St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RT SPEC TRTM PRO PHYSICIST

Facility

$1,631.98

Service Code	HCPCS 77470 TC
Hospital Charge Code	66541223
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$1,305.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$897.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$680.74
Rate for Payer: Aetna Government	$680.74
Rate for Payer: Affinity Essential Plan 1&2	$476.52
Rate for Payer: Affinity Essential Plan 3&4	$476.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$476.52
Rate for Payer: Brighton Health Commercial	$1,223.98
Rate for Payer: Cash Price	$680.74
Rate for Payer: Cash Price	$680.74
Rate for Payer: Cash Price	$680.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$680.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,305.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,109.75
Rate for Payer: Elderplan Medicare Advantage	$680.74
Rate for Payer: EmblemHealth Commercial	$680.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Medicare Advantage	$680.74
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$680.74
Rate for Payer: Group Health Inc Medicare	$680.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$815.99
Rate for Payer: Hamaspik Choice Inc Medicare	$680.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$612.67
Rate for Payer: Healthfirst Medicare Advantage	$680.74
Rate for Payer: Healthfirst QHP	$680.74
Rate for Payer: Humana Medicare	$694.35
Rate for Payer: Senior Whole Health Medicare Advantage	$680.74
Rate for Payer: United Healthcare Medicare Advantage	$680.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$680.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$544.59
Rate for Payer: Wellcare Medicare	$646.70

RT SPEC TRTM PRO PHYSICIST

Facility

$1,631.98

Service Code	HCPCS 77470 TC
Hospital Charge Code	66541223
Hospital Revenue Code	333
Rate for Payer: Cash Price	$680.74

RT SPEC TRTM PROV MGMT

Facility

$1,631.98

Service Code	HCPCS 77470 TC
Hospital Charge Code	66541274
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$1,305.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$897.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$680.74
Rate for Payer: Aetna Government	$680.74
Rate for Payer: Affinity Essential Plan 1&2	$476.52
Rate for Payer: Affinity Essential Plan 3&4	$476.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$476.52
Rate for Payer: Brighton Health Commercial	$1,223.98
Rate for Payer: Cash Price	$680.74
Rate for Payer: Cash Price	$680.74
Rate for Payer: Cash Price	$680.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$680.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,305.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,109.75
Rate for Payer: Elderplan Medicare Advantage	$680.74
Rate for Payer: EmblemHealth Commercial	$680.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Medicare Advantage	$680.74
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$680.74
Rate for Payer: Group Health Inc Medicare	$680.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$815.99
Rate for Payer: Hamaspik Choice Inc Medicare	$680.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$612.67
Rate for Payer: Healthfirst Medicare Advantage	$680.74
Rate for Payer: Healthfirst QHP	$680.74
Rate for Payer: Humana Medicare	$694.35
Rate for Payer: Senior Whole Health Medicare Advantage	$680.74
Rate for Payer: United Healthcare Medicare Advantage	$680.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$680.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$544.59
Rate for Payer: Wellcare Medicare	$646.70

RT SPEC TRTM PROV MGMT

Facility

$1,631.98

Service Code	HCPCS 77470 TC
Hospital Charge Code	66541274
Hospital Revenue Code	333
Rate for Payer: Cash Price	$680.74

RT SRS TREATM MGMT CARNIALLESIONS

Facility

$1,119.30

Hospital Charge Code	66541410
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$895.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$615.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$559.65
Rate for Payer: Aetna Government	$559.65
Rate for Payer: Brighton Health Commercial	$839.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$895.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$761.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$559.65
Rate for Payer: Group Health Inc Medicare	$391.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$559.65
Rate for Payer: Hamaspik Choice Inc Medicare	$559.65

RT STRONTIUM

Facility

$1,329.45

Service Code	HCPCS A9600
Hospital Charge Code	66541281
Hospital Revenue Code	344
Min. Negotiated Rate	$664.72
Max. Negotiated Rate	$4,239.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$731.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,156.57
Rate for Payer: Aetna Government	$4,156.57
Rate for Payer: Affinity Essential Plan 1&2	$2,909.60
Rate for Payer: Affinity Essential Plan 3&4	$2,909.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,909.60
Rate for Payer: Brighton Health Commercial	$4,156.57
Rate for Payer: Cash Price	$4,156.57
Rate for Payer: Cash Price	$4,156.57
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,156.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,063.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$904.03
Rate for Payer: Elderplan Medicare Advantage	$4,156.57
Rate for Payer: EmblemHealth Commercial	$4,156.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,533.09
Rate for Payer: Fidelis Essential Plan Aliesa	$3,533.09
Rate for Payer: Fidelis Essential Plan QHP	$3,699.35
Rate for Payer: Fidelis Medicare Advantage	$4,156.57
Rate for Payer: Fidelis Qualified Health Plan	$3,699.35
Rate for Payer: Group Health Inc Commercial	$4,156.57
Rate for Payer: Group Health Inc Medicare	$4,156.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.72
Rate for Payer: Hamaspik Choice Inc Medicare	$4,156.57
Rate for Payer: Healthfirst Medicare Advantage	$3,533.09
Rate for Payer: Healthfirst QHP	$4,156.57
Rate for Payer: Humana Medicare	$4,239.70
Rate for Payer: Senior Whole Health Medicare Advantage	$4,156.57
Rate for Payer: United Healthcare Commercial	$4,156.57
Rate for Payer: United Healthcare Medicare Advantage	$4,156.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,156.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,325.26
Rate for Payer: Wellcare Medicare	$3,948.74

RT STRONTIUM

Facility

$1,329.45

Service Code	HCPCS A9600
Hospital Charge Code	66541281
Hospital Revenue Code	344
Rate for Payer: Cash Price	$4,156.57

RT SUBS IHC,EXPANDED FOCUSED

Facility

$222.76

Service Code	HCPCS 99232
Hospital Charge Code	66541292
Hospital Revenue Code	987
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$178.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.57
Rate for Payer: Aetna Government	$53.57
Rate for Payer: Brighton Health Commercial	$167.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$151.48
Rate for Payer: Group Health Inc Commercial	$111.38
Rate for Payer: Group Health Inc Medicare	$77.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.38
Rate for Payer: Hamaspik Choice Inc Medicare	$111.38

RT SUBS IHC, HIGH COMPLEXTY

Facility

$317.95

Service Code	HCPCS 99233
Hospital Charge Code	66541293
Hospital Revenue Code	987
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$254.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.48
Rate for Payer: Aetna Government	$77.48
Rate for Payer: Brighton Health Commercial	$238.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$254.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.21
Rate for Payer: Group Health Inc Commercial	$158.98
Rate for Payer: Group Health Inc Medicare	$111.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.98
Rate for Payer: Hamaspik Choice Inc Medicare	$158.98

RT SUBS IHC, PROBLEM FOCUSED

Facility

$135.70

Service Code	HCPCS 99231
Hospital Charge Code	66541291
Hospital Revenue Code	987
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$108.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.44
Rate for Payer: Aetna Government	$29.44
Rate for Payer: Brighton Health Commercial	$101.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.28
Rate for Payer: Group Health Inc Commercial	$67.85
Rate for Payer: Group Health Inc Medicare	$47.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.85
Rate for Payer: Hamaspik Choice Inc Medicare	$67.85

RT SUPERV, HNDL, LOAD -RAD SOURCE

Facility

$258.40

Service Code	HCPCS 77790
Hospital Charge Code	66541330
Hospital Revenue Code	342
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$206.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.63
Rate for Payer: Aetna Government	$19.63
Rate for Payer: Brighton Health Commercial	$193.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.71
Rate for Payer: Group Health Inc Commercial	$129.20
Rate for Payer: Group Health Inc Medicare	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.20
Rate for Payer: Hamaspik Choice Inc Medicare	$129.20

RT SUPERVISION HAND/LOAD

Facility

$258.40

Service Code	HCPCS 77790
Hospital Charge Code	66541251
Hospital Revenue Code	342
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$206.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.63
Rate for Payer: Aetna Government	$19.63
Rate for Payer: Brighton Health Commercial	$193.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.71
Rate for Payer: Group Health Inc Commercial	$129.20
Rate for Payer: Group Health Inc Medicare	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.20
Rate for Payer: Hamaspik Choice Inc Medicare	$129.20

RT SURFACE APPL RAD SOURCE

Facility

$371.65

Service Code	HCPCS 77789 TC
Hospital Charge Code	66541244
Hospital Revenue Code	342
Min. Negotiated Rate	$97.07
Max. Negotiated Rate	$204.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$204.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$138.67
Rate for Payer: Aetna Government	$138.67
Rate for Payer: Affinity Essential Plan 1&2	$97.07
Rate for Payer: Affinity Essential Plan 3&4	$97.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$97.07
Rate for Payer: Brighton Health Commercial	$138.67
Rate for Payer: Cash Price	$138.67
Rate for Payer: Cash Price	$138.67
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$138.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.67
Rate for Payer: Elderplan Medicare Advantage	$138.67
Rate for Payer: EmblemHealth Commercial	$97.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$117.87
Rate for Payer: Fidelis Essential Plan Aliesa	$117.87
Rate for Payer: Fidelis Essential Plan QHP	$123.42
Rate for Payer: Fidelis Medicare Advantage	$138.67
Rate for Payer: Fidelis Qualified Health Plan	$123.42
Rate for Payer: Group Health Inc Commercial	$124.80
Rate for Payer: Group Health Inc Medicare	$124.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.82
Rate for Payer: Hamaspik Choice Inc Medicare	$138.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$124.80
Rate for Payer: Healthfirst Medicare Advantage	$138.67
Rate for Payer: Healthfirst QHP	$138.67
Rate for Payer: Humana Medicare	$141.44
Rate for Payer: Senior Whole Health Medicare Advantage	$138.67
Rate for Payer: United Healthcare Medicare Advantage	$138.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$138.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$110.94
Rate for Payer: Wellcare Medicare	$131.74

RT SURFACE APPL RAD SOURCE

Facility

$371.65

Service Code	HCPCS 77789 TC
Hospital Charge Code	66541244
Hospital Revenue Code	342
Rate for Payer: Cash Price	$138.67

RT TANGENTIAL PORTS 3+

Facility

$1,015.13

Service Code	HCPCS 77290 TC
Hospital Charge Code	66541241
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$812.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$558.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$427.29
Rate for Payer: Aetna Government	$427.29
Rate for Payer: Affinity Essential Plan 1&2	$299.10
Rate for Payer: Affinity Essential Plan 3&4	$299.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$299.10
Rate for Payer: Brighton Health Commercial	$761.35
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$812.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.29
Rate for Payer: Elderplan Medicare Advantage	$427.29
Rate for Payer: EmblemHealth Commercial	$427.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Medicare Advantage	$427.29
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$427.29
Rate for Payer: Group Health Inc Medicare	$427.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.56
Rate for Payer: Hamaspik Choice Inc Medicare	$427.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$384.56
Rate for Payer: Healthfirst Medicare Advantage	$427.29
Rate for Payer: Healthfirst QHP	$427.29
Rate for Payer: Humana Medicare	$435.84
Rate for Payer: Senior Whole Health Medicare Advantage	$427.29
Rate for Payer: United Healthcare Medicare Advantage	$427.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$341.83
Rate for Payer: Wellcare Medicare	$405.93

RT TANGENTIAL PORTS 3+

Facility

$1,015.13

Service Code	HCPCS 77290 TC
Hospital Charge Code	66541241
Hospital Revenue Code	333
Rate for Payer: Cash Price	$427.29

RT THERAPEUTIC RADIO. TRTMNT PLAN

Facility

$298.20

Service Code	HCPCS 77261
Hospital Charge Code	66540133
Hospital Revenue Code	982
Min. Negotiated Rate	$94.55
Max. Negotiated Rate	$223.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.55
Rate for Payer: Aetna Government	$94.55
Rate for Payer: Brighton Health Commercial	$223.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.42
Rate for Payer: Group Health Inc Commercial	$149.10
Rate for Payer: Group Health Inc Medicare	$104.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.10
Rate for Payer: Hamaspik Choice Inc Medicare	$149.10

RT THERAPY RAD PORT FILM

Facility

$103.48

Service Code	HCPCS 77417
Hospital Charge Code	66541234
Hospital Revenue Code	333
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$294.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.55
Rate for Payer: Aetna Government	$14.55
Rate for Payer: Brighton Health Commercial	$77.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$51.74
Rate for Payer: Group Health Inc Medicare	$36.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.74
Rate for Payer: Hamaspik Choice Inc Medicare	$51.74

RT TOTAL BODY IRRADIATION

Facility

$1,631.98

Service Code	HCPCS 77470 TC
Hospital Charge Code	66541275
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$1,305.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$897.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$680.74
Rate for Payer: Aetna Government	$680.74
Rate for Payer: Affinity Essential Plan 1&2	$476.52
Rate for Payer: Affinity Essential Plan 3&4	$476.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$476.52
Rate for Payer: Brighton Health Commercial	$1,223.98
Rate for Payer: Cash Price	$680.74
Rate for Payer: Cash Price	$680.74
Rate for Payer: Cash Price	$680.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$680.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,305.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,109.75
Rate for Payer: Elderplan Medicare Advantage	$680.74
Rate for Payer: EmblemHealth Commercial	$680.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Medicare Advantage	$680.74
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$680.74
Rate for Payer: Group Health Inc Medicare	$680.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$815.99
Rate for Payer: Hamaspik Choice Inc Medicare	$680.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$612.67
Rate for Payer: Healthfirst Medicare Advantage	$680.74
Rate for Payer: Healthfirst QHP	$680.74
Rate for Payer: Humana Medicare	$694.35
Rate for Payer: Senior Whole Health Medicare Advantage	$680.74
Rate for Payer: United Healthcare Medicare Advantage	$680.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$680.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$544.59
Rate for Payer: Wellcare Medicare	$646.70

RT TOTAL BODY IRRADIATION

Facility

$1,631.98

Service Code	HCPCS 77470 TC
Hospital Charge Code	66541275
Hospital Revenue Code	333
Rate for Payer: Cash Price	$680.74

RT TREATMENT PLAN COMPLEX

Facility

$681.65

Service Code	HCPCS 77263
Hospital Charge Code	66541222
Hospital Revenue Code	982
Min. Negotiated Rate	$207.09
Max. Negotiated Rate	$511.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$374.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$207.09
Rate for Payer: Aetna Government	$207.09
Rate for Payer: Brighton Health Commercial	$511.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$317.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.81
Rate for Payer: Group Health Inc Commercial	$340.82
Rate for Payer: Group Health Inc Medicare	$238.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$340.82
Rate for Payer: Hamaspik Choice Inc Medicare	$340.82

RT TREATMENT PLANNING, COMPLEX

Facility

$4,328.59

Service Code	HCPCS 77263
Hospital Charge Code	66541327
Hospital Revenue Code	973
Min. Negotiated Rate	$207.09
Max. Negotiated Rate	$3,246.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,380.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$207.09
Rate for Payer: Aetna Government	$207.09
Rate for Payer: Brighton Health Commercial	$3,246.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$317.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.81
Rate for Payer: Group Health Inc Commercial	$2,164.30
Rate for Payer: Group Health Inc Medicare	$1,515.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.30
Rate for Payer: Hamaspik Choice Inc Medicare	$2,164.30

RT TREATMENT PLAN SIMPLE

Facility

$298.20

Service Code	HCPCS 77261
Hospital Charge Code	66541220
Hospital Revenue Code	982
Min. Negotiated Rate	$94.55
Max. Negotiated Rate	$223.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.55
Rate for Payer: Aetna Government	$94.55
Rate for Payer: Brighton Health Commercial	$223.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.42
Rate for Payer: Group Health Inc Commercial	$149.10
Rate for Payer: Group Health Inc Medicare	$104.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.10
Rate for Payer: Hamaspik Choice Inc Medicare	$149.10

RT TREATMENT PL INTERMEDIATE

Facility

$448.32

Service Code	HCPCS 77262
Hospital Charge Code	66541221
Hospital Revenue Code	982
Min. Negotiated Rate	$141.60
Max. Negotiated Rate	$336.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$141.60
Rate for Payer: Aetna Government	$141.60
Rate for Payer: Brighton Health Commercial	$336.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$214.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$181.38
Rate for Payer: Group Health Inc Commercial	$224.16
Rate for Payer: Group Health Inc Medicare	$156.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$224.16
Rate for Payer: Hamaspik Choice Inc Medicare	$224.16

RT TREATM MGMT 1 OR 2 FRACT

Facility

$740.78

Service Code	HCPCS 77431
Hospital Charge Code	66541273
Hospital Revenue Code	982
Min. Negotiated Rate	$127.73
Max. Negotiated Rate	$555.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$407.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.73
Rate for Payer: Aetna Government	$127.73
Rate for Payer: Brighton Health Commercial	$555.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.53
Rate for Payer: Group Health Inc Commercial	$370.39
Rate for Payer: Group Health Inc Medicare	$259.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$370.39
Rate for Payer: Hamaspik Choice Inc Medicare	$370.39

Know your out-of-pocket cost for care.

All Charges