Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$6.37

Service Code	NDC 50268027811
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$6.37
Rate for Payer: Aetna Commercial	$5.73
Rate for Payer: ASR ASR	$6.18
Rate for Payer: ASR Commercial	$6.18
Rate for Payer: BCBS Trust/PPO	$5.19
Rate for Payer: BCN Commercial	$4.94
Rate for Payer: Cash Price	$5.10
Rate for Payer: Cofinity Commercial	$5.99
Rate for Payer: Encore Health Key Benefits Commercial	$5.10
Rate for Payer: Healthscope Commercial	$6.37
Rate for Payer: Healthscope Whirlpool	$6.18
Rate for Payer: Mclaren Commercial	$5.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: Nomi Health Commercial	$5.22
Rate for Payer: Priority Health Cigna Priority Health	$4.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.61

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$289.44

Service Code	NDC 00904042806
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$115.78
Max. Negotiated Rate	$289.44
Rate for Payer: Aetna Commercial	$260.50
Rate for Payer: Aetna Medicare	$144.72
Rate for Payer: ASR ASR	$280.76
Rate for Payer: ASR Commercial	$280.76
Rate for Payer: BCBS Complete	$115.78
Rate for Payer: BCBS Trust/PPO	$237.02
Rate for Payer: BCN Commercial	$224.40
Rate for Payer: Cash Price	$231.55
Rate for Payer: Cofinity Commercial	$272.07
Rate for Payer: Encore Health Key Benefits Commercial	$231.55
Rate for Payer: Healthscope Commercial	$289.44
Rate for Payer: Healthscope Whirlpool	$280.76
Rate for Payer: Mclaren Commercial	$260.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.02
Rate for Payer: Nomi Health Commercial	$237.34
Rate for Payer: Priority Health Cigna Priority Health	$188.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$253.61
Rate for Payer: Priority Health Narrow Network	$202.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$254.71

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$358.32

Service Code	NDC 60687051365
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$232.91
Max. Negotiated Rate	$358.32
Rate for Payer: Aetna Commercial	$322.49
Rate for Payer: ASR ASR	$347.57
Rate for Payer: ASR Commercial	$347.57
Rate for Payer: BCBS Trust/PPO	$291.99
Rate for Payer: BCN Commercial	$277.81
Rate for Payer: Cash Price	$286.66
Rate for Payer: Cofinity Commercial	$336.82
Rate for Payer: Encore Health Key Benefits Commercial	$286.66
Rate for Payer: Healthscope Commercial	$358.32
Rate for Payer: Healthscope Whirlpool	$347.57
Rate for Payer: Mclaren Commercial	$322.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$304.57
Rate for Payer: Nomi Health Commercial	$293.82
Rate for Payer: Priority Health Cigna Priority Health	$232.91
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$315.32

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$290.64

Service Code	NDC 53489011902
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$116.26
Max. Negotiated Rate	$290.64
Rate for Payer: Aetna Commercial	$261.58
Rate for Payer: Aetna Medicare	$145.32
Rate for Payer: ASR ASR	$281.92
Rate for Payer: ASR Commercial	$281.92
Rate for Payer: BCBS Complete	$116.26
Rate for Payer: BCBS Trust/PPO	$238.01
Rate for Payer: BCN Commercial	$225.33
Rate for Payer: Cash Price	$232.51
Rate for Payer: Cofinity Commercial	$273.20
Rate for Payer: Encore Health Key Benefits Commercial	$232.51
Rate for Payer: Healthscope Commercial	$290.64
Rate for Payer: Healthscope Whirlpool	$281.92
Rate for Payer: Mclaren Commercial	$261.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.04
Rate for Payer: Nomi Health Commercial	$238.32
Rate for Payer: Priority Health Cigna Priority Health	$188.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$254.66
Rate for Payer: Priority Health Narrow Network	$203.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$255.76

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$162.93

Service Code	NDC 00143314250
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$65.17
Max. Negotiated Rate	$162.93
Rate for Payer: Aetna Commercial	$146.64
Rate for Payer: Aetna Medicare	$81.46
Rate for Payer: ASR ASR	$158.04
Rate for Payer: ASR Commercial	$158.04
Rate for Payer: BCBS Complete	$65.17
Rate for Payer: BCBS Trust/PPO	$133.42
Rate for Payer: BCN Commercial	$126.32
Rate for Payer: Cash Price	$130.34
Rate for Payer: Cofinity Commercial	$153.15
Rate for Payer: Encore Health Key Benefits Commercial	$130.34
Rate for Payer: Healthscope Commercial	$162.93
Rate for Payer: Healthscope Whirlpool	$158.04
Rate for Payer: Mclaren Commercial	$146.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.49
Rate for Payer: Nomi Health Commercial	$133.60
Rate for Payer: Priority Health Cigna Priority Health	$105.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$142.76
Rate for Payer: Priority Health Narrow Network	$114.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$143.38

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$318.48

Service Code	NDC 50268027815
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$207.01
Max. Negotiated Rate	$318.48
Rate for Payer: Aetna Commercial	$286.63
Rate for Payer: ASR ASR	$308.93
Rate for Payer: ASR Commercial	$308.93
Rate for Payer: BCBS Trust/PPO	$259.53
Rate for Payer: BCN Commercial	$246.92
Rate for Payer: Cash Price	$254.78
Rate for Payer: Cofinity Commercial	$299.37
Rate for Payer: Encore Health Key Benefits Commercial	$254.78
Rate for Payer: Healthscope Commercial	$318.48
Rate for Payer: Healthscope Whirlpool	$308.93
Rate for Payer: Mclaren Commercial	$286.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$270.71
Rate for Payer: Nomi Health Commercial	$261.15
Rate for Payer: Priority Health Cigna Priority Health	$207.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$280.26

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$290.64

Service Code	NDC 53489011902
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$188.92
Max. Negotiated Rate	$290.64
Rate for Payer: Aetna Commercial	$261.58
Rate for Payer: ASR ASR	$281.92
Rate for Payer: ASR Commercial	$281.92
Rate for Payer: BCBS Trust/PPO	$236.84
Rate for Payer: BCN Commercial	$225.33
Rate for Payer: Cash Price	$232.51
Rate for Payer: Cofinity Commercial	$273.20
Rate for Payer: Encore Health Key Benefits Commercial	$232.51
Rate for Payer: Healthscope Commercial	$290.64
Rate for Payer: Healthscope Whirlpool	$281.92
Rate for Payer: Mclaren Commercial	$261.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.04
Rate for Payer: Nomi Health Commercial	$238.32
Rate for Payer: Priority Health Cigna Priority Health	$188.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$255.76

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$358.32

Service Code	NDC 60687051365
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$143.33
Max. Negotiated Rate	$358.32
Rate for Payer: Aetna Commercial	$322.49
Rate for Payer: Aetna Medicare	$179.16
Rate for Payer: ASR ASR	$347.57
Rate for Payer: ASR Commercial	$347.57
Rate for Payer: BCBS Complete	$143.33
Rate for Payer: BCBS Trust/PPO	$293.43
Rate for Payer: BCN Commercial	$277.81
Rate for Payer: Cash Price	$286.66
Rate for Payer: Cofinity Commercial	$336.82
Rate for Payer: Encore Health Key Benefits Commercial	$286.66
Rate for Payer: Healthscope Commercial	$358.32
Rate for Payer: Healthscope Whirlpool	$347.57
Rate for Payer: Mclaren Commercial	$322.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$304.57
Rate for Payer: Nomi Health Commercial	$293.82
Rate for Payer: Priority Health Cigna Priority Health	$232.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$313.96
Rate for Payer: Priority Health Narrow Network	$251.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$315.32

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$7.17

Service Code	NDC 60687051311
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$7.17
Rate for Payer: Aetna Commercial	$6.45
Rate for Payer: ASR ASR	$6.95
Rate for Payer: ASR Commercial	$6.95
Rate for Payer: BCBS Trust/PPO	$5.84
Rate for Payer: BCN Commercial	$5.56
Rate for Payer: Cash Price	$5.73
Rate for Payer: Cofinity Commercial	$6.74
Rate for Payer: Encore Health Key Benefits Commercial	$5.74
Rate for Payer: Healthscope Commercial	$7.17
Rate for Payer: Healthscope Whirlpool	$6.95
Rate for Payer: Mclaren Commercial	$6.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.09
Rate for Payer: Nomi Health Commercial	$5.88
Rate for Payer: Priority Health Cigna Priority Health	$4.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.31

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$6.37

Service Code	NDC 50268027811
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$6.37
Rate for Payer: Aetna Commercial	$5.73
Rate for Payer: Aetna Medicare	$3.18
Rate for Payer: ASR ASR	$6.18
Rate for Payer: ASR Commercial	$6.18
Rate for Payer: BCBS Complete	$2.55
Rate for Payer: BCBS Trust/PPO	$5.22
Rate for Payer: BCN Commercial	$4.94
Rate for Payer: Cash Price	$5.10
Rate for Payer: Cofinity Commercial	$5.99
Rate for Payer: Encore Health Key Benefits Commercial	$5.10
Rate for Payer: Healthscope Commercial	$6.37
Rate for Payer: Healthscope Whirlpool	$6.18
Rate for Payer: Mclaren Commercial	$5.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: Nomi Health Commercial	$5.22
Rate for Payer: Priority Health Cigna Priority Health	$4.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.58
Rate for Payer: Priority Health Narrow Network	$4.47
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.61

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$318.48

Service Code	NDC 50268027815
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$127.39
Max. Negotiated Rate	$318.48
Rate for Payer: Aetna Commercial	$286.63
Rate for Payer: Aetna Medicare	$159.24
Rate for Payer: ASR ASR	$308.93
Rate for Payer: ASR Commercial	$308.93
Rate for Payer: BCBS Complete	$127.39
Rate for Payer: BCBS Trust/PPO	$260.80
Rate for Payer: BCN Commercial	$246.92
Rate for Payer: Cash Price	$254.78
Rate for Payer: Cofinity Commercial	$299.37
Rate for Payer: Encore Health Key Benefits Commercial	$254.78
Rate for Payer: Healthscope Commercial	$318.48
Rate for Payer: Healthscope Whirlpool	$308.93
Rate for Payer: Mclaren Commercial	$286.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$270.71
Rate for Payer: Nomi Health Commercial	$261.15
Rate for Payer: Priority Health Cigna Priority Health	$207.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$279.05
Rate for Payer: Priority Health Narrow Network	$223.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$280.26

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$162.93

Service Code	NDC 00143314250
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$105.90
Max. Negotiated Rate	$162.93
Rate for Payer: Aetna Commercial	$146.64
Rate for Payer: ASR ASR	$158.04
Rate for Payer: ASR Commercial	$158.04
Rate for Payer: BCBS Trust/PPO	$132.77
Rate for Payer: BCN Commercial	$126.32
Rate for Payer: Cash Price	$130.34
Rate for Payer: Cofinity Commercial	$153.15
Rate for Payer: Encore Health Key Benefits Commercial	$130.34
Rate for Payer: Healthscope Commercial	$162.93
Rate for Payer: Healthscope Whirlpool	$158.04
Rate for Payer: Mclaren Commercial	$146.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.49
Rate for Payer: Nomi Health Commercial	$133.60
Rate for Payer: Priority Health Cigna Priority Health	$105.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$143.38

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$289.44

Service Code	NDC 00904042806
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$188.14
Max. Negotiated Rate	$289.44
Rate for Payer: Aetna Commercial	$260.50
Rate for Payer: ASR ASR	$280.76
Rate for Payer: ASR Commercial	$280.76
Rate for Payer: BCBS Trust/PPO	$235.86
Rate for Payer: BCN Commercial	$224.40
Rate for Payer: Cash Price	$231.55
Rate for Payer: Cofinity Commercial	$272.07
Rate for Payer: Encore Health Key Benefits Commercial	$231.55
Rate for Payer: Healthscope Commercial	$289.44
Rate for Payer: Healthscope Whirlpool	$280.76
Rate for Payer: Mclaren Commercial	$260.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.02
Rate for Payer: Nomi Health Commercial	$237.34
Rate for Payer: Priority Health Cigna Priority Health	$188.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$254.71

DOXYCYCLINE HYCLATE 100 MG CAPSULE

Facility

$7.17

Service Code	NDC 60687051311
Hospital Charge Code	2623
Hospital Revenue Code	637
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$7.17
Rate for Payer: Aetna Commercial	$6.45
Rate for Payer: Aetna Medicare	$3.58
Rate for Payer: ASR ASR	$6.95
Rate for Payer: ASR Commercial	$6.95
Rate for Payer: BCBS Complete	$2.87
Rate for Payer: BCBS Trust/PPO	$5.87
Rate for Payer: BCN Commercial	$5.56
Rate for Payer: Cash Price	$5.73
Rate for Payer: Cofinity Commercial	$6.74
Rate for Payer: Encore Health Key Benefits Commercial	$5.74
Rate for Payer: Healthscope Commercial	$7.17
Rate for Payer: Healthscope Whirlpool	$6.95
Rate for Payer: Mclaren Commercial	$6.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.09
Rate for Payer: Nomi Health Commercial	$5.88
Rate for Payer: Priority Health Cigna Priority Health	$4.66
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6.28
Rate for Payer: Priority Health Narrow Network	$5.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.31

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$69.00

Service Code	NDC 67457043710
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: ASR ASR	$66.93
Rate for Payer: ASR Commercial	$66.93
Rate for Payer: BCBS Trust/PPO	$56.23
Rate for Payer: BCN Commercial	$53.50
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cofinity Commercial	$64.86
Rate for Payer: Encore Health Key Benefits Commercial	$55.20
Rate for Payer: Healthscope Commercial	$69.00
Rate for Payer: Healthscope Whirlpool	$66.93
Rate for Payer: Mclaren Commercial	$62.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.65
Rate for Payer: Nomi Health Commercial	$56.58
Rate for Payer: Priority Health Cigna Priority Health	$44.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.72

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$51.42

Service Code	NDC 66794023702
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$33.42
Max. Negotiated Rate	$51.42
Rate for Payer: Aetna Commercial	$46.28
Rate for Payer: ASR ASR	$49.88
Rate for Payer: ASR Commercial	$49.88
Rate for Payer: BCBS Trust/PPO	$41.90
Rate for Payer: BCN Commercial	$39.87
Rate for Payer: Cash Price	$41.14
Rate for Payer: Cofinity Commercial	$48.33
Rate for Payer: Encore Health Key Benefits Commercial	$41.14
Rate for Payer: Healthscope Commercial	$51.42
Rate for Payer: Healthscope Whirlpool	$49.88
Rate for Payer: Mclaren Commercial	$46.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.71
Rate for Payer: Nomi Health Commercial	$42.16
Rate for Payer: Priority Health Cigna Priority Health	$33.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.25

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$63.39

Service Code	NDC 68382091010
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$25.36
Max. Negotiated Rate	$63.39
Rate for Payer: Aetna Commercial	$57.05
Rate for Payer: Aetna Medicare	$31.70
Rate for Payer: ASR ASR	$61.49
Rate for Payer: ASR Commercial	$61.49
Rate for Payer: BCBS Complete	$25.36
Rate for Payer: BCBS Trust/PPO	$51.91
Rate for Payer: BCN Commercial	$49.15
Rate for Payer: Cash Price	$50.71
Rate for Payer: Cofinity Commercial	$59.59
Rate for Payer: Encore Health Key Benefits Commercial	$50.71
Rate for Payer: Healthscope Commercial	$63.39
Rate for Payer: Healthscope Whirlpool	$61.49
Rate for Payer: Mclaren Commercial	$57.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.88
Rate for Payer: Nomi Health Commercial	$51.98
Rate for Payer: Priority Health Cigna Priority Health	$41.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.54
Rate for Payer: Priority Health Narrow Network	$44.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.78

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$63.39

Service Code	NDC 68382091001
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$41.20
Max. Negotiated Rate	$63.39
Rate for Payer: Aetna Commercial	$57.05
Rate for Payer: ASR ASR	$61.49
Rate for Payer: ASR Commercial	$61.49
Rate for Payer: BCBS Trust/PPO	$51.66
Rate for Payer: BCN Commercial	$49.15
Rate for Payer: Cash Price	$50.71
Rate for Payer: Cofinity Commercial	$59.59
Rate for Payer: Encore Health Key Benefits Commercial	$50.71
Rate for Payer: Healthscope Commercial	$63.39
Rate for Payer: Healthscope Whirlpool	$61.49
Rate for Payer: Mclaren Commercial	$57.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.88
Rate for Payer: Nomi Health Commercial	$51.98
Rate for Payer: Priority Health Cigna Priority Health	$41.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.78

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$68.29

Service Code	NDC 63323013003
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$44.39
Max. Negotiated Rate	$68.29
Rate for Payer: Aetna Commercial	$61.46
Rate for Payer: ASR ASR	$66.24
Rate for Payer: ASR Commercial	$66.24
Rate for Payer: BCBS Trust/PPO	$55.65
Rate for Payer: BCN Commercial	$52.95
Rate for Payer: Cash Price	$54.63
Rate for Payer: Cofinity Commercial	$64.19
Rate for Payer: Encore Health Key Benefits Commercial	$54.63
Rate for Payer: Healthscope Commercial	$68.29
Rate for Payer: Healthscope Whirlpool	$66.24
Rate for Payer: Mclaren Commercial	$61.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.05
Rate for Payer: Nomi Health Commercial	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$44.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.10

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$63.39

Service Code	NDC 68382091010
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$41.20
Max. Negotiated Rate	$63.39
Rate for Payer: Aetna Commercial	$57.05
Rate for Payer: ASR ASR	$61.49
Rate for Payer: ASR Commercial	$61.49
Rate for Payer: BCBS Trust/PPO	$51.66
Rate for Payer: BCN Commercial	$49.15
Rate for Payer: Cash Price	$50.71
Rate for Payer: Cofinity Commercial	$59.59
Rate for Payer: Encore Health Key Benefits Commercial	$50.71
Rate for Payer: Healthscope Commercial	$63.39
Rate for Payer: Healthscope Whirlpool	$61.49
Rate for Payer: Mclaren Commercial	$57.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.88
Rate for Payer: Nomi Health Commercial	$51.98
Rate for Payer: Priority Health Cigna Priority Health	$41.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.78

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$68.29

Service Code	NDC 63323013003
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$27.32
Max. Negotiated Rate	$68.29
Rate for Payer: Aetna Commercial	$61.46
Rate for Payer: Aetna Medicare	$34.14
Rate for Payer: ASR ASR	$66.24
Rate for Payer: ASR Commercial	$66.24
Rate for Payer: BCBS Complete	$27.32
Rate for Payer: BCBS Trust/PPO	$55.92
Rate for Payer: BCN Commercial	$52.95
Rate for Payer: Cash Price	$54.63
Rate for Payer: Cofinity Commercial	$64.19
Rate for Payer: Encore Health Key Benefits Commercial	$54.63
Rate for Payer: Healthscope Commercial	$68.29
Rate for Payer: Healthscope Whirlpool	$66.24
Rate for Payer: Mclaren Commercial	$61.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.05
Rate for Payer: Nomi Health Commercial	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$44.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$59.84
Rate for Payer: Priority Health Narrow Network	$47.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.10

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$68.29

Service Code	NDC 63323013013
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$44.39
Max. Negotiated Rate	$68.29
Rate for Payer: Aetna Commercial	$61.46
Rate for Payer: ASR ASR	$66.24
Rate for Payer: ASR Commercial	$66.24
Rate for Payer: BCBS Trust/PPO	$55.65
Rate for Payer: BCN Commercial	$52.95
Rate for Payer: Cash Price	$54.63
Rate for Payer: Cofinity Commercial	$64.19
Rate for Payer: Encore Health Key Benefits Commercial	$54.63
Rate for Payer: Healthscope Commercial	$68.29
Rate for Payer: Healthscope Whirlpool	$66.24
Rate for Payer: Mclaren Commercial	$61.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.05
Rate for Payer: Nomi Health Commercial	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$44.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.10

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$69.00

Service Code	NDC 67457043700
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: Aetna Medicare	$34.50
Rate for Payer: ASR ASR	$66.93
Rate for Payer: ASR Commercial	$66.93
Rate for Payer: BCBS Complete	$27.60
Rate for Payer: BCBS Trust/PPO	$56.50
Rate for Payer: BCN Commercial	$53.50
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cofinity Commercial	$64.86
Rate for Payer: Encore Health Key Benefits Commercial	$55.20
Rate for Payer: Healthscope Commercial	$69.00
Rate for Payer: Healthscope Whirlpool	$66.93
Rate for Payer: Mclaren Commercial	$62.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.65
Rate for Payer: Nomi Health Commercial	$56.58
Rate for Payer: Priority Health Cigna Priority Health	$44.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.46
Rate for Payer: Priority Health Narrow Network	$48.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.72

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$51.42

Service Code	NDC 66794023741
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$20.57
Max. Negotiated Rate	$51.42
Rate for Payer: Aetna Commercial	$46.28
Rate for Payer: Aetna Medicare	$25.71
Rate for Payer: ASR ASR	$49.88
Rate for Payer: ASR Commercial	$49.88
Rate for Payer: BCBS Complete	$20.57
Rate for Payer: BCBS Trust/PPO	$42.11
Rate for Payer: BCN Commercial	$39.87
Rate for Payer: Cash Price	$41.14
Rate for Payer: Cofinity Commercial	$48.33
Rate for Payer: Encore Health Key Benefits Commercial	$41.14
Rate for Payer: Healthscope Commercial	$51.42
Rate for Payer: Healthscope Whirlpool	$49.88
Rate for Payer: Mclaren Commercial	$46.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.71
Rate for Payer: Nomi Health Commercial	$42.16
Rate for Payer: Priority Health Cigna Priority Health	$33.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.05
Rate for Payer: Priority Health Narrow Network	$36.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.25

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility

$69.00

Service Code	NDC 67457043710
Hospital Charge Code	2622
Hospital Revenue Code	250
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: Aetna Medicare	$34.50
Rate for Payer: ASR ASR	$66.93
Rate for Payer: ASR Commercial	$66.93
Rate for Payer: BCBS Complete	$27.60
Rate for Payer: BCBS Trust/PPO	$56.50
Rate for Payer: BCN Commercial	$53.50
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cofinity Commercial	$64.86
Rate for Payer: Encore Health Key Benefits Commercial	$55.20
Rate for Payer: Healthscope Commercial	$69.00
Rate for Payer: Healthscope Whirlpool	$66.93
Rate for Payer: Mclaren Commercial	$62.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.65
Rate for Payer: Nomi Health Commercial	$56.58
Rate for Payer: Priority Health Cigna Priority Health	$44.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.46
Rate for Payer: Priority Health Narrow Network	$48.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.72

Know your out-of-pocket cost for care.

All Charges