St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GRANULOCYTES

Facility

$6.35

Service Code	HCPCS 85048
Hospital Charge Code	40701189
Hospital Revenue Code	305
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.54
Rate for Payer: Aetna Government	$2.54
Rate for Payer: Affinity Essential Plan 1&2	$1.78
Rate for Payer: Affinity Essential Plan 3&4	$1.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.78
Rate for Payer: Brighton Health Commercial	$4.76
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cash Price	$2.54
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.41
Rate for Payer: Elderplan Medicare Advantage	$2.54
Rate for Payer: EmblemHealth Commercial	$2.54
Rate for Payer: Fidelis Essential Plan Aliesa	$2.16
Rate for Payer: Fidelis Essential Plan QHP	$2.26
Rate for Payer: Fidelis Medicare Advantage	$2.54
Rate for Payer: Fidelis Qualified Health Plan	$2.26
Rate for Payer: Group Health Inc Commercial	$2.54
Rate for Payer: Group Health Inc Medicare	$2.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2.54
Rate for Payer: Healthfirst Medicare Advantage	$2.54
Rate for Payer: Healthfirst QHP	$2.54
Rate for Payer: Humana Medicare	$2.59
Rate for Payer: Senior Whole Health Medicare Advantage	$2.54
Rate for Payer: United Healthcare Commercial	$3.21
Rate for Payer: United Healthcare Medicare Advantage	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.03
Rate for Payer: Wellcare Medicare	$2.29

GRANULOCYTES

Facility

$6.35

Service Code	HCPCS 85048
Hospital Charge Code	40701189
Hospital Revenue Code	305
Rate for Payer: Cash Price	$2.54

GRANULOMA ARMS

Facility

$1,847.58

Service Code	HCPCS 11403
Hospital Charge Code	40013240
Hospital Revenue Code	360
Rate for Payer: Cash Price	$813.63

GRANULOMA ARMS

Facility

$1,847.58

Service Code	HCPCS 11403
Hospital Charge Code	40013240
Hospital Revenue Code	360
Min. Negotiated Rate	$569.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

GRANULOMA EARS

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013249
Hospital Revenue Code	360
Min. Negotiated Rate	$569.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

GRANULOMA EARS

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013249
Hospital Revenue Code	360
Rate for Payer: Cash Price	$813.63

GRANULOMA EYELIDS

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013250
Hospital Revenue Code	360
Min. Negotiated Rate	$569.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

GRANULOMA EYELIDS

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013250
Hospital Revenue Code	360
Rate for Payer: Cash Price	$813.63

GRANULOMA FACE

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013248
Hospital Revenue Code	360
Min. Negotiated Rate	$569.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

GRANULOMA FACE

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013248
Hospital Revenue Code	360
Rate for Payer: Cash Price	$813.63

GRANULOMA FEET

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013246
Hospital Revenue Code	360
Min. Negotiated Rate	$1,312.42
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Affinity Essential Plan 1&2	$1,312.42
Rate for Payer: Affinity Essential Plan 3&4	$1,312.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,312.42
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,874.89
Rate for Payer: Group Health Inc Medicare	$1,874.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Humana Medicare	$1,912.39
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

GRANULOMA FEET

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013246
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,874.89

GRANULOMA GENITALIA

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013247
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,874.89

GRANULOMA GENITALIA

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013247
Hospital Revenue Code	360
Min. Negotiated Rate	$1,312.42
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Affinity Essential Plan 1&2	$1,312.42
Rate for Payer: Affinity Essential Plan 3&4	$1,312.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,312.42
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,874.89
Rate for Payer: Group Health Inc Medicare	$1,874.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Humana Medicare	$1,912.39
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

GRANULOMA HANDS

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013245
Hospital Revenue Code	360
Min. Negotiated Rate	$1,312.42
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Affinity Essential Plan 1&2	$1,312.42
Rate for Payer: Affinity Essential Plan 3&4	$1,312.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,312.42
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,874.89
Rate for Payer: Group Health Inc Medicare	$1,874.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Humana Medicare	$1,912.39
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

GRANULOMA HANDS

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013245
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,874.89

GRANULOMA LEGS

Facility

$1,847.58

Service Code	HCPCS 11403
Hospital Charge Code	40013241
Hospital Revenue Code	360
Min. Negotiated Rate	$569.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

GRANULOMA LEGS

Facility

$1,847.58

Service Code	HCPCS 11403
Hospital Charge Code	40013241
Hospital Revenue Code	360
Rate for Payer: Cash Price	$813.63

GRANULOMA LIPS

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013252
Hospital Revenue Code	360
Rate for Payer: Cash Price	$813.63

GRANULOMA LIPS

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013252
Hospital Revenue Code	360
Min. Negotiated Rate	$569.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

GRANULOMA MUCOUS MEMBRANE

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013253
Hospital Revenue Code	360
Rate for Payer: Cash Price	$813.63

GRANULOMA MUCOUS MEMBRANE

Facility

$1,847.58

Service Code	HCPCS 11440
Hospital Charge Code	40013253
Hospital Revenue Code	360
Min. Negotiated Rate	$569.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

GRANULOMA NECK

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013244
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,874.89

GRANULOMA NECK

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013244
Hospital Revenue Code	360
Min. Negotiated Rate	$1,312.42
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Affinity Essential Plan 1&2	$1,312.42
Rate for Payer: Affinity Essential Plan 3&4	$1,312.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,312.42
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,874.89
Rate for Payer: Group Health Inc Medicare	$1,874.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Humana Medicare	$1,912.39
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

GRANULOMA SCALP

Facility

$4,157.25

Service Code	HCPCS 11423
Hospital Charge Code	40013243
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,874.89

Know your out-of-pocket cost for care.

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