Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

11044 Debridement, bone; first 20 sq cm or less CHARGE

Facility

$2,502.00

Service Code	HCPCS 11044
Hospital Charge Code	3351044
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,805.43
Rate for Payer: Humana Medicare Advantage	$1,050.84
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,501.20

11044 Debridement, bone; first 20 sq cm or less CHARGE

Facility

$2,502.00

Service Code	HCPCS 11044
Hospital Charge Code	3351044
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,376.90
Rate for Payer: Aetna Commercial	$2,251.80
Rate for Payer: UnitedHealthcare Commercial	$2,376.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11045 DEB SUBQ TISSUE ADD-ON

Facility

$450.00

Service Code	HCPCS 11045
Hospital Charge Code	3151045
Hospital Revenue Code	360
Min. Negotiated Rate	$101.11
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna Commercial	$405.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$278.76
Rate for Payer: Humana Medicare Advantage	$189.00
Rate for Payer: UnitedHealthcare Commercial	$427.50
Rate for Payer: UnitedHealthcare Medicaid	$101.11
Rate for Payer: WPPA Medicare Advantage	$270.00

11045 DEB SUBQ TISSUE ADD-ON

Facility

$450.00

Service Code	HCPCS 11045
Hospital Charge Code	3151045
Hospital Revenue Code	360
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$405.00
Rate for Payer: UnitedHealthcare Commercial	$427.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11046 - Debr Skn-SQ Tis,Mus:ea add'l 20 sq cm(after 11043)

Facility

$526.00

Service Code	HCPCS 11046
Hospital Charge Code	3151046
Hospital Revenue Code	360
Min. Negotiated Rate	$101.11
Max. Negotiated Rate	$499.70
Rate for Payer: Aetna Commercial	$473.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$278.76
Rate for Payer: Humana Medicare Advantage	$220.92
Rate for Payer: UnitedHealthcare Commercial	$499.70
Rate for Payer: UnitedHealthcare Medicaid	$101.11
Rate for Payer: WPPA Medicare Advantage	$315.60

11046 - Debr Skn-SQ Tis,Mus:ea add'l 20 sq cm(after 11043)

Facility

$526.00

Service Code	HCPCS 11046
Hospital Charge Code	3151046
Hospital Revenue Code	360
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

11055 Callus Reduction

Facility

$603.00

Service Code	HCPCS 11055
Hospital Charge Code	3291055
Hospital Revenue Code	761
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$572.85
Rate for Payer: Aetna Commercial	$542.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$253.26
Rate for Payer: UnitedHealthcare Commercial	$572.85
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$361.80

11055 Callus Reduction

Facility

$603.00

Service Code	HCPCS 11055
Hospital Charge Code	3291055
Hospital Revenue Code	761
Min. Negotiated Rate	$542.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$542.70
Rate for Payer: UnitedHealthcare Commercial	$572.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11055 Paring or cutting of benign hyperkeratotic lesion single lesion

Facility

$633.00

Service Code	HCPCS 11055
Hospital Charge Code	3290551
Hospital Revenue Code	761
Min. Negotiated Rate	$569.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$569.70
Rate for Payer: UnitedHealthcare Commercial	$601.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11055 Paring or cutting of benign hyperkeratotic lesion single lesion

Facility

$633.00

Service Code	HCPCS 11055
Hospital Charge Code	3290551
Hospital Revenue Code	761
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$601.35
Rate for Payer: Aetna Commercial	$569.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$265.86
Rate for Payer: UnitedHealthcare Commercial	$601.35
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$379.80

11055 Paring or cutting of benign hyperkeratotic lesion, single lesion

Facility

$603.00

Service Code	HCPCS 11055
Hospital Charge Code	3351055
Hospital Revenue Code	360
Min. Negotiated Rate	$542.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$542.70
Rate for Payer: UnitedHealthcare Commercial	$572.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11055 Paring or cutting of benign hyperkeratotic lesion, single lesion

Facility

$603.00

Service Code	HCPCS 11055
Hospital Charge Code	3351055
Hospital Revenue Code	360
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$572.85
Rate for Payer: Aetna Commercial	$542.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$253.26
Rate for Payer: UnitedHealthcare Commercial	$572.85
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$361.80

11056 Paring or cutting of benign hyperkeratotic lesion 2 to 4 lesions

Facility

$237.00

Service Code	HCPCS 11056
Hospital Charge Code	3291056
Hospital Revenue Code	761
Min. Negotiated Rate	$99.54
Max. Negotiated Rate	$225.15
Rate for Payer: Aetna Commercial	$213.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$99.54
Rate for Payer: UnitedHealthcare Commercial	$225.15
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$142.20

11056 Paring or cutting of benign hyperkeratotic lesion 2 to 4 lesions

Facility

$237.00

Service Code	HCPCS 11056
Hospital Charge Code	3291056
Hospital Revenue Code	761
Min. Negotiated Rate	$213.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$213.30
Rate for Payer: UnitedHealthcare Commercial	$225.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11104 Biopsy of skin, subcutaneous tissue and/or mucous membrane; single lesion

Facility

$1,184.00

Service Code	HCPCS 11104
Hospital Charge Code	3291104
Hospital Revenue Code	761
Min. Negotiated Rate	$129.17
Max. Negotiated Rate	$1,124.80
Rate for Payer: Aetna Commercial	$1,065.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$451.17
Rate for Payer: Humana Medicare Advantage	$497.28
Rate for Payer: UnitedHealthcare Commercial	$1,124.80
Rate for Payer: UnitedHealthcare Medicaid	$129.17
Rate for Payer: WPPA Medicare Advantage	$710.40

11104 Biopsy of skin, subcutaneous tissue and/or mucous membrane; single lesion

Facility

$1,184.00

Service Code	HCPCS 11104
Hospital Charge Code	3291104
Hospital Revenue Code	761
Min. Negotiated Rate	$1,065.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,065.60
Rate for Payer: UnitedHealthcare Commercial	$1,124.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11104 Punch biopsy of skin (including simple closure, when performed), single lesion

Facility

$1,025.00

Service Code	HCPCS 11104
Hospital Charge Code	3151104
Hospital Revenue Code	360
Min. Negotiated Rate	$129.17
Max. Negotiated Rate	$973.75
Rate for Payer: Aetna Commercial	$922.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$451.17
Rate for Payer: Humana Medicare Advantage	$430.50
Rate for Payer: UnitedHealthcare Commercial	$973.75
Rate for Payer: UnitedHealthcare Medicaid	$129.17
Rate for Payer: WPPA Medicare Advantage	$615.00

11104 Punch biopsy of skin (including simple closure, when performed), single lesion

Facility

$1,025.00

Service Code	HCPCS 11104
Hospital Charge Code	3151104
Hospital Revenue Code	360
Min. Negotiated Rate	$922.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$922.50
Rate for Payer: UnitedHealthcare Commercial	$973.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11104 PUNCH BIOPSY SKIN SINGLE LESION CHARGE

Facility

$1,076.00

Service Code	HCPCS 11104
Hospital Charge Code	3351104
Hospital Revenue Code	761
Min. Negotiated Rate	$968.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$968.40
Rate for Payer: UnitedHealthcare Commercial	$1,022.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11104 PUNCH BIOPSY SKIN SINGLE LESION CHARGE

Facility

$1,076.00

Service Code	HCPCS 11104
Hospital Charge Code	3351104
Hospital Revenue Code	761
Min. Negotiated Rate	$129.17
Max. Negotiated Rate	$1,022.20
Rate for Payer: Aetna Commercial	$968.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$451.17
Rate for Payer: Humana Medicare Advantage	$451.92
Rate for Payer: UnitedHealthcare Commercial	$1,022.20
Rate for Payer: UnitedHealthcare Medicaid	$129.17
Rate for Payer: WPPA Medicare Advantage	$645.60

11105 Punch biopsy of skin (including simple closure, when performed), each separate/additional lesi

Facility

$986.00

Service Code	HCPCS 11105
Hospital Charge Code	3151051
Hospital Revenue Code	360
Min. Negotiated Rate	$887.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$887.40
Rate for Payer: UnitedHealthcare Commercial	$936.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11105 Punch biopsy of skin (including simple closure, when performed), each separate/additional lesi

Facility

$986.00

Service Code	HCPCS 11105
Hospital Charge Code	3151051
Hospital Revenue Code	360
Min. Negotiated Rate	$394.40
Max. Negotiated Rate	$936.70
Rate for Payer: Aetna Commercial	$887.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$451.17
Rate for Payer: Humana Medicare Advantage	$414.12
Rate for Payer: UnitedHealthcare Commercial	$936.70
Rate for Payer: UnitedHealthcare Medicaid	$394.40
Rate for Payer: WPPA Medicare Advantage	$591.60

11106 Incisional Biopsy of Skin, 1 lesion

Facility

$940.00

Service Code	HCPCS 11106
Hospital Charge Code	3351106
Hospital Revenue Code	761
Min. Negotiated Rate	$846.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$846.00
Rate for Payer: UnitedHealthcare Commercial	$893.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11106 Incisional Biopsy of Skin, 1 lesion

Facility

$940.00

Service Code	HCPCS 11106
Hospital Charge Code	3351106
Hospital Revenue Code	761
Min. Negotiated Rate	$224.57
Max. Negotiated Rate	$893.00
Rate for Payer: Aetna Commercial	$846.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$639.33
Rate for Payer: Humana Medicare Advantage	$394.80
Rate for Payer: UnitedHealthcare Commercial	$893.00
Rate for Payer: UnitedHealthcare Medicaid	$224.57
Rate for Payer: WPPA Medicare Advantage	$564.00

11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed), single lesi

Facility

$940.00

Service Code	HCPCS 11106
Hospital Charge Code	3151106
Hospital Revenue Code	360
Min. Negotiated Rate	$846.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$846.00
Rate for Payer: UnitedHealthcare Commercial	$893.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges