Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Catheter Foley Latex-Free 16FR 30CC Balloon 2Way

Facility

$13.95

Hospital Charge Code	3258517
Hospital Revenue Code	270
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.55
Rate for Payer: UnitedHealthcare Commercial	$13.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 16FR 5CC Balloon 2Way

Facility

$16.43

Hospital Charge Code	3250135
Hospital Revenue Code	270
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$15.61
Rate for Payer: Aetna Commercial	$14.79
Rate for Payer: Humana Medicare Advantage	$6.90
Rate for Payer: UnitedHealthcare Commercial	$15.61
Rate for Payer: UnitedHealthcare Medicaid	$6.57
Rate for Payer: WPPA Medicare Advantage	$9.86

Catheter Foley Latex-Free 16FR 5CC Balloon 2Way

Facility

$16.43

Hospital Charge Code	3250135
Hospital Revenue Code	270
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.79
Rate for Payer: UnitedHealthcare Commercial	$15.61
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 16FR 5CC Balloon 3Way

Facility

$54.27

Hospital Charge Code	3259053
Hospital Revenue Code	270
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$51.56
Rate for Payer: Aetna Commercial	$48.84
Rate for Payer: Humana Medicare Advantage	$22.79
Rate for Payer: UnitedHealthcare Commercial	$51.56
Rate for Payer: UnitedHealthcare Medicaid	$21.71
Rate for Payer: WPPA Medicare Advantage	$32.56

Catheter Foley Latex-Free 16FR 5CC Balloon 3Way

Facility

$54.27

Hospital Charge Code	3259053
Hospital Revenue Code	270
Min. Negotiated Rate	$48.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$48.84
Rate for Payer: UnitedHealthcare Commercial	$51.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 16FR 5CC Balloon Coude Tip

Facility

$21.11

Hospital Charge Code	3258514
Hospital Revenue Code	270
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$20.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 16FR 5CC Balloon Coude Tip

Facility

$21.11

Hospital Charge Code	3258514
Hospital Revenue Code	270
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$20.05
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: UnitedHealthcare Commercial	$20.05
Rate for Payer: UnitedHealthcare Medicaid	$8.44
Rate for Payer: WPPA Medicare Advantage	$12.67

Catheter Foley Latex-Free 18FR 30CC Balloon 3Way

Facility

$50.00

Hospital Charge Code	3258518
Hospital Revenue Code	270
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: UnitedHealthcare Commercial	$47.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 18FR 30CC Balloon 3Way

Facility

$50.00

Hospital Charge Code	3258518
Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Humana Medicare Advantage	$21.00
Rate for Payer: UnitedHealthcare Commercial	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$20.00
Rate for Payer: WPPA Medicare Advantage	$30.00

Catheter Foley Latex-Free 18FR 5CC Balloon 2Way

Facility

$16.11

Hospital Charge Code	3250005
Hospital Revenue Code	270
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna Commercial	$14.50
Rate for Payer: Humana Medicare Advantage	$6.77
Rate for Payer: UnitedHealthcare Commercial	$15.30
Rate for Payer: UnitedHealthcare Medicaid	$6.44
Rate for Payer: WPPA Medicare Advantage	$9.67

Catheter Foley Latex-Free 18FR 5CC Balloon 2Way

Facility

$16.11

Hospital Charge Code	3250005
Hospital Revenue Code	270
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.50
Rate for Payer: UnitedHealthcare Commercial	$15.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 18FR 5CC Balloon 3Way

Facility

$54.95

Hospital Charge Code	3259055
Hospital Revenue Code	270
Min. Negotiated Rate	$21.98
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna Commercial	$49.45
Rate for Payer: Humana Medicare Advantage	$23.08
Rate for Payer: UnitedHealthcare Commercial	$52.20
Rate for Payer: UnitedHealthcare Medicaid	$21.98
Rate for Payer: WPPA Medicare Advantage	$32.97

Catheter Foley Latex-Free 18FR 5CC Balloon 3Way

Facility

$54.95

Hospital Charge Code	3259055
Hospital Revenue Code	270
Min. Negotiated Rate	$49.45
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$49.45
Rate for Payer: UnitedHealthcare Commercial	$52.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 18FR 5CC Balloon Coude Tip

Facility

$21.65

Hospital Charge Code	3258516
Hospital Revenue Code	270
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$20.57
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Humana Medicare Advantage	$9.09
Rate for Payer: UnitedHealthcare Commercial	$20.57
Rate for Payer: UnitedHealthcare Medicaid	$8.66
Rate for Payer: WPPA Medicare Advantage	$12.99

Catheter Foley Latex-Free 18FR 5CC Balloon Coude Tip

Facility

$21.65

Hospital Charge Code	3258516
Hospital Revenue Code	270
Min. Negotiated Rate	$19.48
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: UnitedHealthcare Commercial	$20.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 20FR 30CC Balloon 2Way

Facility

$22.23

Hospital Charge Code	3258508
Hospital Revenue Code	270
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$21.12
Rate for Payer: Aetna Commercial	$20.01
Rate for Payer: Humana Medicare Advantage	$9.34
Rate for Payer: UnitedHealthcare Commercial	$21.12
Rate for Payer: UnitedHealthcare Medicaid	$8.89
Rate for Payer: WPPA Medicare Advantage	$13.34

Catheter Foley Latex-Free 20FR 30CC Balloon 2Way

Facility

$22.23

Hospital Charge Code	3258508
Hospital Revenue Code	270
Min. Negotiated Rate	$20.01
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$20.01
Rate for Payer: UnitedHealthcare Commercial	$21.12
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 20FR 5CC Balloon 2Way

Facility

$18.00

Hospital Charge Code	3258506
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 20FR 5CC Balloon 2Way

Facility

$18.00

Hospital Charge Code	3258506
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Humana Medicare Advantage	$7.56
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: WPPA Medicare Advantage	$10.80

Catheter Foley Latex-Free 22FR 30CC Balloon 2Way

Facility

$36.00

Hospital Charge Code	3258510
Hospital Revenue Code	270
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$32.40
Rate for Payer: UnitedHealthcare Commercial	$34.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 22FR 30CC Balloon 2Way

Facility

$36.00

Hospital Charge Code	3258510
Hospital Revenue Code	270
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$15.12
Rate for Payer: UnitedHealthcare Commercial	$34.20
Rate for Payer: UnitedHealthcare Medicaid	$14.40
Rate for Payer: WPPA Medicare Advantage	$21.60

Catheter Foley Latex-Free 22FR 30CC Balloon 3Way

Facility

$46.26

Hospital Charge Code	3258520
Hospital Revenue Code	270
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$43.95
Rate for Payer: Aetna Commercial	$41.63
Rate for Payer: Humana Medicare Advantage	$19.43
Rate for Payer: UnitedHealthcare Commercial	$43.95
Rate for Payer: UnitedHealthcare Medicaid	$18.50
Rate for Payer: WPPA Medicare Advantage	$27.76

Catheter Foley Latex-Free 22FR 30CC Balloon 3Way

Facility

$46.26

Hospital Charge Code	3258520
Hospital Revenue Code	270
Min. Negotiated Rate	$41.63
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$41.63
Rate for Payer: UnitedHealthcare Commercial	$43.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 24FR 30CC Balloon 2Way

Facility

$38.00

Hospital Charge Code	3258512
Hospital Revenue Code	270
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Latex-Free 24FR 30CC Balloon 2Way

Facility

$38.00

Hospital Charge Code	3258512
Hospital Revenue Code	270
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$36.10
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: UnitedHealthcare Commercial	$36.10
Rate for Payer: UnitedHealthcare Medicaid	$15.20
Rate for Payer: WPPA Medicare Advantage	$22.80

Know your out-of-pocket cost for care.

All Charges