Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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

11200 REMOVAL OF SKIN TAGS <=15 LESIONS CHARGE

Facility

$1,035.00

Service Code	HCPCS 11200
Hospital Charge Code	3151200
Hospital Revenue Code	360
Min. Negotiated Rate	$217.71
Max. Negotiated Rate	$983.25
Rate for Payer: Aetna Commercial	$931.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$434.70
Rate for Payer: UnitedHealthcare Commercial	$983.25
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$621.00

11200 REMOVAL OF SKIN TAGS <=15 LESIONS CHARGE

Facility

$1,035.00

Service Code	HCPCS 11200
Hospital Charge Code	3151200
Hospital Revenue Code	360
Min. Negotiated Rate	$931.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$931.50
Rate for Payer: UnitedHealthcare Commercial	$983.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11200 REMOVAL OF SKIN TAG, UP TO 15 LESIONS CHARGE

Facility

$1,035.00

Service Code	HCPCS 11200
Hospital Charge Code	3351200
Hospital Revenue Code	761
Min. Negotiated Rate	$217.71
Max. Negotiated Rate	$983.25
Rate for Payer: Aetna Commercial	$931.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$434.70
Rate for Payer: UnitedHealthcare Commercial	$983.25
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$621.00

11200 REMOVAL OF SKIN TAG, UP TO 15 LESIONS CHARGE

Facility

$1,035.00

Service Code	HCPCS 11200
Hospital Charge Code	3351200
Hospital Revenue Code	761
Min. Negotiated Rate	$931.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$931.50
Rate for Payer: UnitedHealthcare Commercial	$983.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11200-Removal Skin Tag up to 15

Facility

$186.00

Service Code	HCPCS 11200
Hospital Charge Code	3301200
Hospital Revenue Code	450
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$167.40
Rate for Payer: UnitedHealthcare Commercial	$176.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11200-Removal Skin Tag up to 15

Facility

$186.00

Service Code	HCPCS 11200
Hospital Charge Code	3301200
Hospital Revenue Code	450
Min. Negotiated Rate	$78.12
Max. Negotiated Rate	$336.96
Rate for Payer: Aetna Commercial	$167.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$78.12
Rate for Payer: UnitedHealthcare Commercial	$176.70
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$111.60

11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 TechFee

Facility

$1,035.00

Service Code	HCPCS 11200
Hospital Charge Code	3301200
Hospital Revenue Code	450
Min. Negotiated Rate	$931.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$931.50
Rate for Payer: UnitedHealthcare Commercial	$983.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 TechFee

Facility

$1,035.00

Service Code	HCPCS 11200
Hospital Charge Code	3301200
Hospital Revenue Code	450
Min. Negotiated Rate	$217.71
Max. Negotiated Rate	$983.25
Rate for Payer: Aetna Commercial	$931.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$434.70
Rate for Payer: UnitedHealthcare Commercial	$983.25
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$621.00

11200 REMOVE SKIN TAGS <15 CHARGE

Facility

$1,035.00

Service Code	HCPCS 11200
Hospital Charge Code	3351200
Hospital Revenue Code	761
Min. Negotiated Rate	$217.71
Max. Negotiated Rate	$983.25
Rate for Payer: Aetna Commercial	$931.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$217.71
Rate for Payer: Humana Medicare Advantage	$434.70
Rate for Payer: UnitedHealthcare Commercial	$983.25
Rate for Payer: UnitedHealthcare Medicaid	$336.96
Rate for Payer: WPPA Medicare Advantage	$621.00

11200 REMOVE SKIN TAGS <15 CHARGE

Facility

$1,035.00

Service Code	HCPCS 11200
Hospital Charge Code	3351200
Hospital Revenue Code	761
Min. Negotiated Rate	$931.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$931.50
Rate for Payer: UnitedHealthcare Commercial	$983.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11313 Face, Ears, Nose: Over 2.0 cm/d (11313)

Facility

$516.00

Service Code	HCPCS 11313
Hospital Charge Code	3351313
Hospital Revenue Code	761
Min. Negotiated Rate	$464.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$464.40
Rate for Payer: UnitedHealthcare Commercial	$490.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11313 Face, Ears, Nose: Over 2.0 cm/d (11313)

Facility

$516.00

Service Code	HCPCS 11313
Hospital Charge Code	3351313
Hospital Revenue Code	761
Min. Negotiated Rate	$216.72
Max. Negotiated Rate	$490.20
Rate for Payer: Aetna Commercial	$464.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$371.68
Rate for Payer: Humana Medicare Advantage	$216.72
Rate for Payer: UnitedHealthcare Commercial	$490.20
Rate for Payer: UnitedHealthcare Medicaid	$228.80
Rate for Payer: WPPA Medicare Advantage	$309.60

