Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Needle EMG Electrode Boject/Myoject DHN Natus 37mm X 27G

Facility

$116.00

Hospital Charge Code	3253874
Hospital Revenue Code	270
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$110.20
Rate for Payer: Aetna Commercial	$104.40
Rate for Payer: Humana Medicare Advantage	$48.72
Rate for Payer: UnitedHealthcare Commercial	$110.20
Rate for Payer: UnitedHealthcare Medicaid	$46.40
Rate for Payer: WPPA Medicare Advantage	$69.60

Needle EZ-IO Adult Intraosseous Vascular Access - BLUE

Facility

$430.00

Hospital Charge Code	3259840
Hospital Revenue Code	541
Min. Negotiated Rate	$172.00
Max. Negotiated Rate	$408.50
Rate for Payer: Aetna Commercial	$387.00
Rate for Payer: Humana Medicare Advantage	$180.60
Rate for Payer: UnitedHealthcare Commercial	$408.50
Rate for Payer: UnitedHealthcare Medicaid	$172.00
Rate for Payer: WPPA Medicare Advantage	$258.00

Needle EZ-IO Adult Intraosseous Vascular Access - BLUE

Facility

$430.00

Hospital Charge Code	3259840
Hospital Revenue Code	541
Min. Negotiated Rate	$387.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$387.00
Rate for Payer: UnitedHealthcare Commercial	$408.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle EZ-IO Adult IV Access

Facility

$452.00

Hospital Charge Code	3259840
Hospital Revenue Code	541
Min. Negotiated Rate	$406.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$406.80
Rate for Payer: UnitedHealthcare Commercial	$429.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle EZ-IO Adult IV Access

Facility

$452.00

Hospital Charge Code	3259840
Hospital Revenue Code	541
Min. Negotiated Rate	$180.80
Max. Negotiated Rate	$429.40
Rate for Payer: Aetna Commercial	$406.80
Rate for Payer: Humana Medicare Advantage	$189.84
Rate for Payer: UnitedHealthcare Commercial	$429.40
Rate for Payer: UnitedHealthcare Medicaid	$180.80
Rate for Payer: WPPA Medicare Advantage	$271.20

Needle EZ-IO Large Adult Intraosseous Vascular Access - YELLOW

Facility

$430.00

Hospital Charge Code	3259845
Hospital Revenue Code	541
Min. Negotiated Rate	$172.00
Max. Negotiated Rate	$408.50
Rate for Payer: Aetna Commercial	$387.00
Rate for Payer: Humana Medicare Advantage	$180.60
Rate for Payer: UnitedHealthcare Commercial	$408.50
Rate for Payer: UnitedHealthcare Medicaid	$172.00
Rate for Payer: WPPA Medicare Advantage	$258.00

Needle EZ-IO Large Adult Intraosseous Vascular Access - YELLOW

Facility

$430.00

Hospital Charge Code	3259845
Hospital Revenue Code	541
Min. Negotiated Rate	$387.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$387.00
Rate for Payer: UnitedHealthcare Commercial	$408.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle EZ-IO Large Adult IV Access

Facility

$452.00

Hospital Charge Code	3259845
Hospital Revenue Code	541
Min. Negotiated Rate	$180.80
Max. Negotiated Rate	$429.40
Rate for Payer: Aetna Commercial	$406.80
Rate for Payer: Humana Medicare Advantage	$189.84
Rate for Payer: UnitedHealthcare Commercial	$429.40
Rate for Payer: UnitedHealthcare Medicaid	$180.80
Rate for Payer: WPPA Medicare Advantage	$271.20

Needle EZ-IO Large Adult IV Access

Facility

$452.00

Hospital Charge Code	3259845
Hospital Revenue Code	541
Min. Negotiated Rate	$406.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$406.80
Rate for Payer: UnitedHealthcare Commercial	$429.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle EZ-IO Pediatric Intraosseous Vascular Access - PINK

Facility

$430.00

Hospital Charge Code	3259835
Hospital Revenue Code	541
Min. Negotiated Rate	$172.00
Max. Negotiated Rate	$408.50
Rate for Payer: Aetna Commercial	$387.00
Rate for Payer: Humana Medicare Advantage	$180.60
Rate for Payer: UnitedHealthcare Commercial	$408.50
Rate for Payer: UnitedHealthcare Medicaid	$172.00
Rate for Payer: WPPA Medicare Advantage	$258.00

Needle EZ-IO Pediatric Intraosseous Vascular Access - PINK

Facility

$430.00

Hospital Charge Code	3259835
Hospital Revenue Code	541
Min. Negotiated Rate	$387.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$387.00
Rate for Payer: UnitedHealthcare Commercial	$408.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle EZ-IO Pediatric IV Access

Facility

$414.00

Hospital Charge Code	3259835
Hospital Revenue Code	541
Min. Negotiated Rate	$165.60
Max. Negotiated Rate	$393.30
Rate for Payer: Aetna Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$173.88
Rate for Payer: UnitedHealthcare Commercial	$393.30
Rate for Payer: UnitedHealthcare Medicaid	$165.60
Rate for Payer: WPPA Medicare Advantage	$248.40

Needle EZ-IO Pediatric IV Access

Facility

$414.00

Hospital Charge Code	3259835
Hospital Revenue Code	541
Min. Negotiated Rate	$372.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$372.60
Rate for Payer: UnitedHealthcare Commercial	$393.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Kopans Breast Lesion Localization 20G x 9 cm with Echo Tip

Facility

$118.80

Hospital Charge Code	3255664
Hospital Revenue Code	270
Min. Negotiated Rate	$47.52
Max. Negotiated Rate	$112.86
Rate for Payer: Aetna Commercial	$106.92
Rate for Payer: Humana Medicare Advantage	$49.90
Rate for Payer: UnitedHealthcare Commercial	$112.86
Rate for Payer: UnitedHealthcare Medicaid	$47.52
Rate for Payer: WPPA Medicare Advantage	$71.28

Needle Kopans Breast Lesion Localization 20G x 9 cm with Echo Tip

Facility

$118.80

Hospital Charge Code	3255664
Hospital Revenue Code	270
Min. Negotiated Rate	$106.92
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$106.92
Rate for Payer: UnitedHealthcare Commercial	$112.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Port Access Non-Safety 20G X 1 90 Degree

Facility

$12.00

Hospital Charge Code	3257855
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$11.40
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: Humana Medicare Advantage	$5.04
Rate for Payer: UnitedHealthcare Commercial	$11.40
Rate for Payer: UnitedHealthcare Medicaid	$4.80
Rate for Payer: WPPA Medicare Advantage	$7.20

Needle Port Access Non-Safety 20G X 1 90 Degree

Facility

$12.00

Hospital Charge Code	3257855
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: UnitedHealthcare Commercial	$11.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Port Access Safety 20G X 0.75 90 Degree

Facility

$27.05

Hospital Charge Code	3252198
Hospital Revenue Code	270
Min. Negotiated Rate	$10.82
Max. Negotiated Rate	$25.70
Rate for Payer: Aetna Commercial	$24.34
Rate for Payer: Humana Medicare Advantage	$11.36
Rate for Payer: UnitedHealthcare Commercial	$25.70
Rate for Payer: UnitedHealthcare Medicaid	$10.82
Rate for Payer: WPPA Medicare Advantage	$16.23

Needle Port Access Safety 20G X 0.75 90 Degree

Facility

$27.05

Hospital Charge Code	3252198
Hospital Revenue Code	270
Min. Negotiated Rate	$24.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.34
Rate for Payer: UnitedHealthcare Commercial	$25.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Port Access Safety 20G X 1.5 90 Degree

Facility

$28.13

Hospital Charge Code	3257842
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$26.72
Rate for Payer: Aetna Commercial	$25.32
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: UnitedHealthcare Commercial	$26.72
Rate for Payer: UnitedHealthcare Medicaid	$11.25
Rate for Payer: WPPA Medicare Advantage	$16.88

Needle Port Access Safety 20G X 1.5 90 Degree

Facility

$28.13

Hospital Charge Code	3257842
Hospital Revenue Code	270
Min. Negotiated Rate	$25.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.32
Rate for Payer: UnitedHealthcare Commercial	$26.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Port Access Safety 20G X 1 90 Degree

Facility

$28.13

Hospital Charge Code	3252196
Hospital Revenue Code	270
Min. Negotiated Rate	$25.32
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.32
Rate for Payer: UnitedHealthcare Commercial	$26.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Needle Port Access Safety 20G X 1 90 Degree

Facility

$28.13

Hospital Charge Code	3252196
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$26.72
Rate for Payer: Aetna Commercial	$25.32
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: UnitedHealthcare Commercial	$26.72
Rate for Payer: UnitedHealthcare Medicaid	$11.25
Rate for Payer: WPPA Medicare Advantage	$16.88

Needle RAN 27G x 3.5 Reinforced Anesthesia Needle

Facility

$124.99

Hospital Charge Code	3255165
Hospital Revenue Code	270
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$118.74
Rate for Payer: Aetna Commercial	$112.49
Rate for Payer: Humana Medicare Advantage	$52.50
Rate for Payer: UnitedHealthcare Commercial	$118.74
Rate for Payer: UnitedHealthcare Medicaid	$50.00
Rate for Payer: WPPA Medicare Advantage	$74.99

Needle RAN 27G x 3.5 Reinforced Anesthesia Needle

Facility

$124.99

Hospital Charge Code	3255165
Hospital Revenue Code	270
Min. Negotiated Rate	$112.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$112.49
Rate for Payer: UnitedHealthcare Commercial	$118.74
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges