Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suture 0 PDS II TP-1 Looped

Facility

$23.00

Hospital Charge Code	3258686
Hospital Revenue Code	270
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$21.85
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Humana Medicare Advantage	$9.66
Rate for Payer: UnitedHealthcare Commercial	$21.85
Rate for Payer: UnitedHealthcare Medicaid	$9.20
Rate for Payer: WPPA Medicare Advantage	$13.80

Suture 0 Prolene MO-6

Facility

$13.00

Hospital Charge Code	3258672
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: UnitedHealthcare Commercial	$12.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 0 Prolene MO-6

Facility

$13.00

Hospital Charge Code	3258672
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$12.35
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Humana Medicare Advantage	$5.46
Rate for Payer: UnitedHealthcare Commercial	$12.35
Rate for Payer: UnitedHealthcare Medicaid	$5.20
Rate for Payer: WPPA Medicare Advantage	$7.80

Suture 0 Silk MO-7

Facility

$96.00

Hospital Charge Code	3258648
Hospital Revenue Code	270
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$91.20
Rate for Payer: Aetna Commercial	$86.40
Rate for Payer: Humana Medicare Advantage	$40.32
Rate for Payer: UnitedHealthcare Commercial	$91.20
Rate for Payer: UnitedHealthcare Medicaid	$38.40
Rate for Payer: WPPA Medicare Advantage	$57.60

Suture 0 Silk MO-7

Facility

$96.00

Hospital Charge Code	3258648
Hospital Revenue Code	270
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$86.40
Rate for Payer: UnitedHealthcare Commercial	$91.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 0 Silk SH

Facility

$5.00

Hospital Charge Code	3258658
Hospital Revenue Code	270
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Humana Medicare Advantage	$2.10
Rate for Payer: UnitedHealthcare Commercial	$4.75
Rate for Payer: UnitedHealthcare Medicaid	$2.00
Rate for Payer: WPPA Medicare Advantage	$3.00

Suture 0 Silk SH

Facility

$5.00

Hospital Charge Code	3258658
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: UnitedHealthcare Commercial	$4.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 0 Vicryl CT-1 Undyed

Facility

$9.09

Hospital Charge Code	3251927
Hospital Revenue Code	270
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.18
Rate for Payer: UnitedHealthcare Commercial	$8.64
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 0 Vicryl CT-1 Undyed

Facility

$9.09

Hospital Charge Code	3251927
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.18
Rate for Payer: Humana Medicare Advantage	$3.82
Rate for Payer: UnitedHealthcare Commercial	$8.64
Rate for Payer: UnitedHealthcare Medicaid	$3.64
Rate for Payer: WPPA Medicare Advantage	$5.45

Suture 0 Vicryl CT-2/Antibacterial

Facility

$6.00

Hospital Charge Code	3258666
Hospital Revenue Code	270
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: UnitedHealthcare Commercial	$5.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 0 Vicryl CT-2/Antibacterial

Facility

$6.00

Hospital Charge Code	3258666
Hospital Revenue Code	270
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.70
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Humana Medicare Advantage	$2.52
Rate for Payer: UnitedHealthcare Commercial	$5.70
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: WPPA Medicare Advantage	$3.60

Suture 0 Vicryl CT-3

Facility

$5.54

Hospital Charge Code	3255325
Hospital Revenue Code	270
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: UnitedHealthcare Commercial	$5.26
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 0 Vicryl CT-3

Facility

$5.54

Hospital Charge Code	3255325
Hospital Revenue Code	270
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$5.26
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: Humana Medicare Advantage	$2.33
Rate for Payer: UnitedHealthcare Commercial	$5.26
Rate for Payer: UnitedHealthcare Medicaid	$2.22
Rate for Payer: WPPA Medicare Advantage	$3.32

Suture 0 Vicryl UR-6/Antibacterial

Facility

$10.62

Hospital Charge Code	3258660
Hospital Revenue Code	270
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.56
Rate for Payer: UnitedHealthcare Commercial	$10.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 0 Vicryl UR-6/Antibacterial

Facility

$10.62

Hospital Charge Code	3258660
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$10.09
Rate for Payer: Aetna Commercial	$9.56
Rate for Payer: Humana Medicare Advantage	$4.46
Rate for Payer: UnitedHealthcare Commercial	$10.09
Rate for Payer: UnitedHealthcare Medicaid	$4.25
Rate for Payer: WPPA Medicare Advantage	$6.37

Suture 1 Chromic CT

Facility

$13.00

Hospital Charge Code	3259475
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$12.35
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Humana Medicare Advantage	$5.46
Rate for Payer: UnitedHealthcare Commercial	$12.35
Rate for Payer: UnitedHealthcare Medicaid	$5.20
Rate for Payer: WPPA Medicare Advantage	$7.80

Suture 1 Chromic CT

Facility

$13.00

Hospital Charge Code	3259475
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: UnitedHealthcare Commercial	$12.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 1 Ethibond Excel OS-8

Facility

$10.00

Hospital Charge Code	3252564
Hospital Revenue Code	270
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 1 Ethibond Excel OS-8

Facility

$10.00

Hospital Charge Code	3252564
Hospital Revenue Code	270
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Humana Medicare Advantage	$4.20
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: WPPA Medicare Advantage	$6.00

Suture 1 PDS II TP-1 Looped

Facility

$28.80

Hospital Charge Code	3258687
Hospital Revenue Code	270
Min. Negotiated Rate	$25.92
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: UnitedHealthcare Commercial	$27.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 1 PDS II TP-1 Looped

Facility

$28.80

Hospital Charge Code	3258687
Hospital Revenue Code	270
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$27.36
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Humana Medicare Advantage	$12.10
Rate for Payer: UnitedHealthcare Commercial	$27.36
Rate for Payer: UnitedHealthcare Medicaid	$11.52
Rate for Payer: WPPA Medicare Advantage	$17.28

Suture 1 Polysorb GS-21

Facility

$20.00

Hospital Charge Code	3258667
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 1 Polysorb GS-21

Facility

$20.00

Hospital Charge Code	3258667
Hospital Revenue Code	270
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Humana Medicare Advantage	$8.40
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Medicaid	$8.00
Rate for Payer: WPPA Medicare Advantage	$12.00

Suture 1 Vicryl CT

Facility

$5.85

Hospital Charge Code	3259699
Hospital Revenue Code	270
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.26
Rate for Payer: UnitedHealthcare Commercial	$5.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 1 Vicryl CT

Facility

$5.85

Hospital Charge Code	3259699
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.56
Rate for Payer: Aetna Commercial	$5.26
Rate for Payer: Humana Medicare Advantage	$2.46
Rate for Payer: UnitedHealthcare Commercial	$5.56
Rate for Payer: UnitedHealthcare Medicaid	$2.34
Rate for Payer: WPPA Medicare Advantage	$3.51

Know your out-of-pocket cost for care.

All Charges