Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

26725 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb

Facility

$1,576.00

Service Code	HCPCS 26725
Hospital Charge Code	3256725
Hospital Revenue Code	450
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$1,497.20
Rate for Payer: Aetna Commercial	$1,418.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,137.26
Rate for Payer: Humana Medicare Advantage	$661.92
Rate for Payer: UnitedHealthcare Commercial	$1,497.20
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$945.60

26725 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb

Facility

$1,576.00

Service Code	HCPCS 26725
Hospital Charge Code	3256725
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,497.20
Rate for Payer: Aetna Commercial	$1,418.40
Rate for Payer: UnitedHealthcare Commercial	$1,497.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA TechFee

Facility

$599.00

Service Code	HCPCS 26750
Hospital Charge Code	3366750
Hospital Revenue Code	450
Min. Negotiated Rate	$251.58
Max. Negotiated Rate	$569.05
Rate for Payer: Aetna Commercial	$539.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$432.28
Rate for Payer: Humana Medicare Advantage	$251.58
Rate for Payer: UnitedHealthcare Commercial	$569.05
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$359.40

26750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA TechFee

Facility

$599.00

Service Code	HCPCS 26750
Hospital Charge Code	3366750
Hospital Revenue Code	450
Min. Negotiated Rate	$539.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$539.10
Rate for Payer: UnitedHealthcare Commercial	$569.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26750-Distal Phalangeal w/o manipulation

Facility

$1,593.00

Service Code	HCPCS 26750
Hospital Charge Code	3304670
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,513.35
Rate for Payer: Aetna Commercial	$1,433.70
Rate for Payer: UnitedHealthcare Commercial	$1,513.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26750-Distal Phalangeal w/o manipulation

Facility

$1,593.00

Service Code	HCPCS 26750
Hospital Charge Code	3304670
Hospital Revenue Code	450
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$1,513.35
Rate for Payer: Aetna Commercial	$1,433.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$432.28
Rate for Payer: Humana Medicare Advantage	$669.06
Rate for Payer: UnitedHealthcare Commercial	$1,513.35
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$955.80

26770 CLTX IPHAL JT DISLC W/MANJ

Facility

$4,128.00

Service Code	HCPCS 26770
Hospital Charge Code	3306770
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,921.60
Rate for Payer: Aetna Commercial	$3,715.20
Rate for Payer: UnitedHealthcare Commercial	$3,921.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26770 CLTX IPHAL JT DISLC W/MANJ

Facility

$4,128.00

Service Code	HCPCS 26770
Hospital Charge Code	3306770
Hospital Revenue Code	450
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$3,921.60
Rate for Payer: Aetna Commercial	$3,715.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$1,733.76
Rate for Payer: UnitedHealthcare Commercial	$3,921.60
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$2,476.80

26770-Interphalangeal Hand w/o Anesthesia

Facility

$4,128.00

Service Code	HCPCS 26770
Hospital Charge Code	3305000
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,921.60
Rate for Payer: Aetna Commercial	$3,715.20
Rate for Payer: UnitedHealthcare Commercial	$3,921.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26770-Interphalangeal Hand w/o Anesthesia

Facility

$4,128.00

Service Code	HCPCS 26770
Hospital Charge Code	3305000
Hospital Revenue Code	450
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$3,921.60
Rate for Payer: Aetna Commercial	$3,715.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$1,733.76
Rate for Payer: UnitedHealthcare Commercial	$3,921.60
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$2,476.80

26775-Interphalangeal Hand w/ Anesthesia

Facility

$2,355.00

Service Code	HCPCS 26775
Hospital Charge Code	3302677
Hospital Revenue Code	450
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$2,237.25
Rate for Payer: Aetna Commercial	$2,119.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$989.10
Rate for Payer: UnitedHealthcare Commercial	$2,237.25
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$1,413.00

26775-Interphalangeal Hand w/ Anesthesia

Facility

$2,355.00

Service Code	HCPCS 26775
Hospital Charge Code	3302677
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,237.25
Rate for Payer: Aetna Commercial	$2,119.50
Rate for Payer: UnitedHealthcare Commercial	$2,237.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26951 AMPUTATION FING/THUM [HGHO]

Facility

$4,725.00

Service Code	HCPCS 26951
Hospital Charge Code	3366951
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,488.75
Rate for Payer: Aetna Commercial	$4,252.50
Rate for Payer: UnitedHealthcare Commercial	$4,488.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26951 AMPUTATION FING/THUM [HGHO]

Facility

$4,725.00

Service Code	HCPCS 26951
Hospital Charge Code	3366951
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$4,488.75
Rate for Payer: Aetna Commercial	$4,252.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,595.00
Rate for Payer: Humana Medicare Advantage	$1,984.50
Rate for Payer: UnitedHealthcare Commercial	$4,488.75
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$2,835.00

26951-Partial Amputation of Long Finger

Facility

$2,573.00

Service Code	HCPCS 26951
Hospital Charge Code	3300303
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$3,595.00
Rate for Payer: Aetna Commercial	$2,315.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,595.00
Rate for Payer: Humana Medicare Advantage	$1,080.66
Rate for Payer: UnitedHealthcare Commercial	$2,444.35
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$1,543.80

26951-Partial Amputation of Long Finger

Facility

$2,573.00

Service Code	HCPCS 26951
Hospital Charge Code	3300303
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,444.35
Rate for Payer: Aetna Commercial	$2,315.70
Rate for Payer: UnitedHealthcare Commercial	$2,444.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26989 Unlisted procedure, hands or fingers

Facility

$2,949.00

Service Code	HCPCS 26989
Hospital Charge Code	3156989
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,801.55
Rate for Payer: Aetna Commercial	$2,654.10
Rate for Payer: UnitedHealthcare Commercial	$2,801.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

26989 Unlisted procedure, hands or fingers

Facility

$2,949.00

Service Code	HCPCS 26989
Hospital Charge Code	3156989
Hospital Revenue Code	360
Min. Negotiated Rate	$125.74
Max. Negotiated Rate	$2,801.55
Rate for Payer: Aetna Commercial	$2,654.10
Rate for Payer: Humana Medicare Advantage	$1,238.58
Rate for Payer: UnitedHealthcare Commercial	$2,801.55
Rate for Payer: UnitedHealthcare Medicaid	$125.74
Rate for Payer: WPPA Medicare Advantage	$1,769.40

26990 Incision and drainage, pelvis or hip joint area; deep abscess or hematoma

Facility

$2,492.00

Service Code	HCPCS 26990
Hospital Charge Code	3156990
Hospital Revenue Code	360
Min. Negotiated Rate	$1,046.64
Max. Negotiated Rate	$2,367.40
Rate for Payer: Aetna Commercial	$2,242.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,402.45
Rate for Payer: Humana Medicare Advantage	$1,046.64
Rate for Payer: UnitedHealthcare Commercial	$2,367.40
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$1,495.20

26990 Incision and drainage, pelvis or hip joint area; deep abscess or hematoma

Facility

$2,492.00

Service Code	HCPCS 26990
Hospital Charge Code	3156990
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,367.40
Rate for Payer: Aetna Commercial	$2,242.80
Rate for Payer: UnitedHealthcare Commercial	$2,367.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27043 Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greater

Facility

$1,715.00

Service Code	HCPCS 27043
Hospital Charge Code	3137043
Hospital Revenue Code	761
Min. Negotiated Rate	$431.27
Max. Negotiated Rate	$1,629.25
Rate for Payer: Aetna Commercial	$1,543.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$431.27
Rate for Payer: Humana Medicare Advantage	$720.30
Rate for Payer: UnitedHealthcare Commercial	$1,629.25
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$1,029.00

27043 Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greater

Facility

$1,715.00

Service Code	HCPCS 27043
Hospital Charge Code	3137043
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,629.25
Rate for Payer: Aetna Commercial	$1,543.50
Rate for Payer: UnitedHealthcare Commercial	$1,629.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27043 SUB TUMOR,HIP/PELVIS,GREATER THAN 3CM

Facility

$1,715.00

Service Code	HCPCS 27043
Hospital Charge Code	3407043
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,629.25
Rate for Payer: Aetna Commercial	$1,543.50
Rate for Payer: UnitedHealthcare Commercial	$1,629.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27043 SUB TUMOR,HIP/PELVIS,GREATER THAN 3CM

Facility

$1,715.00

Service Code	HCPCS 27043
Hospital Charge Code	3407043
Hospital Revenue Code	360
Min. Negotiated Rate	$431.27
Max. Negotiated Rate	$1,629.25
Rate for Payer: Aetna Commercial	$1,543.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$431.27
Rate for Payer: Humana Medicare Advantage	$720.30
Rate for Payer: UnitedHealthcare Commercial	$1,629.25
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$1,029.00

27047-Excision of tumor, soft tissue of pelvis and hip area, subcutaneous; less than 3 cm

Facility

$992.00

Service Code	HCPCS 27047
Hospital Charge Code	3357047
Hospital Revenue Code	761
Min. Negotiated Rate	$310.07
Max. Negotiated Rate	$942.40
Rate for Payer: Aetna Commercial	$892.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$310.07
Rate for Payer: Humana Medicare Advantage	$416.64
Rate for Payer: UnitedHealthcare Commercial	$942.40
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$595.20

Know your out-of-pocket cost for care.

All Charges