Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suture 4-0 PDS ll PS-2 Z496G Undyed

Facility

$28.67

Hospital Charge Code	3259698
Hospital Revenue Code	270
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.80
Rate for Payer: UnitedHealthcare Commercial	$27.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Plain Gut FS-2

Facility

$13.00

Hospital Charge Code	3254995
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 4-0 Plain Gut FS-2

Facility

$13.00

Hospital Charge Code	3254995
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 4-0 Plain Gut RB-1 17MM, Yellowish Tan, 1x27

Facility

$12.00

Hospital Charge Code	3258690
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 Plain Gut RB-1 17MM, Yellowish Tan, 1x27

Facility

$12.00

Hospital Charge Code	3258690
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 Polysorb P-12

Facility

$34.00

Hospital Charge Code	3252843
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 4-0 Polysorb P-12

Facility

$34.00

Hospital Charge Code	3252843
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 4-0 Prolene PS-2 19mm 1x18in

Facility

$27.81

Hospital Charge Code	3258673
Hospital Revenue Code	270
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$26.42
Rate for Payer: Aetna Commercial	$25.03
Rate for Payer: Humana Medicare Advantage	$11.68
Rate for Payer: UnitedHealthcare Commercial	$26.42
Rate for Payer: UnitedHealthcare Medicaid	$11.12
Rate for Payer: WPPA Medicare Advantage	$16.69

Suture 4-0 Prolene PS-2 19mm 1x18in

Facility

$27.81

Hospital Charge Code	3258673
Hospital Revenue Code	270
Min. Negotiated Rate	$25.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.03
Rate for Payer: UnitedHealthcare Commercial	$26.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Prolene RB-1

Facility

$20.03

Hospital Charge Code	3252975
Hospital Revenue Code	270
Min. Negotiated Rate	$18.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: UnitedHealthcare Commercial	$19.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Prolene RB-1

Facility

$20.03

Hospital Charge Code	3252975
Hospital Revenue Code	270
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$19.03
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$8.41
Rate for Payer: UnitedHealthcare Commercial	$19.03
Rate for Payer: UnitedHealthcare Medicaid	$8.01
Rate for Payer: WPPA Medicare Advantage	$12.02

Suture 4-0 Vicryl P-3

Facility

$16.00

Hospital Charge Code	3254992
Hospital Revenue Code	270
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$15.20
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Humana Medicare Advantage	$6.72
Rate for Payer: UnitedHealthcare Commercial	$15.20
Rate for Payer: UnitedHealthcare Medicaid	$6.40
Rate for Payer: WPPA Medicare Advantage	$9.60

Suture 4-0 Vicryl P-3

Facility

$16.00

Hospital Charge Code	3254992
Hospital Revenue Code	270
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: UnitedHealthcare Commercial	$15.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Vicryl PS-2/Antibacterial

Facility

$23.18

Hospital Charge Code	3253858
Hospital Revenue Code	270
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$22.02
Rate for Payer: Aetna Commercial	$20.86
Rate for Payer: Humana Medicare Advantage	$9.74
Rate for Payer: UnitedHealthcare Commercial	$22.02
Rate for Payer: UnitedHealthcare Medicaid	$9.27
Rate for Payer: WPPA Medicare Advantage	$13.91

Suture 4-0 Vicryl PS-2/Antibacterial

Facility

$23.18

Hospital Charge Code	3253858
Hospital Revenue Code	270
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$20.86
Rate for Payer: UnitedHealthcare Commercial	$22.02
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Vicryl RB-1

Facility

$7.52

Hospital Charge Code	3258816
Hospital Revenue Code	270
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$7.14
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Humana Medicare Advantage	$3.16
Rate for Payer: UnitedHealthcare Commercial	$7.14
Rate for Payer: UnitedHealthcare Medicaid	$3.01
Rate for Payer: WPPA Medicare Advantage	$4.51

Suture 4-0 Vicryl RB-1

Facility

$7.52

Hospital Charge Code	3258816
Hospital Revenue Code	270
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: UnitedHealthcare Commercial	$7.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Vicryl SH Undyed 27 Braided Coated Absorbable 1-Strand Taperpoint 26mm 1/2 Circle Needl

Facility

$7.52

Hospital Charge Code	3258633
Hospital Revenue Code	270
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: UnitedHealthcare Commercial	$7.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 4-0 Vicryl SH Undyed 27 Braided Coated Absorbable 1-Strand Taperpoint 26mm 1/2 Circle Needl

Facility

$7.52

Hospital Charge Code	3258633
Hospital Revenue Code	270
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$7.14
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Humana Medicare Advantage	$3.16
Rate for Payer: UnitedHealthcare Commercial	$7.14
Rate for Payer: UnitedHealthcare Medicaid	$3.01
Rate for Payer: WPPA Medicare Advantage	$4.51

Suture 5-0 Chromic P-3

Facility

$26.00

Hospital Charge Code	3254983
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Chromic P-3

Facility

$26.00

Hospital Charge Code	3254983
Hospital Revenue Code	270
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Humana Medicare Advantage	$10.92
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Medicaid	$10.40
Rate for Payer: WPPA Medicare Advantage	$15.60

Suture 5-0 Ethilon FS-2

Facility

$11.70

Hospital Charge Code	3253164
Hospital Revenue Code	270
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.53
Rate for Payer: UnitedHealthcare Commercial	$11.12
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Ethilon FS-2

Facility

$11.70

Hospital Charge Code	3253164
Hospital Revenue Code	270
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$11.12
Rate for Payer: Aetna Commercial	$10.53
Rate for Payer: Humana Medicare Advantage	$4.91
Rate for Payer: UnitedHealthcare Commercial	$11.12
Rate for Payer: UnitedHealthcare Medicaid	$4.68
Rate for Payer: WPPA Medicare Advantage	$7.02

Suture 5-0 Ethilon P-3

Facility

$13.00

Hospital Charge Code	3258681
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 5-0 Ethilon P-3

Facility

$13.00

Hospital Charge Code	3258681
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

Know your out-of-pocket cost for care.

All Charges