Heights University Hospital

All Charges

Charge

Type

Setting

Price

ESOPHAGEAL DILATION****

Facility

$270.00

Service Code	HCPCS 43450
Hospital Charge Code	1001130
Hospital Revenue Code	361
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ESOPHAGEAL MOTILITY STUDIES***

Facility

$829.40

Service Code	HCPCS 91010
Hospital Charge Code	2300739
Hospital Revenue Code	759
Min. Negotiated Rate	$107.82
Max. Negotiated Rate	$1,394.95
Rate for Payer: Aetna Commercial	$248.82
Rate for Payer: Aetna Medicare Advantage	$248.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,394.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.50
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.82
Rate for Payer: Qualcare PPO/HMO/WC	$124.41

ESOPHAGEAL MOTILITY STUDIES***

Facility

$829.40

Service Code	HCPCS 91010
Hospital Charge Code	2300739
Hospital Revenue Code	759
Min. Negotiated Rate	$124.41
Max. Negotiated Rate	$124.41
Rate for Payer: Qualcare PPO/HMO/WC	$124.41

ESOPHAGEAL OBTURATOR*****

Facility

$126.00

Hospital Charge Code	8000630
Hospital Revenue Code	279
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$37.80
Rate for Payer: Aetna Medicare Advantage	$37.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.38
Rate for Payer: Oxford Commercial	$63.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$63.00

ESOPHAGEAL OBTURATOR*****

Facility

$126.00

Hospital Charge Code	8000630
Hospital Revenue Code	279
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

ESOPHAGEAL WALL STENT

Facility

$590.00

Hospital Charge Code	270335511
Hospital Revenue Code	278
Min. Negotiated Rate	$88.50
Max. Negotiated Rate	$295.00
Rate for Payer: Aetna Commercial	$177.00
Rate for Payer: Aetna Medicare Advantage	$177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.45
Rate for Payer: Cigna Commercial	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.78
Rate for Payer: Qualcare PPO/HMO/WC	$88.50

ESOPHAGEAL WALL STENT

Facility

$590.00

Hospital Charge Code	270335511
Hospital Revenue Code	278
Min. Negotiated Rate	$88.50
Max. Negotiated Rate	$142.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.78
Rate for Payer: Qualcare PPO/HMO/WC	$88.50

ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC

Facility

$48,635.58

Service Code	MSDRG 391
Min. Negotiated Rate	$13,840.43
Max. Negotiated Rate	$48,635.58
Rate for Payer: Aetna Commercial	$42,766.93
Rate for Payer: Aetna Medicare Advantage	$13,840.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,285.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,285.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,211.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,285.76
Rate for Payer: Cigna Commercial	$27,295.08
Rate for Payer: Cigna Medicare Advantage	$16,211.86
Rate for Payer: Clover Medicare Advantage	$15,401.27
Rate for Payer: EmblemHealth Commercial	$48,635.58
Rate for Payer: Humana Medicare Advantage	$16,698.22
Rate for Payer: Oxford Commercial	$17,058.63
Rate for Payer: UnitedHealthcare Commercial	$19,363.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,211.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17,184.57
Rate for Payer: Wellcare Medicare Advantage	$16,211.86

ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC

Facility

$34,450.68

Service Code	MSDRG 392
Min. Negotiated Rate	$8,507.45
Max. Negotiated Rate	$34,450.68
Rate for Payer: Aetna Commercial	$26,288.02
Rate for Payer: Aetna Medicare Advantage	$8,507.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,777.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,777.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,483.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,777.93
Rate for Payer: Cigna Commercial	$16,777.77
Rate for Payer: Cigna Medicare Advantage	$11,483.56
Rate for Payer: Clover Medicare Advantage	$10,909.38
Rate for Payer: EmblemHealth Commercial	$34,450.68
Rate for Payer: Humana Medicare Advantage	$11,828.07
Rate for Payer: Oxford Commercial	$10,485.62
Rate for Payer: UnitedHealthcare Commercial	$11,902.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,483.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12,172.57
Rate for Payer: Wellcare Medicare Advantage	$11,483.56

ESOPHAGOGASTRDUODSPY W/POLYPEC

Facility

$816.00

Hospital Charge Code	2300143
Hospital Revenue Code	759
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$244.80
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.08
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

ESOPHAGOGASTRDUODSPY W/POLYPEC

Facility

$816.00

Hospital Charge Code	2300143
Hospital Revenue Code	759
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$122.40
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

ESOPHAGOGASTRODUODENOSCOPY***

Facility

$286.00

Hospital Charge Code	2300101
Hospital Revenue Code	759
Min. Negotiated Rate	$37.18
Max. Negotiated Rate	$143.00
Rate for Payer: Aetna Commercial	$85.80
Rate for Payer: Aetna Medicare Advantage	$85.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.93
Rate for Payer: Cigna Commercial	$143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.18
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

ESOPHAGOGASTRODUODENOSCOPY***

Facility

$286.00

Hospital Charge Code	2300101
Hospital Revenue Code	759
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$3,687.00

Service Code	CPT 43235
Hospital Revenue Code	750
Min. Negotiated Rate	$173.65
Max. Negotiated Rate	$3,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$173.65
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BAND LIGATION OF ESOPHAGEAL/GASTRIC VARICES

Facility

$4,569.67

Service Code	CPT 43244
Hospital Revenue Code	750
Min. Negotiated Rate	$173.65
Max. Negotiated Rate	$4,569.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$173.65
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$3,687.00

Service Code	CPT 43239
Hospital Revenue Code	750
Min. Negotiated Rate	$230.64
Max. Negotiated Rate	$3,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.64
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD

Facility

$4,569.67

Service Code	CPT 43255
Hospital Revenue Code	750
Min. Negotiated Rate	$187.45
Max. Negotiated Rate	$4,569.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.45
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF GASTRIC/DUODENAL STRICTURE(S) (EG, BALLOON, BOUGIE)

Facility

$4,569.67

Service Code	CPT 43245
Hospital Revenue Code	750
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$4,569.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE

Facility

$4,829.61

Service Code	CPT 43246
Hospital Revenue Code	750
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$4,829.61
Rate for Payer: Aetna Better Health Medicaid	$4,734.91
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,829.61

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE

Facility

$3,687.00

Service Code	CPT 43236
Hospital Revenue Code	750
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Better Health Medicaid	$2,482.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$161.00
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,531.95

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)

Facility

$3,687.00

Service Code	CPT 43247
Hospital Revenue Code	750
Min. Negotiated Rate	$173.65
Max. Negotiated Rate	$3,687.00
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$173.65
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$4,569.67

Service Code	CPT 43251
Hospital Revenue Code	750
Min. Negotiated Rate	$173.65
Max. Negotiated Rate	$4,569.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$173.65
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)

Facility

$4,829.61

Service Code	CPT 43249
Hospital Revenue Code	750
Min. Negotiated Rate	$151.80
Max. Negotiated Rate	$4,829.61
Rate for Payer: Aetna Better Health Medicaid	$4,734.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.80
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,829.61

ESOPHAGOGASTROENTEROSCOPY***

Facility

$340.00

Hospital Charge Code	2300168
Hospital Revenue Code	759
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

ESOPHAGOGASTROENTEROSCOPY***

Facility

$340.00

Hospital Charge Code	2300168
Hospital Revenue Code	759
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$102.00
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.20
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

Know your out-of-pocket cost for care.

All Charges