Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Cast Padding 3 Sterile Sof-Rol Synthetic

Facility

$8.00

Hospital Charge Code	3254159
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Humana Medicare Advantage	$3.36
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Medicaid	$3.20
Rate for Payer: WPPA Medicare Advantage	$4.80

Cast Padding 3 Water Resistant Non-Sterile LF

Facility

$32.00

Hospital Charge Code	3254168
Hospital Revenue Code	270
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Padding 3 Water Resistant Non-Sterile LF

Facility

$32.00

Hospital Charge Code	3254168
Hospital Revenue Code	270
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Medicaid	$12.80
Rate for Payer: WPPA Medicare Advantage	$19.20

Cast Padding 3 Webril

Facility

$3.00

Hospital Charge Code	3254191
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 3 Webril

Facility

$3.00

Hospital Charge Code	3254191
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 4 Non-Sterile Sof-Rol Synthetic

Facility

$2.52

Hospital Charge Code	3254187
Hospital Revenue Code	270
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.27
Rate for Payer: UnitedHealthcare Commercial	$2.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Padding 4 Non-Sterile Sof-Rol Synthetic

Facility

$2.52

Hospital Charge Code	3254187
Hospital Revenue Code	270
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.39
Rate for Payer: Aetna Commercial	$2.27
Rate for Payer: Humana Medicare Advantage	$1.06
Rate for Payer: UnitedHealthcare Commercial	$2.39
Rate for Payer: UnitedHealthcare Medicaid	$1.01
Rate for Payer: WPPA Medicare Advantage	$1.51

Cast Padding 4 Sterile Sof-Rol Synthetic

Facility

$9.27

Hospital Charge Code	3250248
Hospital Revenue Code	270
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna Commercial	$8.34
Rate for Payer: Humana Medicare Advantage	$3.89
Rate for Payer: UnitedHealthcare Commercial	$8.81
Rate for Payer: UnitedHealthcare Medicaid	$3.71
Rate for Payer: WPPA Medicare Advantage	$5.56

Cast Padding 4 Sterile Sof-Rol Synthetic

Facility

$9.27

Hospital Charge Code	3250248
Hospital Revenue Code	270
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.34
Rate for Payer: UnitedHealthcare Commercial	$8.81
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Padding 4 Sterile Webril Cotton

Facility

$4.00

Hospital Charge Code	3250242
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 4 Sterile Webril Cotton

Facility

$4.00

Hospital Charge Code	3250242
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 4 Webril Non-Sterile

Facility

$3.00

Hospital Charge Code	3254192
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 4 Webril Non-Sterile

Facility

$3.00

Hospital Charge Code	3254192
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 6 Non-Sterile Sof-Rol Synthetic

Facility

$3.00

Hospital Charge Code	3250077
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 6 Non-Sterile Sof-Rol Synthetic

Facility

$3.00

Hospital Charge Code	3250077
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 6 Sterile Sof-Rol Synthetic

Facility

$9.00

Hospital Charge Code	3250249
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Padding 6 Sterile Sof-Rol Synthetic

Facility

$9.00

Hospital Charge Code	3250249
Hospital Revenue Code	270
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.55
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: WPPA Medicare Advantage	$5.40

Cast Padding 6 Sterile Webril II

Facility

$11.00

Hospital Charge Code	3254193
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

Cast Padding 6 Sterile Webril II

Facility

$11.00

Hospital Charge Code	3254193
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

Cast Shoe Large Navy

Facility

$54.86

Hospital Charge Code	3255457
Hospital Revenue Code	270
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$52.12
Rate for Payer: Aetna Commercial	$49.37
Rate for Payer: Humana Medicare Advantage	$23.04
Rate for Payer: UnitedHealthcare Commercial	$52.12
Rate for Payer: UnitedHealthcare Medicaid	$21.94
Rate for Payer: WPPA Medicare Advantage	$32.92

Cast Shoe Large Navy

Facility

$54.86

Hospital Charge Code	3255457
Hospital Revenue Code	270
Min. Negotiated Rate	$49.37
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$49.37
Rate for Payer: UnitedHealthcare Commercial	$52.12
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Shoe Medium Navy

Facility

$57.20

Hospital Charge Code	3255531
Hospital Revenue Code	270
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$54.34
Rate for Payer: Aetna Commercial	$51.48
Rate for Payer: Humana Medicare Advantage	$24.02
Rate for Payer: UnitedHealthcare Commercial	$54.34
Rate for Payer: UnitedHealthcare Medicaid	$22.88
Rate for Payer: WPPA Medicare Advantage	$34.32

Cast Shoe Medium Navy

Facility

$57.20

Hospital Charge Code	3255531
Hospital Revenue Code	270
Min. Negotiated Rate	$51.48
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$51.48
Rate for Payer: UnitedHealthcare Commercial	$54.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Shoe Small Navy

Facility

$86.00

Hospital Charge Code	3255440
Hospital Revenue Code	270
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$77.40
Rate for Payer: UnitedHealthcare Commercial	$81.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cast Shoe Small Navy

Facility

$86.00

Hospital Charge Code	3255440
Hospital Revenue Code	270
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$81.70
Rate for Payer: Aetna Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$36.12
Rate for Payer: UnitedHealthcare Commercial	$81.70
Rate for Payer: UnitedHealthcare Medicaid	$34.40
Rate for Payer: WPPA Medicare Advantage	$51.60

Know your out-of-pocket cost for care.

All Charges