Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760W
Hospital Revenue Code	270
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$196.25
Rate for Payer: Aetna Commercial	$149.15
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	$102.05
Rate for Payer: Oxford Commercial	$78.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.88
Rate for Payer: UnitedHealthcare Commercial	$78.50
Rate for Payer: UnitedHealthcare Community & State	$12.40
Rate for Payer: Wellpoint Medicaid Managed Care	$11.15

SPLINTINGFABRICATION INI 15 MI

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008355
Hospital Revenue Code	430
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$169.48
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	$69.00
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	$115.96
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$14.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

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

SPLINT MED-LG 10.5 LT 1155535

Facility

$58.60

Hospital Charge Code	270642163
Hospital Revenue Code	272
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$29.30
Rate for Payer: Aetna Commercial	$22.27
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	$15.24
Rate for Payer: Oxford Commercial	$11.72
Rate for Payer: Qualcare PPO/HMO/WC	$8.79
Rate for Payer: UnitedHealthcare Commercial	$11.72
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

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 8 LEFT 1155335

Facility

$49.40

Hospital Charge Code	270642161
Hospital Revenue Code	272
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$18.77
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	$12.84
Rate for Payer: Oxford Commercial	$9.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.41
Rate for Payer: UnitedHealthcare Commercial	$9.88
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

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 MEDT DOYLE NASL 1524050

Facility

$278.00

Hospital Charge Code	270627434
Hospital Revenue Code	272
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$139.00
Rate for Payer: Aetna Commercial	$105.64
Rate for Payer: Aetna Medicare Advantage	$83.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.89
Rate for Payer: Cigna Commercial	$139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.28
Rate for Payer: Oxford Commercial	$55.60
Rate for Payer: Qualcare PPO/HMO/WC	$41.70
Rate for Payer: UnitedHealthcare Commercial	$55.60
Rate for Payer: UnitedHealthcare Community & State	$8.78
Rate for Payer: Wellpoint Medicaid Managed Care	$7.90

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

SPLINT METACARPAL L ADULT

Facility

$86.75

Hospital Charge Code	270610011
Hospital Revenue Code	270
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$43.38
Rate for Payer: Aetna Commercial	$32.97
Rate for Payer: Aetna Medicare Advantage	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.12
Rate for Payer: Cigna Commercial	$43.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.55
Rate for Payer: Oxford Commercial	$17.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.01
Rate for Payer: UnitedHealthcare Commercial	$17.35
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2.46

SPLINT METACARPAL L ADULT

Facility

$86.75

Hospital Charge Code	270610011
Hospital Revenue Code	270
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$13.01
Rate for Payer: Qualcare PPO/HMO/WC	$13.01

SPLINT METACARPAL LEFT MEDIUM

Facility

$22.05

Hospital Charge Code	270653987
Hospital Revenue Code	272
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.31

SPLINT METACARPAL LEFT MEDIUM

Facility

$22.05

Hospital Charge Code	270653987
Hospital Revenue Code	272
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$11.03
Rate for Payer: Aetna Commercial	$8.38
Rate for Payer: Aetna Medicare Advantage	$6.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.62
Rate for Payer: Cigna Commercial	$11.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.73
Rate for Payer: Oxford Commercial	$4.41
Rate for Payer: Qualcare PPO/HMO/WC	$3.31
Rate for Payer: UnitedHealthcare Commercial	$4.41
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

SPLINT METACARPAL PADDED SM LT

Facility

$27.30

Hospital Charge Code	270676701
Hospital Revenue Code	270
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

SPLINT METACARPAL PADDED SM LT

Facility

$27.30

Hospital Charge Code	270676701
Hospital Revenue Code	270
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.65
Rate for Payer: Aetna Commercial	$10.37
Rate for Payer: Aetna Medicare Advantage	$8.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.96
Rate for Payer: Cigna Commercial	$13.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.10
Rate for Payer: Oxford Commercial	$5.46
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$5.46
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

SPLINT METACARPAL RIGHT LARGE

Facility

$28.15

Hospital Charge Code	270653990
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.22

SPLINT METACARPAL RIGHT LARGE

Facility

$28.15

Hospital Charge Code	270653990
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.07
Rate for Payer: Aetna Commercial	$10.70
Rate for Payer: Aetna Medicare Advantage	$8.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.18
Rate for Payer: Cigna Commercial	$14.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.32
Rate for Payer: Oxford Commercial	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.22
Rate for Payer: UnitedHealthcare Commercial	$5.63
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

SPLINT METACARPAL RIGHT MEDIUM

Facility

$28.15

Hospital Charge Code	270653989
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.07
Rate for Payer: Aetna Commercial	$10.70
Rate for Payer: Aetna Medicare Advantage	$8.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.18
Rate for Payer: Cigna Commercial	$14.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.32
Rate for Payer: Oxford Commercial	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.22
Rate for Payer: UnitedHealthcare Commercial	$5.63
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

SPLINT METACARPAL RIGHT MEDIUM

Facility

$28.15

Hospital Charge Code	270653989
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.22

SPLINT NASAL DOYLE

Facility

$225.00

Hospital Charge Code	270649759
Hospital Revenue Code	272
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

SPLINT NASAL DOYLE

Facility

$225.00

Hospital Charge Code	270649759
Hospital Revenue Code	272
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

SPLINT NASAL DOYLE II

Facility

$157.50

Hospital Charge Code	270649760
Hospital Revenue Code	272
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$23.62

SPLINT NASAL DOYLE II

Facility

$157.50

Hospital Charge Code	270649760
Hospital Revenue Code	272
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Commercial	$59.85
Rate for Payer: Aetna Medicare Advantage	$47.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.16
Rate for Payer: Cigna Commercial	$78.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.95
Rate for Payer: Oxford Commercial	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.62
Rate for Payer: UnitedHealthcare Commercial	$31.50
Rate for Payer: UnitedHealthcare Community & State	$4.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.47

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 2 X 15

Facility

$173.15

Hospital Charge Code	270651777
Hospital Revenue Code	270
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$86.58
Rate for Payer: Aetna Commercial	$65.80
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	$45.02
Rate for Payer: Oxford Commercial	$34.63
Rate for Payer: Qualcare PPO/HMO/WC	$25.97
Rate for Payer: UnitedHealthcare Commercial	$34.63
Rate for Payer: UnitedHealthcare Community & State	$5.47
Rate for Payer: Wellpoint Medicaid Managed Care	$4.92

Know your out-of-pocket cost for care.

All Charges