Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

TruDi Microdebrider Shaver Blade Straight Shaft 2.0mm

Facility

$600.00

Hospital Charge Code	3256112
Hospital Revenue Code	270
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$540.00
Rate for Payer: UnitedHealthcare Commercial	$570.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Microdebrider Shaver Blade Straight Shaft 2.0mm

Facility

$600.00

Hospital Charge Code	3256112
Hospital Revenue Code	270
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$540.00
Rate for Payer: Humana Medicare Advantage	$252.00
Rate for Payer: UnitedHealthcare Commercial	$570.00
Rate for Payer: UnitedHealthcare Medicaid	$240.00
Rate for Payer: WPPA Medicare Advantage	$360.00

TruDi NAV Cable

Facility

$699.30

Hospital Charge Code	3256101
Hospital Revenue Code	270
Min. Negotiated Rate	$629.37
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$629.37
Rate for Payer: UnitedHealthcare Commercial	$664.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi NAV Cable

Facility

$699.30

Hospital Charge Code	3256101
Hospital Revenue Code	270
Min. Negotiated Rate	$279.72
Max. Negotiated Rate	$664.34
Rate for Payer: Aetna Commercial	$629.37
Rate for Payer: Humana Medicare Advantage	$293.71
Rate for Payer: UnitedHealthcare Commercial	$664.34
Rate for Payer: UnitedHealthcare Medicaid	$279.72
Rate for Payer: WPPA Medicare Advantage	$419.58

TruDi Patient Tracker for ENT Navigation System

Facility

$584.46

Hospital Charge Code	3259977
Hospital Revenue Code	270
Min. Negotiated Rate	$526.01
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$526.01
Rate for Payer: UnitedHealthcare Commercial	$555.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Patient Tracker for ENT Navigation System

Facility

$584.46

Hospital Charge Code	3259977
Hospital Revenue Code	270
Min. Negotiated Rate	$233.78
Max. Negotiated Rate	$555.24
Rate for Payer: Aetna Commercial	$526.01
Rate for Payer: Humana Medicare Advantage	$245.47
Rate for Payer: UnitedHealthcare Commercial	$555.24
Rate for Payer: UnitedHealthcare Medicaid	$233.78
Rate for Payer: WPPA Medicare Advantage	$350.68

TruDi PosiSepX Nasal Dressing 0.6 x 2.0 Hemostat Intranasal Splints

Facility

$441.00

Hospital Charge Code	3256109
Hospital Revenue Code	270
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$418.95
Rate for Payer: Aetna Commercial	$396.90
Rate for Payer: Humana Medicare Advantage	$185.22
Rate for Payer: UnitedHealthcare Commercial	$418.95
Rate for Payer: UnitedHealthcare Medicaid	$176.40
Rate for Payer: WPPA Medicare Advantage	$264.60

TruDi PosiSepX Nasal Dressing 0.6 x 2.0 Hemostat Intranasal Splints

Facility

$441.00

Hospital Charge Code	3256109
Hospital Revenue Code	270
Min. Negotiated Rate	$396.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$396.90
Rate for Payer: UnitedHealthcare Commercial	$418.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Probe 0° Tip Angle

Facility

$845.00

Hospital Charge Code	3256102
Hospital Revenue Code	270
Min. Negotiated Rate	$338.00
Max. Negotiated Rate	$802.75
Rate for Payer: Aetna Commercial	$760.50
Rate for Payer: Humana Medicare Advantage	$354.90
Rate for Payer: UnitedHealthcare Commercial	$802.75
Rate for Payer: UnitedHealthcare Medicaid	$338.00
Rate for Payer: WPPA Medicare Advantage	$507.00

TruDi Probe 0° Tip Angle

Facility

$845.00

Hospital Charge Code	3256102
Hospital Revenue Code	270
Min. Negotiated Rate	$760.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$760.50
Rate for Payer: UnitedHealthcare Commercial	$802.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Probe 70° Tip Angle

Facility

$853.13

Hospital Charge Code	3256103
Hospital Revenue Code	270
Min. Negotiated Rate	$767.82
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$767.82
Rate for Payer: UnitedHealthcare Commercial	$810.47
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Probe 70° Tip Angle

Facility

$853.13

Hospital Charge Code	3256103
Hospital Revenue Code	270
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$810.47
Rate for Payer: Aetna Commercial	$767.82
Rate for Payer: Humana Medicare Advantage	$358.31
Rate for Payer: UnitedHealthcare Commercial	$810.47
Rate for Payer: UnitedHealthcare Medicaid	$341.25
Rate for Payer: WPPA Medicare Advantage	$511.88

TruDi Shaver Blade 4mm Curved DS 60°

Facility

$1,246.88

Hospital Charge Code	3256113
Hospital Revenue Code	270
Min. Negotiated Rate	$1,122.19
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,122.19
Rate for Payer: UnitedHealthcare Commercial	$1,184.54
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruDi Shaver Blade 4mm Curved DS 60°

Facility

$1,246.88

Hospital Charge Code	3256113
Hospital Revenue Code	270
Min. Negotiated Rate	$498.75
Max. Negotiated Rate	$1,184.54
Rate for Payer: Aetna Commercial	$1,122.19
Rate for Payer: Humana Medicare Advantage	$523.69
Rate for Payer: UnitedHealthcare Commercial	$1,184.54
Rate for Payer: UnitedHealthcare Medicaid	$498.75
Rate for Payer: WPPA Medicare Advantage	$748.13

.TR Unit Retype

Facility

$63.00

Service Code	HCPCS 86900
Hospital Charge Code	3560081
Hospital Revenue Code	300
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$56.70
Rate for Payer: UnitedHealthcare Commercial	$59.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

.TR Unit Retype

Facility

$63.00

Service Code	HCPCS 86900
Hospital Charge Code	3560081
Hospital Revenue Code	300
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$210.75
Rate for Payer: Aetna Commercial	$56.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$210.75
Rate for Payer: Humana Medicare Advantage	$26.46
Rate for Payer: UnitedHealthcare Commercial	$59.85
Rate for Payer: UnitedHealthcare Medicaid	$2.99
Rate for Payer: WPPA Medicare Advantage	$37.80

TruNode Probe Gamma Detection

Facility

$755.00

Hospital Charge Code	3250470
Hospital Revenue Code	270
Min. Negotiated Rate	$679.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$679.50
Rate for Payer: UnitedHealthcare Commercial	$717.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TruNode Probe Gamma Detection

Facility

$755.00

Hospital Charge Code	3250470
Hospital Revenue Code	270
Min. Negotiated Rate	$302.00
Max. Negotiated Rate	$717.25
Rate for Payer: Aetna Commercial	$679.50
Rate for Payer: Humana Medicare Advantage	$317.10
Rate for Payer: UnitedHealthcare Commercial	$717.25
Rate for Payer: UnitedHealthcare Medicaid	$302.00
Rate for Payer: WPPA Medicare Advantage	$453.00

Tryptase QST

Facility

$115.00

Service Code	HCPCS 83520
Hospital Charge Code	3558352
Hospital Revenue Code	300
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$109.25
Rate for Payer: Aetna Commercial	$103.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.48
Rate for Payer: Humana Medicare Advantage	$48.30
Rate for Payer: UnitedHealthcare Commercial	$109.25
Rate for Payer: UnitedHealthcare Medicaid	$46.00
Rate for Payer: WPPA Medicare Advantage	$69.00

Tryptase QST

Facility

$115.00

Service Code	HCPCS 83520
Hospital Charge Code	3558352
Hospital Revenue Code	300
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$103.50
Rate for Payer: UnitedHealthcare Commercial	$109.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TSH w/ Rflx to Free T4

Facility

$281.00

Service Code	HCPCS 84443
Hospital Charge Code	3551062
Hospital Revenue Code	300
Min. Negotiated Rate	$252.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: UnitedHealthcare Commercial	$266.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TSH w/ Rflx to Free T4

Facility

$281.00

Service Code	HCPCS 84443
Hospital Charge Code	3551062
Hospital Revenue Code	300
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$266.95
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$43.97
Rate for Payer: Humana Medicare Advantage	$118.02
Rate for Payer: UnitedHealthcare Commercial	$266.95
Rate for Payer: UnitedHealthcare Medicaid	$15.75
Rate for Payer: WPPA Medicare Advantage	$168.60

TSI QST

Facility

$526.00

Service Code	HCPCS 84445
Hospital Charge Code	3554445
Hospital Revenue Code	300
Min. Negotiated Rate	$50.86
Max. Negotiated Rate	$499.70
Rate for Payer: Aetna Commercial	$473.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$469.86
Rate for Payer: Humana Medicare Advantage	$220.92
Rate for Payer: UnitedHealthcare Commercial	$499.70
Rate for Payer: UnitedHealthcare Medicaid	$50.86
Rate for Payer: WPPA Medicare Advantage	$315.60

TSI QST

Facility

$526.00

Service Code	HCPCS 84445
Hospital Charge Code	3554445
Hospital Revenue Code	300
Min. Negotiated Rate	$473.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$473.40
Rate for Payer: UnitedHealthcare Commercial	$499.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tubal Fulgaration Laparoscopic

Facility

$7,512.00

Service Code	HCPCS 58670
Hospital Charge Code	3150346
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,136.40
Rate for Payer: Aetna Commercial	$6,760.80
Rate for Payer: UnitedHealthcare Commercial	$7,136.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges