Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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

27096 INJ SACROILIAC JOINT

Facility

$1,040.00

Service Code	HCPCS 27096
Hospital Charge Code	3157096
Hospital Revenue Code	360
Min. Negotiated Rate	$936.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$936.00
Rate for Payer: UnitedHealthcare Commercial	$988.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27096 INJ SACROILIAC JOINT

Facility

$1,040.00

Service Code	HCPCS 27096
Hospital Charge Code	3157096
Hospital Revenue Code	360
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$988.00
Rate for Payer: Aetna Commercial	$936.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$675.69
Rate for Payer: Humana Medicare Advantage	$436.80
Rate for Payer: UnitedHealthcare Commercial	$988.00
Rate for Payer: UnitedHealthcare Medicaid	$104.00
Rate for Payer: WPPA Medicare Advantage	$624.00

27327 EXC THIGH/KNEE LES SC < 3 CM

Facility

$3,289.00

Service Code	HCPCS 27327
Hospital Charge Code	3150212
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,124.55
Rate for Payer: Aetna Commercial	$2,960.10
Rate for Payer: UnitedHealthcare Commercial	$3,124.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27327 EXC THIGH/KNEE LES SC < 3 CM

Facility

$3,289.00

Service Code	HCPCS 27327
Hospital Charge Code	3150212
Hospital Revenue Code	360
Min. Negotiated Rate	$310.07
Max. Negotiated Rate	$3,124.55
Rate for Payer: Aetna Commercial	$2,960.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$310.07
Rate for Payer: Humana Medicare Advantage	$1,381.38
Rate for Payer: UnitedHealthcare Commercial	$3,124.55
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,973.40

27337 SUB TUMOR,THIGH/KNEE, GREATER THAN 3CM

Facility

$4,190.00

Service Code	HCPCS 27337
Hospital Charge Code	3157337
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,980.50
Rate for Payer: Aetna Commercial	$3,771.00
Rate for Payer: UnitedHealthcare Commercial	$3,980.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27337 SUB TUMOR,THIGH/KNEE, GREATER THAN 3CM

Facility

$4,190.00

Service Code	HCPCS 27337
Hospital Charge Code	3157337
Hospital Revenue Code	360
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$3,980.50
Rate for Payer: Aetna Commercial	$3,771.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,853.25
Rate for Payer: Humana Medicare Advantage	$1,759.80
Rate for Payer: UnitedHealthcare Commercial	$3,980.50
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$2,514.00

27447 TOTAL KNEE ARTHROPLASTY CHARGE

Facility

$21,847.00

Service Code	HCPCS 27447
Hospital Charge Code	3157447
Hospital Revenue Code	360
Min. Negotiated Rate	$4,263.54
Max. Negotiated Rate	$20,754.65
Rate for Payer: Aetna Commercial	$19,662.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15,762.94
Rate for Payer: Humana Medicare Advantage	$9,175.74
Rate for Payer: UnitedHealthcare Commercial	$20,754.65
Rate for Payer: UnitedHealthcare Medicaid	$4,263.54
Rate for Payer: WPPA Medicare Advantage	$13,108.20

27447 TOTAL KNEE ARTHROPLASTY CHARGE

Facility

$21,847.00

Service Code	HCPCS 27447
Hospital Charge Code	3157447
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$20,754.65
Rate for Payer: Aetna Commercial	$19,662.30
Rate for Payer: UnitedHealthcare Commercial	$20,754.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27560 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA TechFee

Facility

$1,121.00

Service Code	HCPCS 27560
Hospital Charge Code	3357560
Hospital Revenue Code	450
Min. Negotiated Rate	$1,008.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,008.90
Rate for Payer: UnitedHealthcare Commercial	$1,064.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27560 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA TechFee

Facility

$1,121.00

Service Code	HCPCS 27560
Hospital Charge Code	3357560
Hospital Revenue Code	450
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,064.95
Rate for Payer: Aetna Commercial	$1,008.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$470.82
Rate for Payer: UnitedHealthcare Commercial	$1,064.95
Rate for Payer: UnitedHealthcare Medicaid	$364.00
Rate for Payer: WPPA Medicare Advantage	$672.60

27562-Patella w/anethesia

Facility

$270.00

Service Code	HCPCS 27562
Hospital Charge Code	3304655
Hospital Revenue Code	450
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$243.00
Rate for Payer: UnitedHealthcare Commercial	$256.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27562-Patella w/anethesia

Facility

$270.00

Service Code	HCPCS 27562
Hospital Charge Code	3304655
Hospital Revenue Code	450
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$2,526.01
Rate for Payer: Aetna Commercial	$243.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,526.01
Rate for Payer: Humana Medicare Advantage	$113.40
Rate for Payer: UnitedHealthcare Commercial	$256.50
Rate for Payer: UnitedHealthcare Medicaid	$364.00
Rate for Payer: WPPA Medicare Advantage	$162.00

27570 FIXATE KNEE JOINT CHARGE

Facility

$2,053.00

Service Code	HCPCS 27570
Hospital Charge Code	3157570
Hospital Revenue Code	360
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$1,950.35
Rate for Payer: Aetna Commercial	$1,847.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,331.18
Rate for Payer: Humana Medicare Advantage	$862.26
Rate for Payer: UnitedHealthcare Commercial	$1,950.35
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$1,231.80

27570 FIXATE KNEE JOINT CHARGE

Facility

$2,053.00

Service Code	HCPCS 27570
Hospital Charge Code	3157570
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,950.35
Rate for Payer: Aetna Commercial	$1,847.70
Rate for Payer: UnitedHealthcare Commercial	$1,950.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27590 Amputation, thigh, through femur, any level

Facility

$4,340.00

Service Code	HCPCS 27590
Hospital Charge Code	3157590
Hospital Revenue Code	360
Min. Negotiated Rate	$1,736.00
Max. Negotiated Rate	$4,123.00
Rate for Payer: Aetna Commercial	$3,906.00
Rate for Payer: Humana Medicare Advantage	$1,822.80
Rate for Payer: UnitedHealthcare Commercial	$4,123.00
Rate for Payer: UnitedHealthcare Medicaid	$1,736.00
Rate for Payer: WPPA Medicare Advantage	$2,604.00

27590 Amputation, thigh, through femur, any level

Facility

$4,340.00

Service Code	HCPCS 27590
Hospital Charge Code	3157590
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,123.00
Rate for Payer: Aetna Commercial	$3,906.00
Rate for Payer: UnitedHealthcare Commercial	$4,123.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27603 INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA TechFee

Facility

$1,201.00

Service Code	HCPCS 27603
Hospital Charge Code	3157603
Hospital Revenue Code	360
Min. Negotiated Rate	$504.42
Max. Negotiated Rate	$1,140.95
Rate for Payer: Aetna Commercial	$1,080.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$818.10
Rate for Payer: Humana Medicare Advantage	$504.42
Rate for Payer: UnitedHealthcare Commercial	$1,140.95
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$720.60

27603 INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA TechFee

Facility

$1,201.00

Service Code	HCPCS 27603
Hospital Charge Code	3157603
Hospital Revenue Code	360
Min. Negotiated Rate	$1,080.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,080.90
Rate for Payer: UnitedHealthcare Commercial	$1,140.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27618 Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm

Facility

$526.00

Service Code	HCPCS 27618
Hospital Charge Code	3407618
Hospital Revenue Code	761
Min. Negotiated Rate	$220.92
Max. Negotiated Rate	$525.22
Rate for Payer: Aetna Commercial	$473.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$310.07
Rate for Payer: Humana Medicare Advantage	$220.92
Rate for Payer: UnitedHealthcare Commercial	$499.70
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$315.60

27618 Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm

Facility

$526.00

Service Code	HCPCS 27618
Hospital Charge Code	3407618
Hospital Revenue Code	761
Min. Negotiated Rate	$473.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$473.40
Rate for Payer: UnitedHealthcare Commercial	$499.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27632 SUB TUMER, LEG/ANKLE, GREATER THAN 3 CM

Facility

$1,505.00

Service Code	HCPCS 27632
Hospital Charge Code	3157632
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,429.75
Rate for Payer: Aetna Commercial	$1,354.50
Rate for Payer: UnitedHealthcare Commercial	$1,429.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27632 SUB TUMER, LEG/ANKLE, GREATER THAN 3 CM

Facility

$1,505.00

Service Code	HCPCS 27632
Hospital Charge Code	3157632
Hospital Revenue Code	360
Min. Negotiated Rate	$310.07
Max. Negotiated Rate	$1,429.75
Rate for Payer: Aetna Commercial	$1,354.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$310.07
Rate for Payer: Humana Medicare Advantage	$632.10
Rate for Payer: UnitedHealthcare Commercial	$1,429.75
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$903.00

27640 Partial excision, bone; tibia

Facility

$4,122.00

Service Code	HCPCS 27640
Hospital Charge Code	3157640
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$3,915.90
Rate for Payer: Aetna Commercial	$3,709.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,402.45
Rate for Payer: Humana Medicare Advantage	$1,731.24
Rate for Payer: UnitedHealthcare Commercial	$3,915.90
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$2,473.20

27640 Partial excision, bone; tibia

Facility

$4,122.00

Service Code	HCPCS 27640
Hospital Charge Code	3157640
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,915.90
Rate for Payer: Aetna Commercial	$3,709.80
Rate for Payer: UnitedHealthcare Commercial	$3,915.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges