Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

IP

$18.00

Service Code	HCPCS J0360
Hospital Charge Code	0641623125
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

OP

$18.00

Service Code	HCPCS J0360
Hospital Charge Code	0641623125
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$14.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.20
Rate for Payer: Aetna Government	$5.20
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: EmblemHealth Commercial	$9.00
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

IP

$17.18

Service Code	HCPCS J0360
Hospital Charge Code	6332361400
Hospital Revenue Code	250
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$8.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.59

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

OP

$4.20

Service Code	HCPCS J0360
Hospital Charge Code	6332361416
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.20
Rate for Payer: Aetna Government	$5.20
Rate for Payer: Brighton Health Commercial	$3.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: EmblemHealth Commercial	$2.10
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.73

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

OP

$4.20

Service Code	HCPCS J0360
Hospital Charge Code	6332361455
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.20
Rate for Payer: Aetna Government	$5.20
Rate for Payer: Brighton Health Commercial	$3.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: EmblemHealth Commercial	$2.10
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.73

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

OP

$17.18

Service Code	HCPCS J0360
Hospital Charge Code	6332361401
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$13.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.20
Rate for Payer: Aetna Government	$5.20
Rate for Payer: Brighton Health Commercial	$12.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.69
Rate for Payer: EmblemHealth Commercial	$8.59
Rate for Payer: Group Health Inc Commercial	$8.59
Rate for Payer: Group Health Inc Medicare	$6.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.59
Rate for Payer: Hamaspik Choice Inc Medicare	$8.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.17

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

IP

$17.18

Service Code	HCPCS J0360
Hospital Charge Code	6332361401
Hospital Revenue Code	250
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$8.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.59

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

OP

$3.50

Service Code	HCPCS J0360
Hospital Charge Code	6332361441
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.20
Rate for Payer: Aetna Government	$5.20
Rate for Payer: Brighton Health Commercial	$2.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.38
Rate for Payer: EmblemHealth Commercial	$1.75
Rate for Payer: Group Health Inc Commercial	$1.75
Rate for Payer: Group Health Inc Medicare	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.27

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

IP

$4.20

Service Code	HCPCS J0360
Hospital Charge Code	6332361455
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

IP

$3.50

Service Code	HCPCS J0360
Hospital Charge Code	6332361441
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.75

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

IP

$4.20

Service Code	HCPCS J0360
Hospital Charge Code	6332361416
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10

HYDRALAZINE HCL 20 MG/ML IJ SOLN

Facility

OP

$17.18

Service Code	HCPCS J0360
Hospital Charge Code	6332361400
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$13.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.20
Rate for Payer: Aetna Government	$5.20
Rate for Payer: Brighton Health Commercial	$12.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.68
Rate for Payer: EmblemHealth Commercial	$8.59
Rate for Payer: Group Health Inc Commercial	$8.59
Rate for Payer: Group Health Inc Medicare	$6.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.59
Rate for Payer: Hamaspik Choice Inc Medicare	$8.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.17

HYDRALAZINE HCL 25 MG PO TABS

Facility

OP

$0.51

Service Code	NDC 2315500201
Hospital Charge Code	2315500201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

HYDRALAZINE HCL 25 MG PO TABS

Facility

IP

$0.51

Service Code	NDC 2315500201
Hospital Charge Code	2315500201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

HYDRALAZINE HCL 25 MG PO TABS

Facility

OP

$0.51

Service Code	NDC 3172252010
Hospital Charge Code	3172252010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

HYDRALAZINE HCL 25 MG PO TABS

Facility

IP

$0.29

Service Code	NDC 0904744861
Hospital Charge Code	0904744861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14

HYDRALAZINE HCL 25 MG PO TABS

Facility

IP

$0.51

Service Code	NDC 3172252010
Hospital Charge Code	3172252010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

HYDRALAZINE HCL 25 MG PO TABS

Facility

OP

$0.29

Service Code	NDC 0904744861
Hospital Charge Code	0904744861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.19
Rate for Payer: EmblemHealth Commercial	$0.14
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

HYDRALAZINE HCL 50 MG PO TABS

Facility

IP

$0.16

Service Code	NDC 6373932810
Hospital Charge Code	6373932810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

HYDRALAZINE HCL 50 MG PO TABS

Facility

OP

$0.36

Service Code	NDC 0904744961
Hospital Charge Code	0904744961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

HYDRALAZINE HCL 50 MG PO TABS

Facility

IP

$0.36

Service Code	NDC 0904744961
Hospital Charge Code	0904744961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

HYDRALAZINE HCL 50 MG PO TABS

Facility

OP

$0.16

Service Code	NDC 6373932810
Hospital Charge Code	6373932810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

HYDRALAZINE HCL 50 MG PO TABS

Facility

IP

$0.56

Service Code	NDC 5107907601
Hospital Charge Code	5107907601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

HYDRALAZINE HCL 50 MG PO TABS

Facility

OP

$0.56

Service Code	NDC 5107907601
Hospital Charge Code	5107907601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS

Facility

OP

$0.28

Service Code	NDC 6068768301
Hospital Charge Code	6068768301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.19
Rate for Payer: EmblemHealth Commercial	$0.14
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

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