Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; < 0.5cm

Facility

$2,502.00

Service Code	HCPCS 11620
Hospital Charge Code	3351620
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; < 0.5cm

Facility

$2,502.00

Service Code	HCPCS 11620
Hospital Charge Code	3351620
Hospital Revenue Code	761
Min. Negotiated Rate	$1,000.80
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,805.43
Rate for Payer: Humana Medicare Advantage	$1,050.84
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: UnitedHealthcare Medicaid	$1,000.80
Rate for Payer: WPPA Medicare Advantage	$1,501.20

11621 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 0.6-1.0cm

Facility

$1,086.00

Service Code	HCPCS 11621
Hospital Charge Code	3351621
Hospital Revenue Code	761
Min. Negotiated Rate	$977.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$977.40
Rate for Payer: UnitedHealthcare Commercial	$1,031.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11621 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 0.6-1.0cm

Facility

$1,086.00

Service Code	HCPCS 11621
Hospital Charge Code	3351621
Hospital Revenue Code	761
Min. Negotiated Rate	$343.20
Max. Negotiated Rate	$1,031.70
Rate for Payer: Aetna Commercial	$977.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$456.12
Rate for Payer: UnitedHealthcare Commercial	$1,031.70
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$651.60

11622 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 1.1-2.0cm

Facility

$1,185.00

Service Code	HCPCS 11622
Hospital Charge Code	3351622
Hospital Revenue Code	761
Min. Negotiated Rate	$1,066.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,066.50
Rate for Payer: UnitedHealthcare Commercial	$1,125.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11622 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 1.1-2.0cm

Facility

$1,185.00

Service Code	HCPCS 11622
Hospital Charge Code	3351622
Hospital Revenue Code	761
Min. Negotiated Rate	$371.80
Max. Negotiated Rate	$1,125.75
Rate for Payer: Aetna Commercial	$1,066.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$497.70
Rate for Payer: UnitedHealthcare Commercial	$1,125.75
Rate for Payer: UnitedHealthcare Medicaid	$371.80
Rate for Payer: WPPA Medicare Advantage	$711.00

11622 EXC S/N/H/F/G MAL+MRG 1.1-2

Facility

$1,185.00

Service Code	HCPCS 11622
Hospital Charge Code	3151622
Hospital Revenue Code	360
Min. Negotiated Rate	$1,066.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,066.50
Rate for Payer: UnitedHealthcare Commercial	$1,125.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11622 EXC S/N/H/F/G MAL+MRG 1.1-2

Facility

$1,185.00

Service Code	HCPCS 11622
Hospital Charge Code	3151622
Hospital Revenue Code	360
Min. Negotiated Rate	$371.80
Max. Negotiated Rate	$1,125.75
Rate for Payer: Aetna Commercial	$1,066.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$497.70
Rate for Payer: UnitedHealthcare Commercial	$1,125.75
Rate for Payer: UnitedHealthcare Medicaid	$371.80
Rate for Payer: WPPA Medicare Advantage	$711.00

11623 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised dia

Facility

$2,502.00

Service Code	HCPCS 11623
Hospital Charge Code	3351623
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,805.43
Rate for Payer: Humana Medicare Advantage	$1,050.84
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,501.20

11623 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised dia

Facility

$2,502.00

Service Code	HCPCS 11623
Hospital Charge Code	3351623
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11623 Exc s/n/h/f/g mal+marg 2.1-3-Tech Fee

Facility

$2,502.00

Service Code	HCPCS 11623
Hospital Charge Code	3151623
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,805.43
Rate for Payer: Humana Medicare Advantage	$1,050.84
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,501.20

11623 Exc s/n/h/f/g mal+marg 2.1-3-Tech Fee

Facility

$2,502.00

Service Code	HCPCS 11623
Hospital Charge Code	3151623
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11624 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 3.1-4.0cm

Facility

$2,502.00

Service Code	HCPCS 11624
Hospital Charge Code	3351624
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,805.43
Rate for Payer: Humana Medicare Advantage	$1,050.84
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,501.20

11624 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 3.1-4.0cm

Facility

$2,502.00

Service Code	HCPCS 11624
Hospital Charge Code	3351624
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11624 EXC S/N/H/F/G MAL+MRG 3.1-4

Facility

$2,502.00

Service Code	HCPCS 11624
Hospital Charge Code	3151624
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,805.43
Rate for Payer: Humana Medicare Advantage	$1,050.84
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,501.20

11624 EXC S/N/H/F/G MAL+MRG 3.1-4

Facility

$2,502.00

Service Code	HCPCS 11624
Hospital Charge Code	3151624
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11626 Excision, malignant lesion including margins, scalp, neck

Facility

$4,276.00

Service Code	HCPCS 11626
Hospital Charge Code	3151626
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11626 Excision, malignant lesion including margins, scalp, neck

Facility

$4,276.00

Service Code	HCPCS 11626
Hospital Charge Code	3151626
Hospital Revenue Code	360
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,795.92
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,565.60

11626 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised dia

Facility

$4,276.00

Service Code	HCPCS 11626
Hospital Charge Code	3351626
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,795.92
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,565.60

11626 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised dia

Facility

$4,276.00

Service Code	HCPCS 11626
Hospital Charge Code	3351626
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11640 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 0.5 cm

Facility

$668.00

Service Code	HCPCS 11640
Hospital Charge Code	3351640
Hospital Revenue Code	761
Min. Negotiated Rate	$280.56
Max. Negotiated Rate	$634.60
Rate for Payer: Aetna Commercial	$601.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$506.01
Rate for Payer: Humana Medicare Advantage	$280.56
Rate for Payer: UnitedHealthcare Commercial	$634.60
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$400.80

11640 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 0.5 cm

Facility

$668.00

Service Code	HCPCS 11640
Hospital Charge Code	3351640
Hospital Revenue Code	761
Min. Negotiated Rate	$601.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$601.20
Rate for Payer: UnitedHealthcare Commercial	$634.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11641 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 0.6-1.0cm

Facility

$911.00

Service Code	HCPCS 11641
Hospital Charge Code	3351641
Hospital Revenue Code	761
Min. Negotiated Rate	$819.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$819.90
Rate for Payer: UnitedHealthcare Commercial	$865.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11641 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 0.6-1.0cm

Facility

$911.00

Service Code	HCPCS 11641
Hospital Charge Code	3351641
Hospital Revenue Code	761
Min. Negotiated Rate	$343.20
Max. Negotiated Rate	$865.45
Rate for Payer: Aetna Commercial	$819.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$657.51
Rate for Payer: Humana Medicare Advantage	$382.62
Rate for Payer: UnitedHealthcare Commercial	$865.45
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$546.60

11641 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 0.6-1.0cm-TechF

Facility

$911.00

Service Code	HCPCS 11641
Hospital Charge Code	3151641
Hospital Revenue Code	360
Min. Negotiated Rate	$343.20
Max. Negotiated Rate	$865.45
Rate for Payer: Aetna Commercial	$819.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$657.51
Rate for Payer: Humana Medicare Advantage	$382.62
Rate for Payer: UnitedHealthcare Commercial	$865.45
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$546.60

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