| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Adult |
$219.11 |
$226.62 |
$234.50 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
BCCTP |
$1,187.06 |
$1,221.95 |
$1,258.27 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Behavioral Health Treatment 0-6 |
$2,997.62 |
$3,074.11 |
$3,153.23 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Behavioral Health Treatment 7-20 |
$2,109.33 |
$2,163.15 |
$2,218.82 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Child |
$92.01 |
$95.94 |
$100.09 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Maternity |
$8,034.47 |
$8,261.07 |
$8,495.86 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Optional Expansion |
$309.48 |
$319.80 |
$330.60 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Optional Expansion - Maternity |
$8,034.47 |
$8,261.07 |
$8,495.86 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
SPD |
$849.48 |
$874.42 |
$900.39 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
SPD/Full-Dual |
$157.14 |
$162.66 |
$168.46 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Adult |
$202.80 |
$209.77 |
$217.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
BCCTP |
$1,040.17 |
$1,071.06 |
$1,103.22 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,349.35 |
$3,434.80 |
$3,523.21 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,420.87 |
$2,482.64 |
$2,546.54 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Child |
$82.64 |
$86.25 |
$90.07 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Maternity |
$8,034.47 |
$8,261.07 |
$8,495.86 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Optional Expansion |
$242.47 |
$250.55 |
$259.01 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Optional Expansion - Maternity |
$8,034.47 |
$8,261.07 |
$8,495.86 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
SPD |
$850.49 |
$875.43 |
$901.41 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
SPD/Full-Dual |
$154.78 |
$160.37 |
$166.24 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Adult |
$226.05 |
$233.55 |
$241.41 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
BCCTP |
$1,066.51 |
$1,097.86 |
$1,130.50 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,150.99 |
$3,231.39 |
$3,314.56 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,097.68 |
$2,151.21 |
$2,206.58 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Child |
$76.98 |
$80.34 |
$83.88 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Maternity |
$8,199.11 |
$8,430.36 |
$8,669.97 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Optional Expansion |
$261.70 |
$270.46 |
$279.62 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Optional Expansion - Maternity |
$8,199.11 |
$8,430.36 |
$8,669.97 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
SPD |
$759.94 |
$782.22 |
$805.41 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
SPD/Full-Dual |
$137.27 |
$142.05 |
$147.07 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Adult |
$221.44 |
$228.75 |
$236.41 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
BCCTP |
$1,020.61 |
$1,050.73 |
$1,082.10 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,635.47 |
$3,728.22 |
$3,824.18 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,575.37 |
$2,641.08 |
$2,709.06 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Child |
$73.11 |
$76.20 |
$79.47 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Maternity |
$7,442.24 |
$7,652.13 |
$7,869.62 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Optional Expansion |
$277.39 |
$286.69 |
$296.43 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,442.24 |
$7,652.13 |
$7,869.62 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
SPD |
$708.29 |
$728.90 |
$750.35 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
SPD/Full-Dual |
$172.72 |
$178.51 |
$184.59 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Adult |
$213.62 |
$220.62 |
$227.95 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
BCCTP |
$1,118.11 |
$1,150.95 |
$1,185.13 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,320.30 |
$3,405.02 |
$3,492.66 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,390.24 |
$2,451.23 |
$2,514.32 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Child |
$63.87 |
$66.57 |
$69.42 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Maternity |
$6,879.92 |
$7,073.96 |
$7,275.01 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Optional Expansion |
$277.22 |
$286.57 |
$296.35 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,879.92 |
$7,073.96 |
$7,275.01 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
SPD |
$702.03 |
$722.38 |
$743.55 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
SPD/Full-Dual |
$122.45 |
$126.72 |
$131.20 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Adult |
$213.07 |
$219.95 |
$227.14 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
BCCTP |
$1,054.82 |
$1,086.05 |
$1,118.57 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,368.91 |
$3,454.87 |
$3,543.79 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,447.49 |
$2,509.94 |
$2,574.54 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Child |
$67.59 |
$70.34 |
$73.24 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Maternity |
$6,625.15 |
$6,812.00 |
$7,005.60 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Optional Expansion |
$269.47 |
$278.53 |
$288.02 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,625.15 |
$6,812.00 |
$7,005.60 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
SPD |
$717.23 |
$737.71 |
$759.00 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
SPD/Full-Dual |
$115.36 |
$119.47 |
$123.79 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Adult |
$256.01 |
$265.02 |
$274.46 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
BCCTP |
$1,117.21 |
$1,151.48 |
$1,187.22 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,869.68 |
$2,942.90 |
$3,018.65 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,291.03 |
$2,349.49 |
$2,409.97 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Child |
$89.66 |
$93.89 |
$98.37 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Maternity |
$8,779.93 |
$9,027.56 |
$9,284.13 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Optional Expansion |
$331.73 |
$342.84 |
$354.47 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Optional Expansion - Maternity |
$8,779.93 |
$9,027.56 |
$9,284.13 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
SPD |
$841.40 |
$866.48 |
$892.62 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
SPD/Full-Dual |
$429.34 |
$442.33 |
$455.95 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Health Homes Non-Dual |
$589.32 |
$627.06 |
$668.29 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Health Homes Dual |
$129.94 |
$138.09 |
$147.16 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Adult |
$214.35 |
$221.44 |
$228.87 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
BCCTP |
$1,043.74 |
$1,074.49 |
$1,106.50 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,229.88 |
$3,312.28 |
$3,397.54 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,356.02 |
$2,416.13 |
$2,478.32 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Child |
$77.56 |
$80.79 |
$84.20 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Maternity |
$7,325.28 |
$7,531.87 |
$7,745.92 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Optional Expansion |
$235.48 |
$243.36 |
$251.62 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,325.28 |
$7,531.87 |
$7,745.92 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
SPD |
$552.32 |
$568.66 |
$585.67 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
SPD/Full-Dual |
$121.70 |
$125.92 |
$130.35 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Adult |
$199.79 |
$206.31 |
$213.14 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
BCCTP |
$1,031.88 |
$1,062.44 |
$1,094.26 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$3,566.92 |
$3,657.92 |
$3,752.07 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$2,384.96 |
$2,445.81 |
$2,508.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Child |
$56.97 |
$59.37 |
$61.89 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Maternity |
$6,796.46 |
$6,988.15 |
$7,186.76 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Optional Expansion |
$268.88 |
$277.93 |
$287.41 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,796.46 |
$6,988.15 |
$7,186.76 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
SPD |
$643.91 |
$662.57 |
$681.99 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
SPD/Full-Dual |
$107.54 |
$111.36 |
$115.38 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Adult |
$241.17 |
$249.16 |
$257.52 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
BCCTP |
$1,144.77 |
$1,177.97 |
$1,212.50 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Behavioral Health Treatment 0-6 |
$3,587.04 |
$3,678.56 |
$3,773.24 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Behavioral Health Treatment 7-20 |
$2,645.70 |
$2,713.20 |
$2,783.03 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Child |
$78.91 |
$82.24 |
$85.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Maternity |
$7,442.24 |
$7,652.13 |
$7,869.62 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Optional Expansion |
$313.96 |
$324.50 |
$335.53 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Optional Expansion - Maternity |
$7,442.24 |
$7,652.13 |
$7,869.62 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
SPD |
$855.94 |
$880.80 |
$906.68 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
SPD/Full-Dual |
$179.53 |
$185.52 |
$191.80 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Adult |
$230.64 |
$238.21 |
$246.13 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
BCCTP |
$1,070.85 |
$1,102.78 |
$1,136.03 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Behavioral Health Treatment 0-6 |
$3,395.24 |
$3,481.87 |
$3,571.48 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Behavioral Health Treatment 7-20 |
$2,397.71 |
$2,458.89 |
$2,522.18 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Child |
$66.19 |
$69.01 |
$71.98 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Maternity |
$6,879.92 |
$7,073.96 |
$7,275.01 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Optional Expansion |
$320.91 |
$331.73 |
$343.05 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Optional Expansion - Maternity |
$6,879.92 |
$7,073.96 |
$7,275.01 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
SPD |
$737.85 |
$759.26 |
$781.52 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
SPD/Full-Dual |
$127.10 |
$131.68 |
$136.50 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Adult |
$250.76 |
$258.83 |
$267.27 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
BCCTP |
$1,036.12 |
$1,067.03 |
$1,099.22 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Behavioral Health Treatment 0-6 |
$3,445.24 |
$3,533.15 |
$3,624.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Behavioral Health Treatment 7-20 |
$2,460.81 |
$2,523.60 |
$2,588.56 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Child |
$70.54 |
$73.42 |
$76.45 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Maternity |
$6,625.15 |
$6,812.00 |
$7,005.60 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Optional Expansion |
$305.47 |
$315.75 |
$326.51 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Optional Expansion - Maternity |
$6,625.15 |
$6,812.00 |
$7,005.60 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
SPD |
$795.01 |
$817.72 |
$841.34 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
SPD/Full-Dual |
$124.42 |
$128.88 |
$133.56 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Adult |
$256.94 |
$265.54 |
$274.55 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
BCCTP |
$1,120.75 |
$1,153.38 |
$1,187.34 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Behavioral Health Treatment 0-6 |
$3,478.94 |
$3,567.72 |
$3,659.56 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Behavioral Health Treatment 7-20 |
$2,482.88 |
$2,546.24 |
$2,611.80 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Child |
$79.70 |
$83.22 |
$86.95 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Maternity |
$8,199.11 |
$8,430.36 |
$8,669.97 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Optional Expansion |
$337.18 |
$348.47 |
$360.28 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Optional Expansion - Maternity |
$8,199.11 |
$8,430.36 |
$8,669.97 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
SPD |
$926.57 |
$953.76 |
$982.07 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
SPD/Full-Dual |
$123.82 |
$128.42 |
$133.27 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Adult |
$206.59 |
$213.37 |
$220.46 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
BCCTP |
$1,032.47 |
$1,062.51 |
$1,093.76 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Behavioral Health Treatment 0-6 |
$3,164.46 |
$3,245.19 |
$3,328.72 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,221.42 |
$2,278.10 |
$2,336.74 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Child |
$64.21 |
$66.96 |
$69.87 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Maternity |
$6,168.78 |
$6,342.75 |
$6,523.00 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Optional Expansion |
$302.30 |
$312.45 |
$323.07 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Optional Expansion - Maternity |
$6,168.78 |
$6,342.75 |
$6,523.00 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
SPD |
$719.22 |
$740.12 |
$761.88 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
SPD/Full-Dual |
$132.09 |
$136.57 |
$141.28 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Adult |
$182.49 |
$188.59 |
$194.98 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
BCCTP |
$984.65 |
$1,013.51 |
$1,043.54 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,956.76 |
$3,032.19 |
$3,110.23 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,496.53 |
$2,560.23 |
$2,626.12 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Child |
$71.12 |
$74.06 |
$77.16 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Maternity |
$6,840.81 |
$7,033.74 |
$7,233.64 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Optional Expansion |
$286.04 |
$295.64 |
$305.68 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Optional Expansion - Maternity |
$6,840.81 |
$7,033.74 |
$7,233.64 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
SPD |
$562.28 |
$578.48 |
$595.34 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
SPD/Full-Dual |
$124.41 |
$128.63 |
$133.07 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Adult |
$194.10 |
$200.49 |
$207.18 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
BCCTP |
$1,059.14 |
$1,089.79 |
$1,121.67 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Behavioral Health Treatment 0-6 |
$3,045.81 |
$3,123.52 |
$3,203.92 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,303.41 |
$2,362.18 |
$2,422.98 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Child |
$63.83 |
$66.58 |
$69.49 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Maternity |
$6,595.36 |
$6,781.37 |
$6,974.09 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Optional Expansion |
$249.43 |
$257.79 |
$266.54 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Optional Expansion - Maternity |
$6,595.36 |
$6,781.37 |
$6,974.09 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
SPD |
$732.68 |
$754.10 |
$776.39 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
SPD/Full-Dual |
$125.00 |
$129.36 |
$133.94 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Adult |
$245.16 |
$253.19 |
$261.60 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
BCCTP |
$1,096.42 |
$1,128.93 |
$1,162.78 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Behavioral Health Treatment 0-6 |
$3,092.99 |
$3,171.91 |
$3,253.55 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,185.38 |
$2,241.14 |
$2,298.83 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Child |
$66.01 |
$68.93 |
$72.02 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Maternity |
$7,311.50 |
$7,517.69 |
$7,731.34 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Optional Expansion |
$282.98 |
$292.43 |
$302.33 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Optional Expansion - Maternity |
$7,311.50 |
$7,517.69 |
$7,731.34 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
SPD |
$828.47 |
$852.43 |
$877.36 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
SPD/Full-Dual |
$124.64 |
$129.11 |
$133.82 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Adult |
$198.44 |
$204.93 |
$211.72 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
BCCTP |
$1,047.78 |
$1,079.08 |
$1,111.68 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Behavioral Health Treatment 0-6 |
$3,193.50 |
$3,274.98 |
$3,359.27 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Behavioral Health Treatment 7-20 |
$2,220.33 |
$2,276.98 |
$2,335.59 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Child |
$56.98 |
$59.40 |
$61.95 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Maternity |
$6,796.46 |
$6,988.15 |
$7,186.76 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Optional Expansion |
$285.23 |
$294.83 |
$304.88 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Optional Expansion - Maternity |
$6,796.46 |
$6,988.15 |
$7,186.76 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
SPD |
$652.76 |
$671.65 |
$691.30 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Tulare |
Health Net of California |
SPD/Full-Dual |
$122.81 |
$127.08 |
$131.57 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Adult |
$254.45 |
$262.78 |
$271.49 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
BCCTP |
$1,251.66 |
$1,288.65 |
$1,327.17 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Behavioral Health Treatment 0-6 |
$2,982.30 |
$3,058.39 |
$3,137.11 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Behavioral Health Treatment 7-20 |
$2,208.46 |
$2,264.82 |
$2,323.12 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Child |
$74.78 |
$77.94 |
$81.28 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Maternity |
$6,595.36 |
$6,781.37 |
$6,974.09 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Optional Expansion |
$309.27 |
$319.62 |
$330.45 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Optional Expansion - Maternity |
$6,595.36 |
$6,781.37 |
$6,974.09 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
SPD |
$767.28 |
$789.64 |
$812.92 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
SPD/Full-Dual |
$102.52 |
$106.45 |
$110.59 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Adult |
$298.38 |
$308.10 |
$318.28 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
BCCTP |
$1,187.60 |
$1,223.04 |
$1,259.95 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Behavioral Health Treatment 0-6 |
$3,181.56 |
$3,262.75 |
$3,346.73 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Behavioral Health Treatment 7-20 |
$2,242.11 |
$2,299.33 |
$2,358.52 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Child |
$75.75 |
$79.09 |
$82.61 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Maternity |
$7,311.50 |
$7,517.69 |
$7,731.34 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Optional Expansion |
$349.43 |
$361.08 |
$373.28 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Optional Expansion - Maternity |
$7,311.50 |
$7,517.69 |
$7,731.34 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
SPD |
$1,053.79 |
$1,084.11 |
$1,115.67 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
SPD/Full-Dual |
$118.43 |
$122.99 |
$127.79 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Adult |
$252.68 |
$260.93 |
$269.55 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
BCCTP |
$1,215.97 |
$1,252.10 |
$1,289.73 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Behavioral Health Treatment 0-6 |
$2,571.56 |
$2,637.17 |
$2,705.05 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Behavioral Health Treatment 7-20 |
$2,048.45 |
$2,100.72 |
$2,154.79 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Child |
$76.92 |
$80.11 |
$83.48 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Maternity |
$5,993.60 |
$6,162.63 |
$6,337.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Optional Expansion |
$365.00 |
$377.22 |
$390.02 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Optional Expansion - Maternity |
$5,993.60 |
$6,162.63 |
$6,337.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
SPD |
$837.60 |
$861.88 |
$887.15 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
SPD/Full-Dual |
$132.05 |
$136.75 |
$141.69 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 01/19-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Health Homes Non-Dual |
$443.60 |
$473.79 |
$506.77 |
| 01/19-06/19 |
2018-19 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Health Homes Dual |
$148.20 |
$158.11 |
$169.15 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Adult |
$253.33 |
$261.63 |
$270.31 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
BCCTP |
$1,253.41 |
$1,290.66 |
$1,329.45 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Behavioral Health Treatment 0-6 |
$2,807.20 |
$2,878.83 |
$2,952.93 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Behavioral Health Treatment 7-20 |
$2,013.68 |
$2,065.06 |
$2,118.21 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Child |
$78.73 |
$82.05 |
$85.54 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Maternity |
$6,293.54 |
$6,471.03 |
$6,654.94 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Optional Expansion |
$336.19 |
$347.45 |
$359.24 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Optional Expansion - Maternity |
$6,293.54 |
$6,471.03 |
$6,654.94 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
SPD |
$830.69 |
$854.82 |
$879.93 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
SPD/Full-Dual |
$118.59 |
$122.89 |
$127.42 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 01/19-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Health Homes Non-Dual |
$446.61 |
$476.88 |
$509.94 |
| 01/19-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Health Homes Dual |
$148.31 |
$158.22 |
$169.26 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Adult |
$234.71 |
$242.38 |
$250.41 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
BCCTP |
$1,204.85 |
$1,240.34 |
$1,277.29 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Behavioral Health Treatment 0-6 |
$3,397.41 |
$3,484.09 |
$3,573.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Behavioral Health Treatment 7-20 |
$2,584.21 |
$2,650.14 |
$2,718.35 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Child |
$70.23 |
$73.20 |
$76.34 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Maternity |
$6,168.78 |
$6,342.75 |
$6,523.00 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Optional Expansion |
$352.56 |
$364.39 |
$376.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Optional Expansion - Maternity |
$6,168.78 |
$6,342.75 |
$6,523.00 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
SPD |
$797.27 |
$820.37 |
$844.41 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
SPD/Full-Dual |
$161.98 |
$167.35 |
$172.98 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Adult |
$195.01 |
$201.57 |
$208.43 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
BCCTP |
$981.99 |
$1,011.27 |
$1,041.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Behavioral Health Treatment 0-6 |
$3,032.71 |
$3,110.08 |
$3,190.12 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Behavioral Health Treatment 7-20 |
$2,293.01 |
$2,351.51 |
$2,412.03 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Child |
$77.27 |
$80.47 |
$83.84 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Maternity |
$6,840.81 |
$7,033.74 |
$7,233.64 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Optional Expansion |
$295.50 |
$305.41 |
$315.78 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Optional Expansion - Maternity |
$6,840.81 |
$7,033.74 |
$7,233.64 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
SPD |
$716.20 |
$736.27 |
$757.15 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
SPD/Full-Dual |
$125.22 |
$129.66 |
$134.32 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Adult |
$187.37 |
$193.51 |
$199.94 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
BCCTP |
$1,013.28 |
$1,042.90 |
$1,073.71 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Behavioral Health Treatment 0-6 |
$2,518.50 |
$2,582.76 |
$2,649.24 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Behavioral Health Treatment 7-20 |
$1,937.49 |
$1,986.93 |
$2,038.07 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Child |
$70.39 |
$73.26 |
$76.30 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Maternity |
$5,993.60 |
$6,162.63 |
$6,337.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Optional Expansion |
$279.17 |
$288.53 |
$298.32 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Optional Expansion - Maternity |
$5,993.60 |
$6,162.63 |
$6,337.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
SPD |
$621.72 |
$639.69 |
$658.39 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
SPD/Full-Dual |
$107.13 |
$110.79 |
$114.64 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 01/19-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Health Homes Non-Dual |
$444.06 |
$474.01 |
$506.72 |
| 01/19-06/19 |
2018-19 |
Two Plan |
Riverside |
Molina Healthcare |
Health Homes Dual |
$139.04 |
$148.80 |
$159.69 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Adult |
$214.95 |
$222.01 |
$229.39 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
BCCTP |
$1,008.98 |
$1,038.48 |
$1,069.18 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Behavioral Health Treatment 0-6 |
$2,444.57 |
$2,506.94 |
$2,571.47 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Behavioral Health Treatment 7-20 |
$1,836.44 |
$1,883.29 |
$1,931.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Child |
$73.64 |
$76.67 |
$79.88 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Maternity |
$6,293.54 |
$6,471.03 |
$6,654.94 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Optional Expansion |
$280.75 |
$290.16 |
$300.01 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Optional Expansion - Maternity |
$6,293.54 |
$6,471.03 |
$6,654.94 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
SPD |
$657.88 |
$677.00 |
$696.90 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
SPD/Full-Dual |
$111.61 |
$115.44 |
$119.46 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 01/19-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Health Homes Non-Dual |
$446.23 |
$476.32 |
$509.19 |
| 01/19-06/19 |
2018-19 |
Two Plan |
San Bernardino |
Molina Healthcare |
Health Homes Dual |
$142.28 |
$152.10 |
$163.05 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Adult |
$234.74 |
$242.86 |
$251.38 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
BCCTP |
$1,116.70 |
$1,149.98 |
$1,184.63 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Behavioral Health Treatment 0-6 |
$2,784.96 |
$2,856.02 |
$2,929.53 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Behavioral Health Treatment 7-20 |
$2,201.32 |
$2,257.49 |
$2,315.60 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Child |
$100.76 |
$105.14 |
$109.77 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Maternity |
$8,779.93 |
$9,027.56 |
$9,284.13 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Optional Expansion |
$367.48 |
$379.80 |
$392.70 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Optional Expansion - Maternity |
$8,779.93 |
$9,027.56 |
$9,284.13 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
SPD |
$798.33 |
$822.07 |
$846.81 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
SPD/Full-Dual |
$169.88 |
$175.85 |
$182.12 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Health Homes Non-Dual |
$585.55 |
$623.14 |
$664.21 |
| 07/18-06/19 |
2018-19 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Health Homes Dual |
$132.13 |
$140.36 |
$149.51 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Adult |
$240.56 |
$248.51 |
$256.83 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
BCCTP |
$993.59 |
$1,022.76 |
$1,053.13 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Behavioral Health Treatment 0-6 |
$3,052.70 |
$3,130.58 |
$3,211.16 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Behavioral Health Treatment 7-20 |
$2,592.29 |
$2,658.42 |
$2,726.84 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Child |
$90.55 |
$94.25 |
$98.17 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Maternity |
$7,325.28 |
$7,531.87 |
$7,745.92 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Optional Expansion |
$288.07 |
$297.71 |
$307.80 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Optional Expansion - Maternity |
$7,325.28 |
$7,531.87 |
$7,745.92 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
SPD |
$629.30 |
$647.90 |
$667.28 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
SPD/Full-Dual |
$124.56 |
$129.07 |
$133.83 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Hepatitis C Non-340B |
$3,784.81 |
$3,910.44 |
$4,050.08 |
| 07/18-06/19 |
2018-19 |
Two Plan |
Santa Clara |
Santa Clara Family Health Plan |
Hepatitis C 340B |
$2,938.18 |
$3,037.18 |
$3,147.04 |