Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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	$1,200.00
Max. Negotiated Rate	$2,535.55
Rate for Payer: Aetna Commercial	$2,402.10
Rate for Payer: UnitedHealthcare Commercial	$2,535.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11423 EXC H-F-NK-SP B9+MARG 2.1-3

Facility

$2,655.00

Service Code	HCPCS 11423
Hospital Charge Code	3150213
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,522.25
Rate for Payer: Aetna Commercial	$2,389.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,640.24
Rate for Payer: Humana Medicare Advantage	$1,115.10
Rate for Payer: UnitedHealthcare Commercial	$2,522.25
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,593.00

11423 EXC H-F-NK-SP B9+MARG 2.1-3

Facility

$2,655.00

Service Code	HCPCS 11423
Hospital Charge Code	3150213
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,522.25
Rate for Payer: Aetna Commercial	$2,389.50
Rate for Payer: UnitedHealthcare Commercial	$2,522.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11423 EXC H-F-NK-SP B9+MARG 2.1-3

Facility

$2,165.00

Service Code	HCPCS 11423
Hospital Charge Code	3351423
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,056.75
Rate for Payer: Aetna Commercial	$1,948.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,640.24
Rate for Payer: Humana Medicare Advantage	$909.30
Rate for Payer: UnitedHealthcare Commercial	$2,056.75
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,299.00

11423 EXC H-F-NK-SP B9+MARG 2.1-3

Facility

$2,165.00

Service Code	HCPCS 11423
Hospital Charge Code	3351423
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,056.75
Rate for Payer: Aetna Commercial	$1,948.50
Rate for Payer: UnitedHealthcare Commercial	$2,056.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11424 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 3.1-4.0cm

Facility

$3,064.00

Service Code	HCPCS 11424
Hospital Charge Code	3351424
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,910.80
Rate for Payer: Aetna Commercial	$2,757.60
Rate for Payer: UnitedHealthcare Commercial	$2,910.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11424 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 3.1-4.0cm

Facility

$3,064.00

Service Code	HCPCS 11424
Hospital Charge Code	3351424
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,910.80
Rate for Payer: Aetna Commercial	$2,757.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,801.84
Rate for Payer: Humana Medicare Advantage	$1,286.88
Rate for Payer: UnitedHealthcare Commercial	$2,910.80
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,838.40

11426 EXC H-F-NK-SP B9+MARG >4 CM

Facility

$2,731.00

Service Code	HCPCS 11426
Hospital Charge Code	3151426
Hospital Revenue Code	360
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$2,594.45
Rate for Payer: Aetna Commercial	$2,457.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,882.64
Rate for Payer: Humana Medicare Advantage	$1,147.02
Rate for Payer: UnitedHealthcare Commercial	$2,594.45
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$1,638.60

11426 EXC H-F-NK-SP B9+MARG >4 CM

Facility

$2,731.00

Service Code	HCPCS 11426
Hospital Charge Code	3151426
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,594.45
Rate for Payer: Aetna Commercial	$2,457.90
Rate for Payer: UnitedHealthcare Commercial	$2,594.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11426 Excision, benign lesion > 4.0 cm including margins, except skin tag (unless listed elsewhere),

Facility

$2,731.00

Service Code	HCPCS 11426
Hospital Charge Code	3351426
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,594.45
Rate for Payer: Aetna Commercial	$2,457.90
Rate for Payer: UnitedHealthcare Commercial	$2,594.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11426 Excision, benign lesion > 4.0 cm including margins, except skin tag (unless listed elsewhere),

Facility

$2,731.00

Service Code	HCPCS 11426
Hospital Charge Code	3351426
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$2,594.45
Rate for Payer: Aetna Commercial	$2,457.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,882.64
Rate for Payer: Humana Medicare Advantage	$1,147.02
Rate for Payer: UnitedHealthcare Commercial	$2,594.45
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$1,638.60

11440 EXC B-FACE 0.5OR<CM

Facility

$1,231.00

Service Code	HCPCS 11440
Hospital Charge Code	3151440
Hospital Revenue Code	360
Min. Negotiated Rate	$286.00
Max. Negotiated Rate	$1,169.45
Rate for Payer: Aetna Commercial	$1,107.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$517.02
Rate for Payer: UnitedHealthcare Commercial	$1,169.45
Rate for Payer: UnitedHealthcare Medicaid	$286.00
Rate for Payer: WPPA Medicare Advantage	$738.60

11440 EXC B-FACE 0.5OR<CM

Facility

$1,231.00

Service Code	HCPCS 11440
Hospital Charge Code	3151440
Hospital Revenue Code	360
Min. Negotiated Rate	$1,107.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,107.90
Rate for Payer: UnitedHealthcare Commercial	$1,169.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11440 EXC FACE-MM B9 MARG 0.5 < CM

Facility

$1,231.00

Service Code	HCPCS 11440
Hospital Charge Code	3351440
Hospital Revenue Code	761
Min. Negotiated Rate	$286.00
Max. Negotiated Rate	$1,169.45
Rate for Payer: Aetna Commercial	$1,107.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$517.02
Rate for Payer: UnitedHealthcare Commercial	$1,169.45
Rate for Payer: UnitedHealthcare Medicaid	$286.00
Rate for Payer: WPPA Medicare Advantage	$738.60

11440 EXC FACE-MM B9 MARG 0.5 < CM

Facility

$1,231.00

Service Code	HCPCS 11440
Hospital Charge Code	3351440
Hospital Revenue Code	761
Min. Negotiated Rate	$1,107.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,107.90
Rate for Payer: UnitedHealthcare Commercial	$1,169.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11441 EXC FACE-MM B9 MARG 0.6-1 CM

Facility

$2,054.00

Service Code	HCPCS 11441
Hospital Charge Code	3351441
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,951.30
Rate for Payer: Aetna Commercial	$1,848.60
Rate for Payer: UnitedHealthcare Commercial	$1,951.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11441 EXC FACE-MM B9 MARG 0.6-1 CM

Facility

$2,054.00

Service Code	HCPCS 11441
Hospital Charge Code	3351441
Hospital Revenue Code	761
Min. Negotiated Rate	$286.00
Max. Negotiated Rate	$1,951.30
Rate for Payer: Aetna Commercial	$1,848.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$862.68
Rate for Payer: UnitedHealthcare Commercial	$1,951.30
Rate for Payer: UnitedHealthcare Medicaid	$286.00
Rate for Payer: WPPA Medicare Advantage	$1,232.40

11441 EXC FACE-MM B9+MARG 0.6-1 CM

Facility

$2,054.00

Service Code	HCPCS 11441
Hospital Charge Code	3150217
Hospital Revenue Code	360
Min. Negotiated Rate	$286.00
Max. Negotiated Rate	$1,951.30
Rate for Payer: Aetna Commercial	$1,848.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$783.57
Rate for Payer: Humana Medicare Advantage	$862.68
Rate for Payer: UnitedHealthcare Commercial	$1,951.30
Rate for Payer: UnitedHealthcare Medicaid	$286.00
Rate for Payer: WPPA Medicare Advantage	$1,232.40

11441 EXC FACE-MM B9+MARG 0.6-1 CM

Facility

$2,054.00

Service Code	HCPCS 11441
Hospital Charge Code	3150217
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,951.30
Rate for Payer: Aetna Commercial	$1,848.60
Rate for Payer: UnitedHealthcare Commercial	$1,951.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11442 EXC FACE-MM B9 MARG 1.1-2 CM

Facility

$2,372.00

Service Code	HCPCS 11442
Hospital Charge Code	3151442
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,253.40
Rate for Payer: Aetna Commercial	$2,134.80
Rate for Payer: UnitedHealthcare Commercial	$2,253.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11442 EXC FACE-MM B9 MARG 1.1-2 CM

Facility

$2,372.00

Service Code	HCPCS 11442
Hospital Charge Code	3151442
Hospital Revenue Code	360
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$2,253.40
Rate for Payer: Aetna Commercial	$2,134.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,226.14
Rate for Payer: Humana Medicare Advantage	$996.24
Rate for Payer: UnitedHealthcare Commercial	$2,253.40
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$1,423.20

11442 Excision of benign lesion 1.1-2.0 cm on the face, ears, eyelids, nose, lip, or mouth.

Facility

$2,372.00

Service Code	HCPCS 11442
Hospital Charge Code	3151442
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,253.40
Rate for Payer: Aetna Commercial	$2,134.80
Rate for Payer: UnitedHealthcare Commercial	$2,253.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11442 Excision of benign lesion 1.1-2.0 cm on the face, ears, eyelids, nose, lip, or mouth.

Facility

$2,372.00

Service Code	HCPCS 11442
Hospital Charge Code	3151442
Hospital Revenue Code	761
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$2,253.40
Rate for Payer: Aetna Commercial	$2,134.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,226.14
Rate for Payer: Humana Medicare Advantage	$996.24
Rate for Payer: UnitedHealthcare Commercial	$2,253.40
Rate for Payer: UnitedHealthcare Medicaid	$257.40
Rate for Payer: WPPA Medicare Advantage	$1,423.20

11443 Excise benign lesion including margins, face ,ears, eyelids, nose, lips; 2.1-3.0cm

Facility

$1,858.00

Service Code	HCPCS 11443
Hospital Charge Code	3351443
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,765.10
Rate for Payer: Aetna Commercial	$1,672.20
Rate for Payer: UnitedHealthcare Commercial	$1,765.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11443 Excise benign lesion including margins, face ,ears, eyelids, nose, lips; 2.1-3.0cm

Facility

$1,858.00

Service Code	HCPCS 11443
Hospital Charge Code	3351443
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$1,765.10
Rate for Payer: Aetna Commercial	$1,672.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,407.94
Rate for Payer: Humana Medicare Advantage	$780.36
Rate for Payer: UnitedHealthcare Commercial	$1,765.10
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,114.80

Know your out-of-pocket cost for care.

All Charges