Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

26116 Exc, tumor/soft tissue/vascular malformation, of hand/finger, subfascial; less than 1.5 cm

Facility

$3,148.00

Service Code	HCPCS 26116
Hospital Charge Code	31156116
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,990.60
Rate for Payer: Aetna Commercial	$2,833.20
Rate for Payer: UnitedHealthcare Commercial	$2,990.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26123 FASCIECTOMY PALM ONLY TechFee

Facility

$3,714.00

Service Code	HCPCS 26123
Hospital Charge Code	3300302
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,528.30
Rate for Payer: Aetna Commercial	$3,342.60
Rate for Payer: UnitedHealthcare Commercial	$3,528.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26123 FASCIECTOMY PALM ONLY TechFee

Facility

$3,714.00

Service Code	HCPCS 26123
Hospital Charge Code	3300302
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$3,528.30
Rate for Payer: Aetna Commercial	$3,342.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,980.61
Rate for Payer: Humana Medicare Advantage	$1,559.88
Rate for Payer: UnitedHealthcare Commercial	$3,528.30
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$2,228.40

26123-Fasciectomy, single finger

Facility

$938.00

Service Code	HCPCS 26123
Hospital Charge Code	3300302
Hospital Revenue Code	450
Min. Negotiated Rate	$844.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$844.20
Rate for Payer: UnitedHealthcare Commercial	$891.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26123-Fasciectomy, single finger

Facility

$938.00

Service Code	HCPCS 26123
Hospital Charge Code	3300302
Hospital Revenue Code	450
Min. Negotiated Rate	$393.96
Max. Negotiated Rate	$1,980.61
Rate for Payer: Aetna Commercial	$844.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,980.61
Rate for Payer: Humana Medicare Advantage	$393.96
Rate for Payer: UnitedHealthcare Commercial	$891.10
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$562.80

26123 RELEASE PALM CONTRACTURE

Facility

$3,714.00

Service Code	HCPCS 26123
Hospital Charge Code	3150302
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,528.30
Rate for Payer: Aetna Commercial	$3,342.60
Rate for Payer: UnitedHealthcare Commercial	$3,528.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26123 RELEASE PALM CONTRACTURE

Facility

$3,714.00

Service Code	HCPCS 26123
Hospital Charge Code	3150302
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$3,528.30
Rate for Payer: Aetna Commercial	$3,342.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,980.61
Rate for Payer: Humana Medicare Advantage	$1,559.88
Rate for Payer: UnitedHealthcare Commercial	$3,528.30
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$2,228.40

26125 Fasciectomy, palm, w/wo Z-plasty, other local tissue rearrangement, or skin grafting; ea add

Facility

$2,211.00

Service Code	HCPCS 26125
Hospital Charge Code	3156125
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,100.45
Rate for Payer: Aetna Commercial	$1,989.90
Rate for Payer: UnitedHealthcare Commercial	$2,100.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26125 Fasciectomy, palm, w/wo Z-plasty, other local tissue rearrangement, or skin grafting; ea add

Facility

$2,211.00

Service Code	HCPCS 26125
Hospital Charge Code	3156125
Hospital Revenue Code	360
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$2,100.45
Rate for Payer: Aetna Commercial	$1,989.90
Rate for Payer: Humana Medicare Advantage	$928.62
Rate for Payer: UnitedHealthcare Commercial	$2,100.45
Rate for Payer: UnitedHealthcare Medicaid	$364.00
Rate for Payer: WPPA Medicare Advantage	$1,326.60

26160 REMOVE TENDON SHEATH LESION

Facility

$3,906.00

Service Code	HCPCS 26160
Hospital Charge Code	3150732
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,710.70
Rate for Payer: Aetna Commercial	$3,515.40
Rate for Payer: UnitedHealthcare Commercial	$3,710.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26160 REMOVE TENDON SHEATH LESION

Facility

$3,906.00

Service Code	HCPCS 26160
Hospital Charge Code	3150732
Hospital Revenue Code	360
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$3,710.70
Rate for Payer: Aetna Commercial	$3,515.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,074.54
Rate for Payer: Humana Medicare Advantage	$1,640.52
Rate for Payer: UnitedHealthcare Commercial	$3,710.70
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$2,343.60

26200 EXCISION HAND BONE LESION CHARGE

Facility

$3,336.00

Service Code	HCPCS 26200
Hospital Charge Code	3356200
Hospital Revenue Code	360
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$3,169.20
Rate for Payer: Aetna Commercial	$3,002.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,980.61
Rate for Payer: Humana Medicare Advantage	$1,401.12
Rate for Payer: UnitedHealthcare Commercial	$3,169.20
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$2,001.60

26200 EXCISION HAND BONE LESION CHARGE

Facility

$3,336.00

Service Code	HCPCS 26200
Hospital Charge Code	3356200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,169.20
Rate for Payer: Aetna Commercial	$3,002.40
Rate for Payer: UnitedHealthcare Commercial	$3,169.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26210 Removal of Finger Lesion

Facility

$2,581.00

Service Code	HCPCS 26210
Hospital Charge Code	3156210
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,451.95
Rate for Payer: Aetna Commercial	$2,322.90
Rate for Payer: UnitedHealthcare Commercial	$2,451.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26210 Removal of Finger Lesion

Facility

$2,581.00

Service Code	HCPCS 26210
Hospital Charge Code	3156210
Hospital Revenue Code	360
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$2,451.95
Rate for Payer: Aetna Commercial	$2,322.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$977.00
Rate for Payer: Humana Medicare Advantage	$1,084.02
Rate for Payer: UnitedHealthcare Commercial	$2,451.95
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$1,548.60

26230 Partial excision of bone; metacarpal

Facility

$3,036.00

Service Code	HCPCS 26230
Hospital Charge Code	3156230
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,884.20
Rate for Payer: Aetna Commercial	$2,732.40
Rate for Payer: UnitedHealthcare Commercial	$2,884.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26230 Partial excision of bone; metacarpal

Facility

$3,036.00

Service Code	HCPCS 26230
Hospital Charge Code	3156230
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$2,884.20
Rate for Payer: Aetna Commercial	$2,732.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,402.45
Rate for Payer: Humana Medicare Advantage	$1,275.12
Rate for Payer: UnitedHealthcare Commercial	$2,884.20
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$1,821.60

26356 REPAIR FLEXOR TENDON, ZONE 2 TechFee

Facility

$2,720.00

Service Code	HCPCS 26356
Hospital Charge Code	3356356
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$2,584.00
Rate for Payer: Aetna Commercial	$2,448.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,660.31
Rate for Payer: Humana Medicare Advantage	$1,142.40
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$1,632.00

26356 REPAIR FLEXOR TENDON, ZONE 2 TechFee

Facility

$2,720.00

Service Code	HCPCS 26356
Hospital Charge Code	3356356
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,584.00
Rate for Payer: Aetna Commercial	$2,448.00
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26530 Arthroplasty, metacarpophalangeal joint; each joint

Facility

$4,413.00

Service Code	HCPCS 26530
Hospital Charge Code	3150230
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,192.35
Rate for Payer: Aetna Commercial	$3,971.70
Rate for Payer: UnitedHealthcare Commercial	$4,192.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26530 Arthroplasty, metacarpophalangeal joint; each joint

Facility

$4,413.00

Service Code	HCPCS 26530
Hospital Charge Code	3150230
Hospital Revenue Code	360
Min. Negotiated Rate	$1,853.46
Max. Negotiated Rate	$4,192.35
Rate for Payer: Aetna Commercial	$3,971.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,980.61
Rate for Payer: Humana Medicare Advantage	$1,853.46
Rate for Payer: UnitedHealthcare Commercial	$4,192.35
Rate for Payer: UnitedHealthcare Medicaid	$2,317.55
Rate for Payer: WPPA Medicare Advantage	$2,647.80

26535 Arthroplasty, interphalangeal joint; each joint

Facility

$7,131.00

Service Code	HCPCS 26535
Hospital Charge Code	3156535
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$6,774.45
Rate for Payer: Aetna Commercial	$6,417.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,856.08
Rate for Payer: Humana Medicare Advantage	$2,995.02
Rate for Payer: UnitedHealthcare Commercial	$6,774.45
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$4,278.60

26535 Arthroplasty, interphalangeal joint; each joint

Facility

$7,131.00

Service Code	HCPCS 26535
Hospital Charge Code	3156535
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,774.45
Rate for Payer: Aetna Commercial	$6,417.90
Rate for Payer: UnitedHealthcare Commercial	$6,774.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26705 - Metacarp w/manip & anesthesia

Facility

$1,599.00

Service Code	HCPCS 26705
Hospital Charge Code	3306705
Hospital Revenue Code	450
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$1,519.05
Rate for Payer: Aetna Commercial	$1,439.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$671.58
Rate for Payer: UnitedHealthcare Commercial	$1,519.05
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$959.40

26705 - Metacarp w/manip & anesthesia

Facility

$1,599.00

Service Code	HCPCS 26705
Hospital Charge Code	3306705
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

Know your out-of-pocket cost for care.

All Charges