CMS Price Transparency Data
New patient office visit (30-44 min)
Facility: Saint Mary's Hospital
Billing Code: 99203 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99203
- Insurance Median: $73
- Cash Discount Price: $234
- vs. Medicare Baseline: 0.62x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Saint Mary's Hospital is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $234. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.62x the Medicare baseline. Located in 56 Franklin Street, Waterbury, CT.
Cash / Self-Pay
$234
Average discount available for prompt cash payment at this facility.
Insurance Median
$73
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$117.57
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $234 (199%)
Insurance Median: $73 (62%)
Cash: $234 (199% of Medicare)
Ins. Median: $73 (62% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $117.57 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
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $46 - $128 | 39% |
| Aetna | $60 - $139 | 51% |
| Albany County Correctional Facility | $60 - $66 | 51% |
| Ambetter / Centene | $60 - $66 | 51% |
| Amish Mennonite | $60 - $66 | 51% |
| Ascension St. Vincent Public Safety Medical | $60 - $66 | 51% |
| Bcccp-Michigan | $60 - $66 | 51% |
| Bccp | $60 - $66 | 51% |
| Blue Cross Blue Shield | $60 - $112 | 51% |
| Bmc Healthnet | $60 - $66 | 51% |
| Breast Grant-Connecticut | $60 - $66 | 51% |
| Broward County Dept of Health | $60 - $66 | 51% |
| California Health and Wellness | $60 - $66 | 51% |
| Can Community Health Inc | $60 - $66 | 51% |
| Cardinal Innovations Lme | $60 - $66 | 51% |
| Care Connections of Northern Iowa | $60 - $66 | 51% |
| Care Oregon Ohp | $60 - $66 | 51% |
| Cencal Health Plan | $60 - $66 | 51% |
| Cenpatico | $60 - $66 | 51% |
| Chhuny | $60 - $66 | 51% |
| Childrens Comm Health Plan | $60 - $66 | 51% |
| Childrens Medical Services Title 19 | $60 - $66 | 51% |
| Cigna | $60 - $73 | 51% |
| City of Philadelphia | $60 - $66 | 51% |
| Cmh Allegan County | $60 - $66 | 51% |
| Cmh Ausable Valley | $60 - $66 | 51% |
| Cmh Barry County | $60 - $66 | 51% |
| Cmh Bay-Arenac County | $60 - $66 | 51% |
| Cmh Berrien County | $60 - $66 | 51% |
| Cmh Cass County | $60 - $66 | 51% |
| Cmh Central Mi County | $60 - $66 | 51% |
| Cmh Clinton-Eaton-Ingham County | $60 - $66 | 51% |
| Cmh Detroit Wayne Integrated Health Network | $60 - $66 | 51% |
| Cmh Genesee County | $60 - $66 | 51% |
| Cmh Ionia County | $60 - $66 | 51% |
| Cmh Jackson County/Lifeways | $60 - $66 | 51% |
| Cmh Kalamazoo | $60 - $66 | 51% |
| Cmh Kent County | $60 - $66 | 51% |
| Cmh Lenawee County | $60 - $66 | 51% |
| Cmh Livingston County | $60 - $66 | 51% |
| Cmh Macomb | $60 - $66 | 51% |
| Cmh Misc | $60 - $66 | 51% |
| Cmh Monroe County | $60 - $66 | 51% |
| Cmh Montcalm County | $60 - $66 | 51% |
| Cmh Muskegon County | $60 - $66 | 51% |
| Cmh Newaygo County | $60 - $66 | 51% |
| Cmh North Country | $60 - $66 | 51% |
| Cmh Northern Lakes County | $60 - $66 | 51% |
| Cmh Oakland County | $60 - $66 | 51% |
| Cmh Ottawa County | $60 - $66 | 51% |
| Cmh Van Buren County | $60 - $66 | 51% |
| Cmh Washtenaw County | $60 - $66 | 51% |
| Cmh Wayne County/Carelink | $60 - $66 | 51% |
| Cmh Wayne Cty/Com Liv Svcs | $60 - $66 | 51% |
| Cmh West Mi County | $60 - $66 | 51% |
| Community Benefit Health | $60 - $66 | 51% |
| Community Care Behavorial Health | $60 - $66 | 51% |
| Community Care Partners | $60 - $66 | 51% |
| Community Health Choice | $60 - $66 | 51% |
| Connections Csp | $60 - $66 | 51% |
| County Coroner | $60 - $66 | 51% |
| County Funding Generic | $60 - $66 | 51% |
| Covid19 Hrsa Uninsured Testing and Treatment Fund | $60 - $66 | 51% |
| Dean Wi Badgercare | $60 - $66 | 51% |
| Delaware County Department of Health | $60 - $66 | 51% |
| Delaware First Health | $60 - $66 | 51% |
| Dph Tb Program | $60 - $66 | 51% |
| Dscc | $60 - $66 | 51% |
| Eastpointe Lme | $60 - $66 | 51% |
| Family Health Network | $60 - $66 | 51% |
| Freedom First Healthcare | $60 - $66 | 51% |
| Fresno County Ccs | $60 - $66 | 51% |
| Ghc Scw Wi Badgercare | $60 - $66 | 51% |
| Harbor Health | $60 - $66 | 51% |
| Health Safety Net | $60 - $66 | 51% |
| Healthy Blue Ne | $60 - $66 | 51% |
| Hennepin Health | $60 - $66 | 51% |
| Humana | $60 - $80 | 51% |
| Id County Ada | $60 - $66 | 51% |
| Id County Canyon | $60 - $66 | 51% |
| Id County Cat Fund | $60 - $66 | 51% |
| Id County Other | $60 - $66 | 51% |
| Id County Payette | $60 - $66 | 51% |
| Idaho Dept Health and Wellfare | $60 - $66 | 51% |
| Idaho Womens Health Check | $60 - $66 | 51% |
| Indiana Breast Cervical Cancer | $60 - $66 | 51% |
| Inland Empire Health Plan | $60 - $66 | 51% |
| Intercommunity Health Ohp | $60 - $66 | 51% |
| Iowa Total Care | $60 - $66 | 51% |
| Jai Medical System | $60 - $66 | 51% |
| Kern Family Health Plan | $60 - $66 | 51% |
| Keystone First | $60 - $66 | 51% |
| Keystone First Chip | $60 - $66 | 51% |
| La Care Health Plan | $60 - $66 | 51% |
| Lakeland Care Inc | $60 - $66 | 51% |
| Managed Health Services - Indiana | $60 - $66 | 51% |
| Maryland Breast & Cervical Program | $60 - $66 | 51% |
| Maryland Healthy Smiles - Scion Dental | $60 - $66 | 51% |
| Maryland Physicians Care | $60 - $66 | 51% |
| Massachusetts Behavioral Health Partnership | $60 - $66 | 51% |
| Mdwise | $60 - $66 | 51% |
| Medi-Cal | $60 - $66 | 51% |
| Medi-Cal Healthnet | $60 - $66 | 51% |
| Medstar Dc Healthy Family | $60 - $66 | 51% |
| Medstar Md Health Choice | $60 - $66 | 51% |
| Mo Home State Health Plan | $60 - $66 | 51% |
| Molina Centennial Care | $60 - $66 | 51% |
| Nascentia Health Options | $60 - $66 | 51% |
| Nebraska Total Care | $60 - $66 | 51% |
| New York Cancer Services Program | $60 - $66 | 51% |
| Nextlevel Health | $60 - $66 | 51% |
| Oregon Screenwise | $60 - $66 | 51% |
| Pace of Southwest Michigan | $60 - $73 | 51% |
| Paramount Advantage | $60 - $66 | 51% |
| Parkland Community Health Plan | $60 - $66 | 51% |
| Partners Behavioral Lme | $60 - $66 | 51% |
| Peach State Healthplan | $60 - $66 | 51% |
| Philadelphia County Funding | $60 - $66 | 51% |
| Presbyterian Centennial Care | $60 - $66 | 51% |
| Prestige Health Choice | $60 - $66 | 51% |
| Priority Partners | $60 - $66 | 51% |
| Robert F Sing Program | $60 - $66 | 51% |
| Rx 340B Pass Along | $60 - $66 | 51% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $60 - $66 | 51% |
| Rx Medi-Cal | $60 - $66 | 51% |
| Rx Meridian Rx | $60 - $66 | 51% |
| Ryan White Florida Mssrp | $60 - $66 | 51% |
| Sandhills Center Lme | $60 - $66 | 51% |
| Screening for Life | $60 - $66 | 51% |
| St Joseph County Hlth Dpt | $60 - $66 | 51% |
| Stephenson Cty Health | $60 - $66 | 51% |
| Sunshine State Health Plan | $60 - $66 | 51% |
| Superior Health | $60 - $66 | 51% |
| Tenncare | $60 - $66 | 51% |
| Texas Children's Health Plan | $60 - $66 | 51% |
| Trillium Community Ohp | $60 - $66 | 51% |
| Tufts Health Public Plans | $60 - $66 | 51% |
| UnitedHealthcare | $60 - $145 | 51% |
| Vaya Health Lme | $60 - $66 | 51% |
| Washtenaw Health Plan | $60 - $66 | 51% |
| Wellsense Health Plan | $60 - $66 | 51% |
| Wi Womens Wellness | $60 - $66 | 51% |
| Align Senior Care | $62 - $73 | 53% |
| Ally Align Care Adv | $62 - $73 | 53% |
| American Health Advantage of Idaho | $62 - $73 | 53% |
| American Health Plan | $62 - $73 | 53% |
| Aurora Special Needs | $62 - $73 | 53% |
| Blue Care Network Advantage | $62 - $73 | 53% |
| Blue Shield - De (Highmark) Medciare Advantage | $62 - $73 | 53% |
| Care Dimensions | $62 - $73 | 53% |
| Care Improvement Plus | $62 - $73 | 53% |
| Care Resources Pace | $62 - $73 | 53% |
| Careplus Health Plans | $62 - $73 | 53% |
| Cca - Zing Health | $62 - $73 | 53% |
| Central Valley Medical Services Corp Pace | $62 - $73 | 53% |
| Champion Health Plan McR Advantage | $62 - $73 | 53% |
| Clear Spring Health | $62 - $73 | 53% |
| Clover Health | $62 - $73 | 53% |
| Commonwealth Care Alliance | $62 - $78 | 53% |
| Community Pace at Home | $62 - $73 | 53% |
| Eddy Senior Care-Pace | $62 - $73 | 53% |
| Eddy Seniorcare Pace | $62 - $73 | 53% |
| Elementcare | $62 - $73 | 53% |
| Evercare | $62 - $73 | 53% |
| Everence | $62 - $73 | 53% |
| Gateway Health Plan | $62 - $73 | 53% |
| Genesys Pace of Genesee County | $62 - $73 | 53% |
| Georgia Health Advantage | $62 - $73 | 53% |
| Gold Advantage | $62 - $73 | 53% |
| Gpa Croell Redi Mix | $62 - $73 | 53% |
| Health America Advantra | $62 - $73 | 53% |
| Highmark Health Options Dual Plan | $62 - $73 | 53% |
| Hope Select Pace | $62 - $73 | 53% |
| Horizon Nj Total Care | $62 - $73 | 53% |
| Hudson Headwaters Pace | $62 - $73 | 53% |
| Huron Valley Pace | $62 - $73 | 53% |
| Innovative Integrated Health Community Plans | $62 - $73 | 53% |
| Iowa Health Advantage | $62 - $73 | 53% |
| Johns Hopkins Advantage Md | $62 - $73 | 53% |
| Lasso Healthcare Msa | $62 - $73 | 53% |
| Life St Marys Pace | $62 - $73 | 53% |
| Lifecircles Pace | $62 - $73 | 53% |
| Longevity Health Plan | $62 - $73 | 53% |
| Longevity IPA of Michigan LLC Health Plan Isnp | $62 - $73 | 53% |
| Martins Point Generations Advantage | $62 - $73 | 53% |
| Mass General Brigham McR Adv | $62 - $73 | 53% |
| Medicare (plans) | $62 - $93 | 53% |
| Medipak Advantage | $62 - $73 | 53% |
| Mercy Life | $62 - $73 | 53% |
| Mercyone Cedar Valley | $62 - $73 | 53% |
| Meridian Complete | $62 - $73 | 53% |
| Michigan Complete Health | $62 - $73 | 53% |
| Nascentia Health Plus | $62 - $73 | 53% |
| New Centry Health Careplus | $62 - $73 | 53% |
| Osu Prime Care Advantage | $62 - $73 | 53% |
| Pace Cny | $62 - $73 | 53% |
| Pace Iowa Immanuel Pathways | $62 - $73 | 53% |
| Pace Southeast | $62 - $73 | 53% |
| Pace-Trinity Health | $62 - $73 | 53% |
| Peak Pace Solutions | $62 - $73 | 53% |
| Perennial Advantage | $62 - $73 | 53% |
| Preferred Care Partners | $62 - $73 | 53% |
| Presbyterian Senior Plan | $62 - $73 | 53% |
| Provider Partners Health Plan of Illinois | $62 - $73 | 53% |
| Provider Partners Health Plan of Indiana | $62 - $73 | 53% |
| Pruitthealth Premier | $62 - $73 | 53% |
| Reliance Community Care Partners Care Resources Pace | $62 - $73 | 53% |
| Rx Allwin | $62 - $73 | 53% |
| Rx Grane Grnmedd | $62 - $73 | 53% |
| Rx Retiree Rx Care | $62 - $73 | 53% |
| Scan Health Plan McR IPA Meritage Oon | $62 - $73 | 53% |
| Secure Horizons Ma Pffs | $62 - $73 | 53% |
| Serenity Pace | $62 - $73 | 53% |
| Siouxland Pace | $62 - $73 | 53% |
| Solis Health Plans | $62 - $73 | 53% |
| Sunnyview-Pace Finance Dept | $62 - $73 | 53% |
| Texan Plus | $62 - $73 | 53% |
| The Health Plan | $62 - $73 | 53% |
| Thome Pace | $62 - $73 | 53% |
| Todays Options | $62 - $73 | 53% |
| Tribute Health Plans | $62 - $73 | 53% |
| Um Health Advantage | $62 - $73 | 53% |
| Union Health Service | $62 - $73 | 53% |
| Welbe Health | $62 - $73 | 53% |
| Wellmed | $62 - $73 | 53% |
| Veterans Administration | $63 - $75 | 54% |
| Cca Senior Care Options | $65 - $77 | 55% |
| Health New England | $65 - $175 | 55% |
| Champva | $68 - $80 | 58% |
| Tricare | $68 - $80 | 58% |
| Triwest Health Alliance | $68 - $80 | 58% |
| Veterans Eval Services | $68 - $80 | 58% |
| Fallon Health | $79 - $157 | 67% |
| Us Family Health Plan | $92 - $170 | 78% |
| Healthscope | $98 - $115 | 83% |
| Connecticare | $99 - $150 | 84% |
| Bcn Domestic | $100 - $112 | 85% |
| Blue Benefit Administrators of Massachusetts | $100 - $112 | 85% |
| Blue Care Network | $100 - $112 | 85% |
| Blue Distinction Transplant | $100 - $112 | 85% |
| Blue Shield - Ca | $100 - $112 | 85% |
| Blue Shield - Id (Regence) | $100 - $112 | 85% |
| Blue Shield - Ny Highmark Northeastern | $100 - $112 | 85% |
| Blue Shield - Ny Highmark Western | $100 - $112 | 85% |
| Blue Shield - PA (Highmark) | $100 - $112 | 85% |
| Blue Shield - Wa (Regence) | $100 - $112 | 85% |
| Health Choices | $100 - $112 | 85% |
| Kaiser Domestic | $100 - $112 | 85% |
| Pre-Employment | $100 - $112 | 85% |
| Wc Domestic | $100 - $112 | 85% |
| Claimdoc | $111 - $131 | 94% |
| Innovative Health Plan II | $111 - $131 | 94% |
| Unicare | $116 - $128 | 99% |
| Wellpoint | $116 - $128 | 99% |
| Coventry | $118 - $139 | 100% |
| First Health | $118 - $139 | 100% |
| Guardian | $118 - $139 | 100% |
| Meritain | $118 - $139 | 100% |
| Mass General Brigham Health Plan | $120 - $176 | 102% |
| Andrie Inc | $121 | 103% |
| East Greenbush Central School District | $121 | 103% |
| Genex Wc | $121 | 103% |
| Healthsmart Workers Comp | $121 | 103% |
| Jag Source | $121 | 103% |
| New York State Insurance Fund | $121 | 103% |
| Njm Insurance Group | $121 | 103% |
| Rx Heatlhcomp | $121 | 103% |
| Rx Restat | $121 | 103% |
| Rx Saif Opdp Wc | $121 | 103% |
| Rx Worker's Comp | $121 | 103% |
| Wc Accident Fund | $121 | 103% |
| Wc Ace | $121 | 103% |
| Wc Acs Federal Employees | $121 | 103% |
| Wc Acuity | $121 | 103% |
| Wc Advantage | $121 | 103% |
| Wc Aegis | $121 | 103% |
| Wc Aig | $121 | 103% |
| Wc Aims | $121 | 103% |
| Wc Alaska National Ins | $121 | 103% |
| Wc Align Network | $121 | 103% |
| Wc Allied | $121 | 103% |
| Wc Am Trust N America | $121 | 103% |
| Wc American Claims Mgmt | $121 | 103% |
| Wc Amerisure | $121 | 103% |
| Wc Amtrust | $121 | 103% |
| Wc Asu Risk Mgt | $121 | 103% |
| Wc Benetech | $121 | 103% |
| Wc Berkley Admin | $121 | 103% |
| Wc Broadspire | $121 | 103% |
| Wc Broward County | $121 | 103% |
| Wc Bunch & Associates | $121 | 103% |
| Wc California State Comp Ins | $121 | 103% |
| Wc California State Ins Fund | $121 | 103% |
| Wc Capitol Area Health Consortium | $121 | 103% |
| Wc Ccmsi | $121 | 103% |
| Wc Chartis | $121 | 103% |
| Wc Chubb | $121 | 103% |
| Wc Cirma | $121 | 103% |
| Wc City of Albany | $121 | 103% |
| Wc City of Sioux City | $121 | 103% |
| Wc Claims Mgmt Inc | $121 | 103% |
| Wc Cna | $121 | 103% |
| Wc Comp One Admin C/O Manageability | $121 | 103% |
| Wc Compone Admin | $121 | 103% |
| Wc Ct Healthcare Trust | $121 | 103% |
| Wc Donegal Insurance Group | $121 | 103% |
| Wc Emc Insurance Company | $121 | 103% |
| Wc Employee Mutual | $121 | 103% |
| Wc Enablecomp | $121 | 103% |
| Wc Encore Health Network | $121 | 103% |
| Wc Erie | $121 | 103% |
| Wc Esis | $121 | 103% |
| Wc Evolutions | $121 | 103% |
| Wc Fcci | $121 | 103% |
| Wc Fed Ex | $121 | 103% |
| Wc Federal Black Lung | $121 | 103% |
| Wc Federated | $121 | 103% |
| Wc Finley Occupational Health | $121 | 103% |
| Wc First Agency/Occunet | $121 | 103% |
| Wc Ford Motor | $121 | 103% |
| Wc Fresno Unified Emp | $121 | 103% |
| Wc Gallagher Bassett | $121 | 103% |
| Wc General Motors | $121 | 103% |
| Wc Generic | $121 | 103% |
| Wc Genex Care for Ohio | $121 | 103% |
| Wc Great West Casualty | $121 | 103% |
| Wc Guarantee Insurance | $121 | 103% |
| Wc Guard Insurance Company | $121 | 103% |
| Wc Hab | $121 | 103% |
| Wc Hartford | $121 | 103% |
| Wc Hastings | $121 | 103% |
| Wc Health Management | $121 | 103% |
| Wc Heritage Summit | $121 | 103% |
| Wc Hireright | $121 | 103% |
| Wc Horizon | $121 | 103% |
| Wc Icw Group | $121 | 103% |
| Wc Idaho State Ins Fund | $121 | 103% |
| Wc Intercare Insurance | $121 | 103% |
| Wc Intermountain | $121 | 103% |
| Wc Johns Eastern | $121 | 103% |
| Wc Kemberton | $121 | 103% |
| Wc Key Ins & Benefit Solutions | $121 | 103% |
| Wc Liberty Mutual | $121 | 103% |
| Wc Mac Risk Management | $121 | 103% |
| Wc Massachusetts | $121 | 103% |
| Wc Mdia | $121 | 103% |
| Wc Meadowbrook Claim | $121 | 103% |
| Wc Medical Administrators | $121 | 103% |
| Wc Meijers | $121 | 103% |
| Wc Memic | $121 | 103% |
| Wc Mercy Workcare | $121 | 103% |
| Wc Michigan | $121 | 103% |
| Wc Michigan Millers Mutual | $121 | 103% |
| Wc Mitchell Frankenmuth | $121 | 103% |
| Wc Mra | $121 | 103% |
| Wc Nationwide | $121 | 103% |
| Wc Nca Comp | $121 | 103% |
| Wc New York | $121 | 103% |
| Wc New York Special Funds | $121 | 103% |
| Wc North American Rishces | $121 | 103% |
| Wc Northeast Health | $121 | 103% |
| Wc Notre Dame | $121 | 103% |
| Wc Novanet | $121 | 103% |
| Wc O'Hara Corp | $121 | 103% |
| Wc Occ Health Allen | $121 | 103% |
| Wc Ohio Bureau | $121 | 103% |
| Wc One Call Medical | $121 | 103% |
| Wc Paradigm | $121 | 103% |
| Wc Peerless | $121 | 103% |
| Wc Pma | $121 | 103% |
| Wc Praxis Health Network | $121 | 103% |
| Wc Price Chopper | $121 | 103% |
| Wc Procura Management | $121 | 103% |
| Wc Qualcare | $121 | 103% |
| Wc Quiktrip | $121 | 103% |
| Wc Reny Company | $121 | 103% |
| Wc Rev Claims | $121 | 103% |
| Wc Risico | $121 | 103% |
| Wc Rural Mutual | $121 | 103% |
| Wc Saif Oregon | $121 | 103% |
| Wc Secura | $121 | 103% |
| Wc Sedgwick | $121 | 103% |
| Wc Sentry | $121 | 103% |
| Wc Sheakley Unicomp | $121 | 103% |
| Wc Smile Lodge | $121 | 103% |
| Wc Society | $121 | 103% |
| Wc Srs | $121 | 103% |
| Wc Taconic (Mro) | $121 | 103% |
| Wc Taconic Farms | $121 | 103% |
| Wc Travelers | $121 | 103% |
| Wc Triad Group | $121 | 103% |
| Wc Tristar | $121 | 103% |
| Wc Troy Ny | $121 | 103% |
| Wc Tyson | $121 | 103% |
| Wc Unified Health Services | $121 | 103% |
| Wc United Heartland | $121 | 103% |
| Wc Us Dept of Labor | $121 | 103% |
| Wc Velocity | $121 | 103% |
| Wc Walmart | $121 | 103% |
| Wc West Bend | $121 | 103% |
| Wc West Bend Mutual/Argent | $121 | 103% |
| Wc Winnebago Industries | $121 | 103% |
| Wc Yankee Trails | $121 | 103% |
| Wc York Risk | $121 | 103% |
| Wc Zenith | $121 | 103% |
| Wc Zurich | $121 | 103% |
| Multiplan | $125 - $147 | 106% |
| Centivo | $138 | 117% |
| Health Smart | $149 - $248 | 127% |
| Wc Corvel | $149 - $248 | 127% |
| Prime Health Services | $152 - $175 | 129% |
| Harvard Pilgrim Healthcare | $155 - $175 | 132% |
| Tufts Health Plan | $170 | 145% |
| Delta Dental Ga | $175 - $292 | 149% |
| Delta Dental Mi | $175 - $292 | 149% |
| Delta Dental Mo | $175 - $292 | 149% |
| Delta Dental Nj | $175 - $292 | 149% |
| Delta Dental Ny | $175 - $292 | 149% |
| Delta Dental Oh | $175 - $292 | 149% |
| Delta Dental Or | $175 - $292 | 149% |
| Delta Dental PA | $175 - $292 | 149% |
| Delta Dental VA | $175 - $292 | 149% |
| Delta Dental Wa | $175 - $292 | 149% |
| Liberty Dental | $175 - $292 | 149% |