Payer: WPPA Medicare Advantage	$20.95

THUMB SPICA 8 Right LG.

Facility

$34.92

Hospital Charge Code	3259915
Hospital Revenue Code	270
Min. Negotiated Rate	$31.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: UnitedHealthcare Commercial	$33.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

THUMB SPICA 8 Right MED

Facility

$34.92

Hospital Charge Code	3259912
Hospital Revenue Code	270
Min. Negotiated Rate	$31.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: UnitedHealthcare Commercial	$33.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

THUMB SPICA 8 Right MED

Facility

$34.92

Hospital Charge Code	3259912
Hospital Revenue Code	270
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$33.17
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: Humana Medicare Advantage	$14.67
Rate for Payer: UnitedHealthcare Commercial	$33.17
Rate for Payer: UnitedHealthcare Medicaid	$13.97
Rate for Payer: WPPA Medicare Advantage	$20.95

THUMB SPICA 8 Right SM

Facility

$34.92

Hospital Charge Code	3259910
Hospital Revenue Code	270
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$33.17
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: Humana Medicare Advantage	$14.67
Rate for Payer: UnitedHealthcare Commercial	$33.17
Rate for Payer: UnitedHealthcare Medicaid	$13.97
Rate for Payer: WPPA Medicare Advantage	$20.95

THUMB SPICA 8 Right SM

Facility

$34.92

Hospital Charge Code	3259910
Hospital Revenue Code	270
Min. Negotiated Rate	$31.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: UnitedHealthcare Commercial	$33.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

THUMB SPICA 8 Right X-LG

Facility

$36.59

Hospital Charge Code	3259917
Hospital Revenue Code	270
Min. Negotiated Rate	$32.93
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$32.93
Rate for Payer: UnitedHealthcare Commercial	$34.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

THUMB SPICA 8 Right X-LG

Facility

$36.59

Hospital Charge Code	3259917
Hospital Revenue Code	270
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$34.76
Rate for Payer: Aetna Commercial	$32.93
Rate for Payer: Humana Medicare Advantage	$15.37
Rate for Payer: UnitedHealthcare Commercial	$34.76
Rate for Payer: UnitedHealthcare Medicaid	$14.64
Rate for Payer: WPPA Medicare Advantage	$21.95

Thumb Spica 8 Right X-Small

Facility

$34.00

Hospital Charge Code	3259908
Hospital Revenue Code	270
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: UnitedHealthcare Commercial	$32.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Thumb Spica 8 Right X-Small

Facility

$34.00

Hospital Charge Code	3259908
Hospital Revenue Code	270
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$32.30
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: Humana Medicare Advantage	$14.28
Rate for Payer: UnitedHealthcare Commercial	$32.30
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: WPPA Medicare Advantage	$20.40

THUMB SPICA LT SM/MED

Facility

$76.00

Hospital Charge Code	3256804
Hospital Revenue Code	270
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: UnitedHealthcare Commercial	$72.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

THUMB SPICA LT SM/MED

Facility

$76.00

Hospital Charge Code	3256804
Hospital Revenue Code	270
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$72.20
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Humana Medicare Advantage	$31.92
Rate for Payer: UnitedHealthcare Commercial	$72.20
Rate for Payer: UnitedHealthcare Medicaid	$30.40
Rate for Payer: WPPA Medicare Advantage	$45.60

Thyroglobulin Abs QST

Facility

$181.00

Service Code	HCPCS 86800
Hospital Charge Code	3552434
Hospital Revenue Code	300
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$162.90
Rate for Payer: UnitedHealthcare Commercial	$171.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Thyroglobulin Abs QST

Facility

$181.00

Service Code	HCPCS 86800
Hospital Charge Code	3552434
Hospital Revenue Code	300
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$171.95
Rate for Payer: Aetna Commercial	$162.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$69.07
Rate for Payer: Humana Medicare Advantage	$76.02
Rate for Payer: UnitedHealthcare Commercial	$171.95
Rate for Payer: UnitedHealthcare Medicaid	$15.91
Rate for Payer: WPPA Medicare Advantage	$108.60

Thyroglobulin Panel QST

Facility

$181.00

Service Code	HCPCS 86800
Hospital Charge Code	3552749
Hospital Revenue Code	300
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$171.95
Rate for Payer: Aetna Commercial	$162.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$69.07
Rate for Payer: Humana Medicare Advantage	$76.02
Rate for Payer: UnitedHealthcare Commercial	$171.95
Rate for Payer: UnitedHealthcare Medicaid	$15.91
Rate for Payer: WPPA Medicare Advantage	$108.60

Thyroglobulin Panel QST

Facility

$181.00

Service Code	HCPCS 86800
Hospital Charge Code	3552749
Hospital Revenue Code	300
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$162.90
Rate for Payer: UnitedHealthcare Commercial	$171.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

thyroid desiccated 30 mg Tab [HMC]

Facility

$7.99

Service Code	NDC 62559074101
Hospital Charge Code	3800974
Hospital Revenue Code	250
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.19
Rate for Payer: UnitedHealthcare Commercial	$7.59
Rate for Payer: WPPA Medicare Advantage	$1,200.00

thyroid desiccated 30 mg Tab [HMC]

Facility

$7.99

Service Code	NDC 62559074101
Hospital Charge Code	3800974
Hospital Revenue Code	250
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$7.59
Rate for Payer: Aetna Commercial	$7.19
Rate for Payer: Humana Medicare Advantage	$3.36
Rate for Payer: UnitedHealthcare Commercial	$7.59
Rate for Payer: UnitedHealthcare Medicaid	$3.20
Rate for Payer: WPPA Medicare Advantage	$4.79

thyroid desiccated 30 mg Tab [HMC]

Facility

$8.14

Service Code	NDC 42192032901
Hospital Charge Code	3800974
Hospital Revenue Code	250
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$7.73
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Humana Medicare Advantage	$3.42
Rate for Payer: UnitedHealthcare Commercial	$7.73
Rate for Payer: UnitedHealthcare Medicaid	$3.26
Rate for Payer: WPPA Medicare Advantage	$4.88

thyroid desiccated 30 mg Tab [HMC]

Facility

$8.14

Service Code	NDC 42192032901
Hospital Charge Code	3800974
Hospital Revenue Code	250
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: UnitedHealthcare Commercial	$7.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

thyroid desiccated 60 mg Tab [HMC]

Facility

$8.85

Service Code	NDC 00456045901
Hospital Charge Code	3804272
Hospital Revenue Code	250
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: UnitedHealthcare Commercial	$8.41
Rate for Payer: WPPA Medicare Advantage	$1,200.00

thyroid desiccated 60 mg Tab [HMC]

Facility

$8.85

Service Code	NDC 00456045901
Hospital Charge Code	3804272
Hospital Revenue Code	250
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$8.41
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Humana Medicare Advantage	$3.72
Rate for Payer: UnitedHealthcare Commercial	$8.41
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: WPPA Medicare Advantage	$5.31

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$5,337.36

Service Code	MSDRG 626
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,337.36
Rate for Payer: UnitedHealthcare Medicaid	$5,337.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$10,770.03

Service Code	MSDRG 625
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,770.03
Rate for Payer: UnitedHealthcare Medicaid	$10,770.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$4,733.73

Service Code	MSDRG 627
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,733.73
Rate for Payer: UnitedHealthcare Medicaid	$4,733.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges