Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

PeritX Peritoneal Indwelling Catheter formerly PleurX Peritoneal for Ascite Mngt

Facility

$3,794.00

Hospital Charge Code	3252063
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,604.30
Rate for Payer: Aetna Commercial	$3,414.60
Rate for Payer: UnitedHealthcare Commercial	$3,604.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PeritX Peritoneal Indwelling Catheter formerly PleurX Peritoneal for Ascite Mngt

Facility

$3,794.00

Hospital Charge Code	3252063
Hospital Revenue Code	270
Min. Negotiated Rate	$1,517.60
Max. Negotiated Rate	$3,604.30
Rate for Payer: Aetna Commercial	$3,414.60
Rate for Payer: Humana Medicare Advantage	$1,593.48
Rate for Payer: UnitedHealthcare Commercial	$3,604.30
Rate for Payer: UnitedHealthcare Medicaid	$1,517.60
Rate for Payer: WPPA Medicare Advantage	$2,276.40

PERL Ring Localization Device 1.5 cm

Facility

$1,047.00

Hospital Charge Code	3250471
Hospital Revenue Code	270
Min. Negotiated Rate	$418.80
Max. Negotiated Rate	$994.65
Rate for Payer: Aetna Commercial	$942.30
Rate for Payer: Humana Medicare Advantage	$439.74
Rate for Payer: UnitedHealthcare Commercial	$994.65
Rate for Payer: UnitedHealthcare Medicaid	$418.80
Rate for Payer: WPPA Medicare Advantage	$628.20

PERL Ring Localization Device 1.5 cm

Facility

$1,047.00

Hospital Charge Code	3250471
Hospital Revenue Code	270
Min. Negotiated Rate	$942.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$942.30
Rate for Payer: UnitedHealthcare Commercial	$994.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Permacath Kit 19cm Pre-Curved Palindrome Precision Catheter

Facility

$693.00

Hospital Charge Code	3256610
Hospital Revenue Code	270
Min. Negotiated Rate	$623.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$623.70
Rate for Payer: UnitedHealthcare Commercial	$658.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Permacath Kit 19cm Pre-Curved Palindrome Precision Catheter

Facility

$693.00

Hospital Charge Code	3256610
Hospital Revenue Code	270
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$658.35
Rate for Payer: Aetna Commercial	$623.70
Rate for Payer: Humana Medicare Advantage	$291.06
Rate for Payer: UnitedHealthcare Commercial	$658.35
Rate for Payer: UnitedHealthcare Medicaid	$277.20
Rate for Payer: WPPA Medicare Advantage	$415.80

Permacath Kit 23cm Pre-Curved Palindrome Precision Catheter

Facility

$693.00

Hospital Charge Code	3256615
Hospital Revenue Code	270
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$658.35
Rate for Payer: Aetna Commercial	$623.70
Rate for Payer: Humana Medicare Advantage	$291.06
Rate for Payer: UnitedHealthcare Commercial	$658.35
Rate for Payer: UnitedHealthcare Medicaid	$277.20
Rate for Payer: WPPA Medicare Advantage	$415.80

Permacath Kit 23cm Pre-Curved Palindrome Precision Catheter

Facility

$693.00

Hospital Charge Code	3256615
Hospital Revenue Code	270
Min. Negotiated Rate	$623.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$623.70
Rate for Payer: UnitedHealthcare Commercial	$658.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$7,243.56

Service Code	MSDRG 243
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,243.56
Rate for Payer: UnitedHealthcare Medicaid	$7,243.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$7,593.03

Service Code	MSDRG 242
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,593.03
Rate for Payer: UnitedHealthcare Medicaid	$7,593.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$6,894.09

Service Code	MSDRG 244
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,894.09
Rate for Payer: UnitedHealthcare Medicaid	$6,894.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pessary Incontinence Ring Size 2 2-1/4

Facility

$241.00

Hospital Charge Code	3258801
Hospital Revenue Code	270
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$228.95
Rate for Payer: Aetna Commercial	$216.90
Rate for Payer: Humana Medicare Advantage	$101.22
Rate for Payer: UnitedHealthcare Commercial	$228.95
Rate for Payer: UnitedHealthcare Medicaid	$96.40
Rate for Payer: WPPA Medicare Advantage	$144.60

Pessary Incontinence Ring Size 2 2-1/4

Facility

$241.00

Hospital Charge Code	3258801
Hospital Revenue Code	270
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$216.90
Rate for Payer: UnitedHealthcare Commercial	$228.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pessary Ring Size 2

