Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

12006 SIMPLE REPAIR SUPERFICIAL WOUNDS; 20.1 CM - 30.0 CM; SCALP, NECK, AXILLAE, EXT GENITALIA, TRUN

Facility

$3,076.00

Service Code	HCPCS 12006
Hospital Charge Code	3302006
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,922.20
Rate for Payer: Aetna Commercial	$2,768.40
Rate for Payer: UnitedHealthcare Commercial	$2,922.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12006 SIMPLE REPAIR SUPERFICIAL WOUNDS; 20.1 CM - 30.0 CM; SCALP, NECK, AXILLAE, EXT GENITALIA, TRUN

Facility

$3,076.00

Service Code	HCPCS 12006
Hospital Charge Code	3302006
Hospital Revenue Code	450
Min. Negotiated Rate	$252.25
Max. Negotiated Rate	$2,922.20
Rate for Payer: Aetna Commercial	$2,768.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,538.23
Rate for Payer: Humana Medicare Advantage	$1,291.92
Rate for Payer: UnitedHealthcare Commercial	$2,922.20
Rate for Payer: UnitedHealthcare Medicaid	$252.25
Rate for Payer: WPPA Medicare Advantage	$1,845.60

12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm

Facility

$620.00

Service Code	HCPCS 12011
Hospital Charge Code	3300212
Hospital Revenue Code	450
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm

Facility

$620.00

Service Code	HCPCS 12011
Hospital Charge Code	3300212
Hospital Revenue Code	450
Min. Negotiated Rate	$68.64
Max. Negotiated Rate	$589.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$475.71
Rate for Payer: Humana Medicare Advantage	$260.40
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: UnitedHealthcare Medicaid	$68.64
Rate for Payer: WPPA Medicare Advantage	$372.00

12011 Laceration Simple Face <2.6 CM

Facility

$620.00

Service Code	HCPCS 12011
Hospital Charge Code	3300212
Hospital Revenue Code	450
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12011 Laceration Simple Face <2.6 CM

Facility

$620.00

Service Code	HCPCS 12011
Hospital Charge Code	3300212
Hospital Revenue Code	450
Min. Negotiated Rate	$68.64
Max. Negotiated Rate	$589.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$475.71
Rate for Payer: Humana Medicare Advantage	$260.40
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: UnitedHealthcare Medicaid	$68.64
Rate for Payer: WPPA Medicare Advantage	$372.00

12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm

Facility

$620.00

Service Code	HCPCS 12011
Hospital Charge Code	3292011
Hospital Revenue Code	761
Min. Negotiated Rate	$68.64
Max. Negotiated Rate	$589.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$475.71
Rate for Payer: Humana Medicare Advantage	$260.40
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: UnitedHealthcare Medicaid	$68.64
Rate for Payer: WPPA Medicare Advantage	$372.00

12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm

Facility

$620.00

Service Code	HCPCS 12011
Hospital Charge Code	3292011
Hospital Revenue Code	761
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12013-Face/Ear/Eyelid/Nose/Lip 2.6-5.0 cm

Facility

$1,599.00

Service Code	HCPCS 12013
Hospital Charge Code	3300241
Hospital Revenue Code	450
Min. Negotiated Rate	$336.96
Max. Negotiated Rate	$1,519.05
Rate for Payer: Aetna Commercial	$1,439.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$475.71
Rate for Payer: Humana Medicare Advantage	$671.58
Rate for Payer: UnitedHealthcare Commercial	$1,519.05
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$959.40

12013-Face/Ear/Eyelid/Nose/Lip 2.6-5.0 cm

Facility

$1,599.00

Service Code	HCPCS 12013
Hospital Charge Code	3300241
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,519.05
Rate for Payer: Aetna Commercial	$1,439.10
Rate for Payer: UnitedHealthcare Commercial	$1,519.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee

Facility

$1,599.00

Service Code	HCPCS 12013
Hospital Charge Code	3300241
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,519.05
Rate for Payer: Aetna Commercial	$1,439.10
Rate for Payer: UnitedHealthcare Commercial	$1,519.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee

Facility

$1,599.00

Service Code	HCPCS 12013
Hospital Charge Code	3300241
Hospital Revenue Code	450
Min. Negotiated Rate	$336.96
Max. Negotiated Rate	$1,519.05
Rate for Payer: Aetna Commercial	$1,439.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$475.71
Rate for Payer: Humana Medicare Advantage	$671.58
Rate for Payer: UnitedHealthcare Commercial	$1,519.05
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$959.40

12014-Face/Ear/Eyelid/Nose/Lip 5.1-7.5 cm

Facility

$1,599.00

Service Code	HCPCS 12014
Hospital Charge Code	3300243
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,519.05
Rate for Payer: Aetna Commercial	$1,439.10
Rate for Payer: UnitedHealthcare Commercial	$1,519.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12014-Face/Ear/Eyelid/Nose/Lip 5.1-7.5 cm

