Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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

11642 EXC F/E/E/N/L MAL+MRG 1.1-2

Facility

$1,217.00

Service Code	HCPCS 11642
Hospital Charge Code	3150211
Hospital Revenue Code	360
Min. Negotiated Rate	$1,095.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,095.30
Rate for Payer: UnitedHealthcare Commercial	$1,156.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11642 EXC F/E/E/N/L MAL+MRG 1.1-2

Facility

$1,217.00

Service Code	HCPCS 11642
Hospital Charge Code	3150211
Hospital Revenue Code	360
Min. Negotiated Rate	$343.20
Max. Negotiated Rate	$1,156.15
Rate for Payer: Aetna Commercial	$1,095.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$793.86
Rate for Payer: Humana Medicare Advantage	$511.14
Rate for Payer: UnitedHealthcare Commercial	$1,156.15
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$730.20

11642 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 1.1-2.0cm

Facility

$1,217.00

Service Code	HCPCS 11642
Hospital Charge Code	3351642
Hospital Revenue Code	761
Min. Negotiated Rate	$1,095.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,095.30
Rate for Payer: UnitedHealthcare Commercial	$1,156.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11642 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 1.1-2.0cm

Facility

$1,217.00

Service Code	HCPCS 11642
Hospital Charge Code	3351642
Hospital Revenue Code	761
Min. Negotiated Rate	$343.20
Max. Negotiated Rate	$1,156.15
Rate for Payer: Aetna Commercial	$1,095.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$793.86
Rate for Payer: Humana Medicare Advantage	$511.14
Rate for Payer: UnitedHealthcare Commercial	$1,156.15
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$730.20

11643 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 2.1-3.0cm

Facility

$1,368.00

Service Code	HCPCS 11643
Hospital Charge Code	3351643
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$1,299.60
Rate for Payer: Aetna Commercial	$1,231.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,036.26
Rate for Payer: Humana Medicare Advantage	$574.56
Rate for Payer: UnitedHealthcare Commercial	$1,299.60
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$820.80

11643 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 2.1-3.0cm

Facility

$1,368.00

Service Code	HCPCS 11643
Hospital Charge Code	3351643
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,299.60
Rate for Payer: Aetna Commercial	$1,231.20
Rate for Payer: UnitedHealthcare Commercial	$1,299.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11644 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 3.1-4.0cm

Facility

$2,177.00

Service Code	HCPCS 11644
Hospital Charge Code	3351644
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,068.15
Rate for Payer: Aetna Commercial	$1,959.30
Rate for Payer: UnitedHealthcare Commercial	$2,068.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11644 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 3.1-4.0cm

Facility

$2,177.00

Service Code	HCPCS 11644
Hospital Charge Code	3351644
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,068.15
Rate for Payer: Aetna Commercial	$1,959.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,315.02
Rate for Payer: Humana Medicare Advantage	$914.34
Rate for Payer: UnitedHealthcare Commercial	$2,068.15
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,306.20

11644 EXC MALIGNANT 3.1-4CM FACE EAR NOSE CHARGE

Facility

$2,177.00

Service Code	HCPCS 11644
Hospital Charge Code	3150805
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,068.15
Rate for Payer: Aetna Commercial	$1,959.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,315.02
Rate for Payer: Humana Medicare Advantage	$914.34
Rate for Payer: UnitedHealthcare Commercial	$2,068.15
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,306.20

11644 EXC MALIGNANT 3.1-4CM FACE EAR NOSE CHARGE

Facility

$2,177.00

Service Code	HCPCS 11644
Hospital Charge Code	3150805
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,068.15
Rate for Payer: Aetna Commercial	$1,959.30
Rate for Payer: UnitedHealthcare Commercial	$2,068.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11646 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 4.0 cm

Facility

$3,798.00

Service Code	HCPCS 11646
Hospital Charge Code	3351646
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$3,608.10
Rate for Payer: Aetna Commercial	$3,418.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,896.78
Rate for Payer: Humana Medicare Advantage	$1,595.16
Rate for Payer: UnitedHealthcare Commercial	$3,608.10
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,278.80

11646 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 4.0 cm

Facility

$3,798.00

Service Code	HCPCS 11646
Hospital Charge Code	3351646
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,608.10
Rate for Payer: Aetna Commercial	$3,418.20
Rate for Payer: UnitedHealthcare Commercial	$3,608.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11646 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 4.0cm

Facility

$3,798.00

Service Code	HCPCS 11646
Hospital Charge Code	3151646
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,608.10
Rate for Payer: Aetna Commercial	$3,418.20
Rate for Payer: UnitedHealthcare Commercial	$3,608.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11646 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 4.0cm

Facility

$3,798.00

Service Code	HCPCS 11646
Hospital Charge Code	3151646
Hospital Revenue Code	360
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$3,608.10
Rate for Payer: Aetna Commercial	$3,418.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,896.78
Rate for Payer: Humana Medicare Advantage	$1,595.16
Rate for Payer: UnitedHealthcare Commercial	$3,608.10
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,278.80

11719 Trimming of nondystrophic nails, any number

Facility

$139.00

Service Code	HCPCS 11719
Hospital Charge Code	3151719
Hospital Revenue Code	761
Min. Negotiated Rate	$125.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$125.10
Rate for Payer: UnitedHealthcare Commercial	$132.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11719 Trimming of nondystrophic nails, any number

Facility

$139.00

Service Code	HCPCS 11719
Hospital Charge Code	3151719
Hospital Revenue Code	761
Min. Negotiated Rate	$55.60
Max. Negotiated Rate	$132.05
Rate for Payer: Aetna Commercial	$125.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$74.74
Rate for Payer: Humana Medicare Advantage	$58.38
Rate for Payer: UnitedHealthcare Commercial	$132.05
Rate for Payer: UnitedHealthcare Medicaid	$55.60
Rate for Payer: WPPA Medicare Advantage	$83.40

11720 Debridement of nail(s) by any method(s) 1 to 5

Facility

$166.00

Service Code	HCPCS 11720
Hospital Charge Code	3291720
Hospital Revenue Code	761
Min. Negotiated Rate	$66.40
Max. Negotiated Rate	$157.70
Rate for Payer: Aetna Commercial	$149.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$69.46
Rate for Payer: Humana Medicare Advantage	$69.72
Rate for Payer: UnitedHealthcare Commercial	$157.70
Rate for Payer: UnitedHealthcare Medicaid	$66.40
Rate for Payer: WPPA Medicare Advantage	$99.60

11720 Debridement of nail(s) by any method(s) 1 to 5

Facility

$166.00

Service Code	HCPCS 11720
Hospital Charge Code	3291720
Hospital Revenue Code	761
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$149.40
Rate for Payer: UnitedHealthcare Commercial	$157.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11721 Debridement of nail(s) by any method(s); 6 or more

Facility

$678.00

Service Code	HCPCS 11721
Hospital Charge Code	3350225
Hospital Revenue Code	761
Min. Negotiated Rate	$610.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11721 Debridement of nail(s) by any method(s); 6 or more

Facility

$678.00

Service Code	HCPCS 11721
Hospital Charge Code	3350225
Hospital Revenue Code	761
Min. Negotiated Rate	$69.46
Max. Negotiated Rate	$644.10
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$69.46
Rate for Payer: Humana Medicare Advantage	$284.76
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: UnitedHealthcare Medicaid	$271.20
Rate for Payer: WPPA Medicare Advantage	$406.80

11721 DEBRIDE NAIL 6 OR MORE CHARGE

Facility

$678.00

Service Code	HCPCS 11721
Hospital Charge Code	3151721
Hospital Revenue Code	761
Min. Negotiated Rate	$610.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11721 DEBRIDE NAIL 6 OR MORE CHARGE

Facility

$678.00

Service Code	HCPCS 11721
Hospital Charge Code	3151721
Hospital Revenue Code	761
Min. Negotiated Rate	$69.46
Max. Negotiated Rate	$644.10
Rate for Payer: Aetna Commercial	$610.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$69.46
Rate for Payer: Humana Medicare Advantage	$284.76
Rate for Payer: UnitedHealthcare Commercial	$644.10
Rate for Payer: UnitedHealthcare Medicaid	$271.20
Rate for Payer: WPPA Medicare Advantage	$406.80

11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee

Facility

$301.00

Service Code	HCPCS 11730
Hospital Charge Code	3300186
Hospital Revenue Code	450
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$270.90
Rate for Payer: UnitedHealthcare Commercial	$285.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee

Facility

$301.00

Service Code	HCPCS 11730
Hospital Charge Code	3300186
Hospital Revenue Code	450
Min. Negotiated Rate	$126.42
Max. Negotiated Rate	$285.95
Rate for Payer: Aetna Commercial	$270.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$126.42
Rate for Payer: UnitedHealthcare Commercial	$285.95
Rate for Payer: UnitedHealthcare Medicaid	$260.00
Rate for Payer: WPPA Medicare Advantage	$180.60

Know your out-of-pocket cost for care.

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