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
Chula Vista, CA
See all hospitals reporting HCPCS J3490 →Price type
Sharp Chula Vista Medical Center’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, 79 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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| # | ||||
|---|---|---|---|---|
| 1 | Aetna first health - leased/ccn fee schedule · outpatient | $1.15 | $0.90 | $0.41 – $1.15 |
| 2 | Aetna aetna - ppo fee schedule · outpatient | $1.00 | $1.00 | $1.00 – $1.00 |
| 3 | Blue Cross Blue Shield blue cross - hmo fee schedule · outpatient | $1.00 | $1.00 | $1.00 – $1.00 |
| 4 | Blue Cross Blue Shield blue cross - mcs fee schedule · outpatient | $1.00 | $1.00 | $1.00 – $1.00 |
| 5 | Cigna cigna - hmo fee schedule · outpatient | $1.00 | $1.00 | $1.00 – $1.00 |
| 6 | Kaiser kaiser - hmo fee schedule · outpatient | $1.00 | $1.00 | $1.00 – $1.00 |
| 7 | UnitedHealthcare united healthcare - ppo fee schedule · outpatient | $1.00 | $1.00 | $1.00 – $1.00 |
| 8 | Blue Cross Blue Shield blue cross - ppo fee schedule · outpatient | $1.15 | $1.15 | $1.15 – $1.15 |
| 9 | Aetna first health medicare fee schedule · outpatient | $1.30 | $1.30 | $1.30 – $1.30 |
| 10 | Aetna aetna - hmo/pos fee schedule · outpatient | $1.15 | $2.44 | $1.00 – $5.18 |
| 11 | Medicare medicare fee schedule · outpatient | $2.48 | $3.12 | $1.15 – $5.74 |
| 12 | UnitedHealthcare united healthcare - hmo fee schedule · outpatient | $1.00 | $4.62 | $1.00 – $11.85 |
| 13 | UnitedHealthcare united healthcare - medicare percent of total billed charges · inpatientfrom % of charges | $1.52 | $10.26 | $0.40 – $91.58 |
| 14 | Medicare medicare percent of total billed charges · inpatientfrom % of charges | $2.02 | $10.42 | $0.11 – $65.77 |
| 15 | Molina molina - cal medi-connect percent of total billed charges · inpatientfrom % of charges | $1.50 | $10.71 | $0.10 – $70.52 |
| 16 | Molina molina - exchange fee schedule · outpatient | $12.09 | $12.09 | $12.09 – $12.09 |
| 17 | Blue Cross Blue Shield blue shield - hmo fee schedule · outpatient | $1.00 | $12.18 | $1.00 – $34.54 |
| 18 | Molina molina - exchange percent of total billed charges · outpatientfrom % of charges | $1.48 | $13.50 | $0.56 – $86.74 |
| 19 | Cigna cigna - ppo percent of total billed charges · inpatientfrom % of charges | $1.16 | $14.44 | $0.18 – $141.53 |
| 20 | Aetna aetna - ppo percent of total billed charges · inpatientfrom % of charges | $2.07 | $14.80 | $0.35 – $88.26 |
| 21 | Blue Cross Blue Shield blue shield - hmo percent of total billed charges · outpatientfrom % of charges | $2.10 | $15.37 | $0.61 – $55.90 |
| 22 | UnitedHealthcare united healthcare - medicare percent of total billed charges · outpatientfrom % of charges | $0.96 | $17.93 | $0.48 – $67.59 |
| 23 | UnitedHealthcare united healthcare - ppo percent of total billed charges · inpatientfrom % of charges | $1.65 | $18.08 | $0.58 – $90.12 |
| 24 | Blue Cross Blue Shield blue cross - prudent buyer percent of total billed charges · outpatientfrom % of charges | $0.75 | $18.27 | $0.15 – $93.99 |
| 25 | Blue Cross Blue Shield blue shield - promise percent of total billed charges · outpatientfrom % of charges | $2.55 | $18.62 | $0.32 – $83.03 |
Last updated: Apr 1, 2026
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