Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT WRIST 10.5 **********

Facility

$46.00

Hospital Charge Code	8003303
Hospital Revenue Code	279
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

SPLINT WRIST 10.5 **********

Facility

$46.00

Hospital Charge Code	8003303
Hospital Revenue Code	279
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$13.80
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.98
Rate for Payer: Oxford Commercial	$23.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$23.00

SPLINT WRIST 8 ***********

Facility

$48.00

Hospital Charge Code	8003295
Hospital Revenue Code	279
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

SPLINT WRIST 8 ***********

Facility

$48.00

Hospital Charge Code	8003295
Hospital Revenue Code	279
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SPLINT WRIST COCK-UP LARGE RT

Facility

$33.00

Hospital Charge Code	270648998
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

SPLINT WRIST COCK-UP LARGE RT

Facility

$33.00

Hospital Charge Code	270648998
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SPLINT WRIST COCK-UP LG LEFT

Facility

$33.00

Hospital Charge Code	270648997
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SPLINT WRIST COCK-UP LG LEFT

Facility

$33.00

Hospital Charge Code	270648997
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

SPLINT WRIST COCK-UP MED LEFT

Facility

$33.00

Hospital Charge Code	270648999
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

SPLINT WRIST COCK-UP MED LEFT

Facility

$33.00

Hospital Charge Code	270648999
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SPLINT WRIST COCK-UP SM LEFT

Facility

$33.00

Hospital Charge Code	270649001
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SPLINT WRIST COCK-UP SM LEFT

Facility

$33.00

Hospital Charge Code	270649001
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

SPLINT WRIST COCK-UP SM RIGHT

Facility

$33.00

Hospital Charge Code	270649002
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SPLINT WRIST COCK-UP SM RIGHT

Facility

$33.00

Hospital Charge Code	270649002
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

SPLINT WRIST COCK-UP XL LEFT

Facility

$33.00

Hospital Charge Code	270648995
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SPLINT WRIST COCK-UP XL LEFT

Facility

$33.00

Hospital Charge Code	270648995
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

SPLINT WRIST COCK-UP XL RT

Facility

$33.00

Hospital Charge Code	270648996
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SPLINT WRIST COCK-UP XL RT

Facility

$33.00

Hospital Charge Code	270648996
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

SPLINT WRIST L 10 1/2

Facility

$100.85

Hospital Charge Code	270600810
Hospital Revenue Code	270
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SPLINT WRIST L 10 1/2

Facility

$100.85

Hospital Charge Code	270600810
Hospital Revenue Code	270
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.11
Rate for Payer: Oxford Commercial	$50.42
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$50.42

SPLINT WRIST L 10 1/2L

Facility

$100.85

Hospital Charge Code	270600805
Hospital Revenue Code	270
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.11
Rate for Payer: Oxford Commercial	$50.42
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$50.42

SPLINT WRIST L 10 1/2L

Facility

$100.85

Hospital Charge Code	270600805
Hospital Revenue Code	270
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SPLINT WRIST L 10 1/2 M

Facility

$100.85

Hospital Charge Code	270600808
Hospital Revenue Code	270
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SPLINT WRIST L 10 1/2 M

Facility

$100.85

Hospital Charge Code	270600808
Hospital Revenue Code	270
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.11
Rate for Payer: Oxford Commercial	$50.42
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$50.42

SPLINT WRIST L 8 LG

Facility

$47.15

Hospital Charge Code	270600800
Hospital Revenue Code	270
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$23.57
Rate for Payer: Aetna Commercial	$14.14
Rate for Payer: Aetna Medicare Advantage	$14.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.02
Rate for Payer: Cigna Commercial	$23.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.13
Rate for Payer: Oxford Commercial	$23.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.07
Rate for Payer: UnitedHealthcare Commercial	$23.57

Know your out-of-pocket cost for care.

All Charges