Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MOMA FLOW REVERSAL DEVICE

Facility

$8,000.00

Hospital Charge Code	270682752
Hospital Revenue Code	272
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,400.00
Rate for Payer: Oxford Commercial	$1,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Commercial	$1,600.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

MOMETASONE 220MCG/INH AER

Facility

$375.33

Service Code	NDC 85134101
Hospital Charge Code	60629954
Hospital Revenue Code	250
Min. Negotiated Rate	$56.30
Max. Negotiated Rate	$56.30
Rate for Payer: Qualcare PPO/HMO/WC	$56.30

MOMETASONE 220MCG/INH AER

Facility

$375.33

Service Code	NDC 85134101
Hospital Charge Code	60629954
Hospital Revenue Code	250
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$187.66
Rate for Payer: Aetna Commercial	$142.63
Rate for Payer: Aetna Medicare Advantage	$112.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.71
Rate for Payer: Cigna Commercial	$187.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.60
Rate for Payer: Oxford Commercial	$75.07
Rate for Payer: Qualcare PPO/HMO/WC	$56.30
Rate for Payer: UnitedHealthcare Commercial	$75.07
Rate for Payer: UnitedHealthcare Community & State	$9.05
Rate for Payer: Wellpoint Medicaid Managed Care	$9.95

MOMETASONE FUROATE 110MCG

Facility

$1,159.10

Service Code	NDC 85146107
Hospital Charge Code	60635779
Hospital Revenue Code	250
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$579.55
Rate for Payer: Aetna Commercial	$440.46
Rate for Payer: Aetna Medicare Advantage	$347.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.57
Rate for Payer: Cigna Commercial	$579.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.73
Rate for Payer: Oxford Commercial	$231.82
Rate for Payer: Qualcare PPO/HMO/WC	$173.87
Rate for Payer: UnitedHealthcare Commercial	$231.82
Rate for Payer: UnitedHealthcare Community & State	$27.93
Rate for Payer: Wellpoint Medicaid Managed Care	$30.72

MOMETASONE FUROATE 110MCG

Facility

$1,159.10

Service Code	NDC 85146107
Hospital Charge Code	60635779
Hospital Revenue Code	250
Min. Negotiated Rate	$173.87
Max. Negotiated Rate	$173.87
Rate for Payer: Qualcare PPO/HMO/WC	$173.87

MOMETASONE FUROATE 220MCG

Facility

$355.00

Hospital Charge Code	60635780
Hospital Revenue Code	250
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.50
Rate for Payer: Oxford Commercial	$71.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Commercial	$71.00
Rate for Payer: UnitedHealthcare Community & State	$8.56
Rate for Payer: Wellpoint Medicaid Managed Care	$9.41

MOMETASONE FUROATE 220MCG

Facility

$355.00

Hospital Charge Code	60635780
Hospital Revenue Code	250
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$53.25
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

MOMETASONE OINT 0.1%

Facility

$234.90

Hospital Charge Code	60628401
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.45
Rate for Payer: Aetna Commercial	$89.26
Rate for Payer: Aetna Medicare Advantage	$70.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.90
Rate for Payer: Cigna Commercial	$117.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.47
Rate for Payer: Oxford Commercial	$46.98
Rate for Payer: Qualcare PPO/HMO/WC	$35.23
Rate for Payer: UnitedHealthcare Commercial	$46.98
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.22

MOMETASONE OINT 0.1%

Facility

$234.90

Hospital Charge Code	60628401
Hospital Revenue Code	250
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$35.23
Rate for Payer: Qualcare PPO/HMO/WC	$35.23

MONBLK CR NEX TRAB MTL58864410

Facility

$18,897.75

Hospital Charge Code	270639087
Hospital Revenue Code	278
Min. Negotiated Rate	$455.44
Max. Negotiated Rate	$9,448.88
Rate for Payer: Aetna Commercial	$7,181.15
Rate for Payer: Aetna Medicare Advantage	$5,669.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,818.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,818.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,779.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,818.93
Rate for Payer: Cigna Commercial	$9,448.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,573.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,157.51
Rate for Payer: Qualcare PPO/HMO/WC	$2,834.66
Rate for Payer: UnitedHealthcare Community & State	$455.44
Rate for Payer: Wellpoint Medicaid Managed Care	$500.79

MONBLK CR NEX TRAB MTL58864410

Facility

$15,118.20

Hospital Charge Code	2709639087
Hospital Revenue Code	278
Min. Negotiated Rate	$364.35
Max. Negotiated Rate	$7,559.10
Rate for Payer: Aetna Commercial	$5,744.92
Rate for Payer: Aetna Medicare Advantage	$4,535.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,855.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,855.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,023.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,855.14
Rate for Payer: Cigna Commercial	$7,559.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,658.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,326.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,267.73
Rate for Payer: UnitedHealthcare Community & State	$364.35
Rate for Payer: Wellpoint Medicaid Managed Care	$400.63

MONBLK CR NEX TRAB MTL58864410

Facility

$18,897.75

Hospital Charge Code	270639087
Hospital Revenue Code	278
Min. Negotiated Rate	$2,834.66
Max. Negotiated Rate	$4,573.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,779.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,573.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,157.51
Rate for Payer: Qualcare PPO/HMO/WC	$2,834.66

MONBLK CR NEX TRAB MTL58864410

Facility

$15,118.20

Hospital Charge Code	2709639087
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.73
Max. Negotiated Rate	$3,658.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,023.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,658.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,326.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,267.73

MONILLA SMEAR***

Facility

$14.00

Hospital Charge Code	3010238
Hospital Revenue Code	306
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

MONILLA SMEAR***

Facility

$14.00

Hospital Charge Code	3010238
Hospital Revenue Code	306
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

MONISTAT 3/200MG/EACH

Facility

$127.97

Service Code	NDC 472173803
Hospital Charge Code	60633443
Hospital Revenue Code	250
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

MONISTAT 3/200MG/EACH

Facility

$127.97

Service Code	NDC 472173803
Hospital Charge Code	60633443
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$63.98
Rate for Payer: Aetna Commercial	$48.63
Rate for Payer: Aetna Medicare Advantage	$38.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.39
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

MONISTAT 7/100MG/EACH

Facility

$18.00

Hospital Charge Code	60633444
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

MONISTAT 7/100MG/EACH

Facility

$18.00

Hospital Charge Code	60633444
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

MONISTAT 7 2%/45GM

Facility

$15.00

Hospital Charge Code	60633445
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

MONISTAT 7 2%/45GM

Facility

$15.00

Hospital Charge Code	60633445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

MONISTAT-DERM 2%/30GM

Facility

$110.00

Hospital Charge Code	60633446
Hospital Revenue Code	250
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

MONISTAT-DERM 2%/30GM

Facility

$110.00

Hospital Charge Code	60633446
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

MONISTAT IV

Facility

$122.00

Hospital Charge Code	60634505
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

MONISTAT IV

Facility

$122.00

Hospital Charge Code	60634505
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

Know your out-of-pocket cost for care.

All Charges