Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

10060 I & D SIMPLE CHARGE

Facility

$1,741.00

Service Code	HCPCS 10060
Hospital Charge Code	3291060
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,653.95
Rate for Payer: Aetna Commercial	$1,566.90
Rate for Payer: UnitedHealthcare Commercial	$1,653.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10060 Incision and drainage of abscess simple or single

Facility

$1,546.00

Service Code	HCPCS 10060
Hospital Charge Code	3150060
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,468.70
Rate for Payer: Aetna Commercial	$1,391.40
Rate for Payer: UnitedHealthcare Commercial	$1,468.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10060 Incision and drainage of abscess simple or single

Facility

$1,546.00

Service Code	HCPCS 10060
Hospital Charge Code	3150060
Hospital Revenue Code	761
Min. Negotiated Rate	$202.02
Max. Negotiated Rate	$1,468.70
Rate for Payer: Aetna Commercial	$1,391.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.72
Rate for Payer: Humana Medicare Advantage	$649.32
Rate for Payer: UnitedHealthcare Commercial	$1,468.70
Rate for Payer: UnitedHealthcare Medicaid	$202.02
Rate for Payer: WPPA Medicare Advantage	$927.60

10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee

Facility

$1,546.00

Service Code	HCPCS 10060
Hospital Charge Code	3304000
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,468.70
Rate for Payer: Aetna Commercial	$1,391.40
Rate for Payer: UnitedHealthcare Commercial	$1,468.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee

Facility

$1,546.00

Service Code	HCPCS 10060
Hospital Charge Code	3304000
Hospital Revenue Code	450
Min. Negotiated Rate	$202.02
Max. Negotiated Rate	$1,468.70
Rate for Payer: Aetna Commercial	$1,391.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.72
Rate for Payer: Humana Medicare Advantage	$649.32
Rate for Payer: UnitedHealthcare Commercial	$1,468.70
Rate for Payer: UnitedHealthcare Medicaid	$202.02
Rate for Payer: WPPA Medicare Advantage	$927.60

10061-I&D Abscess/Cyst/Hematoma Complicated

Facility

$2,925.00

Service Code	HCPCS 10061
Hospital Charge Code	3301110
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,778.75
Rate for Payer: Aetna Commercial	$2,632.50
Rate for Payer: UnitedHealthcare Commercial	$2,778.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10061-I&D Abscess/Cyst/Hematoma Complicated

Facility

$2,925.00

Service Code	HCPCS 10061
Hospital Charge Code	3301110
Hospital Revenue Code	450
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$2,778.75
Rate for Payer: Aetna Commercial	$2,632.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,484.70
Rate for Payer: Humana Medicare Advantage	$1,228.50
Rate for Payer: UnitedHealthcare Commercial	$2,778.75
Rate for Payer: UnitedHealthcare Medicaid	$222.22
Rate for Payer: WPPA Medicare Advantage	$1,755.00

10061 I & D COMPLEX/MULTI CHARGE

Facility

$2,391.00

Service Code	HCPCS 10061
Hospital Charge Code	3290061
Hospital Revenue Code	761
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$2,271.45
Rate for Payer: Aetna Commercial	$2,151.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,484.70
Rate for Payer: Humana Medicare Advantage	$1,004.22
Rate for Payer: UnitedHealthcare Commercial	$2,271.45
Rate for Payer: UnitedHealthcare Medicaid	$222.22
Rate for Payer: WPPA Medicare Advantage	$1,434.60

10061 I & D COMPLEX/MULTI CHARGE

Facility

$2,391.00

Service Code	HCPCS 10061
Hospital Charge Code	3290061
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,271.45
Rate for Payer: Aetna Commercial	$2,151.90
Rate for Payer: UnitedHealthcare Commercial	$2,271.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10061 Incision and drainage of abscess; complicated or multiple.

Facility

$2,391.00

Service Code	HCPCS 10061
Hospital Charge Code	3150723
Hospital Revenue Code	360
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$2,271.45
Rate for Payer: Aetna Commercial	$2,151.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,484.70
Rate for Payer: Humana Medicare Advantage	$1,004.22
Rate for Payer: UnitedHealthcare Commercial	$2,271.45
Rate for Payer: UnitedHealthcare Medicaid	$222.22
Rate for Payer: WPPA Medicare Advantage	$1,434.60

10061 Incision and drainage of abscess; complicated or multiple.

Facility

$2,391.00

Service Code	HCPCS 10061
Hospital Charge Code	3150723
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,271.45
Rate for Payer: Aetna Commercial	$2,151.90
Rate for Payer: UnitedHealthcare Commercial	$2,271.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee

Facility

$2,391.00

Service Code	HCPCS 10061
Hospital Charge Code	3301110
Hospital Revenue Code	450
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$2,271.45
Rate for Payer: Aetna Commercial	$2,151.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,484.70
Rate for Payer: Humana Medicare Advantage	$1,004.22
Rate for Payer: UnitedHealthcare Commercial	$2,271.45
Rate for Payer: UnitedHealthcare Medicaid	$222.22
Rate for Payer: WPPA Medicare Advantage	$1,434.60

10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee

Facility

$2,391.00

Service Code	HCPCS 10061
Hospital Charge Code	3301110
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,271.45
Rate for Payer: Aetna Commercial	$2,151.90
Rate for Payer: UnitedHealthcare Commercial	$2,271.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10080 I&D, pilonidal cyst, simple

