Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suction Canister 1200CC

Facility

$6.75

Hospital Charge Code	3259014
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.41
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Humana Medicare Advantage	$2.83
Rate for Payer: UnitedHealthcare Commercial	$6.41
Rate for Payer: UnitedHealthcare Medicaid	$2.70
Rate for Payer: WPPA Medicare Advantage	$4.05

Suction Canister 1200CC

Facility

$6.75

Hospital Charge Code	3259014
Hospital Revenue Code	270
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: UnitedHealthcare Commercial	$6.41
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Cath 10FR

Facility

$3.29

Hospital Charge Code	3259350
Hospital Revenue Code	270
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.96
Rate for Payer: UnitedHealthcare Commercial	$3.13
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Cath 10FR

Facility

$3.29

Hospital Charge Code	3259350
Hospital Revenue Code	270
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$2.96
Rate for Payer: Humana Medicare Advantage	$1.38
Rate for Payer: UnitedHealthcare Commercial	$3.13
Rate for Payer: UnitedHealthcare Medicaid	$1.32
Rate for Payer: WPPA Medicare Advantage	$1.97

Suction Cath 12FR

Facility

$4.77

Hospital Charge Code	3251448
Hospital Revenue Code	270
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.29
Rate for Payer: UnitedHealthcare Commercial	$4.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Cath 12FR

Facility

$4.77

Hospital Charge Code	3251448
Hospital Revenue Code	270
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.53
Rate for Payer: Aetna Commercial	$4.29
Rate for Payer: Humana Medicare Advantage	$2.00
Rate for Payer: UnitedHealthcare Commercial	$4.53
Rate for Payer: UnitedHealthcare Medicaid	$1.91
Rate for Payer: WPPA Medicare Advantage	$2.86

Suction Cath 14 FR

Facility

$3.00

Hospital Charge Code	3255697
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Humana Medicare Advantage	$1.26
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: WPPA Medicare Advantage	$1.80

Suction Cath 14 FR

Facility

$3.00

Hospital Charge Code	3255697
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Cath 16 FR

Facility

$3.00

Hospital Charge Code	3259368
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Humana Medicare Advantage	$1.26
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: WPPA Medicare Advantage	$1.80

Suction Cath 16 FR

Facility

$3.00

Hospital Charge Code	3259368
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Cath 18 FR

Facility

$3.00

Hospital Charge Code	3257826
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Humana Medicare Advantage	$1.26
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: WPPA Medicare Advantage	$1.80

Suction Cath 18 FR

Facility

$3.00

Hospital Charge Code	3257826
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Cath 6FR - with Chimney Valve

Facility

$2.50

Hospital Charge Code	3250143
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Cath 6FR - with Chimney Valve

Facility

$2.50

Hospital Charge Code	3250143
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Suction Cath 8FR

Facility

$2.50

Hospital Charge Code	3259923
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Suction Cath 8FR

Facility

$2.50

Hospital Charge Code	3259923
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Tubing 12ft x 1/4 with Connectors

Facility

$4.37

Hospital Charge Code	3257560
Hospital Revenue Code	270
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$3.93
Rate for Payer: UnitedHealthcare Commercial	$4.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Tubing 12ft x 1/4 with Connectors

Facility

$4.37

Hospital Charge Code	3257560
Hospital Revenue Code	270
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.15
Rate for Payer: Aetna Commercial	$3.93
Rate for Payer: Humana Medicare Advantage	$1.84
Rate for Payer: UnitedHealthcare Commercial	$4.15
Rate for Payer: UnitedHealthcare Medicaid	$1.75
Rate for Payer: WPPA Medicare Advantage	$2.62

Suction Tubing 6ft x 1/4 with Connectors

Facility

$2.70

Hospital Charge Code	3251076
Hospital Revenue Code	270
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.43
Rate for Payer: Humana Medicare Advantage	$1.13
Rate for Payer: UnitedHealthcare Commercial	$2.56
Rate for Payer: UnitedHealthcare Medicaid	$1.08
Rate for Payer: WPPA Medicare Advantage	$1.62

Suction Tubing 6ft x 1/4 with Connectors

Facility

$2.70

Hospital Charge Code	3251076
Hospital Revenue Code	270
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.43
Rate for Payer: UnitedHealthcare Commercial	$2.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suction Yankauer Tip

Facility

$2.50

Hospital Charge Code	3252413
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

Suction Yankauer Tip

Facility

$2.50

Hospital Charge Code	3252413
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SUFentanil 50 mcg/mL IV Sol [HMC]

Facility

$36.15

Service Code	NDC 17478005001
Hospital Charge Code	3170440
Hospital Revenue Code	250
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$34.34
Rate for Payer: Aetna Commercial	$32.53
Rate for Payer: Humana Medicare Advantage	$15.18
Rate for Payer: UnitedHealthcare Commercial	$34.34
Rate for Payer: UnitedHealthcare Medicaid	$14.46
Rate for Payer: WPPA Medicare Advantage	$21.69

SUFentanil 50 mcg/mL IV Sol [HMC]

Facility

$40.59

Service Code	NDC 00409338221
Hospital Charge Code	3170440
Hospital Revenue Code	250
Min. Negotiated Rate	$36.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.53
Rate for Payer: UnitedHealthcare Commercial	$38.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

SUFentanil 50 mcg/mL IV Sol [HMC]

Facility

$36.15

Service Code	NDC 17478005001
Hospital Charge Code	3170440
Hospital Revenue Code	250
Min. Negotiated Rate	$32.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$32.53
Rate for Payer: UnitedHealthcare Commercial	$34.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges