Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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	$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

17003 Destruction, premalignant lesions, second through 14 lesions, each

Facility

$590.00

Service Code	HCPCS 17003
Hospital Charge Code	3150802
Hospital Revenue Code	360
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$560.50
Rate for Payer: Aetna Commercial	$531.00
Rate for Payer: Humana Medicare Advantage	$247.80
Rate for Payer: UnitedHealthcare Commercial	$560.50
Rate for Payer: UnitedHealthcare Medicaid	$22.88
Rate for Payer: WPPA Medicare Advantage	$354.00

17003 Destruction, premalignant lesions, second through 14 lesions, each

Facility

$590.00

Service Code	HCPCS 17003
Hospital Charge Code	3150802
Hospital Revenue Code	360
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

17110 Destruction of benign lesions 1-14 lesions

Facility

$684.00

Service Code	HCPCS 17110
Hospital Charge Code	3297110
Hospital Revenue Code	761
Min. Negotiated Rate	$615.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: UnitedHealthcare Commercial	$649.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17110 Destruction of benign lesions 1-14 lesions

Facility

$684.00

Service Code	HCPCS 17110
Hospital Charge Code	3297110
Hospital Revenue Code	761
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$649.80
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$287.28
Rate for Payer: UnitedHealthcare Commercial	$649.80
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$410.40

17110 Destruction of benign lesions, 1-14 lesions

Facility

$651.00

Service Code	HCPCS 17110
Hospital Charge Code	3157110
Hospital Revenue Code	360
Min. Negotiated Rate	$585.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$585.90
Rate for Payer: UnitedHealthcare Commercial	$618.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17110 Destruction of benign lesions, 1-14 lesions

Facility

$651.00

Service Code	HCPCS 17110
Hospital Charge Code	3157110
Hospital Revenue Code	360
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$618.45
Rate for Payer: Aetna Commercial	$585.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$273.42
Rate for Payer: UnitedHealthcare Commercial	$618.45
Rate for Payer: UnitedHealthcare Medicaid	$189.79
Rate for Payer: WPPA Medicare Advantage	$390.60

17111 Destruct (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement),

Facility

$3,303.00

Service Code	HCPCS 17111
Hospital Charge Code	3297111
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,137.85
Rate for Payer: Aetna Commercial	$2,972.70
Rate for Payer: UnitedHealthcare Commercial	$3,137.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17111 Destruct (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement),

Facility

$3,303.00

Service Code	HCPCS 17111
Hospital Charge Code	3297111
Hospital Revenue Code	761
Min. Negotiated Rate	$125.63
Max. Negotiated Rate	$3,137.85
Rate for Payer: Aetna Commercial	$2,972.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,799.82
Rate for Payer: Humana Medicare Advantage	$1,387.26
Rate for Payer: UnitedHealthcare Commercial	$3,137.85
Rate for Payer: UnitedHealthcare Medicaid	$125.63
Rate for Payer: WPPA Medicare Advantage	$1,981.80

17250 CHEMICAL CAUTERIZATION GRANULATION TISSUE tech

Facility

$539.00

Service Code	HCPCS 17250
Hospital Charge Code	3257250
Hospital Revenue Code	450
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$485.10
Rate for Payer: UnitedHealthcare Commercial	$512.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17250 CHEMICAL CAUTERIZATION GRANULATION TISSUE tech

Facility

$539.00

Service Code	HCPCS 17250
Hospital Charge Code	3257250
Hospital Revenue Code	450
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$512.05
Rate for Payer: Aetna Commercial	$485.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$388.85
Rate for Payer: Humana Medicare Advantage	$226.38
Rate for Payer: UnitedHealthcare Commercial	$512.05
Rate for Payer: UnitedHealthcare Medicaid	$85.80
Rate for Payer: WPPA Medicare Advantage	$323.40

17262 Destruction, malignant lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0cm

Facility

$387.00

Service Code	HCPCS 17262
Hospital Charge Code	3357262
Hospital Revenue Code	360
Min. Negotiated Rate	$348.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$348.30
Rate for Payer: UnitedHealthcare Commercial	$367.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17262 Destruction, malignant lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0cm

