| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Adult |
$207.24 |
$214.34 |
$221.79 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
BCCTP |
$1,212.70 |
$1,248.14 |
$1,285.03 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Child |
$104.12 |
$108.34 |
$112.78 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Maternity |
$7,787.65 |
$8,006.57 |
$8,233.37 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Optional Expansion |
$323.29 |
$334.10 |
$345.37 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Optional Expansion - Maternity |
$7,787.65 |
$8,006.57 |
$8,233.37 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
SPD |
$770.40 |
$793.00 |
$816.52 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
SPD/Full-Dual |
$145.05 |
$150.06 |
$155.33 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Behavioral Health Treatment 0-6 |
$2,572.27 |
$2,634.63 |
$2,699.10 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Behavioral Health Treatment 7-20 |
$1,946.13 |
$1,993.31 |
$2,042.09 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Adult |
$198.28 |
$205.09 |
$212.24 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Adult |
$218.82 |
$226.01 |
$233.54 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Adult |
$236.50 |
$244.29 |
$252.44 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Adult |
$183.40 |
$189.40 |
$195.68 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Adult |
$187.68 |
$193.77 |
$200.14 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Adult |
$225.26 |
$233.38 |
$241.89 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Adult |
$202.33 |
$209.02 |
$216.01 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Adult |
$204.55 |
$211.21 |
$218.18 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
BCCTP |
$1,101.84 |
$1,134.49 |
$1,168.49 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
BCCTP |
$1,103.94 |
$1,136.43 |
$1,170.27 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
BCCTP |
$1,053.10 |
$1,084.11 |
$1,116.40 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
BCCTP |
$1,136.94 |
$1,170.49 |
$1,205.44 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
BCCTP |
$1,065.06 |
$1,096.25 |
$1,128.72 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
BCCTP |
$1,130.83 |
$1,165.09 |
$1,200.80 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
BCCTP |
$1,066.15 |
$1,097.77 |
$1,130.71 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
BCCTP |
$1,041.77 |
$1,072.36 |
$1,104.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Child |
$96.07 |
$100.02 |
$104.18 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Child |
$80.82 |
$84.15 |
$87.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Child |
$74.51 |
$77.60 |
$80.86 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Child |
$66.78 |
$69.45 |
$72.26 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Child |
$71.10 |
$73.88 |
$76.82 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Child |
$90.77 |
$95.01 |
$99.49 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Child |
$85.43 |
$88.82 |
$92.40 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Child |
$64.61 |
$67.21 |
$69.95 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Maternity |
$7,787.65 |
$8,006.57 |
$8,233.37 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Maternity |
$8,208.98 |
$8,439.72 |
$8,678.79 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Maternity |
$7,535.76 |
$7,747.59 |
$7,967.07 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Maternity |
$6,445.50 |
$6,626.69 |
$6,814.42 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Maternity |
$6,578.64 |
$6,763.58 |
$6,955.19 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Maternity |
$8,634.55 |
$8,877.26 |
$9,128.73 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Maternity |
$7,799.73 |
$8,018.97 |
$8,246.12 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Maternity |
$6,896.82 |
$7,090.71 |
$7,291.58 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Optional Expansion |
$294.27 |
$304.11 |
$314.37 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Optional Expansion |
$320.23 |
$330.93 |
$342.10 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Optional Expansion |
$347.89 |
$359.52 |
$371.65 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Optional Expansion |
$314.13 |
$324.64 |
$335.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Optional Expansion |
$371.20 |
$383.61 |
$396.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Optional Expansion |
$309.31 |
$319.65 |
$330.43 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Optional Expansion |
$276.42 |
$285.66 |
$295.29 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Optional Expansion |
$322.43 |
$333.21 |
$344.45 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,787.65 |
$8,006.57 |
$8,233.37 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Optional Expansion - Maternity |
$8,208.98 |
$8,439.72 |
$8,678.79 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,535.76 |
$7,747.59 |
$7,967.07 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,445.50 |
$6,626.69 |
$6,814.42 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,578.64 |
$6,763.58 |
$6,955.19 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Optional Expansion - Maternity |
$8,634.55 |
$8,877.26 |
$9,128.73 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,799.73 |
$8,018.97 |
$8,246.12 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,896.82 |
$7,090.71 |
$7,291.58 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
SPD |
$761.69 |
$784.07 |
$807.38 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
SPD |
$653.79 |
$672.89 |
$692.77 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
SPD |
$770.32 |
$792.62 |
$815.84 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
SPD |
$628.40 |
$646.51 |
$665.36 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
SPD |
$746.69 |
$768.11 |
$790.38 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
SPD |
$815.86 |
$840.11 |
$865.38 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
SPD |
$525.63 |
$541.01 |
$557.03 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
SPD |
$665.25 |
$684.46 |
$704.44 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
SPD/Full-Dual |
$138.10 |
$143.06 |
$148.27 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
SPD/Full-Dual |
$128.06 |
$132.63 |
$137.42 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
SPD/Full-Dual |
$153.97 |
$159.11 |
$164.51 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
SPD/Full-Dual |
$109.53 |
$113.48 |
$117.62 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
SPD/Full-Dual |
$104.60 |
$108.24 |
$112.07 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
SPD/Full-Dual |
$525.96 |
$538.42 |
$551.47 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
SPD/Full-Dual |
$111.91 |
$115.96 |
$120.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
SPD/Full-Dual |
$114.27 |
$118.31 |
$122.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,572.27 |
$2,634.63 |
$2,699.10 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,474.42 |
$2,534.33 |
$2,596.27 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,926.33 |
$2,997.45 |
$3,070.98 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,434.52 |
$2,493.58 |
$2,554.64 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,429.93 |
$2,488.87 |
$2,549.81 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,417.26 |
$2,475.89 |
$2,536.51 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,290.96 |
$2,346.50 |
$2,403.93 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,549.42 |
$2,611.39 |
$2,675.45 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,946.13 |
$1,993.31 |
$2,042.09 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,824.25 |
$1,868.35 |
$1,913.95 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,825.81 |
$1,870.07 |
$1,915.83 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,853.27 |
$1,898.12 |
$1,944.48 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,829.82 |
$1,874.08 |
$1,919.84 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,816.61 |
$1,860.64 |
$1,906.16 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,672.77 |
$1,713.29 |
$1,755.18 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,843.62 |
$1,888.26 |
$1,934.41 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Adult |
$242.07 |
$250.06 |
$258.43 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Adult |
$201.87 |
$208.49 |
$215.41 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Adult |
$212.57 |
$219.47 |
$226.69 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
BCCTP |
$1,083.54 |
$1,115.49 |
$1,148.76 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
BCCTP |
$1,103.41 |
$1,136.02 |
$1,169.98 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
BCCTP |
$1,131.93 |
$1,165.37 |
$1,200.20 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Child |
$82.80 |
$86.22 |
$89.83 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Child |
$68.57 |
$71.33 |
$74.25 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Child |
$75.84 |
$78.83 |
$81.98 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Maternity |
$7,535.76 |
$7,747.59 |
$7,967.07 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Maternity |
$6,445.50 |
$6,626.69 |
$6,814.42 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Maternity |
$6,578.64 |
$6,763.58 |
$6,955.19 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Optional Expansion |
$357.36 |
$369.30 |
$381.76 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Optional Expansion |
$332.05 |
$343.15 |
$354.72 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Optional Expansion |
$366.90 |
$379.16 |
$391.95 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Optional Expansion - Maternity |
$7,535.76 |
$7,747.59 |
$7,967.07 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Optional Expansion - Maternity |
$6,445.50 |
$6,626.69 |
$6,814.42 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Optional Expansion - Maternity |
$6,578.64 |
$6,763.58 |
$6,955.19 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
SPD |
$830.56 |
$854.51 |
$879.42 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
SPD |
$675.63 |
$695.12 |
$715.39 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
SPD |
$870.61 |
$895.59 |
$921.57 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
SPD/Full-Dual |
$198.60 |
$204.35 |
$210.39 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
SPD/Full-Dual |
$106.54 |
$110.56 |
$114.80 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
SPD/Full-Dual |
$106.58 |
$110.51 |
$114.64 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Behavioral Health Treatment 0-6 |
$2,926.33 |
$2,997.45 |
$3,070.98 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Behavioral Health Treatment 0-6 |
$2,434.52 |
$2,493.58 |
$2,554.64 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Behavioral Health Treatment 0-6 |
$2,429.93 |
$2,488.87 |
$2,549.81 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Behavioral Health Treatment 7-20 |
$1,825.81 |
$1,870.07 |
$1,915.83 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Behavioral Health Treatment 7-20 |
$1,853.27 |
$1,898.12 |
$1,944.48 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Behavioral Health Treatment 7-20 |
$1,829.82 |
$1,874.08 |
$1,919.84 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Adult |
$221.86 |
$229.29 |
$237.08 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
BCCTP |
$1,106.94 |
$1,139.57 |
$1,173.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Child |
$81.67 |
$85.09 |
$88.69 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Maternity |
$8,208.98 |
$8,439.72 |
$8,678.79 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Optional Expansion |
$364.49 |
$376.68 |
$389.39 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Optional Expansion - Maternity |
$8,208.98 |
$8,439.72 |
$8,678.79 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
SPD |
$775.84 |
$798.53 |
$822.16 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
SPD/Full-Dual |
$147.76 |
$152.76 |
$158.01 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Behavioral Health Treatment 0-6 |
$2,474.42 |
$2,534.33 |
$2,596.27 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Behavioral Health Treatment 7-20 |
$1,824.25 |
$1,868.35 |
$1,913.95 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Adult |
$212.89 |
$219.84 |
$227.12 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Adult |
$181.91 |
$187.93 |
$194.23 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Adult |
$182.55 |
$188.55 |
$194.82 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Adult |
$227.38 |
$234.85 |
$242.66 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Adult |
$200.69 |
$207.26 |
$214.14 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
BCCTP |
$1,060.56 |
$1,091.52 |
$1,123.74 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
BCCTP |
$991.17 |
$1,020.44 |
$1,050.92 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
BCCTP |
$1,103.26 |
$1,135.44 |
$1,168.93 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
BCCTP |
$1,150.11 |
$1,184.19 |
$1,219.69 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
BCCTP |
$1,059.97 |
$1,091.12 |
$1,123.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Child |
$67.85 |
$70.66 |
$73.63 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Child |
$70.43 |
$73.26 |
$76.24 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Child |
$66.50 |
$69.26 |
$72.17 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Child |
$69.78 |
$72.76 |
$75.90 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Child |
$67.63 |
$70.38 |
$73.28 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Maternity |
$5,951.90 |
$6,119.21 |
$6,292.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Maternity |
$6,656.24 |
$6,843.33 |
$7,037.17 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Maternity |
$6,650.70 |
$6,837.68 |
$7,031.40 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Maternity |
$6,845.38 |
$7,037.83 |
$7,237.22 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Maternity |
$6,896.82 |
$7,090.71 |
$7,291.58 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Optional Expansion |
$347.08 |
$358.68 |
$370.79 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Optional Expansion |
$295.40 |
$305.27 |
$315.57 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Optional Expansion |
$286.61 |
$296.19 |
$306.19 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Optional Expansion |
$357.49 |
$369.44 |
$381.91 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Optional Expansion |
$328.25 |
$339.22 |
$350.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Optional Expansion - Maternity |
$5,951.90 |
$6,119.21 |
$6,292.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Optional Expansion - Maternity |
$6,656.24 |
$6,843.33 |
$7,037.17 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Optional Expansion - Maternity |
$6,650.70 |
$6,837.68 |
$7,031.40 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Optional Expansion - Maternity |
$6,845.38 |
$7,037.83 |
$7,237.22 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Optional Expansion - Maternity |
$6,896.82 |
$7,090.71 |
$7,291.58 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
SPD |
$660.10 |
$679.26 |
$699.20 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
SPD |
$509.34 |
$524.14 |
$539.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
SPD |
$737.77 |
$759.18 |
$781.47 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
SPD |
$744.20 |
$765.76 |
$788.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
SPD |
$714.10 |
$734.72 |
$756.18 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
SPD/Full-Dual |
$140.70 |
$145.22 |
$149.96 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
SPD/Full-Dual |
$117.15 |
$121.23 |
$125.52 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
SPD/Full-Dual |
$105.17 |
$109.09 |
$113.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
SPD/Full-Dual |
$107.21 |
$111.31 |
$115.62 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
SPD/Full-Dual |
$116.07 |
$120.22 |
$124.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,463.23 |
$2,523.07 |
$2,584.93 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,468.87 |
$2,528.80 |
$2,590.76 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,460.67 |
$2,520.35 |
$2,582.06 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,461.81 |
$2,521.63 |
$2,583.48 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,549.42 |
$2,611.39 |
$2,675.45 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,914.24 |
$1,960.71 |
$2,008.75 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,829.44 |
$1,873.79 |
$1,919.65 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,793.05 |
$1,836.39 |
$1,881.19 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,812.71 |
$1,856.48 |
$1,901.74 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,843.62 |
$1,888.26 |
$1,934.41 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Adult |
$218.48 |
$225.68 |
$233.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Adult |
$258.76 |
$267.25 |
$276.15 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
BCCTP |
$1,180.28 |
$1,215.23 |
$1,251.64 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
BCCTP |
$1,078.46 |
$1,110.43 |
$1,143.74 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Child |
$76.83 |
$79.96 |
$83.27 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Child |
$78.13 |
$81.44 |
$84.93 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Maternity |
$6,650.70 |
$6,837.68 |
$7,031.40 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Maternity |
$6,845.38 |
$7,037.83 |
$7,237.22 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Optional Expansion |
$314.26 |
$324.77 |
$335.73 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Optional Expansion |
$385.99 |
$398.90 |
$412.36 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Optional Expansion - Maternity |
$6,650.70 |
$6,837.68 |
$7,031.40 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Optional Expansion - Maternity |
$6,845.38 |
$7,037.83 |
$7,237.22 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
SPD |
$677.54 |
$697.18 |
$717.62 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
SPD |
$913.03 |
$939.25 |
$966.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
SPD/Full-Dual |
$102.44 |
$106.40 |
$110.57 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
SPD/Full-Dual |
$125.81 |
$130.55 |
$135.53 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Behavioral Health Treatment 0-6 |
$2,460.67 |
$2,520.35 |
$2,582.06 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Behavioral Health Treatment 0-6 |
$2,461.81 |
$2,521.63 |
$2,583.48 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Behavioral Health Treatment 7-20 |
$1,793.05 |
$1,836.39 |
$1,881.19 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Behavioral Health Treatment 7-20 |
$1,812.71 |
$1,856.48 |
$1,901.74 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Adult |
$223.79 |
$231.03 |
$238.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Adult |
$218.27 |
$225.37 |
$232.80 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
BCCTP |
$1,210.80 |
$1,246.82 |
$1,284.35 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
BCCTP |
$1,277.33 |
$1,315.13 |
$1,354.49 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Child |
$73.12 |
$76.05 |
$79.13 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Child |
$76.98 |
$80.05 |
$83.28 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Maternity |
$5,724.46 |
$5,885.41 |
$6,052.16 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Maternity |
$6,113.09 |
$6,284.97 |
$6,463.04 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Optional Expansion |
$366.22 |
$378.47 |
$391.24 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Optional Expansion |
$337.85 |
$349.14 |
$360.92 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Optional Expansion - Maternity |
$5,724.46 |
$5,885.41 |
$6,052.16 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Optional Expansion - Maternity |
$6,113.09 |
$6,284.97 |
$6,463.04 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
SPD |
$696.80 |
$716.85 |
$737.72 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
SPD |
$659.79 |
$678.86 |
$698.70 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
SPD/Full-Dual |
$106.56 |
$110.48 |
$114.61 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
SPD/Full-Dual |
$104.54 |
$108.44 |
$112.54 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Behavioral Health Treatment 0-6 |
$2,299.08 |
$2,354.82 |
$2,412.45 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Behavioral Health Treatment 0-6 |
$2,328.37 |
$2,384.85 |
$2,443.24 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Behavioral Health Treatment 7-20 |
$1,787.66 |
$1,830.96 |
$1,875.73 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Behavioral Health Treatment 7-20 |
$1,692.70 |
$1,733.71 |
$1,776.11 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Adult |
$229.42 |
$236.87 |
$244.66 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
BCCTP |
$1,185.82 |
$1,220.32 |
$1,256.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Child |
$68.66 |
$71.49 |
$74.47 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Maternity |
$5,951.90 |
$6,119.21 |
$6,292.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Optional Expansion |
$353.21 |
$365.02 |
$377.33 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Optional Expansion - Maternity |
$5,951.90 |
$6,119.21 |
$6,292.55 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
SPD |
$712.21 |
$732.83 |
$754.30 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
SPD/Full-Dual |
$135.12 |
$139.72 |
$144.54 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Behavioral Health Treatment 0-6 |
$2,463.23 |
$2,523.07 |
$2,584.93 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Behavioral Health Treatment 7-20 |
$1,914.24 |
$1,960.71 |
$2,008.75 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Adult |
$186.41 |
$192.65 |
$199.19 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
BCCTP |
$965.64 |
$994.18 |
$1,023.91 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Child |
$76.86 |
$79.96 |
$83.22 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Maternity |
$6,656.24 |
$6,843.33 |
$7,037.17 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Optional Expansion |
$302.74 |
$312.86 |
$323.41 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Optional Expansion - Maternity |
$6,656.24 |
$6,843.33 |
$7,037.17 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
SPD |
$606.03 |
$623.66 |
$642.01 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
SPD/Full-Dual |
$116.34 |
$120.59 |
$125.06 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Behavioral Health Treatment 0-6 |
$2,468.87 |
$2,528.80 |
$2,590.76 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Behavioral Health Treatment 7-20 |
$1,829.44 |
$1,873.79 |
$1,919.65 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Adult |
$185.27 |
$191.26 |
$197.52 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Adult |
$196.53 |
$202.90 |
$209.57 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
BCCTP |
$1,022.23 |
$1,051.82 |
$1,082.61 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
BCCTP |
$1,055.76 |
$1,086.37 |
$1,118.23 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Child |
$68.64 |
$71.34 |
$74.18 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Child |
$71.76 |
$74.59 |
$77.58 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Maternity |
$5,724.46 |
$5,885.41 |
$6,052.16 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Maternity |
$6,113.09 |
$6,284.97 |
$6,463.04 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Optional Expansion |
$332.45 |
$343.56 |
$355.16 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Optional Expansion |
$310.53 |
$320.91 |
$331.73 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Optional Expansion - Maternity |
$5,724.46 |
$5,885.41 |
$6,052.16 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Optional Expansion - Maternity |
$6,113.09 |
$6,284.97 |
$6,463.04 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
SPD |
$518.41 |
$533.40 |
$549.01 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
SPD |
$522.34 |
$537.54 |
$553.35 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
SPD/Full-Dual |
$102.72 |
$106.38 |
$110.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
SPD/Full-Dual |
$101.66 |
$105.37 |
$109.27 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Behavioral Health Treatment 0-6 |
$2,299.08 |
$2,354.82 |
$2,412.45 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Behavioral Health Treatment 0-6 |
$2,328.37 |
$2,384.85 |
$2,443.24 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Behavioral Health Treatment 7-20 |
$1,787.66 |
$1,830.96 |
$1,875.73 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Behavioral Health Treatment 7-20 |
$1,692.70 |
$1,733.71 |
$1,776.11 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Adult |
$212.22 |
$219.66 |
$227.46 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
BCCTP |
$1,138.63 |
$1,172.22 |
$1,207.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Child |
$109.05 |
$113.61 |
$118.42 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Maternity |
$8,634.55 |
$8,877.26 |
$9,128.73 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Optional Expansion |
$333.84 |
$345.00 |
$356.64 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Optional Expansion - Maternity |
$8,634.55 |
$8,877.26 |
$9,128.73 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
SPD |
$726.53 |
$748.06 |
$770.49 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
SPD/Full-Dual |
$194.31 |
$200.57 |
$207.15 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Behavioral Health Treatment 0-6 |
$2,417.26 |
$2,475.89 |
$2,536.51 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Behavioral Health Treatment 7-20 |
$1,816.61 |
$1,860.64 |
$1,906.16 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Adult |
$218.47 |
$225.70 |
$233.27 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
BCCTP |
$976.49 |
$1,005.32 |
$1,035.34 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Child |
$101.44 |
$105.38 |
$109.52 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Maternity |
$7,799.73 |
$8,018.97 |
$8,246.12 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Optional Expansion |
$299.81 |
$309.83 |
$320.29 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Optional Expansion - Maternity |
$7,799.73 |
$8,018.97 |
$8,246.12 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
SPD |
$589.14 |
$606.35 |
$624.26 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
SPD/Full-Dual |
$114.42 |
$118.70 |
$123.21 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Behavioral Health Treatment 0-6 |
$2,290.96 |
$2,346.50 |
$2,403.93 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Behavioral Health Treatment 7-20 |
$1,672.77 |
$1,713.29 |
$1,755.18 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Hepatitis C 340B |
$4,910.81 |
$5,014.95 |
$5,123.59 |
| 07/16-06/17 |
2016-17 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Hepatitis C Non-340B |
$6,121.25 |
$6,397.48 |
$6,685.67 |
| None |
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