Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

11402 EXC TR-EXT B9 MARG 1.1-2 CM

Facility

$1,034.00

Service Code	HCPCS 11402
Hospital Charge Code	3351402
Hospital Revenue Code	761
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$982.30
Rate for Payer: Aetna Commercial	$930.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$434.28
Rate for Payer: UnitedHealthcare Commercial	$982.30
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$620.40

11402 EXC TR-EXT B9 MARG 1.1-2 CM

Facility

$1,034.00

Service Code	HCPCS 11402
Hospital Charge Code	3351402
Hospital Revenue Code	761
Min. Negotiated Rate	$930.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$930.60
Rate for Payer: UnitedHealthcare Commercial	$982.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11403 EXC TR-EXT B9 MARG 2.1-3 CM

Facility

$1,034.00

Service Code	HCPCS 11403
Hospital Charge Code	3351403
Hospital Revenue Code	761
Min. Negotiated Rate	$930.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$930.60
Rate for Payer: UnitedHealthcare Commercial	$982.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11403 EXC TR-EXT B9 MARG 2.1-3 CM

Facility

$1,034.00

Service Code	HCPCS 11403
Hospital Charge Code	3351403
Hospital Revenue Code	761
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$982.30
Rate for Payer: Aetna Commercial	$930.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$434.28
Rate for Payer: UnitedHealthcare Commercial	$982.30
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$620.40

11403 EXC TR-EXT B9+MARG 2.1-3CM

Facility

$2,222.00

Service Code	HCPCS 11403
Hospital Charge Code	3150101
Hospital Revenue Code	360
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$2,110.90
Rate for Payer: Aetna Commercial	$1,999.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$933.24
Rate for Payer: UnitedHealthcare Commercial	$2,110.90
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$1,333.20

11403 EXC TR-EXT B9+MARG 2.1-3CM

Facility

$2,222.00

Service Code	HCPCS 11403
Hospital Charge Code	3150101
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,110.90
Rate for Payer: Aetna Commercial	$1,999.80
Rate for Payer: UnitedHealthcare Commercial	$2,110.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11404 EXC B-TRNK 3.1-4.0 CM

Facility

$2,124.00

Service Code	HCPCS 11404
Hospital Charge Code	3151404
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,017.80
Rate for Payer: Aetna Commercial	$1,911.60
Rate for Payer: UnitedHealthcare Commercial	$2,017.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11404 EXC B-TRNK 3.1-4.0 CM

Facility

$2,124.00

Service Code	HCPCS 11404
Hospital Charge Code	3151404
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,017.80
Rate for Payer: Aetna Commercial	$1,911.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,513.99
Rate for Payer: Humana Medicare Advantage	$892.08
Rate for Payer: UnitedHealthcare Commercial	$2,017.80
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,274.40

11404 EXC TR-EXT B9 MARG 3.1-4 CM

Facility

$1,998.00

Service Code	HCPCS 11404
Hospital Charge Code	3290095
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,898.10
Rate for Payer: Aetna Commercial	$1,798.20
Rate for Payer: UnitedHealthcare Commercial	$1,898.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11404 EXC TR-EXT B9 MARG 3.1-4 CM

Facility

$1,998.00

Service Code	HCPCS 11404
Hospital Charge Code	3290095
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$1,898.10
Rate for Payer: Aetna Commercial	$1,798.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,513.99
Rate for Payer: Humana Medicare Advantage	$839.16
Rate for Payer: UnitedHealthcare Commercial	$1,898.10
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,198.80

11406-Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, a

Facility

$2,742.00

Service Code	HCPCS 11406
Hospital Charge Code	3351406
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,604.90
Rate for Payer: Aetna Commercial	$2,467.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,077.57
Rate for Payer: Humana Medicare Advantage	$1,151.64
Rate for Payer: UnitedHealthcare Commercial	$2,604.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,645.20

11406-Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, a

Facility

$2,742.00

Service Code	HCPCS 11406
Hospital Charge Code	3351406
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,604.90
Rate for Payer: Aetna Commercial	$2,467.80
Rate for Payer: UnitedHealthcare Commercial	$2,604.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11406 EXC TR-EXT B9+MARG >4.0 CM

Facility

$3,499.00

Service Code	HCPCS 11406
Hospital Charge Code	3151406
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$3,324.05
Rate for Payer: Aetna Commercial	$3,149.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,077.57
Rate for Payer: Humana Medicare Advantage	$1,469.58
Rate for Payer: UnitedHealthcare Commercial	$3,324.05
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$2,099.40

11406 EXC TR-EXT B9+MARG >4.0 CM

Facility

$3,499.00

Service Code	HCPCS 11406
Hospital Charge Code	3151406
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,324.05
Rate for Payer: Aetna Commercial	$3,149.10
Rate for Payer: UnitedHealthcare Commercial	$3,324.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11420 EXC BEN LES 0.5CM OR LESS CHARGE

Facility

$2,502.00

Service Code	HCPCS 11420
Hospital Charge Code	3151420
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

11420 EXC BEN LES 0.5CM OR LESS CHARGE

Facility

$2,502.00

Service Code	HCPCS 11420
Hospital Charge Code	3151420
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

11420 EXC H-F-NK-SP B9 MARG 0.5 <

Facility

$2,502.00

Service Code	HCPCS 11420
Hospital Charge Code	3351420
Hospital Revenue Code	761
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

11420 EXC H-F-NK-SP B9 MARG 0.5 <

Facility

$2,502.00

Service Code	HCPCS 11420
Hospital Charge Code	3351420
Hospital Revenue Code	761
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

11421 EXC H-F-NK-SP B9 MARG 0.6-1

Facility

$2,133.00

Service Code	HCPCS 11421
Hospital Charge Code	3351421
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,026.35
Rate for Payer: Aetna Commercial	$1,919.70
Rate for Payer: UnitedHealthcare Commercial	$2,026.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11421 EXC H-F-NK-SP B9 MARG 0.6-1

Facility

$2,133.00

Service Code	HCPCS 11421
Hospital Charge Code	3351421
Hospital Revenue Code	761
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$2,026.35
Rate for Payer: Aetna Commercial	$1,919.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$895.86
Rate for Payer: UnitedHealthcare Commercial	$2,026.35
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$1,279.80

11421 Excision, benign lesion including margins, except skin tag, scalp, neck, hands, feet, genitali

Facility

$2,133.00

Service Code	HCPCS 11421
Hospital Charge Code	3151421
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,026.35
Rate for Payer: Aetna Commercial	$1,919.70
Rate for Payer: UnitedHealthcare Commercial	$2,026.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11421 Excision, benign lesion including margins, except skin tag, scalp, neck, hands, feet, genitali

Facility

$2,133.00

Service Code	HCPCS 11421
Hospital Charge Code	3151421
Hospital Revenue Code	360
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$2,026.35
Rate for Payer: Aetna Commercial	$1,919.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$895.86
Rate for Payer: UnitedHealthcare Commercial	$2,026.35
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$1,279.80

11422 EXC H-F-NK-SP B9 MARG 1.1-2

Facility

$2,542.00

Service Code	HCPCS 11422
Hospital Charge Code	3151422
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,414.90
Rate for Payer: Aetna Commercial	$2,287.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,805.43
Rate for Payer: Humana Medicare Advantage	$1,067.64
Rate for Payer: UnitedHealthcare Commercial	$2,414.90
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,525.20

11422 EXC H-F-NK-SP B9 MARG 1.1-2

Facility

$2,542.00

Service Code	HCPCS 11422
Hospital Charge Code	3151422
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,414.90
Rate for Payer: Aetna Commercial	$2,287.80
Rate for Payer: UnitedHealthcare Commercial	$2,414.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11422 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 1.1-2.0cm

Facility

$2,669.00

Service Code	HCPCS 11422
Hospital Charge Code	3351422
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,535.55
Rate for Payer: Aetna Commercial	$2,402.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,805.43
Rate for Payer: Humana Medicare Advantage	$1,120.98
Rate for Payer: UnitedHealthcare Commercial	$2,535.55
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,601.40

Know your out-of-pocket cost for care.

All Charges