Madison Medical Center

All Charges

Charge

Type

Setting

Price

HYDRALAZINE 100MG TAB EMP

Facility

$20.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2623915
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

HYDRALAZINE 100MG TAB EMP

Facility

$20.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2623915
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

HYDRALAZINE 20MG/ML INJ

Facility

$93.00

Service Code	HCPCS J0360
Hospital Charge Code	2655195
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

HYDRALAZINE 20MG/ML INJ

Facility

$93.00

Service Code	HCPCS J0360
Hospital Charge Code	2655195
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

HYDRALAZINE 25MG TAB UD

Facility

$20.00

Service Code	NDC 904644161
Hospital Charge Code	2655186
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

HYDRALAZINE 25MG TAB UD

Facility

$20.00

Service Code	NDC 904644161
Hospital Charge Code	2655186
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

HYDRALAZINE 50MG TAB EMP

Facility

$20.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2625131
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

HYDRALAZINE 50MG TAB EMP

Facility

$20.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2625131
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

HYDRALAZINE (APRESOLINE) 10MG TAB

Facility

$20.00

Service Code	NDC 904644061
Hospital Charge Code	2655185
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

HYDRALAZINE (APRESOLINE) 10MG TAB

Facility

$20.00

Service Code	NDC 904644061
Hospital Charge Code	2655185
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

HYDROACTIVE GEL

Facility

$45.00

Hospital Charge Code	288273
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

HYDROACTIVE GEL

Facility

$45.00

Hospital Charge Code	288273
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

HYDROCHLOROTHIAZIDE 12.5MG TAB EMP

Facility

$16.00

Service Code	NDC 228282011
Hospital Charge Code	2623441
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

HYDROCHLOROTHIAZIDE 12.5MG TAB EMP

Facility

$16.00

Service Code	NDC 228282011
Hospital Charge Code	2623441
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

HYDROCHLOROTHIAZIDE 25MG TAB EMP

Facility

$15.00

Service Code	NDC 172208360
Hospital Charge Code	2697210
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

HYDROCHLOROTHIAZIDE 25MG TAB EMP

Facility

$15.00

Service Code	NDC 172208360
Hospital Charge Code	2697210
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

HYDROCHLOROTHIAZIDE 25MG TAB HE

Facility

$93.00

Service Code	NDC 172208360
Hospital Charge Code	2625812
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

HYDROCHLOROTHIAZIDE 25MG TAB HE

Facility

$93.00

Service Code	NDC 172208360
Hospital Charge Code	2625812
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

HYDROCHLOROTHIAZIDE 50MG TAB EMP

Facility

$13.00

Service Code	NDC 172208960
Hospital Charge Code	2619921
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

HYDROCHLOROTHIAZIDE 50MG TAB EMP

Facility

$13.00

Service Code	NDC 172208960
Hospital Charge Code	2619921
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

HYDROCHLOROTHIAZIDE (ORETIC) 25MG TAB UD

Facility

$93.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2655205
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

HYDROCHLOROTHIAZIDE (ORETIC) 25MG TAB UD

Facility

$93.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2655205
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

HYDROCHLORTHIAZIDE 12.5MG CAP

Facility

$16.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2626517
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

HYDROCHLORTHIAZIDE 12.5MG CAP

Facility

$16.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2626517
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

HYDROCLORTHIAZIDE 12.5MG CAP EMP

Facility

$16.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2625421
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

Know your out-of-pocket cost for care.

All Charges