Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

38120 Laparoscopy, surgical, splenectomy

Facility

$15,500.00

Service Code	HCPCS 38120
Hospital Charge Code	3158120
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$14,725.00
Rate for Payer: Aetna Commercial	$13,950.00
Rate for Payer: UnitedHealthcare Commercial	$14,725.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38221-Bone Marrow Biopsy

Facility

$482.00

Service Code	HCPCS 38221
Hospital Charge Code	3300260
Hospital Revenue Code	450
Min. Negotiated Rate	$433.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$433.80
Rate for Payer: UnitedHealthcare Commercial	$457.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38221-Bone Marrow Biopsy

Facility

$482.00

Service Code	HCPCS 38221
Hospital Charge Code	3300260
Hospital Revenue Code	450
Min. Negotiated Rate	$202.44
Max. Negotiated Rate	$525.22
Rate for Payer: Aetna Commercial	$433.80
Rate for Payer: Humana Medicare Advantage	$202.44
Rate for Payer: UnitedHealthcare Commercial	$457.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$289.20

38500 BIOPSY/REMOVAL, LYMPH NODES

Facility

$3,434.00

Service Code	HCPCS 38500
Hospital Charge Code	3158500
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,262.30
Rate for Payer: Aetna Commercial	$3,090.60
Rate for Payer: UnitedHealthcare Commercial	$3,262.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38500 BIOPSY/REMOVAL, LYMPH NODES

Facility

$3,434.00

Service Code	HCPCS 38500
Hospital Charge Code	3158500
Hospital Revenue Code	360
Min. Negotiated Rate	$1,234.81
Max. Negotiated Rate	$3,262.30
Rate for Payer: Aetna Commercial	$3,090.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,227.05
Rate for Payer: Humana Medicare Advantage	$1,442.28
Rate for Payer: UnitedHealthcare Commercial	$3,262.30
Rate for Payer: UnitedHealthcare Medicaid	$1,234.81
Rate for Payer: WPPA Medicare Advantage	$2,060.40

38505 Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)

Facility

$982.00

Service Code	HCPCS 38505
Hospital Charge Code	3153850
Hospital Revenue Code	360
Min. Negotiated Rate	$412.44
Max. Negotiated Rate	$932.90
Rate for Payer: Aetna Commercial	$883.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$668.62
Rate for Payer: Humana Medicare Advantage	$412.44
Rate for Payer: UnitedHealthcare Commercial	$932.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$589.20

38505 Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)

Facility

$982.00

Service Code	HCPCS 38505
Hospital Charge Code	3153850
Hospital Revenue Code	360
Min. Negotiated Rate	$883.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$883.80
Rate for Payer: UnitedHealthcare Commercial	$932.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38510 BIOPSY/REMOVAL LYMPH NODES

Facility

$5,487.00

Service Code	HCPCS 38510
Hospital Charge Code	3158510
Hospital Revenue Code	360
Min. Negotiated Rate	$1,234.81
Max. Negotiated Rate	$5,212.65
Rate for Payer: Aetna Commercial	$4,938.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,959.20
Rate for Payer: Humana Medicare Advantage	$2,304.54
Rate for Payer: UnitedHealthcare Commercial	$5,212.65
Rate for Payer: UnitedHealthcare Medicaid	$1,234.81
Rate for Payer: WPPA Medicare Advantage	$3,292.20

38510 BIOPSY/REMOVAL LYMPH NODES

Facility

$5,487.00

Service Code	HCPCS 38510
Hospital Charge Code	3158510
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,212.65
Rate for Payer: Aetna Commercial	$4,938.30
Rate for Payer: UnitedHealthcare Commercial	$5,212.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38525 BIOPSY/REMOVAL LYMPH NODES

Facility

$5,824.00

Service Code	HCPCS 38525
Hospital Charge Code	3150656
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,532.80
Rate for Payer: Aetna Commercial	$5,241.60
Rate for Payer: UnitedHealthcare Commercial	$5,532.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38525 BIOPSY/REMOVAL LYMPH NODES

Facility

$5,824.00

Service Code	HCPCS 38525
Hospital Charge Code	3150656
Hospital Revenue Code	360
Min. Negotiated Rate	$1,234.81
Max. Negotiated Rate	$5,532.80
Rate for Payer: Aetna Commercial	$5,241.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,777.40
Rate for Payer: Humana Medicare Advantage	$2,446.08
Rate for Payer: UnitedHealthcare Commercial	$5,532.80
Rate for Payer: UnitedHealthcare Medicaid	$1,234.81
Rate for Payer: WPPA Medicare Advantage	$3,494.40

38525 BIOPSY/REMOVAL, LYMPH NODES, AXILLA

Facility

$5,824.00

Service Code	HCPCS 38525
Hospital Charge Code	3150656
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,532.80
Rate for Payer: Aetna Commercial	$5,241.60
Rate for Payer: UnitedHealthcare Commercial	$5,532.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38525 BIOPSY/REMOVAL, LYMPH NODES, AXILLA

Facility

$5,824.00

Service Code	HCPCS 38525
Hospital Charge Code	3150656
Hospital Revenue Code	360
Min. Negotiated Rate	$1,234.81
Max. Negotiated Rate	$5,532.80
Rate for Payer: Aetna Commercial	$5,241.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,777.40
Rate for Payer: Humana Medicare Advantage	$2,446.08
Rate for Payer: UnitedHealthcare Commercial	$5,532.80
Rate for Payer: UnitedHealthcare Medicaid	$1,234.81
Rate for Payer: WPPA Medicare Advantage	$3,494.40

38530 Biopsy or excision of lymph node(s); open, internal mammary node(s)

Facility

$6,723.00

Service Code	HCPCS 38530
Hospital Charge Code	3358530
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,386.85
Rate for Payer: Aetna Commercial	$6,050.70
Rate for Payer: UnitedHealthcare Commercial	$6,386.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38530 Biopsy or excision of lymph node(s); open, internal mammary node(s)

Facility

$6,723.00

Service Code	HCPCS 38530
Hospital Charge Code	3358530
Hospital Revenue Code	360
Min. Negotiated Rate	$1,234.81
Max. Negotiated Rate	$6,386.85
Rate for Payer: Aetna Commercial	$6,050.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,899.51
Rate for Payer: Humana Medicare Advantage	$2,823.66
Rate for Payer: UnitedHealthcare Commercial	$6,386.85
Rate for Payer: UnitedHealthcare Medicaid	$1,234.81
Rate for Payer: WPPA Medicare Advantage	$4,033.80

38531 - Biopsy or Excision of lymph node(s); open , inguinofemoral

Facility

$1,121.00

Service Code	HCPCS 38531
Hospital Charge Code	3158531
Hospital Revenue Code	360
Min. Negotiated Rate	$470.82
Max. Negotiated Rate	$1,830.41
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	$1,830.41
Rate for Payer: WPPA Medicare Advantage	$672.60

38531 - Biopsy or Excision of lymph node(s); open , inguinofemoral

Facility

$1,121.00

Service Code	HCPCS 38531
Hospital Charge Code	3158531
Hospital Revenue Code	360
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

38792 Injection procedure; radioactive tracer for identification of sentinel node

Facility

$6,519.00

Service Code	HCPCS 38792
Hospital Charge Code	3358792
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,193.05
Rate for Payer: Aetna Commercial	$5,867.10
Rate for Payer: UnitedHealthcare Commercial	$6,193.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38792 Injection procedure; radioactive tracer for identification of sentinel node

Facility

$6,519.00

Service Code	HCPCS 38792
Hospital Charge Code	3358792
Hospital Revenue Code	360
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$6,193.05
Rate for Payer: Aetna Commercial	$5,867.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,751.04
Rate for Payer: Humana Medicare Advantage	$2,737.98
Rate for Payer: UnitedHealthcare Commercial	$6,193.05
Rate for Payer: UnitedHealthcare Medicaid	$171.60
Rate for Payer: WPPA Medicare Advantage	$3,911.40

38900 IO MAP OF SENT LYMPH NODE

Facility

$6,603.00

Service Code	HCPCS 38900
Hospital Charge Code	3158900
Hospital Revenue Code	360
Min. Negotiated Rate	$2,641.20
Max. Negotiated Rate	$6,272.85
Rate for Payer: Aetna Commercial	$5,942.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,764.17
Rate for Payer: Humana Medicare Advantage	$2,773.26
Rate for Payer: UnitedHealthcare Commercial	$6,272.85
Rate for Payer: UnitedHealthcare Medicaid	$2,641.20
Rate for Payer: WPPA Medicare Advantage	$3,961.80

38900 IO MAP OF SENT LYMPH NODE

Facility

$6,603.00

Service Code	HCPCS 38900
Hospital Charge Code	3158900
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,272.85
Rate for Payer: Aetna Commercial	$5,942.70
Rate for Payer: UnitedHealthcare Commercial	$6,272.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38999 Unlisted procedure, hemic or lymphatic system

Facility

$4,580.00

Service Code	HCPCS 38999
Hospital Charge Code	3158999
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,351.00
Rate for Payer: Aetna Commercial	$4,122.00
Rate for Payer: UnitedHealthcare Commercial	$4,351.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

38999 Unlisted procedure, hemic or lymphatic system

Facility

$4,580.00

Service Code	HCPCS 38999
Hospital Charge Code	3158999
Hospital Revenue Code	360
Min. Negotiated Rate	$221.08
Max. Negotiated Rate	$4,351.00
Rate for Payer: Aetna Commercial	$4,122.00
Rate for Payer: Humana Medicare Advantage	$1,923.60
Rate for Payer: UnitedHealthcare Commercial	$4,351.00
Rate for Payer: UnitedHealthcare Medicaid	$221.08
Rate for Payer: WPPA Medicare Advantage	$2,748.00

40500 Vermilionectomy (lip shave), with mucosal advancement

Facility

$1,121.00

Service Code	HCPCS 40500
Hospital Charge Code	3350500
Hospital Revenue Code	360
Min. Negotiated Rate	$470.82
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	$1,042.99
Rate for Payer: WPPA Medicare Advantage	$672.60

40500 Vermilionectomy (lip shave), with mucosal advancement

Facility

$1,121.00

Service Code	HCPCS 40500
Hospital Charge Code	3350500
Hospital Revenue Code	360
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

Know your out-of-pocket cost for care.

All Charges