Heights University Hospital

All Charges

Charge

Type

Setting

Price

ENDOSCOPIC PLANTAR FASCITMY-LT

Facility

$21,064.35

Service Code	HCPCS 29893
Hospital Charge Code	16000257
Hospital Revenue Code	360
Min. Negotiated Rate	$3,159.65
Max. Negotiated Rate	$3,159.65
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.65

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PLACEMENT OF ENDOSCOPIC STENT INTO BILIARY OR PANCREATIC DUCT, INCLUDING PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED, EACH STENT

Facility

$14,457.20

Service Code	CPT 43274
Hospital Revenue Code	750
Min. Negotiated Rate	$242.56
Max. Negotiated Rate	$14,457.20
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$242.56
Rate for Payer: Cigna Commercial	$14,457.20
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF CALCULI/DEBRIS FROM BILIARY/PANCREATIC DUCT(S)

Facility

$9,181.40

Service Code	CPT 43264
Hospital Revenue Code	750
Min. Negotiated Rate	$474.95
Max. Negotiated Rate	$9,181.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.95
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY

Facility

$9,181.40

Service Code	CPT 43262
Hospital Revenue Code	750
Min. Negotiated Rate	$250.70
Max. Negotiated Rate	$9,181.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.70
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

ENDOSCOPIC US****

Facility

$350.00

Hospital Charge Code	2300905
Hospital Revenue Code	759
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ENDOSCOPIC US****

Facility

$350.00

Hospital Charge Code	2300905
Hospital Revenue Code	759
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ENDOSCOPIC US W/NDL ASPIR BX

Facility

$1,356.85

Hospital Charge Code	2300900
Hospital Revenue Code	750
Min. Negotiated Rate	$176.39
Max. Negotiated Rate	$678.42
Rate for Payer: Aetna Commercial	$407.06
Rate for Payer: Aetna Medicare Advantage	$407.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$346.00
Rate for Payer: Cigna Commercial	$678.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.39
Rate for Payer: Qualcare PPO/HMO/WC	$203.53

ENDOSCOPIC US W/NDL ASPIR BX

Facility

$1,356.85

Hospital Charge Code	2300900
Hospital Revenue Code	750
Min. Negotiated Rate	$203.53
Max. Negotiated Rate	$203.53
Rate for Payer: Qualcare PPO/HMO/WC	$203.53

ENDOSCOPIC W/ MIX TIP 5MMX30CM

Facility

$470.00

Hospital Charge Code	270670802
Hospital Revenue Code	272
Min. Negotiated Rate	$61.10
Max. Negotiated Rate	$235.00
Rate for Payer: Aetna Commercial	$141.00
Rate for Payer: Aetna Medicare Advantage	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.85
Rate for Payer: Cigna Commercial	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.10
Rate for Payer: Oxford Commercial	$235.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Commercial	$235.00

ENDOSCOPIC W/ MIX TIP 5MMX30CM

Facility

$470.00

Hospital Charge Code	270670802
Hospital Revenue Code	272
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

ENDOSCOP MULTIBAND LIGAT SET 6

Facility

$360.00

Hospital Charge Code	270700680
Hospital Revenue Code	272
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

ENDOSCOP MULTIBAND LIGAT SET 6

Facility

$360.00

Hospital Charge Code	270700680
Hospital Revenue Code	272
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$108.00
Rate for Payer: Aetna Medicare Advantage	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.80
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$180.00

ENDOSCOPY 1-2 HRS W/ > FIVE BX

Facility

$10,625.00

Hospital Charge Code	2300076
Hospital Revenue Code	750
Min. Negotiated Rate	$1,381.25
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$3,187.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,381.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

ENDOSCOPY 1-2 HRS W/ > FIVE BX

Facility

$10,625.00

Hospital Charge Code	2300076
Hospital Revenue Code	750
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$1,593.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

ENDOSCOPY 1-2 HRS WITH FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300075
Hospital Revenue Code	750
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$1,406.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

ENDOSCOPY 1-2 HRS WITH FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300075
Hospital Revenue Code	750
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$2,812.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,218.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

ENDOSCOPY 1-2 HRS WITH FOUR BX

Facility

$8,125.00

Hospital Charge Code	2300074
Hospital Revenue Code	750
Min. Negotiated Rate	$1,056.25
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$2,437.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,056.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

ENDOSCOPY 1-2 HRS WITH FOUR BX

Facility

$8,125.00

Hospital Charge Code	2300074
Hospital Revenue Code	750
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,218.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

ENDOSCOPY 1-2 HRS WITH ONE BX

Facility

$4,375.00

Hospital Charge Code	2300071
Hospital Revenue Code	750
Min. Negotiated Rate	$568.75
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ENDOSCOPY 1-2 HRS WITH ONE BX

Facility

$4,375.00

Hospital Charge Code	2300071
Hospital Revenue Code	750
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$656.25
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ENDOSCOPY 1-2 HRS WITHOUT BX

Facility

$3,125.00

Hospital Charge Code	2300070
Hospital Revenue Code	750
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$468.75
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

ENDOSCOPY 1-2 HRS WITHOUT BX

Facility

$3,125.00

Hospital Charge Code	2300070
Hospital Revenue Code	750
Min. Negotiated Rate	$406.25
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

ENDOSCOPY 1-2HRS WITH THREE BX

Facility

$6,875.00

Hospital Charge Code	2300073
Hospital Revenue Code	750
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

ENDOSCOPY 1-2HRS WITH THREE BX

Facility

$6,875.00

Hospital Charge Code	2300073
Hospital Revenue Code	750
Min. Negotiated Rate	$893.75
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,062.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$893.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

ENDOSCOPY 1-2 HRS WITH TWO BX

Facility

$5,625.00

Hospital Charge Code	2300072
Hospital Revenue Code	750
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$843.75
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

Know your out-of-pocket cost for care.

All Charges