Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suture 1 Vicryl CT-1

Facility

$13.00

Hospital Charge Code	3253052
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 Vicryl CT-1

Facility

$13.00

Hospital Charge Code	3253052
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 Vicryl Plus CP-1 Undyed

Facility

$8.00

Hospital Charge Code	3252563
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Humana Medicare Advantage	$3.36
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Medicaid	$3.20
Rate for Payer: WPPA Medicare Advantage	$4.80

Suture 1 Vicryl Plus CP-1 Undyed

Facility

$8.00

Hospital Charge Code	3252563
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Black Silk Ties Perma Hand

Facility

$7.29

Hospital Charge Code	8694
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.56
Rate for Payer: UnitedHealthcare Commercial	$6.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Black Silk Ties Perma Hand

Facility

$7.29

Hospital Charge Code	8694
Hospital Revenue Code	270
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.93
Rate for Payer: Aetna Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.06
Rate for Payer: UnitedHealthcare Commercial	$6.93
Rate for Payer: UnitedHealthcare Medicaid	$2.92
Rate for Payer: WPPA Medicare Advantage	$4.37

Suture 2-0 Chromic CT-1

Facility

$34.00

Hospital Charge Code	3258630
Hospital Revenue Code	270
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: UnitedHealthcare Commercial	$32.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Chromic CT-1

Facility

$34.00

Hospital Charge Code	3258630
Hospital Revenue Code	270
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$32.30
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: Humana Medicare Advantage	$14.28
Rate for Payer: UnitedHealthcare Commercial	$32.30
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: WPPA Medicare Advantage	$20.40

Suture 2-0 Chromic SH

Facility

$12.00

Hospital Charge Code	3259707
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

Suture 2-0 Chromic SH

Facility

$12.00

Hospital Charge Code	3259707
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

Suture 2-0 Ethilon FS

Facility

$6.89

Hospital Charge Code	3252660
Hospital Revenue Code	270
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.20
Rate for Payer: UnitedHealthcare Commercial	$6.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Ethilon FS

Facility

$6.89

Hospital Charge Code	3252660
Hospital Revenue Code	270
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$6.55
Rate for Payer: Aetna Commercial	$6.20
Rate for Payer: Humana Medicare Advantage	$2.89
Rate for Payer: UnitedHealthcare Commercial	$6.55
Rate for Payer: UnitedHealthcare Medicaid	$2.76
Rate for Payer: WPPA Medicare Advantage	$4.13

Suture 2-0 Monocryl V-34

Facility

$14.00

Hospital Charge Code	3258682
Hospital Revenue Code	270
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$13.30
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Humana Medicare Advantage	$5.88
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: UnitedHealthcare Medicaid	$5.60
Rate for Payer: WPPA Medicare Advantage	$8.40

Suture 2-0 Monocryl V-34

Facility

$14.00

Hospital Charge Code	3258682
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 PDS II CT-2

Facility

$11.00

Hospital Charge Code	3254987
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 PDS II CT-2

Facility

$11.00

Hospital Charge Code	3254987
Hospital Revenue Code	270
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.45
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Humana Medicare Advantage	$4.62
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: UnitedHealthcare Medicaid	$4.40
Rate for Payer: WPPA Medicare Advantage	$6.60

Suture 2-0 Prolene FS-2

Facility

$11.00

Hospital Charge Code	3258758
Hospital Revenue Code	270
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.45
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Humana Medicare Advantage	$4.62
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: UnitedHealthcare Medicaid	$4.40
Rate for Payer: WPPA Medicare Advantage	$6.60

Suture 2-0 Prolene FS-2

Facility

$11.00

Hospital Charge Code	3258758
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Prolene SH SNG

Facility

$13.00

Hospital Charge Code	3258677
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 2-0 Prolene SH SNG

Facility

$13.00

Hospital Charge Code	3258677
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 2-0 Silk PS

Facility

$15.00

Hospital Charge Code	3258661
Hospital Revenue Code	270
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: UnitedHealthcare Commercial	$14.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Silk PS

Facility

$15.00

Hospital Charge Code	3258661
Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Humana Medicare Advantage	$6.30
Rate for Payer: UnitedHealthcare Commercial	$14.25
Rate for Payer: UnitedHealthcare Medicaid	$6.00
Rate for Payer: WPPA Medicare Advantage	$9.00

Suture 2-0 Silk SH

Facility

$7.29

Hospital Charge Code	3258656
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.56
Rate for Payer: UnitedHealthcare Commercial	$6.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Silk SH

Facility

$7.29

Hospital Charge Code	3258656
Hospital Revenue Code	270
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.93
Rate for Payer: Aetna Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.06
Rate for Payer: UnitedHealthcare Commercial	$6.93
Rate for Payer: UnitedHealthcare Medicaid	$2.92
Rate for Payer: WPPA Medicare Advantage	$4.37

Suture 2-0 Vicryl CT-1 Undyed

Facility

$6.00

Hospital Charge Code	3252562
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

Know your out-of-pocket cost for care.

All Charges