Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Catheter Foley Tray 16FR Latex-Free W/2000ML Drainage Bag

Facility

$27.90

Hospital Charge Code	3250975
Hospital Revenue Code	270
Min. Negotiated Rate	$25.11
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.11
Rate for Payer: UnitedHealthcare Commercial	$26.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Catheter Foley Tray 16FR Latex-Free W/2000ML Drainage Bag

Facility

$27.90

Hospital Charge Code	3250975
Hospital Revenue Code	270
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$26.50
Rate for Payer: Aetna Commercial	$25.11
Rate for Payer: Humana Medicare Advantage	$11.72
Rate for Payer: UnitedHealthcare Commercial	$26.50
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: WPPA Medicare Advantage	$16.74

Catheterization Radial Artery 20G X 1.75 Arterial Line Catheter

Facility

$55.80

Hospital Charge Code	3256640
Hospital Revenue Code	270
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$53.01
Rate for Payer: Aetna Commercial	$50.22
Rate for Payer: Humana Medicare Advantage	$23.44
Rate for Payer: UnitedHealthcare Commercial	$53.01
Rate for Payer: UnitedHealthcare Medicaid	$22.32
Rate for Payer: WPPA Medicare Advantage	$33.48

Catheterization Radial Artery 20G X 1.75 Arterial Line Catheter

Facility

$55.80

Hospital Charge Code	3256640
Hospital Revenue Code	270
Min. Negotiated Rate	$50.22
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$50.22
Rate for Payer: UnitedHealthcare Commercial	$53.01
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Foley 12FR Red Robin

Facility

$3.42

Hospital Charge Code	3254410
Hospital Revenue Code	270
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Humana Medicare Advantage	$1.44
Rate for Payer: UnitedHealthcare Commercial	$3.25
Rate for Payer: UnitedHealthcare Medicaid	$1.37
Rate for Payer: WPPA Medicare Advantage	$2.05

Cath Foley 12FR Red Robin

Facility

$3.42

Hospital Charge Code	3254410
Hospital Revenue Code	270
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: UnitedHealthcare Commercial	$3.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Foley 14FR Red Robin Latex

Facility

$3.69

Hospital Charge Code	3254420
Hospital Revenue Code	270
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.32
Rate for Payer: UnitedHealthcare Commercial	$3.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Foley 14FR Red Robin Latex

Facility

$3.69

Hospital Charge Code	3254420
Hospital Revenue Code	270
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna Commercial	$3.32
Rate for Payer: Humana Medicare Advantage	$1.55
Rate for Payer: UnitedHealthcare Commercial	$3.51
Rate for Payer: UnitedHealthcare Medicaid	$1.48
Rate for Payer: WPPA Medicare Advantage	$2.21

Cath Foley 16FR Red Robin

Facility

$3.00

Hospital Charge Code	3254415
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

Cath Foley 16FR Red Robin

Facility

$3.00

Hospital Charge Code	3254415
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

Cath Foley Self LF 14FR Straight Tip Unisex Intermittent

Facility

$2.50

Hospital Charge Code	3254485
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

Cath Foley Self LF 14FR Straight Tip Unisex Intermittent

Facility

$2.50

Hospital Charge Code	3254485
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

Cath Intermittent Female 14fr 6 PVC Straight Catheter

Facility

$2.88

Hospital Charge Code	3250955
Hospital Revenue Code	270
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: UnitedHealthcare Commercial	$2.74
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Intermittent Female 14fr 6 PVC Straight Catheter

Facility

$2.88

Hospital Charge Code	3250955
Hospital Revenue Code	270
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Humana Medicare Advantage	$1.21
Rate for Payer: UnitedHealthcare Commercial	$2.74
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: WPPA Medicare Advantage	$1.73

Cath Peritoneal Curled Catheter Kit with 2 Cuffs, 62 cm

Facility

$400.08

Hospital Charge Code	3252068
Hospital Revenue Code	270
Min. Negotiated Rate	$360.07
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$360.07
Rate for Payer: UnitedHealthcare Commercial	$380.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Peritoneal Curled Catheter Kit with 2 Cuffs, 62 cm

Facility

$400.08

Hospital Charge Code	3252068
Hospital Revenue Code	270
Min. Negotiated Rate	$160.03
Max. Negotiated Rate	$380.08
Rate for Payer: Aetna Commercial	$360.07
Rate for Payer: Humana Medicare Advantage	$168.03
Rate for Payer: UnitedHealthcare Commercial	$380.08
Rate for Payer: UnitedHealthcare Medicaid	$160.03
Rate for Payer: WPPA Medicare Advantage	$240.05

Cath Secure

Facility

$4.41

Hospital Charge Code	3255291
Hospital Revenue Code	270
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Humana Medicare Advantage	$1.85
Rate for Payer: UnitedHealthcare Commercial	$4.19
Rate for Payer: UnitedHealthcare Medicaid	$1.76
Rate for Payer: WPPA Medicare Advantage	$2.65

Cath Secure

Facility

$4.41

Hospital Charge Code	3255291
Hospital Revenue Code	270
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: UnitedHealthcare Commercial	$4.19
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Tray Add-A-Foley

Facility

$46.49

Hospital Charge Code	3250607
Hospital Revenue Code	270
Min. Negotiated Rate	$41.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$41.84
Rate for Payer: UnitedHealthcare Commercial	$44.17
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Tray Add-A-Foley

Facility

$46.49

Hospital Charge Code	3250607
Hospital Revenue Code	270
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$44.17
Rate for Payer: Aetna Commercial	$41.84
Rate for Payer: Humana Medicare Advantage	$19.53
Rate for Payer: UnitedHealthcare Commercial	$44.17
Rate for Payer: UnitedHealthcare Medicaid	$18.60
Rate for Payer: WPPA Medicare Advantage	$27.89

Cath Tray Intermittent 14fr Latex-Free Straight Cath Kit without Collection Bag

Facility

$14.67

Hospital Charge Code	3250960
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: UnitedHealthcare Commercial	$13.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Tray Intermittent 14fr Latex-Free Straight Cath Kit without Collection Bag

Facility

$14.67

Hospital Charge Code	3250960
Hospital Revenue Code	270
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$13.94
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Humana Medicare Advantage	$6.16
Rate for Payer: UnitedHealthcare Commercial	$13.94
Rate for Payer: UnitedHealthcare Medicaid	$5.87
Rate for Payer: WPPA Medicare Advantage	$8.80

Cath Tray Intermittent 16fr Latex-Free Straight Cath Kit without Collection Bag

Facility

$7.00

Hospital Charge Code	3250965
Hospital Revenue Code	270
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.65
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Humana Medicare Advantage	$2.94
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: WPPA Medicare Advantage	$4.20

Cath Tray Intermittent 16fr Latex-Free Straight Cath Kit without Collection Bag

Facility

$7.00

Hospital Charge Code	3250965
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cath Tray Intermittent w/ Latex 15fr Foley - Uretheral Straight Catheter Tray

Facility

$7.00

Hospital Charge Code	3250972
Hospital Revenue Code	270
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.65
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Humana Medicare Advantage	$2.94
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: WPPA Medicare Advantage	$4.20

Know your out-of-pocket cost for care.

All Charges