Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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	$122.89
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$122.89
Rate for Payer: Aetna Commercial	$117.32
Rate for Payer: Aetna Commercial	$132.96
Rate for Payer: UnitedHealthcare Commercial	$129.72
Rate for Payer: UnitedHealthcare Commercial	$123.84
Rate for Payer: UnitedHealthcare Commercial	$140.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triamcinolone Top 0.1% Crm [HMC]

Facility

$27.78

Service Code	NDC 45802006435
Hospital Charge Code	3807514
Hospital Revenue Code	250
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: UnitedHealthcare Commercial	$26.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triamcinolone Top 0.1% Crm [HMC]

Facility

$30.20

Service Code	NDC 67877025115
Hospital Charge Code	3807514
Hospital Revenue Code	250
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$28.69
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: Humana Medicare Advantage	$12.68
Rate for Payer: UnitedHealthcare Commercial	$28.69
Rate for Payer: UnitedHealthcare Medicaid	$12.08
Rate for Payer: WPPA Medicare Advantage	$18.12

triamcinolone Top 0.1% Crm [HMC]

Facility

$30.20

Service Code	NDC 67877025115
Hospital Charge Code	3807514
Hospital Revenue Code	250
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: UnitedHealthcare Commercial	$28.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triamcinolone Top 0.1% Crm [HMC]

Facility

$27.78

Service Code	NDC 45802006435
Hospital Charge Code	3807514
Hospital Revenue Code	250
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$26.39
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Humana Medicare Advantage	$11.67
Rate for Payer: UnitedHealthcare Commercial	$26.39
Rate for Payer: UnitedHealthcare Medicaid	$11.11
Rate for Payer: WPPA Medicare Advantage	$16.67

triamcinolone topical 0.1% Crm [HMC]

Facility

$30.20

Service Code	NDC 21922006204
Hospital Charge Code	3807514
Hospital Revenue Code	250
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$28.69
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: Humana Medicare Advantage	$12.68
Rate for Payer: UnitedHealthcare Commercial	$28.69
Rate for Payer: UnitedHealthcare Medicaid	$12.08
Rate for Payer: WPPA Medicare Advantage	$18.12

triamcinolone topical 0.1% Crm [HMC]

Facility

$30.20

Service Code	NDC 21922006204
Hospital Charge Code	3807514
Hospital Revenue Code	250
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: UnitedHealthcare Commercial	$28.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triamcinolone topical 0.5% Cream 15g [HMC]

Facility

$37.01

Service Code	NDC 67877031815
Hospital Charge Code	3807516
Hospital Revenue Code	250
Min. Negotiated Rate	$33.31
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$33.31
Rate for Payer: UnitedHealthcare Commercial	$35.16
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triamcinolone topical 0.5% Cream 15g [HMC]

Facility

$37.01

Service Code	NDC 67877031815
Hospital Charge Code	3807516
Hospital Revenue Code	250
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$35.16
Rate for Payer: Aetna Commercial	$33.31
Rate for Payer: Humana Medicare Advantage	$15.54
Rate for Payer: UnitedHealthcare Commercial	$35.16
Rate for Payer: UnitedHealthcare Medicaid	$14.80
Rate for Payer: WPPA Medicare Advantage	$22.21

triazolam 0.25 mg Tab [HMC]

Facility

$20.09

Service Code	NDC 00054485925
Hospital Charge Code	3807555
Hospital Revenue Code	250
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$19.09
Rate for Payer: Aetna Commercial	$18.08
Rate for Payer: Humana Medicare Advantage	$8.44
Rate for Payer: UnitedHealthcare Commercial	$19.09
Rate for Payer: UnitedHealthcare Medicaid	$8.04
Rate for Payer: WPPA Medicare Advantage	$12.05

triazolam 0.25 mg Tab [HMC]

Facility

$16.00

Service Code	NDC 70710128901
Hospital Charge Code	3807555
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$15.20
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Humana Medicare Advantage	$6.72
Rate for Payer: UnitedHealthcare Commercial	$15.20
Rate for Payer: UnitedHealthcare Medicaid	$6.40
Rate for Payer: WPPA Medicare Advantage	$9.60

triazolam 0.25 mg Tab [HMC]

