Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

16020-Burn Dressings/Debridement Small

Facility

$657.00

Service Code	HCPCS 16020
Hospital Charge Code	3306020
Hospital Revenue Code	450
Min. Negotiated Rate	$591.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16020-Burn Dressings/Debridement Small

Facility

$657.00

Service Code	HCPCS 16020
Hospital Charge Code	3306020
Hospital Revenue Code	450
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$624.15
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$275.94
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$394.20

16020 DEBRIDEMENT BURN SMALL CHARGE

Facility

$818.00

Service Code	HCPCS 16020
Hospital Charge Code	3356020
Hospital Revenue Code	761
Min. Negotiated Rate	$736.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$736.20
Rate for Payer: UnitedHealthcare Commercial	$777.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16020 DEBRIDEMENT BURN SMALL CHARGE

Facility

$818.00

Service Code	HCPCS 16020
Hospital Charge Code	3356020
Hospital Revenue Code	761
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$777.10
Rate for Payer: Aetna Commercial	$736.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$343.56
Rate for Payer: UnitedHealthcare Commercial	$777.10
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$490.80

16020 Dressings and/or debridement of partial-thickness burns, initial or subsequent; small

Facility

$818.00

Service Code	HCPCS 16020
Hospital Charge Code	3356020
Hospital Revenue Code	761
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$777.10
Rate for Payer: Aetna Commercial	$736.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$343.56
Rate for Payer: UnitedHealthcare Commercial	$777.10
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$490.80

16020 Dressings and/or debridement of partial-thickness burns, initial or subsequent; small

Facility

$818.00

Service Code	HCPCS 16020
Hospital Charge Code	3356020
Hospital Revenue Code	761
Min. Negotiated Rate	$736.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$736.20
Rate for Payer: UnitedHealthcare Commercial	$777.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16020 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; SMALL ProFee

Facility

$818.00

Service Code	HCPCS 16020
Hospital Charge Code	3290160
Hospital Revenue Code	761
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$777.10
Rate for Payer: Aetna Commercial	$736.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$343.56
Rate for Payer: UnitedHealthcare Commercial	$777.10
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$490.80

16020 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; SMALL ProFee

Facility

$818.00

Service Code	HCPCS 16020
Hospital Charge Code	3290160
Hospital Revenue Code	761
Min. Negotiated Rate	$736.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$736.20
Rate for Payer: UnitedHealthcare Commercial	$777.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16025-Burn Dressings/Debridement Medium

Facility

$3,002.00

Service Code	HCPCS 16025
Hospital Charge Code	3306025
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,851.90
Rate for Payer: Aetna Commercial	$2,701.80
Rate for Payer: UnitedHealthcare Commercial	$2,851.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16025-Burn Dressings/Debridement Medium

Facility

$3,002.00

Service Code	HCPCS 16025
Hospital Charge Code	3306025
Hospital Revenue Code	450
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$2,851.90
Rate for Payer: Aetna Commercial	$2,701.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$1,260.84
Rate for Payer: UnitedHealthcare Commercial	$2,851.90
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$1,801.20

16025 Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium

Facility

$657.00

Service Code	HCPCS 16025
Hospital Charge Code	3296025
Hospital Revenue Code	761
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$624.15
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$275.94
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$394.20

16025 Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium

Facility

$657.00

Service Code	HCPCS 16025
Hospital Charge Code	3296025
Hospital Revenue Code	761
Min. Negotiated Rate	$591.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16025 DRS/DBRDMT PRTL - THKNS BURN MEDIUM CHARGE

Facility

$657.00

Service Code	HCPCS 16025
Hospital Charge Code	3296025
Hospital Revenue Code	761
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$624.15
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$275.94
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$394.20

16025 DRS/DBRDMT PRTL - THKNS BURN MEDIUM CHARGE

Facility

$657.00

Service Code	HCPCS 16025
Hospital Charge Code	3296025
Hospital Revenue Code	761
Min. Negotiated Rate	$591.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16030-Burn Dressings/Debridement Large

Facility

$148.00

Service Code	HCPCS 16030
Hospital Charge Code	3306030
Hospital Revenue Code	450
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$371.68
Rate for Payer: Aetna Commercial	$133.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$62.16
Rate for Payer: UnitedHealthcare Commercial	$140.60
Rate for Payer: UnitedHealthcare Medicaid	$314.60
Rate for Payer: WPPA Medicare Advantage	$88.80

16030-Burn Dressings/Debridement Large

Facility

$148.00

Service Code	HCPCS 16030
Hospital Charge Code	3306030
Hospital Revenue Code	450
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$133.20
Rate for Payer: UnitedHealthcare Commercial	$140.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16030 Dressings and/or debridement of partial-thickness burns, initial or subsequent; large

Facility

$657.00

Service Code	HCPCS 16030
Hospital Charge Code	3296030
Hospital Revenue Code	761
Min. Negotiated Rate	$275.94
Max. Negotiated Rate	$624.15
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$275.94
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: UnitedHealthcare Medicaid	$314.60
Rate for Payer: WPPA Medicare Advantage	$394.20

16030 Dressings and/or debridement of partial-thickness burns, initial or subsequent; large

Facility

$657.00

Service Code	HCPCS 16030
Hospital Charge Code	3296030
Hospital Revenue Code	761
Min. Negotiated Rate	$591.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16030 DRS/DBRDMT PRTL-THKNS BURNS 1ST/SUSQ LG CHARGES

Facility

$657.00

Service Code	HCPCS 16030
Hospital Charge Code	3296030
Hospital Revenue Code	761
Min. Negotiated Rate	$591.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

16030 DRS/DBRDMT PRTL-THKNS BURNS 1ST/SUSQ LG CHARGES

Facility

$657.00

Service Code	HCPCS 16030
Hospital Charge Code	3296030
Hospital Revenue Code	761
Min. Negotiated Rate	$275.94
Max. Negotiated Rate	$624.15
Rate for Payer: Aetna Commercial	$591.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$275.94
Rate for Payer: UnitedHealthcare Commercial	$624.15
Rate for Payer: UnitedHealthcare Medicaid	$314.60
Rate for Payer: WPPA Medicare Advantage	$394.20

1.6MMX6IN STEIN PIN BAYTIP NS

Facility

$148.05

Hospital Charge Code	3258137
Hospital Revenue Code	270
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$140.65
Rate for Payer: Aetna Commercial	$133.25
Rate for Payer: Humana Medicare Advantage	$62.18
Rate for Payer: UnitedHealthcare Commercial	$140.65
Rate for Payer: UnitedHealthcare Medicaid	$59.22
Rate for Payer: WPPA Medicare Advantage	$88.83

1.6MMX6IN STEIN PIN BAYTIP NS

Facility

$148.05

Hospital Charge Code	3258137
Hospital Revenue Code	270
Min. Negotiated Rate	$133.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$133.25
Rate for Payer: UnitedHealthcare Commercial	$140.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17000 DESTROY LESION 1ST CHARGE

Facility

$590.00

Service Code	HCPCS 17000
Hospital Charge Code	3297000
Hospital Revenue Code	761
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

17000 DESTROY LESION 1ST CHARGE

Facility

$590.00

Service Code	HCPCS 17000
Hospital Charge Code	3297000
Hospital Revenue Code	761
Min. Negotiated Rate	$64.86
Max. Negotiated Rate	$560.50
Rate for Payer: Aetna Commercial	$531.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$247.80
Rate for Payer: UnitedHealthcare Commercial	$560.50
Rate for Payer: UnitedHealthcare Medicaid	$64.86
Rate for Payer: WPPA Medicare Advantage	$354.00

17000 Destruction (eg, laser surg, electrosurg, cryosurg, chemosurg, surgical curettement), first le

Facility

$590.00

Service Code	HCPCS 17000
Hospital Charge Code	3150801
Hospital Revenue Code	360
Min. Negotiated Rate	$64.86
Max. Negotiated Rate	$560.50
Rate for Payer: Aetna Commercial	$531.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$247.80
Rate for Payer: UnitedHealthcare Commercial	$560.50
Rate for Payer: UnitedHealthcare Medicaid	$64.86
Rate for Payer: WPPA Medicare Advantage	$354.00

Know your out-of-pocket cost for care.

All Charges