CMS Price Transparency Data
Inguinal hernia repair
Facility: Johnson Memorial Hospital
Billing Code: 49505 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 49505
- Insurance Median: $159
- Cash Discount Price: $1,095
- vs. Medicare Baseline: 0.04x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Johnson Memorial Hospital is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,095. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.04x the Medicare baseline. Located in 201 Chestnut Hill Road, Stafford Springs, CT.
Cash / Self-Pay
$1,095
Average discount available for prompt cash payment at this facility.
Insurance Median
$159
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$3,657.95
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $3,657.95 (100%)
Cash / Self-Pay: $1,095 (30%)
Insurance Median: $159 (4%)
Cash: $1,095 (30% of Medicare)
Ins. Median: $159 (4% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $3,657.95 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Fallon Health | $53 - $5,580 | 1% |
| Bcn Domestic | $54 - $6,585 | 1% |
| Blue Benefit Administrators Of Massachusetts | $54 - $6,585 | 1% |
| Blue Care Network | $54 - $6,585 | 1% |
| Blue Cross Blue Shield | $54 - $6,585 | 1% |
| Blue Distinction Transplant | $54 - $6,585 | 1% |
| Blue Shield - Ca | $54 - $6,585 | 1% |
| Blue Shield - Id (Regence) | $54 - $6,585 | 1% |
| Blue Shield - Ny Highmark Northeastern | $54 - $6,585 | 1% |
| Blue Shield - Ny Highmark Western | $54 - $6,585 | 1% |
| Blue Shield - Pa (Highmark) | $54 - $6,585 | 1% |
| Blue Shield - Wa (Regence) | $54 - $6,585 | 1% |
| Health Choices | $54 - $6,585 | 1% |
| Kaiser Domestic | $54 - $6,585 | 1% |
| Pre-Employment | $54 - $6,585 | 1% |
| Wc Domestic | $54 - $6,585 | 1% |
| Health New England | $55 - $578 | 2% |
| Medicaid / KanCare | $60 - $1,515 | 2% |
| Mass General Brigham Health Plan | $63 - $861 | 2% |
| Aetna | $64 - $4,206 | 2% |
| Align Senior Care | $64 - $398 | 2% |
| Ally Align Care Adv | $64 - $398 | 2% |
| American Health Advantage Of Idaho | $64 - $398 | 2% |
| American Health Plan | $64 - $398 | 2% |
| Aurora Special Needs | $64 - $398 | 2% |
| Blue Care Network Advantage | $64 - $398 | 2% |
| Blue Shield - De (Highmark) Medciare Advantage | $64 - $398 | 2% |
| Care Dimensions | $64 - $398 | 2% |
| Care Improvement Plus | $64 - $398 | 2% |
| Care Resources Pace | $64 - $398 | 2% |
| Careplus Health Plans | $64 - $398 | 2% |
| Cca - Zing Health | $64 - $398 | 2% |
| Central Valley Medical Services Corp Pace | $64 - $398 | 2% |
| Champion Health Plan Mcr Advantage | $64 - $398 | 2% |
| Champva | $64 - $398 | 2% |
| Cigna | $64 - $4,333 | 2% |
| Clear Spring Health | $64 - $398 | 2% |
| Clover Health | $64 - $398 | 2% |
| Commonwealth Care Alliance | $64 - $415 | 2% |
| Community Pace At Home | $64 - $398 | 2% |
| Eddy Senior Care-Pace | $64 - $398 | 2% |
| Eddy Seniorcare Pace | $64 - $398 | 2% |
| Elementcare | $64 - $398 | 2% |
| Evercare | $64 - $398 | 2% |
| Everence | $64 - $398 | 2% |
| Gateway Health Plan | $64 - $398 | 2% |
| Genesys Pace Of Genesee County | $64 - $398 | 2% |
| Georgia Health Advantage | $64 - $398 | 2% |
| Gold Advantage | $64 - $398 | 2% |
| Gpa Croell Redi Mix | $64 - $398 | 2% |
| Health America Advantra | $64 - $398 | 2% |
| Highmark Health Options Dual Plan | $64 - $398 | 2% |
| Hope Select Pace | $64 - $398 | 2% |
| Horizon Nj Total Care | $64 - $398 | 2% |
| Hudson Headwaters Pace | $64 - $398 | 2% |
| Humana | $64 - $398 | 2% |
| Huron Valley Pace | $64 - $398 | 2% |
| Innovative Integrated Health Community Plans | $64 - $398 | 2% |
| Iowa Health Advantage | $64 - $398 | 2% |
| Johns Hopkins Advantage Md | $64 - $398 | 2% |
| Lasso Healthcare Msa | $64 - $398 | 2% |
| Life St Marys Pace | $64 - $398 | 2% |
| Lifecircles Pace | $64 - $398 | 2% |
| Longevity Health Plan | $64 - $398 | 2% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $64 - $398 | 2% |
| Martins Point Generations Advantage | $64 - $398 | 2% |
| Mass General Brigham Mcr Adv | $64 - $398 | 2% |
| Medicare (plans) | $64 - $4,421 | 2% |
| Medipak Advantage | $64 - $398 | 2% |
| Mercy Life | $64 - $398 | 2% |
| Mercyone Cedar Valley | $64 - $398 | 2% |
| Meridian Complete | $64 - $398 | 2% |
| Michigan Complete Health | $64 - $398 | 2% |
| Nascentia Health Plus | $64 - $398 | 2% |
| New Centry Health Careplus | $64 - $398 | 2% |
| Osu Prime Care Advantage | $64 - $398 | 2% |
| Pace Cny | $64 - $398 | 2% |
| Pace Iowa Immanuel Pathways | $64 - $398 | 2% |
| Pace Of Southwest Michigan | $64 - $398 | 2% |
| Pace Southeast | $64 - $398 | 2% |
| Pace-Trinity Health | $64 - $398 | 2% |
| Peak Pace Solutions | $64 - $398 | 2% |
| Perennial Advantage | $64 - $398 | 2% |
| Preferred Care Partners | $64 - $398 | 2% |
| Presbyterian Senior Plan | $64 - $398 | 2% |
| Provider Partners Health Plan Of Illinois | $64 - $398 | 2% |
| Provider Partners Health Plan Of Indiana | $64 - $398 | 2% |
| Pruitthealth Premier | $64 - $398 | 2% |
| Reliance Community Care Partners Care Resources Pace | $64 - $398 | 2% |
| Rx Allwin | $64 - $398 | 2% |
| Rx Grane Grnmedd | $64 - $398 | 2% |
| Rx Retiree Rx Care | $64 - $398 | 2% |
| Scan Health Plan Mcr Ipa Meritage Oon | $64 - $398 | 2% |
| Secure Horizons Ma Pffs | $64 - $398 | 2% |
| Serenity Pace | $64 - $398 | 2% |
| Siouxland Pace | $64 - $398 | 2% |
| Solis Health Plans | $64 - $398 | 2% |
| Sunnyview-Pace Finance Dept | $64 - $398 | 2% |
| Texan Plus | $64 - $398 | 2% |
| The Health Plan | $64 - $398 | 2% |
| Thome Pace | $64 - $398 | 2% |
| Todays Options | $64 - $398 | 2% |
| Tribute Health Plans | $64 - $398 | 2% |
| Tricare | $64 - $398 | 2% |
| Triwest Health Alliance | $64 - $398 | 2% |
| Um Health Advantage | $64 - $398 | 2% |
| Union Health Service | $64 - $398 | 2% |
| UnitedHealthcare | $64 - $4,206 | 2% |
| Veterans Eval Services | $64 - $398 | 2% |
| Welbe Health | $64 - $398 | 2% |
| Wellmed | $64 - $398 | 2% |
| Cca Senior Care Options | $65 - $4,291 | 2% |
| Veterans Administration | $65 - $406 | 2% |
| Us Family Health Plan | $66 - $565 | 2% |
| Unicare | $74 - $6,585 | 2% |
| Wellpoint | $74 - $6,585 | 2% |
| Claimdoc | $76 - $9,014 | 2% |
| Innovative Health Plan Ii | $76 - $9,014 | 2% |
| Connecticare | $89 - $1,120 | 2% |
| Tufts Health Plan | $90 - $848 | 2% |
| Healthscope | $91 - $853 | 2% |
| Multiplan | $91 - $857 | 2% |
| Harvard Pilgrim Healthcare | $95 - $890 | 3% |
| Centivo | $100 - $10,001 | 3% |
| Prime Health Services | $104 - $974 | 3% |
| Coventry | $105 - $980 | 3% |
| First Health | $105 - $980 | 3% |
| Guardian | $105 - $980 | 3% |
| Meritain | $105 - $980 | 3% |
| Andrie Inc | $106 - $997 | 3% |
| East Greenbush Central School District | $106 - $997 | 3% |
| Genex Wc | $106 - $997 | 3% |
| Healthsmart Workers Comp | $106 - $997 | 3% |
| Jag Source | $106 - $997 | 3% |
| New York State Insurance Fund | $106 - $997 | 3% |
| Njm Insurance Group | $106 - $997 | 3% |
| Rx Heatlhcomp | $106 - $997 | 3% |
| Rx Restat | $106 - $997 | 3% |
| Rx Saif Opdp Wc | $106 - $997 | 3% |
| Rx Worker'S Comp | $106 - $997 | 3% |
| Wc Accident Fund | $106 - $997 | 3% |
| Wc Ace | $106 - $997 | 3% |
| Wc Acs Federal Employees | $106 - $997 | 3% |
| Wc Acuity | $106 - $997 | 3% |
| Wc Advantage | $106 - $997 | 3% |
| Wc Aegis | $106 - $997 | 3% |
| Wc Aig | $106 - $997 | 3% |
| Wc Aims | $106 - $997 | 3% |
| Wc Alaska National Ins | $106 - $997 | 3% |
| Wc Align Network | $106 - $997 | 3% |
| Wc Allied | $106 - $997 | 3% |
| Wc Am Trust N America | $106 - $997 | 3% |
| Wc American Claims Mgmt | $106 - $997 | 3% |
| Wc Amerisure | $106 - $997 | 3% |
| Wc Amtrust | $106 - $997 | 3% |
| Wc Asu Risk Mgt | $106 - $997 | 3% |
| Wc Benetech | $106 - $997 | 3% |
| Wc Berkley Admin | $106 - $997 | 3% |
| Wc Broadspire | $106 - $997 | 3% |
| Wc Broward County | $106 - $997 | 3% |
| Wc Bunch & Associates | $106 - $997 | 3% |
| Wc California State Comp Ins | $106 - $997 | 3% |
| Wc California State Ins Fund | $106 - $997 | 3% |
| Wc Capitol Area Health Consortium | $106 - $997 | 3% |
| Wc Ccmsi | $106 - $997 | 3% |
| Wc Chartis | $106 - $997 | 3% |
| Wc Chubb | $106 - $997 | 3% |
| Wc Cirma | $106 - $997 | 3% |
| Wc City Of Albany | $106 - $997 | 3% |
| Wc City Of Sioux City | $106 - $997 | 3% |
| Wc Claims Mgmt Inc | $106 - $997 | 3% |
| Wc Cna | $106 - $997 | 3% |
| Wc Comp One Admin C/O Manageability | $106 - $997 | 3% |
| Wc Compone Admin | $106 - $997 | 3% |
| Wc Ct Healthcare Trust | $106 - $997 | 3% |
| Wc Donegal Insurance Group | $106 - $997 | 3% |
| Wc Emc Insurance Company | $106 - $997 | 3% |
| Wc Employee Mutual | $106 - $997 | 3% |
| Wc Enablecomp | $106 - $997 | 3% |
| Wc Encore Health Network | $106 - $997 | 3% |
| Wc Erie | $106 - $997 | 3% |
| Wc Esis | $106 - $997 | 3% |
| Wc Evolutions | $106 - $997 | 3% |
| Wc Fcci | $106 - $997 | 3% |
| Wc Fed Ex | $106 - $997 | 3% |
| Wc Federal Black Lung | $106 - $997 | 3% |
| Wc Federated | $106 - $997 | 3% |
| Wc Finley Occupational Health | $106 - $997 | 3% |
| Wc First Agency/Occunet | $106 - $997 | 3% |
| Wc Ford Motor | $106 - $997 | 3% |
| Wc Fresno Unified Emp | $106 - $997 | 3% |
| Wc Gallagher Bassett | $106 - $997 | 3% |
| Wc General Motors | $106 - $997 | 3% |
| Wc Generic | $106 - $997 | 3% |
| Wc Genex Care For Ohio | $106 - $997 | 3% |
| Wc Great West Casualty | $106 - $997 | 3% |
| Wc Guarantee Insurance | $106 - $997 | 3% |
| Wc Guard Insurance Company | $106 - $997 | 3% |
| Wc Hab | $106 - $997 | 3% |
| Wc Hartford | $106 - $997 | 3% |
| Wc Hastings | $106 - $997 | 3% |
| Wc Health Management | $106 - $997 | 3% |
| Wc Heritage Summit | $106 - $997 | 3% |
| Wc Hireright | $106 - $997 | 3% |
| Wc Horizon | $106 - $997 | 3% |
| Wc Icw Group | $106 - $997 | 3% |
| Wc Idaho State Ins Fund | $106 - $997 | 3% |
| Wc Intercare Insurance | $106 - $997 | 3% |
| Wc Intermountain | $106 - $997 | 3% |
| Wc Johns Eastern | $106 - $997 | 3% |
| Wc Kemberton | $106 - $997 | 3% |
| Wc Key Ins & Benefit Solutions | $106 - $997 | 3% |
| Wc Liberty Mutual | $106 - $997 | 3% |
| Wc Mac Risk Management | $106 - $997 | 3% |
| Wc Massachusetts | $106 - $997 | 3% |
| Wc Mdia | $106 - $997 | 3% |
| Wc Meadowbrook Claim | $106 - $997 | 3% |
| Wc Medical Administrators | $106 - $997 | 3% |
| Wc Meijers | $106 - $997 | 3% |
| Wc Memic | $106 - $997 | 3% |
| Wc Mercy Workcare | $106 - $997 | 3% |
| Wc Michigan | $106 - $997 | 3% |
| Wc Michigan Millers Mutual | $106 - $997 | 3% |
| Wc Mitchell Frankenmuth | $106 - $997 | 3% |
| Wc Mra | $106 - $997 | 3% |
| Wc Nationwide | $106 - $997 | 3% |
| Wc Nca Comp | $106 - $997 | 3% |
| Wc New York | $106 - $997 | 3% |
| Wc New York Special Funds | $106 - $997 | 3% |
| Wc North American Rishces | $106 - $997 | 3% |
| Wc Northeast Health | $106 - $997 | 3% |
| Wc Notre Dame | $106 - $997 | 3% |
| Wc Novanet | $106 - $997 | 3% |
| Wc O'Hara Corp | $106 - $997 | 3% |
| Wc Occ Health Allen | $106 - $997 | 3% |
| Wc Ohio Bureau | $106 - $997 | 3% |
| Wc One Call Medical | $106 - $997 | 3% |
| Wc Paradigm | $106 - $997 | 3% |
| Wc Peerless | $106 - $997 | 3% |
| Wc Pma | $106 - $997 | 3% |
| Wc Praxis Health Network | $106 - $997 | 3% |
| Wc Price Chopper | $106 - $997 | 3% |
| Wc Procura Management | $106 - $997 | 3% |
| Wc Qualcare | $106 - $997 | 3% |
| Wc Quiktrip | $106 - $997 | 3% |
| Wc Reny Company | $106 - $997 | 3% |
| Wc Rev Claims | $106 - $997 | 3% |
| Wc Risico | $106 - $997 | 3% |
| Wc Rural Mutual | $106 - $997 | 3% |
| Wc Saif Oregon | $106 - $997 | 3% |
| Wc Secura | $106 - $997 | 3% |
| Wc Sedgwick | $106 - $997 | 3% |
| Wc Sentry | $106 - $997 | 3% |
| Wc Sheakley Unicomp | $106 - $997 | 3% |
| Wc Smile Lodge | $106 - $997 | 3% |
| Wc Society | $106 - $997 | 3% |
| Wc Srs | $106 - $997 | 3% |
| Wc Taconic (Mro) | $106 - $997 | 3% |
| Wc Taconic Farms | $106 - $997 | 3% |
| Wc Travelers | $106 - $997 | 3% |
| Wc Triad Group | $106 - $997 | 3% |
| Wc Tristar | $106 - $997 | 3% |
| Wc Troy Ny | $106 - $997 | 3% |
| Wc Tyson | $106 - $997 | 3% |
| Wc Unified Health Services | $106 - $997 | 3% |
| Wc United Heartland | $106 - $997 | 3% |
| Wc Us Dept Of Labor | $106 - $997 | 3% |
| Wc Velocity | $106 - $997 | 3% |
| Wc Walmart | $106 - $997 | 3% |
| Wc West Bend | $106 - $997 | 3% |
| Wc West Bend Mutual/Argent | $106 - $997 | 3% |
| Wc Winnebago Industries | $106 - $997 | 3% |
| Wc Yankee Trails | $106 - $997 | 3% |
| Wc York Risk | $106 - $997 | 3% |
| Wc Zenith | $106 - $997 | 3% |
| Wc Zurich | $106 - $997 | 3% |
| Albany County Correctional Facility | $138 - $208 | 4% |
| Ambetter / Centene | $138 - $208 | 4% |
| Amish Mennonite | $138 - $208 | 4% |
| Ascension St. Vincent Public Safety Medical | $138 - $208 | 4% |
| Bcccp-Michigan | $138 - $208 | 4% |
| Bccp | $138 - $208 | 4% |
| Bmc Healthnet | $138 - $208 | 4% |
| Breast Grant-Connecticut | $138 - $208 | 4% |
| Broward County Dept Of Health | $138 - $208 | 4% |
| California Health And Wellness | $138 - $208 | 4% |
| Can Community Health Inc | $138 - $208 | 4% |
| Cardinal Innovations Lme | $138 - $208 | 4% |
| Care Connections Of Northern Iowa | $138 - $208 | 4% |
| Care Oregon Ohp | $138 - $208 | 4% |
| Cencal Health Plan | $138 - $208 | 4% |
| Cenpatico | $138 - $208 | 4% |
| Chhuny | $138 - $208 | 4% |
| Childrens Comm Health Plan | $138 - $208 | 4% |
| Childrens Medical Services Title 19 | $138 - $208 | 4% |
| City Of Philadelphia | $138 - $208 | 4% |
| Cmh Allegan County | $138 - $208 | 4% |
| Cmh Ausable Valley | $138 - $208 | 4% |
| Cmh Barry County | $138 - $208 | 4% |
| Cmh Bay-Arenac County | $138 - $208 | 4% |
| Cmh Berrien County | $138 - $208 | 4% |
| Cmh Cass County | $138 - $208 | 4% |
| Cmh Central Mi County | $138 - $208 | 4% |
| Cmh Clinton-Eaton-Ingham County | $138 - $208 | 4% |
| Cmh Detroit Wayne Integrated Health Network | $138 - $208 | 4% |
| Cmh Genesee County | $138 - $208 | 4% |
| Cmh Ionia County | $138 - $208 | 4% |
| Cmh Jackson County/Lifeways | $138 - $208 | 4% |
| Cmh Kalamazoo | $138 - $208 | 4% |
| Cmh Kent County | $138 - $208 | 4% |
| Cmh Lenawee County | $138 - $208 | 4% |
| Cmh Livingston County | $138 - $208 | 4% |
| Cmh Macomb | $138 - $208 | 4% |
| Cmh Misc | $138 - $208 | 4% |
| Cmh Monroe County | $138 - $208 | 4% |
| Cmh Montcalm County | $138 - $208 | 4% |
| Cmh Muskegon County | $138 - $208 | 4% |
| Cmh Newaygo County | $138 - $208 | 4% |
| Cmh North Country | $138 - $208 | 4% |
| Cmh Northern Lakes County | $138 - $208 | 4% |
| Cmh Oakland County | $138 - $208 | 4% |
| Cmh Ottawa County | $138 - $208 | 4% |
| Cmh Van Buren County | $138 - $208 | 4% |
| Cmh Washtenaw County | $138 - $208 | 4% |
| Cmh Wayne County/Carelink | $138 - $208 | 4% |
| Cmh Wayne Cty/Com Liv Svcs | $138 - $208 | 4% |
| Cmh West Mi County | $138 - $208 | 4% |
| Community Benefit Health | $138 - $208 | 4% |
| Community Care Behavorial Health | $138 - $208 | 4% |
| Community Care Partners | $138 - $208 | 4% |
| Community Health Choice | $138 - $208 | 4% |
| Connections Csp | $138 - $208 | 4% |
| County Coroner | $138 - $208 | 4% |
| County Funding Generic | $138 - $208 | 4% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $138 - $208 | 4% |
| Dean Wi Badgercare | $138 - $208 | 4% |
| Delaware County Department Of Health | $138 - $208 | 4% |
| Delaware First Health | $138 - $208 | 4% |
| Dph Tb Program | $138 - $208 | 4% |
| Dscc | $138 - $208 | 4% |
| Eastpointe Lme | $138 - $208 | 4% |
| Family Health Network | $138 - $208 | 4% |
| Freedom First Healthcare | $138 - $208 | 4% |
| Fresno County Ccs | $138 - $208 | 4% |
| Ghc Scw Wi Badgercare | $138 - $208 | 4% |
| Harbor Health | $138 - $208 | 4% |
| Health Safety Net | $138 - $208 | 4% |
| Healthy Blue Ne | $138 - $208 | 4% |
| Hennepin Health | $138 - $208 | 4% |
| Id County Ada | $138 - $208 | 4% |
| Id County Canyon | $138 - $208 | 4% |
| Id County Cat Fund | $138 - $208 | 4% |
| Id County Other | $138 - $208 | 4% |
| Id County Payette | $138 - $208 | 4% |
| Idaho Dept Health And Wellfare | $138 - $208 | 4% |
| Idaho Womens Health Check | $138 - $208 | 4% |
| Indiana Breast Cervical Cancer | $138 - $208 | 4% |
| Inland Empire Health Plan | $138 - $208 | 4% |
| Intercommunity Health Ohp | $138 - $208 | 4% |
| Iowa Total Care | $138 - $208 | 4% |
| Jai Medical System | $138 - $208 | 4% |
| Kern Family Health Plan | $138 - $208 | 4% |
| Keystone First | $138 - $208 | 4% |
| Keystone First Chip | $138 - $208 | 4% |
| La Care Health Plan | $138 - $208 | 4% |
| Lakeland Care Inc | $138 - $208 | 4% |
| Managed Health Services - Indiana | $138 - $208 | 4% |
| Maryland Breast & Cervical Program | $138 - $208 | 4% |
| Maryland Healthy Smiles - Scion Dental | $138 - $208 | 4% |
| Maryland Physicians Care | $138 - $208 | 4% |
| Massachusetts Behavioral Health Partnership | $138 - $208 | 4% |
| Mdwise | $138 - $208 | 4% |
| Medi-Cal | $138 - $208 | 4% |
| Medi-Cal Healthnet | $138 - $208 | 4% |
| Medstar Dc Healthy Family | $138 - $208 | 4% |
| Medstar Md Health Choice | $138 - $208 | 4% |
| Mo Home State Health Plan | $138 - $208 | 4% |
| Molina Centennial Care | $138 - $208 | 4% |
| Nascentia Health Options | $138 - $208 | 4% |
| Nebraska Total Care | $138 - $208 | 4% |
| New York Cancer Services Program | $138 - $208 | 4% |
| Nextlevel Health | $138 - $208 | 4% |
| Oregon Screenwise | $138 - $208 | 4% |
| Paramount Advantage | $138 - $208 | 4% |
| Parkland Community Health Plan | $138 - $208 | 4% |
| Partners Behavioral Lme | $138 - $208 | 4% |
| Peach State Healthplan | $138 - $208 | 4% |
| Philadelphia County Funding | $138 - $208 | 4% |
| Presbyterian Centennial Care | $138 - $208 | 4% |
| Prestige Health Choice | $138 - $208 | 4% |
| Priority Partners | $138 - $208 | 4% |
| Robert F Sing Program | $138 - $208 | 4% |
| Rx 340B Pass Along | $138 - $208 | 4% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $138 - $208 | 4% |
| Rx Medi-Cal | $138 - $208 | 4% |
| Rx Meridian Rx | $138 - $208 | 4% |
| Ryan White Florida Mssrp | $138 - $208 | 4% |
| Sandhills Center Lme | $138 - $208 | 4% |
| Screening For Life | $138 - $208 | 4% |
| St Joseph County Hlth Dpt | $138 - $208 | 4% |
| Stephenson Cty Health | $138 - $208 | 4% |
| Sunshine State Health Plan | $138 - $208 | 4% |
| Superior Health | $138 - $208 | 4% |
| Tenncare | $138 - $208 | 4% |
| Texas Children'S Health Plan | $138 - $208 | 4% |
| Trillium Community Ohp | $138 - $208 | 4% |
| Tufts Health Public Plans | $138 - $208 | 4% |
| Vaya Health Lme | $138 - $208 | 4% |
| Washtenaw Health Plan | $138 - $208 | 4% |
| Wellsense Health Plan | $138 - $208 | 4% |
| Wi Womens Wellness | $138 - $208 | 4% |
| Health Smart | $157 - $2,575 | 4% |
| Wc Corvel | $157 - $2,575 | 4% |
| Delta Dental Ga | $185 - $3,029 | 5% |
| Delta Dental Mi | $185 - $3,029 | 5% |
| Delta Dental Mo | $185 - $3,029 | 5% |
| Delta Dental Nj | $185 - $3,029 | 5% |
| Delta Dental Ny | $185 - $3,029 | 5% |
| Delta Dental Oh | $185 - $3,029 | 5% |
| Delta Dental Or | $185 - $3,029 | 5% |
| Delta Dental Pa | $185 - $3,029 | 5% |
| Delta Dental Va | $185 - $3,029 | 5% |
| Delta Dental Wa | $185 - $3,029 | 5% |
| Liberty Dental | $185 - $3,029 | 5% |
| Connecticut Dept Of Correction | $3,964 | 108% |
| Diversified Administrators | $9,014 | 246% |