Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Implant 2.9mm Biocomp Pushlock, DX

Facility

$2,402.00

Hospital Charge Code	3258526
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,281.90
Rate for Payer: Aetna Commercial	$2,161.80
Rate for Payer: UnitedHealthcare Commercial	$2,281.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant AFLEX301 Graft

Facility

$9,626.00

Hospital Charge Code	3258528
Hospital Revenue Code	270
Min. Negotiated Rate	$3,850.40
Max. Negotiated Rate	$9,144.70
Rate for Payer: Aetna Commercial	$8,663.40
Rate for Payer: Humana Medicare Advantage	$4,042.92
Rate for Payer: UnitedHealthcare Commercial	$9,144.70
Rate for Payer: UnitedHealthcare Medicaid	$3,850.40
Rate for Payer: WPPA Medicare Advantage	$5,775.60

Implant AFLEX301 Graft

Facility

$9,626.00

Hospital Charge Code	3258528
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,144.70
Rate for Payer: Aetna Commercial	$8,663.40
Rate for Payer: UnitedHealthcare Commercial	$9,144.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Beveled FT Screw 4X50MM

Facility

$2,650.00

Hospital Charge Code	3258557
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,517.50
Rate for Payer: Aetna Commercial	$2,385.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Beveled FT Screw 4X50MM

Facility

$2,650.00

Hospital Charge Code	3258557
Hospital Revenue Code	270
Min. Negotiated Rate	$1,060.00
Max. Negotiated Rate	$2,517.50
Rate for Payer: Aetna Commercial	$2,385.00
Rate for Payer: Humana Medicare Advantage	$1,113.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.50
Rate for Payer: UnitedHealthcare Medicaid	$1,060.00
Rate for Payer: WPPA Medicare Advantage	$1,590.00

Implant Beveled FT Screw 4X54MM

Facility

$2,650.00

Hospital Charge Code	3258552
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,517.50
Rate for Payer: Aetna Commercial	$2,385.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Beveled FT Screw 4X54MM

Facility

$2,650.00

Hospital Charge Code	3258552
Hospital Revenue Code	270
Min. Negotiated Rate	$1,060.00
Max. Negotiated Rate	$2,517.50
Rate for Payer: Aetna Commercial	$2,385.00
Rate for Payer: Humana Medicare Advantage	$1,113.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.50
Rate for Payer: UnitedHealthcare Medicaid	$1,060.00
Rate for Payer: WPPA Medicare Advantage	$1,590.00

Implant Compr FT Scrw 2.5 Micro 28mm lgth

Facility

$1,168.00

Hospital Charge Code	3258532
Hospital Revenue Code	270
Min. Negotiated Rate	$1,051.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,051.20
Rate for Payer: UnitedHealthcare Commercial	$1,109.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Compr FT Scrw 2.5 Micro 28mm lgth

Facility

$1,168.00

Hospital Charge Code	3258532
Hospital Revenue Code	270
Min. Negotiated Rate	$467.20
Max. Negotiated Rate	$1,109.60
Rate for Payer: Aetna Commercial	$1,051.20
Rate for Payer: Humana Medicare Advantage	$490.56
Rate for Payer: UnitedHealthcare Commercial	$1,109.60
Rate for Payer: UnitedHealthcare Medicaid	$467.20
Rate for Payer: WPPA Medicare Advantage	$700.80

Implant Compr Ft Scrw 2.5 Micro 34mm Lgth

Facility

$1,168.00

Hospital Charge Code	3258533
Hospital Revenue Code	270
Min. Negotiated Rate	$467.20
Max. Negotiated Rate	$1,109.60
Rate for Payer: Aetna Commercial	$1,051.20
Rate for Payer: Humana Medicare Advantage	$490.56
Rate for Payer: UnitedHealthcare Commercial	$1,109.60
Rate for Payer: UnitedHealthcare Medicaid	$467.20
Rate for Payer: WPPA Medicare Advantage	$700.80

Implant Compr Ft Scrw 2.5 Micro 34mm Lgth

Facility

$1,168.00

Hospital Charge Code	3258533
Hospital Revenue Code	270
Min. Negotiated Rate	$1,051.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,051.20
Rate for Payer: UnitedHealthcare Commercial	$1,109.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Compr FT Scrw 2.5 Micro 48mm lgth

Facility

$1,168.00

Hospital Charge Code	3258556
Hospital Revenue Code	270
Min. Negotiated Rate	$467.20
Max. Negotiated Rate	$1,109.60
Rate for Payer: Aetna Commercial	$1,051.20
Rate for Payer: Humana Medicare Advantage	$490.56
Rate for Payer: UnitedHealthcare Commercial	$1,109.60
Rate for Payer: UnitedHealthcare Medicaid	$467.20
Rate for Payer: WPPA Medicare Advantage	$700.80

Implant Compr FT Scrw 2.5 Micro 48mm lgth

Facility

$1,168.00

Hospital Charge Code	3258556
Hospital Revenue Code	270
Min. Negotiated Rate	$1,051.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,051.20
Rate for Payer: UnitedHealthcare Commercial	$1,109.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant DynaFORCE MTP Plate Extended 25mm Clip 0° Dorsiflexion Right

Facility

$4,200.00

Hospital Charge Code	3258335
Hospital Revenue Code	270
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$3,990.00
Rate for Payer: Aetna Commercial	$3,780.00
Rate for Payer: Humana Medicare Advantage	$1,764.00
Rate for Payer: UnitedHealthcare Commercial	$3,990.00
Rate for Payer: UnitedHealthcare Medicaid	$1,680.00
Rate for Payer: WPPA Medicare Advantage	$2,520.00

Implant DynaFORCE MTP Plate Extended 25mm Clip 0° Dorsiflexion Right

Facility

$4,200.00

Hospital Charge Code	3258335
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,990.00
Rate for Payer: Aetna Commercial	$3,780.00
Rate for Payer: UnitedHealthcare Commercial	$3,990.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant DynaForce MTP Plate Standard 18mm Clip 0° Dorsiflexion

Facility

$4,200.00

Hospital Charge Code	3258341
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,990.00
Rate for Payer: Aetna Commercial	$3,780.00
Rate for Payer: UnitedHealthcare Commercial	$3,990.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant DynaForce MTP Plate Standard 18mm Clip 0° Dorsiflexion

Facility

$4,200.00

Hospital Charge Code	3258341
Hospital Revenue Code	270
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$3,990.00
Rate for Payer: Aetna Commercial	$3,780.00
Rate for Payer: Humana Medicare Advantage	$1,764.00
Rate for Payer: UnitedHealthcare Commercial	$3,990.00
Rate for Payer: UnitedHealthcare Medicaid	$1,680.00
Rate for Payer: WPPA Medicare Advantage	$2,520.00

Implant Dynanite .86 DBL TIP NITI G-Wire 2 Zone

Facility

$696.00

Hospital Charge Code	3258537
Hospital Revenue Code	270
Min. Negotiated Rate	$278.40
Max. Negotiated Rate	$661.20
Rate for Payer: Aetna Commercial	$626.40
Rate for Payer: Humana Medicare Advantage	$292.32
Rate for Payer: UnitedHealthcare Commercial	$661.20
Rate for Payer: UnitedHealthcare Medicaid	$278.40
Rate for Payer: WPPA Medicare Advantage	$417.60

Implant Dynanite .86 DBL TIP NITI G-Wire 2 Zone

Facility

$696.00

Hospital Charge Code	3258537
Hospital Revenue Code	270
Min. Negotiated Rate	$626.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$626.40
Rate for Payer: UnitedHealthcare Commercial	$661.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Dynanite Flexwire 1.1mm Double-tipped Nitinol G-wire 2-Zone

Facility

$696.00

Hospital Charge Code	3258531
Hospital Revenue Code	270
Min. Negotiated Rate	$278.40
Max. Negotiated Rate	$661.20
Rate for Payer: Aetna Commercial	$626.40
Rate for Payer: Humana Medicare Advantage	$292.32
Rate for Payer: UnitedHealthcare Commercial	$661.20
Rate for Payer: UnitedHealthcare Medicaid	$278.40
Rate for Payer: WPPA Medicare Advantage	$417.60

Implant Dynanite Flexwire 1.1mm Double-tipped Nitinol G-wire 2-Zone

Facility

$696.00

Hospital Charge Code	3258531
Hospital Revenue Code	270
Min. Negotiated Rate	$626.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$626.40
Rate for Payer: UnitedHealthcare Commercial	$661.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant DynanitePIP Straight 14mm with Instrumentation

Facility

$6,318.00

Hospital Charge Code	3258530
Hospital Revenue Code	270
Min. Negotiated Rate	$2,527.20
Max. Negotiated Rate	$6,002.10
Rate for Payer: Aetna Commercial	$5,686.20
Rate for Payer: Humana Medicare Advantage	$2,653.56
Rate for Payer: UnitedHealthcare Commercial	$6,002.10
Rate for Payer: UnitedHealthcare Medicaid	$2,527.20
Rate for Payer: WPPA Medicare Advantage	$3,790.80

Implant DynanitePIP Straight 14mm with Instrumentation

Facility

$6,318.00

Hospital Charge Code	3258530
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,002.10
Rate for Payer: Aetna Commercial	$5,686.20
Rate for Payer: UnitedHealthcare Commercial	$6,002.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant ForeFoot IB Sys, Peek

Facility

$4,185.00

Hospital Charge Code	3258525
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,975.75
Rate for Payer: Aetna Commercial	$3,766.50
Rate for Payer: UnitedHealthcare Commercial	$3,975.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant ForeFoot IB Sys, Peek

Facility

$4,185.00

Hospital Charge Code	3258525
Hospital Revenue Code	270
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$3,975.75
Rate for Payer: Aetna Commercial	$3,766.50
Rate for Payer: Humana Medicare Advantage	$1,757.70
Rate for Payer: UnitedHealthcare Commercial	$3,975.75
Rate for Payer: UnitedHealthcare Medicaid	$1,674.00
Rate for Payer: WPPA Medicare Advantage	$2,511.00

Know your out-of-pocket cost for care.

All Charges