Facility

$16.00

Service Code	NDC 59762371803
Hospital Charge Code	3807555
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: UnitedHealthcare Commercial	$15.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triazolam 0.25 mg Tab [HMC]

Facility

$16.00

Service Code	NDC 70710128901
Hospital Charge Code	3807555
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: UnitedHealthcare Commercial	$15.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

triazolam 0.25 mg Tab [HMC]

Facility

$16.00

Service Code	NDC 59762371803
Hospital Charge Code	3807555
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$15.20
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Humana Medicare Advantage	$6.72
Rate for Payer: UnitedHealthcare Commercial	$15.20
Rate for Payer: UnitedHealthcare Medicaid	$6.40
Rate for Payer: WPPA Medicare Advantage	$9.60

triazolam 0.25 mg Tab [HMC]

Facility

$20.09

Service Code	NDC 00054485925
Hospital Charge Code	3807555
Hospital Revenue Code	250
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.08
Rate for Payer: UnitedHealthcare Commercial	$19.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Triglycerides

Facility

$61.00

Service Code	HCPCS 84478
Hospital Charge Code	3550825
Hospital Revenue Code	300
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.90
Rate for Payer: UnitedHealthcare Commercial	$57.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Triglycerides

Facility

$61.00

Service Code	HCPCS 84478
Hospital Charge Code	3550825
Hospital Revenue Code	300
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$57.95
Rate for Payer: Aetna Commercial	$54.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$12.35
Rate for Payer: Humana Medicare Advantage	$25.62
Rate for Payer: UnitedHealthcare Commercial	$57.95
Rate for Payer: UnitedHealthcare Medicaid	$5.74
Rate for Payer: WPPA Medicare Advantage	$36.60

trihexyphenidyl 2 mg Tab [HMC]

Facility

$6.10

Service Code	NDC 70954021210
Hospital Charge Code	3800338
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: UnitedHealthcare Commercial	$5.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

trihexyphenidyl 2 mg Tab [HMC]

Facility

$6.10

Service Code	NDC 70954021210
Hospital Charge Code	3800338
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.79
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: Humana Medicare Advantage	$2.56
Rate for Payer: UnitedHealthcare Commercial	$5.79
Rate for Payer: UnitedHealthcare Medicaid	$2.44
Rate for Payer: WPPA Medicare Advantage	$3.66

trihexyphenidyl 2 mg Tab [HMC]

Facility

$5.44

Service Code	NDC 00591533510
Hospital Charge Code	3800338
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

trihexyphenidyl 2 mg Tab [HMC]

Facility

$5.44

Service Code	NDC 00591533510
Hospital Charge Code	3800338
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

Trocar 12mm X 100mm Kii Fios Z-Thread Obturator and Sleeve

Facility

$109.00

Hospital Charge Code	3258230
Hospital Revenue Code	270
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: UnitedHealthcare Commercial	$103.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Trocar 12mm X 100mm Kii Fios Z-Thread Obturator and Sleeve

Facility

$109.00

Hospital Charge Code	3258230
Hospital Revenue Code	270
Min. Negotiated Rate	$43.60
Max. Negotiated Rate	$103.55
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: Humana Medicare Advantage	$45.78
Rate for Payer: UnitedHealthcare Commercial	$103.55
Rate for Payer: UnitedHealthcare Medicaid	$43.60
Rate for Payer: WPPA Medicare Advantage	$65.40

Trocar 12mm x 100mm VersaOne Optical w/Fixation Cannula - Covidien

Facility

$88.92

Hospital Charge Code	3258225
Hospital Revenue Code	270
Min. Negotiated Rate	$80.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$80.03
Rate for Payer: UnitedHealthcare Commercial	$84.47
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Trocar 12mm x 100mm VersaOne Optical w/Fixation Cannula - Covidien

Facility

$88.92

Hospital Charge Code	3258225
Hospital Revenue Code	270
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$84.47
Rate for Payer: Aetna Commercial	$80.03
Rate for Payer: Humana Medicare Advantage	$37.35
Rate for Payer: UnitedHealthcare Commercial	$84.47
Rate for Payer: UnitedHealthcare Medicaid	$35.57
Rate for Payer: WPPA Medicare Advantage	$53.35

Know your out-of-pocket cost for care.

All Charges