Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

Suture 5-0 Vicryl P-1

Facility

$15.00

Hospital Charge Code	3254993
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 Vicryl PC-12

Facility

$36.00

Hospital Charge Code	3258645
Hospital Revenue Code	270
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$15.12
Rate for Payer: UnitedHealthcare Commercial	$34.20
Rate for Payer: UnitedHealthcare Medicaid	$14.40
Rate for Payer: WPPA Medicare Advantage	$21.60

Suture 5-0 Vicryl PC-12

Facility

$36.00

Hospital Charge Code	3258645
Hospital Revenue Code	270
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$32.40
Rate for Payer: UnitedHealthcare Commercial	$34.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 5-0 Vicryl PC-3

Facility

$23.81

Hospital Charge Code	3251513
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 5-0 Vicryl PC-3

Facility

$23.81

Hospital Charge Code	3251513
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 5-0 Vicryl PS-2

Facility

$15.00

Hospital Charge Code	3254980
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 Vicryl PS-2

Facility

$15.00

Hospital Charge Code	3254980
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 6-0 Chromic PS-6

Facility

$30.00

Hospital Charge Code	3257172
Hospital Revenue Code	270
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Humana Medicare Advantage	$12.60
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: WPPA Medicare Advantage	$18.00

Suture 6-0 Chromic PS-6

Facility

$30.00

Hospital Charge Code	3257172
Hospital Revenue Code	270
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 6-0 Ethilon P-1

Facility

$24.21

Hospital Charge Code	3257453
Hospital Revenue Code	270
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$21.79
Rate for Payer: Humana Medicare Advantage	$10.17
Rate for Payer: UnitedHealthcare Commercial	$23.00
Rate for Payer: UnitedHealthcare Medicaid	$9.68
Rate for Payer: WPPA Medicare Advantage	$14.53

Suture 6-0 Ethilon P-1

Facility

$24.21

Hospital Charge Code	3257453
Hospital Revenue Code	270
Min. Negotiated Rate	$21.79
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$21.79
Rate for Payer: UnitedHealthcare Commercial	$23.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 6-0 Ethilon PS-3

Facility

$13.50

Hospital Charge Code	3259590
Hospital Revenue Code	270
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$12.82
Rate for Payer: Aetna Commercial	$12.15
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: UnitedHealthcare Commercial	$12.82
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: WPPA Medicare Advantage	$8.10

Suture 6-0 Ethilon PS-3

Facility

$13.50

Hospital Charge Code	3259590
Hospital Revenue Code	270
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.15
Rate for Payer: UnitedHealthcare Commercial	$12.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 6-0 Monocryl P-1

Facility

$21.00

Hospital Charge Code	3258679
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 6-0 Monocryl P-1

Facility

$21.00

Hospital Charge Code	3258679
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 6-0 PDS II P-1 Violet Dyed

Facility

$20.00

Hospital Charge Code	3254988
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 6-0 PDS II P-1 Violet Dyed

Facility

$20.00

Hospital Charge Code	3254988
Hospital Revenue Code	270
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Humana Medicare Advantage	$8.40
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Medicaid	$8.00
Rate for Payer: WPPA Medicare Advantage	$12.00

Suture 6-0 PDS ll P-1 Z489G Undyed

Facility

$31.14

Hospital Charge Code	3258696
Hospital Revenue Code	270
Min. Negotiated Rate	$28.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.03
Rate for Payer: UnitedHealthcare Commercial	$29.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 6-0 PDS ll P-1 Z489G Undyed

Facility

$31.14

Hospital Charge Code	3258696
Hospital Revenue Code	270
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$29.58
Rate for Payer: Aetna Commercial	$28.03
Rate for Payer: Humana Medicare Advantage	$13.08
Rate for Payer: UnitedHealthcare Commercial	$29.58
Rate for Payer: UnitedHealthcare Medicaid	$12.46
Rate for Payer: WPPA Medicare Advantage	$18.68

Suture 6-0 Prolene BLU 24

Facility

$68.00

Hospital Charge Code	3252977
Hospital Revenue Code	270
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$64.60
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Humana Medicare Advantage	$28.56
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: UnitedHealthcare Medicaid	$27.20
Rate for Payer: WPPA Medicare Advantage	$40.80

Suture 6-0 Prolene BLU 24

Facility

$68.00

Hospital Charge Code	3252977
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 6-0 Prolene P-1

Facility

$29.93

Hospital Charge Code	3258820
Hospital Revenue Code	270
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$28.43
Rate for Payer: Aetna Commercial	$26.94
Rate for Payer: Humana Medicare Advantage	$12.57
Rate for Payer: UnitedHealthcare Commercial	$28.43
Rate for Payer: UnitedHealthcare Medicaid	$11.97
Rate for Payer: WPPA Medicare Advantage	$17.96

Suture 6-0 Prolene P-1

Facility

$29.93

Hospital Charge Code	3258820
Hospital Revenue Code	270
Min. Negotiated Rate	$26.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.94
Rate for Payer: UnitedHealthcare Commercial	$28.43
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Suture 6-0 Vicryl P-1

Facility

$21.60

Hospital Charge Code	3254982
Hospital Revenue Code	270
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$20.52
Rate for Payer: Aetna Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$9.07
Rate for Payer: UnitedHealthcare Commercial	$20.52
Rate for Payer: UnitedHealthcare Medicaid	$8.64
Rate for Payer: WPPA Medicare Advantage	$12.96

Suture 6-0 Vicryl P-1

Facility

$21.60

Hospital Charge Code	3254982
Hospital Revenue Code	270
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$19.44
Rate for Payer: UnitedHealthcare Commercial	$20.52
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges