Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

46050-I&D Perianal Abscess Superficial

Facility

$234.00

Service Code	HCPCS 46050
Hospital Charge Code	3306050
Hospital Revenue Code	450
Min. Negotiated Rate	$210.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: UnitedHealthcare Commercial	$222.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46083 INCISE EXTERNAL HEMORRHOID

Facility

$289.00

Service Code	HCPCS 46083
Hospital Charge Code	3156083
Hospital Revenue Code	360
Min. Negotiated Rate	$260.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: UnitedHealthcare Commercial	$274.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46083 INCISE EXTERNAL HEMORRHOID

Facility

$289.00

Service Code	HCPCS 46083
Hospital Charge Code	3156083
Hospital Revenue Code	360
Min. Negotiated Rate	$116.15
Max. Negotiated Rate	$274.55
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$116.15
Rate for Payer: Humana Medicare Advantage	$121.38
Rate for Payer: UnitedHealthcare Commercial	$274.55
Rate for Payer: UnitedHealthcare Medicaid	$222.22
Rate for Payer: WPPA Medicare Advantage	$173.40

46083 Incision of thrombosed hemorrhoid, external

Facility

$289.00

Service Code	HCPCS 46083
Hospital Charge Code	3356083
Hospital Revenue Code	761
Min. Negotiated Rate	$116.15
Max. Negotiated Rate	$274.55
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$116.15
Rate for Payer: Humana Medicare Advantage	$121.38
Rate for Payer: UnitedHealthcare Commercial	$274.55
Rate for Payer: UnitedHealthcare Medicaid	$222.22
Rate for Payer: WPPA Medicare Advantage	$173.40

46083 Incision of thrombosed hemorrhoid, external

Facility

$289.00

Service Code	HCPCS 46083
Hospital Charge Code	3356083
Hospital Revenue Code	761
Min. Negotiated Rate	$260.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: UnitedHealthcare Commercial	$274.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46200 Fissurectomy, including sphincterotomy, when performed

Facility

$8,031.00

Service Code	HCPCS 46200
Hospital Charge Code	3156200
Hospital Revenue Code	360
Min. Negotiated Rate	$909.58
Max. Negotiated Rate	$7,629.45
Rate for Payer: Aetna Commercial	$7,227.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,101.16
Rate for Payer: Humana Medicare Advantage	$3,373.02
Rate for Payer: UnitedHealthcare Commercial	$7,629.45
Rate for Payer: UnitedHealthcare Medicaid	$909.58
Rate for Payer: WPPA Medicare Advantage	$4,818.60

46200 Fissurectomy, including sphincterotomy, when performed

Facility

$8,031.00

Service Code	HCPCS 46200
Hospital Charge Code	3156200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$7,629.45
Rate for Payer: Aetna Commercial	$7,227.90
Rate for Payer: UnitedHealthcare Commercial	$7,629.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) TechFee

Facility

$2,938.00

Service Code	HCPCS 46221
Hospital Charge Code	3150680
Hospital Revenue Code	360
Min. Negotiated Rate	$296.08
Max. Negotiated Rate	$2,791.10
Rate for Payer: Aetna Commercial	$2,644.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,632.16
Rate for Payer: Humana Medicare Advantage	$1,233.96
Rate for Payer: UnitedHealthcare Commercial	$2,791.10
Rate for Payer: UnitedHealthcare Medicaid	$296.08
Rate for Payer: WPPA Medicare Advantage	$1,762.80

46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) TechFee

Facility

$2,938.00

Service Code	HCPCS 46221
Hospital Charge Code	3150680
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,791.10
Rate for Payer: Aetna Commercial	$2,644.20
Rate for Payer: UnitedHealthcare Commercial	$2,791.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46250 Excision Procedures on the Anus

Facility

$4,963.00

Service Code	HCPCS 46250
Hospital Charge Code	3154625
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,714.85
Rate for Payer: Aetna Commercial	$4,466.70
Rate for Payer: UnitedHealthcare Commercial	$4,714.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46250 Excision Procedures on the Anus

Facility

$4,963.00

Service Code	HCPCS 46250
Hospital Charge Code	3154625
Hospital Revenue Code	360
Min. Negotiated Rate	$909.58
Max. Negotiated Rate	$4,714.85
Rate for Payer: Aetna Commercial	$4,466.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,219.88
Rate for Payer: Humana Medicare Advantage	$2,084.46
Rate for Payer: UnitedHealthcare Commercial	$4,714.85
Rate for Payer: UnitedHealthcare Medicaid	$909.58
Rate for Payer: WPPA Medicare Advantage	$2,977.80

46255-Hemorrhoidectomy, internal & External, single column/group

Facility

$3,151.00

Service Code	HCPCS 46255
Hospital Charge Code	3156255
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,993.45
Rate for Payer: Aetna Commercial	$2,835.90
Rate for Payer: UnitedHealthcare Commercial	$2,993.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46255-Hemorrhoidectomy, internal & External, single column/group

Facility

$3,151.00

Service Code	HCPCS 46255
Hospital Charge Code	3156255
Hospital Revenue Code	360
Min. Negotiated Rate	$909.58
Max. Negotiated Rate	$2,993.45
Rate for Payer: Aetna Commercial	$2,835.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,273.51
Rate for Payer: Humana Medicare Advantage	$1,323.42
Rate for Payer: UnitedHealthcare Commercial	$2,993.45
Rate for Payer: UnitedHealthcare Medicaid	$909.58
Rate for Payer: WPPA Medicare Advantage	$1,890.60

46260 Hemorrhoidectomy Complex

Facility

$4,832.00

Service Code	HCPCS 46260
Hospital Charge Code	3156260
Hospital Revenue Code	360
Min. Negotiated Rate	$909.58
Max. Negotiated Rate	$4,590.40
Rate for Payer: Aetna Commercial	$4,348.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,869.41
Rate for Payer: Humana Medicare Advantage	$2,029.44
Rate for Payer: UnitedHealthcare Commercial	$4,590.40
Rate for Payer: UnitedHealthcare Medicaid	$909.58
Rate for Payer: WPPA Medicare Advantage	$2,899.20

46260 Hemorrhoidectomy Complex

Facility

$4,832.00

Service Code	HCPCS 46260
Hospital Charge Code	3156260
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,590.40
Rate for Payer: Aetna Commercial	$4,348.80
Rate for Payer: UnitedHealthcare Commercial	$4,590.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46270 FISTULOTOMY

Facility

$3,206.00

Service Code	HCPCS 46270
Hospital Charge Code	3150676
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,045.70
Rate for Payer: Aetna Commercial	$2,885.40
Rate for Payer: UnitedHealthcare Commercial	$3,045.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46270 FISTULOTOMY

Facility

$3,206.00

Service Code	HCPCS 46270
Hospital Charge Code	3150676
Hospital Revenue Code	360
Min. Negotiated Rate	$909.58
Max. Negotiated Rate	$3,045.70
Rate for Payer: Aetna Commercial	$2,885.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,312.90
Rate for Payer: Humana Medicare Advantage	$1,346.52
Rate for Payer: UnitedHealthcare Commercial	$3,045.70
Rate for Payer: UnitedHealthcare Medicaid	$909.58
Rate for Payer: WPPA Medicare Advantage	$1,923.60

46280 Surgical treatment of anal fistula; transsphincteric, suprasphincteric, extrasphincteric/multi

Facility

$1,120.00

Service Code	HCPCS 46280
Hospital Charge Code	3156280
Hospital Revenue Code	360
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,008.00
Rate for Payer: UnitedHealthcare Commercial	$1,064.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46280 Surgical treatment of anal fistula; transsphincteric, suprasphincteric, extrasphincteric/multi

Facility

$1,120.00

Service Code	HCPCS 46280
Hospital Charge Code	3156280
Hospital Revenue Code	360
Min. Negotiated Rate	$470.40
Max. Negotiated Rate	$1,064.00
Rate for Payer: Aetna Commercial	$1,008.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$808.00
Rate for Payer: Humana Medicare Advantage	$470.40
Rate for Payer: UnitedHealthcare Commercial	$1,064.00
Rate for Payer: UnitedHealthcare Medicaid	$909.58
Rate for Payer: WPPA Medicare Advantage	$672.00

46320 REMOVAL OF HEMORRHOID CLOT

Facility

$2,609.00

Service Code	HCPCS 46320
Hospital Charge Code	3150436
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,478.55
Rate for Payer: Aetna Commercial	$2,348.10
Rate for Payer: UnitedHealthcare Commercial	$2,478.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46320 REMOVAL OF HEMORRHOID CLOT

Facility

$2,609.00

Service Code	HCPCS 46320
Hospital Charge Code	3150436
Hospital Revenue Code	360
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$2,478.55
Rate for Payer: Aetna Commercial	$2,348.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,691.75
Rate for Payer: Humana Medicare Advantage	$1,095.78
Rate for Payer: UnitedHealthcare Commercial	$2,478.55
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: WPPA Medicare Advantage	$1,565.40

46600 ANOSCOPY DIAGNOSTIC WITH/W/O COLLECTION

Facility

$1,593.00

Service Code	HCPCS 46600
Hospital Charge Code	3296600
Hospital Revenue Code	761
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$1,513.35
Rate for Payer: Aetna Commercial	$1,433.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$140.50
Rate for Payer: Humana Medicare Advantage	$669.06
Rate for Payer: UnitedHealthcare Commercial	$1,513.35
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$955.80

46600 ANOSCOPY DIAGNOSTIC WITH/W/O COLLECTION

Facility

$1,593.00

Service Code	HCPCS 46600
Hospital Charge Code	3296600
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,513.35
Rate for Payer: Aetna Commercial	$1,433.70
Rate for Payer: UnitedHealthcare Commercial	$1,513.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46600 DIAGNOSTIC ANOSCOPY CHARGE

Facility

$399.00

Service Code	HCPCS 46600
Hospital Charge Code	3150695
Hospital Revenue Code	360
Min. Negotiated Rate	$359.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$379.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

46600 DIAGNOSTIC ANOSCOPY CHARGE

Facility

$399.00

Service Code	HCPCS 46600
Hospital Charge Code	3150695
Hospital Revenue Code	360
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$379.05
Rate for Payer: Aetna Commercial	$359.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$140.50
Rate for Payer: Humana Medicare Advantage	$167.58
Rate for Payer: UnitedHealthcare Commercial	$379.05
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: WPPA Medicare Advantage	$239.40

Know your out-of-pocket cost for care.

All Charges