Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

21930 EXC BACK LES SC < 3 CM

Facility

$2,308.00

Service Code	HCPCS 21930
Hospital Charge Code	3151930
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,192.60
Rate for Payer: Aetna Commercial	$2,077.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,496.82
Rate for Payer: Humana Medicare Advantage	$969.36
Rate for Payer: UnitedHealthcare Commercial	$2,192.60
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,384.80

21930 PF EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$2,308.00

Service Code	HCPCS 21930
Hospital Charge Code	3351930
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,192.60
Rate for Payer: Aetna Commercial	$2,077.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,496.82
Rate for Payer: Humana Medicare Advantage	$969.36
Rate for Payer: UnitedHealthcare Commercial	$2,192.60
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,384.80

21930 PF EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$2,308.00

Service Code	HCPCS 21930
Hospital Charge Code	3351930
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,192.60
Rate for Payer: Aetna Commercial	$2,077.20
Rate for Payer: UnitedHealthcare Commercial	$2,192.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

21931 EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>

Facility

$4,275.00

Service Code	HCPCS 21931
Hospital Charge Code	3151931
Hospital Revenue Code	360
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$4,061.25
Rate for Payer: Aetna Commercial	$3,847.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,084.64
Rate for Payer: Humana Medicare Advantage	$1,795.50
Rate for Payer: UnitedHealthcare Commercial	$4,061.25
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$2,565.00

21931 EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>

Facility

$4,275.00

Service Code	HCPCS 21931
Hospital Charge Code	3151931
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,061.25
Rate for Payer: Aetna Commercial	$3,847.50
Rate for Payer: UnitedHealthcare Commercial	$4,061.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

21931 Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater.

Facility

$4,275.00

Service Code	HCPCS 21931
Hospital Charge Code	3351931
Hospital Revenue Code	761
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$4,061.25
Rate for Payer: Aetna Commercial	$3,847.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,084.64
Rate for Payer: Humana Medicare Advantage	$1,795.50
Rate for Payer: UnitedHealthcare Commercial	$4,061.25
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$2,565.00

21931 Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater.

Facility

$4,275.00

Service Code	HCPCS 21931
Hospital Charge Code	3351931
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,061.25
Rate for Payer: Aetna Commercial	$3,847.50
Rate for Payer: UnitedHealthcare Commercial	$4,061.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

21932 Excision, tumor, soft tissue of back or flank, subfascial; less than 5 cm

Facility

$4,772.00

Service Code	HCPCS 21932
Hospital Charge Code	3150665
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,533.40
Rate for Payer: Aetna Commercial	$4,294.80
Rate for Payer: UnitedHealthcare Commercial	$4,533.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

21932 Excision, tumor, soft tissue of back or flank, subfascial; less than 5 cm

Facility

$4,772.00

Service Code	HCPCS 21932
Hospital Charge Code	3150665
Hospital Revenue Code	360
Min. Negotiated Rate	$633.79
Max. Negotiated Rate	$4,533.40
Rate for Payer: Aetna Commercial	$4,294.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,975.46
Rate for Payer: Humana Medicare Advantage	$2,004.24
Rate for Payer: UnitedHealthcare Commercial	$4,533.40
Rate for Payer: UnitedHealthcare Medicaid	$633.79
Rate for Payer: WPPA Medicare Advantage	$2,863.20

21933 EXCISION, TUM, SOFT TISS OF BACK/FLANK, 5CM OR >

Facility

$5,458.00

Service Code	HCPCS 21933
Hospital Charge Code	3151933
Hospital Revenue Code	360
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$5,185.10
Rate for Payer: Aetna Commercial	$4,912.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,372.39
Rate for Payer: Humana Medicare Advantage	$2,292.36
Rate for Payer: UnitedHealthcare Commercial	$5,185.10
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$3,274.80

21933 EXCISION, TUM, SOFT TISS OF BACK/FLANK, 5CM OR >

Facility

$5,458.00

Service Code	HCPCS 21933
Hospital Charge Code	3151933
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,185.10
Rate for Payer: Aetna Commercial	$4,912.20
Rate for Payer: UnitedHealthcare Commercial	$5,185.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

22902 EXC ABD LES SC < 3 CM

Facility

$4,418.00

Service Code	HCPCS 22902
Hospital Charge Code	3152902
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,197.10
Rate for Payer: Aetna Commercial	$3,976.20
Rate for Payer: UnitedHealthcare Commercial	$4,197.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

22902 EXC ABD LES SC < 3 CM

Facility

$4,418.00

Service Code	HCPCS 22902
Hospital Charge Code	3152902
Hospital Revenue Code	360
Min. Negotiated Rate	$633.79
Max. Negotiated Rate	$4,197.10
Rate for Payer: Aetna Commercial	$3,976.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,356.33
Rate for Payer: Humana Medicare Advantage	$1,855.56
Rate for Payer: UnitedHealthcare Commercial	$4,197.10
Rate for Payer: UnitedHealthcare Medicaid	$633.79
Rate for Payer: WPPA Medicare Advantage	$2,650.80

22903 EXC ABD LES SC > 3 CM

Facility

$4,167.00

Service Code	HCPCS 22903
Hospital Charge Code	3152903
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,958.65
Rate for Payer: Aetna Commercial	$3,750.30
Rate for Payer: UnitedHealthcare Commercial	$3,958.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

22903 EXC ABD LES SC > 3 CM

Facility

$4,167.00

Service Code	HCPCS 22903
Hospital Charge Code	3152903
Hospital Revenue Code	360
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$3,958.65
Rate for Payer: Aetna Commercial	$3,750.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,356.33
Rate for Payer: Humana Medicare Advantage	$1,750.14
Rate for Payer: UnitedHealthcare Commercial	$3,958.65
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$2,500.20

23065 BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL ProFee

Facility

$455.00

Service Code	HCPCS 23065
Hospital Charge Code	3153065
Hospital Revenue Code	360
Min. Negotiated Rate	$409.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$409.50
Rate for Payer: UnitedHealthcare Commercial	$432.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

23065 BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL ProFee

Facility

$455.00

Service Code	HCPCS 23065
Hospital Charge Code	3153065
Hospital Revenue Code	360
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$525.22
Rate for Payer: Aetna Commercial	$409.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$310.07
Rate for Payer: Humana Medicare Advantage	$191.10
Rate for Payer: UnitedHealthcare Commercial	$432.25
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$273.00

23071 Excision, tumor soft tissue of shoulder area, subcutaneous; 3cm or greater

Facility

$3,105.00

Service Code	HCPCS 23071
Hospital Charge Code	3153071
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,949.75
Rate for Payer: Aetna Commercial	$2,794.50
Rate for Payer: UnitedHealthcare Commercial	$2,949.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

23071 Excision, tumor soft tissue of shoulder area, subcutaneous; 3cm or greater

Facility

$3,105.00

Service Code	HCPCS 23071
Hospital Charge Code	3153071
Hospital Revenue Code	360
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$2,949.75
Rate for Payer: Aetna Commercial	$2,794.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,936.17
Rate for Payer: Humana Medicare Advantage	$1,304.10
Rate for Payer: UnitedHealthcare Commercial	$2,949.75
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$1,863.00

23071 SUB TUMOR, SHOULDER AREA, GREATER THAN 3 CM

Facility

$3,105.00

Service Code	HCPCS 23071
Hospital Charge Code	3353071
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,949.75
Rate for Payer: Aetna Commercial	$2,794.50
Rate for Payer: UnitedHealthcare Commercial	$2,949.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

23071 SUB TUMOR, SHOULDER AREA, GREATER THAN 3 CM

Facility

$3,105.00

Service Code	HCPCS 23071
Hospital Charge Code	3353071
Hospital Revenue Code	761
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$2,949.75
Rate for Payer: Aetna Commercial	$2,794.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,936.17
Rate for Payer: Humana Medicare Advantage	$1,304.10
Rate for Payer: UnitedHealthcare Commercial	$2,949.75
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$1,863.00

23073 Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greater

Facility

$7,783.00

Service Code	HCPCS 23073
Hospital Charge Code	3153073
Hospital Revenue Code	360
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$7,393.85
Rate for Payer: Aetna Commercial	$7,004.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,191.50
Rate for Payer: Humana Medicare Advantage	$3,268.86
Rate for Payer: UnitedHealthcare Commercial	$7,393.85
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$4,669.80

23073 Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greater

Facility

$7,783.00

Service Code	HCPCS 23073
Hospital Charge Code	3153073
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,393.85
Rate for Payer: Aetna Commercial	$7,004.70
Rate for Payer: UnitedHealthcare Commercial	$7,393.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

23075 SUB TUMOR,SHOULDER AREA, LESS THAN 3CM

Facility

$1,145.00

Service Code	HCPCS 23075
Hospital Charge Code	3153075
Hospital Revenue Code	360
Min. Negotiated Rate	$310.07
Max. Negotiated Rate	$1,087.75
Rate for Payer: Aetna Commercial	$1,030.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$310.07
Rate for Payer: Humana Medicare Advantage	$480.90
Rate for Payer: UnitedHealthcare Commercial	$1,087.75
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$687.00

23075 SUB TUMOR,SHOULDER AREA, LESS THAN 3CM

Facility

$1,145.00

Service Code	HCPCS 23075
Hospital Charge Code	3153075
Hospital Revenue Code	360
Min. Negotiated Rate	$1,030.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,030.50
Rate for Payer: UnitedHealthcare Commercial	$1,087.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges