Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Casting Tape 3 Green

Facility

$11.00

Hospital Charge Code	3250873
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 3 Green

Facility

$11.00

Hospital Charge Code	3250873
Hospital Revenue Code	270
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.45
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Humana Medicare Advantage	$4.62
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: UnitedHealthcare Medicaid	$4.40
Rate for Payer: WPPA Medicare Advantage	$6.60

Casting Tape 3 Mixed

Facility

$11.00

Hospital Charge Code	3250867
Hospital Revenue Code	270
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.45
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Humana Medicare Advantage	$4.62
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: UnitedHealthcare Medicaid	$4.40
Rate for Payer: WPPA Medicare Advantage	$6.60

Casting Tape 3 Mixed

Facility

$11.00

Hospital Charge Code	3250867
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 3 Purple

Facility

$11.00

Hospital Charge Code	3250875
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 3 Purple

Facility

$11.00

Hospital Charge Code	3250875
Hospital Revenue Code	270
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.45
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Humana Medicare Advantage	$4.62
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: UnitedHealthcare Medicaid	$4.40
Rate for Payer: WPPA Medicare Advantage	$6.60

Casting Tape 3 White

Facility

$9.36

Hospital Charge Code	3250866
Hospital Revenue Code	270
Min. Negotiated Rate	$8.42
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.42
Rate for Payer: UnitedHealthcare Commercial	$8.89
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 3 White

Facility

$9.36

Hospital Charge Code	3250866
Hospital Revenue Code	270
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$8.89
Rate for Payer: Aetna Commercial	$8.42
Rate for Payer: Humana Medicare Advantage	$3.93
Rate for Payer: UnitedHealthcare Commercial	$8.89
Rate for Payer: UnitedHealthcare Medicaid	$3.74
Rate for Payer: WPPA Medicare Advantage	$5.62

Casting Tape 4 Mixed

Facility

$14.00

Hospital Charge Code	3250869
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 4 Mixed

Facility

$14.00

Hospital Charge Code	3250869
Hospital Revenue Code	270
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$13.30
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Humana Medicare Advantage	$5.88
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: UnitedHealthcare Medicaid	$5.60
Rate for Payer: WPPA Medicare Advantage	$8.40

Casting Tape 4 White

Facility

$11.43

Hospital Charge Code	3250868
Hospital Revenue Code	270
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$10.86
Rate for Payer: Aetna Commercial	$10.29
Rate for Payer: Humana Medicare Advantage	$4.80
Rate for Payer: UnitedHealthcare Commercial	$10.86
Rate for Payer: UnitedHealthcare Medicaid	$4.57
Rate for Payer: WPPA Medicare Advantage	$6.86

Casting Tape 4 White

Facility

$11.43

Hospital Charge Code	3250868
Hospital Revenue Code	270
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.29
Rate for Payer: UnitedHealthcare Commercial	$10.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 5 White

Facility

$15.39

Hospital Charge Code	3255598
Hospital Revenue Code	270
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.85
Rate for Payer: UnitedHealthcare Commercial	$14.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Casting Tape 5 White

Facility

$15.39

Hospital Charge Code	3255598
Hospital Revenue Code	270
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$14.62
Rate for Payer: Aetna Commercial	$13.85
Rate for Payer: Humana Medicare Advantage	$6.46
Rate for Payer: UnitedHealthcare Commercial	$14.62
Rate for Payer: UnitedHealthcare Medicaid	$6.16
Rate for Payer: WPPA Medicare Advantage	$9.23

Cast Padding 2 Non-Sterile Sof-Rol Synthetic

Facility

$3.00

Hospital Charge Code	3254179
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

Cast Padding 2 Non-Sterile Sof-Rol Synthetic

Facility

$3.00

Hospital Charge Code	3254179
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

Cast Padding 2 Sterile Sof-Rol Synthetic

Facility

$4.00

Hospital Charge Code	3250247
Hospital Revenue Code	270
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Padding 2 Sterile Sof-Rol Synthetic

Facility

$4.00

Hospital Charge Code	3250247
Hospital Revenue Code	270
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.80
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Humana Medicare Advantage	$1.68
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Medicaid	$1.60
Rate for Payer: WPPA Medicare Advantage	$2.40

Cast Padding 2 Water Resistant Non-Sterile LF

Facility

$30.00

Hospital Charge Code	3254167
Hospital Revenue Code	270
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Padding 2 Water Resistant Non-Sterile LF

Facility

$30.00

Hospital Charge Code	3254167
Hospital Revenue Code	270
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Humana Medicare Advantage	$12.60
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: WPPA Medicare Advantage	$18.00

Cast Padding 2 Webril

Facility

$3.00

Hospital Charge Code	3254190
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

Cast Padding 2 Webril

Facility

$3.00

Hospital Charge Code	3254190
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

Cast Padding 3 Non-Sterile Sof-Rol Synthetic

Facility

$2.50

Hospital Charge Code	3254161
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Cast Padding 3 Non-Sterile Sof-Rol Synthetic

Facility

$2.50

Hospital Charge Code	3254161
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Padding 3 Sterile Sof-Rol Synthetic

Facility

$8.00

Hospital Charge Code	3254159
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges