Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Trocar XCEL 5mm Bladeless X-Long 150mm Length Single Patient Use

Facility

$210.00

Hospital Charge Code	3258267
Hospital Revenue Code	270
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: UnitedHealthcare Commercial	$199.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Trocar XCEL 5mm x 10mm Dilating Tip

Facility

$105.00

Hospital Charge Code	3258238
Hospital Revenue Code	270
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$94.50
Rate for Payer: UnitedHealthcare Commercial	$99.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Trocar XCEL 5mm x 10mm Dilating Tip

Facility

$105.00

Hospital Charge Code	3258238
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$99.75
Rate for Payer: Aetna Commercial	$94.50
Rate for Payer: Humana Medicare Advantage	$44.10
Rate for Payer: UnitedHealthcare Commercial	$99.75
Rate for Payer: UnitedHealthcare Medicaid	$42.00
Rate for Payer: WPPA Medicare Advantage	$63.00

Troponin-I

Facility

$67.00

Service Code	HCPCS 82550
Hospital Charge Code	3553550
Hospital Revenue Code	300
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$63.65
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.11
Rate for Payer: Humana Medicare Advantage	$28.14
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: UnitedHealthcare Medicaid	$6.51
Rate for Payer: WPPA Medicare Advantage	$40.20

Troponin-I

Facility

$226.00

Service Code	HCPCS 84484
Hospital Charge Code	3552508
Hospital Revenue Code	300
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$214.70
Rate for Payer: Aetna Commercial	$203.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$68.59
Rate for Payer: Humana Medicare Advantage	$94.92
Rate for Payer: UnitedHealthcare Commercial	$214.70
Rate for Payer: UnitedHealthcare Medicaid	$12.47
Rate for Payer: WPPA Medicare Advantage	$135.60

Troponin-I

Facility

$67.00

Service Code	HCPCS 82550
Hospital Charge Code	3553550
Hospital Revenue Code	300
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: UnitedHealthcare Commercial	$63.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Troponin-I

Facility

$226.00

Service Code	HCPCS 84484
Hospital Charge Code	3552508
Hospital Revenue Code	300
Min. Negotiated Rate	$203.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$203.40
Rate for Payer: UnitedHealthcare Commercial	$214.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

trospium chloride 20 mg Tab [HMC]

Facility

$13.51

Service Code	NDC 23155053006
Hospital Charge Code	3800554
Hospital Revenue Code	250
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: UnitedHealthcare Commercial	$12.83
Rate for Payer: WPPA Medicare Advantage	$1,200.00

trospium chloride 20 mg Tab [HMC]

Facility

$13.51

Service Code	NDC 68462046160
Hospital Charge Code	3800554
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$12.83
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: UnitedHealthcare Commercial	$12.83
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: WPPA Medicare Advantage	$8.11

trospium chloride 20 mg Tab [HMC]

Facility

$13.51

Service Code	NDC 23155053006
Hospital Charge Code	3800554
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$12.83
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: UnitedHealthcare Commercial	$12.83
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: WPPA Medicare Advantage	$8.11

trospium chloride 20 mg Tab [HMC]

Facility

$13.51

Service Code	NDC 68462046160
Hospital Charge Code	3800554
Hospital Revenue Code	250
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: UnitedHealthcare Commercial	$12.83
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Curette 0° Tip Angle

Facility

$910.00

Hospital Charge Code	3256100
Hospital Revenue Code	270
Min. Negotiated Rate	$819.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$819.00
Rate for Payer: UnitedHealthcare Commercial	$864.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Curette 0° Tip Angle

Facility

$910.00

Hospital Charge Code	3256100
Hospital Revenue Code	270
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$864.50
Rate for Payer: Aetna Commercial	$819.00
Rate for Payer: Humana Medicare Advantage	$382.20
Rate for Payer: UnitedHealthcare Commercial	$864.50
Rate for Payer: UnitedHealthcare Medicaid	$364.00
Rate for Payer: WPPA Medicare Advantage	$546.00

TruDi Microdebrider Irrigation Clips

Facility

$84.00

Hospital Charge Code	3256105
Hospital Revenue Code	270
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: UnitedHealthcare Commercial	$79.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Microdebrider Irrigation Clips

Facility

$84.00

Hospital Charge Code	3256105
Hospital Revenue Code	270
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$79.80
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: Humana Medicare Advantage	$35.28
Rate for Payer: UnitedHealthcare Commercial	$79.80
Rate for Payer: UnitedHealthcare Medicaid	$33.60
Rate for Payer: WPPA Medicare Advantage	$50.40

TruDi Microdebrider Irrigation Lines w/2 Flow Rates

Facility

$147.00

Hospital Charge Code	3256104
Hospital Revenue Code	270
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Microdebrider Irrigation Lines w/2 Flow Rates

Facility

$147.00

Hospital Charge Code	3256104
Hospital Revenue Code	270
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$139.65
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: Humana Medicare Advantage	$61.74
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: UnitedHealthcare Medicaid	$58.80
Rate for Payer: WPPA Medicare Advantage	$88.20

TruDi Microdebrider NAV Shaver Blade 0° Straight 4mm Diameter Dbl Serrated Navigatable

Facility

$1,247.00

Hospital Charge Code	3256110
Hospital Revenue Code	270
Min. Negotiated Rate	$498.80
Max. Negotiated Rate	$1,184.65
Rate for Payer: Aetna Commercial	$1,122.30
Rate for Payer: Humana Medicare Advantage	$523.74
Rate for Payer: UnitedHealthcare Commercial	$1,184.65
Rate for Payer: UnitedHealthcare Medicaid	$498.80
Rate for Payer: WPPA Medicare Advantage	$748.20

TruDi Microdebrider NAV Shaver Blade 0° Straight 4mm Diameter Dbl Serrated Navigatable

Facility

$1,247.00

Hospital Charge Code	3256110
Hospital Revenue Code	270
Min. Negotiated Rate	$1,122.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,122.30
Rate for Payer: UnitedHealthcare Commercial	$1,184.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Microdebrider Shaver Blade 60° Curved Double Serrated Concave 3.0mm x110mm

Facility

$630.00

Hospital Charge Code	3256107
Hospital Revenue Code	270
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$567.00
Rate for Payer: UnitedHealthcare Commercial	$598.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Microdebrider Shaver Blade 60° Curved Double Serrated Concave 3.0mm x110mm

Facility

$630.00

Hospital Charge Code	3256107
Hospital Revenue Code	270
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$598.50
Rate for Payer: Aetna Commercial	$567.00
Rate for Payer: Humana Medicare Advantage	$264.60
Rate for Payer: UnitedHealthcare Commercial	$598.50
Rate for Payer: UnitedHealthcare Medicaid	$252.00
Rate for Payer: WPPA Medicare Advantage	$378.00

TruDi Microdebrider Shaver Blade 60° Curved Double Serrated Concave 4.0mm x110mm

Facility

$630.00

Hospital Charge Code	3256108
Hospital Revenue Code	270
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$567.00
Rate for Payer: UnitedHealthcare Commercial	$598.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Microdebrider Shaver Blade 60° Curved Double Serrated Concave 4.0mm x110mm

Facility

$630.00

Hospital Charge Code	3256108
Hospital Revenue Code	270
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$598.50
Rate for Payer: Aetna Commercial	$567.00
Rate for Payer: Humana Medicare Advantage	$264.60
Rate for Payer: UnitedHealthcare Commercial	$598.50
Rate for Payer: UnitedHealthcare Medicaid	$252.00
Rate for Payer: WPPA Medicare Advantage	$378.00

TruDi Microdebrider Shaver Blade Straight Double Serrated 4.0mm x 110mm

Facility

$630.00

Hospital Charge Code	3256106
Hospital Revenue Code	270
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$598.50
Rate for Payer: Aetna Commercial	$567.00
Rate for Payer: Humana Medicare Advantage	$264.60
Rate for Payer: UnitedHealthcare Commercial	$598.50
Rate for Payer: UnitedHealthcare Medicaid	$252.00
Rate for Payer: WPPA Medicare Advantage	$378.00

TruDi Microdebrider Shaver Blade Straight Double Serrated 4.0mm x 110mm

Facility

$630.00

Hospital Charge Code	3256106
Hospital Revenue Code	270
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$567.00
Rate for Payer: UnitedHealthcare Commercial	$598.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges