Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDRALAZINE 10 MG TABLET

Facility

$345.45

Service Code	NDC 68084044711
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$217.63
Max. Negotiated Rate	$310.90
Rate for Payer: Aetna Commercial	$293.63
Rate for Payer: Aetna New Business (MI Preferred)	$224.54
Rate for Payer: Cash Price	$276.36
Rate for Payer: Cofinity Commercial	$241.81
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.81
Rate for Payer: Encore Health Key Benefits Commercial	$276.36
Rate for Payer: Healthscope Commercial	$310.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.63
Rate for Payer: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

HYDRALAZINE 10 MG TABLET

Facility

$3.93

Service Code	NDC 51079007401
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.54
Rate for Payer: Aetna Commercial	$3.34
Rate for Payer: Aetna New Business (MI Preferred)	$2.55
Rate for Payer: Cash Price	$3.14
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Cofinity Commercial	$3.38
Rate for Payer: Cofinity Medicare Advantage	$2.75
Rate for Payer: Encore Health Key Benefits Commercial	$3.14
Rate for Payer: Healthscope Commercial	$3.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.34
Rate for Payer: PHP Commercial	$3.34
Rate for Payer: Priority Health Cigna Priority Health	$2.55
Rate for Payer: Priority Health SBD	$2.48

HYDRALAZINE 10 MG TABLET

Facility

$3.93

Service Code	NDC 51079007401
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.54
Rate for Payer: Aetna Commercial	$3.34
Rate for Payer: Aetna Medicare	$1.97
Rate for Payer: Aetna New Business (MI Preferred)	$2.55
Rate for Payer: BCBS Complete	$1.57
Rate for Payer: Cash Price	$3.14
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Cofinity Commercial	$3.38
Rate for Payer: Cofinity Medicare Advantage	$2.75
Rate for Payer: Encore Health Key Benefits Commercial	$3.14
Rate for Payer: Healthscope Commercial	$3.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.34
Rate for Payer: PHP Commercial	$3.34
Rate for Payer: Priority Health Cigna Priority Health	$2.55
Rate for Payer: Priority Health SBD	$2.48

HYDRALAZINE 20 MG/ML INJECTION SOLUTION

Facility

$27.36

Service Code	HCPCS J0360
Hospital Charge Code	3697
Hospital Revenue Code	636
Min. Negotiated Rate	$17.24
Max. Negotiated Rate	$24.62
Rate for Payer: Aetna Commercial	$23.26
Rate for Payer: Aetna Commercial	$19.78
Rate for Payer: Aetna Commercial	$149.10
Rate for Payer: Aetna Commercial	$31.60
Rate for Payer: Aetna New Business (MI Preferred)	$114.02
Rate for Payer: Aetna New Business (MI Preferred)	$24.17
Rate for Payer: Aetna New Business (MI Preferred)	$15.13
Rate for Payer: Aetna New Business (MI Preferred)	$17.78
Rate for Payer: Cash Price	$21.89
Rate for Payer: Cash Price	$140.33
Rate for Payer: Cash Price	$29.74
Rate for Payer: Cash Price	$18.62
Rate for Payer: Cofinity Commercial	$26.03
Rate for Payer: Cofinity Commercial	$31.97
Rate for Payer: Cofinity Commercial	$122.79
Rate for Payer: Cofinity Commercial	$16.29
Rate for Payer: Cofinity Commercial	$20.01
Rate for Payer: Cofinity Commercial	$150.85
Rate for Payer: Cofinity Commercial	$19.15
Rate for Payer: Cofinity Commercial	$23.53
Rate for Payer: Cofinity Medicare Advantage	$16.29
Rate for Payer: Cofinity Medicare Advantage	$122.79
Rate for Payer: Cofinity Medicare Advantage	$19.15
Rate for Payer: Cofinity Medicare Advantage	$26.03
Rate for Payer: Encore Health Key Benefits Commercial	$140.33
Rate for Payer: Encore Health Key Benefits Commercial	$21.89
Rate for Payer: Encore Health Key Benefits Commercial	$29.74
Rate for Payer: Encore Health Key Benefits Commercial	$18.62
Rate for Payer: Healthscope Commercial	$157.87
Rate for Payer: Healthscope Commercial	$33.46
Rate for Payer: Healthscope Commercial	$24.62
Rate for Payer: Healthscope Commercial	$20.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$149.10
Rate for Payer: PHP Commercial	$19.78
Rate for Payer: PHP Commercial	$23.26
Rate for Payer: PHP Commercial	$31.60
Rate for Payer: PHP Commercial	$149.10
Rate for Payer: Priority Health Cigna Priority Health	$114.02
Rate for Payer: Priority Health Cigna Priority Health	$24.17
Rate for Payer: Priority Health Cigna Priority Health	$17.78
Rate for Payer: Priority Health Cigna Priority Health	$15.13
Rate for Payer: Priority Health SBD	$17.24
Rate for Payer: Priority Health SBD	$110.51
Rate for Payer: Priority Health SBD	$14.66
Rate for Payer: Priority Health SBD	$23.42

