Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suture 3-0 PDS II SH

Facility

$11.00

Hospital Charge Code	3258663
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 3-0 PDS II SH

Facility

$11.00

Hospital Charge Code	3258663
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 3-0 Plain Gut CT

Facility

$10.62

Hospital Charge Code	3258683
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 3-0 Plain Gut CT

Facility

$10.62

Hospital Charge Code	3258683
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 3-0 Plain Gut CT-3

Facility

$18.09

Hospital Charge Code	3258665
Hospital Revenue Code	270
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: UnitedHealthcare Commercial	$17.19
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Plain Gut CT-3

Facility

$18.09

Hospital Charge Code	3258665
Hospital Revenue Code	270
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: Humana Medicare Advantage	$7.60
Rate for Payer: UnitedHealthcare Commercial	$17.19
Rate for Payer: UnitedHealthcare Medicaid	$7.24
Rate for Payer: WPPA Medicare Advantage	$10.85

Suture 3-0 Polysorb CV-23

Facility

$25.00

Hospital Charge Code	3258632
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 Polysorb CV-23

Facility

$25.00

Hospital Charge Code	3258632
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 Polysorb GS-21

Facility

$20.12

Hospital Charge Code	3252876
Hospital Revenue Code	270
Min. Negotiated Rate	$18.11
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.11
Rate for Payer: UnitedHealthcare Commercial	$19.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Polysorb GS-21

Facility

$20.12

Hospital Charge Code	3252876
Hospital Revenue Code	270
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$19.11
Rate for Payer: Aetna Commercial	$18.11
Rate for Payer: Humana Medicare Advantage	$8.45
Rate for Payer: UnitedHealthcare Commercial	$19.11
Rate for Payer: UnitedHealthcare Medicaid	$8.05
Rate for Payer: WPPA Medicare Advantage	$12.07

Suture 3-0 Prolene FS-1

Facility

$18.50

Hospital Charge Code	3258642
Hospital Revenue Code	270
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.65
Rate for Payer: UnitedHealthcare Commercial	$17.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Prolene FS-1

Facility

$18.50

Hospital Charge Code	3258642
Hospital Revenue Code	270
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$17.57
Rate for Payer: Aetna Commercial	$16.65
Rate for Payer: Humana Medicare Advantage	$7.77
Rate for Payer: UnitedHealthcare Commercial	$17.57
Rate for Payer: UnitedHealthcare Medicaid	$7.40
Rate for Payer: WPPA Medicare Advantage	$11.10

Suture 3-0 Prolene FS-2

Facility

$28.00

Hospital Charge Code	3258643
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Prolene FS-2

Facility

$28.00

Hospital Charge Code	3258643
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Humana Medicare Advantage	$11.76
Rate for Payer: UnitedHealthcare Commercial	$26.60
Rate for Payer: UnitedHealthcare Medicaid	$11.20
Rate for Payer: WPPA Medicare Advantage	$16.80

Suture 3-0 Prolene PS-2

Facility

$21.00

Hospital Charge Code	3256661
Hospital Revenue Code	270
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Prolene PS-2

Facility

$21.00

Hospital Charge Code	3256661
Hospital Revenue Code	270
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$19.95
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Humana Medicare Advantage	$8.82
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Medicaid	$8.40
Rate for Payer: WPPA Medicare Advantage	$12.60

Suture 3-0 Prolene SH DBL

Facility

$54.00

Hospital Charge Code	3257461
Hospital Revenue Code	270
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: UnitedHealthcare Commercial	$51.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Prolene SH DBL

Facility

$54.00

Hospital Charge Code	3257461
Hospital Revenue Code	270
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Humana Medicare Advantage	$22.68
Rate for Payer: UnitedHealthcare Commercial	$51.30
Rate for Payer: UnitedHealthcare Medicaid	$21.60
Rate for Payer: WPPA Medicare Advantage	$32.40

Suture 3-0 Prolene SH V-20

Facility

$12.42

Hospital Charge Code	3258641
Hospital Revenue Code	270
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.18
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Prolene SH V-20

Facility

$12.42

Hospital Charge Code	3258641
Hospital Revenue Code	270
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$11.80
Rate for Payer: Aetna Commercial	$11.18
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: UnitedHealthcare Medicaid	$4.97
Rate for Payer: WPPA Medicare Advantage	$7.45

Suture 3-0 Silk FS-1

Facility

$19.00

Hospital Charge Code	3258650
Hospital Revenue Code	270
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$18.05
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Humana Medicare Advantage	$7.98
Rate for Payer: UnitedHealthcare Commercial	$18.05
Rate for Payer: UnitedHealthcare Medicaid	$7.60
Rate for Payer: WPPA Medicare Advantage	$11.40

Suture 3-0 Silk FS-1

Facility

$19.00

Hospital Charge Code	3258650
Hospital Revenue Code	270
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$18.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Silk RB-1 Black 18 Braided Permahand

Facility

$40.00

Hospital Charge Code	3258689
Hospital Revenue Code	270
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Silk RB-1 Black 18 Braided Permahand

Facility

$40.00

Hospital Charge Code	3258689
Hospital Revenue Code	270
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$38.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: UnitedHealthcare Medicaid	$16.00
Rate for Payer: WPPA Medicare Advantage	$24.00

Suture 3-0 Silk RB-1 Black 30 Braided Permahand

Facility

$7.00

Hospital Charge Code	3258628
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

Know your out-of-pocket cost for care.

All Charges