Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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

Facility

$7.00

Hospital Charge Code	3258628
Hospital Revenue Code	270
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.65
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Humana Medicare Advantage	$2.94
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: WPPA Medicare Advantage	$4.20

Suture 3-0 Silk SH

Facility

$5.00

Hospital Charge Code	3258657
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 3-0 Silk SH

Facility

$5.00

Hospital Charge Code	3258657
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 3-0 Silk SH Perma-Hand

Facility

$50.40

Hospital Charge Code	3258651
Hospital Revenue Code	270
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$47.88
Rate for Payer: Aetna Commercial	$45.36
Rate for Payer: Humana Medicare Advantage	$21.17
Rate for Payer: UnitedHealthcare Commercial	$47.88
Rate for Payer: UnitedHealthcare Medicaid	$20.16
Rate for Payer: WPPA Medicare Advantage	$30.24

Suture 3-0 Silk SH Perma-Hand

Facility

$50.40

Hospital Charge Code	3258651
Hospital Revenue Code	270
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.36
Rate for Payer: UnitedHealthcare Commercial	$47.88
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Silk Ties Labyrinth Package

Facility

$11.00

Hospital Charge Code	3258659
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 Silk Ties Labyrinth Package

Facility

$11.00

Hospital Charge Code	3258659
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 Vicryl CT-1

Facility

$6.00

Hospital Charge Code	3253783
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 3-0 Vicryl CT-1

Facility

$6.00

Hospital Charge Code	3253783
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 3-0 Vicryl FS-2/Antibacterial

Facility

$9.00

Hospital Charge Code	3258675
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Vicryl FS-2/Antibacterial

Facility

$9.00

Hospital Charge Code	3258675
Hospital Revenue Code	270
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.55
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: UnitedHealthcare Commercial	$8.55
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: WPPA Medicare Advantage	$5.40

Suture 3-0 Vicryl Ligapak

Facility

$8.00

Hospital Charge Code	3253841
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 3-0 Vicryl Ligapak

Facility

$8.00

Hospital Charge Code	3253841
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 3-0 Vicryl Ligapak Antibacterial

Facility

$93.00

Hospital Charge Code	3253842
Hospital Revenue Code	270
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$88.35
Rate for Payer: Aetna Commercial	$83.70
Rate for Payer: Humana Medicare Advantage	$39.06
Rate for Payer: UnitedHealthcare Commercial	$88.35
Rate for Payer: UnitedHealthcare Medicaid	$37.20
Rate for Payer: WPPA Medicare Advantage	$55.80

Suture 3-0 Vicryl Ligapak Antibacterial

Facility

$93.00

Hospital Charge Code	3253842
Hospital Revenue Code	270
Min. Negotiated Rate	$83.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$83.70
Rate for Payer: UnitedHealthcare Commercial	$88.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Vicryl Plus CT-1

Facility

$7.00

Hospital Charge Code	3258653
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

Suture 3-0 Vicryl Plus CT-1

Facility

$7.00

Hospital Charge Code	3258653
Hospital Revenue Code	270
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.65
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Humana Medicare Advantage	$2.94
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: WPPA Medicare Advantage	$4.20

Suture 3-0 Vicryl PS-2

Facility

$15.00

Hospital Charge Code	3254991
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 Vicryl PS-2

Facility

$15.00

Hospital Charge Code	3254991
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 Vicryl SH Undyed 8 x 18 8-Strands Control Release

Facility

$65.70

Hospital Charge Code	3257182
Hospital Revenue Code	270
Min. Negotiated Rate	$26.28
Max. Negotiated Rate	$62.41
Rate for Payer: Aetna Commercial	$59.13
Rate for Payer: Humana Medicare Advantage	$27.59
Rate for Payer: UnitedHealthcare Commercial	$62.41
Rate for Payer: UnitedHealthcare Medicaid	$26.28
Rate for Payer: WPPA Medicare Advantage	$39.42

Suture 3-0 Vicryl SH Undyed 8 x 18 8-Strands Control Release

Facility

$65.70

Hospital Charge Code	3257182
Hospital Revenue Code	270
Min. Negotiated Rate	$59.13
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$59.13
Rate for Payer: UnitedHealthcare Commercial	$62.41
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Vicryl SH Undyed/Antibacterial

Facility

$8.64

Hospital Charge Code	3258654
Hospital Revenue Code	270
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$8.21
Rate for Payer: Aetna Commercial	$7.78
Rate for Payer: Humana Medicare Advantage	$3.63
Rate for Payer: UnitedHealthcare Commercial	$8.21
Rate for Payer: UnitedHealthcare Medicaid	$3.46
Rate for Payer: WPPA Medicare Advantage	$5.18

Suture 3-0 Vicryl SH Undyed/Antibacterial

Facility

$8.64

Hospital Charge Code	3258654
Hospital Revenue Code	270
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.78
Rate for Payer: UnitedHealthcare Commercial	$8.21
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 3-0 Vicryl SH Violet

Facility

$6.00

Hospital Charge Code	3257180
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 3-0 Vicryl SH Violet

Facility

$6.00

Hospital Charge Code	3257180
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