| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Adult |
$211.80 |
$219.06 |
$226.66 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
BCCTP |
$1,287.02 |
$1,324.68 |
$1,363.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Child |
$95.45 |
$99.39 |
$103.55 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Maternity |
$7,955.39 |
$8,179.32 |
$8,411.34 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Optional Expansion |
$305.07 |
$315.17 |
$325.75 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Optional Expansion Maternity |
$7,955.39 |
$8,179.32 |
$8,411.34 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
SPD |
$798.11 |
$821.47 |
$845.80 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
SPD/Full-Dual |
$158.03 |
$163.52 |
$169.30 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Behavioral Health Treatment 0-6 |
$2,682.92 |
$2,746.12 |
$2,811.43 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Behavioral Health Treatment 7-20 |
$1,942.88 |
$1,988.64 |
$2,035.94 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Adult |
$197.23 |
$203.98 |
$211.05 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
BCCTP |
$1,056.08 |
$1,086.94 |
$1,119.07 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Child |
$83.75 |
$87.29 |
$91.03 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Maternity |
$7,955.39 |
$8,179.32 |
$8,411.34 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Optional Expansion |
$250.00 |
$258.28 |
$266.94 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Optional Expansion Maternity |
$7,955.39 |
$8,179.32 |
$8,411.34 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
SPD |
$789.86 |
$812.97 |
$837.04 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
SPD/Full-Dual |
$149.27 |
$154.54 |
$160.08 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Adult |
$220.70 |
$227.97 |
$235.58 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
BCCTP |
$1,097.80 |
$1,129.98 |
$1,163.47 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Child |
$77.48 |
$80.76 |
$84.23 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Maternity |
$8,235.96 |
$8,467.80 |
$8,708.00 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Optional Expansion |
$268.48 |
$277.38 |
$286.69 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Optional Expansion Maternity |
$8,235.96 |
$8,467.80 |
$8,708.00 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
SPD |
$664.74 |
$684.23 |
$704.51 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
SPD/Full-Dual |
$138.26 |
$143.06 |
$148.10 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Adult |
$227.33 |
$234.83 |
$242.68 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
BCCTP |
$1,058.01 |
$1,089.13 |
$1,121.54 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Child |
$71.43 |
$74.43 |
$77.60 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Maternity |
$7,579.28 |
$7,792.63 |
$8,013.68 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Optional Expansion |
$304.73 |
$314.88 |
$325.50 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Optional Expansion Maternity |
$7,579.28 |
$7,792.63 |
$8,013.68 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
SPD |
$752.75 |
$774.59 |
$797.32 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
SPD/Full-Dual |
$155.43 |
$160.65 |
$166.12 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Adult |
$195.96 |
$202.36 |
$209.06 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
BCCTP |
$1,150.09 |
$1,183.95 |
$1,219.21 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Child |
$63.27 |
$65.88 |
$68.63 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Maternity |
$6,311.36 |
$6,489.02 |
$6,673.09 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Optional Expansion |
$291.58 |
$301.31 |
$311.50 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Optional Expansion Maternity |
$6,311.36 |
$6,489.02 |
$6,673.09 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
SPD |
$666.59 |
$685.90 |
$705.98 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
SPD/Full-Dual |
$119.46 |
$123.58 |
$127.91 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Adult |
$200.18 |
$206.71 |
$213.53 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
BCCTP |
$1,094.19 |
$1,126.09 |
$1,159.28 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Child |
$68.55 |
$71.29 |
$74.18 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Maternity |
$6,538.91 |
$6,722.97 |
$6,913.67 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Optional Expansion |
$327.16 |
$338.08 |
$349.50 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Optional Expansion Maternity |
$6,538.91 |
$6,722.97 |
$6,913.67 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
SPD |
$812.49 |
$835.65 |
$859.72 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
SPD/Full-Dual |
$107.04 |
$110.79 |
$114.73 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Adult |
$248.85 |
$257.66 |
$266.92 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
BCCTP |
$1,133.23 |
$1,167.65 |
$1,203.54 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Child |
$88.53 |
$92.71 |
$97.14 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Maternity |
$9,158.89 |
$9,416.70 |
$9,683.82 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Optional Expansion |
$304.11 |
$314.22 |
$324.80 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Optional Expansion Maternity |
$9,158.89 |
$9,416.70 |
$9,683.82 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
SPD |
$844.69 |
