Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Tubal Fulgaration Laparoscopic

Facility

$7,512.00

Service Code	HCPCS 58670
Hospital Charge Code	3150346
Hospital Revenue Code	360
Min. Negotiated Rate	$1,869.18
Max. Negotiated Rate	$7,136.40
Rate for Payer: Aetna Commercial	$6,760.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$5,096.14
Rate for Payer: Humana Medicare Advantage	$3,155.04
Rate for Payer: UnitedHealthcare Commercial	$7,136.40
Rate for Payer: UnitedHealthcare Medicaid	$1,869.18
Rate for Payer: WPPA Medicare Advantage	$4,507.20

Tube Endobronchial 37Fr Left Cuff Dual Lumen

Facility

$189.00

Hospital Charge Code	3251713
Hospital Revenue Code	270
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$170.10
Rate for Payer: UnitedHealthcare Commercial	$179.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tube Endobronchial 37Fr Left Cuff Dual Lumen

Facility

$189.00

Hospital Charge Code	3251713
Hospital Revenue Code	270
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$179.55
Rate for Payer: Aetna Commercial	$170.10
Rate for Payer: Humana Medicare Advantage	$79.38
Rate for Payer: UnitedHealthcare Commercial	$179.55
Rate for Payer: UnitedHealthcare Medicaid	$75.60
Rate for Payer: WPPA Medicare Advantage	$113.40

Tube Endobronchial 39Fr Left Cuff Dual Lumen

Facility

$189.00

Hospital Charge Code	3251714
Hospital Revenue Code	270
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$170.10
Rate for Payer: UnitedHealthcare Commercial	$179.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tube Endobronchial 39Fr Left Cuff Dual Lumen

Facility

$189.00

Hospital Charge Code	3251714
Hospital Revenue Code	270
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$179.55
Rate for Payer: Aetna Commercial	$170.10
Rate for Payer: Humana Medicare Advantage	$79.38
Rate for Payer: UnitedHealthcare Commercial	$179.55
Rate for Payer: UnitedHealthcare Medicaid	$75.60
Rate for Payer: WPPA Medicare Advantage	$113.40

Tube Endobronchial 41Fr Left Cuff Dual Lumen

Facility

$189.00

Hospital Charge Code	3251715
Hospital Revenue Code	270
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$179.55
Rate for Payer: Aetna Commercial	$170.10
Rate for Payer: Humana Medicare Advantage	$79.38
Rate for Payer: UnitedHealthcare Commercial	$179.55
Rate for Payer: UnitedHealthcare Medicaid	$75.60
Rate for Payer: WPPA Medicare Advantage	$113.40

Tube Endobronchial 41Fr Left Cuff Dual Lumen

Facility

$189.00

Hospital Charge Code	3251715
Hospital Revenue Code	270
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$170.10
Rate for Payer: UnitedHealthcare Commercial	$179.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tube EndoTracheal with Bronchial Blocker 7.0 fr Single-Lumen

Facility

$956.00

Hospital Charge Code	3251716
Hospital Revenue Code	270
Min. Negotiated Rate	$860.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$860.40
Rate for Payer: UnitedHealthcare Commercial	$908.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tube EndoTracheal with Bronchial Blocker 7.0 fr Single-Lumen

Facility

$956.00

Hospital Charge Code	3251716
Hospital Revenue Code	270
Min. Negotiated Rate	$382.40
Max. Negotiated Rate	$908.20
Rate for Payer: Aetna Commercial	$860.40
Rate for Payer: Humana Medicare Advantage	$401.52
Rate for Payer: UnitedHealthcare Commercial	$908.20
Rate for Payer: UnitedHealthcare Medicaid	$382.40
Rate for Payer: WPPA Medicare Advantage	$573.60

Tube EndoTracheal with Bronchial Blocker 7.5 fr Single-Lumen

Facility

$956.00

Hospital Charge Code	3251717
Hospital Revenue Code	270
Min. Negotiated Rate	$860.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$860.40
Rate for Payer: UnitedHealthcare Commercial	$908.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tube EndoTracheal with Bronchial Blocker 7.5 fr Single-Lumen

Facility

$956.00

Hospital Charge Code	3251717
Hospital Revenue Code	270
Min. Negotiated Rate	$382.40
Max. Negotiated Rate	$908.20
Rate for Payer: Aetna Commercial	$860.40
Rate for Payer: Humana Medicare Advantage	$401.52
Rate for Payer: UnitedHealthcare Commercial	$908.20
Rate for Payer: UnitedHealthcare Medicaid	$382.40
Rate for Payer: WPPA Medicare Advantage	$573.60

Tube EndoTracheal with Bronchial Blocker 8.0 fr Single-Lumen

Facility

$956.00

Hospital Charge Code	3251718
Hospital Revenue Code	270
Min. Negotiated Rate	$860.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$860.40
Rate for Payer: UnitedHealthcare Commercial	$908.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tube EndoTracheal with Bronchial Blocker 8.0 fr Single-Lumen

Facility

$956.00

Hospital Charge Code	3251718
Hospital Revenue Code	270
Min. Negotiated Rate	$382.40
Max. Negotiated Rate	$908.20
Rate for Payer: Aetna Commercial	$860.40
Rate for Payer: Humana Medicare Advantage	$401.52
Rate for Payer: UnitedHealthcare Commercial	$908.20
Rate for Payer: UnitedHealthcare Medicaid	$382.40
Rate for Payer: WPPA Medicare Advantage	$573.60

tuberculin purified protein derivative 5 TU/0.1 mL ID Sol [HMC]

Facility

$202.04

Service Code	NDC 49281075221
Hospital Charge Code	3807563
Hospital Revenue Code	250
Min. Negotiated Rate	$181.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$181.84
Rate for Payer: UnitedHealthcare Commercial	$191.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

tuberculin purified protein derivative 5 TU/0.1 mL ID Sol [HMC]

Facility

$202.04

Service Code	NDC 49281075221
Hospital Charge Code	3807563
Hospital Revenue Code	250
Min. Negotiated Rate	$80.82
Max. Negotiated Rate	$191.94
Rate for Payer: Aetna Commercial	$181.84
Rate for Payer: Humana Medicare Advantage	$84.86
Rate for Payer: UnitedHealthcare Commercial	$191.94
Rate for Payer: UnitedHealthcare Medicaid	$80.82
Rate for Payer: WPPA Medicare Advantage	$121.22

Tubigrip Bandage Size D Length 1 meter Color Natural

Facility

$13.68

Hospital Charge Code	3259125
Hospital Revenue Code	270
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.31
Rate for Payer: UnitedHealthcare Commercial	$13.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tubigrip Bandage Size D Length 1 meter Color Natural

Facility

$13.68

Hospital Charge Code	3259125
Hospital Revenue Code	270
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$12.31
Rate for Payer: Humana Medicare Advantage	$5.75
Rate for Payer: UnitedHealthcare Commercial	$13.00
Rate for Payer: UnitedHealthcare Medicaid	$5.47
Rate for Payer: WPPA Medicare Advantage	$8.21

Tubular Gauze Size 1 Wound Dressing Retainer 5/8

Facility

$3.00

Hospital Charge Code	3257815
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Humana Medicare Advantage	$1.26
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: WPPA Medicare Advantage	$1.80

Tubular Gauze Size 1 Wound Dressing Retainer 5/8

Facility

$3.00

Hospital Charge Code	3257815
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tumor Necrosis Factor-Alpha, Highly Sensitive QST

Facility

$263.00

Service Code	HCPCS 83520
Hospital Charge Code	3550520
Hospital Revenue Code	300
Min. Negotiated Rate	$236.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: UnitedHealthcare Commercial	$249.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Tumor Necrosis Factor-Alpha, Highly Sensitive QST

Facility

$263.00

Service Code	HCPCS 83520
Hospital Charge Code	3550520
Hospital Revenue Code	300
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$249.85
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$36.48
Rate for Payer: Humana Medicare Advantage	$110.46
Rate for Payer: UnitedHealthcare Commercial	$249.85
Rate for Payer: UnitedHealthcare Medicaid	$105.20
Rate for Payer: WPPA Medicare Advantage	$157.80

Tuna (F40) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552808
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$19.95
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$8.82
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$12.60

Tuna (F40) IgE QST

Facility

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552808
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TUR Y Tubing

Facility

$37.13

Hospital Charge Code	3257149
Hospital Revenue Code	270
Min. Negotiated Rate	$33.42
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$33.42
Rate for Payer: UnitedHealthcare Commercial	$35.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TUR Y Tubing

Facility

$37.13

Hospital Charge Code	3257149
Hospital Revenue Code	270
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$35.27
Rate for Payer: Aetna Commercial	$33.42
Rate for Payer: Humana Medicare Advantage	$15.59
Rate for Payer: UnitedHealthcare Commercial	$35.27
Rate for Payer: UnitedHealthcare Medicaid	$14.85
Rate for Payer: WPPA Medicare Advantage	$22.28

Know your out-of-pocket cost for care.

All Charges