Facility

$1,362.00

Service Code	HCPCS 10080
Hospital Charge Code	3150080
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,293.90
Rate for Payer: Aetna Commercial	$1,225.80
Rate for Payer: UnitedHealthcare Commercial	$1,293.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10080 I&D, pilonidal cyst, simple

Facility

$1,362.00

Service Code	HCPCS 10080
Hospital Charge Code	3150080
Hospital Revenue Code	360
Min. Negotiated Rate	$227.92
Max. Negotiated Rate	$1,293.90
Rate for Payer: Aetna Commercial	$1,225.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$982.73
Rate for Payer: Humana Medicare Advantage	$572.04
Rate for Payer: UnitedHealthcare Commercial	$1,293.90
Rate for Payer: UnitedHealthcare Medicaid	$227.92
Rate for Payer: WPPA Medicare Advantage	$817.20

10081 INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED.

Facility

$3,656.00

Service Code	HCPCS 10081
Hospital Charge Code	3150081
Hospital Revenue Code	360
Min. Negotiated Rate	$286.00
Max. Negotiated Rate	$3,473.20
Rate for Payer: Aetna Commercial	$3,290.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,968.49
Rate for Payer: Humana Medicare Advantage	$1,535.52
Rate for Payer: UnitedHealthcare Commercial	$3,473.20
Rate for Payer: UnitedHealthcare Medicaid	$286.00
Rate for Payer: WPPA Medicare Advantage	$2,193.60

10081 INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED.

Facility

$3,656.00

Service Code	HCPCS 10081
Hospital Charge Code	3150081
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,473.20
Rate for Payer: Aetna Commercial	$3,290.40
Rate for Payer: UnitedHealthcare Commercial	$3,473.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10120 ER Incision & Removal of foreign body, subq, simple

Facility

$1,910.00

Service Code	HCPCS 10120
Hospital Charge Code	3304775
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,814.50
Rate for Payer: Aetna Commercial	$1,719.00
Rate for Payer: UnitedHealthcare Commercial	$1,814.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10120 ER Incision & Removal of foreign body, subq, simple

Facility

$1,910.00

Service Code	HCPCS 10120
Hospital Charge Code	3304775
Hospital Revenue Code	450
Min. Negotiated Rate	$223.08
Max. Negotiated Rate	$1,814.50
Rate for Payer: Aetna Commercial	$1,719.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,075.65
Rate for Payer: Humana Medicare Advantage	$802.20
Rate for Payer: UnitedHealthcare Commercial	$1,814.50
Rate for Payer: UnitedHealthcare Medicaid	$223.08
Rate for Payer: WPPA Medicare Advantage	$1,146.00

10120-Incision and removal of foreign body, subcutaneous tissue, simple

Facility

$1,741.00

Service Code	HCPCS 10120
Hospital Charge Code	3352001
Hospital Revenue Code	761
Min. Negotiated Rate	$223.08
Max. Negotiated Rate	$1,653.95
Rate for Payer: Aetna Commercial	$1,566.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,075.65
Rate for Payer: Humana Medicare Advantage	$731.22
Rate for Payer: UnitedHealthcare Commercial	$1,653.95
Rate for Payer: UnitedHealthcare Medicaid	$223.08
Rate for Payer: WPPA Medicare Advantage	$1,044.60

10120-Incision and removal of foreign body, subcutaneous tissue, simple

Facility

$1,741.00

Service Code	HCPCS 10120
Hospital Charge Code	3352001
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,653.95
Rate for Payer: Aetna Commercial	$1,566.90
Rate for Payer: UnitedHealthcare Commercial	$1,653.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10120 Incision and removal of foreign body, subcutaneous tissues; simple

Facility

$1,741.00

Service Code	HCPCS 10120
Hospital Charge Code	3352001
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,653.95
Rate for Payer: Aetna Commercial	$1,566.90
Rate for Payer: UnitedHealthcare Commercial	$1,653.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10120 Incision and removal of foreign body, subcutaneous tissues; simple

Facility

$1,741.00

Service Code	HCPCS 10120
Hospital Charge Code	3352001
Hospital Revenue Code	761
Min. Negotiated Rate	$223.08
Max. Negotiated Rate	$1,653.95
Rate for Payer: Aetna Commercial	$1,566.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,075.65
Rate for Payer: Humana Medicare Advantage	$731.22
Rate for Payer: UnitedHealthcare Commercial	$1,653.95
Rate for Payer: UnitedHealthcare Medicaid	$223.08
Rate for Payer: WPPA Medicare Advantage	$1,044.60

10120 INC & REM FB SQ SMPL CHARGE

Facility

$1,910.00

Service Code	HCPCS 10120
Hospital Charge Code	3151120
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,814.50
Rate for Payer: Aetna Commercial	$1,719.00
Rate for Payer: UnitedHealthcare Commercial	$1,814.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

10120 INC & REM FB SQ SMPL CHARGE

Facility

$1,910.00

Service Code	HCPCS 10120
Hospital Charge Code	3151120
Hospital Revenue Code	360
Min. Negotiated Rate	$223.08
Max. Negotiated Rate	$1,814.50
Rate for Payer: Aetna Commercial	$1,719.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,075.65
Rate for Payer: Humana Medicare Advantage	$802.20
Rate for Payer: UnitedHealthcare Commercial	$1,814.50
Rate for Payer: UnitedHealthcare Medicaid	$223.08
Rate for Payer: WPPA Medicare Advantage	$1,146.00

Know your out-of-pocket cost for care.

All Charges