Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT GLASS ROLL 4X15

Facility

$334.50

Hospital Charge Code	270600745W
Hospital Revenue Code	270
Min. Negotiated Rate	$43.48
Max. Negotiated Rate	$167.25
Rate for Payer: Aetna Commercial	$100.35
Rate for Payer: Aetna Medicare Advantage	$100.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.30
Rate for Payer: Cigna Commercial	$167.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.48
Rate for Payer: Oxford Commercial	$167.25
Rate for Payer: Qualcare PPO/HMO/WC	$50.17
Rate for Payer: UnitedHealthcare Commercial	$167.25

SPLINT GLASS ROLL 4X15

Facility

$334.50

Hospital Charge Code	270600745W
Hospital Revenue Code	270
Min. Negotiated Rate	$50.17
Max. Negotiated Rate	$50.17
Rate for Payer: Qualcare PPO/HMO/WC	$50.17

SPLINT GLASS ROLL 4X15

Facility

$334.50

Hospital Charge Code	270600745
Hospital Revenue Code	270
Min. Negotiated Rate	$50.17
Max. Negotiated Rate	$50.17
Rate for Payer: Qualcare PPO/HMO/WC	$50.17

SPLINT GLASS ROLL 4X15

Facility

$334.50

Hospital Charge Code	270600745
Hospital Revenue Code	270
Min. Negotiated Rate	$43.48
Max. Negotiated Rate	$167.25
Rate for Payer: Aetna Commercial	$100.35
Rate for Payer: Aetna Medicare Advantage	$100.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.30
Rate for Payer: Cigna Commercial	$167.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.48
Rate for Payer: Oxford Commercial	$167.25
Rate for Payer: Qualcare PPO/HMO/WC	$50.17
Rate for Payer: UnitedHealthcare Commercial	$167.25

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760
Hospital Revenue Code	270
Min. Negotiated Rate	$51.02
Max. Negotiated Rate	$196.25
Rate for Payer: Aetna Commercial	$117.75
Rate for Payer: Aetna Medicare Advantage	$117.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.09
Rate for Payer: Cigna Commercial	$196.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.02
Rate for Payer: Oxford Commercial	$196.25
Rate for Payer: Qualcare PPO/HMO/WC	$58.88
Rate for Payer: UnitedHealthcare Commercial	$196.25

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760
Hospital Revenue Code	270
Min. Negotiated Rate	$58.88
Max. Negotiated Rate	$58.88
Rate for Payer: Qualcare PPO/HMO/WC	$58.88

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760W
Hospital Revenue Code	270
Min. Negotiated Rate	$51.02
Max. Negotiated Rate	$196.25
Rate for Payer: Aetna Commercial	$117.75
Rate for Payer: Aetna Medicare Advantage	$117.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.09
Rate for Payer: Cigna Commercial	$196.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.02
Rate for Payer: Oxford Commercial	$196.25
Rate for Payer: Qualcare PPO/HMO/WC	$58.88
Rate for Payer: UnitedHealthcare Commercial	$196.25

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760W
Hospital Revenue Code	270
Min. Negotiated Rate	$58.88
Max. Negotiated Rate	$58.88
Rate for Payer: Qualcare PPO/HMO/WC	$58.88

SPLINTINGFABRICATION INI 15 MI

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008355
Hospital Revenue Code	430
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

SPLINTINGFABRICATION INI 15 MI

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008355
Hospital Revenue Code	430
Min. Negotiated Rate	$57.98
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

SPLINT IROM REGULAR LONG

Facility

$1,625.65

Hospital Charge Code	270610223
Hospital Revenue Code	270
Min. Negotiated Rate	$211.33
Max. Negotiated Rate	$812.83
Rate for Payer: Aetna Commercial	$487.69
Rate for Payer: Aetna Medicare Advantage	$487.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.54
Rate for Payer: Cigna Commercial	$812.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.33
Rate for Payer: Oxford Commercial	$812.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.85
Rate for Payer: UnitedHealthcare Commercial	$812.83

SPLINT IROM REGULAR LONG

Facility

$1,625.65

Hospital Charge Code	270610223
Hospital Revenue Code	270
Min. Negotiated Rate	$243.85
Max. Negotiated Rate	$243.85
Rate for Payer: Qualcare PPO/HMO/WC	$243.85

SPLINT IROM REGULAR SHORT

Facility

$1,625.65

Hospital Charge Code	270610222
Hospital Revenue Code	270
Min. Negotiated Rate	$243.85
Max. Negotiated Rate	$243.85
Rate for Payer: Qualcare PPO/HMO/WC	$243.85

SPLINT IROM REGULAR SHORT

Facility

$1,625.65

Hospital Charge Code	270610222
Hospital Revenue Code	270
Min. Negotiated Rate	$211.33
Max. Negotiated Rate	$812.83
Rate for Payer: Aetna Commercial	$487.69
Rate for Payer: Aetna Medicare Advantage	$487.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.54
Rate for Payer: Cigna Commercial	$812.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.33
Rate for Payer: Oxford Commercial	$812.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.85
Rate for Payer: UnitedHealthcare Commercial	$812.83

SPLINT LARGE RESTING HAND

Facility

$645.00

Hospital Charge Code	270647015
Hospital Revenue Code	271
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$322.50
Rate for Payer: Aetna Commercial	$193.50
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.85
Rate for Payer: Oxford Commercial	$322.50
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Commercial	$322.50

SPLINT LARGE RESTING HAND

Facility

$645.00

Hospital Charge Code	270647015
Hospital Revenue Code	271
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

SPLINT MED-LG 10.5 LT 1155535

Facility

$58.60

Hospital Charge Code	270642163
Hospital Revenue Code	272
Min. Negotiated Rate	$7.62
Max. Negotiated Rate	$29.30
Rate for Payer: Aetna Commercial	$17.58
Rate for Payer: Aetna Medicare Advantage	$17.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.94
Rate for Payer: Cigna Commercial	$29.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.62
Rate for Payer: Oxford Commercial	$29.30
Rate for Payer: Qualcare PPO/HMO/WC	$8.79
Rate for Payer: UnitedHealthcare Commercial	$29.30

SPLINT MED-LG 10.5 LT 1155535

Facility

$58.60

Hospital Charge Code	270642163
Hospital Revenue Code	272
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$8.79
Rate for Payer: Qualcare PPO/HMO/WC	$8.79

SPLINT MED-LG 10.5 RT 1155635

Facility

$56.60

Hospital Charge Code	270642164
Hospital Revenue Code	272
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$8.49

SPLINT MED-LG 10.5 RT 1155635

Facility

$56.60

Hospital Charge Code	270642164
Hospital Revenue Code	272
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$28.30
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna Medicare Advantage	$16.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.43
Rate for Payer: Cigna Commercial	$28.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.36
Rate for Payer: Oxford Commercial	$28.30
Rate for Payer: Qualcare PPO/HMO/WC	$8.49
Rate for Payer: UnitedHealthcare Commercial	$28.30

SPLINT MED-LG 8 LEFT 1155335

Facility

$49.40

Hospital Charge Code	270642161
Hospital Revenue Code	272
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$14.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.60
Rate for Payer: Cigna Commercial	$24.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.42
Rate for Payer: Oxford Commercial	$24.70
Rate for Payer: Qualcare PPO/HMO/WC	$7.41
Rate for Payer: UnitedHealthcare Commercial	$24.70

SPLINT MED-LG 8 LEFT 1155335

Facility

$49.40

Hospital Charge Code	270642161
Hospital Revenue Code	272
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$7.41

SPLINT MED-LG 8 RIGHT 1155435

Facility

$48.45

Hospital Charge Code	270642162
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$24.23
Rate for Payer: Aetna Commercial	$14.54
Rate for Payer: Aetna Medicare Advantage	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.35
Rate for Payer: Cigna Commercial	$24.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$24.23
Rate for Payer: Qualcare PPO/HMO/WC	$7.27
Rate for Payer: UnitedHealthcare Commercial	$24.23

SPLINT MED-LG 8 RIGHT 1155435

Facility

$48.45

Hospital Charge Code	270642162
Hospital Revenue Code	272
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$7.27
Rate for Payer: Qualcare PPO/HMO/WC	$7.27

SPLINT MEDT DOYLE NASL 1524050

Facility

$278.00

Hospital Charge Code	270627434
Hospital Revenue Code	272
Min. Negotiated Rate	$41.70
Max. Negotiated Rate	$41.70
Rate for Payer: Qualcare PPO/HMO/WC	$41.70

Know your out-of-pocket cost for care.

All Charges