Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
La Mesa, CA
See all hospitals reporting HCPCS J3490 →Price type
Grossmont Hospital Corporation’s median price of $2 is 96% below the median hospital's median price ($48), higher than 7% of the 1,749 hospitals reporting HCPCS J3490. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 88 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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Filter by billing class
| # | ||||
|---|---|---|---|---|
| 1 | Blue Cross Blue Shield blue cross - mcs fee schedule · outpatient | $0.55 | $0.55 | $0.10 – $1.00 |
| 2 | Blue Cross Blue Shield blue cross - hmo fee schedule · outpatient | $0.61 | $0.61 | $0.11 – $1.10 |
| 3 | Aetna first health - leased/ccn fee schedule · outpatient | $1.00 | $0.75 | $0.11 – $1.15 |
| 4 | Blue Cross Blue Shield blue cross - ppo fee schedule · outpatient | $1.00 | $1.00 | $1.00 – $1.00 |
| 5 | Aetna first health - direct fee schedule · outpatient | $1.05 | $1.05 | $1.00 – $1.10 |
| 6 | Kaiser kaiser - hmo fee schedule · outpatient | $1.05 | $1.05 | $1.00 – $1.10 |
| 7 | UnitedHealthcare united healthcare - hmo fee schedule · outpatient | $1.15 | $1.10 | $1.00 – $1.15 |
| 8 | Blue Cross Blue Shield blue cross - standard fee schedule · outpatient | $1.00 | $5.21 | $1.00 – $13.63 |
| 9 | Cigna cigna - ppo fee schedule · outpatient | $5.22 | $5.22 | $5.22 – $5.22 |
| 10 | Aetna aetna whole health fee schedule · outpatient | $5.23 | $5.23 | $5.23 – $5.23 |
| 11 | Blue Cross Blue Shield blue cross - hmo percent of total billed charges · inpatientfrom % of charges | $1.89 | $6.80 | $0.14 – $45.17 |
| 12 | Aetna aetna - hmo/pos fee schedule · outpatient | $7.76 | $7.76 | $1.00 – $14.52 |
| 13 | UnitedHealthcare united healthcare - ppo fee schedule · outpatient | $1.00 | $8.02 | $1.00 – $22.05 |
| 14 | Molina molina - exchange percent of total billed charges · inpatientfrom % of charges | $1.65 | $8.09 | $0.54 – $45.17 |
| 15 | UnitedHealthcare united healthcare - medicare fee schedule · outpatient | $9.30 | $9.46 | $1.15 – $17.93 |
| 16 | Molina molina medi-cal fee schedule · outpatient | $9.70 | $10.15 | $0.71 – $20.81 |
| 17 | Blue Cross Blue Shield blue shield - promise percent of total billed charges · inpatientfrom % of charges | $1.53 | $11.46 | $0.14 – $92.18 |
| 18 | Medicare medicare percent of total billed charges · outpatientfrom % of charges | $1.18 | $11.90 | $0.34 – $104.94 |
| 19 | Molina molina - exchange percent of total billed charges · outpatientfrom % of charges | $1.11 | $12.58 | $0.20 – $84.49 |
| 20 | Blue Cross Blue Shield blue shield - ppo fee schedule · outpatient | $12.68 | $12.68 | $12.68 – $12.68 |
| 21 | MultiPlan multiplan percent of total billed charges · inpatientfrom % of charges | $1.70 | $12.81 | $0.52 – $75.48 |
| 22 | Aetna first health - direct percent of total billed charges · inpatientfrom % of charges | $1.84 | $13.90 | $0.09 – $122.90 |
| 23 | Molina molina medi-cal percent of total billed charges · outpatientfrom % of charges | $1.15 | $13.94 | $0.14 – $115.22 |
| 24 | Blue Cross Blue Shield blue shield - promise percent of total billed charges · outpatientfrom % of charges | $4.40 | $14.59 | $0.65 – $91.70 |
| 25 | Medicaid medi-cal percent of total billed charges · outpatientfrom % of charges | $2.17 | $15.91 | $0.67 – $71.53 |
Last updated: Apr 1, 2026
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