Facility

$241.00

Hospital Charge Code	3258815
Hospital Revenue Code	270
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$228.95
Rate for Payer: Aetna Commercial	$216.90
Rate for Payer: Humana Medicare Advantage	$101.22
Rate for Payer: UnitedHealthcare Commercial	$228.95
Rate for Payer: UnitedHealthcare Medicaid	$96.40
Rate for Payer: WPPA Medicare Advantage	$144.60

Pessary Ring Size 2

Facility

$241.00

Hospital Charge Code	3258815
Hospital Revenue Code	270
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$216.90
Rate for Payer: UnitedHealthcare Commercial	$228.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pessary Ring Size 3

Facility

$175.60

Hospital Charge Code	3258800
Hospital Revenue Code	270
Min. Negotiated Rate	$70.24
Max. Negotiated Rate	$166.82
Rate for Payer: Aetna Commercial	$158.04
Rate for Payer: Humana Medicare Advantage	$73.75
Rate for Payer: UnitedHealthcare Commercial	$166.82
Rate for Payer: UnitedHealthcare Medicaid	$70.24
Rate for Payer: WPPA Medicare Advantage	$105.36

Pessary Ring Size 3

Facility

$175.60

Hospital Charge Code	3258800
Hospital Revenue Code	270
Min. Negotiated Rate	$158.04
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$158.04
Rate for Payer: UnitedHealthcare Commercial	$166.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pessary Ring Size 4

Facility

$175.60

Hospital Charge Code	3258805
Hospital Revenue Code	270
Min. Negotiated Rate	$158.04
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$158.04
Rate for Payer: UnitedHealthcare Commercial	$166.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pessary Ring Size 4

Facility

$175.60

Hospital Charge Code	3258805
Hospital Revenue Code	270
Min. Negotiated Rate	$70.24
Max. Negotiated Rate	$166.82
Rate for Payer: Aetna Commercial	$158.04
Rate for Payer: Humana Medicare Advantage	$73.75
Rate for Payer: UnitedHealthcare Commercial	$166.82
Rate for Payer: UnitedHealthcare Medicaid	$70.24
Rate for Payer: WPPA Medicare Advantage	$105.36

Pessary Ring Size 5

Facility

$175.60

Hospital Charge Code	3258810
Hospital Revenue Code	270
Min. Negotiated Rate	$158.04
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$158.04
Rate for Payer: UnitedHealthcare Commercial	$166.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pessary Ring Size 5

Facility

$175.60

Hospital Charge Code	3258810
Hospital Revenue Code	270
Min. Negotiated Rate	$70.24
Max. Negotiated Rate	$166.82
Rate for Payer: Aetna Commercial	$158.04
Rate for Payer: Humana Medicare Advantage	$73.75
Rate for Payer: UnitedHealthcare Commercial	$166.82
Rate for Payer: UnitedHealthcare Medicaid	$70.24
Rate for Payer: WPPA Medicare Advantage	$105.36

Pessary Ring Size 6

Facility

$232.00

Hospital Charge Code	3258811
Hospital Revenue Code	270
Min. Negotiated Rate	$208.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$208.80
Rate for Payer: UnitedHealthcare Commercial	$220.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pessary Ring Size 6

Facility

$232.00

Hospital Charge Code	3258811
Hospital Revenue Code	270
Min. Negotiated Rate	$92.80
Max. Negotiated Rate	$220.40
Rate for Payer: Aetna Commercial	$208.80
Rate for Payer: Humana Medicare Advantage	$97.44
Rate for Payer: UnitedHealthcare Commercial	$220.40
Rate for Payer: UnitedHealthcare Medicaid	$92.80
Rate for Payer: WPPA Medicare Advantage	$139.20

Pessary Ring Size 7

Facility

$232.00

Hospital Charge Code	3258813
Hospital Revenue Code	270
Min. Negotiated Rate	$92.80
Max. Negotiated Rate	$220.40
Rate for Payer: Aetna Commercial	$208.80
Rate for Payer: Humana Medicare Advantage	$97.44
Rate for Payer: UnitedHealthcare Commercial	$220.40
Rate for Payer: UnitedHealthcare Medicaid	$92.80
Rate for Payer: WPPA Medicare Advantage	$139.20

Pessary Ring Size 7

Facility

$232.00

Hospital Charge Code	3258813
Hospital Revenue Code	270
Min. Negotiated Rate	$208.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$208.80
Rate for Payer: UnitedHealthcare Commercial	$220.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges