Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Mesh Fixation Device Permanent CapSure 30 BD

Facility

$720.00

Hospital Charge Code	3258973
Hospital Revenue Code	270
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$684.00
Rate for Payer: Aetna Commercial	$648.00
Rate for Payer: Humana Medicare Advantage	$302.40
Rate for Payer: UnitedHealthcare Commercial	$684.00
Rate for Payer: UnitedHealthcare Medicaid	$288.00
Rate for Payer: WPPA Medicare Advantage	$432.00

Mesh Fixation Device Permanent CapSure 30 BD

Facility

$720.00

Hospital Charge Code	3258973
Hospital Revenue Code	270
Min. Negotiated Rate	$648.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$648.00
Rate for Payer: UnitedHealthcare Commercial	$684.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh Hernia ProGrip Self-Gripping Left Atatomical 12cm X 8cm

Facility

$873.00

Service Code	HCPCS C1781
Hospital Charge Code	3254560
Hospital Revenue Code	278
Min. Negotiated Rate	$349.20
Max. Negotiated Rate	$829.35
Rate for Payer: Aetna Commercial	$785.70
Rate for Payer: Humana Medicare Advantage	$366.66
Rate for Payer: UnitedHealthcare Commercial	$829.35
Rate for Payer: UnitedHealthcare Medicaid	$349.20
Rate for Payer: WPPA Medicare Advantage	$523.80

Mesh Hernia ProGrip Self-Gripping Left Atatomical 12cm X 8cm

Facility

$873.00

Service Code	HCPCS C1781
Hospital Charge Code	3254560
Hospital Revenue Code	278
Min. Negotiated Rate	$785.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$785.70
Rate for Payer: UnitedHealthcare Commercial	$829.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh Hernia ProGrip Self-Gripping Right Atatomical 12cm X 8cm

Facility

$873.00

Service Code	HCPCS C1781
Hospital Charge Code	3254561
Hospital Revenue Code	278
Min. Negotiated Rate	$785.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$785.70
Rate for Payer: UnitedHealthcare Commercial	$829.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh Hernia ProGrip Self-Gripping Right Atatomical 12cm X 8cm

Facility

$873.00

Service Code	HCPCS C1781
Hospital Charge Code	3254561
Hospital Revenue Code	278
Min. Negotiated Rate	$349.20
Max. Negotiated Rate	$829.35
Rate for Payer: Aetna Commercial	$785.70
Rate for Payer: Humana Medicare Advantage	$366.66
Rate for Payer: UnitedHealthcare Commercial	$829.35
Rate for Payer: UnitedHealthcare Medicaid	$349.20
Rate for Payer: WPPA Medicare Advantage	$523.80

MESH PLUG & PATCH LRG

Facility

$598.32

Service Code	HCPCS C1781
Hospital Charge Code	3257446
Hospital Revenue Code	278
Min. Negotiated Rate	$538.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$538.49
Rate for Payer: UnitedHealthcare Commercial	$568.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MESH PLUG & PATCH LRG

Facility

$598.32

Service Code	HCPCS C1781
Hospital Charge Code	3257446
Hospital Revenue Code	278
Min. Negotiated Rate	$239.33
Max. Negotiated Rate	$568.40
Rate for Payer: Aetna Commercial	$538.49
Rate for Payer: Humana Medicare Advantage	$251.29
Rate for Payer: UnitedHealthcare Commercial	$568.40
Rate for Payer: UnitedHealthcare Medicaid	$239.33
Rate for Payer: WPPA Medicare Advantage	$358.99

MESH PLUG & PATCH MEDIUM

Facility

$589.00

Service Code	HCPCS C1781
Hospital Charge Code	3257396
Hospital Revenue Code	278
Min. Negotiated Rate	$235.60
Max. Negotiated Rate	$559.55
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: Humana Medicare Advantage	$247.38
Rate for Payer: UnitedHealthcare Commercial	$559.55
Rate for Payer: UnitedHealthcare Medicaid	$235.60
Rate for Payer: WPPA Medicare Advantage	$353.40

MESH PLUG & PATCH MEDIUM

Facility

$589.00

Service Code	HCPCS C1781
Hospital Charge Code	3257396
Hospital Revenue Code	278
Min. Negotiated Rate	$530.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: UnitedHealthcare Commercial	$559.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MESH PLUG & PATCH SMALL

Facility

$559.00

Service Code	HCPCS C1781
Hospital Charge Code	3252107
Hospital Revenue Code	278
Min. Negotiated Rate	$223.60
Max. Negotiated Rate	$531.05
Rate for Payer: Aetna Commercial	$503.10
Rate for Payer: Humana Medicare Advantage	$234.78
Rate for Payer: UnitedHealthcare Commercial	$531.05
Rate for Payer: UnitedHealthcare Medicaid	$223.60
Rate for Payer: WPPA Medicare Advantage	$335.40

MESH PLUG & PATCH SMALL

Facility

$559.00

Service Code	HCPCS C1781
Hospital Charge Code	3252107
Hospital Revenue Code	278
Min. Negotiated Rate	$503.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$503.10
Rate for Payer: UnitedHealthcare Commercial	$531.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MESH PROLENE 3X6

Facility

$291.00

Hospital Charge Code	3253873
Hospital Revenue Code	278
Min. Negotiated Rate	$261.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$261.90
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

MESH PROLENE 3X6

Facility

$291.00

Hospital Charge Code	3253873
Hospital Revenue Code	278
Min. Negotiated Rate	$116.40
Max. Negotiated Rate	$276.45
Rate for Payer: Aetna Commercial	$261.90
Rate for Payer: Humana Medicare Advantage	$122.22
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: UnitedHealthcare Medicaid	$116.40
Rate for Payer: WPPA Medicare Advantage	$174.60

Mesh Sepramesh 12 X 14 Rectangle

Facility

$3,800.00

Hospital Charge Code	3253863
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,610.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: UnitedHealthcare Commercial	$3,610.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh Sepramesh 12 X 14 Rectangle

Facility

$3,800.00

Hospital Charge Code	3253863
Hospital Revenue Code	270
Min. Negotiated Rate	$1,520.00
Max. Negotiated Rate	$3,610.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Humana Medicare Advantage	$1,596.00
Rate for Payer: UnitedHealthcare Commercial	$3,610.00
Rate for Payer: UnitedHealthcare Medicaid	$1,520.00
Rate for Payer: WPPA Medicare Advantage	$2,280.00

Mesh Sepramesh 3 X 6 Rectangle

Facility

$157.50

Hospital Charge Code	3253861
Hospital Revenue Code	270
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$141.75
Rate for Payer: UnitedHealthcare Commercial	$149.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh Sepramesh 3 X 6 Rectangle

Facility

$157.50

Hospital Charge Code	3253861
Hospital Revenue Code	270
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$149.62
Rate for Payer: Aetna Commercial	$141.75
Rate for Payer: Humana Medicare Advantage	$66.15
Rate for Payer: UnitedHealthcare Commercial	$149.62
Rate for Payer: UnitedHealthcare Medicaid	$63.00
Rate for Payer: WPPA Medicare Advantage	$94.50

Mesh Sepramesh 6 X 8 Rectangle

Facility

$1,565.00

Hospital Charge Code	3253862
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,486.75
Rate for Payer: Aetna Commercial	$1,408.50
Rate for Payer: UnitedHealthcare Commercial	$1,486.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh Sepramesh 6 X 8 Rectangle

Facility

$1,565.00

Hospital Charge Code	3253862
Hospital Revenue Code	270
Min. Negotiated Rate	$626.00
Max. Negotiated Rate	$1,486.75
Rate for Payer: Aetna Commercial	$1,408.50
Rate for Payer: Humana Medicare Advantage	$657.30
Rate for Payer: UnitedHealthcare Commercial	$1,486.75
Rate for Payer: UnitedHealthcare Medicaid	$626.00
Rate for Payer: WPPA Medicare Advantage	$939.00

Mesh Sepramesh 8 X 12 Rectangle

Facility

$2,053.40

Hospital Charge Code	3253860
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,950.73
Rate for Payer: Aetna Commercial	$1,848.06
Rate for Payer: UnitedHealthcare Commercial	$1,950.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh Sepramesh 8 X 12 Rectangle

Facility

$2,053.40

Hospital Charge Code	3253860
Hospital Revenue Code	270
Min. Negotiated Rate	$821.36
Max. Negotiated Rate	$1,950.73
Rate for Payer: Aetna Commercial	$1,848.06
Rate for Payer: Humana Medicare Advantage	$862.43
Rate for Payer: UnitedHealthcare Commercial	$1,950.73
Rate for Payer: UnitedHealthcare Medicaid	$821.36
Rate for Payer: WPPA Medicare Advantage	$1,232.04

Mesh Soft Pre-Shaped Large Keyhole Davol

Facility

$370.00

Service Code	HCPCS C1781
Hospital Charge Code	3253878
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$351.50
Rate for Payer: Aetna Commercial	$333.00
Rate for Payer: Humana Medicare Advantage	$155.40
Rate for Payer: UnitedHealthcare Commercial	$351.50
Rate for Payer: UnitedHealthcare Medicaid	$148.00
Rate for Payer: WPPA Medicare Advantage	$222.00

Mesh Soft Pre-Shaped Large Keyhole Davol

Facility

$370.00

Service Code	HCPCS C1781
Hospital Charge Code	3253878
Hospital Revenue Code	278
Min. Negotiated Rate	$333.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$333.00
Rate for Payer: UnitedHealthcare Commercial	$351.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Mesh SurgiMesh Easy Plug

Facility

$919.00

Service Code	HCPCS C1781
Hospital Charge Code	3254565
Hospital Revenue Code	278
Min. Negotiated Rate	$827.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$827.10
Rate for Payer: UnitedHealthcare Commercial	$873.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges