Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

28296 Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy

Facility

$6,504.00

Service Code	HCPCS 28296
Hospital Charge Code	3158296
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,178.80
Rate for Payer: Aetna Commercial	$5,853.60
Rate for Payer: UnitedHealthcare Commercial	$6,178.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28296 Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy

Facility

$6,504.00

Service Code	HCPCS 28296
Hospital Charge Code	3158296
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$6,178.80
Rate for Payer: Aetna Commercial	$5,853.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,324.92
Rate for Payer: Humana Medicare Advantage	$2,731.68
Rate for Payer: UnitedHealthcare Commercial	$6,178.80
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$3,902.40

28298 Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy

Facility

$6,504.00

Service Code	HCPCS 28298
Hospital Charge Code	3158298
Hospital Revenue Code	360
Min. Negotiated Rate	$2,317.55
Max. Negotiated Rate	$6,178.80
Rate for Payer: Aetna Commercial	$5,853.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,374.41
Rate for Payer: Humana Medicare Advantage	$2,731.68
Rate for Payer: UnitedHealthcare Commercial	$6,178.80
Rate for Payer: UnitedHealthcare Medicaid	$2,317.55
Rate for Payer: WPPA Medicare Advantage	$3,902.40

28298 Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy

Facility

$6,504.00

Service Code	HCPCS 28298
Hospital Charge Code	3158298
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,178.80
Rate for Payer: Aetna Commercial	$5,853.60
Rate for Payer: UnitedHealthcare Commercial	$6,178.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28299 Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy

Facility

$11,063.00

Service Code	HCPCS 28299
Hospital Charge Code	3158299
Hospital Revenue Code	360
Min. Negotiated Rate	$4,425.20
Max. Negotiated Rate	$10,509.85
Rate for Payer: Aetna Commercial	$9,956.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$7,981.47
Rate for Payer: Humana Medicare Advantage	$4,646.46
Rate for Payer: UnitedHealthcare Commercial	$10,509.85
Rate for Payer: UnitedHealthcare Medicaid	$4,425.20
Rate for Payer: WPPA Medicare Advantage	$6,637.80

28299 Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy

Facility

$11,063.00

Service Code	HCPCS 28299
Hospital Charge Code	3158299
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$10,509.85
Rate for Payer: Aetna Commercial	$9,956.70
Rate for Payer: UnitedHealthcare Commercial	$10,509.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28306 INCISION OF METATARSAL

Facility

$3,773.00

Service Code	HCPCS 28306
Hospital Charge Code	3158306
Hospital Revenue Code	360
Min. Negotiated Rate	$1,584.66
Max. Negotiated Rate	$3,584.35
Rate for Payer: Aetna Commercial	$3,395.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,721.95
Rate for Payer: Humana Medicare Advantage	$1,584.66
Rate for Payer: UnitedHealthcare Commercial	$3,584.35
Rate for Payer: UnitedHealthcare Medicaid	$2,317.55
Rate for Payer: WPPA Medicare Advantage	$2,263.80

28306 INCISION OF METATARSAL

Facility

$3,773.00

Service Code	HCPCS 28306
Hospital Charge Code	3158306
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,584.35
Rate for Payer: Aetna Commercial	$3,395.70
Rate for Payer: UnitedHealthcare Commercial	$3,584.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28308 INCISION OF METATARSAL

Facility

$4,138.00

Service Code	HCPCS 28308
Hospital Charge Code	3158308
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$3,931.10
Rate for Payer: Aetna Commercial	$3,724.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,157.36
Rate for Payer: Humana Medicare Advantage	$1,737.96
Rate for Payer: UnitedHealthcare Commercial	$3,931.10
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$2,482.80

28308 INCISION OF METATARSAL

Facility

$4,138.00

Service Code	HCPCS 28308
Hospital Charge Code	3158308
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,931.10
Rate for Payer: Aetna Commercial	$3,724.20
Rate for Payer: UnitedHealthcare Commercial	$3,931.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28313 Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes

Facility

$3,168.00

Service Code	HCPCS 28313
Hospital Charge Code	3158313
Hospital Revenue Code	360
Min. Negotiated Rate	$1,048.57
Max. Negotiated Rate	$3,009.60
Rate for Payer: Aetna Commercial	$2,851.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,157.36
Rate for Payer: Humana Medicare Advantage	$1,330.56
Rate for Payer: UnitedHealthcare Commercial	$3,009.60
Rate for Payer: UnitedHealthcare Medicaid	$1,048.57
Rate for Payer: WPPA Medicare Advantage	$1,900.80

28313 Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes

Facility

$3,168.00

Service Code	HCPCS 28313
Hospital Charge Code	3158313
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,009.60
Rate for Payer: Aetna Commercial	$2,851.20
Rate for Payer: UnitedHealthcare Commercial	$3,009.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28490-Great Toe/Phalanges w/o manip

Facility

$1,546.00

Service Code	HCPCS 28490
Hospital Charge Code	3308490
Hospital Revenue Code	456
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$1,468.70
Rate for Payer: Aetna Commercial	$1,391.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,454.40
Rate for Payer: Humana Medicare Advantage	$649.32
Rate for Payer: UnitedHealthcare Commercial	$1,468.70
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$927.60

28490-Great Toe/Phalanges w/o manip

Facility

$1,546.00

Service Code	HCPCS 28490
Hospital Charge Code	3308490
Hospital Revenue Code	456
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,468.70
Rate for Payer: Aetna Commercial	$1,391.40
Rate for Payer: UnitedHealthcare Commercial	$1,468.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28510-Phalanx w/o Manipulation; Not Great Toe

Facility

$1,748.00

Service Code	HCPCS 28510
Hospital Charge Code	3300275
Hospital Revenue Code	450
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$1,660.60
Rate for Payer: Aetna Commercial	$1,573.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$432.28
Rate for Payer: Humana Medicare Advantage	$734.16
Rate for Payer: UnitedHealthcare Commercial	$1,660.60
Rate for Payer: UnitedHealthcare Medicaid	$312.00
Rate for Payer: WPPA Medicare Advantage	$1,048.80

28510-Phalanx w/o Manipulation; Not Great Toe

Facility

$1,748.00

Service Code	HCPCS 28510
Hospital Charge Code	3300275
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,660.60
Rate for Payer: Aetna Commercial	$1,573.20
Rate for Payer: UnitedHealthcare Commercial	$1,660.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28545-Tarsal Bone w/anethesia

Facility

$764.00

Service Code	HCPCS 28545
Hospital Charge Code	3304615
Hospital Revenue Code	450
Min. Negotiated Rate	$305.60
Max. Negotiated Rate	$809.01
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$320.88
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: UnitedHealthcare Medicaid	$305.60
Rate for Payer: WPPA Medicare Advantage	$458.40

28545-Tarsal Bone w/anethesia

Facility

$764.00

Service Code	HCPCS 28545
Hospital Charge Code	3304615
Hospital Revenue Code	450
Min. Negotiated Rate	$687.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$687.60
Rate for Payer: UnitedHealthcare Commercial	$725.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28630-Metatarsophalangeal w/o Anesthesia

Facility

$492.00

Service Code	HCPCS 28630
Hospital Charge Code	3304660
Hospital Revenue Code	450
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$809.01
Rate for Payer: Aetna Commercial	$442.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$809.01
Rate for Payer: Humana Medicare Advantage	$206.64
Rate for Payer: UnitedHealthcare Commercial	$467.40
Rate for Payer: UnitedHealthcare Medicaid	$114.40
Rate for Payer: WPPA Medicare Advantage	$295.20

28630-Metatarsophalangeal w/o Anesthesia

Facility

$492.00

Service Code	HCPCS 28630
Hospital Charge Code	3304660
Hospital Revenue Code	450
Min. Negotiated Rate	$442.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$442.80
Rate for Payer: UnitedHealthcare Commercial	$467.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28635 TREAT/METATARSOPHALANGEAL DIS-ER SERV PR

Facility

$1,423.00

Service Code	HCPCS 28635
Hospital Charge Code	3308635
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,351.85
Rate for Payer: Aetna Commercial	$1,280.70
Rate for Payer: UnitedHealthcare Commercial	$1,351.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28635 TREAT/METATARSOPHALANGEAL DIS-ER SERV PR

Facility

$1,423.00

Service Code	HCPCS 28635
Hospital Charge Code	3308635
Hospital Revenue Code	450
Min. Negotiated Rate	$569.20
Max. Negotiated Rate	$1,351.85
Rate for Payer: Aetna Commercial	$1,280.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,077.67
Rate for Payer: Humana Medicare Advantage	$597.66
Rate for Payer: UnitedHealthcare Commercial	$1,351.85
Rate for Payer: UnitedHealthcare Medicaid	$569.20
Rate for Payer: WPPA Medicare Advantage	$853.80

28750 Arthrodesis, great toe; metatarsophalangeal joint

Facility

$13,824.00

Service Code	HCPCS 28750
Hospital Charge Code	3158750
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$13,132.80
Rate for Payer: Aetna Commercial	$12,441.60
Rate for Payer: UnitedHealthcare Commercial	$13,132.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

28750 Arthrodesis, great toe; metatarsophalangeal joint

Facility

$13,824.00

Service Code	HCPCS 28750
Hospital Charge Code	3158750
Hospital Revenue Code	360
Min. Negotiated Rate	$2,317.55
Max. Negotiated Rate	$13,132.80
Rate for Payer: Aetna Commercial	$12,441.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$8,539.55
Rate for Payer: Humana Medicare Advantage	$5,806.08
Rate for Payer: UnitedHealthcare Commercial	$13,132.80
Rate for Payer: UnitedHealthcare Medicaid	$2,317.55
Rate for Payer: WPPA Medicare Advantage	$8,294.40

28810 Amputation, metatarsal, with toe, single

Facility

$7,206.00

Service Code	HCPCS 28810
Hospital Charge Code	3158810
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,845.70
Rate for Payer: Aetna Commercial	$6,485.40
Rate for Payer: UnitedHealthcare Commercial	$6,845.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges