Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT NASAL XOMED MED

Facility

$1,226.45

Hospital Charge Code	2700061285
Hospital Revenue Code	272
Min. Negotiated Rate	$159.44
Max. Negotiated Rate	$613.23
Rate for Payer: Aetna Commercial	$367.94
Rate for Payer: Aetna Medicare Advantage	$367.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.74
Rate for Payer: Cigna Commercial	$613.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.44
Rate for Payer: Oxford Commercial	$613.23
Rate for Payer: Qualcare PPO/HMO/WC	$183.97
Rate for Payer: UnitedHealthcare Commercial	$613.23

SPLINT NASAL XOMED MED

Facility

$1,226.45

Hospital Charge Code	2700061285
Hospital Revenue Code	272
Min. Negotiated Rate	$183.97
Max. Negotiated Rate	$183.97
Rate for Payer: Qualcare PPO/HMO/WC	$183.97

SPLINT NASAL XOMED MED 1528126

Facility

$165.75

Hospital Charge Code	270628738
Hospital Revenue Code	272
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$82.88
Rate for Payer: Aetna Commercial	$49.73
Rate for Payer: Aetna Medicare Advantage	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.27
Rate for Payer: Cigna Commercial	$82.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.55
Rate for Payer: Oxford Commercial	$82.88
Rate for Payer: Qualcare PPO/HMO/WC	$24.86
Rate for Payer: UnitedHealthcare Commercial	$82.88

SPLINT NASAL XOMED MED 1528126

Facility

$165.75

Hospital Charge Code	270628738
Hospital Revenue Code	272
Min. Negotiated Rate	$24.86
Max. Negotiated Rate	$24.86
Rate for Payer: Qualcare PPO/HMO/WC	$24.86

SPLINT ORTHOGLASS 1x15

Facility

$166.10

Hospital Charge Code	270651769
Hospital Revenue Code	271
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$24.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.91

SPLINT ORTHOGLASS 1x15

Facility

$166.10

Hospital Charge Code	270651769
Hospital Revenue Code	271
Min. Negotiated Rate	$21.59
Max. Negotiated Rate	$83.05
Rate for Payer: Aetna Commercial	$49.83
Rate for Payer: Aetna Medicare Advantage	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.36
Rate for Payer: Cigna Commercial	$83.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.59
Rate for Payer: Oxford Commercial	$83.05
Rate for Payer: Qualcare PPO/HMO/WC	$24.91
Rate for Payer: UnitedHealthcare Commercial	$83.05

SPLINT ORTHOGLASS 2 X 15

Facility

$173.15

Hospital Charge Code	270651777
Hospital Revenue Code	270
Min. Negotiated Rate	$22.51
Max. Negotiated Rate	$86.58
Rate for Payer: Aetna Commercial	$51.95
Rate for Payer: Aetna Medicare Advantage	$51.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$86.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.51
Rate for Payer: Oxford Commercial	$86.58
Rate for Payer: Qualcare PPO/HMO/WC	$25.97
Rate for Payer: UnitedHealthcare Commercial	$86.58

SPLINT ORTHOGLASS 2 X 15

Facility

$173.15

Hospital Charge Code	270651777
Hospital Revenue Code	270
Min. Negotiated Rate	$25.97
Max. Negotiated Rate	$25.97
Rate for Payer: Qualcare PPO/HMO/WC	$25.97

SPLINT ORTHOGLASS 3

Facility

$268.80

Hospital Charge Code	270651688
Hospital Revenue Code	272
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$40.32
Rate for Payer: Qualcare PPO/HMO/WC	$40.32

SPLINT ORTHOGLASS 3

Facility

$268.80

Hospital Charge Code	270651688
Hospital Revenue Code	272
Min. Negotiated Rate	$34.94
Max. Negotiated Rate	$134.40
Rate for Payer: Aetna Commercial	$80.64
Rate for Payer: Aetna Medicare Advantage	$80.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.54
Rate for Payer: Cigna Commercial	$134.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: Oxford Commercial	$134.40
Rate for Payer: Qualcare PPO/HMO/WC	$40.32
Rate for Payer: UnitedHealthcare Commercial	$134.40

SPLINT ORTHO GLASS 3INX15FT

Facility

$642.45

Hospital Charge Code	270652829
Hospital Revenue Code	272
Min. Negotiated Rate	$96.37
Max. Negotiated Rate	$96.37
Rate for Payer: Qualcare PPO/HMO/WC	$96.37

SPLINT ORTHO GLASS 3INX15FT

Facility

$642.45

Hospital Charge Code	270652829
Hospital Revenue Code	272
Min. Negotiated Rate	$83.52
Max. Negotiated Rate	$321.23
Rate for Payer: Aetna Commercial	$192.74
Rate for Payer: Aetna Medicare Advantage	$192.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.82
Rate for Payer: Cigna Commercial	$321.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.52
Rate for Payer: Oxford Commercial	$321.23
Rate for Payer: Qualcare PPO/HMO/WC	$96.37
Rate for Payer: UnitedHealthcare Commercial	$321.23

SPLINT ORTHOGLASS 4

Facility

$322.55

Hospital Charge Code	270651689
Hospital Revenue Code	272
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$48.38
Rate for Payer: Qualcare PPO/HMO/WC	$48.38

SPLINT ORTHOGLASS 4

Facility

$322.55

Hospital Charge Code	270651689
Hospital Revenue Code	272
Min. Negotiated Rate	$41.93
Max. Negotiated Rate	$161.28
Rate for Payer: Aetna Commercial	$96.77
Rate for Payer: Aetna Medicare Advantage	$96.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.25
Rate for Payer: Cigna Commercial	$161.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.93
Rate for Payer: Oxford Commercial	$161.28
Rate for Payer: Qualcare PPO/HMO/WC	$48.38
Rate for Payer: UnitedHealthcare Commercial	$161.28

SPLINT ORTHOGLASS 5

Facility

$364.10

Hospital Charge Code	270651694
Hospital Revenue Code	272
Min. Negotiated Rate	$54.62
Max. Negotiated Rate	$54.62
Rate for Payer: Qualcare PPO/HMO/WC	$54.62

SPLINT ORTHOGLASS 5

Facility

$364.10

Hospital Charge Code	270651694
Hospital Revenue Code	272
Min. Negotiated Rate	$47.33
Max. Negotiated Rate	$182.05
Rate for Payer: Aetna Commercial	$109.23
Rate for Payer: Aetna Medicare Advantage	$109.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.85
Rate for Payer: Cigna Commercial	$182.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.33
Rate for Payer: Oxford Commercial	$182.05
Rate for Payer: Qualcare PPO/HMO/WC	$54.62
Rate for Payer: UnitedHealthcare Commercial	$182.05

SPLINT ORTHO GLASS 5IN X 15FT

Facility

$962.45

Hospital Charge Code	270652831
Hospital Revenue Code	272
Min. Negotiated Rate	$144.37
Max. Negotiated Rate	$144.37
Rate for Payer: Qualcare PPO/HMO/WC	$144.37

SPLINT ORTHO GLASS 5IN X 15FT

Facility

$962.45

Hospital Charge Code	270652831
Hospital Revenue Code	272
Min. Negotiated Rate	$125.12
Max. Negotiated Rate	$481.23
Rate for Payer: Aetna Commercial	$288.74
Rate for Payer: Aetna Medicare Advantage	$288.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.42
Rate for Payer: Cigna Commercial	$481.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.12
Rate for Payer: Oxford Commercial	$481.23
Rate for Payer: Qualcare PPO/HMO/WC	$144.37
Rate for Payer: UnitedHealthcare Commercial	$481.23

SPLINT ORTHOGLASS 6

Facility

$586.63

Hospital Charge Code	270651782
Hospital Revenue Code	272
Min. Negotiated Rate	$87.99
Max. Negotiated Rate	$87.99
Rate for Payer: Qualcare PPO/HMO/WC	$87.99

SPLINT ORTHOGLASS 6

Facility

$586.63

Hospital Charge Code	270651782
Hospital Revenue Code	272
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$293.31
Rate for Payer: Aetna Commercial	$175.99
Rate for Payer: Aetna Medicare Advantage	$175.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.59
Rate for Payer: Cigna Commercial	$293.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.26
Rate for Payer: Oxford Commercial	$293.31
Rate for Payer: Qualcare PPO/HMO/WC	$87.99
Rate for Payer: UnitedHealthcare Commercial	$293.31

SPLINT ORTHOGLASS PRECUT 5x30

Facility

$70.66

Hospital Charge Code	270655934
Hospital Revenue Code	271
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$10.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.60

SPLINT ORTHOGLASS PRECUT 5x30

Facility

$70.66

Hospital Charge Code	270655934
Hospital Revenue Code	271
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$35.33
Rate for Payer: Aetna Commercial	$21.20
Rate for Payer: Aetna Medicare Advantage	$21.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.02
Rate for Payer: Cigna Commercial	$35.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.19
Rate for Payer: Oxford Commercial	$35.33
Rate for Payer: Qualcare PPO/HMO/WC	$10.60
Rate for Payer: UnitedHealthcare Commercial	$35.33

SPLINT PLSTC TIB/FIB HIP LGT**

Facility

$99.00

Hospital Charge Code	8003592
Hospital Revenue Code	279
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.87
Rate for Payer: Oxford Commercial	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$49.50

SPLINT PLSTC TIB/FIB HIP LGT**

Facility

$99.00

Hospital Charge Code	8003592
Hospital Revenue Code	279
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345N
Hospital Revenue Code	271
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

Know your out-of-pocket cost for care.

All Charges