Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suture 5-0 Ethilon PC-3

Facility

$25.02

Hospital Charge Code	3257214
Hospital Revenue Code	270
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$23.77
Rate for Payer: Aetna Commercial	$22.52
Rate for Payer: Humana Medicare Advantage	$10.51
Rate for Payer: UnitedHealthcare Commercial	$23.77
Rate for Payer: UnitedHealthcare Medicaid	$10.01
Rate for Payer: WPPA Medicare Advantage	$15.01

Suture 5-0 Ethilon PC-3

Facility

$25.02

Hospital Charge Code	3257214
Hospital Revenue Code	270
Min. Negotiated Rate	$22.52
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.52
Rate for Payer: UnitedHealthcare Commercial	$23.77
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Ethilon PS-2

Facility

$19.58

Hospital Charge Code	3252846
Hospital Revenue Code	270
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.62
Rate for Payer: UnitedHealthcare Commercial	$18.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Ethilon PS-2

Facility

$19.58

Hospital Charge Code	3252846
Hospital Revenue Code	270
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$18.60
Rate for Payer: Aetna Commercial	$17.62
Rate for Payer: Humana Medicare Advantage	$8.22
Rate for Payer: UnitedHealthcare Commercial	$18.60
Rate for Payer: UnitedHealthcare Medicaid	$7.83
Rate for Payer: WPPA Medicare Advantage	$11.75

Suture 5-0 Ethilon PS-3

Facility

$14.00

Hospital Charge Code	3254984
Hospital Revenue Code	270
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$13.30
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Humana Medicare Advantage	$5.88
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: UnitedHealthcare Medicaid	$5.60
Rate for Payer: WPPA Medicare Advantage	$8.40

Suture 5-0 Ethilon PS-3

Facility

$14.00

Hospital Charge Code	3254984
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Monocryl PC-3

Facility

$35.37

Hospital Charge Code	3258121
Hospital Revenue Code	270
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna Commercial	$31.83
Rate for Payer: Humana Medicare Advantage	$14.86
Rate for Payer: UnitedHealthcare Commercial	$33.60
Rate for Payer: UnitedHealthcare Medicaid	$14.15
Rate for Payer: WPPA Medicare Advantage	$21.22

Suture 5-0 Monocryl PC-3

Facility

$35.37

Hospital Charge Code	3258121
Hospital Revenue Code	270
Min. Negotiated Rate	$31.83
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.83
Rate for Payer: UnitedHealthcare Commercial	$33.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 PDS II P-3

Facility

$28.67

Hospital Charge Code	3258684
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 5-0 PDS II P-3

Facility

$28.67

Hospital Charge Code	3258684
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

Suture 5-0 PDS II PS-2

Facility

$18.00

Hospital Charge Code	3254979
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Humana Medicare Advantage	$7.56
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: WPPA Medicare Advantage	$10.80

Suture 5-0 PDS II PS-2

Facility

$18.00

Hospital Charge Code	3254979
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: UnitedHealthcare Commercial	$17.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Plain Gut P-3

Facility

$25.00

Hospital Charge Code	3254996
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 5-0 Plain Gut P-3

Facility

$25.00

Hospital Charge Code	3254996
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 5-0 Plain Gut PC-1

Facility

$27.00

Hospital Charge Code	3258685
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Humana Medicare Advantage	$11.34
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: UnitedHealthcare Medicaid	$10.80
Rate for Payer: WPPA Medicare Advantage	$16.20

Suture 5-0 Plain Gut PC-1

Facility

$27.00

Hospital Charge Code	3258685
Hospital Revenue Code	270
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Prolene P-3

Facility

$50.00

Hospital Charge Code	3256372
Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Humana Medicare Advantage	$21.00
Rate for Payer: UnitedHealthcare Commercial	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$20.00
Rate for Payer: WPPA Medicare Advantage	$30.00

Suture 5-0 Prolene P-3

Facility

$50.00

Hospital Charge Code	3256372
Hospital Revenue Code	270
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: UnitedHealthcare Commercial	$47.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Prolene PS-2

Facility

$17.00

Hospital Charge Code	3252959
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 5-0 Prolene PS-2

Facility

$17.00

Hospital Charge Code	3252959
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

Suture 5-0 Prolene RB-1

Facility

$15.00

Hospital Charge Code	3252976
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 5-0 Prolene RB-1

Facility

$15.00

Hospital Charge Code	3252976
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 5-0 Silk P-3

Facility

$14.00

Hospital Charge Code	3254998
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Silk P-3

Facility

$14.00

Hospital Charge Code	3254998
Hospital Revenue Code	270
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$13.30
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Humana Medicare Advantage	$5.88
Rate for Payer: UnitedHealthcare Commercial	$13.30
Rate for Payer: UnitedHealthcare Medicaid	$5.60
Rate for Payer: WPPA Medicare Advantage	$8.40

Suture 5-0 Vicryl P-1

Facility

$15.00

Hospital Charge Code	3254993
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

Know your out-of-pocket cost for care.

All Charges