NDC 904043004
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
00904-0430-04 - doxycycline hyclate 100 mg Tab
Reported by 15 hospitals in the network under the other methodology.
Based on 13–130 billing samples across every hospital reporting.
Low
$0
Average
$6
Median
$4
High
$14
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 15 hospitals; the 90th percentile is 24.6× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | Location | Approximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price. | |||||
|---|---|---|---|---|---|---|---|---|
| 1 | Naples HMA LLC | Naples, FL | $13 | $12 | $3 | 4–40 | $2 | $13 |
| 2 | Naples HMA LLC | Naples, FL | $13 | $12 | $3 | 4–40 | $2 | $13 |
| 3 | Naples HMA LLC | Naples, FL | $13 | $11 | $3 | 3–30 | $2 | $13 |
| 4 | Northwest Sahurita Hospital LLC | Tucson, AZ | $0 | $0 | $0 | 1–10 | $0 | $2 |
| 5 | Northwest Sahurita Hospital LLC | Sahuarita, AZ | $0 | $0 | $0 | 1–10 | $0 | $2 |
| 6 | St. Joseph Health System, LLC | Wayne, IN | $14 | $14 | — | — | $3 | $14 |
| 7 | Vicksburg Healthcare LLC | Vicksburg, MS | $14 | $14 | $6 | — | $3 | $19 |
| 8 | Northwest Hospital LLC | Tucson, AZ | $0 | $1 | $0 | — | $0 | $2 |
| 9 | Gadsden Regional Medical Center LLC | Gadsden, AL | $2 | $2 | — | — | $2 | $2 |
| 10 | Laredo Texas Hospital Company LP | Laredo, TX | $4 | $4 | $0 | — | $2 | $36 |
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