HYDRALAZINE 20 MG/ML INJECTION SOLUTION

Facility

$27.36

Service Code	HCPCS J0360
Hospital Charge Code	3697
Hospital Revenue Code	636
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$24.62
Rate for Payer: Aetna Commercial	$23.26
Rate for Payer: Aetna Commercial	$19.78
Rate for Payer: Aetna Commercial	$31.60
Rate for Payer: Aetna Commercial	$149.10
Rate for Payer: Aetna Medicare	$18.59
Rate for Payer: Aetna Medicare	$13.68
Rate for Payer: Aetna Medicare	$11.63
Rate for Payer: Aetna Medicare	$87.70
Rate for Payer: Aetna New Business (MI Preferred)	$17.78
Rate for Payer: Aetna New Business (MI Preferred)	$114.02
Rate for Payer: Aetna New Business (MI Preferred)	$15.13
Rate for Payer: Aetna New Business (MI Preferred)	$24.17
Rate for Payer: BCBS Complete	$70.16
Rate for Payer: BCBS Complete	$14.87
Rate for Payer: BCBS Complete	$9.31
Rate for Payer: BCBS Complete	$10.94
Rate for Payer: Cash Price	$29.74
Rate for Payer: Cash Price	$18.62
Rate for Payer: Cash Price	$21.89
Rate for Payer: Cash Price	$140.33
Rate for Payer: Cofinity Commercial	$20.01
Rate for Payer: Cofinity Commercial	$31.97
Rate for Payer: Cofinity Commercial	$19.15
Rate for Payer: Cofinity Commercial	$26.03
Rate for Payer: Cofinity Commercial	$23.53
Rate for Payer: Cofinity Commercial	$122.79
Rate for Payer: Cofinity Commercial	$150.85
Rate for Payer: Cofinity Commercial	$16.29
Rate for Payer: Cofinity Medicare Advantage	$19.15
Rate for Payer: Cofinity Medicare Advantage	$122.79
Rate for Payer: Cofinity Medicare Advantage	$16.29
Rate for Payer: Cofinity Medicare Advantage	$26.03
Rate for Payer: Encore Health Key Benefits Commercial	$21.89
Rate for Payer: Encore Health Key Benefits Commercial	$29.74
Rate for Payer: Encore Health Key Benefits Commercial	$140.33
Rate for Payer: Encore Health Key Benefits Commercial	$18.62
Rate for Payer: Healthscope Commercial	$157.87
Rate for Payer: Healthscope Commercial	$33.46
Rate for Payer: Healthscope Commercial	$20.94
Rate for Payer: Healthscope Commercial	$24.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$149.10
Rate for Payer: PHP Commercial	$19.78
Rate for Payer: PHP Commercial	$31.60
Rate for Payer: PHP Commercial	$23.26
Rate for Payer: PHP Commercial	$149.10
Rate for Payer: Priority Health Cigna Priority Health	$15.13
Rate for Payer: Priority Health Cigna Priority Health	$17.78
Rate for Payer: Priority Health Cigna Priority Health	$114.02
Rate for Payer: Priority Health Cigna Priority Health	$24.17
Rate for Payer: Priority Health SBD	$110.51
Rate for Payer: Priority Health SBD	$17.24
Rate for Payer: Priority Health SBD	$14.66
Rate for Payer: Priority Health SBD	$23.42

HYDRALAZINE 25 MG TABLET

Facility

$258.50

Service Code	NDC 00904644161
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$162.85
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$219.72
Rate for Payer: Aetna New Business (MI Preferred)	$168.03
Rate for Payer: Cash Price	$206.80
Rate for Payer: Cofinity Commercial	$180.95
Rate for Payer: Cofinity Commercial	$222.31
Rate for Payer: Cofinity Medicare Advantage	$180.95
Rate for Payer: Encore Health Key Benefits Commercial	$206.80
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.72
Rate for Payer: PHP Commercial	$219.72
Rate for Payer: Priority Health Cigna Priority Health	$168.03
Rate for Payer: Priority Health SBD	$162.85

HYDRALAZINE 25 MG TABLET

Facility

$258.50

Service Code	NDC 00904644161
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$219.72
Rate for Payer: Aetna Medicare	$129.25
Rate for Payer: Aetna New Business (MI Preferred)	$168.03
Rate for Payer: BCBS Complete	$103.40
Rate for Payer: Cash Price	$206.80
Rate for Payer: Cofinity Commercial	$180.95
Rate for Payer: Cofinity Commercial	$222.31
Rate for Payer: Cofinity Medicare Advantage	$180.95
Rate for Payer: Encore Health Key Benefits Commercial	$206.80
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.72
Rate for Payer: PHP Commercial	$219.72
Rate for Payer: Priority Health Cigna Priority Health	$168.03
Rate for Payer: Priority Health SBD	$162.85

HYDRALAZINE 25 MG TABLET

Facility

$4.26

Service Code	NDC 51079007501
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna Medicare	$2.13
Rate for Payer: Aetna New Business (MI Preferred)	$2.77
Rate for Payer: BCBS Complete	$1.70
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cofinity Commercial	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Cofinity Medicare Advantage	$2.98
Rate for Payer: Encore Health Key Benefits Commercial	$3.41
Rate for Payer: Healthscope Commercial	$3.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.62
Rate for Payer: PHP Commercial	$3.62
Rate for Payer: Priority Health Cigna Priority Health	$2.77
Rate for Payer: Priority Health SBD	$2.68

HYDRALAZINE 25 MG TABLET

Facility

$82.25

Service Code	NDC 23155083301
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$74.03
Rate for Payer: Aetna Commercial	$69.91
Rate for Payer: Aetna Medicare	$41.12
Rate for Payer: Aetna New Business (MI Preferred)	$53.46
Rate for Payer: BCBS Complete	$32.90
Rate for Payer: Cash Price	$65.80
Rate for Payer: Cofinity Commercial	$57.58
Rate for Payer: Cofinity Commercial	$70.73
Rate for Payer: Cofinity Medicare Advantage	$57.58
Rate for Payer: Encore Health Key Benefits Commercial	$65.80
Rate for Payer: Healthscope Commercial	$74.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.91
Rate for Payer: PHP Commercial	$69.91
Rate for Payer: Priority Health Cigna Priority Health	$53.46
Rate for Payer: Priority Health SBD	$51.82

HYDRALAZINE 25 MG TABLET

Facility

$4.26

Service Code	NDC 51079007501
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna New Business (MI Preferred)	$2.77
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cofinity Commercial	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Cofinity Medicare Advantage	$2.98
Rate for Payer: Encore Health Key Benefits Commercial	$3.41
Rate for Payer: Healthscope Commercial	$3.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.62
Rate for Payer: PHP Commercial	$3.62
Rate for Payer: Priority Health Cigna Priority Health	$2.77
Rate for Payer: Priority Health SBD	$2.68

HYDRALAZINE 25 MG TABLET

Facility

$82.25

Service Code	NDC 23155083301
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$51.82
Max. Negotiated Rate	$74.03
Rate for Payer: Aetna Commercial	$69.91
Rate for Payer: Aetna New Business (MI Preferred)	$53.46
Rate for Payer: Cash Price	$65.80
Rate for Payer: Cofinity Commercial	$57.58
Rate for Payer: Cofinity Commercial	$70.73
Rate for Payer: Cofinity Medicare Advantage	$57.58
Rate for Payer: Encore Health Key Benefits Commercial	$65.80
Rate for Payer: Healthscope Commercial	$74.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.91
Rate for Payer: PHP Commercial	$69.91
Rate for Payer: Priority Health Cigna Priority Health	$53.46
Rate for Payer: Priority Health SBD	$51.82

HYDRALAZINE 50 MG TABLET

Facility

$244.15

Service Code	NDC 51079007620
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$97.66
Max. Negotiated Rate	$219.74
Rate for Payer: Aetna Commercial	$207.53
Rate for Payer: Aetna Medicare	$122.08
Rate for Payer: Aetna New Business (MI Preferred)	$158.70
Rate for Payer: BCBS Complete	$97.66
Rate for Payer: Cash Price	$195.32
Rate for Payer: Cofinity Commercial	$170.91
Rate for Payer: Cofinity Commercial	$209.97
Rate for Payer: Cofinity Medicare Advantage	$170.91
Rate for Payer: Encore Health Key Benefits Commercial	$195.32
Rate for Payer: Healthscope Commercial	$219.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.53
Rate for Payer: PHP Commercial	$207.53
Rate for Payer: Priority Health Cigna Priority Health	$158.70
Rate for Payer: Priority Health SBD	$153.81

HYDRALAZINE 50 MG TABLET

Facility

$2.45

Service Code	NDC 51079007601
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$2.08
Rate for Payer: Aetna Medicare	$1.23
Rate for Payer: Aetna New Business (MI Preferred)	$1.59
Rate for Payer: BCBS Complete	$0.98
Rate for Payer: Cash Price	$1.96
Rate for Payer: Cofinity Commercial	$1.72
Rate for Payer: Cofinity Commercial	$2.11
Rate for Payer: Cofinity Medicare Advantage	$1.72
Rate for Payer: Encore Health Key Benefits Commercial	$1.96
Rate for Payer: Healthscope Commercial	$2.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.08
Rate for Payer: PHP Commercial	$2.08
Rate for Payer: Priority Health Cigna Priority Health	$1.59
Rate for Payer: Priority Health SBD	$1.54

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584073401
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$80.18
Max. Negotiated Rate	$180.41
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna Medicare	$100.22
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: BCBS Complete	$80.18
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.31
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Cofinity Medicare Advantage	$140.31
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$130.29
Rate for Payer: Priority Health SBD	$126.28

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584073401
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.41
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.31
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Cofinity Medicare Advantage	$140.31
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$130.29
Rate for Payer: Priority Health SBD	$126.28

HYDRALAZINE 50 MG TABLET

Facility

$2.45

Service Code	NDC 51079007601
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$2.08
Rate for Payer: Aetna New Business (MI Preferred)	$1.59
Rate for Payer: Cash Price	$1.96
Rate for Payer: Cofinity Commercial	$1.72
Rate for Payer: Cofinity Commercial	$2.11
Rate for Payer: Cofinity Medicare Advantage	$1.72
Rate for Payer: Encore Health Key Benefits Commercial	$1.96
Rate for Payer: Healthscope Commercial	$2.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.08
Rate for Payer: PHP Commercial	$2.08
Rate for Payer: Priority Health Cigna Priority Health	$1.59
Rate for Payer: Priority Health SBD	$1.54

HYDRALAZINE 50 MG TABLET

Facility

$218.55

Service Code	NDC 00904644261
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Commercial	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Cofinity Medicare Advantage	$152.99
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$142.06
Rate for Payer: Priority Health SBD	$137.69

HYDRALAZINE 50 MG TABLET

Facility

$218.55

Service Code	NDC 00904644261
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$87.42
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna Medicare	$109.28
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: BCBS Complete	$87.42
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Commercial	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Cofinity Medicare Advantage	$152.99
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$142.06
Rate for Payer: Priority Health SBD	$137.69

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584073411
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.41
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.31
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Cofinity Medicare Advantage	$140.31
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$130.29
Rate for Payer: Priority Health SBD	$126.28

HYDRALAZINE 50 MG TABLET

Facility

$98.70

Service Code	NDC 23155000301
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Commercial	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Cofinity Medicare Advantage	$69.09
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health Cigna Priority Health	$64.16
Rate for Payer: Priority Health SBD	$62.18

HYDRALAZINE 50 MG TABLET

Facility

$2.65

Service Code	NDC 60687083311
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare	$1.32
Rate for Payer: Aetna New Business (MI Preferred)	$1.72
Rate for Payer: BCBS Complete	$1.06
Rate for Payer: Cash Price	$2.12
Rate for Payer: Cofinity Commercial	$1.85
Rate for Payer: Cofinity Commercial	$2.28
Rate for Payer: Cofinity Medicare Advantage	$1.85
Rate for Payer: Encore Health Key Benefits Commercial	$2.12
Rate for Payer: Healthscope Commercial	$2.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.25
Rate for Payer: PHP Commercial	$2.25
Rate for Payer: Priority Health Cigna Priority Health	$1.72
Rate for Payer: Priority Health SBD	$1.67

HYDRALAZINE 50 MG TABLET

Facility

$98.70

Service Code	NDC 23155000301
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna Medicare	$49.35
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: BCBS Complete	$39.48
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Commercial	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Cofinity Medicare Advantage	$69.09
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health Cigna Priority Health	$64.16
Rate for Payer: Priority Health SBD	$62.18

HYDRALAZINE 50 MG TABLET

Facility

$264.10

Service Code	NDC 60687083301
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$166.38
Max. Negotiated Rate	$237.69
Rate for Payer: Aetna Commercial	$224.49
Rate for Payer: Aetna New Business (MI Preferred)	$171.66
Rate for Payer: Cash Price	$211.28
Rate for Payer: Cofinity Commercial	$184.87
Rate for Payer: Cofinity Commercial	$227.13
Rate for Payer: Cofinity Medicare Advantage	$184.87
Rate for Payer: Encore Health Key Benefits Commercial	$211.28
Rate for Payer: Healthscope Commercial	$237.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$224.49
Rate for Payer: PHP Commercial	$224.49
Rate for Payer: Priority Health Cigna Priority Health	$171.66
Rate for Payer: Priority Health SBD	$166.38

HYDRALAZINE 50 MG TABLET

Facility

$264.10

Service Code	NDC 60687083301
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$105.64
Max. Negotiated Rate	$237.69
Rate for Payer: Aetna Commercial	$224.49
Rate for Payer: Aetna Medicare	$132.05
Rate for Payer: Aetna New Business (MI Preferred)	$171.66
Rate for Payer: BCBS Complete	$105.64
Rate for Payer: Cash Price	$211.28
Rate for Payer: Cofinity Commercial	$184.87
Rate for Payer: Cofinity Commercial	$227.13
Rate for Payer: Cofinity Medicare Advantage	$184.87
Rate for Payer: Encore Health Key Benefits Commercial	$211.28
Rate for Payer: Healthscope Commercial	$237.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$224.49
Rate for Payer: PHP Commercial	$224.49
Rate for Payer: Priority Health Cigna Priority Health	$171.66
Rate for Payer: Priority Health SBD	$166.38

HYDRALAZINE 50 MG TABLET

Facility

$2.65

Service Code	NDC 60687083311
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna New Business (MI Preferred)	$1.72
Rate for Payer: Cash Price	$2.12
Rate for Payer: Cofinity Commercial	$1.85
Rate for Payer: Cofinity Commercial	$2.28
Rate for Payer: Cofinity Medicare Advantage	$1.85
Rate for Payer: Encore Health Key Benefits Commercial	$2.12
Rate for Payer: Healthscope Commercial	$2.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.25
Rate for Payer: PHP Commercial	$2.25
Rate for Payer: Priority Health Cigna Priority Health	$1.72
Rate for Payer: Priority Health SBD	$1.67

Know your out-of-pocket cost for care.

All Charges