Facility

$1,599.00

Service Code	HCPCS 12014
Hospital Charge Code	3300243
Hospital Revenue Code	450
Min. Negotiated Rate	$336.96
Max. Negotiated Rate	$1,519.05
Rate for Payer: Aetna Commercial	$1,439.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$475.71
Rate for Payer: Humana Medicare Advantage	$671.58
Rate for Payer: UnitedHealthcare Commercial	$1,519.05
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$959.40

12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee

Facility

$590.00

Service Code	HCPCS 12014
Hospital Charge Code	3300243
Hospital Revenue Code	450
Min. Negotiated Rate	$247.80
Max. Negotiated Rate	$560.50
Rate for Payer: Aetna Commercial	$531.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$475.71
Rate for Payer: Humana Medicare Advantage	$247.80
Rate for Payer: UnitedHealthcare Commercial	$560.50
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$354.00

12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee

Facility

$590.00

Service Code	HCPCS 12014
Hospital Charge Code	3300243
Hospital Revenue Code	450
Min. Negotiated Rate	$531.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$531.00
Rate for Payer: UnitedHealthcare Commercial	$560.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12015-Face/Ear/Eyelid/Nose/Lip 7.6-12.5 cm

Facility

$426.00

Service Code	HCPCS 12015
Hospital Charge Code	3300244
Hospital Revenue Code	450
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$383.40
Rate for Payer: UnitedHealthcare Commercial	$404.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12015-Face/Ear/Eyelid/Nose/Lip 7.6-12.5 cm

Facility

$426.00

Service Code	HCPCS 12015
Hospital Charge Code	3300244
Hospital Revenue Code	450
Min. Negotiated Rate	$178.92
Max. Negotiated Rate	$809.01
Rate for Payer: Aetna Commercial	$383.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$178.92
Rate for Payer: UnitedHealthcare Commercial	$404.70
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$255.60

12016-Face/Ear/Eyelid/Nose/Lip 12.6-20.0 cm

Facility

$426.00

Service Code	HCPCS 12016
Hospital Charge Code	3300245
Hospital Revenue Code	450
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$383.40
Rate for Payer: UnitedHealthcare Commercial	$404.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12016-Face/Ear/Eyelid/Nose/Lip 12.6-20.0 cm

Facility

$426.00

Service Code	HCPCS 12016
Hospital Charge Code	3300245
Hospital Revenue Code	450
Min. Negotiated Rate	$178.92
Max. Negotiated Rate	$809.01
Rate for Payer: Aetna Commercial	$383.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$178.92
Rate for Payer: UnitedHealthcare Commercial	$404.70
Rate for Payer: UnitedHealthcare Medicaid	$370.66
Rate for Payer: WPPA Medicare Advantage	$255.60

12020-Treatment Superficial Wound Dehiscence

Facility

$2,598.00

Service Code	HCPCS 12020
Hospital Charge Code	3305801
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,468.10
Rate for Payer: Aetna Commercial	$2,338.20
Rate for Payer: UnitedHealthcare Commercial	$2,468.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12020-Treatment Superficial Wound Dehiscence

Facility

$2,598.00

Service Code	HCPCS 12020
Hospital Charge Code	3305801
Hospital Revenue Code	450
Min. Negotiated Rate	$216.14
Max. Negotiated Rate	$2,468.10
Rate for Payer: Aetna Commercial	$2,338.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$216.14
Rate for Payer: Humana Medicare Advantage	$1,091.16
Rate for Payer: UnitedHealthcare Commercial	$2,468.10
Rate for Payer: UnitedHealthcare Medicaid	$370.66
Rate for Payer: WPPA Medicare Advantage	$1,558.80

12020 TX SUPERFICAL WOUND SIMPLE CLOSURE CHARGE

Facility

$406.00

Service Code	HCPCS 12020
Hospital Charge Code	3152020
Hospital Revenue Code	360
Min. Negotiated Rate	$365.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$365.40
Rate for Payer: UnitedHealthcare Commercial	$385.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

12020 TX SUPERFICAL WOUND SIMPLE CLOSURE CHARGE

Facility

$406.00

Service Code	HCPCS 12020
Hospital Charge Code	3152020
Hospital Revenue Code	360
Min. Negotiated Rate	$170.52
Max. Negotiated Rate	$385.70
Rate for Payer: Aetna Commercial	$365.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$216.14
Rate for Payer: Humana Medicare Advantage	$170.52
Rate for Payer: UnitedHealthcare Commercial	$385.70
Rate for Payer: UnitedHealthcare Medicaid	$370.66
Rate for Payer: WPPA Medicare Advantage	$243.60

12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE ProFee

Facility

$406.00

Service Code	HCPCS 12020
Hospital Charge Code	3305801
Hospital Revenue Code	450
Min. Negotiated Rate	$365.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$365.40
Rate for Payer: UnitedHealthcare Commercial	$385.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges