Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$7.63
Max. Negotiated Rate	$134.40
Rate for Payer: Aetna Commercial	$102.14
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	$69.89
Rate for Payer: Oxford Commercial	$53.76
Rate for Payer: Qualcare PPO/HMO/WC	$40.32
Rate for Payer: UnitedHealthcare Commercial	$53.76
Rate for Payer: UnitedHealthcare Community & State	$8.49
Rate for Payer: Wellpoint Medicaid Managed Care	$7.63

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	$9.16
Max. Negotiated Rate	$161.28
Rate for Payer: Aetna Commercial	$122.57
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	$83.86
Rate for Payer: Oxford Commercial	$64.51
Rate for Payer: Qualcare PPO/HMO/WC	$48.38
Rate for Payer: UnitedHealthcare Commercial	$64.51
Rate for Payer: UnitedHealthcare Community & State	$10.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.16

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	$10.34
Max. Negotiated Rate	$182.05
Rate for Payer: Aetna Commercial	$138.36
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	$94.67
Rate for Payer: Oxford Commercial	$72.82
Rate for Payer: Qualcare PPO/HMO/WC	$54.62
Rate for Payer: UnitedHealthcare Commercial	$72.82
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SPLINT ORTHOGLASS PRECUT 5x30

Facility

$70.66

Hospital Charge Code	270655934
Hospital Revenue Code	271
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$35.33
Rate for Payer: Aetna Commercial	$26.85
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	$18.37
Rate for Payer: Oxford Commercial	$14.13
Rate for Payer: Qualcare PPO/HMO/WC	$10.60
Rate for Payer: UnitedHealthcare Commercial	$14.13
Rate for Payer: UnitedHealthcare Community & State	$2.23
Rate for Payer: Wellpoint Medicaid Managed Care	$2.01

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 POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345N
Hospital Revenue Code	271
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
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	$50.70
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$6.16
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345
Hospital Revenue Code	271
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
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	$50.70
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$6.16
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

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 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

SPLINT PRECUT 3x12

Facility

$14.73

Hospital Charge Code	270655933
Hospital Revenue Code	271
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna Commercial	$5.60
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	$3.83
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$2.95
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

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	$4.04
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna Commercial	$54.04
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	$36.97
Rate for Payer: Oxford Commercial	$28.44
Rate for Payer: Qualcare PPO/HMO/WC	$21.33
Rate for Payer: UnitedHealthcare Commercial	$28.44
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.04

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	$0.59
Max. Negotiated Rate	$10.44
Rate for Payer: Aetna Commercial	$7.93
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	$5.43
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$4.17
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

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 THERMOPLASTICS NASAL

Facility

$748.65

Hospital Charge Code	270688753
Hospital Revenue Code	272
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$374.32
Rate for Payer: Aetna Commercial	$284.49
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	$194.65
Rate for Payer: Oxford Commercial	$149.73
Rate for Payer: Qualcare PPO/HMO/WC	$112.30
Rate for Payer: UnitedHealthcare Commercial	$149.73
Rate for Payer: UnitedHealthcare Community & State	$23.66
Rate for Payer: Wellpoint Medicaid Managed Care	$21.26

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	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

SPLINT THUMB/WRIST L L

Facility

$72.00

Hospital Charge Code	270665595
Hospital Revenue Code	270
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
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	$18.72
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

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	$2.04
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
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	$18.72
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

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

Know your out-of-pocket cost for care.

All Charges