$869.74 |
$895.85 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
SPD/Full-Dual |
$460.68 |
$474.27 |
$488.50 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Adult |
$204.34 |
$211.11 |
$218.19 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
BCCTP |
$1,083.03 |
$1,114.87 |
$1,148.02 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Child |
$84.40 |
$87.82 |
$91.42 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Maternity |
$7,780.81 |
$7,999.83 |
$8,226.75 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Optional Expansion |
$247.92 |
$256.16 |
$264.77 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Optional Expansion Maternity |
$7,780.81 |
$7,999.83 |
$8,226.75 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
SPD |
$547.42 |
$563.45 |
$580.13 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
SPD/Full-Dual |
$117.54 |
$121.69 |
$126.05 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Adult |
$203.33 |
$209.96 |
$216.90 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
BCCTP |
$1,053.23 |
$1,084.19 |
$1,116.42 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Child |
$60.29 |
$62.76 |
$65.36 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Maternity |
$6,905.92 |
$7,100.32 |
$7,301.72 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Optional Expansion |
$299.62 |
$309.62 |
$320.09 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Optional Expansion Maternity |
$6,905.92 |
$7,100.32 |
$7,301.72 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
SPD |
$660.39 |
$679.46 |
$699.30 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
SPD/Full-Dual |
$109.72 |
$113.59 |
$117.64 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,055.21 |
$3,127.18 |
$3,201.55 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,157.33 |
$2,208.15 |
$2,260.66 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,938.25 |
$3,007.47 |
$3,078.99 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,019.21 |
$2,066.78 |
$2,115.93 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,232.24 |
$3,308.38 |
$3,387.06 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,304.79 |
$2,359.09 |
$2,415.19 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,004.51 |
$3,075.28 |
$3,148.42 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,146.98 |
$2,197.56 |
$2,249.82 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,060.56 |
$3,132.66 |
$3,207.16 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,141.18 |
$2,191.62 |
$2,243.74 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,787.38 |
$2,853.04 |
$2,920.89 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,097.53 |
$2,146.94 |
$2,198.00 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,850.35 |
$2,917.49 |
$2,986.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,149.25 |
$2,199.88 |
$2,252.20 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,102.42 |
$3,175.50 |
$3,251.02 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,121.23 |
$2,171.20 |
$2,222.83 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Adult |
$243.37 |
$251.42 |
$259.84 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
BCCTP |
$1,141.70 |
$1,174.93 |
$1,209.50 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Child |
$79.79 |
$83.13 |
$86.66 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Maternity |
$7,579.28 |
$7,792.63 |
$8,013.68 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Optional Expansion |
$335.76 |
$346.94 |
$358.63 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Optional Expansion Maternity |
$7,579.28 |
$7,792.63 |
$8,013.68 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
SPD |
$862.37 |
$887.34 |
$913.32 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
SPD/Full-Dual |
$181.97 |
$187.95 |
$194.22 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Adult |
$227.91 |
$235.35 |
$243.13 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
BCCTP |
$1,099.33 |
$1,132.02 |
$1,166.06 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Child |
$65.47 |
$68.22 |
$71.11 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Maternity |
$6,311.36 |
$6,489.02 |
$6,673.09 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Optional Expansion |
$318.95 |
$329.60 |
$340.75 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Optional Expansion Maternity |
$6,311.36 |
$6,489.02 |
$6,673.09 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
SPD |
$764.13 |
$786.25 |
$809.27 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
SPD/Full-Dual |
$119.27 |
$123.62 |
$128.21 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Adult |
$236.00 |
$243.66 |
$251.67 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
BCCTP |
$1,100.70 |
$1,133.36 |
$1,167.37 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Child |
$72.68 |
$75.61 |
$78.70 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Maternity |
$6,538.91 |
$6,722.97 |
$6,913.67 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Optional Expansion |
$338.68 |
$349.98 |
$361.81 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Optional Expansion Maternity |
$6,538.91 |
$6,722.97 |
$6,913.67 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
SPD |
$902.69 |
$928.49 |
$955.31 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
SPD/Full-Dual |
$113.80 |
$117.92 |
$122.26 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Behavioral Health Treatment 0-6 |
$2,989.93 |
$3,060.36 |
$3,133.14 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Behavioral Health Treatment 7-20 |
$2,306.19 |
$2,360.51 |
$2,416.65 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Behavioral Health Treatment 0-6 |
$2,974.72 |
$3,044.79 |
$3,117.20 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Behavioral Health Treatment 7-20 |
$2,117.95 |
$2,167.84 |
$2,219.40 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Behavioral Health Treatment 0-6 |
$3,073.19 |
$3,145.58 |
$3,220.40 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Behavioral Health Treatment 7-20 |
$2,135.41 |
$2,185.71 |
$2,237.70 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Adult |
$238.27 |
$246.24 |
$254.58 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
BCCTP |
$1,127.31 |
$1,160.11 |
$1,194.25 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Child |
$80.11 |
$83.56 |
$87.20 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Maternity |
$8,235.96 |
$8,467.80 |
$8,708.00 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Optional Expansion |
$336.75 |
$347.91 |
$359.59 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Optional Expansion Maternity |
$8,235.96 |
$8,467.80 |
$8,708.00 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
SPD |
$837.69 |
$862.25 |
$887.83 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
SPD/Full-Dual |
$138.73 |
$143.63 |
$148.78 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Behavioral Health Treatment 0-6 |
$2,992.15 |
$3,062.63 |
$3,135.47 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Behavioral Health Treatment 7-20 |
$2,222.92 |
$2,275.29 |
$2,329.40 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Adult |
$189.62 |
$195.85 |
$202.36 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
BCCTP |
$1,064.26 |
$1,095.49 |
$1,127.99 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Child |
$66.57 |
$69.32 |
$72.22 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Maternity |
$5,993.89 |
$6,162.61 |
$6,337.42 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Optional Expansion |
$304.12 |
$314.26 |
$324.86 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Optional Expansion Maternity |
$5,993.89 |
$6,162.61 |
$6,337.42 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
SPD |
$663.42 |
$682.60 |
$702.56 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
SPD/Full-Dual |
$138.67 |
$143.27 |
$148.11 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Adult |
$189.61 |
$195.88 |
$202.45 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
BCCTP |
$1,008.97 |
$1,038.54 |
$1,069.32 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Child |
$71.18 |
$74.08 |
$77.13 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Maternity |
$6,849.39 |
$7,042.20 |
$7,241.96 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Optional Expansion |
$282.95 |
$292.35 |
$302.19 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Optional Expansion Maternity |
$6,849.39 |
$7,042.20 |
$7,241.96 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
SPD |
$542.77 |
$558.56 |
$574.99 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
SPD/Full-Dual |
$118.82 |
$122.85 |
$127.08 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Adult |
$198.94 |
$205.47 |
$212.31 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
BCCTP |
$1,076.12 |
$1,107.71 |
$1,140.60 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Child |
$64.92 |
$67.69 |
$70.61 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Maternity |
$6,809.86 |
$7,001.55 |
$7,200.15 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Optional Expansion |
$252.59 |
$260.98 |
$269.75 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Optional Expansion Maternity |
$6,809.86 |
$7,001.55 |
$7,200.15 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
SPD |
$765.32 |
$787.49 |
$810.56 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
SPD/Full-Dual |
$113.31 |
$117.34 |
$121.57 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Adult |
$227.31 |
$234.77 |
$242.58 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
BCCTP |
$1,116.59 |
$1,149.88 |
$1,184.56 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Child |
$68.80 |
$71.75 |
$74.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Maternity |
$7,060.62 |
$7,259.36 |
$7,465.27 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Optional Expansion |
$308.33 |
$318.55 |
$329.25 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Optional Expansion Maternity |
$7,060.62 |
$7,259.36 |
$7,465.27 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
SPD |
$784.89 |
$807.56 |
$831.15 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
SPD/Full-Dual |
$109.07 |
$113.08 |
$117.31 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Adult |
$195.22 |
$201.63 |
$208.33 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
BCCTP |
$1,041.01 |
$1,071.87 |
$1,104.02 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Child |
$61.86 |
$64.42 |
$67.12 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Maternity |
$6,905.92 |
$7,100.32 |
$7,301.72 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Optional Expansion |
$311.84 |
$322.25 |
$333.15 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Optional Expansion Maternity |
$6,905.92 |
$7,100.32 |
$7,301.72 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
SPD |
$707.18 |
$727.60 |
$748.84 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
SPD/Full-Dual |
$119.24 |
$123.46 |
$127.90 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,989.27 |
$3,059.69 |
$3,132.46 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,145.40 |
$2,195.94 |
$2,248.17 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,780.91 |
$2,846.42 |
$2,914.11 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,365.20 |
$2,420.92 |
$2,478.49 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,887.55 |
$2,955.57 |
$3,025.86 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,075.65 |
$2,124.55 |
$2,175.08 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,830.56 |
$2,897.23 |
$2,966.14 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,100.90 |
$2,150.39 |
$2,201.54 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,891.29 |
$2,959.40 |
$3,029.78 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,116.63 |
$2,166.49 |
$2,218.01 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Adult |
$248.84 |
$256.97 |
$265.48 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
BCCTP |
$1,274.83 |
$1,312.41 |
$1,351.53 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Child |
$75.93 |
$79.10 |
$82.44 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Maternity |
$6,809.86 |
$7,001.55 |
$7,200.15 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Optional Expansion |
$309.35 |
$319.60 |
$330.33 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Optional Expansion Maternity |
$6,809.86 |
$7,001.55 |
$7,200.15 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
SPD |
$745.97 |
$767.57 |
$790.05 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
SPD/Full-Dual |
$101.77 |
$105.68 |
$109.80 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Adult |
$269.42 |
$278.24 |
$287.47 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
BCCTP |
$1,180.24 |
$1,215.16 |
$1,251.52 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Child |
$77.64 |
$80.98 |
$84.50 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Maternity |
$7,060.62 |
$7,259.36 |
$7,465.27 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Optional Expansion |
$363.63 |
$375.66 |
$388.25 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Optional Expansion Maternity |
$7,060.62 |
$7,259.36 |
$7,465.27 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
SPD |
$1,009.54 |
$1,038.49 |
$1,068.60 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
SPD/Full-Dual |
$118.92 |
$123.43 |
$128.18 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Behavioral Health Treatment 0-6 |
$2,734.31 |
$2,798.72 |
$2,865.29 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Behavioral Health Treatment 7-20 |
$2,124.91 |
$2,174.96 |
$2,226.70 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Behavioral Health Treatment 0-6 |
$2,875.25 |
$2,942.98 |
$3,012.97 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Behavioral Health Treatment 7-20 |
$2,095.76 |
$2,145.13 |
$2,196.15 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Adult |
$232.20 |
$239.76 |
$247.67 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
BCCTP |
$1,237.07 |
$1,273.83 |
$1,312.13 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Child |
$79.69 |
$82.89 |
$86.27 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Maternity |
$5,693.09 |
$5,853.34 |
$6,019.38 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Optional Expansion |
$357.50 |
$369.38 |
$381.81 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Optional Expansion Maternity |
$5,693.09 |
$5,853.34 |
$6,019.38 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
SPD |
$759.34 |
$781.13 |
$803.80 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
SPD/Full-Dual |
$110.65 |
$114.65 |
$118.86 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Adult |
$228.20 |
$235.67 |
$243.48 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
BCCTP |
$1,277.96 |
$1,315.85 |
$1,355.32 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Child |
$81.76 |
$85.06 |
$88.55 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Maternity |
$6,100.88 |
$6,272.61 |
$6,450.53 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Optional Expansion |
$334.39 |
$345.51 |
$357.13 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Optional Expansion Maternity |
$6,100.88 |
$6,272.61 |
$6,450.53 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
SPD |
$746.14 |
$767.54 |
$789.81 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
SPD/Full-Dual |
$106.30 |
$110.22 |
$114.35 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Behavioral Health Treatment 0-6 |
$2,411.15 |
$2,467.94 |
$2,526.64 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Behavioral Health Treatment 7-20 |
$1,905.54 |
$1,950.43 |
$1,996.82 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Behavioral Health Treatment 0-6 |
$2,698.81 |
$2,762.38 |
$2,828.08 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Behavioral Health Treatment 7-20 |
$1,948.54 |
$1,994.44 |
$2,041.88 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Adult |
$210.89 |
$217.79 |
$225.00 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
BCCTP |
$1,183.09 |
$1,217.58 |
$1,253.48 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Child |
$69.79 |
$72.64 |
$75.65 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Maternity |
$5,993.89 |
$6,162.61 |
$6,337.42 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Optional Expansion |
$333.78 |
$344.89 |
$356.51 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Optional Expansion Maternity |
$5,993.89 |
$6,162.61 |
$6,337.42 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
SPD |
$731.30 |
$752.36 |
$774.28 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
SPD/Full-Dual |
$142.87 |
$147.63 |
$152.64 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Behavioral Health Treatment 0-6 |
$2,986.08 |
$3,056.42 |
$3,129.11 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Behavioral Health Treatment 7-20 |
$2,344.52 |
$2,399.74 |
$2,456.82 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Adult |
$192.46 |
$198.90 |
$205.63 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
BCCTP |
$982.72 |
$1,011.66 |
$1,041.79 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Child |
$77.30 |
$80.45 |
$83.77 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Maternity |
$6,849.39 |
$7,042.20 |
$7,241.96 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Optional Expansion |
$284.26 |
$293.71 |
$303.61 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Optional Expansion Maternity |
$6,849.39 |
$7,042.20 |
$7,241.96 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
SPD |
$638.79 |
$657.40 |
$676.77 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
SPD/Full-Dual |
$121.98 |
$126.33 |
$130.91 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Behavioral Health Treatment 0-6 |
$2,616.69 |
$2,678.32 |
$2,742.01 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Behavioral Health Treatment 7-20 |
$2,090.46 |
$2,139.70 |
$2,190.58 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Adult |
$182.10 |
$188.05 |
$194.27 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
BCCTP |
$1,026.48 |
$1,056.23 |
$1,087.18 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Child |
$72.34 |
$75.22 |
$78.25 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Maternity |
$5,693.09 |
$5,853.34 |
$6,019.38 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Optional Expansion |
$296.97 |
$306.85 |
$317.18 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Optional Expansion Maternity |
$5,693.09 |
$5,853.34 |
$6,019.38 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
SPD |
$593.04 |
$610.04 |
$627.72 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
SPD/Full-Dual |
$106.99 |
$110.67 |
$114.53 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Adult |
$205.79 |
$212.54 |
$219.59 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
BCCTP |
$1,042.88 |
$1,073.05 |
$1,104.43 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Child |
$75.85 |
$78.88 |
$82.09 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Maternity |
$6,100.88 |
$6,272.61 |
$6,450.53 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Optional Expansion |
$290.81 |
$300.46 |
$310.56 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Optional Expansion Maternity |
$6,100.88 |
$6,272.61 |
$6,450.53 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
SPD |
$624.94 |
$642.86 |
$661.51 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
SPD/Full-Dual |
$106.17 |
$109.87 |
$113.76 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Behavioral Health Treatment 0-6 |
$2,508.68 |
$2,567.78 |
$2,628.85 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Behavioral Health Treatment 7-20 |
$1,912.37 |
$1,957.42 |
$2,003.97 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Behavioral Health Treatment 0-6 |
$2,478.10 |
$2,536.47 |
$2,596.80 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Behavioral Health Treatment 7-20 |
$1,904.06 |
$1,948.91 |
$1,995.26 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Adult |
$243.37 |
$251.74 |
$260.51 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
BCCTP |
$1,146.14 |
$1,179.82 |
$1,214.89 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Child |
$103.12 |
$107.53 |
$112.18 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Maternity |
$9,158.89 |
$9,416.70 |
$9,683.82 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Optional Expansion |
$331.74 |
$342.79 |
$354.35 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Optional Expansion Maternity |
$9,158.89 |
$9,416.70 |
$9,683.82 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
SPD |
$755.62 |
$777.94 |
$801.20 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
SPD/Full-Dual |
$185.78 |
$192.14 |
$198.82 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Behavioral Health Treatment 0-6 |
$2,759.33 |
$2,824.33 |
$2,891.50 |
| 07/17-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Behavioral Health Treatment 7-20 |
$2,041.50 |
$2,089.59 |
$2,139.29 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Adult |
$234.27 |
$242.02 |
$250.14 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
BCCTP |
$984.37 |
$1,013.41 |
$1,043.65 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Child |
$99.98 |
$103.96 |
$108.14 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Maternity |
$7,780.81 |
$7,999.83 |
$8,226.75 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Optional Expansion |
$290.22 |
$299.87 |
$309.97 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Optional Expansion Maternity |
$7,780.81 |
$7,999.83 |
$8,226.75 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
SPD |
$640.31 |
$659.01 |
$678.48 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
SPD/Full-Dual |
$120.80 |
$125.26 |
$129.96 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Behavioral Health Treatment 0-6 |
$2,843.42 |
$2,910.40 |
$2,979.61 |
| 07/17-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Behavioral Health Treatment 7-20 |
$2,073.31 |
$2,122.15 |
$2,172.62 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 01/18-06/18 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-12/17 |
2017-18 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |