Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

K-Wire 1.1 x 150 mm with TRC TIP (PK/5)

Facility

$606.30

Hospital Charge Code	3258573
Hospital Revenue Code	270
Min. Negotiated Rate	$545.67
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$545.67
Rate for Payer: UnitedHealthcare Commercial	$575.99
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-Wire 1.1 x 150 mm with TRC TIP (PK/5)

Facility

$606.30

Hospital Charge Code	3258573
Hospital Revenue Code	270
Min. Negotiated Rate	$242.52
Max. Negotiated Rate	$575.99
Rate for Payer: Aetna Commercial	$545.67
Rate for Payer: Humana Medicare Advantage	$254.65
Rate for Payer: UnitedHealthcare Commercial	$575.99
Rate for Payer: UnitedHealthcare Medicaid	$242.52
Rate for Payer: WPPA Medicare Advantage	$363.78

K-Wire 1.4mm X 150mm Blunt/Trocar

Facility

$165.00

Hospital Charge Code	3258586
Hospital Revenue Code	270
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-Wire 1.4mm X 150mm Blunt/Trocar

Facility

$165.00

Hospital Charge Code	3258586
Hospital Revenue Code	270
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$156.75
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Humana Medicare Advantage	$69.30
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicaid	$66.00
Rate for Payer: WPPA Medicare Advantage	$99.00

K-Wire 1.4 X 150mm Sterile

Facility

$165.00

Hospital Charge Code	3258594
Hospital Revenue Code	270
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-Wire 1.4 X 150mm Sterile

Facility

$165.00

Hospital Charge Code	3258594
Hospital Revenue Code	270
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$156.75
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Humana Medicare Advantage	$69.30
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicaid	$66.00
Rate for Payer: WPPA Medicare Advantage	$99.00

K-WIRE COCR 0.9 X 95MM

Facility

$115.15

Hospital Charge Code	3258131
Hospital Revenue Code	270
Min. Negotiated Rate	$103.64
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$103.64
Rate for Payer: UnitedHealthcare Commercial	$109.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-WIRE COCR 0.9 X 95MM

Facility

$115.15

Hospital Charge Code	3258131
Hospital Revenue Code	270
Min. Negotiated Rate	$46.06
Max. Negotiated Rate	$109.39
Rate for Payer: Aetna Commercial	$103.64
Rate for Payer: Humana Medicare Advantage	$48.36
Rate for Payer: UnitedHealthcare Commercial	$109.39
Rate for Payer: UnitedHealthcare Medicaid	$46.06
Rate for Payer: WPPA Medicare Advantage	$69.09

K-Wire Double Ended Trocar Tip 1.1mm x 150mm

Facility

$147.00

Hospital Charge Code	3258376
Hospital Revenue Code	270
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$139.65
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: Humana Medicare Advantage	$61.74
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: UnitedHealthcare Medicaid	$58.80
Rate for Payer: WPPA Medicare Advantage	$88.20

K-Wire Double Ended Trocar Tip 1.1mm x 150mm

Facility

$147.00

Hospital Charge Code	3258376
Hospital Revenue Code	270
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-Wire Double Ended Trocar Tip 1.4mm x 150mm

Facility

$147.00

Hospital Charge Code	3258377
Hospital Revenue Code	270
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$139.65
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: Humana Medicare Advantage	$61.74
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: UnitedHealthcare Medicaid	$58.80
Rate for Payer: WPPA Medicare Advantage	$88.20

K-Wire Double Ended Trocar Tip 1.4mm x 150mm

Facility

$147.00

Hospital Charge Code	3258377
Hospital Revenue Code	270
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-Wire Double Ended Trocar Tip 1.6mm x 30mm Blunt

Facility

$147.00

Hospital Charge Code	3258373
Hospital Revenue Code	270
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$139.65
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: Humana Medicare Advantage	$61.74
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: UnitedHealthcare Medicaid	$58.80
Rate for Payer: WPPA Medicare Advantage	$88.20

K-Wire Double Ended Trocar Tip 1.6mm x 30mm Blunt

Facility

$147.00

Hospital Charge Code	3258373
Hospital Revenue Code	270
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-Wires 1.6mm x 6

Facility

$714.00

Hospital Charge Code	3258330
Hospital Revenue Code	270
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$678.30
Rate for Payer: Aetna Commercial	$642.60
Rate for Payer: Humana Medicare Advantage	$299.88
Rate for Payer: UnitedHealthcare Commercial	$678.30
Rate for Payer: UnitedHealthcare Medicaid	$285.60
Rate for Payer: WPPA Medicare Advantage	$428.40

K-Wires 1.6mm x 6

Facility

$714.00

Hospital Charge Code	3258330
Hospital Revenue Code	270
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$642.60
Rate for Payer: UnitedHealthcare Commercial	$678.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-Wire Single Ended Trocar Tip Smooth 1.1 X 150mm

Facility

$147.00

Hospital Charge Code	3258318
Hospital Revenue Code	270
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

K-Wire Single Ended Trocar Tip Smooth 1.1 X 150mm

Facility

$147.00

Hospital Charge Code	3258318
Hospital Revenue Code	270
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$139.65
Rate for Payer: Aetna Commercial	$132.30
Rate for Payer: Humana Medicare Advantage	$61.74
Rate for Payer: UnitedHealthcare Commercial	$139.65
Rate for Payer: UnitedHealthcare Medicaid	$58.80
Rate for Payer: WPPA Medicare Advantage	$88.20

labetalol 100 mg Tab [HMC]

Facility

$6.20

Service Code	NDC 00904710961
Hospital Charge Code	3805930
Hospital Revenue Code	250
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.58
Rate for Payer: UnitedHealthcare Commercial	$5.89
Rate for Payer: WPPA Medicare Advantage	$1,200.00

labetalol 100 mg Tab [HMC]

Facility

$6.54

Service Code	NDC 68001038100
Hospital Charge Code	3805930
Hospital Revenue Code	250
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.89
Rate for Payer: UnitedHealthcare Commercial	$6.21
Rate for Payer: WPPA Medicare Advantage	$1,200.00

labetalol 100 mg Tab [HMC]

Facility

$7.02

Service Code	NDC 70377006012
Hospital Charge Code	3805930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: Humana Medicare Advantage	$2.95
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicaid	$2.81
Rate for Payer: WPPA Medicare Advantage	$4.21

labetalol 100 mg Tab [HMC]

Facility

$7.02

Service Code	NDC 68382079801
Hospital Charge Code	3805930
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: WPPA Medicare Advantage	$1,200.00

labetalol 100 mg Tab [HMC]

Facility

$7.02

Service Code	NDC 68382079801
Hospital Charge Code	3805930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: Humana Medicare Advantage	$2.95
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicaid	$2.81
Rate for Payer: WPPA Medicare Advantage	$4.21

labetalol 100 mg Tab [HMC]

Facility

$7.02

Service Code	NDC 70377006012
Hospital Charge Code	3805930
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: WPPA Medicare Advantage	$1,200.00

labetalol 100 mg Tab [HMC]

Facility

$6.54

Service Code	NDC 68001038100
Hospital Charge Code	3805930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$6.21
Rate for Payer: Aetna Commercial	$5.89
Rate for Payer: Humana Medicare Advantage	$2.75
Rate for Payer: UnitedHealthcare Commercial	$6.21
Rate for Payer: UnitedHealthcare Medicaid	$2.62
Rate for Payer: WPPA Medicare Advantage	$3.92

Know your out-of-pocket cost for care.

All Charges