Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

27695 REPAIR OF ANKLE LIGAMENT

Facility

$5,355.00

Service Code	HCPCS 27695
Hospital Charge Code	3157695
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,087.25
Rate for Payer: Aetna Commercial	$4,819.50
Rate for Payer: UnitedHealthcare Commercial	$5,087.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27695 REPAIR OF ANKLE LIGAMENT

Facility

$5,355.00

Service Code	HCPCS 27695
Hospital Charge Code	3157695
Hospital Revenue Code	360
Min. Negotiated Rate	$2,249.10
Max. Negotiated Rate	$5,087.25
Rate for Payer: Aetna Commercial	$4,819.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,307.75
Rate for Payer: Humana Medicare Advantage	$2,249.10
Rate for Payer: UnitedHealthcare Commercial	$5,087.25
Rate for Payer: UnitedHealthcare Medicaid	$2,317.55
Rate for Payer: WPPA Medicare Advantage	$3,213.00

27786-Distal Fibular w/o Manipulation

Facility

$869.00

Service Code	HCPCS 27786
Hospital Charge Code	3307786
Hospital Revenue Code	450
Min. Negotiated Rate	$782.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$782.10
Rate for Payer: UnitedHealthcare Commercial	$825.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

27786-Distal Fibular w/o Manipulation

Facility

$869.00

Service Code	HCPCS 27786
Hospital Charge Code	3307786
Hospital Revenue Code	450
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$1,454.40
Rate for Payer: Aetna Commercial	$782.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,454.40
Rate for Payer: Humana Medicare Advantage	$364.98
Rate for Payer: UnitedHealthcare Commercial	$825.55
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$521.40

28002 Incision and drainage below fascia, w/wo tendon sheath involvement, foot; single bursal space

Facility

$2,450.00

Service Code	HCPCS 28002
Hospital Charge Code	3158002
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,327.50
Rate for Payer: Aetna Commercial	$2,205.00
Rate for Payer: UnitedHealthcare Commercial	$2,327.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28002 Incision and drainage below fascia, w/wo tendon sheath involvement, foot; single bursal space

Facility

$2,450.00

Service Code	HCPCS 28002
Hospital Charge Code	3158002
Hospital Revenue Code	360
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$2,327.50
Rate for Payer: Aetna Commercial	$2,205.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,454.40
Rate for Payer: Humana Medicare Advantage	$1,029.00
Rate for Payer: UnitedHealthcare Commercial	$2,327.50
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$1,470.00

28010 Tenotomy, percutaneous, toe; single tendon

Facility

$610.00

Service Code	HCPCS 28010
Hospital Charge Code	3298010
Hospital Revenue Code	761
Min. Negotiated Rate	$549.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$549.00
Rate for Payer: UnitedHealthcare Commercial	$579.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28010 Tenotomy, percutaneous, toe; single tendon

Facility

$610.00

Service Code	HCPCS 28010
Hospital Charge Code	3298010
Hospital Revenue Code	761
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$579.50
Rate for Payer: Aetna Commercial	$549.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$158.40
Rate for Payer: Humana Medicare Advantage	$256.20
Rate for Payer: UnitedHealthcare Commercial	$579.50
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$366.00

28010 Tenotomy, percutaneous, toe; singl tendon

Facility

$610.00

Service Code	HCPCS 28010
Hospital Charge Code	3158010
Hospital Revenue Code	360
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$579.50
Rate for Payer: Aetna Commercial	$549.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$158.40
Rate for Payer: Humana Medicare Advantage	$256.20
Rate for Payer: UnitedHealthcare Commercial	$579.50
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$366.00

28010 Tenotomy, percutaneous, toe; singl tendon

Facility

$610.00

Service Code	HCPCS 28010
Hospital Charge Code	3158010
Hospital Revenue Code	360
Min. Negotiated Rate	$549.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$549.00
Rate for Payer: UnitedHealthcare Commercial	$579.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28011 Tenotomy, percutaneous, toe; multiple tendons

Facility

$1,061.00

Service Code	HCPCS 28011
Hospital Charge Code	3298011
Hospital Revenue Code	761
Min. Negotiated Rate	$954.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$954.90
Rate for Payer: UnitedHealthcare Commercial	$1,007.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28011 Tenotomy, percutaneous, toe; multiple tendons

Facility

$1,061.00

Service Code	HCPCS 28011
Hospital Charge Code	3298011
Hospital Revenue Code	761
Min. Negotiated Rate	$445.62
Max. Negotiated Rate	$1,007.95
Rate for Payer: Aetna Commercial	$954.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$851.00
Rate for Payer: Humana Medicare Advantage	$445.62
Rate for Payer: UnitedHealthcare Commercial	$1,007.95
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$636.60

28024 Arthrotomy, incld exploration, drainage, or removal of foreign body; interphalangeal joint

Facility

$2,332.00

Service Code	HCPCS 28024
Hospital Charge Code	3158024
Hospital Revenue Code	360
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$2,215.40
Rate for Payer: Aetna Commercial	$2,098.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,454.40
Rate for Payer: Humana Medicare Advantage	$979.44
Rate for Payer: UnitedHealthcare Commercial	$2,215.40
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$1,399.20

28024 Arthrotomy, incld exploration, drainage, or removal of foreign body; interphalangeal joint

Facility

$2,332.00

Service Code	HCPCS 28024
Hospital Charge Code	3158024
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,215.40
Rate for Payer: Aetna Commercial	$2,098.80
Rate for Payer: UnitedHealthcare Commercial	$2,215.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28039 EXC FOOT/TOE TUM SC 1.5 CM/>

Facility

$2,237.00

Service Code	HCPCS 28039
Hospital Charge Code	3158039
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,125.15
Rate for Payer: Aetna Commercial	$2,013.30
Rate for Payer: UnitedHealthcare Commercial	$2,125.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28039 EXC FOOT/TOE TUM SC 1.5 CM/>

Facility

$2,237.00

Service Code	HCPCS 28039
Hospital Charge Code	3158039
Hospital Revenue Code	360
Min. Negotiated Rate	$847.14
Max. Negotiated Rate	$2,125.15
Rate for Payer: Aetna Commercial	$2,013.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,381.68
Rate for Payer: Humana Medicare Advantage	$939.54
Rate for Payer: UnitedHealthcare Commercial	$2,125.15
Rate for Payer: UnitedHealthcare Medicaid	$847.14
Rate for Payer: WPPA Medicare Advantage	$1,342.20

28043 Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm

Facility

$1,400.00

Service Code	HCPCS 28043
Hospital Charge Code	3358043
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,330.00
Rate for Payer: Aetna Commercial	$1,260.00
Rate for Payer: UnitedHealthcare Commercial	$1,330.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28043 Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm

Facility

$1,400.00

Service Code	HCPCS 28043
Hospital Charge Code	3358043
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$1,330.00
Rate for Payer: Aetna Commercial	$1,260.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,010.00
Rate for Payer: Humana Medicare Advantage	$588.00
Rate for Payer: UnitedHealthcare Commercial	$1,330.00
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$840.00

28045 EXC FOOT/TOE TUM DEEP <1.5CM

Facility

$3,424.00

Service Code	HCPCS 28045
Hospital Charge Code	3158045
Hospital Revenue Code	360
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$3,252.80
Rate for Payer: Aetna Commercial	$3,081.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,711.95
Rate for Payer: Humana Medicare Advantage	$1,438.08
Rate for Payer: UnitedHealthcare Commercial	$3,252.80
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,054.40

28045 EXC FOOT/TOE TUM DEEP <1.5CM

Facility

$3,424.00

Service Code	HCPCS 28045
Hospital Charge Code	3158045
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,252.80
Rate for Payer: Aetna Commercial	$3,081.60
Rate for Payer: UnitedHealthcare Commercial	$3,252.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28080 EXCISION MORTON'S NEUROMA

Facility

$2,815.00

Service Code	HCPCS 28080
Hospital Charge Code	3158080
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,674.25
Rate for Payer: Aetna Commercial	$2,533.50
Rate for Payer: UnitedHealthcare Commercial	$2,674.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28080 EXCISION MORTON'S NEUROMA

Facility

$2,815.00

Service Code	HCPCS 28080
Hospital Charge Code	3158080
Hospital Revenue Code	360
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$2,674.25
Rate for Payer: Aetna Commercial	$2,533.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,031.11
Rate for Payer: Humana Medicare Advantage	$1,182.30
Rate for Payer: UnitedHealthcare Commercial	$2,674.25
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$1,689.00

28090 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy); foot

Facility

$4,596.00

Service Code	HCPCS 28090
Hospital Charge Code	3158090
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,366.20
Rate for Payer: Aetna Commercial	$4,136.40
Rate for Payer: UnitedHealthcare Commercial	$4,366.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28090 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy); foot

Facility

$4,596.00

Service Code	HCPCS 28090
Hospital Charge Code	3158090
Hospital Revenue Code	360
Min. Negotiated Rate	$520.65
Max. Negotiated Rate	$4,366.20
Rate for Payer: Aetna Commercial	$4,136.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,865.37
Rate for Payer: Humana Medicare Advantage	$1,930.32
Rate for Payer: UnitedHealthcare Commercial	$4,366.20
Rate for Payer: UnitedHealthcare Medicaid	$520.65
Rate for Payer: WPPA Medicare Advantage	$2,757.60

28110 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)

Facility

$5,035.00

Service Code	HCPCS 28110
Hospital Charge Code	3158110
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$4,783.25
Rate for Payer: Aetna Commercial	$4,531.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,847.19
Rate for Payer: Humana Medicare Advantage	$2,114.70
Rate for Payer: UnitedHealthcare Commercial	$4,783.25
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$3,021.00

Know your out-of-pocket cost for care.

All Charges