Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Implant GuideWire 1.4MM Beveled FT 3.5MM

Facility

$287.00

Hospital Charge Code	3258558
Hospital Revenue Code	270
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$272.65
Rate for Payer: Aetna Commercial	$258.30
Rate for Payer: Humana Medicare Advantage	$120.54
Rate for Payer: UnitedHealthcare Commercial	$272.65
Rate for Payer: UnitedHealthcare Medicaid	$114.80
Rate for Payer: WPPA Medicare Advantage	$172.20

Implant GuideWire 1.4MM Beveled FT 3.5MM

Facility

$287.00

Hospital Charge Code	3258558
Hospital Revenue Code	270
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$258.30
Rate for Payer: UnitedHealthcare Commercial	$272.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant GuideWire 1.6MM Beveled FT 4MM

Facility

$171.50

Hospital Charge Code	3258553
Hospital Revenue Code	270
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$162.93
Rate for Payer: Aetna Commercial	$154.35
Rate for Payer: Humana Medicare Advantage	$72.03
Rate for Payer: UnitedHealthcare Commercial	$162.93
Rate for Payer: UnitedHealthcare Medicaid	$68.60
Rate for Payer: WPPA Medicare Advantage	$102.90

Implant GuideWire 1.6MM Beveled FT 4MM

Facility

$171.50

Hospital Charge Code	3258553
Hospital Revenue Code	270
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$154.35
Rate for Payer: UnitedHealthcare Commercial	$162.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant GuideWire 1.6X150MM Capital Frag

Facility

$171.50

Hospital Charge Code	3258554
Hospital Revenue Code	270
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$162.93
Rate for Payer: Aetna Commercial	$154.35
Rate for Payer: Humana Medicare Advantage	$72.03
Rate for Payer: UnitedHealthcare Commercial	$162.93
Rate for Payer: UnitedHealthcare Medicaid	$68.60
Rate for Payer: WPPA Medicare Advantage	$102.90

Implant GuideWire 1.6X150MM Capital Frag

Facility

$171.50

Hospital Charge Code	3258554
Hospital Revenue Code	270
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$154.35
Rate for Payer: UnitedHealthcare Commercial	$162.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Guide Wire Double Ended Trocar 0.86mm

Facility

$175.00

Hospital Charge Code	3258535
Hospital Revenue Code	270
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$166.25
Rate for Payer: Aetna Commercial	$157.50
Rate for Payer: Humana Medicare Advantage	$73.50
Rate for Payer: UnitedHealthcare Commercial	$166.25
Rate for Payer: UnitedHealthcare Medicaid	$70.00
Rate for Payer: WPPA Medicare Advantage	$105.00

Implant Guide Wire Double Ended Trocar 0.86mm

Facility

$175.00

Hospital Charge Code	3258535
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$157.50
Rate for Payer: UnitedHealthcare Commercial	$166.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Guide Wire Trocar Tip 0.86MM

Facility

$129.50

Hospital Charge Code	3258551
Hospital Revenue Code	270
Min. Negotiated Rate	$116.55
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$116.55
Rate for Payer: UnitedHealthcare Commercial	$123.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant Guide Wire Trocar Tip 0.86MM

Facility

$129.50

Hospital Charge Code	3258551
Hospital Revenue Code	270
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$123.03
Rate for Payer: Aetna Commercial	$116.55
Rate for Payer: Humana Medicare Advantage	$54.39
Rate for Payer: UnitedHealthcare Commercial	$123.03
Rate for Payer: UnitedHealthcare Medicaid	$51.80
Rate for Payer: WPPA Medicare Advantage	$77.70

Implant HiMAX DynaForce Single Pack 18mm x 14mm x 14mm

Facility

$5,148.00

Hospital Charge Code	3258340
Hospital Revenue Code	270
Min. Negotiated Rate	$2,059.20
Max. Negotiated Rate	$4,890.60
Rate for Payer: Aetna Commercial	$4,633.20
Rate for Payer: Humana Medicare Advantage	$2,162.16
Rate for Payer: UnitedHealthcare Commercial	$4,890.60
Rate for Payer: UnitedHealthcare Medicaid	$2,059.20
Rate for Payer: WPPA Medicare Advantage	$3,088.80

Implant HiMAX DynaForce Single Pack 18mm x 14mm x 14mm

Facility

$5,148.00

Hospital Charge Code	3258340
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,890.60
Rate for Payer: Aetna Commercial	$4,633.20
Rate for Payer: UnitedHealthcare Commercial	$4,890.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant HiMax DynaForce Staple Kit 18mm x 14mm x 14mm

Facility

$5,347.00

Hospital Charge Code	3258343
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,079.65
Rate for Payer: Aetna Commercial	$4,812.30
Rate for Payer: UnitedHealthcare Commercial	$5,079.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant HiMax DynaForce Staple Kit 18mm x 14mm x 14mm

Facility

$5,347.00

Hospital Charge Code	3258343
Hospital Revenue Code	270
Min. Negotiated Rate	$2,138.80
Max. Negotiated Rate	$5,079.65
Rate for Payer: Aetna Commercial	$4,812.30
Rate for Payer: Humana Medicare Advantage	$2,245.74
Rate for Payer: UnitedHealthcare Commercial	$5,079.65
Rate for Payer: UnitedHealthcare Medicaid	$2,138.80
Rate for Payer: WPPA Medicare Advantage	$3,208.20

Implant HiMax Staple Kit 25mm x 14mm x14mm

Facility

$5,347.00

Hospital Charge Code	3258333
Hospital Revenue Code	270
Min. Negotiated Rate	$2,138.80
Max. Negotiated Rate	$5,079.65
Rate for Payer: Aetna Commercial	$4,812.30
Rate for Payer: Humana Medicare Advantage	$2,245.74
Rate for Payer: UnitedHealthcare Commercial	$5,079.65
Rate for Payer: UnitedHealthcare Medicaid	$2,138.80
Rate for Payer: WPPA Medicare Advantage	$3,208.20

Implant HiMax Staple Kit 25mm x 14mm x14mm

Facility

$5,347.00

Hospital Charge Code	3258333
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,079.65
Rate for Payer: Aetna Commercial	$4,812.30
Rate for Payer: UnitedHealthcare Commercial	$5,079.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MiniBunion 3.5mm Offset Plate

Facility

$6,339.00

Hospital Charge Code	3258350
Hospital Revenue Code	270
Min. Negotiated Rate	$2,535.60
Max. Negotiated Rate	$6,022.05
Rate for Payer: Aetna Commercial	$5,705.10
Rate for Payer: Humana Medicare Advantage	$2,662.38
Rate for Payer: UnitedHealthcare Commercial	$6,022.05
Rate for Payer: UnitedHealthcare Medicaid	$2,535.60
Rate for Payer: WPPA Medicare Advantage	$3,803.40

Implant MiniBunion 3.5mm Offset Plate

Facility

$6,339.00

Hospital Charge Code	3258350
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,022.05
Rate for Payer: Aetna Commercial	$5,705.10
Rate for Payer: UnitedHealthcare Commercial	$6,022.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MiniBunion Locking Screw 3.0mm x 20mm

Facility

$768.00

Hospital Charge Code	3258353
Hospital Revenue Code	270
Min. Negotiated Rate	$691.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$691.20
Rate for Payer: UnitedHealthcare Commercial	$729.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MiniBunion Locking Screw 3.0mm x 20mm

Facility

$768.00

Hospital Charge Code	3258353
Hospital Revenue Code	270
Min. Negotiated Rate	$307.20
Max. Negotiated Rate	$729.60
Rate for Payer: Aetna Commercial	$691.20
Rate for Payer: Humana Medicare Advantage	$322.56
Rate for Payer: UnitedHealthcare Commercial	$729.60
Rate for Payer: UnitedHealthcare Medicaid	$307.20
Rate for Payer: WPPA Medicare Advantage	$460.80

Implant MiniBunion Locking Screw 3.0mm x 24mm

Facility

$768.00

Hospital Charge Code	3258352
Hospital Revenue Code	270
Min. Negotiated Rate	$307.20
Max. Negotiated Rate	$729.60
Rate for Payer: Aetna Commercial	$691.20
Rate for Payer: Humana Medicare Advantage	$322.56
Rate for Payer: UnitedHealthcare Commercial	$729.60
Rate for Payer: UnitedHealthcare Medicaid	$307.20
Rate for Payer: WPPA Medicare Advantage	$460.80

Implant MiniBunion Locking Screw 3.0mm x 24mm

Facility

$768.00

Hospital Charge Code	3258352
Hospital Revenue Code	270
Min. Negotiated Rate	$691.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$691.20
Rate for Payer: UnitedHealthcare Commercial	$729.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MiniBunion Non-Locking Screw

Facility

$697.00

Hospital Charge Code	3258351
Hospital Revenue Code	270
Min. Negotiated Rate	$278.80
Max. Negotiated Rate	$662.15
Rate for Payer: Aetna Commercial	$627.30
Rate for Payer: Humana Medicare Advantage	$292.74
Rate for Payer: UnitedHealthcare Commercial	$662.15
Rate for Payer: UnitedHealthcare Medicaid	$278.80
Rate for Payer: WPPA Medicare Advantage	$418.20

Implant MiniBunion Non-Locking Screw

Facility

$697.00

Hospital Charge Code	3258351
Hospital Revenue Code	270
Min. Negotiated Rate	$627.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$627.30
Rate for Payer: UnitedHealthcare Commercial	$662.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Implant MiniBunion Non-Locking Screw 2.7mm x 16mm

Facility

$697.00

Hospital Charge Code	3258354
Hospital Revenue Code	270
Min. Negotiated Rate	$627.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$627.30
Rate for Payer: UnitedHealthcare Commercial	$662.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges