Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suture 3-0 Vicryl SH Violet 18 8-Strands Control Release

Facility

$49.00

Hospital Charge Code	3257181
Hospital Revenue Code	270
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$46.55
Rate for Payer: Aetna Commercial	$44.10
Rate for Payer: Humana Medicare Advantage	$20.58
Rate for Payer: UnitedHealthcare Commercial	$46.55
Rate for Payer: UnitedHealthcare Medicaid	$19.60
Rate for Payer: WPPA Medicare Advantage	$29.40

Suture 3-0 Vicryl SH Violet 18 8-Strands Control Release

Facility

$49.00

Hospital Charge Code	3257181
Hospital Revenue Code	270
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$44.10
Rate for Payer: UnitedHealthcare Commercial	$46.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Chromic Gut Brown RB-1 17MM 1 x 27in

Facility

$12.00

Hospital Charge Code	3258691
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 4-0 Chromic Gut Brown RB-1 17MM 1 x 27in

Facility

$12.00

Hospital Charge Code	3258691
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 4-0 Chromic Gut FS-2 1x27IN Brown

Facility

$11.00

Hospital Charge Code	3258627
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 4-0 Chromic Gut FS-2 1x27IN Brown

Facility

$11.00

Hospital Charge Code	3258627
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 4-0 Chromic P-3

Facility

$23.00

Hospital Charge Code	3258634
Hospital Revenue Code	270
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: UnitedHealthcare Commercial	$21.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Chromic P-3

Facility

$23.00

Hospital Charge Code	3258634
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 4-0 Ethilon FS-2

Facility

$10.89

Hospital Charge Code	3252686
Hospital Revenue Code	270
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$10.35
Rate for Payer: Aetna Commercial	$9.80
Rate for Payer: Humana Medicare Advantage	$4.57
Rate for Payer: UnitedHealthcare Commercial	$10.35
Rate for Payer: UnitedHealthcare Medicaid	$4.36
Rate for Payer: WPPA Medicare Advantage	$6.53

Suture 4-0 Ethilon FS-2

Facility

$10.89

Hospital Charge Code	3252686
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.80
Rate for Payer: UnitedHealthcare Commercial	$10.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Ethilon P-3

Facility

$23.94

Hospital Charge Code	3254981
Hospital Revenue Code	270
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$21.55
Rate for Payer: UnitedHealthcare Commercial	$22.74
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Ethilon P-3

Facility

$23.94

Hospital Charge Code	3254981
Hospital Revenue Code	270
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$22.74
Rate for Payer: Aetna Commercial	$21.55
Rate for Payer: Humana Medicare Advantage	$10.05
Rate for Payer: UnitedHealthcare Commercial	$22.74
Rate for Payer: UnitedHealthcare Medicaid	$9.58
Rate for Payer: WPPA Medicare Advantage	$14.36

Suture 4-0 Ethilon PC-3

Facility

$23.81

Hospital Charge Code	3257206
Hospital Revenue Code	270
Min. Negotiated Rate	$21.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$21.43
Rate for Payer: UnitedHealthcare Commercial	$22.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Ethilon PC-3

Facility

$23.81

Hospital Charge Code	3257206
Hospital Revenue Code	270
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$22.62
Rate for Payer: Aetna Commercial	$21.43
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: UnitedHealthcare Commercial	$22.62
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: WPPA Medicare Advantage	$14.29

Suture 4-0 Ethilon PS-2

Facility

$19.35

Hospital Charge Code	3258668
Hospital Revenue Code	270
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$18.38
Rate for Payer: Aetna Commercial	$17.41
Rate for Payer: Humana Medicare Advantage	$8.13
Rate for Payer: UnitedHealthcare Commercial	$18.38
Rate for Payer: UnitedHealthcare Medicaid	$7.74
Rate for Payer: WPPA Medicare Advantage	$11.61

Suture 4-0 Ethilon PS-2

Facility

$19.35

Hospital Charge Code	3258668
Hospital Revenue Code	270
Min. Negotiated Rate	$17.41
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.41
Rate for Payer: UnitedHealthcare Commercial	$18.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Monocryl PC-3

Facility

$34.88

Hospital Charge Code	3258655
Hospital Revenue Code	270
Min. Negotiated Rate	$31.39
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: UnitedHealthcare Commercial	$33.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Monocryl PC-3

Facility

$34.88

Hospital Charge Code	3258655
Hospital Revenue Code	270
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$33.14
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Humana Medicare Advantage	$14.65
Rate for Payer: UnitedHealthcare Commercial	$33.14
Rate for Payer: UnitedHealthcare Medicaid	$13.95
Rate for Payer: WPPA Medicare Advantage	$20.93

Suture 4-0 Monocryl PS-2 27

Facility

$33.53

Hospital Charge Code	3258629
Hospital Revenue Code	270
Min. Negotiated Rate	$30.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$30.18
Rate for Payer: UnitedHealthcare Commercial	$31.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Monocryl PS-2 27

Facility

$33.53

Hospital Charge Code	3258629
Hospital Revenue Code	270
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$31.85
Rate for Payer: Aetna Commercial	$30.18
Rate for Payer: Humana Medicare Advantage	$14.08
Rate for Payer: UnitedHealthcare Commercial	$31.85
Rate for Payer: UnitedHealthcare Medicaid	$13.41
Rate for Payer: WPPA Medicare Advantage	$20.12

Suture 4-0 Monocryl PS-2 Undyed 1 x 18

Facility

$32.63

Hospital Charge Code	3258646
Hospital Revenue Code	270
Min. Negotiated Rate	$29.37
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.37
Rate for Payer: UnitedHealthcare Commercial	$31.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Monocryl PS-2 Undyed 1 x 18

Facility

$32.63

Hospital Charge Code	3258646
Hospital Revenue Code	270
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$31.00
Rate for Payer: Aetna Commercial	$29.37
Rate for Payer: Humana Medicare Advantage	$13.70
Rate for Payer: UnitedHealthcare Commercial	$31.00
Rate for Payer: UnitedHealthcare Medicaid	$13.05
Rate for Payer: WPPA Medicare Advantage	$19.58

Suture 4-0 PDS II PS-2 Violet Dyed

Facility

$39.96

Hospital Charge Code	3258664
Hospital Revenue Code	270
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$37.96
Rate for Payer: Aetna Commercial	$35.96
Rate for Payer: Humana Medicare Advantage	$16.78
Rate for Payer: UnitedHealthcare Commercial	$37.96
Rate for Payer: UnitedHealthcare Medicaid	$15.98
Rate for Payer: WPPA Medicare Advantage	$23.98

Suture 4-0 PDS II PS-2 Violet Dyed

Facility

$39.96

Hospital Charge Code	3258664
Hospital Revenue Code	270
Min. Negotiated Rate	$35.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$35.96
Rate for Payer: UnitedHealthcare Commercial	$37.96
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 PDS ll PS-2 Z496G Undyed

Facility

$28.67

Hospital Charge Code	3259698
Hospital Revenue Code	270
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$27.24
Rate for Payer: Aetna Commercial	$25.80
Rate for Payer: Humana Medicare Advantage	$12.04
Rate for Payer: UnitedHealthcare Commercial	$27.24
Rate for Payer: UnitedHealthcare Medicaid	$11.47
Rate for Payer: WPPA Medicare Advantage	$17.20

Know your out-of-pocket cost for care.

All Charges