Facility

$387.00

Service Code	HCPCS 17262
Hospital Charge Code	3357262
Hospital Revenue Code	360
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$367.65
Rate for Payer: Aetna Commercial	$348.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$74.74
Rate for Payer: Humana Medicare Advantage	$162.54
Rate for Payer: UnitedHealthcare Commercial	$367.65
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$232.20

17271 Dest, malig lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical cur

Facility

$332.00

Service Code	HCPCS 17271
Hospital Charge Code	3357271
Hospital Revenue Code	360
Min. Negotiated Rate	$298.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: UnitedHealthcare Commercial	$315.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17271 Dest, malig lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical cur

Facility

$332.00

Service Code	HCPCS 17271
Hospital Charge Code	3357271
Hospital Revenue Code	360
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$315.40
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$74.74
Rate for Payer: Humana Medicare Advantage	$139.44
Rate for Payer: UnitedHealthcare Commercial	$315.40
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$199.20

17271 Lesion diameter 0.6 to 1.0cm

Facility

$332.00

Service Code	HCPCS 17271
Hospital Charge Code	3297271
Hospital Revenue Code	761
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$315.40
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$74.74
Rate for Payer: Humana Medicare Advantage	$139.44
Rate for Payer: UnitedHealthcare Commercial	$315.40
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$199.20

17271 Lesion diameter 0.6 to 1.0cm

Facility

$332.00

Service Code	HCPCS 17271
Hospital Charge Code	3297271
Hospital Revenue Code	761
Min. Negotiated Rate	$298.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: UnitedHealthcare Commercial	$315.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17272 Destruction, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0

Facility

$99.00

Service Code	HCPCS 17272
Hospital Charge Code	3297272
Hospital Revenue Code	761
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$89.10
Rate for Payer: UnitedHealthcare Commercial	$94.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17272 Destruction, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0

Facility

$99.00

Service Code	HCPCS 17272
Hospital Charge Code	3297272
Hospital Revenue Code	761
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$89.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$74.74
Rate for Payer: Humana Medicare Advantage	$41.58
Rate for Payer: UnitedHealthcare Commercial	$94.05
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$59.40

17273 Destruction, malignant lesion (eg, laser surgery, electrosur-Tech Fee

Facility

$547.00

Service Code	HCPCS 17273
Hospital Charge Code	3157273
Hospital Revenue Code	360
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$519.65
Rate for Payer: Aetna Commercial	$492.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$74.74
Rate for Payer: Humana Medicare Advantage	$229.74
Rate for Payer: UnitedHealthcare Commercial	$519.65
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$328.20

17273 Destruction, malignant lesion (eg, laser surgery, electrosur-Tech Fee

Facility

$547.00

Service Code	HCPCS 17273
Hospital Charge Code	3157273
Hospital Revenue Code	360
Min. Negotiated Rate	$492.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$492.30
Rate for Payer: UnitedHealthcare Commercial	$519.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17273 Destruction, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0

Facility

$547.00

Service Code	HCPCS 17273
Hospital Charge Code	3297273
Hospital Revenue Code	761
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$519.65
Rate for Payer: Aetna Commercial	$492.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$74.74
Rate for Payer: Humana Medicare Advantage	$229.74
Rate for Payer: UnitedHealthcare Commercial	$519.65
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$328.20

17273 Destruction, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0

Facility

$547.00

Service Code	HCPCS 17273
Hospital Charge Code	3297273
Hospital Revenue Code	761
Min. Negotiated Rate	$492.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$492.30
Rate for Payer: UnitedHealthcare Commercial	$519.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17274 Destruction, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0

Facility

$658.00

Service Code	HCPCS 17274
Hospital Charge Code	3157274
Hospital Revenue Code	360
Min. Negotiated Rate	$592.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$592.20
Rate for Payer: UnitedHealthcare Commercial	$625.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

17274 Destruction, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0

Facility

$658.00

Service Code	HCPCS 17274
Hospital Charge Code	3157274
Hospital Revenue Code	360
Min. Negotiated Rate	$276.36
Max. Negotiated Rate	$625.10
Rate for Payer: Aetna Commercial	$592.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$276.36
Rate for Payer: UnitedHealthcare Commercial	$625.10
Rate for Payer: UnitedHealthcare Medicaid	$343.20
Rate for Payer: WPPA Medicare Advantage	$394.80

Know your out-of-pocket cost for care.

All Charges