Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Stapler Reload 45mm White Lap Powered Articulating Echelon Flex

Facility

$735.87

Hospital Charge Code	3251021
Hospital Revenue Code	270
Min. Negotiated Rate	$294.35
Max. Negotiated Rate	$699.08
Rate for Payer: Aetna Commercial	$662.28
Rate for Payer: Humana Medicare Advantage	$309.07
Rate for Payer: UnitedHealthcare Commercial	$699.08
Rate for Payer: UnitedHealthcare Medicaid	$294.35
Rate for Payer: WPPA Medicare Advantage	$441.52

Stapler Reload 45mm White Lap Powered Articulating Echelon Flex

Facility

$735.87

Hospital Charge Code	3251021
Hospital Revenue Code	270
Min. Negotiated Rate	$662.28
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$662.28
Rate for Payer: UnitedHealthcare Commercial	$699.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stapler Reload 60mm Blue Lap Powered Articulating Echelon Flex

Facility

$663.08

Hospital Charge Code	3251017
Hospital Revenue Code	270
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$629.93
Rate for Payer: Aetna Commercial	$596.77
Rate for Payer: Humana Medicare Advantage	$278.49
Rate for Payer: UnitedHealthcare Commercial	$629.93
Rate for Payer: UnitedHealthcare Medicaid	$265.23
Rate for Payer: WPPA Medicare Advantage	$397.85

Stapler Reload 60mm Blue Lap Powered Articulating Echelon Flex

Facility

$663.08

Hospital Charge Code	3251017
Hospital Revenue Code	270
Min. Negotiated Rate	$596.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$596.77
Rate for Payer: UnitedHealthcare Commercial	$629.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stapler Reload 60mm White Lap Powered Articulating Echelon Flex

Facility

$663.08

Hospital Charge Code	3251016
Hospital Revenue Code	270
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$629.93
Rate for Payer: Aetna Commercial	$596.77
Rate for Payer: Humana Medicare Advantage	$278.49
Rate for Payer: UnitedHealthcare Commercial	$629.93
Rate for Payer: UnitedHealthcare Medicaid	$265.23
Rate for Payer: WPPA Medicare Advantage	$397.85

Stapler Reload 60mm White Lap Powered Articulating Echelon Flex

Facility

$663.08

Hospital Charge Code	3251016
Hospital Revenue Code	270
Min. Negotiated Rate	$596.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$596.77
Rate for Payer: UnitedHealthcare Commercial	$629.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stapler Reload Curved Blue Cutter Contour

Facility

$664.00

Hospital Charge Code	3251051
Hospital Revenue Code	270
Min. Negotiated Rate	$265.60
Max. Negotiated Rate	$630.80
Rate for Payer: Aetna Commercial	$597.60
Rate for Payer: Humana Medicare Advantage	$278.88
Rate for Payer: UnitedHealthcare Commercial	$630.80
Rate for Payer: UnitedHealthcare Medicaid	$265.60
Rate for Payer: WPPA Medicare Advantage	$398.40

Stapler Reload Curved Blue Cutter Contour

Facility

$664.00

Hospital Charge Code	3251051
Hospital Revenue Code	270
Min. Negotiated Rate	$597.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$597.60
Rate for Payer: UnitedHealthcare Commercial	$630.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stapler Reloads Blue 75mm Linear Cuttler Open Proximate

Facility

$340.83

Hospital Charge Code	3251002
Hospital Revenue Code	270
Min. Negotiated Rate	$306.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$306.75
Rate for Payer: UnitedHealthcare Commercial	$323.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stapler Reloads Blue 75mm Linear Cuttler Open Proximate

Facility

$340.83

Hospital Charge Code	3251002
Hospital Revenue Code	270
Min. Negotiated Rate	$136.33
Max. Negotiated Rate	$323.79
Rate for Payer: Aetna Commercial	$306.75
Rate for Payer: Humana Medicare Advantage	$143.15
Rate for Payer: UnitedHealthcare Commercial	$323.79
Rate for Payer: UnitedHealthcare Medicaid	$136.33
Rate for Payer: WPPA Medicare Advantage	$204.50

Stapler Skin 30 Insorb Absorbable Staple

Facility

$159.00

Hospital Charge Code	3253563
Hospital Revenue Code	270
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$151.05
Rate for Payer: Aetna Commercial	$143.10
Rate for Payer: Humana Medicare Advantage	$66.78
Rate for Payer: UnitedHealthcare Commercial	$151.05
Rate for Payer: UnitedHealthcare Medicaid	$63.60
Rate for Payer: WPPA Medicare Advantage	$95.40

Stapler Skin 30 Insorb Absorbable Staple

Facility

$159.00

Hospital Charge Code	3253563
Hospital Revenue Code	270
Min. Negotiated Rate	$143.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$143.10
Rate for Payer: UnitedHealthcare Commercial	$151.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stapler Skin 35 Regular

Facility

$28.76

Hospital Charge Code	3253560
Hospital Revenue Code	270
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$27.32
Rate for Payer: Aetna Commercial	$25.88
Rate for Payer: Humana Medicare Advantage	$12.08
Rate for Payer: UnitedHealthcare Commercial	$27.32
Rate for Payer: UnitedHealthcare Medicaid	$11.50
Rate for Payer: WPPA Medicare Advantage	$17.26

Stapler Skin 35 Regular

Facility

$28.76

Hospital Charge Code	3253560
Hospital Revenue Code	270
Min. Negotiated Rate	$25.88
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.88
Rate for Payer: UnitedHealthcare Commercial	$27.32
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stapler Skin 35 Wide

Facility

$20.52

Hospital Charge Code	3253561
Hospital Revenue Code	270
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$19.49
Rate for Payer: Aetna Commercial	$18.47
Rate for Payer: Humana Medicare Advantage	$8.62
Rate for Payer: UnitedHealthcare Commercial	$19.49
Rate for Payer: UnitedHealthcare Medicaid	$8.21
Rate for Payer: WPPA Medicare Advantage	$12.31

Stapler Skin 35 Wide

Facility

$20.52

Hospital Charge Code	3253561
Hospital Revenue Code	270
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.47
Rate for Payer: UnitedHealthcare Commercial	$19.49
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Stapler Skin 35 Wide Gun Style

Facility

$34.65

Hospital Charge Code	3253562
Hospital Revenue Code	270
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$32.92
Rate for Payer: Aetna Commercial	$31.18
Rate for Payer: Humana Medicare Advantage	$14.55
Rate for Payer: UnitedHealthcare Commercial	$32.92
Rate for Payer: UnitedHealthcare Medicaid	$13.86
Rate for Payer: WPPA Medicare Advantage	$20.79

Stapler Skin 35 Wide Gun Style

Facility

$34.65

Hospital Charge Code	3253562
Hospital Revenue Code	270
Min. Negotiated Rate	$31.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.18
Rate for Payer: UnitedHealthcare Commercial	$32.92
Rate for Payer: WPPA Medicare Advantage	$1,200.00

STERILE TOWEL

Facility

$7.00

Hospital Charge Code	3252207
Hospital Revenue Code	270
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.65
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Humana Medicare Advantage	$2.94
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: WPPA Medicare Advantage	$4.20

STERILE TOWEL

Facility

$7.00

Hospital Charge Code	3252207
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sterile water 500 mL Sol [HMC]

Facility

$35.36

Service Code	HCPCS A4217
Hospital Charge Code	3256945
Hospital Revenue Code	272
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.82
Rate for Payer: UnitedHealthcare Commercial	$33.59
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sterile water 500 mL Sol [HMC]

Facility

$35.36

Service Code	HCPCS A4217
Hospital Charge Code	3256945
Hospital Revenue Code	272
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$33.59
Rate for Payer: Aetna Commercial	$31.82
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3.34
Rate for Payer: Humana Medicare Advantage	$14.85
Rate for Payer: UnitedHealthcare Commercial	$33.59
Rate for Payer: UnitedHealthcare Medicaid	$14.14
Rate for Payer: WPPA Medicare Advantage	$21.22

Sterile Water for Inhalation 1000ml [HMC]

Facility

$17.00

Service Code	NDC 10083350332
Hospital Charge Code	3254237
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$16.15
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Humana Medicare Advantage	$7.14
Rate for Payer: UnitedHealthcare Commercial	$16.15
Rate for Payer: UnitedHealthcare Medicaid	$6.80
Rate for Payer: WPPA Medicare Advantage	$10.20

Sterile Water for Inhalation 1000ml [HMC]

Facility

$17.00

Service Code	NDC 10083350332
Hospital Charge Code	3254237
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: UnitedHealthcare Commercial	$16.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

sterile water for irrigation 1000 mL - Sol [HMC]

Facility

$35.50

Service Code	HCPCS A4217
Hospital Charge Code	3256945
Hospital Revenue Code	272
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$33.73
Rate for Payer: Aetna Commercial	$31.95
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3.34
Rate for Payer: Humana Medicare Advantage	$14.91
Rate for Payer: UnitedHealthcare Commercial	$33.73
Rate for Payer: UnitedHealthcare Medicaid	$14.20
Rate for Payer: WPPA Medicare Advantage	$21.30

Know your out-of-pocket cost for care.

All Charges