11400 Excision Benign Lesion (trunk, arms, or legs) </= 0.5 CM

Facility

$1,016.00

Service Code	HCPCS 11400
Hospital Charge Code	3151400
Hospital Revenue Code	360
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$965.20
Rate for Payer: Aetna Commercial	$914.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$426.72
Rate for Payer: UnitedHealthcare Commercial	$965.20
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$609.60

11400 Excision Benign Lesion (trunk, arms, or legs) </= 0.5 CM

Facility

$1,016.00

Service Code	HCPCS 11400
Hospital Charge Code	3151400
Hospital Revenue Code	360
Min. Negotiated Rate	$914.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$914.40
Rate for Payer: UnitedHealthcare Commercial	$965.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11400 EXC TR-EXT B9 MARG 0.5 < CM

Facility

$1,016.00

Service Code	HCPCS 11400
Hospital Charge Code	3351400
Hospital Revenue Code	761
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$965.20
Rate for Payer: Aetna Commercial	$914.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$426.72
Rate for Payer: UnitedHealthcare Commercial	$965.20
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$609.60

11400 EXC TR-EXT B9 MARG 0.5 < CM

Facility

$1,016.00

Service Code	HCPCS 11400
Hospital Charge Code	3351400
Hospital Revenue Code	761
Min. Negotiated Rate	$914.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$914.40
Rate for Payer: UnitedHealthcare Commercial	$965.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11401 EXC TR-EXT B9 MARG 0.6-1 CM

Facility

$1,230.00

Service Code	HCPCS 11401
Hospital Charge Code	3351401
Hospital Revenue Code	761
Min. Negotiated Rate	$1,107.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,107.00
Rate for Payer: UnitedHealthcare Commercial	$1,168.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11401 EXC TR-EXT B9 MARG 0.6-1 CM

Facility

$1,230.00

Service Code	HCPCS 11401
Hospital Charge Code	3351401
Hospital Revenue Code	761
Min. Negotiated Rate	$252.25
Max. Negotiated Rate	$1,168.50
Rate for Payer: Aetna Commercial	$1,107.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$451.17
Rate for Payer: Humana Medicare Advantage	$516.60
Rate for Payer: UnitedHealthcare Commercial	$1,168.50
Rate for Payer: UnitedHealthcare Medicaid	$252.25
Rate for Payer: WPPA Medicare Advantage	$738.00

11401 REMOVE SKIN LESION CHARGE

Facility

$1,230.00

Service Code	HCPCS 11401
Hospital Charge Code	3150103
Hospital Revenue Code	360
Min. Negotiated Rate	$1,107.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,107.00
Rate for Payer: UnitedHealthcare Commercial	$1,168.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11401 REMOVE SKIN LESION CHARGE

Facility

$1,230.00

Service Code	HCPCS 11401
Hospital Charge Code	3150103
Hospital Revenue Code	360
Min. Negotiated Rate	$252.25
Max. Negotiated Rate	$1,168.50
Rate for Payer: Aetna Commercial	$1,107.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$451.17
Rate for Payer: Humana Medicare Advantage	$516.60
Rate for Payer: UnitedHealthcare Commercial	$1,168.50
Rate for Payer: UnitedHealthcare Medicaid	$252.25
Rate for Payer: WPPA Medicare Advantage	$738.00

11402 BENIGN LESION 1-2CM IN OUTPT

Facility

$1,430.00

Service Code	HCPCS 11402
Hospital Charge Code	3150104
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,358.50
Rate for Payer: Aetna Commercial	$1,287.00
Rate for Payer: UnitedHealthcare Commercial	$1,358.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11402 BENIGN LESION 1-2CM IN OUTPT

Facility

$1,430.00

Service Code	HCPCS 11402
Hospital Charge Code	3150104
Hospital Revenue Code	360
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,358.50
Rate for Payer: Aetna Commercial	$1,287.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$600.60
Rate for Payer: UnitedHealthcare Commercial	$1,358.50
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$858.00

11402-Excision Lesion Benign Trunk/Extremity 1.1-2.0 cm

Facility

$2,006.00

Service Code	HCPCS 11402
Hospital Charge Code	3301402
Hospital Revenue Code	450
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,905.70
Rate for Payer: Aetna Commercial	$1,805.40
Rate for Payer: UnitedHealthcare Commercial	$1,905.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11402-Excision Lesion Benign Trunk/Extremity 1.1-2.0 cm

Facility

$2,006.00

Service Code	HCPCS 11402
Hospital Charge Code	3301402
Hospital Revenue Code	450
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,905.70
Rate for Payer: Aetna Commercial	$1,805.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$842.52
Rate for Payer: UnitedHealthcare Commercial	$1,905.70
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$1,203.60

Know your out-of-pocket cost for care.

All Charges