Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345
Hospital Revenue Code	271
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.35
Rate for Payer: Oxford Commercial	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$97.50

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345N
Hospital Revenue Code	271
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.35
Rate for Payer: Oxford Commercial	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$97.50

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

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

SPLINT PRECUT 3x12

Facility

$14.73

Hospital Charge Code	270655933
Hospital Revenue Code	271
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna Commercial	$4.42
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.91
Rate for Payer: Oxford Commercial	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$7.37

SPLINT PRECUT 3x12

Facility

$14.73

Hospital Charge Code	270655933
Hospital Revenue Code	271
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

SPLINT PRECUT 4x30

Facility

$142.20

Hospital Charge Code	270655927
Hospital Revenue Code	271
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna Commercial	$42.66
Rate for Payer: Aetna Medicare Advantage	$42.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.26
Rate for Payer: Cigna Commercial	$71.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.49
Rate for Payer: Oxford Commercial	$71.10
Rate for Payer: Qualcare PPO/HMO/WC	$21.33
Rate for Payer: UnitedHealthcare Commercial	$71.10

SPLINT PRECUT 4x30

Facility

$142.20

Hospital Charge Code	270655927
Hospital Revenue Code	271
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$21.33
Rate for Payer: Qualcare PPO/HMO/WC	$21.33

SPLINT PRECUT SAFETY 4inx15

Facility

$20.87

Hospital Charge Code	270655930
Hospital Revenue Code	271
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$10.44
Rate for Payer: Aetna Commercial	$6.26
Rate for Payer: Aetna Medicare Advantage	$6.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$10.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$10.44

SPLINT PRECUT SAFETY 4inx15

Facility

$20.87

Hospital Charge Code	270655930
Hospital Revenue Code	271
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

SPLINT RADIAL BAR WRIST A171

Facility

$228.85

Hospital Charge Code	270610296
Hospital Revenue Code	270
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$114.42
Rate for Payer: Aetna Commercial	$68.66
Rate for Payer: Aetna Medicare Advantage	$68.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.36
Rate for Payer: Cigna Commercial	$114.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.75
Rate for Payer: Oxford Commercial	$114.42
Rate for Payer: Qualcare PPO/HMO/WC	$34.33
Rate for Payer: UnitedHealthcare Commercial	$114.42

SPLINT RADIAL BAR WRIST A171

Facility

$228.85

Hospital Charge Code	270610296
Hospital Revenue Code	270
Min. Negotiated Rate	$34.33
Max. Negotiated Rate	$34.33
Rate for Payer: Qualcare PPO/HMO/WC	$34.33

SPLINT THERMOPLASTICS NASAL

Facility

$748.65

Hospital Charge Code	270688753
Hospital Revenue Code	272
Min. Negotiated Rate	$97.32
Max. Negotiated Rate	$374.32
Rate for Payer: Aetna Commercial	$224.59
Rate for Payer: Aetna Medicare Advantage	$224.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$190.91
Rate for Payer: Cigna Commercial	$374.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.32
Rate for Payer: Oxford Commercial	$374.32
Rate for Payer: Qualcare PPO/HMO/WC	$112.30
Rate for Payer: UnitedHealthcare Commercial	$374.32

SPLINT THERMOPLASTICS NASAL

Facility

$748.65

Hospital Charge Code	270688753
Hospital Revenue Code	272
Min. Negotiated Rate	$112.30
Max. Negotiated Rate	$112.30
Rate for Payer: Qualcare PPO/HMO/WC	$112.30

SPLINT THUMB/WRIST L L

Facility

$72.00

Hospital Charge Code	270665595
Hospital Revenue Code	270
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

SPLINT THUMB/WRIST L L

Facility

$72.00

Hospital Charge Code	270665595
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

SPLINT THUMB/WRIST L M

Facility

$72.00

Hospital Charge Code	270665594
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

SPLINT THUMB/WRIST L M

Facility

$72.00

Hospital Charge Code	270665594
Hospital Revenue Code	270
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

SPLINT/THUMB WRIST L S

Facility

$69.75

Hospital Charge Code	270665593
Hospital Revenue Code	270
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$10.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.46

SPLINT/THUMB WRIST L S

Facility

$69.75

Hospital Charge Code	270665593
Hospital Revenue Code	270
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$34.88
Rate for Payer: Aetna Commercial	$20.93
Rate for Payer: Aetna Medicare Advantage	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.79
Rate for Payer: Cigna Commercial	$34.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.07
Rate for Payer: Oxford Commercial	$34.88
Rate for Payer: Qualcare PPO/HMO/WC	$10.46
Rate for Payer: UnitedHealthcare Commercial	$34.88

SPLINT THUMB/WRIST R L

Facility

$72.00

Hospital Charge Code	270665598
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

SPLINT THUMB/WRIST R L

Facility

$72.00

Hospital Charge Code	270665598
Hospital Revenue Code	270
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

SPLINT THUMB/WRIST R M

Facility

$72.00

Hospital Charge Code	270665596
Hospital Revenue Code	270
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

SPLINT THUMB/WRIST R M

Facility

$72.00

Hospital Charge Code	270665596
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

Splint Thumb Wrist Rt sm 70313

Facility

$72.00

Hospital Charge Code	270665606
Hospital Revenue Code	270
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

Splint Thumb Wrist Rt sm 70313

Facility

$72.00

Hospital Charge Code	270665606
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

Know your out-of-pocket cost for care.

All Charges