Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

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

Facility

$2,437.00

Service Code	HCPCS 11443
Hospital Charge Code	3151443
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,315.15
Rate for Payer: Aetna Commercial	$2,193.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,407.94
Rate for Payer: Humana Medicare Advantage	$1,023.54
Rate for Payer: UnitedHealthcare Commercial	$2,315.15
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,462.20

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

Facility

$2,437.00

Service Code	HCPCS 11443
Hospital Charge Code	3151443
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,315.15
Rate for Payer: Aetna Commercial	$2,193.30
Rate for Payer: UnitedHealthcare Commercial	$2,315.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11444- Excision, other benign lesion including margins, face, ears, eyelids, nose, lips, mucos membr

Facility

$2,660.00

Service Code	HCPCS 11444
Hospital Charge Code	3351444
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,527.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: UnitedHealthcare Commercial	$2,527.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11444- Excision, other benign lesion including margins, face, ears, eyelids, nose, lips, mucos membr

Facility

$2,660.00

Service Code	HCPCS 11444
Hospital Charge Code	3351444
Hospital Revenue Code	761
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,527.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,919.00
Rate for Payer: Humana Medicare Advantage	$1,117.20
Rate for Payer: UnitedHealthcare Commercial	$2,527.00
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,596.00

11444-Excision, other benign lesion including margins, face, ears, eyelids, nose, lips, mucos membra

Facility

$2,660.00

Service Code	HCPCS 11444
Hospital Charge Code	3150216
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,527.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: UnitedHealthcare Commercial	$2,527.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11444-Excision, other benign lesion including margins, face, ears, eyelids, nose, lips, mucos membra

Facility

$2,660.00

Service Code	HCPCS 11444
Hospital Charge Code	3150216
Hospital Revenue Code	360
Min. Negotiated Rate	$525.22
Max. Negotiated Rate	$2,527.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1,919.00
Rate for Payer: Humana Medicare Advantage	$1,117.20
Rate for Payer: UnitedHealthcare Commercial	$2,527.00
Rate for Payer: UnitedHealthcare Medicaid	$525.22
Rate for Payer: WPPA Medicare Advantage	$1,596.00

11446 EXCBENIGNLESIONFACE> [HGHO]

Facility

$4,007.00

Service Code	HCPCS 11446
Hospital Charge Code	3151446
Hospital Revenue Code	360
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$3,806.65
Rate for Payer: Aetna Commercial	$3,606.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,890.62
Rate for Payer: Humana Medicare Advantage	$1,682.94
Rate for Payer: UnitedHealthcare Commercial	$3,806.65
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,404.20

11446 EXCBENIGNLESIONFACE> [HGHO]

Facility

$4,007.00

Service Code	HCPCS 11446
Hospital Charge Code	3151446
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,806.65
Rate for Payer: Aetna Commercial	$3,606.30
Rate for Payer: UnitedHealthcare Commercial	$3,806.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11446 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; > 4.0cm

Facility

$4,007.00

Service Code	HCPCS 11446
Hospital Charge Code	3351446
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,806.65
Rate for Payer: Aetna Commercial	$3,606.30
Rate for Payer: UnitedHealthcare Commercial	$3,806.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11446 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; > 4.0cm

Facility

$4,007.00

Service Code	HCPCS 11446
Hospital Charge Code	3351446
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$3,806.65
Rate for Payer: Aetna Commercial	$3,606.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2,890.62
Rate for Payer: Humana Medicare Advantage	$1,682.94
Rate for Payer: UnitedHealthcare Commercial	$3,806.65
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,404.20

11450 Excision Skin, Subcut Tissue for Hidradenitis, Axillary

Facility

$4,276.00

Service Code	HCPCS 11450
Hospital Charge Code	3151450
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11450 Excision Skin, Subcut Tissue for Hidradenitis, Axillary

Facility

$4,276.00

Service Code	HCPCS 11450
Hospital Charge Code	3151450
Hospital Revenue Code	360
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,795.92
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,565.60

11450 REMOVAL, SWEAT GLAND LESION,AXILLARY

Facility

$4,276.00

Service Code	HCPCS 11450
Hospital Charge Code	3351450
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,795.92
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,565.60

11450 REMOVAL, SWEAT GLAND LESION,AXILLARY

Facility

$4,276.00

Service Code	HCPCS 11450
Hospital Charge Code	3351450
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11451 Excision of skin/subcutaneous tissue for hidradenitis, axillary; w/ complex repair

Facility

$5,910.00

Service Code	HCPCS 11451
Hospital Charge Code	3351451
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,614.50
Rate for Payer: Aetna Commercial	$5,319.00
Rate for Payer: UnitedHealthcare Commercial	$5,614.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11451 Excision of skin/subcutaneous tissue for hidradenitis, axillary; w/ complex repair

Facility

$5,910.00

Service Code	HCPCS 11451
Hospital Charge Code	3351451
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$5,614.50
Rate for Payer: Aetna Commercial	$5,319.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4,477.33
Rate for Payer: Humana Medicare Advantage	$2,482.20
Rate for Payer: UnitedHealthcare Commercial	$5,614.50
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$3,546.00

11462 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermedia

Facility

$4,276.00

Service Code	HCPCS 11462
Hospital Charge Code	3361462
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11462 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermedia

Facility

$4,276.00

Service Code	HCPCS 11462
Hospital Charge Code	3361462
Hospital Revenue Code	360
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,795.92
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,565.60

11462 Excision of skin/subcutaneous tissue for hidradenitis, inguinal; w/ simple or interm repair

Facility

$4,072.00

Service Code	HCPCS 11462
Hospital Charge Code	3351462
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,868.40
Rate for Payer: Aetna Commercial	$3,664.80
Rate for Payer: UnitedHealthcare Commercial	$3,868.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11462 Excision of skin/subcutaneous tissue for hidradenitis, inguinal; w/ simple or interm repair

Facility

$4,072.00

Service Code	HCPCS 11462
Hospital Charge Code	3351462
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$3,868.40
Rate for Payer: Aetna Commercial	$3,664.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,710.24
Rate for Payer: UnitedHealthcare Commercial	$3,868.40
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,443.20

11463 Excision of skin/subcutaneous tissue for hidradenitis, inguinal; with complex repair

Facility

$4,072.00

Service Code	HCPCS 11463
Hospital Charge Code	3351463
Hospital Revenue Code	761
Min. Negotiated Rate	$1,628.80
Max. Negotiated Rate	$3,868.40
Rate for Payer: Aetna Commercial	$3,664.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,710.24
Rate for Payer: UnitedHealthcare Commercial	$3,868.40
Rate for Payer: UnitedHealthcare Medicaid	$1,628.80
Rate for Payer: WPPA Medicare Advantage	$2,443.20

11463 Excision of skin/subcutaneous tissue for hidradenitis, inguinal; with complex repair

Facility

$4,072.00

Service Code	HCPCS 11463
Hospital Charge Code	3351463
Hospital Revenue Code	761
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,868.40
Rate for Payer: Aetna Commercial	$3,664.80
Rate for Payer: UnitedHealthcare Commercial	$3,868.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11470 Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical;

Facility

$4,276.00

Service Code	HCPCS 11470
Hospital Charge Code	3151147
Hospital Revenue Code	360
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,795.92
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,565.60

11470 Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical;

Facility

$4,276.00

Service Code	HCPCS 11470
Hospital Charge Code	3151147
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,062.20
Rate for Payer: Aetna Commercial	$3,848.40
Rate for Payer: UnitedHealthcare Commercial	$4,062.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00

11470 Exc skin/subq tissue for hidradenitis, perianal/perineal/umbilical; w/ simple or interm repair

Facility

$4,072.00

Service Code	HCPCS 11470
Hospital Charge Code	3351470
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$3,868.40
Rate for Payer: Aetna Commercial	$3,664.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3,084.55
Rate for Payer: Humana Medicare Advantage	$1,710.24
Rate for Payer: UnitedHealthcare Commercial	$3,868.40
Rate for Payer: UnitedHealthcare Medicaid	$920.50
Rate for Payer: WPPA Medicare Advantage	$2,443.20

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All Charges