Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suture 2-0 Vicryl CT-1 Undyed

Facility

$6.00

Hospital Charge Code	3252562
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 2-0 Vicryl SH

Facility

$5.31

Hospital Charge Code	3259764
Hospital Revenue Code	270
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.78
Rate for Payer: UnitedHealthcare Commercial	$5.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Vicryl SH

Facility

$5.31

Hospital Charge Code	3259764
Hospital Revenue Code	270
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$5.04
Rate for Payer: Aetna Commercial	$4.78
Rate for Payer: Humana Medicare Advantage	$2.23
Rate for Payer: UnitedHealthcare Commercial	$5.04
Rate for Payer: UnitedHealthcare Medicaid	$2.12
Rate for Payer: WPPA Medicare Advantage	$3.19

Suture 2-0 Vicryl UR-6 26mm Violet coated absorbable/Antibacterial

Facility

$6.66

Hospital Charge Code	3252249
Hospital Revenue Code	270
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.99
Rate for Payer: UnitedHealthcare Commercial	$6.33
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 2-0 Vicryl UR-6 26mm Violet coated absorbable/Antibacterial

Facility

$6.66

Hospital Charge Code	3252249
Hospital Revenue Code	270
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$6.33
Rate for Payer: Aetna Commercial	$5.99
Rate for Payer: Humana Medicare Advantage	$2.80
Rate for Payer: UnitedHealthcare Commercial	$6.33
Rate for Payer: UnitedHealthcare Medicaid	$2.66
Rate for Payer: WPPA Medicare Advantage	$4.00

Suture 2-0 Vicryl XLH

Facility

$20.00

Hospital Charge Code	3252248
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 2-0 Vicryl XLH

Facility

$20.00

Hospital Charge Code	3252248
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 3-0 Chromic CT-1

Facility

$15.00

Hospital Charge Code	3252470
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 3-0 Chromic CT-1

Facility

$15.00

Hospital Charge Code	3252470
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 3-0 Chromic RB-1

Facility

$25.00

Hospital Charge Code	3252462
Hospital Revenue Code	270
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Humana Medicare Advantage	$10.50
Rate for Payer: UnitedHealthcare Commercial	$23.75
Rate for Payer: UnitedHealthcare Medicaid	$10.00
Rate for Payer: WPPA Medicare Advantage	$15.00

Suture 3-0 Chromic RB-1

Facility

$25.00

Hospital Charge Code	3252462
Hospital Revenue Code	270
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: UnitedHealthcare Commercial	$23.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Chromic SH

Facility

$13.00

Hospital Charge Code	3252488
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 3-0 Chromic SH

Facility

$13.00

Hospital Charge Code	3252488
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 3-0 Ethilon FS-1

Facility

$8.46

Hospital Charge Code	3252678
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$8.04
Rate for Payer: Aetna Commercial	$7.61
Rate for Payer: Humana Medicare Advantage	$3.55
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: UnitedHealthcare Medicaid	$3.38
Rate for Payer: WPPA Medicare Advantage	$5.08

Suture 3-0 Ethilon FS-1

Facility

$8.46

Hospital Charge Code	3252678
Hospital Revenue Code	270
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.61
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Ethilon FSL/PSL

Facility

$10.08

Hospital Charge Code	3258644
Hospital Revenue Code	270
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.07
Rate for Payer: UnitedHealthcare Commercial	$9.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Ethilon FSL/PSL

Facility

$10.08

Hospital Charge Code	3258644
Hospital Revenue Code	270
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$9.58
Rate for Payer: Aetna Commercial	$9.07
Rate for Payer: Humana Medicare Advantage	$4.23
Rate for Payer: UnitedHealthcare Commercial	$9.58
Rate for Payer: UnitedHealthcare Medicaid	$4.03
Rate for Payer: WPPA Medicare Advantage	$6.05

Suture 3-0 Ethilon PS-2

Facility

$15.00

Hospital Charge Code	3258662
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 3-0 Ethilon PS-2

Facility

$15.00

Hospital Charge Code	3258662
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 3-0 Monocryl KS

Facility

$13.00

Hospital Charge Code	3258638
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 3-0 Monocryl KS

Facility

$13.00

Hospital Charge Code	3258638
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 3-0 Monocryl PS-1

Facility

$24.00

Hospital Charge Code	3252565
Hospital Revenue Code	270
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$22.80
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Humana Medicare Advantage	$10.08
Rate for Payer: UnitedHealthcare Commercial	$22.80
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: WPPA Medicare Advantage	$14.40

Suture 3-0 Monocryl PS-1

Facility

$24.00

Hospital Charge Code	3252565
Hospital Revenue Code	270
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: UnitedHealthcare Commercial	$22.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 PDS II PS-2

Facility

$17.00

Hospital Charge Code	3254994
Hospital Revenue Code	270
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

Suture 3-0 PDS II PS-2

Facility

$17.00

Hospital Charge Code	3254994
Hospital Revenue Code	270
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

Know your out-of-pocket cost for care.

All Charges